In the U.S., some 6.7 million people have chronic wounds that—for one reason or another—refuse to heal for months, even years. On its own, a chronic wound can seriously diminish a person’s quality of life and eventually, if left untreated, lead to loss of a limb. In 2009, after years of improvement, rates of lower-limb amputations on diabetic adults in the U.S. (one of the country’s most preventable surgeries) began to slip in the wrong direction, growing 50 percent by 2015, with Black, low-income, or underinsured patients most likely to undergo amputation. Data suggest that, by a conservative estimate, Medicare spends an estimated $28.1 billion annually on wounds. These are “very dramatic” figures, says Steven Kravitz, the president of the Academy of Physicians in Wound Healing, “and they’re not getting better.”
In some ways, this is an old problem—festering wounds are one of the most archaic threats to human life—and maggots are an old solution. Maya healers dressed lesions with cattle-blood-soaked bandages to attract flies and make wounds squirm with maggots; legend has it that Genghis Khan traveled with a wagon of larvae for wounded soldiers. Safe to say, today’s patients and doctors are more comfortable with the aseptic medical practices developed over the past century. “Our expectation is that medicine can do everything,” says David S. Jones, an epidemiologist and a historian of medicine at Harvard. “We have earned our worm-free existence.”
But with rates of chronic conditions, diabetic ulcers, and hospital superbugs rising, troublesome wounds are a very current threat, pressing clinicians and patients to reconsider the role of maggots. With new approaches to harnessing their powers and new strategies for mitigating their yuck factor, maggots might shed their reputation as an erstwhile cure and take their place in the future of medicine.
At any given moment, trillions of maggots, or fly larvae, are wriggling across North America. A fly mother can smell decomposition from up to 10 miles away and arrive within minutes to lay her offspring. (In some species, she will bury herself six feet underground to get to a dead body.) Scientists have witnessed adult and juvenile flies penetrate seemingly sealed barriers—including coffins and suitcase zippers—with ease. One can find maggots at lake bottoms, in camel nostrils and petroleum pits, on toadstool mushrooms and spider abdomens, and of course, in virtually every burial ground most everywhere in the world, according to the London Natural History Museum senior curator Erica McAlister, who also wrote The Inside Out of Flies.
During this stage of a fly’s life (in many species, its longest), the larva is driven by a two-pronged mission to eat as much as possible and avoid being eaten. “To this end,” McAlister writes, “its body is nothing more than a basic eating machine, with no wings, no genitalia and no true legs.” In other words, maggots are hungry bags of goo traveling along streams of enzymatic saliva in search of decaying flesh.