Thursday, July 26, 2018


The Doctor's Bag

The blog about Medicine and Surgery in the Old West 

By Keith Souter aka CLAY MORE

The thought of a maggot-ridden wound makes most people cringe. Writers often pop such images into their tales for that very reason. The squirm factor can be effective in keeping the  reader reading. After all, a wound that has actual crawling maggots in it just seems so awful. It looks unclean and the reader may suppose that it is a bad sign.

The movies often have maggot-ridden scenes. Take Gladiator, for example. There is an early scene  with Maximus reaching to remove maggots from a gaping arm wound, only to be advised by his (soon to be) friend and fellow gladiator, Juba, to leave it alone. And indeed, the maggots clean the wound and it heals.

Aristotle's doctrine of spontaneous generation 
Maggots have had a bad press since antiquity. Aristotle proposed the theory of spontaneous generation, or abiogenesis. (a-bio, meaning 'without life', and genesis meaning 'origin of'). Essentially, it was a belief that living things grew from non-living matter. Maggots were seen to develop in rotting meat or in carcases. Similarly, the Egyptians had noted that frogs seemed to develop in the Nile mud after the annual inundation. 

Aristotle 384-322 BC

This theory survived for two thousand years until the Italian doctor and 'father of experimental biology,' Francesco Redi challenged the concept of abiogenesis. 

Francesco Redi (1626-1697)

He performed some rather elegant experiments on maggots and flies, which he published in 1688 as Esperienze Intorno alla Generazione degli Insetti (Experiments on the Generation of Insects). He concluded in this series of experiments  that flies laid eggs in decaying matter and that larvae (maggots) hatched from them and ultimately turned into adult flies. He did it using jars into which he put identical quantities of meat or fish. In one group the jars were covered with gauze, which let air in, but secluded entry to flies. The others were left open and exposed to flies. No maggots developed in the fly-excluded jars, but the others produced maggots, then a cocoon stage, from which adult flies emerged.

As you can see from the illustrations he used in his book he accurately described the life cycle of the fly, which undergoes a complete metamorphosis from egg to larva, to pupa, to imago or adult fly. 
Of course, Redi had to be careful about how he described this, because the church was so powerful and several men of science had paid dearly for declaring scientific theories that the church considered to be heresy. 

Biogenic generation
Accordingly, it was another two centuries before Louis Pasteur, a French scientist finally blew a hole in the theory of abiogenesis. 

Louis Pasteur (1822-1895)

To do this Pasteur prepared some  sterile nutrient broth and placed equal amounts in two flasks with swan shaped necks.  He broke the neck of one flask and left the other. The broth in the broken necked flask quickly became cloudy as micro-organisms grew in it. The other remained sterile, until he eventually broke the neck, when it also eventually became cloudy. The cloudiness was due to the presence of microorganisms. 

One of Pasteur's swan- neck flasks

The S shaped neck had prevented dust particles and microorganisms in the air from reaching the broth, until the neck was broken. 

Instead of the abiogenesis theory of spontaneous generation, we then had the theory of biogenic generation. 

Maggot-ridden wounds 
Although maggots have the association with decay, yet over the centuries it had been observed  that maggot-infested wounds  often did better than expected. 

The Mayans used to cover wounds in cloths soaked in animal blood and dried in the sun. When they started to pulsate, as maggots hatched and moved about, they believed that the wound would heal. Often it would. 

Aborigines in Australia used to actively put maggots into wounds to heal them. 

The french military surgeon, Ambroise Pare (1510-1590), one of the most notable surgeons of the Renaissance described the benefits he had seen in maggot-infested wounds. Similarly, the French surgeon, Baron Dominique-Jean Larry (1766-1842), observed that blue fly maggots seemed to remove necrotic or dead tissue from wounds and speeded up healing. 

During the Civil War maggot-ridden wounds were thought to be a bad sign of infection and soldiers were understandably distressed to see maggots in their wounds. Wars have always been times when medicine and surgery have been given opportunities to make advancements. This happened in a prison stockade in Chattanooga, where Confederate surgeons were not given supplies of bandages and dressings, or adequate amounts of chloroform (which was used to bathe wounds to clean them). Their  patients who had often developed gangrene were forced  to leave the wounds unbound and fly-infested, whereas Union surgeons de-maggoted their patients' wounds. Much to their astonishment  the maggot-ridden Confederate wounds cleared up far quicker and more effectively than the so-called cleaned and dressed wounds. Indeed, death rates were significantly lower in the Confederate patents. 

Dr William Williams Keen (1837-1932), observed that maggots certainly did not hamper recovery in many cases. He said that despite their revolting appearance, they were not detrimental to the healing process. After the war he studied in Paris and London and e would go on to become the first neurosurgeon in the USA.  

Dr William Williams Keen (1837-1932)

Doctors in the Great War also saw the surprising effects of maggot-ridden wounds. Dr William Stephenson Baer (1872-1931) was an American surgeon  serving with the American Expeditionary Force in France. In 1917 he treated two badly wounded  soldiers who had lain injured on the battlefield for seven days. Their wounds were totally maggot-ridden and at first he feared for their lives. Yet on examination and after clearing the maggots away, he found that the underlying tissues were clean, free of pus and that healing with granulation tissue was occurring. He said: " ...the wounds showed the most beautiful pink granulation tissue that one can imagine.” Both soldiers healed  swiftly and recovered completely.

Dr Baer went on to become the founding chairman of orthopaedics at John Hopkins University and a surgical innovator in both hip and spine surgery. He also followed up his work from the Great War and did research on thee use of maggot therapy (Maggot Debridement Therapy, or MDT) in the control of persistent wound and bone infection. In 1931 he wrote a paper, The Treatment of Chronic Osteomyelitis with the Maggot (Larva of the Blow Fly). It is considered one of the classic papers in surgery.

Maggot therapy
Not all maggot-ridden wounds will be clean, though. The problem is that the blow fly that lays the eggs is a vector, that means a carrier of disease. If it has contaminated mouthparts or feet, then it can cause the infection in a wound. If no infection is present, then the lava that hatch may indeed act as scavengers to eat up any necrotic tissue, kill organisms in the wound and absorb pus to allow healing to take place. 

Dr Baer actually grew larvae on a windowsill in the Baltimore Children's Hospital as he researched on the use of maggots in chronically infected wounds. Unfortunately two patients died from tetanus, which made him realise that the maggots had to be sterile. He managed to develop a technique of producing larvae in a sterile environment, after which the 1930s saw a huge rise in the use of maggot therapy. Lederle laboratories in New York  started to produce sterile maggots ands were able to supply hospitals.

Maggot therapy then fell into disuse when the sulpha drugs and then modern antibiotics were discovered and  became an essential part of modern medicine.  However, because of the developing worldwide problem with antibiotic resistance, chronic infections are again a problem and there has been a resurgence of interest and active research into the maggot and its abilities to clean wounds. 


If you are interested in reading more about medicine and surgery in the frontier days, including the work of Doctor George Goodfellow, then you may find The Doctor's bag useful. It is a collection of my blog posts, published by Sundown Press.

The novel about Dr George Goodfellow, the Tombstone surgeon to the gunfighters

The novel about Ned Buntline, the King of the Dime Novelists

Buy The Dime Novelist


  1. Fascinating. It does seem the past holds a key to the future. I'd read some on the use of maggots, but appreciate the more complete information.

    I'm one of those who is in the 'yuk' catagory when it comes to flies and maggots. Still, nature does have a way of balancing the scales. Thank you for a very useful post. Doris

    1. Thanks, Doris. I agree, the past holds a key to the future. Indeed, Sir Francis Bacon (1561-1626) wrote:

      “Medicine is a science which hath been (as we have said) more professed than laboured, and yet more laboured than advanced: the labour having been, in my judgment, rather in circle than in progression. “

      In my practice over the years I concur. New ideas become old ideas, then become new ideas again!

  2. Keith,
    I was passingly familiar with medicinal maggots, but your article added a wealth of information to my little bit of knowledge. Thank you for that.

    But I have to tell you that on a scale of 1-10 for an 'ewwwww factor', I topped out at least at 20 by the time I finished your article. *grin*

    Maggots as healers reminded me of my nephew who had an index finger cut off in a table saw accident. The surgeon reattached his finger, and the treatment was leeches to keep the reattachment from failing. The leech approach worked. While he doesn't have full-range bending capability, it was a successful reattachment.

    My ewwww factor for leeches is just about as high as with maggots. Getting past the ick, though, this type of healing is truly amazing.

    1. Thank you, Kaye. Leeches are fascinating and another example of the rediscovery of the old.

      Interestingly, in Anglo-Saxon times, a doctor was called a ‘leche,’ after the use of the leech. Also, early medical textbooks were called leche books or leech books.

  3. Keith, that is so interesting. I'm fascinated by this kind of medicine--how it was discovered, and how they "improved" the methods of it. It is kind of "ick"--but really, leeches have the 100% "ick" factor for me--even over the maggots. Great post, as always!

    1. Thanks, Cheryl.

      I didn't Want to stretch the ick factor any further by considering forensic entomology!

  4. Dr. Keith,

    Give me a sterile maggot any day. NOT!

    I read every word. Well, I am glad I am NOT a physician or a patient with a maggot filled wound.

    I did read about maggot therapy years ago. I recall doctors could not cure a horrible infection in a leg and as a LAST resort placed maggots. To the astonishment of the physicians (and the patient) the wound healed.

    Only Dr. Keith Souter could write this stuff and help us keep WESTERNS historically accurate!


    1. Thanks, Charlie. You are too kind.

      The research into this phenomenon is on-going. It isn't just that they eat dead tissue (leaving living tissue intact), but their secretions inhibit 'complement.' This is a natural chemical that is involved in the inflammatory response. Some complete is necessary for wound healing, but too much leads to chronic infection. This seems to be part of the reason that they are so effective.

  5. I had read about the use of maggots by British, Australian, and American prisoners of war held by the Japanese in WWII. Many POWs developed tropical ulsers and had other infected injuries. In Vietnam I had a Cambodian company and in a firefight two were slightly wounded--upper arm and hand. They were not all that bad off and instead of calling a MEDIVAC which would have told the bad guys where we were, I held off as we were getting extracted by helicopters the next day. Then a storm hit and we couldn't be extracted. The wounds became infected regardless of what I put on them and sure enough maggots appeared, which freaked out the Cambods. I had to convince them this was a good thing and they actually improved after a couple of days. Once we got them out the docs reported that they could have gotten a lot worse or even gangrene if I'd not left the maggots. Another thing I had read that the POWs did was to sit a man with infected wounds in a river and small fish would nibble away the dead flesh and infected tissue.

    1. Thanks for commenting, Gordo. That is great to have your first hand evidence in the real life situations.

      And yes, 'Doctor Fish,' are good at removing skin scales. They have been used in fish therapy for psoriasis. Gara Rufa, members of the Cyprinidae family ( which includes carp, I believe) have round, toothless mouths and they painlessly remove scales. I actually went to a demonstration with them and sat with my feet in a pool of them. It was a strange, tickling sensation they gave you.

  6. Another informative post, even if it's slightly "icky" - thanks again Keith!

    1. Thanks, J.E,S. I try to refrain from actual ick, hence no clinical photographs. I am conscious that a lot of readers might not get beyond the pictures. In this case I left it up to the reader’s imagination.

  7. Fascinating reading. I'd want to be unconscious before ever submitting to this kind of healing, though. Getting your book, The Doctor's Bag has been on my buy list ever since I first heard about it.

    1. Thank you, Elizabeth. I hope you find it of some interest and use.