Treating a Bullet Wound with Processed White Sugar

To help heal seriously infected wounds, some surgeons have revived a 4,000-year-old treatment, born on the battlefields of ancient Egypt: they pack the depths of treacherous wounds with sweet substances like sugar.

Dressings made of sugar and honey, favored by healers throughout history, fell into disfavor with the development of antibiotics over half a century ago. But even the most sophisticated modern preparations have proved unable at times to overcome the hearty bacteria that live in deep wounds, and a handful of doctors, mostly in Europe, are turning once again to sugar ''It's a very old and very simple treatment which was forgotten for a while but is now coming back, like a fashion,'' said Prof. Rudy Siewert, chairman of the department of surgery at the Klinikum Rechts der Isar in Munich, West Germany.

Renaissance vs. Skepticism

Professor Siewert said that in the last five years the technique had enjoyed a wide renaissance in Germany and to a lesser extent in the rest of Europe. Despite the interest abroad, most American surgeons express mild skepticism.

''For the right kind of wound it works fine, and it's fun to look at an ancient remedy,'' said Dr. Mary H. McGrath, chief of the division of plastic surgery at the George Washington University Medical Center in Washington, D.C. Doctors there have used sugar to treat uninfected bedsores. ''But there are about 600 lotions and potions for healing wounds, and I think you can get a lot more effect with our contemporary local antibacterials.''

Experts say the ancient treament probably works because sugar tends to draw water into its gritty midst, through osmosis. This action both dries the bed of the wound to promote new tissue growth and dehydrates the bacteria that cause infection, leaving them weak and fragile. Several American pharmaceutical concerns make expensive wound pastes composed of synthetic microscopic water-absorbing beads that perform this same function. Revival Began in U.S. Although sugar dressings have few American advocates, Europeans ascribe the current revival in part to the work of an American, Dr. Richard A. Knutson, an orthopedic surgeon in Greenville, Miss., who published one of the few papers on the technique a decade ago.

About 15 years ago, frustrated by stubborn, pus-filled wounds filled with bacteria resistent to all drugs, Dr. Knutson began experimenting with sugar dressings at the suggestion of a retired nurse who had worked in the Deep South before the antibiotic era.

''When we started I thought it was absolutely nuts,'' Dr. Knutson said in a recent telephone interview. ''Sugar! The first thing you think about is the old jar of marmalade in the fridge growing all that junk. You think you'll create a perfect medium for bacterial growth. That turned out not to be the case.''

He has since used a salve made of sugar, which he now mixes with a mild bacteria-killing iodine liquid, on about 6,000 patients with anything from burns to shotgun wounds. The mixture is applied as a paste. ''It's easy to use, painless, inexpensive, and it works,'' he said, ''You can't ask for more. If it has a fancy name and cost $300 a bottle everyone would be buying it.'' Most European surgeons use sugar alone.

The care of deep wounds is a major challenge to surgeons. Although doctors sew up small clean cuts, the skin above penetrating injuries that are likely to be infected is generally left open, both to allow the doctors to clean the cavity and to allow the body to grow new tissue, called granulation tissue, from the deep wound base.

New Tissue Fills Wound

Over weeks to months, the wound becomes sterile and slowly fills with new tissue. Systemic antibiotics are often required to aid the healing process. Sometimes skin and muscle must be surgically moved from other parts of the body to cover areas that would otherwise never completely heal.

Using the resurrected technique, doctors alter the usual cleaning regimen by sprinkling granulated sugar or spreading sugar paste in the wound two to four times a day, before applying new bandages. The sugar liquefies somewhat as it absorbs fluid from the wound, so it is simple to rinse out the sugar, along with dead tissue, at the next dressing change.

Doctors who use the method say that even dirty injuries are often germ-free after several days and that wounds seem to heal faster and more completely than with conventional treatments.

''The granulation tissue is much pinker and healthier,'' said Dr. B. G. Spell, a surgeon at the Methodist Rehabilitation Hospital in Jackson, Miss., who says he uses the technique daily to heal infected amputations and the deep pressure sores that plague paraplegics. ''The dead tissue breaks down more easily, so there's not as much debridement,'' he said.

In a series of articles in the British medical journal Lancet over the last five years, doctors at various European medical centers have reported success using the technique in a variety of situations in which nothing else worked. Dr. J. L. Trouillet at the Hopital Bichat in Paris described using granulated sugar bought from a supermarket for successful treatment of 19 critically ill cardiac surgery patient who had mediastinitis, a frequently deadly infection of the compartment in the chest that contains the heart.

Patients expecting high-tech medicine are often surprised to find their injuries sweetened. ''The doctors had mentioned that they were going to use 'wound sugar,' but it didn't register,'' said John Tagliabue, a New York Times reporter who was shot and seriously wounded last December while covering the revolution in Romania.

Like Cookie Crumbs

His wound was packed with sugar at the Klinikum in Munich, where he was moved for treatment. ''One day I noticed this sandy material on the sheets, like crumbs from eating cookies in bed.'' he said. ''Then it hit me: They really meant sugar.''

Will the enthusiasm for the revival spread to the Americas? ''There are better treatments these days,'' said Dr. McGrath, in an opinion that half a dozen prominent American surgeons echoed in interviews. Dr. McGrath's own research includes studying the effect of molecules called growth factors, manufactured by genetically altering organisms, on a type of cell involved in healing.

''Over all, I think the Europeans are a little less rigorous in their journals,'' she said. And, in truth, despite nearly 4,000 years of use, there are no comparative scientific studies of sugar dressings to be found.

But Professor Siewert has a slightly different take on the issue. ''The American way is more scientific,'' he said, ''The European way sometimes comes more from history and experience. That's good, too.''

Other Remedies From History

Until a century ago, doctors applied leeches for almost every illness in the mistaken belief that they would draw out ''bad blood.'' Today they are used after microsurgery that reattaches fingers, toes and other body parts. An operation can fail because tiny blood vessels become clogged. But when a small European leech, Hirudo medicinalis, is attached, it sucks out an ounce or two of blood from the clogged vessels. The leech's saliva containes an anticoagulant and an antiseptic.

Maggots, fly larvae, once allowed to clean festering battlefield wounds, have been used to save the legs of a 17-year-old girl who developed a blood infection that caused clotting in her legs. Oral antibiotics could not reach the sores, so physicians at Children's Hospital in Washington D.C., applied 1,500 maggots. They ate away dead skin while allowing healthy skin to thrive.

Scientists have also validated a folk remedy for cuts used by Arab fishermen. The Arabian saltwater catfish, Arius bilineatis, secretes a slimy, gellike substance that contains proteins that coagulate blood to stop bleeding and enzymes that speed the growth of new tissue.

Photo: Dr. Richard A. Knutson demonstrating the use of a sugar paste for wounds on Richard Blake at Delta Medical Center, Greenville, Miss. (The New York Times/Vicki Van Hook); graph showing how the average number of clinic visits required for patients with serios wounds, burns or external ulcers droped sharply after sugar treatments started in '76) (source: Richard A. Knutson, M.D.)