Mary Roach - Grunt

Historically, battlefields were even worse. Combat is a filth fly cornucopia—a bounty of rotting organic matter to eat, to lay eggs in, to nourish the offspring. On Pacific islands during World War II, says the Armed Forces Pest Management Board guide, “flies developed in corpses on battlefields and excrement in latrines to levels beyond modern comprehension.” A similar scenario developed in the aftermath of battle in El Alamein, Egypt, prompting officers of the British Eighth Army to mandate fly death quotas—each soldier responsible for killing at least fifty flies a day. During the Vietnam War, corpses became so heavily infested with maggots that pesticides had to be used inside body bags. [40] Post-Vietnam-era mortuary practice forbids this, as the pesticides could interfere with the chemical and genetic analyses done as part of an autopsy. Also verboten in morgues: electric fly zappers. They cause the flies to explode, scattering their DNA and the DNA of whatever bodies they’ve been crawling on. Military morgues rely on “air curtains” to keep flies out. The air curtain is a high-tech version of the “fly curtain,” the beaded strands that hang in doorways in Middle Eastern homes, allowing breezes, but not flies, to pass. Who among the thousands of youthful 1970s doofs who hung these in their bedrooms had any clue as to the beads’ provenance as fly control? Not this doof. In Conlon’s camp on the Kuwait border, accumulating garbage exacerbated the problem. The Marines weren’t allowed to burn it—the normal disposal strategy—because the fires would give away the camp’s position. (The garbage eventually became part of military strategy. It was hauled away under cover of darkness and burned at a distant site, to trick the Iraqis.)

Nowhere was the filth fly situation more dire—or perhaps just more memorably documented—than in the American Civil War. “Few recruits bothered to use the slit trench latrines…,” wrote Stewart Marshall Brooks, in Civil War Medicine. “Garbage was everywhere… [alongside] the emanations of slaughtered cattle and kitchen offal.” Entomologists Gary Miller and Peter Adler, in a paper on insects and the Civil War, quote a letter by an Indiana infantryman describing the scene: “The deluge of rain which had fallen… soaked the ground until the whole face of the earth was a reeking sea of carrion…. Countless thousands of green flies… were constantly depositing their eggs… which the broiling sun soon hatched into millions of maggots, which wiggled until the leaves and grass on the ground moved and wiggled too.”

You can imagine what might happen to the open wounds of a soldier lying on a battlefield for any length of time. Most likely you would be wrong.

THE SOLDIERS, two of them, are not named, nor is the battlefield on which they were hit. We know that it happened in France during World War I, sometime in 1917. We know that it wasn’t winter, because the men arrived at an army hospital having lain “in the brush” for seven days. And because it was fly season.

On removing the clothing from the wounded part, much was my surprise to see the wound filled with thousands and thousands of maggots…. The sight was very disgusting and measures were taken hurriedly to wash out these abominable looking creatures. Then the wounds were irrigated with normal salt solution and the most remarkable picture was presented…. these wounds were filled with the most beautiful pink granulation tissue that one could imagine.

That’s US Expeditionary Forces surgeon William Baer relating the story of how he came upon the unseemly idea of intentionally infesting wounds with maggots to help them heal. Filth fly larvae—blowfly maggots, most notably—prefer their meat dead or decaying. When the meat is part of an open wound, the act of eating performs upon the meal a kind of natural debridement. Debridement—the removal of dead or dying tissue—fights infection and facilitates healing. Because dead tissue has no blood supply and thus no immune defenses, it’s easily colonized by bacteria. This encourages infection of the healthy tissue and inflammation, which slows healing.

Baer was impressed that the soldiers had no fever or signs of gangrene. The mortality rate from the type of injuries the men had—compound fractures and large, open wounds—was about 75 percent with “the best of medical and surgical care that the Army and Navy could provide.” In 1928, a decade after the war had ended, Baer summoned his courage and experimented on civilians. His inaugural patients were children, four of them, all with recurrent bone infections from blood-borne tuberculosis, a condition that antiseptics and surgery sometimes failed to quell. Raymond Lenhard, the author of a biographical monograph on Baer, recalled hearing the great surgeon tell the story. Lenhard had been a student of Baer’s at Children’s Hospital School in Baltimore and, reluctantly, a dining companion. (“Often during lunch he would make us lose our appetites.”) Using the offspring of blowflies trapped near the hospital, Baer “loaded up” a wound and proceeded to watch the results. After six weeks, the wound had healed. As did the wounds of the other three children.

What sort of person experimentally infests a child with maggots? A confident sort, certainly. A maverick. Someone comfortable with the unpretty facts of biology. Someone who is perhaps himself an unpretty fact of biology. “The Chief was overweight, breathed audibly, and snorted in the fashion of a tic,” wrote Lenhard. Baer would sometimes go from operating room to lecture hall without changing, delivering his talks in baggy, bloodstained surgical trousers. He bred Chow Chows at his home, bringing yet more snorting and audible breathing to the Baer household.

Beneath the earthy exterior, Baer was an exacting and dedicated practitioner. He considered his “maggot treatment” far less abhorrent than the alternative: amputation. To Baer, the removal of a limb was “the ultimate in destruction,” wrote Lenhard, showing a flair for video game marketing eighty years premature.

So impressed was Baer by the work of his larval “friends” that he designed and built a thermostat-controlled wood and glass fly incubator at the hospital. Only thrice in an ensuing eighty-nine cases did the maggots fail and the patient succumb to infection. Fearing that the larvae may have introduced the offending bacteria, Baer devised a protocol for raising sterile specimens. Remnants of his technique live on today at Monarch Labs, in Irvine, California. Their Medical Maggots are also sterile, as required by the Food and Drug Administration (FDA), which in 2007 approved live blowfly larvae as a medical device.

While the majority of modern “maggot therapists” treat the hard-to-heal foot ulcers of diabetics, WRAIR’s George Peck has been seeking to take medicinal maggots back to their roots in the military. In 2010, he was funded for a study looking into the efficacy of blowfly larvae in treating chronically infected IED wounds. More recently, Peck received a grant to genetically modify blowfly maggots such that they produce antibiotics. Though maggots already prevent infection, these “supermaggots” could be tailored for specific bacterial infections.

Peck offered to hatch a “clutch” of maggots for me, taking care to time things such that when I arrive at his and his wife’s home for dinner, the larvae will be the size of Medical Maggots at the time they’re released in a wound (about two millimeters long). I don’t have any wounds. Just questions.

GEORGE PECK and his future wife, Vanessa, worked together in the basement insectary at WRAIR. An insectary is a facility for rearing insects—insects used, in this case, for testing vaccines and repellents against whatever has been lately plaguing troops. Vanessa cared for a colony of sand flies, [41] Tobin Rowland, the man who now holds the job, gave me the WRAIR Insect Kitchen recipe for sandfly larvae food. Mix rabbit feces, alfalfa, and water, and pour into nine large round pans. Soak for two weeks, or until mold covers entire surface, yielding what WRAIR entomology director Dan Szumlas calls a “lemon-meringue feces” appearance. Let dry and grind. Rabbit dung is used because it smells better than cow dung, not because it’s cheap. Rabbit turds are more expensive than rabbits. WRAIR’s supplier, which holds a monopoly by virtue of no one else’s having wanted or thought to compete, charges $35 a gallon. while George was down the hall with his filth flies. It’s a setting that might dampen the ardor of another pair, but Peck remains besotted. You hear it behind his words when he talks about her. Peck is a man easily taken by emotion. At Mi Rancho a few nights earlier, as we were getting ready to leave, the topic turned briefly away from flies. As I rose from my chair I heard Peck say, to no one specific, “I just love bees.” The word love breathy with feeling.