Doctor’s Orders: Leeches and maggots and your health

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“How can old wounds heal while maggots linger so richly?” — Kazuo Ishiguro, “The Buried Giant” (2015)

“Leeches should be kept a day before applying them. They should be squeezed to make them eject the contents of their stomachs.” — Avicenna (d. 1037)

Leeches and maggots are often the subject of campy horror and sci-fi movies. For example, “Attack of the Giant Leeches” scarred audiences in the 1950s, and for some reason was re-made in 2008. Many classic vampire and monster movies inevitably had squirmy white wormy maggots in a coffin. Yuck!

But these creatures also have a vital part to play in the armamentarium of modern medicine.

I first learned about the value of maggots and their use in the care of diabetic wounds at a conference. A primary care physician from Appalachia told me how a patient arrived at the primary care physician’s office with her foot wrapped in gauze. When the nursing staff removed the gauze, they noted the wound was teaming with maggots! The foot was placed in a bath of warm water, which killed the maggots. However, the wound itself was clean. The maggots had debrided away only the dead, non-viable tissue.

In the early 1930s, Dr. William S. Baer wrote an influential paper describing his experiences using the larvae (commonly known as maggots) of the common blow fly in the treatment of osteomyelitis. Like many discoveries in the history of medicine and surgery, war played a role in finding a new therapy. Baer noted that several soldiers in World War I who had maggot-infested wounds did much better than those who did not. And, until the widespread availability of antibiotics, maggot therapy was used in many hospitals with great success.

Maggot therapy is still used today by some specially trained wound specialists. Dr. Aletha Tippett is an Ohio-based physician who uses sterile maggots to treat diabetic-related and other wounds and ulcers. She applies the maggots to the wound and then covers the area. After a day or two, the maggots are removed and the wound examined. I have seen some of the before and after maggot therapy photos. Wow!

Leeches also have a long and venerable association with the history of medicine. Leech therapy was part of the tradition of “bleeding” a patient to restore humoral balance. Some practitioners used leeches and some used knives. (In England, physicians were once known as “leeches.”)

Barbers also “bled” people (the red and white pole that is in the front of many a barber shop represents the drying bloody bandages removed from patients). In fact, the great American patriot, physician and abolitionist, Benjamin Rush, was noted to be an aggressive practitioner of “bleeding” patients.

Modern contemporary medicine has found a use for the slithery creature. The use of leeches in plastic surgery is FDA-approved and is used to control hematomas or postoperative bruising.

Dr. Marco Ellis is a professor and plastic surgeon at Northwestern Hospital who occasionally uses leeches in certain types of cases. (Sterile medicinal leeches are acquired from a special lab, not the local bait shop.) He places the leech on the post-surgical area. After a few hours the leech becomes satiated and it is removed and placed in sterile alcohol. The alcohol kills the leech. (They are not re-usable.) If need be, another leech is applied to the affected area.

Leeches also produce certain enzymes and blood thinners that aid in this valuable healing process.

So while we can rightfully marvel at the spectacular discoveries of modern medicine, we should also remember that some “ low tech” therapies may continue to help us treat diseases as well.

Dr. Alan Jackson is a cardiologist and clinical assistant professor of medicine at the University of Illinois Chicago. He also is a member of the Sun-Times board of directors.

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