Investigation of suture surgery with ant by Hakim
Mohammad the Iranian surgeon of Safavid Era (1501 to 1736)
Saeed Sepehrikia 1,2,
Marzieh Qaraaty 1,2 , Fatemeh Kolangi 3*
1 Clinical
Research Development Unit (CRDU), Sayad Shirazi Hospital, Golestan University
of Medical Sciences, Gorgan, Iran
2 Department of Persian Medicine, School of Persian Medicine,
Golestan University of Medical Sciences, Gorgan, Iran
3
Counseling and Reproductive Health
Research Centre, Department of Persian Medicine, School of Persian Medicine,
Golestan University of Medical Sciences, Gorgan, Iran
*Corresponding Author: Fatemeh Kolangi
* Email: dr.kolaangi@gmail.com
Abstract
Hakim Mohammad, a military physician, and surgeon of the Safavid Era
(1501 to 1736) and the author of Dhakhira-Yi-Kamilah book, served as a young
man in the Ottoman Empire Officer as a surgeon physician. In this study, the method of suturing by Hakim Mohammad has been
introduced. Suturing with ant was a wound healing method that was carried out
by Hakim Muhammad to treat the wounds of certain areas of the body, by a
special species of ants called fire ants, and by the lower jaw of these ants.
Also, Hakim Mohammed suggested specific food and drug in order to take
care of the wound and control infection and pain followed by this type of
suture. Study of the treatment methods of predecessors shows us developments
and the path to the progress of surgical affairs and can be used in the
direction of further advances.
Keywords: Hakim Muhammad, Suture, Ant, Wound Healing, Persian Medicine
Introduction
Surgery is an important discipline in the history of medical
science because it can be used to treat many different diseases (1).
The study surrounding the history of the Safavid Era in comparison
with some other sciences faces special problems (2).
Medical science in the Safavid Era was generally not in the hands
of trained physicians; But some physicians learned medicine wholly
scientifically from a teacher and through this, and in this way, the physician,
when completed his studying course, could not do treatment, especially surgery
without receiving licenses (3). Among the important physicians in the Safavid
Era was Hakim Bashi (court physician) had a significant and valuable place in
court (4).
In this study, the way that Hakim Mohammed used to suture and the
subsequent recommendations for healing wounds are addressed.
In this review, we used books and valid scientific articles, and
also through search engines of Pubmed, Magiran, Sid and Google Scholar. The
keywords that were searched included “Safavid Era”, “Suture”, “Wound Healing”,
“Ant”, “Hakim Mohammed”, “Military Surgeon”, and “Persian Medicine (PM)”. In
this research, by studying the sources and after classification and
summarization, the results are presented in this paper.
Medicine in the Safavid Era
At the end of the fifteenth century, the Safavid dynasty built the
Iranian Empire by forming a stable successful and long-term government
(1501-1736)(5).
During the Safavid Era, physicians’ education was very similar to
the training of surgeons, and the young physician came to the service of
experienced physicians for an internship, and for this purpose, this physician
was one of those who worked in hospitals (6). Medicine was important in the
Safavid Era, such as other courses (7). One of the physicians of this era was
Hakim Muhammad who served as a military surgeon as well as one of the
physicians of Safavid Era serving the Ottoman Empire (5).
Hakim Mohammed
Hakim Mohammad Surgeon was contemporary with Shah Abbas 1 (1571-1629) and Shah Safi 1 (1611-1642).
There is not enough information about this surgeon; but in
Dhakhira-yi-Kamilah's book, he introduced himself (8). His teachings and
opinions about wounding, surgical procedures, and treatment are reflecting his
views that are expressed exactly and certainly and naturally some of them are
not correct (6).
Hakim Mohammed, who served as a military surgeon to the Ottoman
Empire (1299-1922), collected his surgical experiences in the
Dhakhira-yi-Kamilah book, and this book is written in Persian and mainly about
the management of wounds and practical techniques (8). Dhakhira-yi-Kamilah includes an introduction, 6 chapters and 30
titles.
At the beginning of this book, the author wrote about general
issues, and then he explained more about wounds. It also expressed practical
damage and techniques in detail. Hakim Mohamed described the details of the
treatment of abdominal and intestinal wounds and suturing of the intestinal
hole with ant bite in two different parts of the book (8-10). Dhakhira-yi-Kamilah is of
great importance in terms of clarifying the dark corners of medicine in the
Safavid Era. This book was written in thirteen years (8,9).
Wound and suture
Skin wounds and reducing their recovery time are one of important
aspects of medicine (11).
The healing of wound is to reinstate the physical integrity of
damaged structures (12). Treatment and care of wounds, increased speed and
prevention of infection have always been the attention of physicians. When
there is a shear in the body for any reason, they use sutures (13, 14).
Closing wounds with yarn and needles go back thousands of years
ago. The remaining writings of ancient Egypt identify that at that time, metal
yarns were used for sutures, but these threads had disadvantages such as
difficulty in knotting. At the end of the nineteenth century, various materials
such as cotton, flax, hemp, silk, animal hair and so on were used to suture and
close wounds(13, 14).
Ants
Insects are one of the most mysterious creatures of creation (15)
Ants are among the most diverse creatures on earth and are social insects (16).
There were different opinions about the role of ants in medicine
and veterinarians (17).
A number of ants that are capable of biting, stinging and injecting
poison into the host body are called stinging ants (18). There are many types
of bite ants in the world, and in different areas, there are many species that
are known as fire ants (10). The most important aggressive ants, in terms of
medicine, are fire ants from the family of Solenopsis (19). Trap-jaw ants use
their long lower jaws to disable the prey. When they approach the bait, the
lower jaw is opened with an angle of 280° and in this range, they shut their
jaw quickly (in less than a millisecond) to crush their prey and hunt the prey (20)
(Figure 1 and 2).
Figure 1. An image of the lower jaw of the ant.
Figure 2. An image of the lower jaw of the ant.
Method of suturing with ants and aftercare
The medical use of the ant existed from the ancient period in a
simple way and one of its medical applications in suture was wounds and
injuries. In this regard “Angela Royston” says: “Physicians, instead of
suturing in surgery, benefited from the jaws of big ants in order to put the
corners of the wounds on each other so that they can easily heal the wounds.
When the jaws of the live ant are placed on the scar, the ant started to bite
(Figure 3), hence the ends of the wounds reached together, then the physician,
cut off the body of the ant and separated it from the wound(21) (Figure 4).
Susruta, an Indian surgeon around 500 BCE suggested removing foreign material
from the wound, then applying large black ants to the wound's edges and
separating their bodies from their heads once they had tightly bitten the
section with their jaws (22) Ants have been used for centuries to close and
suture wounds in Central and South America (23). In Dhakhira-yi-Kamilah's book,
Hakim Mohammad has described in particular the surgery of intestinal and
abdominal wounds and the suture of the intestinal hole among ant stings (5).
Hakim Muhammad used this method to treat wounds and holes in the intestine, and
after suturing the intestine with this method, he put it in the abdomen and
treated the abdomen, and after putting burned cotton on the wound, he covered
it (dressing it up) (8).
Figure 3. How to do suture with ant.
Figure 4. The suture was done by ant.
The stings of ants are often painful and with severe itching, and
in some cases, with blisters and some other symptoms, and even complications,
such as severe sensitivity, anaphylaxis shock and even death(10). In the view
of Hakim Mohammad, wound care is that in these patients, the wound is well
covered and does not feed (heavy foods) the patient for two days and since
three hours after the suture, fatty soup (very light food) must be consumed
that is anti-thirst and has nutritious features and do not feed water to the
patient to prevent wound infection, and then tamarisk water should be given
(boiled water of tamarisk).
the patient should be given this soup for three days and on the
fourth day if the patient wants water, he may be given it according to the following
method: First, break and ground the pieces of tamarisk and boil in a stone
cauldron with water, screen and re-boil to halve and then use.
Among other important points to be considered in these patients is
that the patient must be well taken care of and must wear warm clothing. The
patient should be barred from having visitors, and if the wound suffered from
pus, it should be treated by the following method: olive oil, white wax,
turmeric, Onosma dichroanthum Boiss, and washed swamp stone, Chelidonium majus
L, washed lentil hematite, and tragacanth; Mix all and put on the wound and
remove a few days later. If the patient has pain, resolve the pain in the
following way: 45 grams of unripe olive, 13.5 grams of white wax, 18 grams of
grounded frankincense, 13.5 grams of alum crystal; make a poultice of them all
and add egg oil and put on the scar every day (8).
In addition, many findings indicate that ant treatment and suturing
are also effective in preventing infection, which may be due to the ants' chemical
defense against infectious agents. The secreted glands are involved in
destroying many microorganisms (24).
Nowadays, new and modern methods have been replaced, but sutures
with ants are similar to today's sutures, including the following:
- In terms of suture pattern, given that in this method, sutures
were individually and in a row. Therefore, it can be known as similar to modern
sutures today.
- In terms of absorbability, given that this type of suture was
performed in the intestine and intra-abdomen, it seems that it was absorbed and
it can be divided into today’s absorbent sutures.
Certainly, the method that Hakim Mohammad introduced in his time
and used ants to treat wounds was a very amazing issue and opened a new path in
suturing techniques for humanity. But this method had limitations. It was
possible to use sutures with ants in certain places such as the intestines and
abdomen. Its use in some organs that are hard and cartilaginous is considered
one of the limitations of the work. Sometimes, if necessary, to improve the
condition of the sutures in the wounds, it was necessary to use the ant several
times to create a stronger suture. The killing of ants in this process is also
one of the disadvantages of this technique.
Today's medicine is the result of the work and actions of the
former times and even events that occurred in the past.
Conclusions
Suturing is one of these methods.
Hakim Mohammed used ant for sutures of abdominal wounds and intestines.
In this paper, suturing method with ant and
nutrition method and treatment of pain and after suturing pus by Hakim Mohammad
during the Safavid Era was investigated. It is worth mentioning that the
present study, based on the latest data of the researchers of this paper, is
the first research on suture surgery with ant by Hakim Mohammad, the Iranian
physician of the Safavid Era, so there is not much information about Hakim
Muhammad and the suture method with ant. Study of the treatment methods of
predecessors shows us developments and the path to the progress of surgical
affairs and can be used in the direction of further advance.
Author contribution
SS writing, methodology, investigation. MQ, investigation, writing.
FK conceptualization, supervision, writing, investigation.
Conflict of interest
No potential conflict of interest was reported by the authors.
Ethical
approval
IR.GOUMS.REC.1401.205
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