Larval therapy

This is not a subject for the squeamish, but the term is currently appearing on news pages as well as in research publications. With larval therapy larvae or maggots of the bluebottle or greenbottle are introduced to wounds to clean them and encourage healing.

There’s nothing new about either the idea or the name. Experience on battlefields in the American Civil War and the First World War showed that wounds healed quicker among casualties who had been left untreated long enough to be infected by maggots hatched from fly eggs. The maggots of these flies remove dead tissue and secrete chemicals that inhibit bacteria, but don’t eat living flesh, so giving healthy tissue the chance to regrow. The technique was used during the 1930s and 1940s to treat burns, abscesses, leg ulcers and gangrene. It went out of fashion when antibiotics came in after World War Two, though I’ve read it is still taught to army surgeons in some countries.

It’s coming back into use, not least because it can successfully treat wounds infected with bacteria resistant to antibiotics. It has been reported this month that a team at Manchester University has found maggots can heal foot ulcers infected with the superbug MRSA (methicillin-resistant Staphylococcus aureus). The team has been awarded a grant to carry out a controlled trial.

Early doctors called it maggot therapy, employing a medieval word that might be a variation on the old Germanic maddock or mathe, now known only in dialect, or which the Oxford English Dictionary thinks might have been influenced by Magot or Maggot, pet-names of Margery or Margaret. But there’s nothing in the least affectionate about maggot itself and doctors came to realise that calling it maggot therapy was a public-relations no-no. In the early 1930s larval therapy began to appear instead, based on a rather more recent and specific scientific term that had been borrowed from Latin larva, a ghost, spectre, or hobgoblin, which figuratively took a grub to be a ghost of the final adult form of an insect. However, larval therapy was not so much better that it entirely extinguished shudders from fastidious potential patients or their physicians.

Around a decade ago, biosurgery became popular as a euphemistic alternative. But this has become much more common in surgery to mean a wide variety of techniques based on biologically active or biologically compatible materials (biomaterials or biotherapeutics). So the unambiguous term larval therapy continues in use, as does maggot therapy. It’s also sometimes called maggot debridement therapy, in which debridement is the cleansing of a wound, a nineteenth-century borrowing from French, literally meaning unbridling, though the link with saddlery is obscure.