Dracarys!

'House of the Dragon' Episode 2's maggot scene is scientifically accurate

“They’ve saved so many lives.”

The appeal of the Game of Thrones universe is how it combines modern principles with a Middle Ages aesthetic. The politics can feel like an episode of Succession or The Sopranos, but it’s happening against a backdrop of violent jousting tournaments and medical procedures based on the theory of the four humors.

In Episode 2 of House of the Dragon, a gruesome medical technique used on King Viserys may seem like a relic of the Dark Ages, but it’s actually still used today. We’re talking, of course, about that memorable moment when Viserys plunges his rotting ringer into a wriggling bowl full of maggots.

It might seem like high fantasy, but maggot therapy is a real thing used by doctors today. And some are worried that House of the Dragon could do more harm than good when it comes to distagmatizing the practice. Inverse spoke to one expert to get the truth behind King Viserys Targaryen’s creepy and crawly treatement.

House of the Dragon and maggot therapy

In House of the Dragon Episode 1, we saw King Viserys with what looks like a bedsore on his back. His maester suggests leeches, a common (but pretty useless in this case) medical technique in the Middle Ages. But in Episode 2, we see a necrotic finger treated with another creature — maggots.

Maggot therapy is, in fact, a real medical treatment still in use today. It’s used, just like in House of the Dragon, for “debridement” — the removal of necrotic (dead) skin from the body. Dr. Yamni Nigam, professor of health care science at Swansea University, tells Inverse the treatment has been around for millennia.

“The oldest record of the positive association between maggots and human wounds is in the Bible, in the book of Job,” she says. “We know there are reports of ancient tribes and cultures, in the Mayan Indian tribe they were known to soak cattle blood on white cloth and hang it up to the sun where it was infested with flies that laid their eggs, they would hatch into maggots. The minute that that cloth was wriggling, they’d put it on various lesions.”

King Viserys is treated by Red Keep staff for a wound on his back.HBO

Maggot therapy in modern times came into use again during the Napoleonic wars. Soldiers who had their wounds infested with maggots had a lower rate of infection. After World War I, Dr. William Baer grew a colony of maggots and, in 1929, started purposefully infecting wounds for the purposes of debridement.

With the rise of antibiotics, however, maggot therapy fell out of use. But now, there’s a new fight that’s bringing the old-school methods back into vogue.

“We used antibiotics for everything,” Nigram says. “We’d take them if we had an itch or a sore throat or whatever. It was fab until the ’80s when we really realized that we are losing this battle against bacteria because they’re evolving resistance to all of our drugs.”

In response, the use of maggot therapy rose throughout the ’80s and ’90s. Now, medical maggots are FDA-approved and available to prescribe for chronic wounds like diabetic foot ulcers and pressure ulcers.

The science of maggot therapy

Maggots for maggot therapy on leg ulcers at an NHS-funded walk-in clinic.John Giles - PA Images/PA Images/Getty Images

Why are maggots so effective? They’re simply more precise than any scalpel could be when it comes to removing dead tissue. Unlike surgical debridement, there’s no chance of any healthy tissue being harmed. That’s because the species approved for maggot therapy, Lucilia sericata, only eats dead tissue.

“It will starve on healthy tissue,” Nigam says. Medical maggots are also raised in a sterile environment, so there’s no possibility of further infection.

Still, there’s a stigma around placing maggots (a creature usually associated with decomposition and death) on a living person. Nigam sees this all the time. She’s had grant funding rejected because it was related to maggots, and is trying to fight this stigma with her Love a Maggot educational campaign.

Unfortunately, the use of maggots in House of the Dragon isn’t exactly doing the work to show how this is actually useful. Instead, the HBO show basically equates it with every other laughably ineffective medical treatment on the show — like those leeches. Nigam just hopes the show doesn’t take this plotline too far.

“What I really don’t want is that he will die because of his wounds,” Nigam says. “I hope they don’t show that maggots weren’t able to help because we know that maggots can really help wounds. They’ve saved so many limbs from amputation, so many lives. It’s all in the literature.”

House of the Dragon is now streaming on HBO Max.

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