Dr. M. I. ShaÃ½kh
Recently, at the G-Mex Centre in Manchester UK, I attended the CLOTECH 96 exhibition. The organizers had gathered an entire textile world under one roof - everything was on display, from humble scissors, buttons, needles and colourful threads to the latest computerized textile manufacturing equipment and embroidery software to execute complex stitching tasks on the newest high-speed machines.
I am not a tailor, I do not make or sell clothes for a living, I am not in the textile business in any way. Even so, what had brought me to this exhibition was curiosity about such devices as stitches, stitching needles, scissors and the like. More precisely, I had come to see what I could find out about the history and development of such devices in relation to cutting and joining in surgical procedures, especially sutures.
Every display in the great hall was presented by a team of experts who were there to answer questions. I asked many. In the end, rather to my surprise, I met one expert who was able to give me the kind of help I was looking for. He was Paul Breuer from Aachen, representing the German company SNF MANF, who, as it happens, manufacture surgical needles. Paul Breuer astonished me with his knowledge of a wide range of methods for sewing skin, including the use of ants. Naturally, I was intrigued, and Paul promised to post to me a photograph of an ant being used as a skin stitch, after his return to Aachen.
An embroidery equipment specialist, Caroline Sayers, of the company DATA STITCH, said she could design an ant stitch, if I could supply her with a suitable photograph. The very next day after I had supplied the photograph, the ant was scanned, digitized and an embroidery machine executed for us the amazing ant stitch.
My curiosity about this unusual suture technique led me to further investigations which finally bore fruit when I came across Welcome Institute for the History of Medicine’s 1973 publication, Albucasis on surgery and instruments. This book is a definitive edition of the original Arabic text with English translation and commentary by MS. Spink and G.L. Lewis.
In Book 2, Chapter 85, on suture materials used by the Arab surgeons, Albucasis (the Latinized version of Abu l-Qasim) mentions two techniques. Spink and Lewis, 1973, p.538, comment:
1 Ants’ nippers. This is not a classical method; but is said to be used by African tribes as a way of bringing skin edges together (modern Michel clips); evidently the Arabian ant-nippers acted in the same way.
2 Gut sutures. Gut was used by the earliest Greeks for bow-strings; but it is not mentioned as used for surgical purposes until the Arab era of surgery. Albucasis then describes it as ‘rubbed-down gut, well cleansed’. This may be the earliest reference to this now universal suture material.
Abu 1-Qasim’s own account (ibid., p.550) is a vivid description of sutures using ants and cat gut:
Some men of experience have said that when a wound occurs in the intestine and it is small, it should be sutured in this manner, namely: ants with large heads are taken; then the edges of the wound are brought together and one of these ants is applied by its jaws then the head is cut off, and it will stick and will not loosen. Then another ant is applied near the first; and you proceed after this manner with a number of ants according to the size of the wound. Then reduce the intestine and sew up the wound; for the heads will remain sticking to the intestine until it is healed up; and no harm will come to the patient.
The intestine may be sewn up with fine suture which is extracted from an animals gut and sticks to it after being threaded in a needle. The method is that the end is taken of this suture made of gut, well scraped; and to this end is fixed a linen thread, twisted, and then that thread is passed through the needle affixed to the suture of animalis gut, with which the intestine is sewn and then replaced in the abdominal cavity (Abu l-Qasim al-Zahrawi, Al-Tasrif, Book 2 Chapter 85).
Abu 1-Qasim Al-Zahrawi (936-1013) wrote his remarkable surgery manual Al-Tasrif during the period of Arab/Islamic rule in Spain about a thousand years ago. I felt a curious and wonderful sensation at the link between an ant stitch, mentioned and talked about in an exhibition of textile craftsmanship in Manchester near the end of the twentieth century, and the dedication and craftsmanly skills of the Muslim scholar who, a millenium before, had adapted the use of ants, and invented the use of cat gut, for making sutures. This was not the only contribution this extraordinary man made to the development of modern surgery techniques, nor was he the only Muslim to have made significant and striking advances in the field of medicine.
It is hard not to feel awe (and, naturally, some pride) at the achievement of the Muslims in that great period of Islamic civilization. I have no doubt that their success was owed to the excellence of their faith and their consequent commitment to working for the improvement of human well-being and the advancement of learning. And I realize that I am merely at the beginning of a long quest for information about what was achieved by Muslims dedicated to Islam in the broadest sense-namely, a way that improves the quality of human life and the quality of our understanding of the world we live in.