It’s 1985, and Harvard plastic surgeon Joseph Upton has a problem. The hospital emergency room has sent him a five-year-old boy whose ear has been torn off by a dog. For an experienced surgeon, reattaching a severed ear is a straightforward matter. But the reattached ear will have none of it. It immediately blackens because blood cannot escape it.
The renaissance in leeching was off and running – uh, sucking.[i] Leech bites, we now know, not only release an anti-coagulant to prevent clotting, but also a vasodilator. And to make good matters still better, their chemical broth contains a “spreading factor” that liquifies hardening blood away from the site of reattachment. In this manner, leech secretions establish an “artificial circulation” that keeps a reattached appendage alive while the patient grows new veins. This is good.[ii]
A succession of leech-assisted reattachments followed, and in 2004 the FDA approved leeches as a “medical device.” Earlier that year, it paid similar homage to the leech’s brother-in- arms, the maggot.
Ah, the maggot, larva of the blow fly. It was not a matter only of their secretions, but of their appetites. By a quirk (or gift) of nature, they were ravenous for human tissue – but only dead or diseased tissue, not healthy tissue. Maggot therapy goes back to antiquity, with such notable early exponents as Ambrose Paré and Dominique Jean Larrey, Napoleon’s chief surgeon. During Napoleon’s Egyptian campaign of 1799, he took pains to reassure frightened wounded soldiers that the swarms of Syria’s blue flies on their wounds, far from being harmful, “shortened the work of Nature” in getting them back on their feet. During the American Civil War, a group of Confederate medical officers tended gangrenous wounds at a Chattanooga prison absent medical supplies, such as bandages and wrappings; they watched in amazement as maggot-infested uncovered Confederate wounds cleared up quickly. [iii]
But it was William Baer, a Johns Hopkins surgeon, who brought it into the modern age.[iv] In 1917, as a consulting surgeon to the American Expeditionary Force in France, Baer was brought two wounded soldiers left on the battlefield for a week prior to arrival at a military hospital. And behold! To Baer’s amazement, their wounds were not festering with bacteria. Indeed, they were free of any infection or purulence. In Baer’s own words, the wounds had the “most beautiful pink granulation tissue that one can imagine.”[v] And more amazing still, the wounds were swarming with maggots.
After the war, Baer returned to his civilian duties at Johns Hopkins, where, at the suggestion of his mentor, Harvey Cushing, and approved by William Halsted, he founded and directed Hopkins’ orthopedic service. Beginning in the 1920s, with his wartime experience still fresh, he began treating osteomyelitis (chronic bone infection) with maggot therapy at Baltimore Children’s Hospital.[vi] His experiments were extremely encouraging, though several of his young patients developed tetanus and two eventually died. But the problem was readily solvable: it was a matter of using sterilized fly larvae. Henceforth, there was no more tetanus, and persistent infections routinely healed in no more than six weeks.[vii] Maggot therapy, relying on sterilized larvae, was off and running – uh, ingesting.
Maggots at work. Note the healthy tissue around the periphery of the wound.
In the 1940s, maggots took an extended leave, replaced on the frontline of infection management by the sulfa drugs and then penicillin. In cases of drug- resistant infections, however, they were called up and, without fanfare or publicity, did what was asked of them. In 1976, they briefly reclaimed the spotlight, when maggots were used to clear up the mastoiditis of a 67-year-old man at the University of Texas Health Science Center.[viii] The resurgence of maggot therapy in recent years encompasses a variety of wounds, including pressure ulcers, diabetic foot ulcers, venous ulcers, necrotizing fasciitis, crush injuries, and burn wounds.[ix] Aided by dozens of laboratories worldwide, often getting medicinal maggots to those who need them via overnight courier services, maggots are once again on the frontlines, attacking and neutralizing major life-threatening infections.
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What do MAGA supporters know of America – its values, its guiding ideals, the political and moral imperatives transposed to paper in Philadelphia in 1787 by the Founding Fathers? What do they know of American history and its fitful and tragically incomplete journey to liberty and justice for all? And what do they know of the role of immigrants in that journey, of what they brought to these shores and contributed to the perduring experiment in representative democracy?
And what do they know of the “greatness” that can be imputed to nation-states? Is it simply a matter of sending away immigrants, refugees, and victims of persecution seeking safe haven? What prototypes of greatness do they have in mind? Ancient Egypt? Imperial Rome? Napoleonic France? Bismarckian Germany? Nazi Germany? Fascist Italy? Stalinist Russia?
Since MAGAs seek to make America great “again,” which periods of American history capture the greatness they seek to restore? And what is it about these historical interludes – these oases of greatness – that made them great? Does American greatness refer back to the enforced insularity of the early 20th century, when successive immigration acts of 1917, 1921, and 1924, all suffused with racist disdain for immigrants outside the zone of West European whiteness, kept racial and ethnic undesirables off these shores? Or do they yearn for the greatness of Depression-era America, free from the governmental tyrannies that came with the New Deal and post-war emergence of the modern welfare state?
Beyond turning immigrants and refugees away, sending illegals back home, and shearing away layers of social welfare legislation – Social Security, Medicare, Medicaid, Obamacare – what exactly do they have in mind? Perhaps they hearken back to life in the antebellum South, or perhaps to the Jim Crow era that took shape in the 1880s, when racial separatism was codified in race laws so unyielding that they provided an inspiring precedent for the Nazi lawyers who formulated the Nuremberg Laws of 1935 . Perhaps these laws could be rejuvenated to protect MAGA Americans from ethnic contamination by the dog-eating Haitians who have taken over Springfield.
No, I’ll take a nation of MAGGOTs any day of the week. Give me a segmented worm that liquifies and ingests dead and decaying tissue, all the while releasing chemicals that kill bacteria and promote the growth of healthy tissue — give me such an insect larva and I’ll give you a facilitator of greatness in the host organism – or nation. Let us opt for an America guided by a commitment to the promotion of health of whatever diseased organism it happens upon. The maggot cares not about species membership, only that the object of ingestion is diseased and dead tissue, life-threatening to the living organism.
Here is a tag that puts MAGA to shame: Give me a presidential candidate whose supporters rally around the MAGGOT credo: Make America’s Great Goodness Overcome Tyrants – and tyrants in all their deceptive guises and delusionally pretty packaging. Between now and the Presidential election of November 5th, let us become MAGGOT AMERICA. Did you get your cap?
[i] Iain Whitaker, et al., “The Efficacy of Medicinal Leeches in Plastic and Reconstructive Surgery: A Systematic Review of 277 Reported Clinical Cases,” Microsurgery, March 2012. This review of 67 publications reports on 277 cases of leech use between 1966 and 2009. It found an overall reported “success” rate following leech therapy of 77.98%, i.e., in 216 or 277 reports.
[ii] John Colapinto,“Bloodsuckers: How the Leech Made a Comeback,” New Yorker, June 25, 2005, 72-81.
[iii] Joel Grossman, “Flies as Medical Allies,” published in World and I, October 1994, Military and Government Collection.
[iv] M. M. Manring & J. H. Calhoun, “Biographical Sketch: William H. Baer,” Clinical Orthop. Relat. Res., 460:917-919, 2011, and R. E. Lenhard, William Stevenson Baer. Baltimore: Schneidereith, 1973, 26pp.
[v] W. S. Baer, “The Treatment of Chronic Osteomyelitis with the Maggot (Larva of the Blowfly),” J. Bone Joint Surg. Am., 13:438-475, 1931.
[vii] Grossman, “Flies as Medical Allies,” op. cit.
[viii] Wainwright, Miracle Cure, p. 112.
[ix] Ronald A. Sherman, “Maggot Therapy Takes Us Back to the Future of Wound Care: New and Improved Maggot Therapy for the 21st Century,” J. Diabetes Sci. Technol., 3:336-344, 2009.
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