Maggot Therapy

Wound bed preparation (WBP) is an integral part of the care programme for chronic wounds. The acronym TIME is used in the context of WBP and describes four barriers to healing in chronic wounds; namely, dead Tissue, Infection and inflammation, Moisture imbalance and a non-migrating Edge. Larval debridement therapy (LDT) stems from observations that larvae of the blowfly Lucilia sericata clean wounds of debris. Subsequent clinical studies have proven debriding efficacy, which is likely to occur as a result of enzymatically active alimentary products released by the insect. The antimicrobial, anti-inflammatory and wound healing activities of LDT have also been investigated, predominantly in a pre-clinical context. This review summarises the findings of investigations into the molecular mechanisms of LDT and places these in context with the clinical concept of WBP and TIME. It is clear from these findings that biotherapy with L. sericata conforms with TIME, through the enzymatic removal of dead tissue and its associated biofilm, coupled with the secretion of defined antimicrobial peptides. This biotherapeutic impact on the wound serves to reduce inflammation, with an associated capacity for an indirect effect on moisture imbalance. Furthermore, larval serine proteinases have the capacity to alter fibroblast behaviour in a manner conducive to the formation of granulation tissue.

Speculative fiction is able to foresee the changes of the environment and social strata via imitation of future society (Gough, 2003; Otto, 2012). With the same intention, Margaret Atwood makes use of an alternative natural medication, maggot therapy, as an important recuperative method to cure physical lesions and injuries in The Year of the Flood (2009). Historically, although once a common practice among healers of antiquity, maggot therapy has since been discarded from medical context, partly due to its carnivorous and parasitic nature. The present paper intends to discuss the implication of this kind of natural therapy and its sense of monstrosity and grotesqueness as presented in Atwood's novel. In using this therapy as motif, the novel illustrates the grotesque through exaggeration and gory and monstrous features, which lead not only the characters but also the readers to experience disorientation due to the unfamiliar state of savagery. With a focus on relevant theories of the grotesque, the study aims to highlight how the monstrosity inherent in maggot therapy renders the grotesque in this novel, that is, by juxtaposing savagery and culture and evoking repulsion and attraction.