Reading: Matching Headings: Question 7

A Long before modern medicine understood why, military surgeons occasionally noticed something strange on the battlefield: wounds that had been colonised by fly larvae sometimes healed more cleanly, and with less infection, than wounds kept meticulously free of insects. Physicians serving with Napoleon's army and, later, doctors treating casualties of the First World War recorded similar observations among soldiers whose injuries had been left unattended in the field for several days.

B It was the American orthopaedic surgeon William Baer who, having witnessed this pattern among wounded soldiers during the First World War, deliberately introduced sterilised fly larvae into the wounds of patients under his care during the 1920s. Baer's early results were striking enough that maggot therapy, as it became known, was soon adopted by a number of hospitals across the United States as a recognised treatment for wounds that would not otherwise heal.

C The therapy's rise was, however, short-lived. Following the discovery of penicillin and the subsequent development of other antibiotics from the 1940s onward, physicians increasingly turned to pharmaceutical drugs that could be administered as an injection or a tablet, rather than a treatment that required live insects to be placed directly onto a patient's skin. Within a few decades, maggot therapy had all but disappeared from mainstream medical practice.

D Interest in the treatment has revived considerably since the 1990s, largely because of two related problems: a growing number of bacterial strains that no longer respond to standard antibiotics, and a rising incidence of chronic wounds, particularly diabetic foot ulcers, that resist conventional treatment for months or even years. For patients facing these conditions, maggot therapy has re-emerged as a viable option where other treatments have failed.

E In current clinical use, the larvae of a specific species, the green bottle fly, are bred and sterilised under laboratory conditions before being placed inside a fine mesh dressing over the wound. As they feed, the larvae consume only dead and infected tissue, leaving healthy tissue largely undisturbed, while also secreting substances that appear to have an antimicrobial effect on the surrounding area.

F Despite this clinical effectiveness, uptake of the therapy remains limited by a factor with nothing to do with its medical merit: many patients report finding the idea of live larvae on their skin distressing, and some hospital staff share this reaction. Overcoming this discomfort, clinicians note, is often a greater obstacle to wider adoption than any remaining question about the treatment's efficacy.

The passage has six paragraphs, A–F.

List of Headings i. Early observations that wounds containing insect larvae healed unusually well ii. The mechanism by which larvae clean a wound iii. A treatment introduced into formal medical practice after wartime observation iv. Two modern medical problems have revived interest in an old treatment v. Patient discomfort remains an obstacle to wider use vi. Legal restrictions on breeding insects for medical use vii. A treatment abandoned once a faster alternative became available viii. International regulation of larval therapy products

Choose the correct heading for each paragraph from the list of headings below.

Paragraph A Paragraph B Paragraph C Paragraph D Paragraph E Paragraph F