CHAPTER 13

Wound Healing

For many years, doctors thought there was no way to speed up the healing of a wound. Nature set the pace and nothing researchers came up with seemed to help her along.

In the 1940s, however, some possibilities came up in the booming new field of vitamin and mineral research. Researchers revealed how malnutrition could slow wound healing and confirmed the body’s need for a full complement of vitamins and minerals to synthesize connective tissue. They showed that the adrenal glands need vitamins B₂ and B₅ to generate hormones and learned that patients’ adrenals are typically exhausted by the second or third day following surgery. They found that rectifying folate deficiencies alone could help many patients whose wounds failed to heal. Finally, at least eight studies proved wound healing depends on adequate vitamin C status because connective tissue cannot be synthesized without it.

Because the body doesn’t store vitamin C or the B complex for long, researchers recommended supplements for surgery patients to compensate for the fact that people in hospitals rarely eat well. While appropriate supplements can favorably influence healing from surgery, there’s another obvious takeaway: Hospital food needs a checkup—and needs to include old-fashioned bone broth as well as other nutrient-rich foods. In their wisdom, our ancestors served plenty of easy-to-digest broth and gelatin-rich foods to patients recovering from illness or injury. Modern hospitals keep up the tradition, but with industrially processed soups made from hydrolyzed vegetable protein, not bones, and gelatin in the form of sugary, brightly colored Jell-O. What patients need is nourishing broth, rich in cartilage, collagen, glycine, glutamine, and other healing components.

Gelatin was first heavily investigated as a dietary staple and wound healer during the Napoleonic Wars. Nineteenth-century researchers explored its use as a hemostatic agent to stop the loss of blood and then to build new blood. Because sterile gelatin is hypoallergenic, it even served as a plasma substitute in the treatment of severe hemorrhage or shock. During World War I, gelatin saline solutions were routinely used as emergency substitutes for whole blood transfusions, though hospital technicians were none too fond of its habit of setting like Jell-O in the tubes and cannulae if rooms were too cold. Investigators found no evidence of liver damage or impairment of kidney function from IV gelatin. Plant-based pectins and other substitutes were also tried but proved riskier and less effective than gelatin.

Though most of this gelatin research was driven by the need to help the war wounded, the scientists also found that gelatin could help bleeding from hemorrhoids, ulcers, hemophilia, dysentery, anemia, excessive menstrual flow, and childbirth. Indeed, history records its therapeutic usage as a hemostatic agent back to the first century AD. Similarly, Chinese medicine has long recommended donkey gelatin for bleeding disorders.

Gelatin biscuits, bonbons, and cubes were also heavily used as war rations through World War I. Florence Nightingale, who came to prominence as a nurse during the Crimean War, wrote in Notes on Nursing that many patients were actually starving to death because of overreliance on the nutritional benefits of “meat tea.”

By the 1930s and 1940s, interest shifted from gelatin—which had been oversold as a “wonder food” and had failed to live up to grandiose claims—to the emerging research in vitamins and minerals. The subject was new and controversial, but even open-minded surgeons who checked out the research on vitamins, minerals, and wound healing could not fail to note that the research showed they would help only patients who were seriously deficient in those substances to begin with. People who tested as clinically normal except for their wounds did not seem to benefit from supplements.

In the meantime, the research on wound healing went on, with persistent researchers testing one topical substance after another, including products as curious as colchicine, detergents, cod liver oil, and even aluminum foil. But nothing worked well or worked consistently. During the Korean War, surgeons called out in desperation for a wound-healing agent that could counteract the notoriously bad effects of cortisone. Cortisone had burst on the scene in 1949 as a wonder drug capable of stopping inflammation, fever, and pain. This it did, but with a significant downside. Inflammation is the first step in wound healing for a reason. It’s the phase in which the body dispatches microbes, foreign material, and dying tissue in preparation for repair. Take it away with cortisone and the regeneration of connective tissue is retarded—the last thing needed for the healing of a wound.

Worse, cortisone had an unseemly tendency to reopen wounds, spilling guts and gore. Young Dr. John F. Prudden, tending to severely injured Korean War soldiers as head of the wound-healing unit at Fort Sam, Houston, Texas, saw it all. “Anastomoses in the bowel fell apart, producing peritonitis. Bronchial stump closures split open. Abdominal and chest wounds fell apart. All producing fatalities.” The drug furthermore was linked to leaking blood vessels, infections, metabolic disturbances, and the creation of non-healing ulcers. Not surprisingly, surgeons considered finding a remedy a high priority. Speeding normal wound healing was highly desirable; reversing the deleterious side effects of cortisone was a necessity.

The answer to both prayers was cartilage.

Dr. Prudden didn’t discover the wound-healing properties of cartilage, but his name will be linked with it forever. In 1954, he returned to New York City from service in the Army Medical Corps to read a draft of a research paper by his old professor Raffaele Lattes, MD, MSD. It recounted a surprising discovery: Cartilage could counteract the harmful effects of cortisone on wound healing.

Dr. Lattes, a professor of surgical pathology at Columbia University, along with two other colleagues from Columbia, Karl Meyer, a biochemist, and Charles Regan, a professor of surgery, had completed a wound-healing experiment involving laboratory rats. Each rat had been equipped with tiny chambers inserted under an area of skin that was wounded with an incision. The chamber was then filled with cortisone plus a substance that the researchers hoped would counteract the drug’s unwanted side effects.

An Upstart’s Advice

Although many substances were tried, nothing worked, and the rats rallied poorly, if at all. Watching the attempts every Tuesday was J. R. Martin, a young doctor from the Royal Victoria Hospital in Montreal, who had come to Columbia-Presbyterian to study with Dr. Arthur Purdy Stout, the world-famous director of surgical pathology. As the respected older scientists tried and failed every week, the upstart started offering unasked-for advice, including the tip that cartilage chips might be just the thing to try.

“This suggestion was astonishing to the three professors for different reasons but universally rejected,” said Dr. Prudden. “But this young man was made of stern Canadian stuff and did not cease from harassing them, saying that was what they should do. Finally he drove them into a state of distraction with his constant suggestion, so they decided to humor him. They attained some cartilage chips from the knee joint of a recently amputated human leg, made it into micro chips, and placed it in the wounds in rats. Their hope was he would see it did not work, leave with his tail between his legs and stop bothering them.” Instead, the fast and positive result astonished everyone. Everyone, apparently, but the Canadian, who mysteriously disappeared before the results even came in.

“ Knee Surgery

I can’t praise bone broth enough for its therapeutic value. I suffered for eight years after knee surgery with almost constant pain and swelling. When I started drinking bone broth twice daily, the pain and swelling went down after about three weeks. It’s been several months now and my knee has been great. I’m still amazed!

—Stuart Haas, Glen Rock, New Jersey ”

Though this was a remarkable discovery, Dr. Lattes and the other eminent researchers decided they were too busy to pursue further studies. “They all sang the same song: ‘I haven’t got enough money, haven’t got enough time, too many students. I’m not going to follow up on it in the foreseeable future,’ ” said Dr. Prudden. “So I sang the song I already had sung, that I felt it was glittering with promise, that they were making a very bad mistake, and said ‘If you aren’t going to do it, then I am.’ ”

Thus Dr. Prudden began the research on cartilage that would lead from the breakthroughs in wound healing to the discoveries that oral cartilage could turn around incurable diseases such as osteoarthritis, Crohn’s disease, scleroderma, and stage four cancers.

His first step was to try to round up Dr. Martin. As he told the story, “At Columbia-Presbyterian, I heard he had gone back to the Royal Vic, but no one there had seen him, and there was no record on file of immediate family. I called the Canadian Medical Association in case he’d gone off to treat the Eskimos. I got the AMA looking for him in case he’d stayed here. Finally, I became suspicious of foul play and asked the New York Police Department if any unidentified bodies had turned up. Nothing. It’s a complete mystery. Who was this messenger from on high who came in to show me the way and then disappeared into the void?”

Unable to find Dr. Martin, Dr. Prudden got to work. For a tightly controlled experimental model, he chose to wound rats with precisely placed, carefully cut and measured incisions. To determine the speed and extent of wound healing, he decided to measure tensile strength, which is the amount of stress a wound can accept without splitting open. The key issues under investigation were why some wounds fail to attain adequate structural strength and whether it is possible to achieve this strength earlier than usual.

Most of these wound-healing experiments involved pairs of laboratory rats who were purposely wounded with incisions. In each case, one of the rats was treated with cartilage powder, which was applied as a thin “frost” on the edges of the wound, and the other received none. After a given period (usually seven days), the researchers removed the sutures and evaluated the wound strength by inflating a balloon in the peritoneal cavity until the wound broke open. This proved the cartilage-treated wounds gained tensile strength more quickly and helped Dr. Prudden ascertain the rate of gain.

Further investigation involved testing cartilage in the form of pellets implanted under the rats’ skin. Even when implanted far from the wound, they had a good effect. Studies by other researchers followed, including one by Dr. John C. Houck of the Biochemical Research Laboratory at the Children’s Hospital in Washington, DC, who proved that cartilage aided the healing of the chronically inflamed, tumor-like lesions known as granulomas. Treated by cartilage, they healed in a mere fifteen days compared to twenty-eight days in the control group.

Most of the rats in the early experiments were hale and hardy, a fact that raised an obvious question about how well cartilage would do on sicker specimens. After all, hospitalized people in need of wound-healing acceleration are far from prime specimens. Normally very sick rats afflicted with Alloxan diabetes (a laboratory-induced diabetes) or Cushing’s syndrome (hyperadrenocorticism) heal their wounds very slowly if at all. The question Dr. Prudden asked was, would they heal more quickly and strongly with cartilage therapy? Experiments proved that the answer was an unequivocal yes.

Wound Treatment in Humans

By the early 1960s, it was time to let rats retire and put human volunteers to work. Dr. Prudden then set up two sets of experiments. The first involved the treatment of sixty long-suffering patients troubled by chronic, non-granulating wounds that had failed to fill in with the grainy, pink, capillary-rich newborn connective tissue that customarily forms during the wound-healing process. The wounds were truly chronic, never less than two months in age, and up to seven years in duration. The question was, would cartilage initiate this long-delayed granulation? It did.

The second was a better-controlled study in which two incisions were made in the skin of each of fifteen human volunteers. Some of the subjects were private patients of Dr. Prudden; others were inmates at Sing Sing Prison. Of the paired incisions on each body, one was treated with powdered cartilage, the other was not. When the wounds were later tested for tensile strength, twelve of the fifteen people showed cartilage-treated wounds stronger than the controls. The net increase in mean strength was an impressive 41.8 percent.

Dr. Prudden then decided it was time to quantify Dr. Lattes’s finding that cartilage could counteract the effects of cortisone. His study, published in Surgery, Gynecology and Obstetrics in 1967, reported the wound-healing progress of rats in the light of different dosages of cartilage and cortisone. As expected, cartilage reversed the drug’s inhibition of wound healing consistently and considerably, even at excessively high doses of cortisone. Surprisingly, the study also showed that cartilage potentiated cortisone—allowing it to fulfill its wonder drug potential.

All in all, Dr. Prudden published nineteen studies in major medical journals, proving cartilage had the right stuff to speed wound healing. Equally remarkable, though less often reported, is the finding that cartilage could also put on the brakes. Otherwise, cartilage-treated wounds would grow and grow into the massive, raised overgrowths of scar tissue known as keloids. What happens is quite the reverse. Cartilage-treated wounds look better cosmetically—smoother, flatter, altogether more natural—than wounds treated without it. At the same time, cartilage-treated wounds are stronger, more flexible, and less likely to rupture.

“ Aneurism and Brain Surgery

When I was recovering from a brain aneurysm and brain surgery, I was in ICU for several weeks. My brother-in-law made his Lebanese mother’s beef bone broth recipe, which is virtually identical to the one in the Nourishing Traditions, and brought it to me repeatedly in the hospital. I was in bad shape, had nearly died, was racked with pain, and was recovering tethered to machines. The bone broth felt like liquid gold and seemed to bring me exactly what I needed. I had excellent medical care, and was surrounded by many loving family members and friends who brought much to my recovery, but that bone broth was life-sustaining medicine, a healing substance like none other. The doctors reported that I had one of those mysterious miraculous recoveries, with no deficits nor difficulties past the initial recovery from the surgery. It is almost as if the aneurysm never actually happened.

—Stacey J., Sacramento, California ”

Dr. Prudden most often used cartilage from the tracheas of calves. The obvious question was whether this was the best type for rats, and the evidence came in that rat cartilage worked as well as the calf cartilage but not better. The cartilage of sharks, tegu lizards, crocodiles, and cow fetuses possessed similar healing properties, provided proper processing had taken place. The cartilage from older animals, however, was less potent. Whatever the type of cartilage chosen, it seemed to work on all animals, including rats, mice, guinea pigs, dogs, and humans.

How cartilage induced and accelerated healing was a mystery that intrigued Dr. Prudden for the rest of his life. “We always believed that one of our most important tasks was the isolation of the specific chemical agent responsible for this striking biologic phenomenon,” he said. Over the years he explored multiple possibilities, ultimately deciding credit needed to go to the multiple synergistic factors found naturally in whole cartilage products. Research on the many individual components of cartilage—as well as the additional ones found in broth prepared from skin, cartilage, and bones—continues apace today, as scientists test fractionated “active factors.”

Still Not in Use

Dr. Prudden’s findings should have set the standard for wound healing. He not only published multiple articles on this topic in major medical journals throughout the 1950s and 1960s but saw his work lauded in Sabiston’s Textbook of Surgery, where Dr. J. Madden wrote, “After decades of experimentation, only one substance has been shown to affect healing unequivocally.” Yet fifty years later cartilage is still not in general use in hospitals, a fact that frustrated Dr. Prudden during his lifetime.

By the 1990s, genetic engineering had emerged as Big Pharma’s great white hope for wound healing. Compared to low-cost, low-tech, all-natural cartilage, recombinant DNA technology offered an artificially made molecule that could be replicated and sold at great profit. It involves using enzymes to break isolated DNA molecules into fragments, then rearranging them in a more desirable sequence. Dr. Prudden’s comments in 1997 remain relevant today. “There has been considerable premature publicity regarding the capability of these entities to accelerate wound healing,” he said. “Yes, in laboratory tissue cultures they can speed the growth of fibroblasts, but that doesn’t prove a thing. There’s a bottom to the laboratory pot so the growth factors have nothing to do but stick around. It never seems to occur to them that in human beings they’re not going to be there anymore! The molecular weight of growth factors is so low that they are sucked into the wound capillaries and excreted through the kidney.”

Back in 1965, an editorial in the Journal of the American Medical Association (JAMA) recognized Dr. Prudden for the high quality of his wound-healing work and concluded with the words, “The value of these observations is appreciated if we remember that most of the correctable morbidity and mortality of surgery is due to failures of wound healing.”

Almost sixty years later, “correctable morbidity and mortality” goes on with attendant pain, suffering—and profit.