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Would you rather have a festering wound that won't seem to heal, or have these guys inside you for awhile to heal things up? Your choice—under certain circumstances—but it could make all the difference.

Most people today would scoff at doctors in previous centuries who used leeches to extract diseased blood from patients (as seen in this circa-16th-century image). But actually leech therapy is making a comeback.

You may not want to get up close and personal with the suckers of a leech (shown here slightly magnified), but in certain hospitals and under certain conditions today, doctors very well might recommend that you do.

9.15.2005 Maggot Medicine

Robert Krulwich and Jonah Lehrer

Jonah Lehrer: I've got a multiple-choice question for you.

Robert Krulwich: Fire away.

Lehrer: Let's say you're a diabetic, and you've got a terrible and infected wound on your foot that just won't heal. What should your doctor do:

apply lots of antibiotics, the stronger the better
just flush the wound with water and wait
feed the wound with thousands of hungry maggots

Krulwich: You gotta be kidding me. That's the easiest question ever. Of course, the answer is a. Put endless amounts of the strongest possible antibiotic cream on the wound. That should clear the infection right up.

Lehrer: Actually, you're completely wrong. The answer is c. For a truly festering flesh wound, maggots are a very valuable treatment. In fact, maggots are often better than anything else modern medicine has to offer.

Krulwich: I don't believe you. This is the 21st century. We can watch babies in the womb and transplant hearts. We can perform brain surgery. And you have the gall to tell me that doctors are using maggots? Do I look especially gullible today?

Lehrer: Wait. It gets worse.

Krulwich: It couldn't possibly get worse. You've already supplied me with my next nightmare.

Lehrer: Well, prepare for another nightmare. What is the only thing more disgusting that having maggots in a wound?

Krulwich: I don't know. Maybe having a leech sucking my blood.

Lehrer: Exactly.

Krulwich: Oh, no you don't. There is no way modern medicine is using leeches. No way.

Lehrer: Way.

Krulwich: What possible good could a leech do? I thought we gave up all the bloodletting stuff hundreds of years ago.

Lehrer: We did, and we made a mistake. Take this scenario. Let's say your finger gets cut off. Luckily, you find the finger, pack it in ice, and rush off to the emergency room, where doctors are able to reattach the digit.

Krulwich: Eeeww. I hope this story has a point.

Lehrer: Unfortunately, these types of reattachment surgeries often suffer from serious circulatory problems. After surgery, blood tends to engorge the reattached body part. And because the blood isn't circulating, it will clot and kill the flesh. This is where leeches come in. Leeches come with their own pharmacy. They naturally inject patients with an anticoagulant to keep blood moving, an anesthetic to dull the pain, and an antibiotic to prevent infection. Pretty high-tech, huh?

Krulwich: I still don't get how attaching a slimy vampire to my finger helps anything.

Lehrer: Well, the leeches encourage bleeding, which prevents blood from gathering in the newly reattached part. Leeches also encourage the growth of new veins.

Krulwich: Personally, I might prefer a four-fingered hand, but I can see how leeches might be useful under certain post-surgical conditions.

Lehrer: Actually, leeches are so useful that the Food and Drug Administration is now trying to figure out how to regulate them. According to the FDA, leeches—like maggots—are just another medical mechanical device.

Krulwich: Last time I checked, most medical devices didn't want to suck my blood.

Lehrer: You're so 20th century. This is progress. Imagine how tough it would be to engineer a tool as complicated and effective as a leech. Here is an invertebrate perfectly engineered for its new medical purpose.

Krulwich: You're calling me old-fashioned? I'm not the one advocating a return to an ancient medical practice. Ever since Hippocrates, misguided doctors have been using leeches to treat just about everything. In fact, I remember hearing stories about how leeches used to be so popular that the French and German governments had to set up farms for leeches, which they would feed with old horses.

Lehrer: Poor horses. But to answer your question, doctors are not using leeches the way those 19th-century doctors did. In other words, bloodletting by leeches will not cure obesity or migraine headaches or pneumonia. Leeches are really only useful for dealing with the aftereffects of microsurgery.

Krulwich: Fine. Maybe I would put a leech or two on my finger if they let me keep it. I like having five fingers. But maggots? What could maggots possibly be useful for?

Lehrer: As I mentioned earlier, maggots are useful for treating wounds that can't be helped by conventional methods. They are a last-ditch resort before amputation, because they help remove dead tissue and expose healthy tissue, a process called debridement. Hopefully, once that dead tissue is out of the way, the body can begin repairing itself.

Krulwich: I have to lie down. This really is straight out of my nightmares. The idea of creepy-crawlies eating my insides makes me sick.

Lehrer: You're probably one of those people who faints every time you see a needle. Of course, no doctor likes the idea of using maggots. But sometimes, there really is no other viable option. And when it comes to healing gangrenous wounds, maggots held in place by wire-mesh bandages are unparalleled. There is nothing better.

Krulwich: So is this the start of a whole new range of gross, ancient, but strangely effective medical treatments? Are leeches and maggots just the beginning?

Lehrer: Probably not. You won't see witches brewing up potions in hospitals anytime soon. But the fact is, there are many old-fashioned treatments that medicine used to think of as being cruel and worthless that are now being reevaluated.

Krulwich: Like?

Lehrer: How about electroshock therapy?

Krulwich: Don't tell me we're still doing that. Isn't that what they used on Jack Nicholson in "One Flew Over the Cuckoo's Nest"?

Lehrer: Yup. Electroshock therapy, or ECT for short, went out of fashion for about 30 years. It was regarded as cruel and useless. But now ECT is back. No one quite knows how or why it works, but for many patients who can't be helped by drugs or therapy, ECT is their last, best hope.

Krulwich: So I guess we should never count out any treatment.

Lehrer: Hopefully not. Medicine uses what works. Until we find better healing devices than leeches and maggots, plan on seeing them at your local hospital.

Robert Krulwich is host and executive editor of NOVA scienceNOW. Jonah Lehrer is a NOVA scienceNOW online contributing editor. He recently completed a Rhodes scholarship at Oxford University's Wolfson College.