9/13/2004

St. Louis Post-Dispatch

By Lyrysa Smith

They make even the most stalwart among us squirm and say, "Ewwwwww."

Many doctors, however, are greeting leeches and maggots with open arms. They call them "medical saviors."

In fact, while you've been busy slapping mosquitoes and checking for ticks, leeches and maggots have gained accredited status. Right along with sutures and pacemakers, leeches and maggots are now officially approved medical devices -- the first live animals to earn the distinction. The FDA sanctioned leeches in July; maggots were certified in January.

"They don't have glamorous reputations, but patients who've been treated with them proclaim their virtues, as do doctors, who credit them with healing tissue and restoring health," says Ronald Stram, a physician with the Center for Integrative Health and Healing in Delmar, N.Y.

We may not be used to thinking of slimy, wriggling creatures as health heroes, but leeches and maggots have been used medicinally for hundreds of years.

Blood-sucking leeches are distant cousins to earthworms and live in fresh water. First used by the ancient Egyptians, leeches were in constant use by the 19th century for a variety of maladies because they were believed to remove "bad blood."

The practice of bloodletting became excessive, however, and fell into disrepute when doctors realized that patients often fared worse. Some historians say bloodletting may have contributed to George Washington's death from a throat infection.

Better Blood Flow

In the second half of the 20th century, leeches' reputation began anew as doctors found new ways to tap their powers. Now leeches are placed on failing skin grafts and reattached tissue to improve blood flow to the transplanted skin in plastic and reconstructive surgeries.

Albany, N.Y., plastic surgeon Josh King first used leeches during his residency in the early 1990s. Today, the plastic surgeon uses leeches a few times a year.

"In surgical procedures, veins, which carry blood to the heart, are more difficult to reattach than arteries, which carry blood from the heart," King says. "If there isn't adequate outflow, the area pools with blood, which will kill the tissue."

Often, surgery can't fix the problem, but leeches can -- their blood-sucking restores circulation in blocked veins and assists in the healing of the reattached tissue or a body part such as a finger, toe, leg or ear. Doctors apply leeches' mouths to the wound and let them clamp on to the tissue and suck. Once they're engorged, they fall off in about an hour's time, says King.

A leech's saliva is also useful, because it contains substances that act as anticoagulants and painkillers. "So even after the leech drops off, it's still helping blood to flow," says King.

Although a typical treatment requires three to five days and about 50 leeches, King has never had a patient reject the use of leeches, even on eyelids and lips, "although not every nurse is up for the job," he says.

The "Gross" Factor

If it's possible to have a higher "gross" rating than leeches, maggots have it. They're smaller and operate in groups, writhing over rotting tissue.

But maggots have great benefit as "miniature surgeons," says Stram. "They can get into small places and clean out a wound extremely well."

Stram did some of his training in a New York City hospital, where indigent people would come in with maggots already in wounds. Often, they would heal better than patients with similar wounds who didn't have the maggots.

Likewise, early military surgeons noted similar results with soldiers who already had maggots in their wounds.

Maggot therapy was successfully performed by thousands of physicians until the mid-1940s, when its use was supplanted by the new antibiotics and surgical techniques that were developed during World War II, says Ronald Sherman, an infectious-disease physician in Irvine, Calif., who conducted research on maggot therapy.

These days, people with burns, pressure ulcers or deep wounds sometimes get infections, even after being treated with antibiotics, and the wounds don't heal.

"Maggots, as medicinal devices, have three actions that save the day," says Sherman. "They clean wounds by dissolving the dead infected tissue, they disinfect the wound by killing bacteria and they stimulate healing."

Sherman, who has an entomology degree, began using maggots in 1990 to treat patients as part of a clinical study. Word of the study's success spread; suddenly, Sherman had people lining up for treatments.

Soon, he was supplying maggots to hundreds of hospitals requesting them nationwide, including the Washington Hospital Center in Washington. Officials there called Sherman on Sept. 11, 2001, asking for maggots to treat victims' burns and other injuries from the terrorist attack on the Pentagon.

"No planes were flying," Sherman recalls. "But I got a call from FEMA, and they arranged it. I drove the maggots to the LA airport on Sept. 12, they flew to Pennsylvania on a special flight and they got a police escort from Pennsylvania into D.C. as emergency medical supplies."

What's the next animal to go to work for modern medicine? The honeybee.

Even though bees have been approved by the FDA only for allergy desensitization purposes, researchers expect more certification in the near future.

Honeybee venom reduces inflammation and provides pain relief to people with arthritis, multiple sclerosis, rheumatism, asthma, psoriasis, epilepsy, depression and some types of cancer, says the American Apitherapy Society.