2ih 



"Maggots have "been found to "be a tremendously 

 useful adjunct to thorough surgical treatment of 

 chronic osteomyelitis. . . 



"Maggots, "by their digestive action, clear 

 away the minute fragments of hone and tissue 

 sloughs caused "by operative trauma in a way not 

 accomplished "by any other means. This is a tre- 

 mendously valuable asset in the healing of a 

 wound. 



"Maggots cause wounds to "become alkaline and 

 in this way diminish growth of pathogenic "bac- 

 teria. 



"Maggots seem to have other more subtle 

 "biochemical effects within the wound itself and 

 perhaps cause also a constitutional reaction 

 inimical to "bacterial growth. " 



Though Baer did not live to fully investigate the "more 

 subtle "biochemical effects/ 1 subsequent investigation has 

 shed more light on this phenomenon. 



The following species of fly larvae were used in the 

 early treatment of osteomyelitis : Luc ilia sericata 

 Meig. , L. caesar Linn. , Phormia regina , and Wohlfahrtia 

 nuba Wied. Lucilia sericata was used most commonly. 

 After working with this species, Stewart (193*0 concluded 



"L. sericata larvae are "beneficial in osteo- 

 myelitis wounds "because they injest, by means 

 of macerating mouth -hooks and excreted tryptase, 

 acid forming and bacterial -growth-supporting 

 necrotic tissue; because, most, if not all, of 

 the bacteria ingested with the necrotic tissue 

 and pus are killed by the acid in the middle 

 portion of the mid- intestine; because they alka- 

 lize the wounds by means of excreted ammonia 

 and calcium carbonate, and thereby reduce swell- 

 ing, consequently increasing drainage and de- 

 creasing bone destruction and protect tissue 

 cells from autolysis; because the exuded calcium 

 carbonate stimulates phagocytosis; because the 

 bacterial exotoxin is probably rendered inert by 

 the acid condition of the middle region of the 

 mid-gut; and because they promote the growth of 

 healthy granulation tissue apparently by either 

 raising the pH of the wound or by the activity 

 of the exuded calcium ions, or both." 



