Needles and Suturing
During the Civil War Era
by Dr. Michael Echols
Tuesday, October 04, 2016
Sometimes the most obvious things are
sitting right under your nose. Based on how suturing is done today, it
suddenly dawned on me I had never seen a suture forceps in any of the
surgical sets of my pre-1870 collection. None! There were lots of
suture needles and suture materials (wire and thread), but no suture needle
forceps! Why? ...Because they used their fingers to suture, just
like women and tailors of the time used their fingers to sew! That is why
the curved and straight needles found in surgical sets are so large. The suture
needles of today are very fine and curved along the size of a dime and require
handling by sturdy needle forceps to place sutures, where as those prior to the
late 1880's were curved along the size of a silver dollar or twenty dollar gold
piece and sutures were placed by hand in most cases. Now, all that
being said, there were 'needle holders', just not the type we associate with
suturing later in the 1900's. Forceps with grooves in the beaks are seen
that would have stabilized a suture needle. But dedicated locking suture
needle holders per se, were not commonly found in American sets.
In one Snowden and Brother
Civil War surgical case, I found a Physick's forceps which is expressly used to hold
a needle firmly in a grove in the jaws of the tip. I have also seen this
Physick's forceps referred to in multiple texts for deep suturing in a wound.
Physick's forceps for suturing
As shown below, there were needle holders
available in an 1846 text book by Liston and Mutter, but I have not seen one in any
pre-1870 American set I've examined. That is not to say they didn't exist,
because they did, but just not in the hundreds of earlier amputation sets or
Civil War surgical sets
I have examined over fifteen years.
Size references: $1 silver, $20 gold, $10 gold
Click on any image to enlarge
|Pins used to approximate the
sides of a soft tissue incision, from an 1864 Tiemann surgery set.
The pins are round with a round, not a flat head. These
needles were found in the paper holder and would have been supplied
diagram, the pins are shown with suture material wrapped in a
criss-cross on either side of the incision and tied to close the
incision, rather than being passed through the tissue.
An image of a Buck's suture
pin director is shown, which would have been used to guide the
placement of a pin.
|Various curved and straight
cutting edge suture needles. If you enlarge the photos, you
can see that the needles are flat, not round and the edges are very
sharp (cutting edge suture needles).
In a typical amputation set, the
various needles are stored in a piece of buckskin leather.
In this set of
photos are the various needles, suture thread or silk (still in the
original wrapping paper), 2 loops or spools of silver suture wire
and pieces of bone wax (used to stop bleeding of cut bone).
From Civil War Hosp. Dept. surgical sets.
|In this drawing of a cutting
suture needle, you can see the back end of the needle has a
cut-out which allows either thread or silver wire to pass out the
back end of the needle for smooth passage through tissue. The
image is illustrating Price's needle for wire suture.
|On the left is an example of
the same curved needle as above with suture thread showing the
thickness of the thread and groove in the back end of the needle.
Also shown on the right are
two coils of silver suture wire and dark suture material.
|In the image to the right is
shown an aneurism needle, which was not used to suture an
incision, but to ligate an artery or vein. They can be found
in many amputation or surgery sets.
|In Liston and Mutter's text,
1848, Liston (an English surgeon) shows a locking handle suture
needle holder, but I have never seen one in an American-made set
with the exact design of the handle. I have see the smaller
Snowden Physick's forcep in a leather pocket kit like the one shown
below the longer locking type.
|Tiemann developed a locking
suture needle holder, called a Degaine's Russian Needle Holder after
the Civil War
|A drawing from the 1866
Gemrig catalogue showing a 'locking' forceps for carrying a suture
needle. See the 1866
Gemrig catalogue. The importance of
this drawing is it shows use of a locking catch between the finger
holes of the forceps, which allows locking the needle in place
during use. See an article on this instrument which dates this
style to 1864 by French maker Mathieu
with detachable handle above, used to ligate or tie-off arteries,
not to 'suture' a wound or incision
|Shown in this image is a
method of using 'quills' on either side of an incision, which would
have been approximated by passing an intra-dermal suture from side
to side and then tightening the suture when tying to draw the two
sides together. ( From Gross's Surgery text, 1856 ).
|An example of what would be
called a 'continuous' suture where the suture needle is passed in a
circular spiral down the length of an incision and tied on each end.
(From, Gross, Surgery text, 1856)
|An example of an interrupted
suture, with individual sutures which were each tied and cut .
The image shows tape between each suture.
From the 1886 Tiemann catalogue,
a discussion of suturing and sutures
|Surgical suture needles from
the 1870's Tiemann catalogue, 67 Chatham St.
From the medical text book
Handbook of Surgical Operations,
(in this collection) written during the Civil War by
the application of the suture the needle and thread are employed. The best
form of needle for general ' use is about two inches in length, and straight
two-thirds of its length, the remaining third being gently curved, with two
cutting edges (Fig. 9). In some cases a needle curved throughout its entire
length is found useful, as where the wound is deeply seated;
finally, the straight needle, with sharp point and three cutting edges, is
the most serviceable form in wounds on a slightly elevated surface. In some
deeply- seated wounds, a needle with a handle that is fixed or
attached by a screw, will answer a better purpose than either of those
Material for Sutures.—The material used for
sutures may be animal, vegetable, or metallic.
Of the first, catgut has been most frequently
employed; it has, however, never proved reliable.
Of the second, silk is almost universally
selected, and still maintains its supremacy as a suture and a ligature. What
is known as dentists' silk, with three threads, is the best form.
Of the third, the silver wire is preferred, as
combining the least irritating properties with great flexibility. It may be
obtained of different sizes, and the larger should generally be preferred,
as it is less liable to cut the edges of the wound. The wire suture may be
inserted with the common surgical needle, but a needle has been devised by
Mr. Lister, having a groove in the shaft from the eye to the butt, in which
the wire is completely buried, and which thus prevents the mass of
wire occasioned by its being doubled upon itself at the eye. Another needle
answering the same purpose has been invented by Mr. Price , which
has two eyes, and a groove on each surface; the wire is passed from the
lower to the upper, and then doubled and twisted.
There are various forms of suture, as follows:
Interrupted Suture.—A needle of
the desired shape, armed with a ligature of the material chosen, is passed
from without inwards through the right lip of the wound, at a distance from
its margin, varying from a line to one-third of an inch, and being
continued, it should be passed through the left lip from within outwards,
exactly opposite the point of insertion in the right. All the sutures should
be introduced before any are tied; the common reef-knot is then made, and
the ends cut off closely.
Continued Suture.—This suture is that made by
the glover, and consists in passing the needle, as in the interrupted
suture, diagonally, and leaving the thread uninterrupted ; it is used in
wounds of the intestines.
Quilled Suture.—In this suture the double
thread is passed through the lips of the wound, as in the interrupted
suture, but at greater distances, and the ends are tied over quills or
pieces of bougie cut of the proper length. It is used to close deep wounds.