LONDON (Reuters) - Phyllis Hulme's family and friends were aghast when she told them doctors planned to put maggots on her leg ulcer.
"I got some horrified looks. I think they thought: she's old, she doesn't know any better, she's gone a bit gaga," said the 81-year-old, who suffers from diabetes.
"But it's been marvelous. I used to feel like screaming sometimes, the pain was so bad, and the first night they were on the pain went."
It may sound gruesome, but it turns out that maggots are remarkably efficient at cleaning up infected wounds by eating dead tissue and killing off bacteria that could block the healing process.
Maggot medicine, in fact, has a long history. Napoleon's battle surgeon wrote of the healing powers of maggots 200 years ago, and they were put to work during the American Civil War and in the trenches in World War One.
With the arrival of modern Antibiotics in the 1940s, however, maggots were consigned to the medical dustbin.
Now a new generation of physicians, keen to cut back on Antibiotic use, is waking up to the creatures' charms. Some believe maggots are one of the most effective ways of treating wounds infected by the superbug methicillin-resistant Staphylococcus aureus (MRSA).
In a bid to prove the case for maggots conclusively, Dr Pauline Raynor of the University of York is recruiting 600 patients across Britain for the world's biggest ever maggot trial.
Her three-year study is being keenly watched by doctors and wound care specialists around the globe.
One third of patients -- selected at random -- will be treated with loose maggots, held in place by a dressing; one third with maggots contained in a gauze bag; and one third with hydrogel, a standard wound-cleaning therapy.
DON'T BE SQUEAMISH
So far, most patients have been enthusiastic -- once they are reassured that the sterilized greenfly larvae will not start burrowing into healthy flesh.
"These maggots are only interested in dead and unhealthy tissue. Rather than strip a leg, they will start eating each other instead," Raynor said.
"Some patients obviously aren't very keen, but we've found the majority are willing to take part. It has not been a problem in terms of squeamishness."
The maggots are tiny when applied to the wound but can grow to half a centimeter after they have eaten their fill.
In the long run, maggots could save patients a lot of pain -- and governments a lot of money -- if wounds heal faster.
Britain alone spends some 600 million pounds ($1.15 billion) a year treating leg ulcers, which affect 1 percent of the population and can persist for years.
Conventional treatment may take months, while maggot therapy normally involves just two or three sessions, each of 3 days.
Dr Kosta Mumcuoglu of the Hebrew University Hadassah Medical School in Jerusalem, who has been practicing maggot therapy since 1996, says international interest in the treatment is growing fast.
"It's becoming much more acceptable. It is changing from an alternative treatment to a conventional method," he said.
Last year, the U.S. Food and Drug Administration approved maggots as a "medical device" and Britain has also made them available on prescription within the National Health Service, demonstrating how maggots are entering the mainstream, he said.
Mumcuoglu is president of the International Biotherapy Society, which supports the medical use of living organisms to fight disease -- including bee venom for rheumatism and leeches to clear congested blood in plastic surgery.
He estimates there are now 2,000 practitioners of maggot therapy and more than 20,000 people have been treated since the mid-1990s, mainly in Britain, Germany, the United States and Israel.
That has created a niche business in breeding surgical grade fly larvae. Produced from sterilized eggs, a batch of maggots for treating one wound sells for around 80 to 100 pounds ($153-$192.
Commercial companies already exist in Germany, and the Biosurgical Research Unit at the Princess of Wales Hospital in Bridgend, Wales -- Britain's sole maggot breeder -- plans to spin off its production operation in April to create a new firm, Zoobiotic Ltd, with the backing of venture capitalists.
"We've got big ambitions," said unit head Dr Steve Thomas, who will be technical director of the new firm. "There has been a substantial increase in demand in maggot usage over the last 5 years, and it's growing year by year."