Why are Maggots Considered "Yuckier" than Leeches?: Examining our Associations with Maggots and Leeches in Wound Care and Beyond

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by Ron Sherman MD, MSC, DTM&H

Two hundred years ago, Joseph Joubert wrote: “To teach is to learn twice.” For me, preparing for a lecture or workshop is like learning the latest information all over again. But giving the lecture and pondering over the students’ questions is like learning a third time. This is one of the reasons that I so enjoy teaching.

I recently presented the maggot therapy hands-on workshop at the Wild on Wounds (WOW) conference in Las Vegas (The BTER Foundation has produced the maggot therapy workshop for WOW for the past five years). For the first time, I was asked the question: Why are health care professionals more accepting of leech therapy than maggot therapy?

I had actually pondered this question several times over the past few years, but never gave it as much thought as I felt it deserved at that moment. Now I believe that our revelations are worthy even of this valuable blog space.

In my mind, three characteristics of maggots set them apart from leeches (or, at least give them a higher score on the “yuck-o-meter”): their place in medical history, our personal contact with them, and the cultural and scientific context in which we place them (the associations or mental connections).

The first difference between maggot therapy and leech therapy is the long and continuous employment of leeches – but not maggots – in medical practice. While we may joke that maggot therapy has developed over millions of years of evolution, the fact is that the intentional application of fly larvae to treat wounds is, at least in Western medicine, a practice less than 100 years old. On the other hand, leeching (hirudotherapy) has been practiced for thousands of years, and is well-documented in the ancient European, Eastern, and Middle-Eastern medical texts.

Additionally, very few people have actually seen a leech, except, perhaps, from images in books or film. But many, if not most people, have seen – and smelled – maggots in their garbage, or in dog poop, or on a patients’ wound . . . or somewhere else, equally disgusting and unexpected. The odor of these rotting things is enough, alone, to turn our stomachs; and that odor stains our mental image of the maggots more indelibly than it stains nasal neurons.

These two factors contribute to the mental connections that we form around maggots and leeches. On top of these intellectual and emotional associations, we must add the natural and cultural contexts in which we associate maggots with flies and filth, garbage and death . . . the very antithesis of everything society proclaims is healthy. Leeches may be “blood suckers”, but they elicit none of these repulsive sentiments. For many people, the first thought that comes to mind after hearing the word “leeches” is traditional medicine itself.

Altogether, these are the emotional associations which I believe help explain why we sometimes see more resistance to employing maggots in our hospitals and clinics, than there is towards employing leeches.

What do you think, and what has been your experience?

Joseph Joubert: The Notebooks of Joseph Joubert. Edited and Translated by Paul Auster. North Point Press, San Franscisco, 1983.
Robert and Michele Root-Bernstein: Honey Mud Maggots and Other Medical Marvels. Houghton Mifflin Company, New York, 1998.

About The Author
Ron Sherman MD, MSC, DTM&H has led a long career at the forefront of biotherapy, pioneering the development of medicinal maggots for over 25 years. He is now retired from his faculty position at the University of California, but continues to volunteer as Director and Board Chair of the BTER Foundation, and as Laboratory Director of Monarch Labs.

The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.

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I have to choose a topic to speak about for the Biochem class I am currently taking. Maggot therapy immediately jumped to mind. Dr. Sherman spoke to my medical anthropology class taught by Dr. Ron Loewe at Cal State Long Beach several years ago. He has remained an inspiration to me ever since. After receiving my anthropology degree I decided to take the long, strange path to medical school. I just can't wait to get into the good stuff, and now I'm finally starting to get there. It would mean the world to me if I could have the opportunity to intern or volunteer in the revolutionary work of maggot therapy. Dr. Sherman, could your efforts use a pre-med student in any capacity? I will be free starting the middle of December and would love nothing more than to spend my holidays with maggots!

I've attended your lecture and hands on experience at the Palliative Wound Conference, blogged about your content myself once, and then this week actually thought about your lecture when reading The Omnivore's Delimma, a great book about the food we eat that my daughter bought me as a holiday gift. This book points out that there are biological reasons that species are predisposed to avoid eating meat of their own kind. The chapter is about feed lots and meat processing and some of the things we've fed these cows in the past, and now don't by law, because of mad cow disease which occurs when cows digest parts of their own species. The author says that there is a similar disease that humans develop when they eat meat from their own species and so mentions a "natural" human aversion to things related to death and decomposition. I'm betting the maggot revulsion is one of those deeply seated safety mechanisms (no matter how one thinks they developed) and that it's normal to think human nurses, therapists and physicians will have to do some mental psych up when they are first exposed to your wonderful creatures! Leeches are slimy but not associated with decaying flesh...so just gross as you say, but not retching/running away gross, just gross! Have a great day and happy new year!

As the testimonials speaks about the MDT and its advantages which is having excellent results in chronic infected wounds.

Dr. Sherman should be facilitated in his research and service by bringing MDT possible and reachable for mankind again. Amidst human getting eaten away by high antibiotics in present scenario, MDT gives him/her a set aside treatment by giving him a natural remedy for healing.

we request your kind teachings here also in INDIA.

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