This Podcast Will Kill You - Ep 141 Maggots: Such noble work

Episode Date: May 28, 2024

Just reading the title of this episode may have been enough to make you feel grossed out and creepy crawly. And now we’re asking you to listen to a whole episode about maggots? But trust us, it’s worth the journey. Because these little creatures have a hidden depth to them that will surprise, delight, and, we would venture to say, inspire. In this episode, we explore the many ways that maggots have been used by medicine over the centuries up to the present day and the properties they possess that make them heroes of healing. With a discerning palate and something called extracorporeal digestion, maggots can show us that, when it comes to wound healing, teamwork makes the dream work. See omnystudio.com/listener for privacy information.

This is exactly right. There are already enough things charging your card every month. Dinner should not be one of them, which is exactly why Blue Apron is now subscription-free. You heard that right, Blue Apron no longer requires a subscription. You can order meals when you want them and skip when you don't without adding another recurring charge. Blue Apron meals are designed by chefs and arrive with pre-portioned ingredients, so there's no meal planning and no extra grocery trip. Order now at Blue Apron.com. Get 50% off your first two orders plus free shipping with code this podcast 50.

Terms and conditions apply. Visit blueapron.com slash terms for more information. When someone you love is facing cancer, you want to do more than send a card or flowers that will wilt in a week. You want to actually help. That's where the balm box comes in. Our care packages are built from research with over 500 cancer patients and caregivers, packed with items people actually use during treatment. Think soothing, practical, thank goodness I have this kind of relief.

For you, it's not just a gift. It's a way to show up in a moment where words fall short. For them, it's comfort, calm, and a reminder they're not alone. From chemo-friendly boxes to mastectomy recovery kits, even options for men, we've made it simple to give something that's elegant, premium, and genuinely useful. And yes, domestic shipping's always free on orders over $50, because making someone feel cared for shouldn't be complicated.

So skip the empty, get well soon. Send real help, real comfort, and maybe even a laugh. Visit the balmbox.com. That's T-H-E-B-A-L-M-B-O-X.com. Balm, like healing and care. The balm box, because cancer patients don't need bouquets and brownies.

They need balm. I'm Clayton Eckerd. In 2022, I was the lead of ABC's The Bachelor. But here's the thing. Bachelor fans hated him. If I could press a button and rewind it all I would. That's when his life took a disturbing turn.

A one-night stand would end in a courtroom. The media is here. This case has gone viral. The dating contract. Agree to date me, but I'm also suing you. This is unlike anything I've ever seen before. I'm Stephanie Young. Listen to Love Trapped on the IHeart Radio app, Apple Podcasts, or wherever you get your podcast.

At a certain battle during 1917, two soldiers with compound fractures of the femur and large flesh wounds of the abdomen and scrotum were brought into the hospital. For seven days, they lay on the battlefield without water, without food, and exposed to the weather and all the insects which were about that region. On their arrival at the hospital, I found that they had no fever and that there was no evidence of septicemia or blood poisoning. Indeed, their condition was remarkably good, and if it had not been for their starvation and thirst, we would have said they were in excellent condition. When I noticed the extent of the wounds, I could not but marvel at the good constitutional condition of the patients. This unusual fact quickly attracted my attention. I could not understand how a man who had lain on the ground for seven days with a compound fracture

of the femur, without food and water, should be free of fever and evidence of sepsis. On removing the clothing from the wounded part, much was my surprise to see the wound filled with thousands and thousands of maggots, apparently those of the blowfly. These maggots simply swarmed and filled the entire wounded area. The site was very disgusting, and measures were taken hurriedly to wash out these abominable-looking creatures. Instead of having a wound filled with pus, as one would have expected, these wounds were filled with the most beautiful pink granulation tissue that one could imagine. These patients went on to healing, notwithstanding the fact that we removed their friends, which had been doing such noble work. I love it so much, Erin. It's so good.

It's such noble work. I can, it's such noble work. I just love maggots, Erin. This episode has transformed. It is something I never thought that I would say, ever. And I love them so much. I love them. They're the best. That first-hand account was from William Bear from 1931 in a paper titled, The Treatment of Chronic Osteomyelitis with the Maggot, Larva of the Blowfly. Love it. Those blowfly larva. Hi, I'm Erin Welsh. And I'm Aaron Alman Updike.

And this is, this podcast will kill you. Welcome to today's episode. It's all about maggots. It's going to be so much fun. And what makes it even more fun is that this is kind of like a two-parter. It is. Yeah, it's like companion pieces. It was originally intended as a two-parter that we realized was

really two companion pieces, because who knew there was so much to love about both maggots and next week's stars, leeches. Leeches. I mean, and like I think the connection will become fairly clear as when we get through these. But basically, these are two organisms that carry with them a certain ick or yuck factor. A major. But they have been used in medicine for centuries, thousands of, of years even and have kind of recently experienced a resurgence in popularity. And I just,

there are so many amazing things about them. So it's going to be really fun. It's a really going to be a fun episode. Next week's also going to be so much fun. I'm thrilled. I just, I learned so much researching for this and like, ugh, maggots. Maggots. Who knew? A lot of people. A lot of people did. And now, and now we get. to know to. But before we get into all of that good stuff about maggots, it's quarantine time. It is. What are we drinking this week? We're drinking a tale of two worms. Wait. That is, oh my gosh. No, that is actually the title. That is the title. But I like, I made the quarantini picture and the recipe as the best of both worms. No, did you really?

Yes, I did. Let me pull it up. I sent it over to you, Erin, too. How did I not even notice, Erin? Best of both words. You did best of both words. That's how it was written down in my notebook. And so I was like, oh yeah, and it literally did not cross my memory.

And I obviously, I looked at all of your things, didn't even read the title. Mm-mm. Cool. Okay, so we're drinking either. It's going to be easy to change. I think we're drinking a tale of two worms. A tale of two worms. I love it because we're telling tales of these two squirmy worm things.

Asterisk, we know that maggots are not worms. We're very well aware. Yeah, but there's one like worms so like, you know. Colloquial term. Spiders are bugs. That kind of thing. Like we know the difference, but forgive us. We do.

Oh, but in Best of Burms. both worms. Oh my God. In a tale of two worms, we have, it's basically like fancy fruit punch with vodka and gummy worms. Delicious. We'll post the full recipe for that quarantini as well as our non-alcoholic pussy burrito on our website, this podcast with kill you.com, and on all of our social media channels. We will. If you're not already following us on our social media channels, you really should because we're putting out some pretty cool content. You know, we've got some reels. We got normal posts.

Normal posts. We're on TikTok even. We're on TikTok even, finally getting with the program right before it probably will be banned. Yep. You know, and check us out there. Also, our website. Let's shout out our website, as we usually do. It's got some good stuff.

It's got transcripts. It's got our bookshop.org affiliate account. It's got our good reads list. It's got all the sources for all of our episodes, links to merch, links to music by Bloodmobile, links to Patreon, links to a form where you can submit your first-hand account, which is awesome. We get so many incredible people who share their stories with us that we cannot think enough. And so if you're interested in sharing a story or have a request for a particular topic, please reach out to us.

Well, with that, shall we get into this episode all about maggots? Let's do it right after this break. Dinner shows up every night, whether you're prepared for it or not. And with Blue Apron, you won't need to panic order takeout again. Blue Apron meals are designed by chefs and arrive with pre-portioned ingredients so there's no meal planning and no extra grocery trip. Their assemble and bake meals take about five minutes of hands-on prep. Just spread the pre-chopped ingredients on a sheet pan, put it in the oven, and that's it. And if there's truly no time to cook, dish by Blue Apron meals are fully prepared. Just heat them in the oven or microwave, and dinner is ready. And here's the exciting news. Blue Apron no longer requires a subscription.

You can order meals when you want them and skip when you don't without adding another recurring charge. Order now at Blue Apron.com. Get 50% off your first two orders plus free shipping with code this podcast 50. Terms and conditions apply. Visit blueapron.com slash terms for more information. Anyone who works long hours knows the routine. Wash, sanitize, repeat. By the end of the day, your hands feel like they've been through something. That's why O'Keefe's Working Hands hand cream is such a relief. It's a concentrated hand cream that is specifically designed to relieve extremely dry, cracked hands caused by constant hand washing and harsh conditions. Working hands creates a protective layer on the skin that locks in moisture. It's non-greasy, unscented, and absorbs quickly. A little

goes a long way. Moisturization that lasts up to 48 hours. It's made for people whose hands take a beating at work, from health care and food service to salon, lab, and caregiving environments. It's been relied on for decades by people who wash their hands constantly or work in harsh conditions because it actually works. O'Keefs is my hand cream of choice in these dry Colorado winters when it feels like my skin is always on the verge of cracking. It keeps them soft and smooth, no matter how harsh it is outside. We're offering our listeners 15% off their first order of O'Keefs. Just visit O'Keefscompan.com slash this podcast and code this podcast at checkout. When someone you love is facing cancer, you want to do more than send a card or flowers that will

wilt in a week. You want to actually help. That's where the balm box comes in. Our care packages are built from research with over 500 cancer patients and caregivers. Packed with items people actually use during treatment. Think soothing, practical, thank goodness I have this kind of relief. For you, it's not just a gift. It's a way to show up in a moment where words fall short. For them, it's comfort, calm, and a reminder they're not alone. From chemo-friendly boxes to mastectomy recovery kits, even options for men, we've made it simple to give something that's elegant, premium, and genuinely useful. And yes, domestic shipping's always free on orders over $50 because making someone feel cared for shouldn't be complicated.

So skip the empty, get well soon. Send real health, real comfort, and maybe even a laugh. Visit the balmbox.com. That's T-H-E-B-A-L-M-B-O-X.com. Balm, like healing and care. The balm box, because cancer patients don't need bouquets and brownies. They need balm. I have to start out just by giving a huge shout-out to the

pretty much only source that I used for this biology section of maggots, which was a paper, except I think it's more like a book, a compendium, a book called the Complete Guide to Maggot Therapy, clinical practice, therapeutic principles, production, distribution, and ethics. When they say complete, that is as complete as it gets. It was such a gem to read. I love it so much. And I loved it so much that I actually want to start off with a beautiful line from the introduction chapter. Are you ready for this? I think so. Quote, the human body is fragile, and therefore wounds, acute and chronic, have always been

part of the human condition since time immemorial. Likewise, flies have evolved to exploit during larval development the ephemeral cadavers and wounds of living animals, humans included. Ephemeral cadavers. It's beautiful. I just loved it. So flowery. I don't get to read things like that very often for this podcast. So I want to start off. I mean, I already started off. But first, I want to talk about chronic wounds because they're a really important part of the maggot story. Chronic wounds, the idea of a chronic wound is simply a wound that doesn't heal along a typical trajectory. And so you see this a lot in medicine, and there's not necessarily one specific time frame on when you would consider a wound chronic versus acute or something like that. But generally,

chronic wounds can be present for months to years. And if something isn't done, some kind of wound care to help chronic wounds heal, they can persist for years or decades and be very debilitating, physically, mentally, emotionally, they can lead to a lot of complications down the line. So why chronic wounds? Why are these important? Chronic wounds often have a significant amount of necrotic or dead tissue that covers them. And in order for them to heal, part of the wound care process is that they have to be debreded, meaning that the necrotic tissue has to be removed all the way down to a layer of more well vascular. like healthy bleeding tissue, what was described in the first-hand account as that granulation tissue.

That granulation tissue is our body's healing from the bottom up, which is actually how wounds heal. So how can we accomplish this process? Like what does wound care entail? That is where we can enter maggots sometimes. So maggots, for anyone who is un-initiable, is a colloquial term for the larvae of flies. Flies, large group, obviously, hollow metabolist insects, so their larvae look nothing like the adult. They have to pupate, they rearrange the whole body. Caterpillars are butterfly larva, grubs, beetle larva, maggots, fly larva. But flies are a huge, huge, huge order of insects that includes mosquitoes, houseflies,

horseflies. So when we say maggots, which is not like a scientific term, it's very much a colloquial term, we kind of specifically use that for the larva of flies that you probably think of when you think of the word fly. Does that make sense? Yeah. Okay. Like it's still a pretty general term, but it's like most of the flies that you look at it and you're like, that's a fly, their larva are maggots. Okay. So the flies that we. talk about in medicine, medicinal maggots, generally are from the specific species Lucilla sericata, I think is how you pronounce it. I tried really hard to look it up. But this is the common green bottlefly. And one other species, Lucilia cuprina, which is the Australian sheep blowfly.

So both of these are blowfly species. They're actually kind of pretty. They're green. They're really shiny and metallic. And again, they look like a fly, just green. Okay, I'm with you. You're with me. Thank you. Good. The maggots themselves, if anyone hasn't had the pleasure of seeing maggots, look like little wiggly grains of rice, especially when they're in their first instar. They're pretty small, and they just sort of wiggle around. And then as they molt through their various instars, they get a little bit larger. And then you can tell that they have little segments on their bodies, and they breathe through spiracles on their butts. So they bury their heads into wounds or decaying flesh, and they stick their butts out in order to breathe. So when it comes to

the use of maggots in medicine, and the reason that I talked about chronic wounds at the top, is that the primary use of maggots is in the treatment of chronic wounds. Sometimes maggots can be used for other wounds or acute things like burns, but mostly they're used for chronic wounds. And in this capacity, they have three incredible functions that I will get into in detail. First, they can help to remove that dead or necrotic tissue that prevents chronic wounds from healing. Two, is that they help to control infection, which is a huge issue in chronic wounds. And three, they actually promote wound healing. They're really cool.

So how do they do all of these three amazing things? Like they are worm babies. How do they do this? Blow fly larva, maggots, in the wild, eat dead animal tissue. That is what they do. That is what they have evolved to do. So they will happily eat the necrotic or dead tissue on a wound. Like that part makes sense.

They will eat dead tissue, any dead tissue that they can find. But there are a few things about these. blowflies, especially the ones that we use in medicine, that make them especially good at wound debreedment. First, maggots don't have any real mouth parts, so they can't bite you. They can't crush your flesh. They don't pierce you. Instead, they rely on what's called extracorporeal digestion. It's one of my new favorite phrases. Yeah. Meaning that they are secreting a whole bunch of digestive enzymes and antimicrobial substances. They're spitting it out. They're letting that flow over their food, which if it's a chronic wound, is your wound. And then they have these two

little mouth hooks that they use to kind of separate out their food bits. And they also use these hooks to crawl their little bodies around. That's how they crawl around. And this helps those digestive enzymes that they've secreted out to penetrate deeper into the surface of the tissue that they're digesting. And then they suck up that juice and that's what they eat, which allows them to grow. Also, this way of feeding, this extra core, I'm so excited, I can't have to pause for a question yet. But this way of feeding helps their neighbors as well, because all of the maggots in a group will combine resources, combine all of those digestive enzymes, which increases the efficiency in large populations.

Okay. I have so many thoughts. That is amazing. I assume at a certain point, are resources limited when then it's not helpful if they run out of tissue or whatever to eat? Yes. Okay. Okay.

Yes. So they are very efficient at just finding that necrotic tissue for the most part. And we'll get into like there could be complications. But yes, they are going to find like the most necrotic tissue, and that is what they are going to specialize on for the most part. And then when they're done, they're going to leave. They're going to go someplace new, right? So on a chronic wound that's full of dead tissue, they are secreting these enzymes that are literally digesting it, which is a form of chemical debreedment, right? So that's the first way that they're debriefing it. But on top of that, their little mouth hooks are also helping to break up that dead tissue.

So they're also doing physical debridement. And not passively, the way that like a piece of gauze with bleach sits on the surface and does a chemical debreedment. And then when you pull that gauze off, it's going to have some kind of physical debreedment. But these are active live maggots who, like you said, Erin, are. seeking out the deepest, most necrotic tissue because that's the areas of greatest food for them. So they are incredibly efficient at this debreedment process. Do we know what chemicals and enzymes and what's in their secretions? Can we mimic it?

Would we want to ever mimic it? It's a great, great question. I feel like that is one of the big questions about so many of the things with maggots and with leeches, like we'll talk about later. We know some of the compounds. A lot of them are like proteolytic enzymes and a bunch of other things as well, too. There certainly are compounds that we have that we might use that are very similar. But as we'll see, it's like it's a combination, right? Like it isn't just the chemicals that they're secreting.

It's also the way that they're moving. It's their mouth parts doing the things that they're doing. It's them scooting their bodies along. So yes, it is possible. And I think we'll talk a lot more about that idea of like, can we, identify these specific compounds and can we mimic them? Well, it's also like just the removal process, like you said. Like it's not just dissolving or whatever. They're sucking it up too. They're amazing. Anyone who works long hours knows the routine. Wash, sanitize, repeat. By the end of

the day, your hands feel like they've been through something. That's why O'Keefe's working hands hand cream is such a relief. It's a concentrated hand cream that is specifically designed to relieve extremely dry, cracked hands caused by constant hand washing and harsh conditions. Working hands creates a protective layer on the skin that locks in moisture. It's non-greasy, unscented, and absorbs quickly. A little goes a long way. Moisturization that lasts up to 48 hours. It's made for people whose hands take a beating at work, from health care and food service to salon, lab, and caregiving environments. It's been relied on for decades by people who wash their hands constantly or work in harsh conditions because it actually works. O'Keefs is my hand cream of choice in these dry Colorado

winters when it feels like my skin is always on the verge of cracking. It keeps them soft and smooth, no matter how harsh it is outside. We're offering our listeners 15% off their first order of O'Keefs. Just visit O'Keef's Company.com slash this podcast and code this podcast at checkout. When someone you love is facing cancer, you want to do more than send a card or flowers that will wilt in a week. You want to actually help. That's where the balm box comes in. Our care packages are built from research with over 500 cancer patients and caregivers, packed with items people actually use during treatment. Think soothing, practical, thank goodness I have this kind of relief. For you, it's not just a gift. It's a way to show up in a moment where words fall short. For them,

it's comfort, calm, and a reminder they're not alone. From chemo-friendly boxes to Mestect. recovery kits, even options for men, we've made it simple to give something that's elegant, premium, and genuinely useful. And yes, domestic shipping's always free on orders over $50, because making someone feel cared for shouldn't be complicated. So skip the empty get well soon. Send real help, real comfort, and maybe even a laugh. Visit the balmbox.com. That's t-h-h-e-b-l-m-b-O-X.com. Balm, like healing and care. The balm box, because cancer patients don't need bouquets and brownies. They need balm.

In 2023, a story gripped the UK, evoking horror and disbelief. The nurse who should have been in charge of caring for tiny babies is now the most prolific child killer in modern British history. Everyone thought they knew how it ended. A verdict? A villain. A nurse named Bolle. Lucy Letby. Lucy Letby has been found guilty.

But what if we didn't get the whole story? The moment you look at the whole picture, the case collapses. I'm Amanda Knox, and in the new podcast, doubt the case of Lucy Letby, we follow the evidence and hear from the people that lived it, to ask what really happened when the world decided who Lucy Lettby was. No voicing of any skepticism or doubt. It'll cause so much harm at every single level

of the British establishment of this is wrong. Listen to doubt the case of Lucy Letby on the Iheart Radio app, Apple Podcasts, or wherever you get your podcasts. But that's not all. That's like not even close to all. So maggots, because in the wild, they're feeding on this decaying tissue that's just ripe with other organisms like bacteria, but also viruses, protozoans, other bugs, like everything. So it makes sense that they would have also evolved ways to thrive in an environment that is chock full of other microbes, right? Ways of either out competing for food or making sure, or and I guess, making sure that they don't get infected with all of the other microorganisms that are around. And they do exactly that.

Maggots secrete not just these enzymes that are breaking down tissue, but a whole host of antimicrobial compounds that in studies have been shown to be actually. against things like staff and strep, which are really common skin flora. And interestingly, they're less effective, perhaps against other types of bacteria, which might be less common to be found on decaying carcasses. But on top of that, they're also eating a whole bunch of these microbes that could potentially be infecting a wound. So they're disinfecting the wound. They're controlling the infection of chronic wounds. And their little mouth hooks, help to disrupt biofilm formation.

And biofilms, when bacteria are able to, like, latch on and form a biofilm on top of a chronic wound, that is very difficult to deal with. And maggots are great at it. And if that wasn't enough, if you're not yet convinced listeners, because, Aaron, I know you are. I'm totally convinced. That maggots are just like the bee's knees when it comes to wound healing. They literally help promote the healing of wounds. How?

So wounds in many studies that have been treated with maggot therapy heal faster than wounds not treated with maggot therapy. So let's talk a little bit about what that means. Like how do wounds actually heal? There's three major phases of wound healing. There's inflammation, proliferation, like of the tissue, and then maturation. Chronic wounds, the type that are really, like, good for maggot therapy, are usually stuck in an inflammatory state. like they're stuck there and they just can't progress because of the necrotic tissue, because of bacteria, because of a whole bunch of stuff. Some of the secretions from maggots act to inhibit

this inflammation. And that helps the wound to actually progress further through the stages of healing. And some of these compounds also seem to help to stimulate angiogenesis. Angiogenesis is the process of which we make new blood vessels so that you can get more oxygen to a wound, which, by the way, is how hyperbaric oxygen therapy works to help hear wounds. Oh. And so this combination of things also helps to actually speed along the process of wound healing. So it's just amazing that maggots can do all of this.

Yeah. Why do those things help wound? Like, not why, but do you know what I mean? Why? Yeah, why. Not why, but also why. Also why? I had the same thought, especially the idea that, like, why would they be anti-inflammatory? Because if a lot of what they are feeding on is, like, dead necrotic tissue, in my brain,

I wouldn't expect for there to necessarily be a lot of inflammation. But it seems like a lot of it is that they reduce some of the pro-inflammatory cytokines that we have circulating and reactive oxygen species. And reactive oxygen is something that definitely is present in the environment when cells start to lice, which is what's going to happen during necrosis and as something is decaying. So in that way, it kind of makes sense that it's like to protect themselves, they're reducing reactive oxygen species. That's my best. I didn't read that directly, but that's my best way of understanding it. Okay.

Can I ask some questions? Absolutely, Erin. Please. I have like two more pages of info. you might ask me questions about. Okay, let's see if we can get through it. Now, I'm going to hit all those paragraphs. Yeah.

Okay, so when is maggot therapy indicated and when is it not? So that's a really good question. Chronic wounds is a very broad category. There's lots of different things that cause chronic wounds. There's lots of different types of chronic wounds. There isn't necessarily like one wound that is like, oh, definitely use maggots for this and other wounds that you're like, ooh, never use maggots for this. In general, maggots are really safe to use for most all types of wounds, but any wounds that have a lot of necrotic tissue, like that dead tissue, anything that looks black on top is necrotic, that is going to be an especially good wound for maggots to be able to be helpful for.

They can be helpful in things like burns, which need debreeding right away and in a pretty, like, gentle kind of way. and they're very helpful for anything that's like difficult to reach or difficult to visualize because they're going to crawl their way into nooks and crannies, but then always come back up to the surface, either because they run out of food or because they need air or because they're done growing and they need to mold. So really like any type of skin and soft tissue wound could be amenable to maggot therapy, less so for things like bone and tendons and ligaments just because all of these things that are so great

about maggots don't work as well on those types of tissues. Interesting. Okay. But they're still not used as much as you would think given all of the benefits that I just mentioned. Yeah. So like how many hospitals have a maggot colony? It's a great question. I have no idea. Okay. I think most hospitals probably have access to them in some capacity. I know when I have rotated through wound care, they do use them sometimes. But in general, they use them very often as kind of like a last resort rather than like a first line therapy, which I find really interesting. Is that just the ick factor? I think that's a big part of it. There's definitely a lot of research on like what is preventing people from using maggot therapy and a lot of it comes back to either education,

not knowing how great they can be, not knowing that they're effective. And, like, yeah, the yuck factor. Yeah. Interestingly, more for practitioners than patients, which I think is very interesting. That is really interesting. Yeah. Yeah. Okay.

Let's say that you go in, you have a wound and your physicians, like, we think that maggot therapy is the right call here. And you say, yes, I consent to this. Because I assume there's, like, consent involved in magat therapy. and like sort of this is. So then what happens next? What can you expect to happen? So this is such a good question. So generally what they'll do is they'll take five to ten maggots per square centimeter of area that you need wound debreedment on. Oh, that's so many maggots. Okay. Is it? They're quite small, like a little. I know. I just just jam packing them in there. Just yeah, you want them to be efficient.

And then you basically put them on the wound. There's two different ways to do this. Sometimes you just put them all in a little baggy that they can't escape from and put that baggy on the wound and then kind of tape it on. And that way you know for sure they can't wander off. And when you're done, you literally just pick up the bag and toss them. The other option, and that's great, especially if you're like, I don't want to touch the maggots. Like you're not really ever coming in direct contact with individual maggots, but they're much less efficient that way because they're not going to be able to wander all the way to the edges. You have to make sure, you know, so it's just a little less efficient.

So the other way is taking individual maggots and usually putting them in like a gauze or something, but just not a closed system, putting them onto the wound, and then enclosing the edges of that wound. So making sure that they can't just escape from and go wherever and wander off. And then you leave them on for a couple of. couple of days in both cases. Usually 48 to 72 hours, maybe a little more depending on the area and things like that. And then you take them off and you see what it looks like. And if you need another round or a few other rounds, you may or you may not. And that's it. What happens to the

maggots after they're full? Their lives have been sacrificed. Yeah, they're done. Okay. Thank you for giving your lives in service of wound healing. of wound healing. Yeah. And I should also mention that the maggots used for medicinal therapy are, like, grown in a lab, they're sterilized. They're like, this is a very rigorous. It is an FDA regulated process in the U.S., and in most of their countries it's regulated by some capacity. How does maggot therapy use very globally?

Oh, great question. I don't know. And I don't think that we have a good sense of it, in all honesty, from what I read. It's not like I just failed to look for it. It's just that we don't really have a great sense. of like it is a great option. It's not, it's not accessible everywhere necessarily. It's probably used in some places in different ways. So yeah, we don't have a good sense of like numbers globally. Okay. So one of the things that I came across in the history of maggots and their use for medicinal

purposes was that they began to realize pretty quickly in the 20th century after, after centuries and millennia of using maggots, they were really. like, oh, we need to have an entomologist on hand who can distinguish between the different types of flies because not all flies create the type of maggots that will just eat necrotic tissue. Correct. Yes. So that is very true. So the types of maggots used for wound care are a couple of very specific species. Maggots in wound care is not the same thing. thing as maggots infesting open wounds or parasitizing healthy flesh. So the technical name for that process is myiasis, which is being parasitized by fly larva, either by healthy flesh or open wounds.

And that can be a very serious health problem, both for animals and for humans. And that is, could be from a few different reasons. It could be the right kind of of like blow flies, but too many of them, because once they start replicating, right, like they grow into adults and then they lay more eggs and then that infection can get out of control pretty quickly. Or it could be that it's the wrong type. There's so literally hundreds of thousands of species of flies, many of which love to eat flesh.

That's what they do. And so in those cases, it is very dangerous to have a maggot that's infesting a wound. This is in a medical setting, very different. Okay. We also use blowflies for forensics. Just throwing it out there. So, Aaron. Yeah.

I know that historically this is not all that maggots were used for, so please, can you tell me about how we got to this point? Can't wait. Let's just take a quick break and then I'll get into it. Ancient Remedies are one of the staples of our podcast. I love it so much. We bring these up all the time, right? Like, I think rabies featured a lot of these. And when we talk about these, when we bring up these examples, I think it's pretty easy to think, oh, my gosh, how absurd can you believe people ever thought that the ashes of a shrews tail applied to the bite of a rabid dog would do anything.

We are so guilty of that, too. Totally. Totally. Because from our perspective in the 21st century, we know that rabies is caused by a virus. and that there's no effective treatment. And we feel smugly superior to those foolish ideas of the past. But, and this is something that I think that we've gained more of an appreciation for over the course of making this podcast,

that attitude, that superior attitude ignores two crucial things. The first one being that, yes, many ancient remedies show little to no efficacy in what they were intended to treat. But many others do. and have just been rebranded as modern medical advancements, like digitalis or aspirin even, without their long history and early use acknowledged. And the second thing that is ignored is that we're in the same boat with medicine today. We may have better methods of testing efficacy and safety,

but it's really arrogant to think that we're at the pinnacle of medical knowledge, and that our ideas and cures today won't face similar ridicule in the future. And so this is my call, maybe especially for myself, but broadly too, to like eat some humble pie and consider what these cures have to offer us today, whether that's an insight into the past or novel and effective treatments for today. Let's start with maggots. I love it. There is this unavoidable yuck factor.

that we've talked about when it comes to maggots, and it's for a good reason. The places that we're likely to encounter maggots are things like decomposing carcasses, rotting food, things that can make us sick if we get too close. And maggots, along with the stench of rot, provide a pretty good signal to stay away. Peace out. Yep. But these delightfully disgusting habitat preferences of flies and their larvae have been harnessed by humans for millennia. As you talked about Aaron, the larvae of some fly species are amazing at discerning healthy from dead tissue and just taking care of business, TCOB, by eating that dead tissue.

And it turns out that larval therapy or biosurgery, as I saw it, rebranded biotherapy. Okay. Uh-huh, uh-huh. It has been used for a really long time around the world. There's evidence that the Nyampar people of New South Wales used larval therapy, as did certain ethnic groups in the hilly regions of Myanmar and Mayan healers in Central America. And I don't really think it's a huge stretch to imagine how people first came up with using larvae from flies to treat wounds. Like, you have a wound, it begins to fester.

The ripe flies lay eggs in that wound. Larva hatch, they begin feeding. on the disease tissue, your wound heals, the larvae leave, and hey, you know what, that worked better than expected. Right. I did not expect this, but hey, love it. But it worked out. It worked out.

Try it again. Uh-huh, uh-huh. We know that maggots have infested wounds since ancient times because it's what they do. But if you want written proof, I've got some in the form of some Old Testament goodness. So this is from the book of Job. my body is clothed with worms and scabs. My skin is broken and festering, end quote. That's my aiasis, right? It's not. Yeah, my aiasis, sounds like it. Yeah. Sounds like not the good worms. Not the good worms. Yeah. My body is clothed with worms. It sounds really painful and miserable. Yeah. But in terms of ancient medical texts

mentioning larval therapy, I didn't really come across any specifically. Interesting. And the first written mentions of using maggots to treat wounds comes from the 1500s. And again, we know that it goes much further back across the globe. And so this is sort of like what I would say, the first documented rediscovery of the practice or like reclaiming as like, oh, wow, I came up with this great idea. Ambois Parre, the famous French surgeon who I've definitely mentioned on the podcast before, I have. I have, Erin. I just don't know what. I believe you. So he used maggots in treating wounds in the mid-1500s, especially on the battlefield. It seems like he came across it accidentally, kind of like in the first-hand account.

One of his patients had a really deep head wound where months later, months later, Aaron, a, quote, large number of maggots emerged from the wound. And Paray thought it could be the end for that patient because he, had seen other times where maggots had just destroyed tissue. But apparently these were more discriminating maggots, eating only dead tissue, and the person recovered. He lost a chunk of bone, the size of a hand, but he recovered. Wow. Yeah, I don't know how, but he did. And so after this, Paray would occasionally use maggot therapy. Then fast forward a little over 200 years, and another French surgeon on another battlefield, this time Napoleon's army in Syria,

would also recognize the benefits of maggots. Baron Dominique Jean Larray wrote about maggots of the quote-unquote bluefly, removing dead tissue and helping to clean wounds. Quote, they are produced in a few hours and increase with such rapidity that in the course of a night they grow to the size of the barrel of a small quill. Although these insects were troublesome, they expedited the healing of the wounds by shortening the work of nature and causing the sluffs to fall off, end quote. I love that. Wow. And then about 60 years after that, in the 1860s, yet another war, this time the American Civil War, would provide yet another opportunity for someone to test out maggot therapy.

Maryland surgeon John Forney Zacharias wrote, quote, During my service in the hospital at Danville, Virginia, I first used maggots to remove the decayed tissue in hospital gangrene and with eminent satisfaction. In a single day, they would clean a wound much better than any agents we had at our command. I used them afterwards at various places. I am sure I saved many lives by their use, escaped septicemia, and had run. rapid recoveries, end quote. Wow. I mean, ringing endorsement. 100%. And there was another Civil War doctor who also saw the benefits of maggots,

but by and large, any pro-maggot physician was absolutely in the minority during this time. And that minority would shrink to basically non-existent once germ theory came about. because this concept made it very clear that wounds got infected from dirt or things that were dirty, and people definitely saw maggots as dirty and had for years, forever. Maggots fell out of style from the mid-1800s until yet another war. Are you seeing a pattern here? Always. Always a war. World War I.

And that's where our first-hand account, of course, came from. That surgeon, William Bear was so impressed with. those little friends that he went on to use them in non-war conditions. But I just have to also add one little thing about the firsthand account. So he pointed out that compound fractures of the femur at that time of that first-hand account, which one of those people had, led to death in about 75 to 80 percent of cases, even with all of the care that could be provided. And that person lived. Wow. So again, like pretty convinced. saying, I would be convinced. I am convinced. And this is a quote from him once he began to use these

maggots in non-war times. Quote, in September 1928, there were four cases of children that came into the hospital, each one of whom had been operated upon three or four times and treatment had covered a period of from one to five years. Being baffled in their cure by the means usually employed, I thought it was time to put into active use the observation, with a capital O, I might add, that I had made on the battlefield. We, therefore, obtained the maggots from the blowfly from our immediate neighborhood. And without sterilization of the fly or maggot, we loaded the wound up with these maggots and proceeded to watch the results. At the end of about six weeks, the wounds had entirely healed, not only in the deeper structures, but even as to, the skin, end quote. Wow. Wow. Six weeks. Yeah. Yeah. That's incredible. It's incredible. And also just

to put this in context, too, this is pre-antibiotics still. So even in 1928, like, penicillin was not going to be widely available for another. I think this is only when it was first beginning to be discovered. Wow. And then it was only in the 40s that it was available. So anyway, clearly bear was on to something. Something. But his methods needed some refining. I don't know if the phrase... Just go in your backyard and collect blowfly larvae?

No thing. Exactly. Without sterilization. I don't know if that stuck out to you, but yeah, that was a problem. So one issue, though, that he had was that the blowflies he used were seasonal. And so he couldn't just go to his backyard or his neighborhood and get them all during the year. these treatments he could only do in certain times of year. And secondly, was the lack of sterilization.

Unfortunately, some of these maggots came with hitchhikers in the form of Clostridium perfringens and Clostridium tetany. Oh, no. Yeah. He added, quote, this was a rather disconcerting observation. Yeah. Yeah. That's a little bit of an understatement.

Certainly. certainly, fortunately he was able to get antitoxin, tetanus antitoxin, into his patients and most who were infected survived. But he saw, he was like, okay, we need to find a way to raise

these maggots in a sterile environment if we're going to keep doing this. And that would also eliminate the problem of the flies not being available year round because he could just have this breeding ground for maggots. And so he listed, the help of some entomologists, and they came to a solution. And that really helped maggot therapy to become quite popular in the U.S. in the 1930s and 40s, with more than 300 hospitals in the U.S.

introducing a maggot therapy program, which is kind of amazing. Like, I just had no idea that it was so popular. Even then, you know? Yeah. But then they fell back out of style. It's like this waxing and waning, like extreme peaks in popularity. I mean, I feel like it makes sense, though, in that like there's always going to be that yuck factor, like you said. And it's also like as new, it's probably correlates with like new therapies. Like, oh, well, we have this new dressing or we have this new debreeder or whatever it is. So then it's like, we don't need maggots anymore. So they fall out of favor and things like that. Yeah. So the new medical development or technology in the 1940s was of course antibiotics and you know and and there is something like would you rather take antibiotics and have

antiseptics and go through wound debreedment try that first and then go to maggots or would you rather just like let's that's hit with maggots straight up right right now yeah yeah some of the descriptions are like you can hear them depending on where the wound is like you can hear them feeding that's incredibly itchy and there's like yeah this this net bandage that like keeps them all in but they're all there. That's all still the case. Yeah. So there are definitely downsides to it.

And it also can be quite painful as well. Oh, that makes sense. Okay. Yeah. Once they get like closer to the living tissue. And I think too just like because they're using their mouth hooks to kind of help break things up, I think that process, it's usually not painful right away, but like after and at first like 24 hours or so, it can be.

Okay. So yeah. Okay. Downsides, pros, cons, you know. It's a mixed bag, as most things in life are, tradeoffs, right? But yeah, so once the 1940s came about and antibiotics were available, larval therapy fell out a favor. It still was used here and there, but largely was forgotten.

I found a paper by a researcher named Milton Wainwright that was published in 1988, where he writes quote, fortunately, maggot therapy is now relegated to a historical backwater of interest more for its bizarre nature than its effect on the course of medical science, end quote. But he spoke too soon. Yeah, didn't age well. It did not age well. Because as this paper was going to press with the first line stating, quote, The Conquest of Bacterial Infection has been one of the major triumphs of the major triumphs

of modern medicine, end quote. Oh, dear. Yeah, as this paper was published, antibiotic resistance was on the rise, had been on the rise for a long time. And some physicians and surgeons were resorting back to the old ways to treat those stubborn infected wounds that just didn't seem to be able to heal. In the 1990s, maggot therapy, rebranded in some cases as biotherapy, experienced yet another renaissance, this time backed by clinical trials and data that supported

what amazing healing properties these little guys have. And I feel like there's just like this good lesson in maggot therapy. It reminds me a kind of like fecal transplants or a phage therapy. It's like sometimes a solution is already there, but we need to challenge ourselves to think more outside the box. I don't know. But that's what I've got for maggots. I love it, Erin. I love it so much. I do too. So should we do sources? We should. Okay. Let me pull up. I have a lot. I'm going to shout out two in particular. One is by Whitaker at all from 2007 titled Larval Therapy from Antiquity to the

present day, mechanisms of action, clinical applications, and future potential. And then there's a paper from 2000 by Sherman Hall and Thomas titled medicinal maggots an ancient remedy for some contemporary afflictions. Excellent. I had shockingly, like essentially one, which has never happened to me. But it really was so comprehensive. And that was the volume edited by Stadler from 2022 titled A Complete Guide to Maggot Therapy, Clinical Practice, Therapeutic Principles, Production, Distribution, and Ethics, literally such a fun read. Had a couple of other papers. We'll post the list of all of the sources from this episode

and every single one of our episodes on our website, this podcast will kill you.com under the episodes tab. We certainly will. A big thank you to Bloodmobile for providing the music for this episode and all of our episodes. Thank you to Tom Brifogel and Leanna Squalachi for the incredible audio mixing. Thank you too exactly right.

And thank you so much to you, listeners. we hope that you had as much fun as we did this week and get ready because next week is going to be awesome. Oh my gosh, it is. And honestly, like, if you stuck with it the whole way, props. Yeah. And also, I hope that you gained a new appreciation for maggots. Right? They're kind of cool. They're awesome. They're very cool. And a big thank you, of course, to our lovely, generous, wonderful patrons. Your support means the world to us. Thank you. Thank you, thank you, thank you. Well, until next time, wash your hands.

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