Suture needles and suturing methods during the Civil War

Sometimes the most obvious things are sitting right under your nose. Based on how suturing is done today, it suddenly dawned on me that I had never seen a suture forceps in any of the surgical sets of this 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 1800'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 case, I have 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.

As shown below, there were needle holders available in an 1846 text (Liston and Mutter), but I have not seen one in any American set I've examined pre-1870. 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 sets that I have examined.

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 this way. In the 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. In the amputation set, the various needles are stored in a piece of buckskin leather.
In this photo are the various needles, suture thread (still in the original wrapping paper), silver suture wire and a piece of bone wax (used to stop bleeding of cut bone). From an 1865 Hernstein Civil War set.
In this close-up 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.
An example of the same curved needle as above with suture thread showing the thickness of the thread.
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 shown below the longer locking type.
Tiemann developed a locking suture needle holder, called a Degaine's Russian Needle Holder, but at this time, I believe it was invented after the close of the Civil War.
Shown in this image is a method of using 'quills' on either side of an incision, which would have been approximated by passing an intradermal suture from side to side and then tighening the suture when tying to draw the two side 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.

American Civil War Surgical Antiques

(A Private Collection - Research and Identification Project)

Civil War Era Surgical Sets, Surgeon's Swords & Images

Suture Needles and Suturing during the Civil War era

American Civil War Surgical Antiques