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The Classic: The Treatment of Chronic Osteomyelitis With the Maggot (Larva of the Blow Fly)

  • Symposium: Periprosthetic Joint Infection
  • The Classic
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Clinical Orthopaedics and Related Research®

Abstract

This Classic article is a reprint of the original work by William S. Baer, MD, The Treatment of Chronic Osteomyelitis With the Maggot (Larva of the Blow Fly). An accompanying biographical sketch on William Baer, is available at DOI 10.1007/s11999-010-1415-4. The Classic Article is ©1931 by the Journal of Bone and Joint Surgery, Inc. and is reprinted with permission from Baer WS. The treatment of chronic osteomyelitis with the maggot (larva of the blow fly). J Bone Joint Surg Am. 1931;13:438–475.

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Notes

  1. D. J. Larrey, the famous military surgeon of Napoleon’s armies, observes as follows in his Memoirs of Military Surgery (Translation by R. W. Hall, I, 177, 1814): “During the progress of suppuration, the patients were only troubled by worms or larvae of the blue flies common in Syria. The hatching of the eggs, which these flies constantly deposit in the wounds or dressings, was assisted by the heat of the weather and by the quality of the dressings, which were of cotton, which alone could be procured in this country. The presence of these insects in the wounds, appeared to accelerate their suppuration; but they caused a disagreeable pruritis, and obliged us to dress them three or four times a day. They are produced in a few hours, and increase with such rapidity, that in the course of a night they grow to the size of the barrel of a small quill. It is necessary, at each dressing, to use lotions of a strong decoction of rue with a small portion of sage, which destroys them; but they were soon reproduced for want of proper means to prevent the approach of the flies and to destroy their eggs. Although these insects were troublesome, they expedited the healing of the wounds by shortening the work of nature, and causing the sloughs to fall off.”

    Larrey again mentions maggots, commenting as follows:—“In spite of the importunities of these insects they have accelerated the cicatrization of the wounds by abbreviating the work of nature and in provoking the destruction of scar tissue, which they destroy”.

    J. G. Millingen in his Curiosities of Medical Experience, American Edition, 1838, p. 171, says,—“During the retreat of our troops after the battle of Talavera (1809) I found the wounds of many of our men, that had not been dressed for three or four days, pullulating with maggots. This was not the case with the Spanish soldiers, who, to prevent this annoyance (which was more terrific than dangerous) had poured olive oil upon their dressings. I invariably resorted to the same practice when I subsequently had to remove the wounded in hot weather.”

    W. W. Keen says, “During the Civil War maggots were very common in summer— the resulting maggots were certainly disgusting but so far as I ever observed they did no harm.”

    Most interesting of all is a quotation from J. F. Zacharias of Cumberland, Md. who, as a surgeon in the Confederate Army, wrote as follows of his Civil War experiences:— “During my Service in the hospital at Danville, Virginia, I first used maggots to remove the decayed tissue in hospital gangrene and with eminent satisfaction. In a single day they would clean a wound much better than any agents we had at our command. I used them afterwards at various places. I am sure I saved many lives by their use, escaped septicaemia, and had rapid recoveries.”

    Similar clinical observations were made by others in the World War, but no further investigation of the phenomenon was attempted by any one during the ten years following.

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Authors and Affiliations

  1. Baltimore, MD, USA

    William S. Baer MD

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  1. William S. Baer MD
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Correspondence to William S. Baer MD.

Additional information

Read by Dr. Baer at the Annual Meeting of the American Orthopaedic Association, Chatham, Massachusetts, June 21, 1930. The final arrangement of this paper for publication has been completed since the death of Dr. Baer by his associate, Dr. George E. Bennett.

Richard A. Brand MD (✉) Clinical Orthopaedics and Related Research, 1600 Spruce Street, Philadelphia, PA 19103, USA e-mail: dick.brand@clinorthop.org

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Baer, W.S. The Classic: The Treatment of Chronic Osteomyelitis With the Maggot (Larva of the Blow Fly). Clin Orthop Relat Res 469, 920–944 (2011). https://doi.org/10.1007/s11999-010-1416-3

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  • DOI: https://doi.org/10.1007/s11999-010-1416-3

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