On removing the clothing from the wounded part, much was my surprise to see the wound filled with thousands and thousands of maggots. . . . The sight was very disgusting and measures were taken hurriedly to wash out these abominable looking creatures. Then the wounds were irrigated with normal salt solution and the most remarkable picture was presented. . . . these wounds were filled with the most beautiful pink granulation tissue that one could imagine.
That’s US Expeditionary Forces surgeon William Baer relating the story of how he came upon the unseemly idea of intentionally infesting wounds with maggots to help them heal. Filth fly larvae—blowfly maggots, most notably—prefer their meat dead or decaying. When the meat is part of an open wound, the act of eating performs upon the meal a kind of natural debridement. Debridement—the removal of dead or dying tissue—fights infection and facilitates healing. Because dead tissue has no blood supply and thus no immune defenses, it’s easily colonized by bacteria. This encourages infection of the healthy tissue and inflammation, which slows healing.
Baer was impressed that the soldiers had no fever or signs of gangrene. The mortality rate from the type of injuries the men had—compound fractures and large, open wounds—was about 75 percent with “the best of medical and surgical care that the Army and Navy could provide.” In 1928, a decade after the war had ended, Baer summoned his courage and experimented on civilians. His inaugural patients were children, four of them, all with recurrent bone infections from blood-borne tuberculosis, a condition that antiseptics and surgery sometimes failed to quell. Raymond Lenhard, the author of a biographical monograph on Baer, recalled hearing the great surgeon tell the story. Lenhard had been a student of Baer’s at Children’s Hospital School in Baltimore and, reluctantly, a dining companion. (“Often during lunch he would make us lose our appetites.”) Using the offspring of blowflies trapped near the hospital, Baer “loaded up” a wound and proceeded to watch the results. After six weeks, the wound had healed. As did the wounds of the other three children.
What sort of person experimentally infests a child with maggots? A confident sort, certainly. A maverick. Someone comfortable with the unpretty facts of biology. Someone who is perhaps himself an unpretty fact of biology. “The Chief was overweight, breathed audibly, and snorted in the fashion of a tic,” wrote Lenhard. Baer would sometimes go from operating room to lecture hall without changing, delivering his talks in baggy, bloodstained surgical trousers. He bred Chow Chows at his home, bringing yet more snorting and audible breathing to the Baer household.
Beneath the earthy exterior, Baer was an exacting and dedicated practitioner. He considered his “maggot treatment” far less abhorrent than the alternative: amputation. To Baer, the removal of a limb was “the ultimate in destruction,” wrote Lenhard, showing a flair for video game marketing eighty years premature.
So impressed was Baer by the work of his larval “friends” that he designed and built a thermostat-controlled wood and glass fly incubator at the hospital. Only thrice in an ensuing eighty-nine cases did the maggots fail and the patient succumb to infection. Fearing that the larvae may have introduced the offending bacteria, Baer devised a protocol for raising sterile specimens. Remnants of his technique live on today at Monarch Labs, in Irvine, California. Their Medical Maggots are also sterile, as required by the Food and Drug Administration (FDA), which in 2007 approved live blowfly larvae as a medical device.
While the majority of modern “maggot therapists” treat the hard-to-heal foot ulcers of diabetics, WRAIR’s George Peck has been seeking to take medicinal maggots back to their roots in the military. In 2010, he was funded for a study looking into the efficacy of blowfly larvae in treating chronically infected IED wounds. More recently, Peck received a grant to genetically modify blowfly maggots such that they produce antibiotics. Though maggots already prevent infection, these “supermaggots” could be tailored for specific bacterial infections.
Peck offered to hatch a “clutch” of maggots for me, taking care to time things such that when I arrive at his and his wife’s home for dinner, the larvae will be the size of Medical Maggots at the time they’re released in a wound (about two millimeters long). I don’t have any wounds. Just questions.
GEORGE PECK and his future wife, Vanessa, worked together in the basement insectary at WRAIR. An insectary is a facility for rearing insects—insects used, in this case, for testing vaccines and repellents against whatever has been lately plaguing troops. Vanessa cared for a colony of sand flies,? while George was down the hall with his filth flies. It’s a setting that might dampen the ardor of another pair, but Peck remains besotted. You hear it behind his words when he talks about her. Peck is a man easily taken by emotion. At Mi Rancho a few nights earlier, as we were getting ready to leave, the topic turned briefly away from flies. As I rose from my chair I heard Peck say, to no one specific, “I just love bees.” The word love breathy with feeling.
Peck abandoned a career in solar physics, because he felt it was taking him too far away from the natural world. He and Vanessa share their home with more of that world than most. They keep as pets a tarantula (Henrietta) and a small community of Madagascar hissing cockroaches. Like William Baer, Peck is a man some might find eccentric, but those who know him even slightly can see that it all comes down to a generous and open heart.
Vanessa clears the dinner plates while I finish my wine. The children are doing homework in the living room. George sets a glass dessert dish in front of me. Chocolate pudding, my brain offers optimistically, but it’s not that. It’s raw liver.
“These are about one day old.” Peck points out a cluster of maggots, maybe twenty or thirty, feeding side by side, packed in close. They’re easy to miss, because all that can be seen of them is their tail ends. Insects take in oxygen through openings in the exoskeleton called spiracles. In the larvae, these are, specifically, anal spiracles. On top of its other charms, the maggot breathes through its ass. It is a handy evolutionary adaptation if, as Peck puts it, “you spend your whole day with your head buried in slimy dead flesh.” Compared to lungs and a diaphragm, it’s an inefficient system, which is one reason the Insecta class never evolved to be as large as Mammalia. Having several minutes ago viewed a fly under George Peck’s home microscope, I assure you that’s a good thing.