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The history of the suture

From ancient Egypt to Nobel Prizes: delve into the history of stitches.

Getting stitches is a rite of passage as a kid. Fall off your BMX, run into something sharp or gouge yourself leaping out of a tree, and you were off to the doc quick-smart, wincing and wailing as they sewed you back up. But did you ever stop to consider who first thought to ‘repair’ a tear in people’s skin by stitching it back together like a seamstress or tailor?

Mentions of physicians suturing human skin stretch all the way back to 3000 BC and the Ancient Egyptians. But given their penchant for opening up dead people, removing their organs and sewing them back shut (archeologists have found sutures on mummies dating back to 1100 BC), it’s still unclear whether they first got the idea for stitching up wounds on the living, or the other way around.

Nonetheless, the practice was scribbled down in detail by a famed text of the Classical Sankskrit era called the Sushrut Samhita. This tome was written in about 500 BC by the legendary Indian sage Sushruta, who even now is regarded as the granddaddy of surgery. Around about the same time, another toga-toting forefather of medicine, Hippocrates (he was the Greek guy whom the doctor’s oath is named after), laid out his own version of how to stitch clumsy people up. Copying their Ancient Greek buddies’ work as usual, the Romans followed suit a century or so later, with both the mysterious encyclopaedist Aulus Cornelius Celsus mentioning it in his dusty old tome De Medicina around 47 AD, and a hundred years on, the polymath Galen talking up sutures he successfully performed on internal gut injuries.

“Observing the work of an embroider, Carrel had been inspired when an attack on the French president Sadi Carnot by a knife-wielding assassin in 1894 saw the poor politician bleed out before his resident quacks could save him.”

 

Up until that point and much later, however, sutures were usually carried out using fibrous plant stuffs like hemp, flax and cotton, and had to be cut and plucked out before they caused too much infection. But around about the 10th century, the fabled Andalusian surgeon Abulcasis noticed one of his pet monkeys chowing down on some lute strings. The strings were made of catgut, and when the monkey didn’t die, it occurred to the beardy Abulcasis that catgut’s dissolvable nature might make it usable for suturing wounds.

Over the next thousand years or more, while needle designs improved and new suturing patterns and knots were learned and exchanged, the materials didn’t change much. Animal products such as hair, silkthread and dried-out arterial, nerve, muscle and intestinal fibre became increasingly adopted for stitching wounds, while the needle material itself didn’t vary from either silver, copper or bronze wire.

As techniques improved, it wasn’t until the 1860s that Scottish surgeon Sir Joseph Lister introduced sterilisation of all suture threads and needles using carbolic acid. Joe was influenced by is mate Louis’ pasteurisation process, and he led a slow but sure acknowledgement among the medical fraternity of the real existence of ‘tiny microbes’. The consequences were revolutionary – not only did fewer surgery patients die from infection, but sutured wounds tended to scar less. Even more so when sterile catgut was first pulled off in 1906 by treating it with iodine.

Interestingly, controversial French physician Alexis Carrel was the first surgeon to ever develop the technique of ‘triangulation’ to reconnect severed blood vessels. Observing the work of an embroider, Carrel had been inspired when an attack on the French president Sadi Carnot by a knife-wielding assassin in 1894 saw the poor politician bleed out before his resident quacks could save him. While Carrel pioneered a new wave in vascular medicine that eventually saw him awarded a Nobel Prize, unfortunately, he also had some less savoury ideas – including a whole treatise on the value of ‘eugenics’, which popped up later and heavily informed Nazi ideology.

Fast forward, and by the 1930s, mass manufacture of several different types of synthetic sutures saw the development of absorbable stitches made of polyvinyl alcohol. By the ’50s, radiation caught on as a better means of sterilisation, ten years later, a dissolvable suture made of polyglycolic acid was invented and became universal throughout most surgeries by the 1970s. Even now, most sutures are made of polymer fibres.

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