Richard Atwood

Maggots: A Treatment of Hemophilia?

Laurie Kelley June 15, 2024

I’ve been doing a lot of gardening this spring, and have come across helpful and lowly creatures like snails, earthworms and spiders.

This got me thinking of other helpful creatures, like… maggots.

I detest flies with all my heart. But I realize that maggots—the larva form of flies—have had many uses to both animals and humans. They break down carrion; they eat dead flesh from wounds when there is no other treatment. And they have been used historically to treat complications from hemophilia.

Excerpted from our national archivist, Richard Atwood, from North Carolina:

In 1937, Frederick J. Pohle MD and Stephen Maddock MD at the Thorndike Memorial Laboratory and Harvard Medical School in Boston, Massachusetts reported on the treatment of an infected wound with maggot therapy in a severe case of hemophilia. I.G. was a single, nineteen-year-old, 150-pound, Jewish youth who was first diagnosed as being a “bleeder” at age six when a small cut on the buccal mucous membranes bled for twelve days. The symptoms of easy bruising were followed by frequent hemarthroses in his knees, ankles, and elbows. There was no family history of hemophilia.

Earlier in 1932, an attempt to forcefully correct a bent left knee resulted in a severe hemorrhage that was controlled with three blood transfusions. Then a hemorrhage developed in the left calf muscles, the posterior skin broke down, and the extensive infected wound did not completely heal for one year even with constant care by the physicians.

I.G. had recurrent hemorrhages into both knees and had not walked for the previous five months. On January 18, 1937, I.G. was admitted to the hospital with the chief complaint of “swollen knees.” There was moderate effusion in both knee joints and restricted motion due to pain. An x-ray examination revealed chronic degenerative arthritis. With the patient confined to bed, the knees were treated with radiant heat and active and passive exercises. After a spontaneous hemorrhage into the right calf muscles on February 4, the leg was elevated, immobilized, and packed with ice. Then two transfusions totaling 500 cc. of whole citrated blood during the following 44 hours stopped the bleeding and opiates relieved the pain. The lower right leg was swollen to three times its normal size. After several large blisters containing brown fluid developed on the posterior side of the right leg, a sterile dressing was applied daily. The blisters ruptured on the twelfth day discharging large amounts of blood-tinged liquid. The calf developed a deep denuded area measuring 6 by 15 cm. and the back of the knee developed a lesion that refused to heal due to pressure necrosis and low-grade infection. The right knee, with a 25 degree flexion deformity, was treated with baking and massage, and the drop right foot was treated with electrical stimulation.

At five weeks after hemorrhage the infected wounds were not healing. There was a daily fever between 100° and 102° F. Maggots—yes, maggots— were then placed in the infected wounds with additional maggots added daily as necessary. The dressings were changed daily. One week later, the patient’s temperature dropped to normal and much of the old blood clot and necrotic material had been removed by the maggots. The wound measured 4.5 cm. in depth and exposed the gastrocnemius muscle. Maggot therapy continued for four weeks entirely clearing up the infection and rapidly healing the wound. A clean granulating area of 1 by 5 cm. remained that was treated with an application of warm boric acid packs and was healed in two weeks. There was no evidence of bleeding during maggot therapy. After three months of therapy, the wound was healed. I.G. became ambulatory and was discharged on May 8, 1937.

In 1963, C.B. Kerr MB at the University of Sydney, Australia, reported a case with R.D., a 32-year-old with mild factor IX deficiency. A rotary mower injured his right big toe. R.D. had bleeding from at least six lacerations and had a severe staph infection. Even with wound cleansing, local hemostatics, adequate plasma for 72 hours and appropriate antibiotic therapy, control of the hemorrhage and infection required 14 days in the hospital. After another 14 days, amputation was considered necessary. Then during a hot weekend, several maggots developed within the dressing and thoroughly cleaned the wound. Healing was complete in ten days.

Maggots helped clean wounds in people with hemophilia. The abominable fly was proven to have a place in helping those with injuries, hemophilia or not, and an important role in medicine.

References:

Kerr CB. 1963 The Management of Haemophilia. Glebe, New South Wales, Australia. Australasian Medical Publishing Company Limited.

Pohle FJ and S Maddock. 1937 Maggot therapy in an infected wound in hemophilia. Journal of the American. Medical Association 109:2055-6, December 18.

Hemophilia and Poetry

Laurie Kelley April 28, 2024

To finish up National Poetry Month, let’s consider two more poets with hemophilia.

by Richard J. Atwood

To me, poetry specializes in the efficient expression of emotions and descriptions. It condenses writing into a purer form. You might compare poetry to the fractionation and purification of blood plasma to get the purest factor proteins, but I guess that metaphor would be a stretch.

Though I’m not an expert, I admire well-written poetry. Take time to read the exceptional works by the following poets who happen to have hemophilia.

Read My Mind by Jerome Stephens

Kildanore Press, 1990

Jerome Stephens (1955–1993) was born in Ireland with mild factor VIII deficiency. As he grew up, he was careful to avoid physical injuries and unnecessary knocks, and became a strong and robust young man who enjoyed outdoor activities. Living in Dublin, Jerome married and had children. In 1982, he underwent an appendix operation and was treated with contaminated factor concentrate imported from America. He was diagnosed with AIDS in 1987.

            Jerome was an artist who expressed himself through sculpture and poetry. But he is better known for speaking out publicly—the first to do so openly for a television camera—about how AIDS had ravaged his life and family. With encouragement from his hemophilia nurse, Jerome published Read My Mind, a collection of 52 poems that includes photographs of six wooden sculptures carved by the poet. He does not mention hemophilia. Instead, his poems emphasize his struggles, and how his love and religion, along with his family and friends, strengthened him to fight.

            Jerome wanted to speak on behalf of all Irish people with hemophilia and AIDS. His poems still capture that desire. After he died, his daughter spoke on his behalf in 2000, giving emotional testimony at the Lindsay Tribunal, after which those infected with HIV or their families received a financial settlement.

4:56: Poems by Carlos Fuentes Lemus

Dalkey Archive Press, 2012

Carlos Fuentes Lemus (1973–1999) was born to a literary family: his father, Carlos Fuentes, was a Spanish-language Mexican novelist and ambassador to France; his mother, Silvia Lemus, was a journalist. Carlos was a Mexican citizen who grew up mostly in Princeton, New Jersey, with short stays in various American cities where his father taught.

            Carlos was factor VIII deficient and was infected with HIV by 1985. Carlos was a bright student, but never finished high school. He immersed himself in literature (mainly English) and in music. His interest in pop culture and the arts led him to become a writer, poet, photographer, painter, and movie director.

            Carlos wanted to publish his first book of poetry after E. Shaken Bumas solicited several of his poems for the Minnesota Review in 1999. Bumas helped to record over 50 of Carlos’s poems that were to be used as the soundtrack for Carlos’s unfinished movie Gallo de Pelea. Unfortunately, Carlos died before completing those projects. Instead, his poems were posthumously published in 4:56: Poems. Written in English with some Spanish words and syntax, the poems delve into imaginative interpretations of youthful experiences. There is no mention of hemophilia in these lively poems that seem almost experimental or unfinished. Carlos also collaborated with his father on the book Retratos en el Tiempo (1998), in which his father wrote profiles of famous people he knew and Carlos took their photographs.

Poetry is an international genre that appears in many forms. These two poets with hemophilia did not have to include their bleeding disorder in what they wrote, but having it possibly sparked their passion to write. Maybe you’d like to express yourself in a poem? Go ahead! Dream, compose, write.

This review originally appeared in the Parent Empowerment Newsletter, May 2016

An Irish Genealogy of Hemophilia—and a Mystery

Laurie Kelley March 11, 2024

With St. Patrick’s Day coming up, I thought it would be interesting to look at an Irish tale involving hemophilia. From our archivist and researcher from North Carolina, Richard Atwood: “Ghosts of the Missing (2020) is a cold case missing person mystery that accurately portrays hemophilia, then weaves it into the multigenerational story of missing girls and their ghosts. The author, Kathleen Donohoe, who serves on the board of Irish Americans Writers & Artists, lives in Brooklyn, New York.” From Amazon: In the vein of The Lovely Bones and The Little Friend, Ghosts of the Missing follows the mysterious disappearance of a twelve-year-old girl during a town parade and the reverberations of this tragedy throughout the town.

William Moye builds his foundry in the Hudson River Valley in what will become Culleton, New York. Irish-Catholic immigrants work in the foundry, which specializes in creating bells. The workers live in the shantytown called Cullytown. Helen Dunleavy, age 16 with green eyes, arrives in 1856 to work in the Moye household. She comes from Ballyineen (or Daughtertown) in Galway, Ireland. Dunleavy women are healers: they have the ability to cure. The women are also cursed: girls live, while the boys die in infancy. Helen brings to America the cure and the curse, or broken gene (later identified as factor VIII deficiency or hemophilia A). Her son dies, while her twin daughters, named Clara and Lucy, live. Clara does not have the gene. Lucy has it and passes it on.

Cassius Moye, the son of William, is born in 1843. He is captured during the Civil War, and develops tuberculosis. When he returns home, he writes The Lost Girl and Other Stories. His cousin Augustus runs the foundry. At his death in 1884, Cassius passes the Moye House to his publisher, who eventually sells it to Marjorie Moye Pearse, a descendant of Augustus, in 1946. The Moye House Writers’ Colony is established in 1953 to be located in the house where Cassius Moye was born. Culleton holds a Lost Girl celebration every October 27. Cecilia Burke, a descendant of Lucy Dunleavy, marries Daragh McCrohan and has two sons, Michan and Cathal. Both sons have hemophilia. Their factor VIII is a miracle treatment: it saved them before it killed them. “Factor VIII was a blood product manufactured as a powdered concentrate that caused blood to clot.” (p. 79). Michan, born in 1967, is spared HIV due to immunity or resistance, but acquires Hepatitis C. He becomes a poet and a professor at Gilbride College.

As a bachelor, Michan takes up residence in Moye House and publishes Lost Girls: An Anthology of Stories Written at Moye House Writers’ Colony. Cathal and his wife Lissa acquire HIV and die of AIDS, while their daughter Adair develops AIDS. Michan brings the orphan Adair, then 11, to Moye House in 1994. Rowan Kinnane is a fifth cousin of Adair McCrohan (Helen Dunleavy is four times great grandmother to both girls). Rowan, a descendant of Clara Dunleavy, befriends Adair, who is shunned at school for having AIDS. On October 28, 1995, Rowan, aged 12, disappears under suspicious circumstances. The police never solve her case.

Adair starts HAART treatment, an antiviral cocktail, in 1996. Adair experiences visions of Rowan. In 2010 while living in Brooklyn, she stops taking her medicines to be hospitalized with pneumonia. She returns to Moye House under the care of Michan, once again. Ciaran Riordan, a stepbrother of Rowan living in Ballyineen, Ireland, enrolls in the Moye House Writers’ Colony to research missing children, including Rowan. Both Adair and Ciaran investigate the disappearance of Rowan by eliminating suspects and finding clues associated with the rowan tree, or quicken tree, located next to the Rosary Chapel and a book of magic called A Charm for Lasting Love: Spells and Cures from Ireland, that includes a cure for the chronically ill.

Adair McCrohan explains hemophilia: “Culleton had known for a century that my family was cursed. Boys die. Girls live. At least this was how they put it before the disease was called by its proper name: hemophilia. From the Greek: haima = blood + philia = to love. Though ‘to love’ in this context is interpreted as “tendency to.” The blood doesn’t clot properly. Tendency to bleed. Women are carriers. Their sons get the disease but their daughters don’t.”

Concussions and Hemophilia

Laurie Kelley September 4, 2022

Recently, a mother posted a question on a Facebook mothers’ group: how did everyone feel about allowing their child with severe hemophilia to go on roller coaster rides?

It’s a great question. During summer, I usually rerun one of our most popular “As I See It” pieces, on rollercoasters and head injuries, by the now retired but always great Dr. Richard Lipton, formerly of Long Island Jewish Hospital.

Also recently, our amazing archivist, Richard Atwood, of North Carolina, sent to us his review of the 2015 movie “Concussion,” starring Will Smith, about the discovery of chronic traumatic encephalopathy (CTE). It’s a fabulous movie, based on a true story, that uncovers how repeated head blows can lead to degenerative brain functioning. Hemophilia is mentioned in the movie.

Richard writes: “I’m surprised that the hemophilia community didn’t acknowledge this movie when it was released. Of course, it’s Hollywood. While the facts may be inaccurately portrayed, the movie still tells the important story of CTEs.”

So while there might be still time to visit an amusement park before summer ends, read this review, watch the movie and also read our article by Dr. Lipton.

During September 2002, in a Pittsburgh, Pennsylvania courtroom, Dr. Bennet Omalu testifies as an expert witness at the retrial, after the successful appeal, for a convicted murderer named Thomas Chambers. Dr. Omalu presents his credentials: medical degree from the University of Nigeria, residency at Columbia University, master’s degree in public health for epidemiology, board certification in pathology, certified physician executive in emergency medicine, completing an MBA at Carnegie-Mellon University, and a master’s degree in the theory of music from the Royal School of Music in London.

Dr. Omalu displays a blown-up photo of the hands from the female murder victim, showing blood, scratches, and torn fingernails, to demonstrate how she fought her killer, and lost. Dr. Omalu also displays a blown-up photo of the hands of the defendant, showing blood from the victim, but no wounds. Chambers claims that he only touched the female victim to aid her. Dr. Omalu is puzzled by these photos. He learns from the medical records that Chambers stated, “I hate blood,” because as a child, after he had a tooth pulled, the bleeding did not stop. There is a history of hemophilia in the family, yet Chamber’s father, when asked, stated that there is none. Dr. Omalu tests for a strain of hemophilia A so rare that it is not tested for. Thomas Chambers tests positive for hemophilia A. Dr. Omalu claims that if Chambers were scratched or bitten, then he would bleed to death. Therefore, convicting Chambers to a death sentence would be killing an innocent man.

Dr. Omalu, the most junior coroner in Pittsburgh, Pennsylvania, is on call when the body of Mike Webster, age 50, a former Pittsburgh Steelers football player, is brought to the morgue after his suicide. Dr. Omalu, at his own expense, studies Webster’s brain. When he finds tau protein in the brain slides, similar to the effects of Alzheimers’ disease, Dr. Omalu calls the condition Chronic Traumatic Encephalopathy (CTE). He publishes his case report in a medical journal. The National Football League disputes the scientific proof of CTE being caused by football collisions because, according to the NFL, football players do not experience concussions. Dr. Omalu finds CTE in the brains of other deceased former professional football players, but the NFL continues to dispute the results, even snubbing Dr. Omalu at a medical conference on concussions.

This movie is based on a true story. The Special Features selection on the DVD includes a short documentary film called ‘Inside the True Story.’ The real Dr. Bennet Omalu, Dr. Julian Bailes, Dr. Cyril Wecht, and Dr. Ronald Hamilton are interviewed. The viewer can compare these individuals to the actors who play them: Will Smith, Alec Baldwin, Albert Brooks, and Stephen Meyer. The author Jeanne Marie Laskas, who wrote the article and the book about Dr. Omalu’s discovery of CTEs and his fight with the NFL, is listed as a consultant in the movie credits. Hemophilia is mentioned only in the short opening courtroom scene, in which Dr. Omalu is introduced to the movie audience. The movie states that certain names and situations have been altered, and this is evident from the retrial of the real individual with hemophilia named Thomas Kimbell (not ‘Thomas Chambers’), who never touched any of the four murder victims (not just one female). Will Smith does not exhibit the real Dr. Omalu’s short height, shrill voice, or shrieking laughter, and even tones down his Nigerian-formal English accent, yet he still portrays a convincing character role.

Concussion, 2015, Sony Pictures. Writer and Director: Peter Landesman

Cast: Will Smith, Alec Baldwin, Albert Brooks. Rated PG-13; 2 Hrs. 3 Mins.

Remembering Fathers in Hemophilia: Samuel Appleton

Laurie Kelley June 19, 2022

A tribute on Father’s Day to the first known father of a son with hemophilia in the Americas

by Richard Atwood

I search for intriguing stories about people with bleeding disorders. By discovering those stories, including historical ones, I always learn something valuable. Often, I find inspiration in the stories of other family members, as in the case of the Appletons, who were connected with the powerful origins of our country.

One father of a child with hemophilia was Major Samuel Appleton (1625–1696). His son, Oliver Appleton, was the first person identified with hemophilia to be born in the American colonies.1 Samuel spent a lifetime in public service fulfilling legislative, judicial, and military roles. He stuck to his principles about the illegality of improper taxation, and he remained calm in times of distress—during battle, and during the infamous Salem witch trials.

Samuel was only 11 when his family left England to settle in the Massachusetts Bay Colony in 1636. His father, also named Samuel, was one of the original settlers of historic Ipswich. The family owned a house and eight acres in town, and a 400-acre farm on the Ipswich River. 2

One of five children, Samuel grew up to help run the family farm and businesses. He married Hannah Paine in 1651, and they had three children. After his wife’s death, in 1656 he married Mary Oliver (1640–1698), a hemophilia carrier, and had eight more children, including Oliver in 1677. Oliver’s bleeding disorder was noted by family members, but probably not as a genetic condition. Only later, in retrospect, did family members realize the distinctness of the bleeding.

Due to periodic threats of Indian attacks, Samuel Appleton led the local militia. From lieutenant in 1668, he rose to the rank of captain during King Philip’s War, and commanded an infantry of 100 men. At the decisive battle near Hatfield along the Connecticut River in 1675, Samuel was commander-in-chief of more than 500 men. A turning point for the colonists, this battle proved that the Indian warriors could be defeated. During the fighting, a bullet passed through Samuel’s hair. If he had died then, his son Oliver with hemophilia would never have been born.

Samuel held several elected offices. As a legislator, he was a commissioner of Essex County in 1668. He was a representative of the General Court from 1669 to 1680. And he served on the Governor’s Council from 1681 to 1692. Appleton opposed the government of the colonial governor, Sir Edmond Andros. When in 1687 Andros levied a tax of one penny on a pound, the town of Ipswich refused to collect the tax, stating that it was against the rights of Englishmen for any taxes to be levied without consent of an assembly chosen by landowners, or “freeholders.” An arbitrary and illegal warrant was issued for the arrest of Samuel and other leaders in the opposition to the tax. Samuel took refuge in Saugus, where he stood on a rock and denounced the government. A Massachusetts historical marker now acknowledges the site as “Appleton’s Pulpit.” Refusing to apologize, Samuel was imprisoned in November 1687. He petitioned in January for his release due to his age and weakness, but wasn’t freed until March 1688, when he posted a 1,000-pound bond.

In 1689, during the coup of crown-appointed Governor Andros, Samuel and other leaders in the Massachusetts Bay Colony put Andros on a boat to the island prison in Boston Harbor. Colonial revolutionaries 100 years later simplified the opposition to taxes with the slogan “No taxation without representation.” But it’s important to remember that the ideas for the American Revolution began long before 1776: to be properly recognized, Ipswich adopted the motto “The Birthplace of American Independence 1687.”

Samuel Appleton served on the judiciary. He was a deputy to the Massachusetts General Court from 1668 to 1681. As a member of the Council of Assistants from 1681 to 1686, Samuel attended the examination of accused witches in Salem on April 11, 1692. His role may have been minor; he isn’t always listed as one of the seven judges. And apparently he did not serve as a judge in any of the trials that executed 20 alleged witches in 1692. On May 2, 1693, the first Supreme Court convened in Ipswich to try Andover residents charged with witchcraft. As a judge at that hearing, Samuel cleared everyone accused of witchcraft, ending the infamous witch trials and demonstrating his rationality. During the hysterical witchcraft proceedings in Salem, Oliver Appleton was a 15-year-old with hemophilia living at home in Ipswich.

The story of Major Samuel Appleton reveals essential information about colonial America. Some of our defining principles that we cherish today were sown by the colonists years before the revolution for independence. We need to honor those colonial leaders for their contributions, and remember that Major Samuel Appleton also raised a son with hemophilia.

1. “The Appletons: America’s ‘First Family’ with Hemophilia.” PEN, Nov. 2002.

2. That farm still exists today. Called Appleton Farms, it is the second oldest continuously run farm in America, now administered by the Trustees of Reservations, a nonprofit conservation organization in Massachusetts.

© 2016 LA Kelley Communications, Inc. Reprinted with permission. All rights reserved.

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