House of the Dragon’s Gnarliest Moment So Far: Maggot Therapy

Needless to say, House of the Dragon’s Viserys Targaryen is a busy guy. Between being king, tending to his long white locks, and answering constant questions about his line of succession, this is not a man with a lot of time on his hands. We did, however, get a little down time with the king during this past Sunday’s installment of the Game of Thrones prequel—and speaking of the king’s hands, I’ll admit I was not prepared for what they were about to do.

Game of Thrones was known, among many things, for its passion for all things visceral. (Two deaths that continue to haunt me on a monthly basis: Oberyn Martell’s eye-popping demise and that one dude who got his bowels chewed out by a bunch of rats.) So far, House of the Dragon has been a little sparser with the gore—although there is, of course, still plenty of time. This week, the show did give us one genuinely gnarly moment: King Viserys sitting down for a round of maggot therapy.

Whoever did the Foley work on this scene deserves an Emmy all their own, as does whoever polished up the visuals on these squirmy worms. As the king unwraps a gangrenous finger, his assistant opens a gold jar and scoops a heaping load of maggots onto a little tray. (Nothing but the best for our ramen-haired monarch!) “The maggots will remove the dead flesh and hopefully stop the advance of the rot,” we’re told. Then all the men in the room returned to their favorite topic of conversation: Who should become King Viserys’ child bride?

I have to admit, though, I was still stuck on the bugs for several minutes afterward. (And then for a few more days after that.) Was this a real thing at one point? The medieval times were, after all, known to be metal as hell; perhaps this was inspired by real life?

It definitely was! But this is also not an ancient practice we’ve left behind. Turns out, I’ve spent more than 30 years ignorant to a pretty commonplace corner of medical science—in which clean, lab-bred maggots are used to treat necrotic flesh. Conveniently, these little guys only want to eat the dead stuff, so they’re great at removing rotting tissue while leaving the rest alone.

Last year, The Atlantic declared this “truly revolting” treatment is having its own Renaissance—even if, as University of Miami Hospital Wound Center director Robert Kirsner told the magazine, “Not everyone, psychologically, can deal with that sensation and knowing maggots are chewing on their flesh.”

As The Atlantic notes, maggot therapy has a rich history across the globe. The Mayans used it and, according to legend, so did Genghis Khan. Confederate surgeon John Forney Zacharias became among the first documented practitioners to intentionally apply maggots to wounds as a treatment course during the Civil War, and military surgeon William Baer used the technique again decades later during World War I.

Baer’s research, published posthumously, documented the surgeon’s treatment of 100 children with osteomyelitis and problematic soft tissue wounds. Hundreds of U.S. hospitals started using maggots for wound treatment in the decade after his death, per The Atlantic, but their use diminished quickly during the 1940s. (A study from the Journal of Diabetes Science and Technology blames the demise of the flies on improved antibiotics and surgical interventions that don’t carry the same “ick” factor.)

By 1950, maggot therapy had all but disappeared from published literature. Now, however, non-healing wounds are on the rise—and so, the use maggot therapy is taking flight once more.

For those wondering at home how this works—but that said, please don’t try this at home—physicians use five to 10 clean larvae per square centimeter of wound surface area. The maggots must be left to their slurping for 48 to 72 hours, at which point they can be removed.

As admittedly skin-crawly as maggot therapy might be, scientific advances now allow patients a little psychological reprieve. Perhaps most importantly, the Journal notes, the dressing materials of today have “minimized the risk of escaping maggots”—thank God—and the proliferation of laboratories and overnight courier services have also made the critters more readily available. (Because, to be clear, the maggots used in maggot therapy were bred in a lab and not scraped off the nearest garbage-can steak.)

There are “maggot confinement dressings,” which allow maggots to feast but prevent them from escaping, and pouch-like “maggot containment dressings” come with the added bonus of keeping the larvae completely out of view from both the patient and the practitioner applying them.

Some people will, as Kirsner noted, just never be okay with letting maggots feast on their flesh while they’re still breathing. Evidently, however, a growing number of patients have decided they’re willing to endure the psychological torment in order to heal treatment-resistant wounds: The Atlantic reports that by 2008, the number had risen to 50,000 times annually worldwide.

If it’s good enough for a Targaryen king, I guess it’s good enough for all of us. That said, you’ll still find me checking my pinkie fingers for signs of life every hour, on the hour, until further notice.

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