Ancient Maggot and Leech Therapy Sees Revival to Fight Antibiotic Resistance
A sharp increase in global antibiotic resistance has caused scientists to search for viable alternatives. But while innovative ancient treatments using maggots, leeches and honey are being resurrected, the “yuck factor” remains a problem.
History books record maggot therapy being applied to heal soldiers in the Napoleonic wars, the American Civil War and the First World War. However, the specific type of flies used to produce these medicinal maggots was lost in time. In the 1990’s, Ronald Sherman, a doctor pursuing an infectious diseases fellowship, travelled across southern California catching flies, aiming to test maggots as a potential treatment for cleaning wounds.
Sherman showed that the creepy crawlies did indeed consume infected tissue and as such they promoted wound healing, and he claimed it was faster than conventional dressings. Based on Sherman’s work, British doctor Steve Thomas, who works for the Welsh NHS Trust, formed a private company called BioMonde, who since 2004 have been supplying maggots to the NHS, keeping alive ancient traditions. But be careful what you read, for all is not what it seems.
This History of Maggot and Leech Therapy
The use of maggots and leeches as medical treatment has a long and storied history dating back to ancient times. The ancient Egyptian text known as the Ebers Papyrus records that leeches were used for a wide range of medical conditions, including headaches, skin diseases, and infections. According to ancient Greek physician Hippocrates, the ancient Greeks also used leeches for a variety of ailments, including fever, epilepsy, and hemorrhoids – try not to visualize the latter!
In the Middle Ages, leeches were commonly used for bloodletting, a popular medical treatment at the time that involved removing blood from a patient in the belief that it would cure a wide range of illnesses.
The use of maggots to treat wounds and infections also dates back to ancient times. The earliest recorded use of maggots in medicine comes from ancient Egypt, where they were used to treat abscesses. This cringe-worthy method of treatment became more widespread in the 18 th and 19 th centuries in Europe, where it was used to treat gangrene, osteomyelitis, and infected wounds.
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An undated French satirical cartoon—one of many of its kind—depicts a man urging a nurse to bleed a weary patient with leeches. Source: Wellcome Collection / Public Domain.
The Medical Benefits of Creepy Crawlies
An article in The Guardian explains that due to growing antibiotic resistance between 2007 and 2019 “the number of NHS patients treated with maggots increased by 47%.” Furthermore, leeches, which can thin blood and improve blood circulation, and honey, with its powerful antibacterial properties, have also made a comeback since the rising global antibiotic resistance.
Until now, the associated “yuck factor” prevented nurses from practising maggot therapy, but clinicians are now increasingly keen to avoid using antibiotic therapy. Fulfilling this increasing demand, BioMonde has a maggot-production factory in Wales which manages 24,000 flies, and they are the sole provider of medical maggots to the NHS. The maggots are shipped out in aseptic polyester nets called BioBags, and around 9,000 are sent out to the NHS every year.
Vicky Phillips, a clinical support manager at BioMonde, teaches medics about the benefits of maggot therapy, and she told The Guardian that “larvae will only eat dead tissue.” This is accurate according to Rosalyn Thomas, an acute foot podiatrist for Swansea Bay University Health Board who specialises in diabetic foot care who has been using maggots on her patients for 26 years. Not only are maggots the quickest way to clean up a wound, but they are a more cost-effective surgery and patients can often go home right after having a bag applied, according to Thomas.
Maggot debridement therapy on a wound on a diabetic foot. (CC by SA 3.0)
The ancient Egyptians used honey to treat wounds and, over the last two decades, the NHS has reluctantly applied honey dressings. However, in September 2022 a team of scientists at the University of Manchester argued that honey should be considered as “an alternative to antimicrobial drugs.” Postgraduate researcher, Joel Yupanqui Mieles, said that facing “rising global antibiotic resistance” the development of novel therapies as alternatives to combat infections has never been so important, and maggots, leeches and honey have major roles to play.
Goodnight Black Blood Suckers
Leech therapy, also known as “hirudotherapy,” enhances circulation and promotes the healing of wounds. Peters-Bond worked for BioPharm Leeches, who during the 1990s produced a small number of leeches per year, however, over the next two decades demand and production has spiked. Leech therapy can last between 10 minutes and an hour, and after the creatures are full of blood, they are disposed of in BioPharm's leech disposal kits, named Nos da (Welsh for "goodnight").
There are different opinions, however, on how it feels having leeches and maggots crawling around an open wound. The Guardian gives a ‘glowing’ report from Susan Barnard, a type 1 diabetic who underwent maggot therapy for a foot wound in 2016. Barnard said as the maggots consumed the flesh of her wound and grew in size, she began to feel “a sensation akin to the crawling feeling one experiences on their skin, minus the accompanying shivers.” However, not everyone is as satisfied with having a bag of maggots tied around a wound.
Illustration from French humorist Pierre Boaistuau’s collection of oddities, Histoires prodigieuses, which includes the story of a rotund king who tried to extract his fat with leeches. Boaistuau presented this manuscript to Queen Elizabeth I in 1560. (Wellcome Collection / CC by SA 4.0)
The Downsides to Ancient Cures
With all this said, Maggot therapy is not without potential complications, and the most common reported side effect to maggot therapy is pain at the application site. According to an article in Podiatry Today, some patients feel a “nipping” or “picking” sensation that can be so painful that oral analgesics are required. Furthermore, patients have reported “intense local itching, transient fever, foul odour from the exudate and excoriations along healthy skin if the larvae escape”. And in many cases patients request early termination of the treatment.
The most concerning complication for patients, however, was that the dressings would open and that the maggots might escape into their homes or workplaces, making sufferers very uncomfortable. So, while maggot producers are declaring all the benefits of ancient treatments, maggot therapy is complicated, and has not yet been scientifically proven as a superior treatment, and it clearly has an associated “yuck” factor. But despite the taboos, the revival of ancient remedies is taking off, and Sherman, who caught the flies three decades ago, is now asking what other lost remedies might be hidden in the historical archives.
By Ashley Cowie
Top image: Leech therapy. Source: Natalia Terenteva / Adobe Stock