Letter Re: Maggots for Wound Debridement

Has anyone, including you, ever posted information on your site regarding the application of maggots for treating/cleaning infected wounds and dead tissue? This topic ties in well with the subject of survival in worst case scenario situations. Thank You. – JD

JWR Replies: I actually had that posted as one of my “Best of Readers Letters” and Replies. But so that it can be found via our search window or via search engines that employ Technorati tags, here it is again. (Scroll down to paragraph 22-3):



22-1. GENERAL.
a. This chapter covers a number of primitive treatments using materials that are found worldwide. It does not cover herbal medicines because specific herbs (plants) are difficult to identify and some are found only in specific areas of the world. This does not mean, however that they should not be used. To get information concerning types and uses of herbal medicines in a particular area, talk to the natives. But remember, it is preventive medicine (PM) that must be stressed. Proper hygiene, care in preparation of food and drink, waste disposal, insect and rodent control, and a good immunization program can greatly reduce the causes and number of diseases.
b. All of us—patients and doctors alike—-depend upon wonder drugs, fine laboratories, and modern equipment. We have lost sight of the “country Doctor” type of medicine—determination, common sense, and a few primitive treatments that can be lifesaving. Many areas of the world still depend on the practices of the local witch doctor or healer. And many herbs (plants) and treatments that they use are as effective as the most modern medicine available. Herbal medicine has been practiced worldwide since before recorded history, and many modern medications come from refined herbs. for example pectin can be obtained from the rinds (white stringy part) of citrus fruits and from apple pomace (the pulp left after the juice has been pressed out). if either is mixed with ground chalk, the result will be a primitive form of Kaopectate.
c. Although many herbal medicines and exotic treatments are effective, use them with extreme caution and only when faced with limited or non-existent medical supplies. Some are dangerous and, instead of treating the disease or injury, may cause further damage or even death.
22-2 Primitive treatments.
a. Diarrhea is a common, debilitating ailment that can be caused by almost anything. Most cases can be avoided by following good preventative medicine (PM) practices. Treatment in many cases is fluids only for 24 hours. If that does not work and no anti-diarrheal medication is available, grind chalk, charcoal, or dried bones into a powder. Mix one handful of powder with treated water and administer every 2 hours until diarrhea has slowed or stopped. adding equal parts of apple pomace or citrus rinds to this mixture makes it more effective. Tannic acid, which is found in tea , can also help control diarrhea. Prepare a strong solution of tea, if available, and administer 1 cup every 2 hours until diarrhea has slowed or stopped. The inner bark of hardwood trees also contains tannic acid. Boil the inner bark for 2 hours or more to release the tannic acid. The resultant black brew has a vile taste and smell but will stop most cases of diarrhea.
b. Worms and intestinal parasites. Infestations can usually be avoided by maintaining strict preventive medicine measures. For example, never go barefooted. The following home remedies appear to work or at least control the degree of infestation, but they are not without danger. Most work on the principle of changing the environment of the gastrointestinal tract.
(1) Salt water. Four tablespoons of salt in 1 quart of water. This should be taken on a one time basis only.
(2) Tobacco. Eat 1 to 1 1/2 cigarettes. The nicotine in the cigarette kills or stuns the worms long enough for them to be passed. If the infestation is severe, the treatment can be repeated in 24 to 48 hours, BUT NO SOONER
(3) Kerosene. Drink 2 tablespoons. Don’t drink more. The treatment can be repeated in 24 to 48 hours but no sooner.
(4) Hot peppers. Put peppers in soups, rice, meat dishes or eat them raw. This treatment is not effective unless peppers are made a steady part of the diet.
c. Sore throats are common and usually can be taken care of by gargling with salt water. If the tongue is coated, scrape it off with a tooth brush, a clean stick, or even a clean fingernail; then gargle with warm salt water.
d. Skin infections.
(1) Fungal infections. Keep the area clean and dry, and expose to sunlight as much as possible.
(2) Heat rash. Keep the area clean, dry, and cool. If powder is available, use it on affected area.
(3) The rule of thumb for all skin diseases is: “if it is wet, dry it, and if it is dry, wet it.”
e. Burns. Soak dressings or clean rags that have been boiled for 10 minutes in tannic acid (tea or inner bark of hardwood trees), cool and apply over the burns. this relieves the pain somewhat, seems to help speed healing, and offers some protection against infection.
f. Leeches and Ticks. Apply a lit cigarette or a flaming match to the back of the leach or tick, and it will drop off. Covering it with moistened tobacco, grease or oil will also make it drop off. Do not try to pull it off; part of the head may remain attached to the skin and cause an infection.
g. Bee, wasp, and hornet stings. Inspect the wound carefully and remove stinger if present. Apply baking soda, cold compress, mud or coconut meat to the area. Spider, scorpion, and centipede bites can be treated the same way.
h. Chiggers. Nail polish applied over the red spots will cut off the chigger’s air supply and kill it. any variation of this, e.g., tree sap, will work.

a. Introducing maggots into a wound can be hazardous because the wound must be exposed to flies. Flies, because of their filthy habits, are likely to introduce bacteria into the wound, causing additional complications. Maggots will also invade live healthy tissue when the dead tissue is gone or not readily available. Maggot invasion of healthy tissue causes extreme pain and hemorrhage, possibly enough to be fatal.
b. Despite the hazards involved , maggot therapy should be considered a viable alternative when, in the absence of antibiotics, a wound becomes severely infected, does not heal, and ordinary debridement is impossible.
(1) All bandages should be removed so that the wound is exposed to circulating flies. Flies are attracted to foul or fetid odors coming from the infected wound; they will not deposit eggs on fresh clean wounds.
(2) In order to limit further contamination of the wound by disease organisms carried by the flies, those flies attracted to the wound should not be permitted to light directly on the wound surface. Instead, their activity should be restricted to the intact skin surface along the edge of the wound. Live maggots deposited here and/or maggots hatching from eggs deposited here will find their way into the wound with less additional contamination than if the flies were allowed free access to the wound.
(3) One exposure to the flies is usually all that is necessary to ensure more than enough maggots for thorough debridement of a wound. Therefore, after the flies have deposited eggs the wound should be covered with a bandage.
(4) The bandage should be removed daily to check for maggots. If no maggots are observed in the wound within 2 days after exposure to the flies, the bandage should be removed and the wound should be re-exposed. if the wound is found to be teeming with maggots when the bandage is removed as many as possible should be removed using forceps or some other sterilized instrument or by flushing with sterile water. Only 50 – 100 maggots should remain in the wound.
(5) Once the maggots have become established in the wound, it should be covered with a bandage again, but the maggot activity should be monitored closely each day. A frothy fluid produced by the maggots will make it difficult to see them. This fluid should be “sponged out” of the wound with an absorbent cloth so that all of the maggots in the wound can be seen. Care should be taken not to remove the maggots with the fluid.
(6) The period of time necessary for maggot debridement of a wound depends on a number of factors, including the depth and extent of the wound, the part of the body affected, the number of maggots present in the wound, and the fly species involved. In a survival situation an individual will be able to control only one of these factors– the number, and sometimes not even that; therefore the exact time to remove the maggots cannot be given in specific numbers of hours or days. However it can be said with certainty that the maggots should be removed immediately once they have removed all the dead tissue and before they have become established in healthy tissue. When the maggots begin feeding on normal healthy tissue, the individual will experience an increased level of pain at the site of the wound as the maggots come in contact with “live” nerves. Bright red blood in the wound also indicates that the maggots have reached healthy tissue.
(7) The maggots should be removed by flushing the wound repeatedly with sterile water. When all the maggots have been removed, the wound should be bandaged. To ensure that the wound is free of maggots, check it every four hours or more often for several days. Any remaining maggots should be removed with sterilized forceps or by flushing with sterile water.
(8) Once all of the maggots have been removed, bandage the wound and treat it as any other wound. It should heal normally provided there are no further complications.
The treatments discussed in this chapter are by no means all of the primitive treatments or home remedies available for use. Most people have their own home remedy for various problems. Some work, some don’t. The ones presented here have been used and do work, although some can be dangerous. The lack of modern medicine does not rule out medical treatment. Common sense, determination to succeed, and advice from the natives in the area on primitive treatments can provide a solution to a medical problem. Just keep one thing in mind: “First I shall do no harm.”