In 1917, at the height of the Great War, William Baer made a chance, startling discovery. The result was his exploration of a novel form of treatment, one that - while somewhat grim to contemplate, is still used today. His experiences and early experiments are described in this paper, "The Treatment of Chronic Osteomyelitis with the Maggot (Larva of the Blow Fly)" [1].

Baer's inspiration came from his experiences dealing with the casualties of the Great War, and one case in particular.

"At a certain battle during 1917, two soldiers with compound fractures of the femur and large flesh wounds of the abdomen and scrotum were brought into the hospital. These men had been wounded during an engagement and in such a part of the country, hidden by brush, that when the wounded of that battle were picked up they were overlooked. For seven days they lay on the battlefield without water, without food, and exposed to the weather and all the insects which were about that region. On their arrival at the hospital ... their condition was remarkably good, and if it had not been for their starvation and thirst, we would have said they were in excellent condition."

This was pretty staggering, given the seriousness of their injuries. Even with the best available medical care, "at that time the mortality of compound fractures of the femur was about seventy-five to eighty per cent." But this wasn't the only surprise for Dr. Baer.

"On removing the clothing from t.he wounded part, much was my surprise to see the wound filled with thousands and thousands of maggots, apparently those of the blow fly. These maggots simply swarmed and filled the entire wounded area. The sight was very disgusting and measures were taken hurriedly to wash out these abominable looking creatures."

It must have been a hellish vision. The maggots were quickly removed from their meaty home, and the wounds were cleaned and irrigated with salt water, but then came the next surprise...

"...the most remarkable picture was presented in the character of the wound which was exposed. Instead of having a wound filled with pus, as one would have expected, due to the degeneration of devitalized tissue and to the presence of the numerous types of bacteria, these wounds were filled with the most. beautiful pink granulation tissue that one could imagine. There was practically no bare bone to be seen and the internal structure of the wounded bone, as well as the surrounding parts, was entirely covered with the pink, rosy granulation tissue which filled the wound. Bacterial cultures were made and, while one found a few staphylococci and streptococci still remaining, they were very few in number and not sufficient at that time to cause a pus formation."

The wounds were completely clean, not just superficially, but to the extent that even germs had failed to take a hold. Dead flesh had been excised, and the tissues were healing beautifully. Wounds that should have been fatal were being healed, apparently by these maggots. The case had such an impact on Baer, that ten years later, the war over, he decided to try and put these observations to use in civil surgery.

Much of the remainder of the paper is taken up with detailed descriptions of case studies, including numerous photos of treatments. I won't describe them all here, but it's an interesting read if, like me, you curiously fascinated by problems like "how does one sterilize a fly egg?" At any rate, the result of the work was that Baer was able to reach the following conclusions.

"1. Maggots have been found to be a tremendously useful adjunct to thorough surgical treatment of chronic osteomyelitis, and, in our opinion, are far more successful in securing permanent healing of these extensive wounds than any other method tried by us."

"2. Maggots, by their digestive action, clear away the minute fragments of bone and tissue sloughs caused by operative trauma in a way not accomplished by any other means. This is a tremendously valuable asset in the healing of a wound."

"3. Maggots cause wounds to become alkaline and in this way diminish growth of pathogenic bacteria.

"4. Maggots seem to have other more subtle biochemical effects within the wound itself and perhaps cause also a constitutional reaction inimical to bacterial growth. This is under investigation.

"5. Maggots as raised and sterilized in the manner described may be used in any wound without risk to the patient."

"6. The post-traumatic or postoperative general condition of the patient is better in maggot treatment than in the older forms of treatment where infection was combatted by chemicals or other types of dressing. There is less absorption and less toxic reaction."

"7. In open tuberculous abscesses, with or without secondary infection, wide exposure followed by maggot treatment has proved surprisingly effective in a small number of cases and will be given further trial."

Today, nearly 80 years later, his findings have been borne out, as you can see in the video below. It was a brilliant piece of work that in my opinion sums up many of the best things about science, from the remarkable ways in which nature often beats our own solutions, to the sort of mentality it takes to be the first doctor that decides "I know, I'll treat my patients with maggots."

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[1] Baer, W.S. (1931). The Treatment of Chronic Osteomyelitis with the Maggot (Larva of the Blow Fly). Journal of Bone and Joint Surgery, 13, 438-475.