Sawbones: A Marital Tour of Misguided Medicine - Sawbones: Wound Care

Episode Date: December 7, 2017

This week on Sawbones, Justin and Dr. Sydnee explore all the weird, terrible ways we've tried to fix one of the human body's most basic problem. It's a history of wound care! Music: "Medicines" by The Taxpayers

Saubones is a show about medical history, and nothing the hosts say should be taken as medical advice or opinion. It's for fun. Can't you just have fun for an hour and not try to diagnose your mystery boil? We think you've earned it. Just sit back, relax, and enjoy a moment of distraction from that weird growth. You're worth it. that weird growth. You're worth it. Alright, what's wrong with these about? It's books! One, two, one, Saul Bones,

a marital tour of misguided medicine. I'm your co-host Justin McAroy. And I'm Sydney McAroy. Well, Justin, I was trying to prepare for the show this week, and I found a way to prepare for both this show and my day job all at once, and I was very excited. How'd you swing that, Sid? It is so rare that you'd think the two for both this show and my day job all at once. And I was very excited. I just went that said.

It is so rare that you'd think the two would overlap a lot since they're both medically oriented, but telling patients about how we use to bleed people and then actually practicing medicine, actually don't do very different ideas. Don't coincide very often. So how did you find this overlap? Well, I'm going to do a I'm going to do a grand rounds. Do you know what a grand round is?

I mean, I do. But why don't you explain it for everybody out there? I guess that's worth explaining. Grand rounds as opposed to making rounds when a doctor says they're making rounds and many people might already know this, but just in case you don't, that usually means we're walking around and physically seeing patients in a hospital or then follow that, following that up by sitting at a table and talking about them. Those are rounds. But grand rounds, grand rounds, is when we all sit in a room together and teach each other something. So it used to actually involve a patient back in the day.

You would actually bring a patient into the room and tell all of the residents or students or whatever about them and you know go over their case in front of everybody and hopefully like get some good ideas about what to do next. And the patient will be present? Yes. Okay. The patient would be present. Wild. Yeah. It's an uncomfortable day, I feel like. Nowadays, that's rarely done, although there are times where patients are invited in to share their stories and such. It's very different. It's very different context, but most of the time, it's about a topic or a case that we can all learn from or something like that. And so it's like an educational opportunity. So I'm doing a grand round. And I thought, you know, why not do something that I think I'm getting

pretty good at, which is medical history. And we don't learn a lot about that in med school. So I was going to do the history of wound care. And I thought, you know, what we should do that as a show. But that said, if somebody was there at the grand roundsounds. Right. If you are, depending on when exactly you put this show up, if you have or are planning on attending family medicine Grand Rounds tomorrow in dining room six off the cafeteria, you probably don't want to listen yet. It's going to be a repeat. It's going to be a repeat. It's going to, I know that a lot of our listeners will be there at Grand Rounds. It's a sorry in advance.

You just signed the sheet in the cafeteria and you get free food. Nice. What, we're talking to schlotskeys or pizza? No, I mean, it's hospital cafeteria food. But still. But as much as you want. Wow. They have good bacon.

They do. Not a hot. They're a hospital. Yeah, for a hospital. They're very great at all. They're not a hospital. Yeah, for a hospital. They're very great at bacon. But let's talk about wound care. Okay. So thank you to all the people who recommended this topic.

Cara Embria, an Allison and Charles and Vanessa Amanda Glinge, Jennifer Lindsey Shawna, Shannon and Celia. A lot of people. And a lot of people recommend this because one, there's a lot to say about wound care through the ages as long as humans have been getting wounds. Exactly, which is since there have been humans, essentially. But we also do a lot of gross stuff. Great.

And people love that. I found. So what's interesting is that some of the principles of wound care that still exists today actually have persisted through the ages. There is a clay tablet from 2200 BCE with a description of what they call the three healing gestures of wound care and those are wash the wound, make the plaster and bandage the wound. Okay, you got it. There you go. Make the plaster. I'm not sure about, but you know, it's interesting. So the term plaster, I know they use that as bandage in the UK. Right. So when you think of what we think of like here, stateside, what

we call a bandaid, generally, which is a brand name, I guess, but we call everything like that a bandaid. That is a plaster, am I understanding in the UK, but a plaster, as I'm referencing it historically, obviously, they didn't have from the start adhesive bandages. So a plaster was some sort of dressing for a wound. Throughout history, it was usually made of like clay or mud, and then it may have some sort of healing herbs kind herbs mixed with it. So like getting it dirty. Basically.

You would get the wound really dirty. Get it dirty. So the three good things are wash the wound, get it dirty. And then wrap it up. No, but you would put the plaster on there to try to absorb moisture out of the wound. There was a thought that if you tried to, because if it had like drainage and stuff, like pus coming out of it, like just absorb all that and the clay or mud or whatever, and then wrap it in a bandage to keep it dry.

And then sometimes you would add oil to the plaster because then it wouldn't stick to the wound, which was a smart idea. Because you know, that's, you've ever had like, the edge of the band-aid stick to like the actual part of the cut. I mean, that's no fun. Yeah, yeah. That's great. Exactly.

So, what's interesting is if you look back to like wound care, one of the primary ingredients used by the ancient Sumerians was beer. Oh, nice. For wounds. Yes. And I didn't know this. They actually were big-time brewers. They brewed like 19 different kinds of beer.

Brew marians. That's just good, Justin. Thanks. And if you even talking to my dad. But they would they would apply beer to directly to wounds or add it to wound dressings. They take it out of the bottle first, I was assuming. It would just use it to cold compress. I don't think it was bottled beer. That's going to be my guess. That's a good point. I imagine like giant casks or something.

But they would add something like one recipe involved, turpentine and daisy and some flour and some milk and some beer and you mix it all together in a small copper pan, then you spread it on the skin and then you bandage it. And I don't know, this sounds like also some weird holiday drink that involves beer too. Yeah, yeah, it's like a low grade egg dog. Yeah. But I just thought it was fascinating

that they were expert brewers apparently. Yeah. Beer is ancient and magical, Justin. You're right Sydney. I miss it very much. I know you do. You make me very aware of that every single day of our lives. Just throwing that in there.

The Egyptians were the first to introduce the idea of honey to wound healing. And we've done a whole episode on honey so I won't belabor this point, but honey is actually helpful in some cases in wound healing. So. I don't belabor this point, but Honey is actually helpful in some cases in wound healing. So, right. And we have known that for, obviously, a very long time.

Um, we've been using it for a very long time. No, it's a very strong word. I don't think we knew but at this point, we randomly guessed it and it turned out to be right for a very long time So it was a primary component of a lot of their wound dressing recipes along with grease and lint and so when I say that With you guys now hold on let me break it down for you. And like pizza we found on the ground. So jam. Greece, Lynn and Honey was like a basic wound dressing. And the Lint, when they say the word Lint,

when we use the word Lint, they probably mean some kind of like fibrous material from vegetables. Okay, okay, okay, like smut. That's different, right? Silt? It's corn silk, is that what you're thinking of? Silt, not smut. No, smuts like the... That's different. Like silk, yeah, corn silk. Yeah, like something like that, something fibrous. And the idea was that it would absorb drainage from the wound to try to keep it dry again.

The grease would have been some sort of animal fat. So the idea was like to create a barrier on top of the wound. To protect it from stuff. So you take some grease as a barrier, you put some honey on there to heal it, you put some grease on there as a barrier and some let it keep it dry. It doesn't sound as wild when you break it down. You're right Sydney, I'm sorry, ancient, ancient folks. And as we've talked about with honey before, interestingly, the use of honey arose in different

cultures independently. So they, so maybe we did observe something. I don't know. Ancient Indians were also using, I don't want to detract. We're also using honey. But much of why the Egyptians were probably good at wound dressing is because they were so good at mummies. So good at mummies. They're so good at mummies. Hey, what's up? My name's Derek. I'm an ancient Egyptian and I'm good at mummies. The Egyptians also made the first adhesive bandage.

Oh, yeah. Yeah. Congratulations, guys. That's self-sticking bandage. I don't think they call that bandaid. I'm fairly certain bandaid does not date back to the ancient Egyptians. That's very good. That's true.

They also... Great mark that. What did you say, bandaid? Very good. Because it provides aid. It provides aid and it's a band. They also... Great mark that. What did you say, band aid? Very good. Because it provides aid. It provides aid and it's a band. Very good.

Was that how Egyptian sound? Yeah. I don't... The ancient ones. They probably didn't even speak English. You know what? But they didn't. There's a lot of movies that probably need to know that.

Yeah, because they... Yeah, like Prince of Egypt. Yes. There's head and commandments. Or like the common default, if we're not sure what language we should have the character speak, we'll have them sort of speak very proper English. Yeah, or Transatlantic. Yeah, it's not, it's not British accent or American accent. It's right, it's just that sort of... Like, it's basically the accent or American accent. It's right. It's just that sort of like,

it's basically the accent for fanciness. Yeah. That's what I mean. It's like a very fancy English. Yeah. But it's for, it's no country. It's no specific area. And it's the wrong language.

So never mind. Uh, but anyway, I've, I've, of your diversions. This is a thing on the top 10, I think. Thanks. I mean, hey, I'll use it tomorrow and grain around. Perfect. Yeah. Well, no, you can mark that one off. It's like, okay, I think. Thanks. Hey, I'll use it tomorrow in Grand Rounds. Perfect. Yeah.

Well, no, you can mark that one off. It's like, okay, that's a dud. I'm not going to do the ancient Egyptian accent stuff. Of course, I won't be there for you to kick around. So, I begged and pleaded for Sydney to let me come because they wanted to do a sort of medical history of Grand Rounds. I was like, well, that's not going to be the same without hoops. She was like, I think it'll be fine.

I actually have to teach them. Go on. And I, the too many distractions sometimes, fart jokes. It's what you mean. You can say the word, Sydney. The, the Egyptians also believed that the color green was healing and was the color of life, so a lot of wounds would be painted green. I read this note as I was reading about wound healing

techniques throughout history and I thought, okay, well, that's obviously off base. And then the author tried to kind of make a case for like, now what's interesting is that they may have used a copper-based paint and copper in Petri dishes is somewhat inhibitory to bacterial growth. And so you could make the argument. And I was like, nah, that's a stretch. It might be enough for what I'm going to call a anecdotal justification, right? It might be enough to like, I don't know, it seemed to have worked. Right? Like it might be an effort to have helped some people like

maybe, but then again, as we've talked about before on the show, just because something works in a lab doesn't mean it works in a human body. Right. So we don't try. Copper inhibiting back to your growth in a lab doesn't necessarily. Yeah. And if you go through a lot of the ancient, um, Egyptian, uh, like the Smith Papyrus, the Ebers Papyrus, the Berlin Papyrus, uh, they all kind of have this common idea that the presence of pus in a wound is actually a good thing. It, it's not technically incorrect, right? I mean, you should, you not technically incorrect, right? I mean, you should, you want it out, right? Well, I mean, if you're talking about like an abscess, once you see pus, that is better

because that means you've opened it and it's draining and it's not, you know, and then it will heal. Yeah. But generally speaking, if you have like an ulcer or a cut, you'd rather they're not be pus, they're honey. not be pus there, honey. That's true. Yeah, because then infection has occurred generally. Yeah.

So, so a plus is usually a bad thing, but there was this concept of pus being a sign of healing. Too much was bad, but you wanted some pus. Like the pus is how you know it's working. Right. This concept, it's really interesting because this hung around in wound healing for like 3,000 years. The Romans would call it laudable pus Lotta bullpuss your puss is lot of that was actually my nickname on the high school basketball team. I'm sorry honey This this would hang around until like the 1500s when French surgeon,

Paré finally said, I think this is wrong. I think maybe we should not be encouraging so much plus in all of these open wounds. We've done terribly wrong. If you, let's say that you had an open cut or what we would call laceration, like a cut that needed to be closed, and not all wounds need to be closed, but let's say that this is a wound that needed to be closed and not all wounds need to be closed But let's say that this is a wound that needed to be closed stitches

Yes, but do you know what they would use as stitches at times in ancient Egypt? No, this is maybe my favorite thing I learned tell me Aunt Pinchers, Pinsers Tell me. Ant, pincers, pincers. They would take an ant and grip the bottom of it and hold its little mandibles, its little pincers open. And then make sure that those kind of get on either side of the wound and then let them

squeeze together to pull the wound edges together. And then once they had it in place, they would just like yank its little head off and just leave the pincers there. That's mean, but... And that's the, those were the sutures. That's why that can't true. I don't believe that.

I have seen pictures of this done in modern day. Really? Yes. You can look that up like ant pensors used as sutures and find images of this if you're interested. So gnarly. I mean, and it as far as like the wound healing aspect, I don't I don't know how that would work like 24 hours, 48 hours a week later, but it will pull the edges of the wound approximate the edges of the wound. It will do that.

It will pull them together. That must be confusing for any ants. It's like, okay, well, that's good. But now, what animals, pinchers, are we gonna get to hold Greg's neck shut? Because now Greg has this issue. Are there smaller ants that we don't know about? Who's pinchers we can use to hold Greg's neck shut because now Greg has this issue. Are there smaller ants that we don't know about? Those pictures we can use to hold Greg's neck. They're smaller and smaller ants. I guess you need to find like wicked small ants, huh?

Poor Greg. So the Greeks were the first to introduce the idea that wound should be kept clean. So they actually advised washing wounds like with boiled water, wine, vinegar, this idea that like remaining, keeping the wound clean throughout the duration of a healing was actually important. They also kind of distinguish between an acute wound and a chronic wound, which is really interesting because you do manage them differently. And they, Hippocrates talked about that. Like there were different cures and polices

and herbs recommended for a wound you just got as opposed to like a chronic ulcer that wouldn't heal. That kind of thing. Hippocrates specific note on chronic wounds for an obstinate ulcer, sweet wine and a lot of patients should be enough. That doesn't make any sense, Hippocres. I don't understand what you're saying. On the flip side, sweet wine and a lot of patients is probably enough for most things in life.

I don't think it's bad advice if you have no idea what you're doing. Right. The sweet wine is for me. And also, the lot of patients is for me. I have no idea what's happening. I don't know. We make this up as we go along at this point in history. I don't know if you heard. Things get worse before they get better. Sorry. Not for many millennia. Anyway, here's your sticker. You did a great job. The Romans introduced what we consider in medicine, kind of like the cardinal signs of inflammation. So if a wound is inflamed, you look for redness, you look for heat, pain, swelling,

rubour, colore, doleurotomore, two more. Those are classic signs of inflammation. And Celsius introduced this concept. And this was very key to the idea of like following a wound and seeing if it was healing appropriately or if something had gone wrong. From there it broke down into like some like Celsius advised using honey and bran or cork and ashes on wounds were common things. Galen continued the vinegar and wine theme. I was very popular. Plenty of the elder, one of our favorites. You know, it's really disappointing. I read everything from natural history, I could find. That's Plenty's big book on wound healing and various things to put on wounds for just one of those good old like plenty of the elder wacky

Wacky like what are you what are you thinking Plenty why and He really let me down this time He would often say just let it breathe and leave it open and it will probably heal And then even in his variety of actual treatments for wounds and there are many, they're extensive lists, it's really just various herbs or roots mixed with honey. Almost every single one ends with an add some honey. So it's really hard to poke fun at all plenty with this one because I think it was really just about the honey.

And then he would throw in different herbs depending on what location of the body or what caused the wound. Well, it's your next time, plenty. Yeah. So plenty, you get a pass on wound. The report job is perfect. If every part job were perfect, we wouldn't have hot dogs. So it's there.

That's true. That's the only one that says it's good advice, Jess. What about after after the Little Romans there. Well things as I already alluded to things are gonna get worse before they get better nice Middle Ages. Yeah, but before we get to the Middle Ages, let's hit the billing department. Let's go The medicines that escalate my God for the mouth. Okay, so I'm fired up. You know, the Middle Ages is always the worst what they got. Well, overall, in the Middle Ages, as you may imagine, techniques were not greatly improved.

There were some things that were still being gleaned from the writings of Ancient Greece and Rome, and we're still being used to like, linen dressings, wine, lint, honey, you know, those kinds of things were persisting, but as far as advances in the field, they generally were not a lot at period. On anything. Really? Yeah, it was rough. There's still debating about, you know, should we, every time somebody gets a wound, should we sew it up, should we leave it be? I don't know.

Oh, it's the middle ages, man. Just figure it out. And, and part of that is that at the time, a lot of kind of magical thinking overtook scientific inquiry, the use of charms to ward off, you know, infections and that kinds of things, or just things like prayer, you know, a lot of treatments were religiously motivated. So, you know, go pray. And you'll get better, you won't. That's pretty much it. The dominant theory in medicine of the time was the humoral theory. So, you know, the four humans.

The four humans in balance, yeah. Exactly. So treatments for that usually included like bleeding the patient or cupping things that would make you puke, things that would make you poop, things that would make you pee, that kind of thing. And even for wounds, it's really interesting that bleeding would be used for wounds. But it was. Yeah.

I have a wound. It's bleeding. Well, let me cut you somewhere else. Good news. Like, my treatment is already working. Now, there were, I found this interesting. So one common wound problem in the middle ages were arrow wounds because I guess the Longbow was a popular weapon at this point in history.

And so the way that a wound, or the way that an arrow head was attached to the shaft was usually like with beeswax or something. So it wasn't on there that tightly. I mean, it's, it, they usually would stay on for like the duration of the, they got the job done. Yes. I mean, they flew through the air and landed in a human if your aim was good. So they did the job from that perspective. But. And you were aiming at a human because it may have just been a warning shot. You were trying to do. We're trying to. That's true. That really depends on your aim though.

That's not the fault of the arrow. Fair. But the problem is if you got shot and you didn't die and then someone was trying to treat you for that arrow wound, they would probably try to remove the arrow. That was usually like the first thing to do. If you just grabbed the arrow and pulled, well, other than the fact that there were arrows with hooks and barbs and all kinds of... And the fletching would get caught.

Ugh. Yeah, all kinds of awful things like that. The other problem is that the head of the arrow would often just come off. So you would get the shaft out, but you still have this arrow head lodged in your body somewhere. And every metal detector from then on out, it was so annoying. So, and I mean, it's not like the arrows were clean to begin with. So, like, this is bad. This is we're in a bad, you're in a bad way. Yeah, it's rough. So one specialized instrument that

was invented at this time in history was called the arrow spoon. Okay. Which was kind of a hooked, a long hooked instrument. And the way you would use this is first you would wanna widen the wound some. Okay. So you would wanna kinda just probe around the arrow head and just like push out. Groovy, okay.

So that the wound got a little bigger. Yes. And then you would use this spoon device to kind of hook underneath the arrowhead and then yank it out of there. And there were different variations. There were some that even had like screws in them and you would try to like insert them into the arrowhead and screw them in and then pull it out that way.

And then the patient had been anesthetized. We had no anesthesia. If they were lucky, they had a stick to bite on. And after you got the arrow head out, if your patient has survived this, then of course the natural progression, you would take a hot iron and stick it in the wound to cauterize it, to stop the bleeding.

So is that an advance? I don't know that we can count that as an advance. No, no, it was a tool that got a job done. It did something. I would not call it an elegant tool. No. And probably not really a multitasker there. No, just that one. Single use. Maybe if you need an emellent baller on a short, on short notice, it would work. Now, I will say that as we move into like the 1400s, we see the concepts of a debridement, meaning cleaning up like dead tissue and stuff from a wound that is inhibiting healing, getting rid of that without actually just kind of cutting the whole wound. You're just getting rid of the stuff that's going to stop it from healing and cleansing it and trying to like

recognize that there's a certain kind of tissue that means a wound is healing called granulation tissue. It's like pink fresh looking tissue on the edges of the wound. Okay. That's a good sign. And if you see that, like encourage that. Keep that growing and get rid of the dead stuff. Like there was that recognition by English surgeon, Thomas Morstead all the way back in the 1400s. That's something. Now then during the 1500s, that's when we get into Ambrose Paray who revolutionized wound care, not just with the ideas

I mentioned earlier that Puss is not a good sign and we should not try to encourage things to be infected. But by encouraging just just basic care things, like good nutrition, sleep, better dressings, ligature, the idea of ligating blood vessels is opposed to cotorizing them, don't just burn a wound to stop it from bleeding, you could actually sew up vessels to stop them and then that doesn't do as much tissue damage.

Obviously. And then the idea of like a pressure ulcer, something that had developed from just putting too much pressure on it, like something that had been laying on a bed, a bed sore for a long time, just offload the pressure. So put a pillow under their leg or something and get their heel off the bed. Revolutionary idea, so simple.

But there we go. There you go. It wasn't until, as we move into the 18th century, surgery was really its own field at this point. And that's when you see more surgical involvement in wound care, as I mentioned, like the idea that we need to surgically clean certain wounds to allow them to heal.

And then we move into things like the process of antiseptic technique. And then after that, things like antibiotics. And all that happened because in the 1800s, and I think we've talked about this before, Ignoss Simmelweis, the guy who told you to wash your hands. The revolutionary. Much to the chagrin of everybody else. Right, the revolutionary idea to wash your hands was was introduced. And then Joseph Lister was the one who said, you know what, in the operating room, we should wash things with certain, I think it was using things like carbolic acid or something. But anyway, thanks to clean instruments and whatnot, the idea that, you know, if you use dressings and instruments that have been cleaned,

perhaps not everybody wants Kangry. Exactly. And then we get to Pastures' germ theory of disease. And we suddenly understand how infection is spread, more or less. It's rad for a listener that he got that before past your, about his jam going. It's quite the cold shot. Well, it's the same with Semmelvice. I mean, he came up with the idea that washing your hands improved outcomes for patients

without really knowing why. You know? And again, this was a time in medicine where like the bloodier your coat was when you walked into surgery, the better a surgeon you were considered to be. You wanted it stiffened by blood. That's how physicians, other physicians, she's new,

you're a legit. Exactly. And you walked into the OR that way, not out. Not out. In that way. As we look at advances in wound care from this point forward, a lot of it's traced to various wars. As you can imagine, those were times where there were lots of wounds being created. And so a lot of advances were made kind of on the fly as to how to treat them. So in the Civil War, we see better bandages and iodine beginning to be used to clean wounds. In World War I, we come up with something called Daken's solution, which was created by English chemist Henry Drysdale Daken and French surgeon Alexis Carroll. It was a solution of sodium hypochlorite, which is sort of like bleach.

It's basically bleach, but it's like a dilute bleach. But anyway, Dakin's solution was good at removing dead tissue and leaving the living tissue safe. And it's still used to this day in some cases. Good job, Dakin. Yeah. So it's pretty cool. Good job, Taken. Yeah. So, it crushed it. So, pretty cool.

One side note that has happened already in chronologically speaking, but I wanted to give a little bit of time to, at the end of our show, our maggots. Nature's bugs. Microsurgence, maybe. Nature's microsurgence, maybe. Nature's micrissurgence, okay. How about that? So maggots, many people are kind of aware maggots are used, maybe. Do you know that?

maggots are still used today? Yeah, I spot only know that because I'm married to you. Okay. maggots are, they really are nature's micrissurgence. So it has been noticed for hundreds of years that if a wound gets infested with maggots, fly larva, in some cases, it actually does a little better. This is because maggots are very good

at eating only dead tissue. They don't eat living tissue. Not interested. And what that good good dead stuff because they nasty. As I mentioned getting the dead tissue out of a wound is very important to the healing process. So my ISS or the wound being infested with larva my ISS or just you're being infested with larva in general, has probably been noticed for, I mean, thousands of years, certainly. There's some evidence that maybe the Mayans and some of the Aboriginal tribes of Australia knew about this and utilized this technique for a long time. But the first time we actually have recorded, yes, maggots

are good for wounds use dates back to Napoleon in 1829 Napoleon Surgeon General Baron Dominique Larray described wounds on the battlefield that had been infested with fly larvae that actually seemed to do better than wounds that weren't infested with fly larvae. I began to theorize that the larva larva were doing something to the wounds that were actually, that was actually helping. So in the Civil War, there were actually times where blowfly larvae were introduced into wounds to clean them. And then again, even more so in World War I, American surgeon William Bear noticed that soldiers who had maggot infested gashes

didn't seem to have the infection issue or the swelling in the wound that patients who didn't have maggot infested. The willpower it would take to not just knock those bad boys up. So not only did he not knock them off, but Dr. Bear actually started using this did he not knock him off, but Dr. Bear actually started using this at Johns Hopkins in 1929. He actually was mainly using it. He was working at the Associated Children's Hospital and using it in cases of chronic wounds with osteomyelitis, which is an infection of the bone in children. And... Nurse, this patient is very serious. Bring me my giant box of maggots. I keep in my office. But this, he was getting, he was getting really great results from this.

His, the wound, the wound healing process was greatly improved at his facility and in the patients that he, he tried this with. So within five years of him doing this and publishing it, over a thousand American Canadian European surgeons were using maggots in their practice. For wound healing. Great. A lot of hospitals started to operate their own insectaries to grow and utilize maggots because you don't want to go like scrape them off roadkill. You want them at the ready. You want them sterile. You want them clean.

It's a fun gig. It's not good to go get them off like dead animals out in the wild. Wow, I thought they're so great. It needed only a death cell. No, we want the clean larva. And there was even a lab that opened, uh, literally labs in Pearl River, New York,

where you could get your supply of surgical medigots if you needed them, if you didn't have an insectery. So from 1931, you're they transform into blow flies when you're cured? That's how you know, like they've had enough beer in there. That sounds like magical thinking. They will, I mean, they will at some point become flies. Right. And then they'll leave.

They grow up so fast. The, so by 1931, it was pretty commonplace. Stereo maggots of the green bottle fly are the most common. And I think persists as the most commonly used, Lucilia, Serracata, if you're interested in that kind of thing, what kind of fly is used? No, not. And you really see like this, so 1931, it's introduced, everybody is raving about this new therapy.

And wild for it. It really dies down in the 40s with the introduction of antibiotics. Don't need you maggots anymore, close the insectore. Because everybody thinks, well, we'll just stinkyinky, stinky dogs out of a job. We'll just get rid of my otter. We'll just get rid of my otter. Stinky dog. But that was kind of a misunderstanding of what they're doing because they're cleaning

up the wound, they're cleaning up dead tissue. Antibiotics don't do that. They might kill bacteria, but they don't clean up dead tissue the way that maggots do. So there was still this undercurrent of people insisting there's probably a place for this in medicine and then it wasn't really until the FDA approved it again in I think 2004. Wow. Yeah, that recently when they said, you know what, you're right, there is a place for maggot therapy and it can be reintroduced. So maggot debridement therapy or MDT is what we call it now.

You introduce up to a thousand maggots into a wound. You leave them there for anywhere from one to three days at a time. And you can use it for any kind of wound that has like, like I said, dead tissue, the skin is kind of sloughy. There's pus, you know, something that needs to be cleaned up. This would be an alternative to other ways, other surgical methods of cleaning up a wound or not even surgical chemical methods of breeding a wound. The neat thing is that we have a lot of studies that say it does in fact help,

that it reduces the intense pain from some of these wounds. It reduces the odor. Sure. That's nice. And in 80 to 95% of cases, a complete or significant debridement of the wound is achieved. All right. Yeah.

So it actually is pretty successful if you're in the right case. It reduces your risk of amputation. Nice. Which is great. It reduces your risk of bacteremia, which is infection in your bloodstream. And the only real side, the only real side effect, well, there are a couple. One, there are some people who have discomfort with it. Okay. Not a lot. Not as many as you'd think. 20 to 25%.

But I think some people are fibbing. I would assume it would be higher. Yeah, no kidding. But no way. How are you stitches? It's 27. It's stitch me up. And it depends on the wound. I mean, if you have like exposed nerves and things and you've got a maggot crawling across it, that's probably going to cause some pain. But if you're talking about something like a chronic diabetic foot ulcer, that patient may not have any sensation left in that foot. They may have such severe nerve damage that they're not feeling anything.

And so in which case, you probably wouldn't have more pain for maggot therapy. So it depends on the wound in the patient. There are some other drawbacks, medicinal maggots are alive. And so you have to ship them there. Assuming you don't have your own in your own lab, which most hospitals don't, ours doesn't.

But you have to ship them there alive and you have to care for them and make sure they maintain their living status. Keep your spirits up, play the music. So about 1% arrive dead. That's actually, again, not as bad as I would have assumed. Yeah. And also though, because they're alive, they can escape.

They do move. Fun. Okay, great. And once they escape, I saw the, the, the, them called mobile pho-mites, meaning that a pho-mite is, uh, an object that can spread disease, like a white coat is a classic example of a pho-mite. So I, that's why there's more and more studies encouraging us to be careful about wearing white coats because we're going in and out of rooms,

wearing white coats and spreading disease maybe on our white coats. They're a foamite. Well, these are mobile ones. Yeah. They're covered in infectious material and they move. Let's all agree, they're a mobile foamite when they brought them in again.

I mean, let's see how I say, and now they're bugs. No, they've been bugs the whole time. You brought bugs into your hospital, clever girl. Come on. So you have to keep the dressings over top of them pretty tight to keep them in place. You don't want them wiggling away. And if they do wriggle away, but fugitives is what I saw them referred to in some of the papers. If you have fugitives, I mean, they will become flies. Perfect.

Which is not great in a hospital. Yeah. And then somebody's just gonna swat him. And it's like, that's a doctor. What are you doing? That maggot is a doctor. And then a lot of people, there are a lot of papers that talk about the Yuck Factor.

It actually tends to be a bigger problem for the doctor than for the patients who get maggot to breed with therapy. In general, most patients tolerate it pretty well. And if it's working, I think, and you're able to avoid amputating your foot or something than it's worth it. But they do have like special dressings to help cut down on that. It was sort of like a double-sided enclosed kind of dressing that you can peel off and apply to the wound. There are ways to do it so that the person applying the dressing and the patient themselves never really see the maggots.

They have all kinds of advance encasement dressings that you can put on and the maggots are there and they're doing their thing, but you don't really see them. That's no good. Don't lie to me. So. Well, Sid, that was all very gritty. Sorry, but I hope you're proud of yourself.

Thank you for listening to Saul Bones. A couple of things going on, I'm only going to tell you about. It's not too late. We're going to be at pod con this weekend. And you can, if you can get out there to Seattle, I think they got tickets at the door, or you can go to podcon.com and you actually get a remote ticket and you can listen to a lot of the shows and enjoy them right from the comfort of your own home.

So it's gonna be cool. Check it out, PodCon, Moobin Bam is gonna be there, still buffering and go see them live. Get some stuff signed. You can see we're doing an adventure zone discussion, not a live adventure zone, but we're doing a talk about it. And a bunch of panels and stuff. Nightville is going to be there. Hank and John Green going to be there. It's going to be fun.

So we're doing a live show. Oh, yes, all bones. The podcast is going to be there. So check that out. polka.com. I also want podcast. Yeah, it can be there. So check that out, holly.apocah.com. I also want to mention it's a candlelight season. We're doing a live candlelight show in Huntington. It actually sold out pretty quickly.

So for other people that want to get in on the holiday spirit, Sydney sister Riley also is still buffering, organized a fundraiser called BiaC candlelight 2017 star. And you can, the way it works. You can kick in five or more dollars towards the cause, which I'll tell you about in a second. And you can get a star in the Camelights tree. And the cause is big brothers, big sisters of South Central, West Virginia, because when they started supporting offering more services and got a grant for LGBTQ plus youth, they were actually had a big donor pull $80,000 away from them because

of that work. And that is severely impacting their ability to provide services in general to kids in the area. So all of candle lights is gonna go to them, all the ticket sales, all the merch, and this candle lights 2017 star, you can get yours at bit.ly forward slash Mbmbm stars.

Can I also say I was on a different podcast. Ah, there you. Sorry about that, but if you feel so inclined, you can hear me on court appointed next week. They publish this coming Monday, where my dad and my uncle Michael, who is an actual real deal lawyer, my dad is not, but he makes lots of dad jokes, talk about vaccine law. And I'm there for the science. So you can check that out. Excellent. And then you find out at iTunes. Yes. Search for a quarter pointed. And folks, that is going to do it for us.

Thank you so much for listening. Thank you to you at home. Just for being you. But also for helping to spread the word about the show, rating our viewing of iTunes, tweeting about it, etc. But that's gonna do for us. So until next week, my name is Justin McAroy. I'm Sydney McAroy. And as always, don't chill a hole in your head. Alright! Maximumfund.org Comedy and Culture, Artistone,

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