King's College London
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From Microbes to Matrons


black and white photograph of T. J. Mackie, after 1923Professor T. J. Mackie, 1888-1955, after 1923Catgut, used as both a ligature and suture, derives from sheep’s intestine and has been in surgical use since the mid-nineteenth century.

The earliest-known reference to its use in surgery appears in the Provincial Medical and Surgical Journal in 1840, when, at the Hotel Dieu in Paris, one surgeon used a “very strong catgut cord attached to different parts of the leg” to treat a 45-year old woman with anchylosis of the knee.

Drawing on Lister’s antiseptic principles, catgut was often carbolised before use in surgery. Lister himself spent much time and effort preparing carbolised catgut and always prepared his own, even after commercial supplies emerged later in the century.

Catgut and post-operative tetanus

colour photograph of catgut ligatures, c. 1929Catgut ligatures, prepared by a Glasgow chemist, c. 1929. Royal College of Physicians and Surgeons of Glasgowcolour photograph of catgut ligatures, c. 1929Colour photograph of catgut ligatures, c. 1929In the 1920s, catgut was linked to a tetanus outbreak at the Royal Infirmary of Edinburgh. Hospital supplies of catgut were stopped immediately.

The research of Professor T. J. Mackie, Honorary Bacteriologist to the Infirmary, into the outbreak radically changed British catgut sterilisation procedures in both industry and the hospital. In his investigations,

Mackie found that catgut sutures were used in all 11 cases of suspected or confirmed post-operative tetanus.

Mackie’s visits to the hospital’s catgut supplier, G. F. Merson Ltd of Edinburgh, in May 1927, followed by bacteriological tests, confirmed that catgut supplies were often contaminated with organisms, due to the fact that the catgut had been prepared with outdated sterilisation methods devised 30 years previously.

Mackie advocated treating catgut with iodine water and hydrogen peroxide, while also proposing the batching and numbering of catgut strands and the bacteriological testing of samples from each batch. His methods soon became standard. Leading medical textbooks began to endorse his methods.

The Therapeutic Substances (Catgut) Regulations Act of 1931 also made explicit reference to catgut’s role in causing post-operative tetanus.

Under the Regulations, manufacturers wishing to sell catgut – and hospitals wishing to buy it – had to obtain a license from the Ministry of Health or from the Scottish Board of Health.

Licenses were granted on the condition that licensees complied with routine sterility checks and inspections of the “premises, staff and methods of manufacture”. In 1936, the Ministry wrote that state control over catgut had ‘raised very considerably the standard of sterility of surgical catgut’ and indicated that Mackie’s sterilisation methods had been introduced in factories across the UK.

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