Closing wounds: stitches or staples

[Epictetus]

While looking at these fantastic surgical implements, I remembered watching a documentary that stated Roman surgeons often used staples to close up wounds. If I recall correctly, they even showed some staples that had been found in archeological digs. However, I've been doing some internet searching and can't find anything.

Does anyone know how wounds were typically closed - using thread and needle or staples? Does anyone know of any actual finds of surgical staples?

[Martin Moser]

Quickly checked Celsus, De medicina - according to him, both suture and fibulae were in use, see Book V, 26. 23:

English: http://penelope.uchicago.edu/Thayer/E/R ... html#26.23
Latin: http://penelope.uchicago.edu/Thayer/L/R ... html#26.23

[Epictetus]

Thanks. I never thought of Celsus, for some reason, and finding anything in Galen is like looking for a needle in a haystack when you can't find the haystack.

I'm still curious to see a recovered staple, if anyone knows of any.

[M. Demetrius]

A fibula could be any kind of a pin, right? I'd suspect the simple twisted wire types like seem to have been used at the shoulder of a chiton. Not the decorative crossbow fibulae you'd see on a sagum.

[ParthianBow]

Hmmmm. I've been shown staples by a Roman reenactor, and assured that they were reconstructed from archaeological finds. (I know that that sounds like 'I met a guy down the pub...' but my assumption, prehaps naively, would be that a reenactor wouldn't use such a thing unless it had been found. *Waits for heaps of alternative opinions to rain down.* I was also impressed because the staples looked exactly like the ones I used to use to close bovine skin when finishing a caesarean section.

[Epictetus]

On page 337 of The Evolution of Surgical Instruments is a very small image of some. On the next page it says they were "possible examples found in Roman London."

Judging from the end notes, the illustration of the fibulae were taken from a photo in a 1907 book, Milne's Surgical Instruments in Greek and Roman Times.

I keep thinking there must be better images out there somewhere.

[D B Campbell]

... the staples looked exactly like the ones I used to use to close bovine skin when finishing a caesarean section.

Come on. Am I the only one whose mind is boggling just now? hock:

[ParthianBow]

You may goggle, but before hearing about the staples, which are used all the time by Dutch vets, I used to do individual mattress stitches in the skin. It takes blinking ages to close an abdominal wound 30-50cm in length! Using the staples reduced the operating time by ten to fifteen minutes. They were a lifesaver...

[Medicus matt]

Threadromancy!
Been looking into this today after a discussion with Robert Wimmers. I was sure I'd seen pictures of staples and was trying to find them for him. I must admit I'd assumed that they would be silver because, well, because we all know that that's what was used, right?

The line drawings in The Evolution of Surgical Instruments ARE taken from Milne's 'Surgical Instruments in Greek and Roman Times' but my copy is a modern reprint of the 1907 original and the clarity of the photos leaves a lot to be desired. HOwever, it does clearly show three small clips/staples found in London and exhibted at the Guildhall Museum, but they're bronze, not silver (the Guildhall Museum has now been rolled into the Museum of London so I shall be asking them for better pictures of these 'staples'.

So far, I've not been able to find any actual evidence that staples were ever made from silver and I now wonder of the whole thing was a conflation of three different things set down by ancient sources.
Celcus (and others after him) describe the use of 'fibula' in place of sutures for gaping wounds, especially those where muscle contraction holds the wound open.

Hippocrates describes the use of 'silver flowers', ground to a powder as an effective treatment for ulcerations and Pliny talks of 'scoria of silver' being used on plasters (lenia emplastra, also mentioned by Celcus and others), again for healing ulcerous wounds (unfortunately, it's thought that none if these refer to actual silver, but to lead oxides obtained during the silver smelting process).

Galen mentions the use of wire (gold rather than silver though) for ligatures.

I wonder if someone with an awareness that the use of silver staples for rapid, hygenic wound closure became popular in the 19th century put all of these things together, concluded that the ancients also used silver for their staples and held it up as an example of one of those things known to the Romans that became lost until the modern era?

I might be missing something, there might be some specific text or find that I've overlooked. If so, I'd love to know about it but I'm coming to the conclusion that this thing that we all know is, in fact, a much repeated modern myth.

[Lothia]

Ave Civitas,

You might want to look in "The Healing Hand" by Guido Majno. Subtitled, "Man and Wound in the Ancient World". His last chapter, 10, deals with Galen. A Doctor of Medicine, he verifies and vilifies techniques used.
It is the most interesting book I have read on treating wounds.

[Medicus matt]

Thanks Lothia. I've read the surviving works that detail what Galen, Paulus Aegineta, Celcus and Hippocrates had to say on the subject of wound closure; all I'm interested in is any evidence that anyone may have had that silver (specifically silver) staples, wires, pins, fibulae...whatever were used, because the only references I can find for the use of silver in roman or hellenistic medicine relates to the use of what seem to be lead oxides in paste form, not solid silver itself (with the exception of surgical instruments made from or decorated with silver).

[Kegluneq]

There is a third option. Thorns could also be used to close wounds, as suggested by Annette Frolich of the University of Copenhagen. I'm unaware of a historical reference, but this was the use she suggested of a large group of thorns found in association with Roman militaria in various offering bogs in Denmark. Thorns could both hold a wound closed and presumably also provide a base for stitching. Some thorns also have antibiotic properties, I believe, making them a cheaper alternative to silver certainly.

Unfortunately, the use of thorns in closing even now is attested ethnographically - in countries that practice FGM. Rather puts the cow caesarean into perspective.

[Medicus matt]

Thorns could also be used to close wounds, as suggested by Annette Frolich of the University of Copenhagen. I'm unaware of a historical reference, but this was the use she suggested of a large group of thorns found in association with Roman militaria in various offering bogs in Denmark.

Yes, the "wound thorns" found at Illerup, Nydam etc. Frolich wasn't the first to suggest this, in fact thorn sutures were (possibly still are) used for wound closures in relatively recent years in some cultures.
Historically, insect mandibles have been used as well.

[D B Campbell]

... Milne's 'Surgical Instruments in Greek and Roman Times' but my copy is a modern reprint of the 1907 original and the clarity of the photos leaves a lot to be desired.

You can get a copy of the original here: http://archive.org/details/surgicalinstrume00milnrich. (The staples are in Plate LII.)

[Medicus matt]

Very useful, thank you Duncan. Much clearer than in my copy.