Australian Scientists Explore The Medical Marvels Of Ancient Maggot Therapy

Australian Scientists Explore The Medical Marvels Of Ancient Maggot Therapy

The ‘next’ button is probably the best option for those readers of a prudish or squeamish nature, as this is a news story telling of advancements in the ancient medical arts of ‘Maggot therapy’ and why this somewhat cringeworthy treatment is making a comeback in modern therapeutic applications in Australia.

Dr Frank Stadler of Griffith University recently received international recognition for his Maggot therapy project which “studied the use of maggots for therapeutic medicinal purposes in war zones and other compromised health care settings.” In September this year Dr Stadler's research project was recommended for a $250,000 funding grant by Humanitarian Grand Challenge Canada and according to an article on ABC.NET he said,

“Maggots are fantastic… They remove dead tissue… Sterilize wounds… Eat all the dead and decaying tissue in the wound.”

The use of maggots in medical treatments was developed independently around the world over the last 1000 years by several ancient cultures, for example: the Hill people of Northern Myanmar (Burma) and the Mayan healers of Central America, and, the aboriginal Ngemba tribe of New South Wales in Australia. A paper published on the US National Library of Medicine written by a team of researchers led by Dr Iain S Whitaker, Department of Burns and Plastic Surgery, Morriston Hospital, Swansea, UK, states:

“Larval association with infected wounds has been reported since ancient times, with the Old Testament being the oldest written piece to cite the infestation of an infected wound of a man by fly larvae (myiasis).”

Maggot debridement therapy on a wound on a diabetic foot. ( CC BY-SA 3.0 )

In Australia, the maggot medicines of ancient indigenous communities were brought back to life during the First and Second World Wars. “They remove bacteria by eating them and digesting them, and through their excretions and secretions that they place into the wound… So they have anti-microbial properties… This controls the infection sufficiently for the body to heal the wound” Dr Stadler told reporters. He added that it was for these reasons "In recent times, since World War I, maggot therapy has been used in the modern clinical settings.”

The Ancient Healing Skills Of Medical Maggots

The maggots can be applied directly on wounds, for a maximum of two to four days, with a net dressing like a ‘fly screen’ to keep the maggots on the affected area, or they can be “sealed into a tea bag-like pouch and placed on the wound, which means they can be applied gently and non-offensively,” according to Dr Stadler. “This works because maggots don't have chewing mouthparts, they first liquefy the dead tissue with excretions and then suck their food up,” he added. When the dead maggot dressing is removed new maggots can then be reapplied if necessary.

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Unlike caterpillars, maggots don’t have a chewing mouth. ( Ezume Images /Adobe Stock)

The research team believe their work could not only “make a real contribution to life and limb-saving wound care in conflict” but that the “value of the humble maggot would increase as antibiotic resistance increases in the community.” As humans evolve we are developing a resistance to antibiotics and according to Dr Stadler, while “Penicillin is losing its potency,” Maggot therapy has proven to be “efficient in antibiotic resistant infections like staph infections.”

Does this mean if you get hacked playing football and cut your shin, you can now walk into your Dr’s surgery with a bag of maggots as ask them to apply them in a treatment? Well, yes, it actually does, but you might expect your doctor to show some resistance at first. However, Dr Stadler told reporters that:

“In many cases today when people present to hospital with maggot-infested wounds, the health care professionals have to admit that the wounds look perfect, they look fine.”

The maggots used in Dr Stadler’s clinical trials are were specially sterilized, “We harvest maggots from the wild. Then we establish a colony, a fly colony, then the fly colony is maintained, eggs are harvested in a sterile way so the larvae emerging from the eggs are sterile when they are placed onto wounds that require treatment,” he said. However, currently in Australia, Westmead Hospital in Sydney is the only approved provider of sterilized medical maggots and it is servicing patients with extreme medical cases seeking to enhance mainstream treatments.

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Maggots in medical packaging. ( CC BY-SA 4.0 )

Maggot Therapy Offers Hope To Diabetics

Medical treatments with indigenous origins often involve the application and sometimes the digestion of crushed up insects, beetles, animals and birds and applying such medicines is simply a ‘no no’ with a vast majority of the public. Maggot therapy, according to Dr Stadler “was perceived to be a last resort treatment in Australia… but it is ideally suited for early interventions.” Offering an example of where Maggot therapy might help at the primary stages of a treatment Dr Stadler said “When someone presents with a diabetic ulcer, maggot therapy is fantastic in treating that ulcer and setting the wound up for healing.”

Peter Lazzarini, a principal research fellow at QUT and co-chair of Diabetic Foot Australia, told reporters at ABC.AU that “a handful of small studies have tested maggot therapy on diabetic foot ulcer patients with mixed results.” He added, “The rationale for using larval therapy is promising, but we need larger studies to prove if it is as effective, or more effective, than other forms of debridement yet.”


Gross medicine: hundreds of years ago, maggots and leeches were "medicine cabinet" staples. Now, old is new again: ready to try them? (Life science: circulatory system).

A dazed young man recently stumbled into Pensacola, Florida's Baptist Hospital, bleeding profusely from a gaping facial wound. "He'd lost a chunk off his nose," says plastic surgeon Dr. Ian Rogers. "It was dangling from this little flap of flesh." Rogers performed delicate microsurgery to suture (stitch together) the patient's delicate nerves, blood vessels, and skin tissue--reattaching the nose tip.

The operation seemed a success, until the nose grew swollen and turned purple as a grape. The problem: Blood flowed into the reattached flesh through vessels called arteries, but the veins didn't transport blood away from the area fast enough. The condition, known as venous congestion, often occurs after reconstructive surgery, because damaged veins are thin-walled and difficult to repair. To clear out the congested blood, "I decided we needed to put a leech on his nose," says Rogers.

Is he crazy. No way. When venous congestion strikes, a doctor must restore circulation quickly or else tissue dies. Enter leeches, a type of bloodsucking worm. "We always keep about a half-dozen of the little guys on hand in a refrigerator," says Rogers. "If all else fails, we call in the worms."

It may turn your stomach, but up-to-date doctors across the nation are taking a new look at the healing power of "folk" remedies like leeches and maggots (caterpillar-like fly larvae). These creepy crawlies were standard medical fare for centuries, until scientific advances supplanted them: In the late 19th century the sepsis theory held that keeping wounds and instruments free from germs promotes healing. Twentieth-century breakthroughs--like antibiotics, or germ-killing medicines--all but banished folk cures from modern hospitals.

Now, "almost by chance we're relearning that nature's medicines--often called `gross'--are sometimes the best," says Michele Root-Bernstein, author of Honey, Mud, Maggots and Other Medical Marvels.

Today, as in the past, doctors use maggots to eat dead tissue and clean out infected wounds. In nature, some fly species lay eggs in dead animals (carcasses). When the eggs hatch into wormlike larvae, called maggots, they secrete chemical enzymes that break down large molecules into smaller, digestible ones.

Scientists don't yet understand how these enzymes work, but the substances dissolve rotting flesh into a liquid that maggots slurp up like soup. "The maggots are satiated [full] after 48 hours," says maggot-therapy expert Dr. Ronald Sherman at the University of California in Irvine. When full, the maggots instinctively squirm away from the carcass and bury themselves in the ground to pupate, or become a pupa. A pupa is the inactive stage in the metamorphosis, or transformation, of many insects it follows the larval stage and precedes the adult stage. During the pupal stage, larvae transform into adult flies inside protective cocoons.

During the Civil War and World War I, flies were naturally drawn to battlefield hospitals and sometimes laid eggs in the rotting flesh of soldiers' wounds. Amazed military physicians observed that wounds infested with maggots tended to heal better than noninfested wounds. Maggot therapy was born.

Today, physicians at 280 U.S. medical centers prescribe maggots to treat infected pressure ulcers (bed sores), burns, leg and foot ulcers, stab wounds, and post-surgical wounds that refuse to heal. "Maggots work faster than any nonsurgical method for wound healing and aren't as likely to injure healthy tissue," says Sherman, who raises medicinal maggots in an "insectary."

There, blowflies (Phaenicia sericata) "blow" up to 2,000 eggs at a time onto slabs of raw liver. Technicians wash eggs in disinfectant and place them in a sterile (microbe-free) container, so that larvae hatch in an environment without bacteria. In nature, blowfly larvae hatch in rotting animal flesh full of bacteria. But only maggots fed on sterilized meat in a lab are clean enough for medical use.

When a patient has, say, a large leg wound that doesn't heal despite surgery and months--or years--of treatment with antibiotic oinments and cleansers, two options remain: amputation or maggot therapy. Which would you choose?

Treatment begins when a doctor places sterile fly larvae--no more than 8 per square centimeter--directly in the wound and covers it with a sheer nylon mesh "cage" to prevent maggots from worming away. The doctor then layers absorbent gauze atop the cage to keep larvae moist and absorb any liquified dead flesh. Maggots act in three key ways on a wound, Sherman says: "They debride [remove dead, infected tissue], disinfect, and stimulate healthy tissue growth."

About 48 hours after application, a doctor picks off the maggots with a moist gauze pad and discards them with other infectious medical waste, which is usually incinerated (burned). In a recent study, researchers found that the average maggot-treated leg or foot wound displays healthy tissue growth within three weeks (see chart, p. 9).

Does the notion of maggot therapy make patients' skin crawl? "I've never had anyone freak out--not even those who are initially grossed out by the idea," says plastic surgeon Dr. Jane Petro at Westchester County Medical Center in Valhalla, New York.

If the thought of writhing maggots on your body makes you cringe, how about bloodsucking leeches? For centuries, doctors applied leeches (Hirudo medicinalis) for bloodletting, or phlebotomy they mistakenly thought blood loss healed the body by letting impurities and excess fluid escape.

Today, when it comes to restoring blood circulation after reconstructive surgery, "leeches are very effective," says Dr. Donald Mackay of Pennsylvania State University College of Medicine. Why? One slug-like worm can gorge on up to five times its own body weight in blood! The medicinal leech, one of 650 leech species, is a 10 centimeter (4 inch)-long carnivorous (flesh and blood-eating) worm, found naturally in European bogs and ponds. A leech has a sucker on each end the smaller one features hundreds of teeth (see diagram, left). Surprisingly, a leech bite doesn't hurt. That's because the worm's saliva contains a natural anesthetic, or painkiller.

Leech saliva also contains hirudin, a substance that keeps blood from clotting. During a 30-minute feed, a leech can draw off 30 milliliters of blood--about 5 or 6 thimbles full. The leech then drops off to digest its meal. But, says Ian Rogers, "thanks to hirudin, the bite keeps bleeding and promoting circulation for 12 to 15 hours." Leeches also produce a vasodilator, or substance that opens blood vessels. "Leeches are like a mini-drugstore," says Anna Baldwin at the Biopharm Leech Center in Charleston, South Carolina.

What about patient squeamishness? When a reattached finger is swollen with blood due to venous congestion, the choice is simple, says Dr. Jeffrey Friedman, a plastic surgeon at Baylor College of Medicine in Houston: "We can cut your finger off again or use a leech." Adds Donald Mackay: "I've never had any patient refuse the treatment. One patient even gave the leeches names!"

HEALING WOUNDS: MAGGOTS VS ANTIBIOTICS

In a study of 103 patients, wounds treated with maggots healed and shrunk in size faster than antibiotic-treated wounds.

Necrotic (dead) tissue fills a patient's skin ulcers (left). The open sores didn't respond to IV (intravenous) antibiotics. Three months after maggot therapy (right), necrotic tissue is replaced by healthy new skin.

In nature, the medicinal leech lurks in European ponds, where it feeds on blood just once every 18 months.

LET IT FLOW: Scientists extract the drug orgelase from leech saliva. It widens blood vessels, increasing blood flow.

After reading the article, choose the correct answer to these questions:

BETTER THAN THE REAL THING?

Many doctors agree: Nothing beats a leech to promote blood flow in damaged tissue. But not every patient relishes the idea, says University of Wisconsin surgeon Dr. Gregory Hartig. That's why Hartig, along with Michael Conforti and Nadine Connor, invented a tiny bloodsucking gadget that mimics a squirming leech. "In the case of leech medicine, we can improve on nature," says Connor. Has the leech met its mechanical match?

In addition to its sleek, clinical design, the mechanical leech never gets full and falls off, so it can remove far more blood than the real thing. Here's how it works:

A A teflon-coated cone, or "sucker," is inserted beneath a patient's skin. Holes in the sucker cone release a cleansing solution.

B A tube delivers an anti-clothing drug into the wound

C A suction tube draws blood and solution to promote circulation.

D A glass vacuum chamber maintains suction.

Life Science: Circulatory System

* Researchers at the Essen-Mitte Clinic in Germany recently applied leeches to 10 patients who had knee pain due to osteoarthritis (degenerative joint disease). The treatment relieved pain and inflammation, but U.S. doctors say further study is needed before they'd advocate leech therapy for arthritis.

* Medicinal leeches, which cost about $7.50 each, can survive for months in a refrigerated jar of saline solution.

* Maggots excrete a chemical similar to ammonia that kills bacteria in a wound.

History: Have students research and report on other unusual medicinal beliefs and practices in the Middle Ages.

Critical Thinking: snake and bee venom, white clay, even honey have current medical uses. Choose one and research what doctors use it for.


Complementary and Alternative Healthcare: Is it Evidence-based?

Complementary and alternative healthcare and medical practices (CAM) is a group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine. The list of practices that are considered as CAM changes continually as CAM practices and therapies that are proven safe and effective become accepted as the “mainstream” healthcare practices. Today, CAM practices may be grouped within five major domains: alternative medical systems, mind-body interventions, biologically-based treatments, manipulative and body-based methods and energy therapies.

TCM is a system of healing that dates back to 200 B.C. in written form. China, Korea, Japan, India and Vietnam have all developed their own unique versions of traditional medicine. Alternative medicine is commonly categorized together with complementary medicine under the umbrella term 𠇌omplementary and alternative medicine”. Complementary medicine refers to therapies that complement traditional western (or allopathic) medicine and is used together with conventional medicine, and alternative medicine is used in place of conventional medicine. Alternative medicine refers to therapeutic approaches taken in place of traditional medicine and used to treat or ameliorate disease. Integrative medicine refers to combining complementary treatments with conventional care. The basic philosophy of complementary and alternative medicine include holistic care, which focuses on treating a human being as a whole person.

Examples of complementary and alternative medicine healing systems include Ayurveda, which originated in India more than 5,000 years ago, emphasizes a unique cure per individual circumstances. It incorporates treatments including yoga, meditation, massage, diet and herbs Homeopathy uses minute doses of a substance that causes symptoms to stimulate the body’s self-healing response. Naturopathy focuses on non-invasive treatments to help your body do its own healing. Ancient medicines (complementary and alternative medicine treatments) include Chinese, Asian, Pacific Islander, American Indian and Tibetan practices.

Conventional medicine relies on methods proved to be safe and effective with carefully designed trials and research. But, many complementary and alternative treatments lack solid research on which to base sound decisions. The dangers and possible benefits of many complementary and alternative treatments remain unproved.

While the whole medical systems differ in their philosophical approaches to the prevention and treatment of disease, they share a number of common elements. These systems are based on the belief that one’s body has the power to heal itself. Healing often involves marshalling multiple techniques that involve the mind, body and spirit. Treatment is often individualized and dependent on the presenting symptoms.

Basic principles of integrative medicine include a partnership between the patient and the practitioner in the healing process, the appropriate use of conventional and alternative methods to facilitate the body’s innate healing response, the consideration of all factors that influence health, wellness and disease, including mind, spirit and community as well as body, a philosophy that neither rejects conventional medicine nor accepts alternative medicine uncritically, recognition that good medicine should be based in good science, inquiry driven and open to new paradigms, the use of natural, less invasive interventions whenever possible, the broader concepts of promotion of health and the prevention of illness as well as the treatment of disease. Studies are underway to determine the safety and usefulness of many CAM practices. As research continues, many of the answers about whether these treatments are safe or effective will become clearer.

The use of alternative medicine appears to be increasing. A 1998 study showed that the use of alternative medicine in the USA had risen from 33.8% in 1990 to 42.1% in 1997 [1] . The most common CAM therapies used in the USA in 2002 were prayer (45.2%), herbalism (18.9%), breathing meditation (11.6%), meditation (7.6%), chiropractic medicine (7.5%), yoga (5.1%), body work (5.0%), diet-based therapy (3.5%), progressive relaxation (3.0%), mega-vitamin therapy (2.8%) and visualization (2.1%) [2, 3] . In the United Kingdom, limited data seem to support the idea that CAM use in the United Kingdom is high and is increasing.

Increasing numbers of medical colleges have started offering courses in alternative medicine. Accredited Naturopathic colleges and universities are increasing in number and popularity in the USA. They offer the most complete medical training in complimentary medicines that is available today [4, 5] . In Britain, no conventional medical schools offer courses that teach the clinical practice of alternative medicine. However, alternative medicine is taught in several unconventional schools as part of their curriculum. Teaching is based mostly on theory and understanding of alternative medicine, with emphasis on being able to communicate with alternative medicine specialists.

Naturopathy (naturopathic medicine) is a whole medical system that has its roots in Germany. It was developed further in the late 19th and early 20th centuries in the United States, where today it is part of CAM. Naturopathy aims to support the body’s ability to heal itself through the use of dietary and lifestyle changes together with CAM therapies such as herbs, massage and joint manipulation. Naturopathy is a whole medical system. It views disease as a manifestation of alterations in the processes by which the body naturally heals itself and emphasizes health restoration rather than disease treatment. Naturopathic physicians employ an array of healing practices, including diet and clinical nutrition, homeopathy, acupuncture, herbal medicine, hydrotherapy, spinal and soft-tissue manipulation, physical therapies involving electric currents, ultrasound and light therapy, therapeutic counseling and pharmacology. Today, naturopathy is practiced in a number of countries, including the United States, Canada, Great Britain, Australia and New Zealand.

The acupuncture is being practiced for relief or the prevention of pain and for various other health conditions. Preclinical studies have documented acupuncture’s effects, but they have not been able to fully explain how acupuncture works within the framework of the western system of medicine.

Ayurveda, which literally means “the science of life”, is a natural healing system developed in India. It is a comprehensive system of medicine that places equal emphasis on the body, mind and spirit, and strives to restore the innate harmony of the individual. Some of the primary Ayurvedic treatments include diet, exercise, meditation, herbs, massage, exposure to sunlight, and controlled breathing, Ayurvedic medications have the potential to be toxic. Most Ayurvedic medications consist of combinations of herbs and other medicines, so it can be challenging to know which ones are having an effect and why.

Other traditional medical systems have been developed by Native American, Aboriginal, African, Middle-Eastern, Tibetan, Central and South American cultures.

Homeopathy is a system of medical theory and practice. Its founder, German physician Samuel Christian Hahnemann (1755�), hypothesized that one can select therapies on the basis of how closely symptoms produced by a remedy match the symptoms of the patient’s disease. He called this the “principle of similars”. Since homeopathy is administered in minute or potentially non-existent material dosages, there is an a priori skepticism in the scientific community about its efficacy [6𠄹] .

Traditional oriental medicine emphasizes the proper balance or disturbances of qi (pronounced chi), or vital energy, in health and disease, respectively. Traditional oriental medicine consists of a group of techniques and methods, including acupuncture, herbal medicine, oriental massage and qi gong (a form of energy therapy described more fully below).

Naturopathy (naturopathic medicine) is a whole medical system that has its roots in Germany. It was affect bodily function and symptoms. Only a subset of mind-body interventions is considered CAM. Many that have a well-documented theoretical basis, for example, patient education and cognitive-behavioral approaches are now considered “mainstream”. On the other hand, meditation, certain uses of hypnosis, dance, music and art therapy and prayer and mental healing are categorized as complementary and alternative.

Biofeedback is a type of mind-body therapy. Using feedback from a variety of monitoring procedures and equipment, a biofeedback specialist will try to teach you to control certain involuntary body responses, such as: brain activity, blood pressure, muscle tension and heart rate. Biofeedback has been shown to be helpful in treating several medical conditions, including asthma, Raynaud’s disease, irritable bowel syndrome, incontinence, headaches, cardiac arrhythmias, high blood pressure, epilepsy, etc.

The term meditation refers to a variety of techniques or practices intended to focus or control attention. Most of them are rooted in Eastern religious or spiritual traditions. These techniques have been used by many different cultures throughout the world for thousands of years.

People have used prayer and other spiritual practices for their own and others’ health concerns for thousands of years. Scientific investigation of these practices has begun quite recently, however, to better understand whether they work if so, how and for what diseases/conditions and populations. Many Americans are using prayer and other spiritual practices. Prayer is the therapy most commonly used among all the CAM therapies.

Manipulative and body-based practices include methods that are based on manipulation and/or the movement of the body. For example, chiropractors focus on the relationship between structure (primarily the spine) and function, and how that relationship affects the preservation and restoration of health, using manipulative therapy as an integral treatment tool. Massage therapists manipulate the soft tissues of the body to normalize those tissues.

Energy therapies focus either on energy fields originating within the body (biofields) or those from other sources (electromagnetic fields). Biofield therapies are intended to affect the energy fields, whose existence is not yet experimentally proven, that surround and penetrate the human body. Some forms of energy therapy manipulate biofields by applying pressure and/or manipulating the body by placing the hands in, or through, these fields. Examples include Qi gong, Reiki, Prana and Therapeutic Touch. Bioelectromagnetic-based therapies involve the unconventional use of electromagnetic fields, such as pulsed fields, magnetic fields or alternating current or direct current fields, to, for example, treat asthma or cancer, or manage pain and migraine headaches.

Hypnosis is an altered state of consciousness. Hypnotherapy has the potential to help relieve the symptoms of a wide variety of diseases and conditions. It can be used independently or along with other treatments.

Natural and biologically-based practices, interventions and products refer to the use of dietary supplements and include herbal, special dietary, orthomolecular and individual biological therapies. Examples include botanicals, animal-derived extracts, vitamins, minerals, fatty acids, amino acids, proteins and prebiotics, Thousands of studies of various dietary supplements have been performed. However, no single supplement has been proven effective in a compelling way.

In India, which is the home of several alternative systems of medicines, Ayurveda, Siddha, Unani and Homeopathy are licenced by the government, despite the lack of reputable scientific evidence. Naturopathy will also be licensed soon because several universities now offer bachelors degrees in it. Other activities such as Panchakarma and massage therapy related to Ayurveda are also licensed by the government now [10] .

About half the general population in developed countries uses CAM [10] . A survey released in May 2004 by the National Center for Complementary and Alternative Medicine, part of the National Institutes of Health in the United States, found that in 2002, 36% of Americans used some form of alternative therapy in the past 12 months, 50% in a lifetime𠅊 category that included yoga, meditation, herbal treatments and the Atkins diet. The majority of individuals (54.9%) used CAM in conjunction with conventional medicine. Most people use CAM to treat and/or prevent musculoskeletal conditions or other conditions associated with chronic or recurring pain. Women were more likely than men to use CAM. The largest sex differential is seen in the use of mind-body therapies including prayer specifically for health reasons [2, 3] . If prayer was counted as an alternative therapy, the figure rose to 62.1%. 25% of people who use CAM do so because a medical professional suggested it [11] . A British telephone survey by the BBC of 1,209 adults in 1998 shows that around 20% of adults in Britain had used alternative medicine in the past 12 months.

Advocates of alternative medicine hold that the various alternative treatment methods are effective in treating a wide range of major and minor medical conditions, and contend that recently published research (Michalsen, 2003 Gonsalkorale, 2003 Berga, 2003) proves the effectiveness of specific alternative treatments [6𠄹] .

Evidence-based medicine (EBM) applies the scientific method to medical practice, and aims for the ideal that healthcare professionals should make 𠇌onscientious, explicit, and judicious use of current best evidence” in their everyday practice. Although advocates of alternative medicine acknowledge that the placebo effect may play a role in the benefits that some receive from alternative therapies, they point out that this does not diminish their validity. They believe that alternative medicine may provide health benefits through patient empowerment, by offering more choices to the public. Researchers who judge treatments using the scientific method are concerned by this viewpoint, since it fails to address the possible inefficacy of alternative treatments.

As long as alternative treatments are used alongside conventional treatments, the majority of medical doctors find most forms of complementary medicine acceptable. Consistent with previous studies, the CDC recently reported that the majority of individuals in the United States (i.e., 54.9%) used CAM in conjunction with conventional medicine.

The issue of alternative medicine interfering with conventional medical practices is minimized when it is turned to only after conventional treatments have been exhausted. Many patients feel that alternative medicine may help in coping with chronic illnesses for which conventional medicine offers no cure, only management. Classifying treatments need to be based on the objectively verifiable criteria of the scientific method evidence-based medicine, i.e. scientifically proven evidence of efficacy (or lack thereof), and not on the changing curricula of various medical schools or social sphere of usage [12] .

Since many alternative remedies have recently found their way into the medical mainstream, there cannot be two kinds of medicine - conventional and alternative. There is only medicine that has been adequately tested and medicine that has not, medicine that works and medicine that may or may not work. Once a treatment has been tested rigorously, it no longer matters whether it was considered alternative at the outset. If it is found to be reasonably safe and effective, it will be accepted [13] .

It is argued that there is no alternative medicine. There is only scientifically proven, evidence-based medicine supported by solid data or unproven medicine, for which scientific evidence is lacking. Whether a therapeutic practice is �stern” or “Western”, is unconventional or mainstream, or involves mind-body techniques or molecular genetics is largely irrelevant except for historical purposes and cultural interest. As believers in science and evidence, we must focus on fundamental issues—namely, the patient, the target disease or condition, the proposed or practiced treatment, and the need for convincing data on safety and therapeutic efficacy [14] . The Cochrane Collaboration [15] and Edzard Ernst [16] agree that all treatments, whether “mainstream” or 𠇊lternative”, ought to be held to standards of the scientific method.

Many forms of alternative medicine are rejected by conventional medicine because the efficacy of the treatments has not been demonstrated through double-blind randomized controlled trials in contrast, conventional drugs reach the market only after such trials have proved their efficacy. A person may attribute symptomatic relief to an otherwise ineffective therapy due to the placebo effect, the natural recovery from or the cyclical nature of an illness (the regression fallacy), or the possibility that the person never originally had a true illness [17] . CAM proponents point out this may also apply in cases where conventional treatments have been used. To this, CAM critics point out that this does not account for conventional medical success in double blind clinical trials.

People should be free to choose whatever method of healthcare they want, but stipulate that people must be informed as to the safety and efficacy of whatever method they choose. People who choose alternative medicine may think they are choosing a safe, effective medicine, while they may only be getting quack remedies. Grapefruit seed extract is an example of quackery when multiple studies demonstrate its universal antimicrobial effect is due to synthetic antimicrobial contamination [18, 19] .

Those who have had success with one alternative therapy for a minor ailment may be convinced of its efficacy and persuaded to extrapolate that success to some other alternative therapy for a more serious, possibly life-threatening illness. For this reason, critics contend that therapies that rely on the placebo effect to define success are very dangerous. Scientifically unsupported health practices can lead individuals to forgo effective treatments and this can be referred to as “opportunity cost”. Individuals who spend large amounts of time and money on ineffective treatments may be left with precious little of either, and may forfeit the opportunity to obtain treatments that could be more helpful. More research must be undertaken to prove the effectiveness of complimentary therapies before they can be incorporated in formal medical practice. Sufficient evidence is required for biological or clinical plausibility in order to justify the investment of time and energy in exploring the merits of alternative medicine. After all, human life is precious and no chances can be taken to comprise the health of any individual.


The History of Wound Care

The history of wound healing is, in a sense, the history of humankind. This brief history of wound healing has been compiled for the benefit of readers. It is amazing to see that some of the basic principles of wound healing have been known since 2000 bc .

The history of wound healing is, in a sense, the history of humankind. One of the oldest medical manuscripts known to man is a clay tablet that dates back to 2200 bc . This tablet describes, perhaps for the first time, the “three healing gestures”—washing the wounds, making the plasters, and bandaging the wound.1,2,3

What the ancients and early moderns referred to as plasters is the present-day equivalent of wound dressings. These plasters were mixtures of substances including mud or clay, plants, and herbs. Plasters were applied to wounds to provide protection and to absorb exudate. One of the most common ingredients used in plasters was oil. Oil may have provided some protection from infection as bacteria grow poorly in oil, and oil would have prevented the bandage from sticking to the wound as a nonadherent dressing.1

One of the interesting earliest known wound care products was beer. The Sumerians brewed at least 19 different types of beer. An interesting prescription for wound healing described in Mesopotamian culture stated, “Pound together fur-turpentine, pine-turpentine, tamarisk, daisy, flour of inninnu strain mix in milk and beer in a small copper pan spread on skin bind on him, and he shall recover.𠇑

The Egyptians may have been the first people to use adhesive bandages and were most certainly the first people to apply honey to the wounds. Honey, grease, and lint were the main components of the most common plaster used by Egyptians. Lint made from vegetable fiber probably aided drainage of the wound grease and honey may have protected the wound from infection. Grease made from animal fat may have provided a barrier to bacteria. While honey appears to be an effective antibacterial agent, it has many other healing properties. Honey has been used for thousands of years and is still part of many advanced wound dressings. Honey was also used for wound care in India long before the time of Christ, demonstrating that separate medical cultures empirically arrived at the same successful therapy.1,4,5

Egyptians painted wounds with green color. Green indicates life, and green paint contains copper, which is toxic to bacteria. When most people think of ancient Egypt, they think of pyramids and mummies, and the art of wrapping the bodies of the dead probably influenced the bandaging of wounds. Also the art of preventing decomposition by embalming may have contributed to early advances in controlling infection.1,2

The Greeks stressed the importance of cleanliness. They recommended washing the wound with clean water, often boiled first, vinegar (acetic acid), and wine. The Greeks also differentiated between 𠇏resh,” or acute, and nonhealing, or chronic, wounds. One of the interesting excerpts from the Hippocratic collection about wound healing is, 𠇏or an obstinate ulcer, sweet wine and a lot of patience should be enough.” An early description of the 𠇏our cardinal signs of inflammation”—rubor, tumor, calor, et dolor (redness, swelling, heat, and pain)�me from the Romans.1,2,6,7

It was not until the 18th century that surgery began to be considered as a distinct and respected branch of medicine. In the 19th century, the antiseptic technique was a major breakthrough. The introduction of antibiotics helped control infections and decrease mortality.1,7,8

In the 20th century came the advent of modern wound healing. At the present time, there are more than 5,000 wound care products. Most modern dressings contain materials that are highly absorbent, such as alginates, foam, or carboxymethylcellulose. There are occlusive dressings and semiocclusive dressings. There are growth factors, advanced honey-based dressings, and hypochlorous acid�sed cleansers. Bioengineered tissue, negative pressure therapy, and hyperbaric oxygen therapy have changed the way we treat a lot of chronic wounds today.

There are more than 1,000 wound healing centers in the United States today, and wound healing has become a specialty, with fellowship programs offered at some academic centers.

In summary, The first wound treatments were described 5 millennia ago. Since then, various principles of wound care have been passed on from generation to generation. In contrast to large numbers of general technological inventions over the past 100 years, progress beyond ancient wound care practices is a recent phenomenon. It is essential to know the historical aspects of wound treatment (both successes and failures) in order to continue this progress and provide future direction.9


'Promising' treatment for diabetics

Dr Stadler said it was unfortunate that maggot therapy was perceived to be a last resort treatment in Australia.

"It is ideally suited for early interventions," he said.

"When someone presents with a diabetic ulcer, maggot therapy is fantastic in treating that ulcer and setting the wound up for healing."

Peter Lazzarini, a principal research fellow at QUT and co-chair of Diabetic Foot Australia, said a handful of small studies have tested maggot therapy on diabetic foot ulcer patients with mixed results.

"Maggot or larval therapy has been shown to be pretty effective in scientific labs at essentially gobbling up this devitalized tissue without touching the healthy ulcer tissue," he said.

"The rationale for using larval therapy is promising, but we need larger studies to prove if it is as effective, or more effective, than other forms of debridement yet."

While he has not used the technique on patients, Dr Lazzarini said he was aware of cases where it had been used for complex wounds where removing the tissue with a scalpel proved difficult.

"The larvae seem to be pretty good 𧷫riders' in these cases," he said.


Honey, Mud, Maggots and Other Medical Marvels: The Science Behind Folk Remedies and Old Wives' Tales

The actual remedies are interesting, unfortunately the writing is distractingly poor. I started skipping the last sentence of each chapter to avoid the inevitable atrocious puns that were lurking there. These are not clever puns (which may make you roll your eyes but still make you smile), these are groan out loud, painful and embarrassing to read Fozzie Bear caliber puns:
pg. 30 " After all, maggot therapy didn&apost turn out to be such a flyblown idea, did it?"
pg: 70 "chalk up another success for The actual remedies are interesting, unfortunately the writing is distractingly poor. I started skipping the last sentence of each chapter to avoid the inevitable atrocious puns that were lurking there. These are not clever puns (which may make you roll your eyes but still make you smile), these are groan out loud, painful and embarrassing to read Fozzie Bear caliber puns:
pg. 30 " After all, maggot therapy didn't turn out to be such a flyblown idea, did it?"
pg: 70 "chalk up another success for geopharmacy!" (chapter on eating soil, clay and dirt)
pg. 86. "Far from absurd, bloodletting is proving itself to be a bloody good remedy"
Wocka Wocka Wocka!

I appreciate that they tried to make the subject matter fun and engaging, but I don't think it was successfully executed.

The chapter on circumcision is a soapbox the authors make their stance on the matter known and just repeat it for an entire chapter. (as another reviewer also noted, it feels totally out of place).

An entire chapter is devoted to how the development of medicine parallels Lamarckian evolution. eh?

The last few chapters feel like the first half of the book was put in a blender and just thrown back together in different configurations.

What's the difference between myself and an angler?
One hates this book.The other baits his hook. . more

Interesting info but the tone and the writing aren’t the best. The idea was sound, it’s helpful to understand what folk remedies can actually do beyond the placebo effect. The book is nicely organized, though the chapter order seems a bit of a hodge-podge. The writing is ok but the chapters are often repetitive within. The serious weakness of this book is the tone, it tends to give too much credit to folk remedies and their positive benefits without pointing out the obvious, much of the remedies Interesting info but the tone and the writing aren’t the best. The idea was sound, it’s helpful to understand what folk remedies can actually do beyond the placebo effect. The book is nicely organized, though the chapter order seems a bit of a hodge-podge. The writing is ok but the chapters are often repetitive within. The serious weakness of this book is the tone, it tends to give too much credit to folk remedies and their positive benefits without pointing out the obvious, much of the remedies are based on the placebo effect. While I found the info and argument for folk remedies convincing for limited purposes, I’m not sure the author really made that clear…they seem to be more focused on attacking the medical industry for not following up fully on these remedies. That said, the book did meet my expectations.

Still, I give this one a 3. I think the info is useful in limited contexts but I didn’t really enjoy the writing and agenda. By all means, ask your doctor about some of these ideas but, don’t do anything with this stuff yourself…I also think authors of post-apocalyptic works could benefit from this book…it’s what doctors would use to heal if modern medicine crumbled away.
. more

I found this book fascinating.

I must admit, I usually pick up nonfiction books with a bit of trepidation. Some of them are so dry, I fall asleep reading the intro. This book I could not set down though. I was fascinated by all the squirm-worthy and nasty cures in this book and the medical science behind them.

Until I read this, I could never understand why bleeding and leeches was such a popular cure for so long. Now I see that it was used to lower a fever and it actually worked. If only people I found this book fascinating.

I must admit, I usually pick up nonfiction books with a bit of trepidation. Some of them are so dry, I fall asleep reading the intro. This book I could not set down though. I was fascinated by all the squirm-worthy and nasty cures in this book and the medical science behind them.

Until I read this, I could never understand why bleeding and leeches was such a popular cure for so long. Now I see that it was used to lower a fever and it actually worked. If only people wouldn’t have taken so much blood, it might not have killed the patient. If you’re ever curious as to why people used to put urine in sleeping droughts, this book will tell you why.

This was a fast easy read and I whipped right through it. I have to laugh, because the atrocious puns that one reviewer complained about didn’t bother me at all. I rather thought it was a fun read. I was bit off though by the preachy chapter on circumcision. Consequently I knocked off a star.


The top 12 most amazing Israeli medical advances

Israeli ingenuity is responsible for some of the world’s most amazing medical advances.

Whether they’re futuristic, such as Given Imaging’s PillCam capsule endoscopy or Itamar Medical’s fingertip monitors for sleep disorders and cardiac issues — or cleverly simple, such as First Care Products’ Emergency Bandage – blue-and-white inventions are changing the face of healthcare in hospitals, doctors’ offices, homes and even battlefields worldwide.

“It’s almost a cliché to say Israel is an excellent place for medical innovation,” says Eran Perry, managing director at Israel Health Care Ventures (IHCV), one of the largest venture capital funds in the country.

“But if you look at [global] statistics, it’s evident — from total expenditure on civilian R&D, where we are ranked first to human infrastructure and entrepreneurship, where we rank in the top five. You can see the results in patents. We are first in the world for medical device patents per capita, and second in Europe for bio-pharma.”

About 1,000 Israeli companies are in healthcare or life-science products, including 700 in medical devices. Approximately half are already generating revenue.

“There has been an ecosystem created for life sciences, so these 1,000 companies don’t exist in a vacuum but in an environment where they have access to everything they need — engineering, labs, regulatory consultants, manufacturing consultants,” Perry tells ISRAEL21c. “Many young companies can be a one-man show until they get to the clinical trial stage, relying on this excellent ecosystem around them. You can see Israeli companies reaching the same stage as American ones with a fraction of the capital investment.”

IHCV reviews 200 to 300 new opportunities per year. Perry estimates that 60 to 70 Israeli healthcare companies are founded annually. Proceeds from mergers and acquisitions involving Israeli healthcare companies totalled around $1 billion in the past year.

That’s why ISRAEL21c had a hard time narrowing the field to this top 12 list of the most significant recent Israeli contributions to the medical field.

We have chosen products already on, or very near, the market. If you’ve got other companies you think also deserve a mention please don’t hesitate to add them to the comments section below.

And watch for a future top 10 list of the most exciting Israeli medical-device and pharmaceutical developments just around the corner.

And now … ISRAEL21c’s top 12 Israeli medical innovations, in alphabetical order.

1. ApiFix system to correct severe curvature of the spine (scoliosis) minimizes risks, scar size, complications, recovery time and cost. The miniature ratchet mechanism has successfully been implanted in 15 patients so far. Limited sales of the product have begun while clinical trials are in the last stages.

2. Argo Medical Technologies’ Rewalk robotic exoskeleton from was featured on the hit TV show “Glee” and enabled paraplegic runners in London and Tel Aviv to complete marathons. The ReWalk Rehabilitation model currently is used by patients in rehab centers from New York to Dusseldorf. ReWalk Personal, for everyday home use, is available throughout Europe and awaiting FDA clearance in the United States.

3. Gamida Cell is developing stem-cell therapy products to treat blood cancers, solid tumors, non-malignant blood diseases such as sickle-cell anemia, autoimmune diseases and genetic metabolic diseases. On Sept. 9, the first patient was successfully transplanted at Duke University Medical Center (North Carolina) in the second Phase I/II study of NiCord, Gamida’s experimental treatment for blood cancers.

4. GI View Aer-O-Scope disposable colorectal cancer screening device, now in US trials, will make lifesaving colonoscopy screenings cheaper, safer and more accessible worldwide. The self-navigating, flexible Aer-O-Scope removes the risk of perforating the colon, provides superior imaging and can be used by a trained nurse or technician so a gastroenterologist does not have to be present.

5. IceCure Medical’s IceSense3 has been used by US doctors since 2011 to remove benign breast lumps in a 10-minute ultrasound-guided procedure that penetrates the tumor and engulfs it with ice. The system is being clinically tested over the next few years against small malignant breast tumors as well. The procedure is done in a doctor’s office, clinic or breast center, and the patient can get up and leave afterward with no recovery period or post-care.

6. InSightec’s ExAblate OR uses MRI-guided focused ultrasound to destroy tumors and uterine fibroid cysts without surgery. The company has begun a Phase III trial of its next product, ExAblate Neuro, to cure essential tremor — a common movement disorder – using the same non-invasive technology to significantly lower risk of infection, hemorrhage and brain damage.

7. IonMed’s BioWeld1 bonds surgical incisions using cold plasma — instead of painful stitches, staples or glue – within minutes, sealing and disinfecting the wound with minimal scarring and recovery time. The CE Mark is expected in October, with European sales and US FDA approval process starting in early 2014.

8. Nano Retina’s Bio-Retina, a tiny implantable device inserted into the retina in a 30-minute procedure, turns into an artificial retina that melds to the neurons in the eye. Activated by special eyeglasses, the device transforms natural light into an electrical impulse that stimulates neurons to send images to the brain. The prototype is advancing quickly through clinical trials.

9. NanoPass Technologies’ MicronJet is a unique, FDA-approved single-use needle for painless delivery of vaccines into the skin using semiconductor technology. The product has been proven to generate superior immune response with less vaccine, because it does not go past the skin level. Licensed last year to Janssen Pharmaceuticals, MicronJet is being used by the US Center of Disease Control (CDC) in a large trial of polio vaccine for infants in Southeast Asia.

10. OrSense’s NBM-200 non-invasive monitor is relied upon by blood donation centers in 40 countries for continuous and spot measuring of potential donors’ hemoglobin level (to check for anemia) and other blood parameters. This device eliminates the need for finger pricking as well as biologically hazardous equipment and waste. Studies show that donors screened this way are more likely to become repeat blood donors. OrSense recently completed successful trials using its technology to detect hemorrhage and anemia in pregnant women.

11. Surpass Medical’s NeuroEndoGraft flow diverters redirect blood flow from a brain aneurysm (a bulge in a weak artery wall), so that a stable clot can form and the potentially fatal aneurysm no longer is in danger of rupturing. The family of devices has the CE Mark and has been used successfully in dozens of patients. US medical device manufacturer Stryker acquired Surpass for $100 million in October 2012.

12. VitalGo Systems’ Total Lift bed is the world’s only hospital-grade bed that can elevate a patient from a lying to a fully standing position — and all points in between — for treatment and transfer with no lifting required of the caregiver. Two major companies are distributing Total Lift in the acute-care and home-care markets in the United States.


The Medical Book by Clifford A. Pickover

Last year, I was treated to The Physics Book by Clifford A Pickover, which took a huge and sometimes-difficult subject and broke it down into delightful bite-sized pieces anyone can understand. This year, Dr. Pickover has done the exact same thing with an even more universal subject: health. In The Medical Book: From Witch Doctors to Robot Surgeons, there are 250 topics, one page each, with gorgeous illustrations. The topics are presented in more or less chronological order of the subject's discovery or a scientific breakthrough, so The Medical Book is also a history book. Flipping through the topics gives you a sense of how astonishingly recent our knowledge about how human bodies work really is.

Of the 250 topics, it was hard to select just a few to share, but these intrigued me. You'll find others in the book that particularly appeal to you.

10,000 B.C. Witch Doctor

For thousands of years, human health, illness, and injury were all magical concepts.

Shamanic practices, involving healers who appear to be in contact with a spirit world, probably originated in Paleolithic (Old Stone Age) times. For example, evidence for Mesolithic (Middle Stone Age) shamanism was found in Israel in the form of an old woman from a burial dating to around 10,000 B.C. The importance of this woman, along with her possible close association with nature and animals, is suggested by the special arrangement of stones by her body, along with 50 complete tortoise shells, a human foot, and remains of birds, boars, leopards, cows, and eagles. Today, the vast majority of the traditional Nguni societies of southern Africa make use of sangomas who employ herbal medicine, divination, and counseling.

Thousands of years later, the science of human biology and the healing arts began to advance in fits and starts, through trial and error, involving a lot of misery on the way to enlightenment. But advance it did, and many of those discoveries are recorded in The Medical Book.

1346 Biological Weapons

Not all those advances were positive. An understanding of germ theory was not necessary to see the nefarious possibilities of contagious diseases, especially in causing harm to one's enemies.

Biological warfare has been conducted for millennia. In 184 B.C., the soldiers of Hannibal of Carthage threw clay pots filled with venomous snakes onto enemy ships. In 1346, Tatar forces threw warriors who died of plague over the walls of Kaffa, a Crimean city, and an outbreak of plague followed. In 1763, representatives of the Delaware Indians were given blankets exposed to smallpox. In 1940, Japanese warplanes flew over China and dropped ceramic bombs filled with fleas carrying bubonic plague.

Yet the goal most medical research is to help the sick and injured. Bodies were dissected, medicines tried, patients suffered and died, and scientists and physicians built upon the knowledge of those who came before.

1683 The Zoo Within Us

Dutch microbiologist Anton Philips van Leeuwenhoek built his own microscope and studied his own body. In 1683, he observed "little living animalcules" in scrapings of his dental plaque. This discovery led to our knowledge of the human microbiome, in which a diverse collection of microbes help our bodies function.

Beneficial and harmful microbes typically reside on and in the skin, mouth, gastrointestinal tract, vagina, nose, and other various orifices. More than 500 species of bacteria live in the human intestines, motivating researchers to think of this population as comprising a "virtual organ." The creatures in our gut can ferment food to aid in digestion, produce vitamins for our bodies, and prevent the growth of harmful species. Such bacteria rapidly colonize a baby's intestines starting from birth.

Hail, hail, the gang's all here -whether you like it or not!

1929 Maggot Therapy

1929 was a banner year for medical discoveries and breakthroughs, and there are quite a few labeled with that year in The Medical Book. One is maggot therapy. Maggots, or fly larvae, had been observed to clean and debride wounds since antiquity, but it was American physician William Baer who tried applying maggots deliberately to infected wounds.

During World War I, Baer had observed a soldier who remained on the battlefield for days with many serious wounds. Back at the hospital, when the soldier's clothes were removed, Baer saw "thousands and thousands" of maggots in the wounds. Surprisingly, the soldier exhibited no fever and had healthy pink tissue in the wounds. These experiences led Baer, in 1929, to apply maggots to the tissue of patients with intractable chronic osteomyelitis (infection of the bone). The maggots worked miracles, and Baer noticed rapid debridement (removal of dead, damaged, or infected tissues), reduction in the number of disease-causing organisms, reduced odor, and rapid rates of healing.

The next time the subject of maggot therapy comes up and someone inevitably says, "Now, what on earth ever gave someone the notion to try that?", you can set them straight --it was based on previous observations of what occasionally happens naturally.

1946 Cancer Chemotherapy

As medical science built on previous research, advances in healing began to take marvelous leaps forward. When cancer was found to be caused by the uncontrolled growth of cells, scientists confronted the problem of how to stop those cells without killing our healthy cells at the same time. It took a tragedy to point them in the right direction.

Surprisingly, one of the first effective anticancer drugs was discovered when American pharmacologists Alfred Gilman and Lewis Goodman performed research, under the cloak of wartime secrecy, after more than 1,000 people were accidently exposed to American-made mustard gas bombs. This chemical warfare agent was found to damage rapidly-growing white blood cells, and scientists reasoned that this might be useful for treating certain lymphomas (cancers of certain white blood cells). When a patient with non-Hodgkin's lymphoma was injected with a related nitrogen compound in 1943, Gilman and Goodman observed a dramatic but temporary shrinkage of the tumor masses. The government gave Gilman and Goodman permission to publish their findings in 1946.

That observation and subsequent experiments opened the floodgates to many different chemotherapy regimens that have been developed since then and are used all over the world today.

1961 Self-Surgery

There are pages in which The Medical Book steps sideways and presents stories that will curl your hair. As fascinating as medical advances and discoveries are, those stories pale beside the tales of a select group of people who have performed surgery on themselves.

For example, on April 30, 1961, Russian general practitioner Leonid Rogozov removed his own infected appendix at the Soviet Novolazararevskaya Research Station in Antarctica. This surgery was probably the first successful self-appendectomy undertaken beyond a hospital setting, with no possibility of outside assistance, and with no other medical personnel present. Prior to his surgery, Rogozov recorded in his journal: "I did not sleep at all last night. It hurts like the devil! A snowstorm whipping through my soul, wailing like a hundred jackals. I have to think through the only possible way out: to operate on myself. It's almost impossible. but I can't just fold my arms and give up."

Luckily, Rogozov recovered completely, but his story is only one of several self-surgeries related in the book.

The Medical Book is a wonderful resource on what we've learned and when and how we learned about our own health. The oh-so-useful way the book is presented makes it a delightful and appropriate gift for readers of all ages who like to take a break and learn something new and interesting. Who knows --you may find yourself reading it all the way through at once! The Medical Book: From Witch Doctors to Robot Surgeons, 250 Milestones in the History of Medicine is available now at Amazon, Barnes & Noble, and at a bookstore near you. Visit author Clifford A Pickover at his website and at Cliff Pickover's Reality Carnival. He also likes to Tweet.


HEALTH Healing Treatment, 4,000 Years Old, Is Revived

To help heal seriously infected wounds, some surgeons have revived a 4,000-year-old treatment, born on the battlefields of ancient Egypt: they pack the depths of treacherous wounds with sweet substances like sugar.

Dressings made of sugar and honey, favored by healers throughout history, fell into disfavor with the development of antibiotics over half a century ago. But even the most sophisticated modern preparations have proved unable at times to overcome the hearty bacteria that live in deep wounds, and a handful of doctors, mostly in Europe, are turning once again to sugar ''It's a very old and very simple treatment which was forgotten for a while but is now coming back, like a fashion,'' said Prof. Rudy Siewert, chairman of the department of surgery at the Klinikum Rechts der Isar in Munich, West Germany.

Renaissance vs. Skepticism

Professor Siewert said that in the last five years the technique had enjoyed a wide renaissance in Germany and to a lesser extent in the rest of Europe. Despite the interest abroad, most American surgeons express mild skepticism.

'ɿor the right kind of wound it works fine, and it's fun to look at an ancient remedy,'' said Dr. Mary H. McGrath, chief of the division of plastic surgery at the George Washington University Medical Center in Washington, D.C. Doctors there have used sugar to treat uninfected bedsores. 'ɻut there are about 600 lotions and potions for healing wounds, and I think you can get a lot more effect with our contemporary local antibacterials.''

Experts say the ancient treament probably works because sugar tends to draw water into its gritty midst, through osmosis. This action both dries the bed of the wound to promote new tissue growth and dehydrates the bacteria that cause infection, leaving them weak and fragile. Several American pharmaceutical concerns make expensive wound pastes composed of synthetic microscopic water-absorbing beads that perform this same function. Revival Began in U.S. Although sugar dressings have few American advocates, Europeans ascribe the current revival in part to the work of an American, Dr. Richard A. Knutson, an orthopedic surgeon in Greenville, Miss., who published one of the few papers on the technique a decade ago.

About 15 years ago, frustrated by stubborn, pus-filled wounds filled with bacteria resistent to all drugs, Dr. Knutson began experimenting with sugar dressings at the suggestion of a retired nurse who had worked in the Deep South before the antibiotic era.

''When we started I thought it was absolutely nuts,'' Dr. Knutson said in a recent telephone interview. ''Sugar! The first thing you think about is the old jar of marmalade in the fridge growing all that junk. You think you'll create a perfect medium for bacterial growth. That turned out not to be the case.''

He has since used a salve made of sugar, which he now mixes with a mild bacteria-killing iodine liquid, on about 6,000 patients with anything from burns to shotgun wounds. The mixture is applied as a paste. ''It's easy to use, painless, inexpensive, and it works,'' he said, ''You can't ask for more. If it has a fancy name and cost $300 a bottle everyone would be buying it.'' Most European surgeons use sugar alone.

The care of deep wounds is a major challenge to surgeons. Although doctors sew up small clean cuts, the skin above penetrating injuries that are likely to be infected is generally left open, both to allow the doctors to clean the cavity and to allow the body to grow new tissue, called granulation tissue, from the deep wound base.

Over weeks to months, the wound becomes sterile and slowly fills with new tissue. Systemic antibiotics are often required to aid the healing process. Sometimes skin and muscle must be surgically moved from other parts of the body to cover areas that would otherwise never completely heal.

Using the resurrected technique, doctors alter the usual cleaning regimen by sprinkling granulated sugar or spreading sugar paste in the wound two to four times a day, before applying new bandages. The sugar liquefies somewhat as it absorbs fluid from the wound, so it is simple to rinse out the sugar, along with dead tissue, at the next dressing change.

Doctors who use the method say that even dirty injuries are often germ-free after several days and that wounds seem to heal faster and more completely than with conventional treatments.

''The granulation tissue is much pinker and healthier,'' said Dr. B. G. Spell, a surgeon at the Methodist Rehabilitation Hospital in Jackson, Miss., who says he uses the technique daily to heal infected amputations and the deep pressure sores that plague paraplegics. ''The dead tissue breaks down more easily, so there's not as much debridement,'' he said.

In a series of articles in the British medical journal Lancet over the last five years, doctors at various European medical centers have reported success using the technique in a variety of situations in which nothing else worked. Dr. J. L. Trouillet at the Hopital Bichat in Paris described using granulated sugar bought from a supermarket for successful treatment of 19 critically ill cardiac surgery patient who had mediastinitis, a frequently deadly infection of the compartment in the chest that contains the heart.

Patients expecting high-tech medicine are often surprised to find their injuries sweetened. ''The doctors had mentioned that they were going to use 'wound sugar,' but it didn't register,'' said John Tagliabue, a New York Times reporter who was shot and seriously wounded last December while covering the revolution in Romania.

His wound was packed with sugar at the Klinikum in Munich, where he was moved for treatment. ''One day I noticed this sandy material on the sheets, like crumbs from eating cookies in bed.'' he said. ''Then it hit me: They really meant sugar.''

Will the enthusiasm for the revival spread to the Americas? ''There are better treatments these days,'' said Dr. McGrath, in an opinion that half a dozen prominent American surgeons echoed in interviews. Dr. McGrath's own research includes studying the effect of molecules called growth factors, manufactured by genetically altering organisms, on a type of cell involved in healing.

''Over all, I think the Europeans are a little less rigorous in their journals,'' she said. And, in truth, despite nearly 4,000 years of use, there are no comparative scientific studies of sugar dressings to be found.

But Professor Siewert has a slightly different take on the issue. ''The American way is more scientific,'' he said, ''The European way sometimes comes more from history and experience. That's good, too.''

Other Remedies From History

Until a century ago, doctors applied leeches for almost every illness in the mistaken belief that they would draw out '𧮭 blood.'' Today they are used after microsurgery that reattaches fingers, toes and other body parts. An operation can fail because tiny blood vessels become clogged. But when a small European leech, Hirudo medicinalis, is attached, it sucks out an ounce or two of blood from the clogged vessels. The leech's saliva containes an anticoagulant and an antiseptic.

Maggots, fly larvae, once allowed to clean festering battlefield wounds, have been used to save the legs of a 17-year-old girl who developed a blood infection that caused clotting in her legs. Oral antibiotics could not reach the sores, so physicians at Children's Hospital in Washington D.C., applied 1,500 maggots. They ate away dead skin while allowing healthy skin to thrive.

Scientists have also validated a folk remedy for cuts used by Arab fishermen. The Arabian saltwater catfish, Arius bilineatis, secretes a slimy, gellike substance that contains proteins that coagulate blood to stop bleeding and enzymes that speed the growth of new tissue.


Band-Aids

It may seem odd to consider anything adorned with Rugrats or Spider-Man as a medicine-changing tool, but don’t make the mistake of dismissing Band-Aids simply because they can be cute. Huge numbers of people see the world’s first self-adhesive bandages not just as temporary fixes but, rather, a device helping put the care into health care.

A caring cotton buyer for Johnson & Johnson (Band-Aids’ maker) invented them in 1920 so he could tend to the many cuts and minor burns his beloved and accident-prone wife got while cooking and keeping house.

By 1942, millions of Johnson & Johnson’s adhesive bandages accompanied World War II soldiers overseas. In 1963, Mercury astronauts took them into space. Back here on Earth, Band-Aids became the go-to therapy for parents wanting to make boo-boos better.

They act as medals for bravery in the face of inoculations, they hide the tear-inducing sight of a skinned knee, and they actually do help minor wounds heal better with fewer scars and infections. Turns out, we really are stuck on Band-Aids. By 2001, the number manufactured had rocketed past 100 billion.


Watch the video: Maggot therapy, the use of maggots to clear away necrotic tissue, as a method of the debridement..