World Journal of Surgery

, Volume 32, Issue 4, pp 648–655 | Cite as

Heraklas on Knots: Sixteen Surgical Nooses and Knots from the First Century A.D.

Article

Abstract

In the first century of our common era, the Greek physician Heraklas wrote a brief essay on how to tie 16 knots and nooses for surgical and orthopedic purposes. His work is reintroduced and discussed here because its place in the origin and evolution of surgery needs to be properly acknowledged and recorded in the current medical literature. To do so, Raeder’s definitive Greek edition of the oldest extant manuscripts of Heraklas’ essay was studied along with the various illustrated interpretations of his text published over the last six centuries. Moreover, the contemporary literature was searched for current applications of Heraklas’ knots by use of a database of surgical knots. It was found that seven of Heraklas’ 16 knots and nooses were still applied surgically of late, and that four of these have even been recently rediscovered for such applications. Therefore, it is concluded that Hellenistic, Roman, and Byzantine medicine had a rich knowledge and high standards. Contemporary surgical techniques may be found to be truly ancient if we search deep enough, far enough, and long enough.

Notes

Acknowledgment

The author is very grateful to Mr. Adri Jans, medical illustrator, for his artwork and critical encouragement.

References

  1. 1.
    Ashley CW (1944) The Ashley book of knots. New York: DoubledayGoogle Scholar
  2. 2.
    Graumont R (1945) Handbook of knots. Centreville, MD: Cornell Maritime PressGoogle Scholar
  3. 3.
    Graumont R, Hensel J (1952) Encyclopedia of knots and fancy rope work, 4th ed. Centreville, MD: Cornell Maritime PressGoogle Scholar
  4. 4.
    Day CL (1967) Practical knots. In: Day CL (eds.), Quipus and witches’ knots. Lawrence, KS: University of Kansas Press, pp 80–91Google Scholar
  5. 5.
    Raeder I (1931) Oribasios Iatrikon Synagogon - Biblion XLVIII, chapters 1–18. In: Raeder I (eds.), Oribasii Collectionum Medicarum Reliquiae, Vol. III, Libri XXIV–VVV, XLIII–XLVIII. Leipzig and Berlin: Teubner, pp 253–268Google Scholar
  6. 6.
    Day CL (1967) Oribasius De Laqueis (Appendices). In: Day CL (eds.), Quipus and witches’ knots. Lawrence, KS: University of Kansas Press, pp 101–151Google Scholar
  7. 7.
    Hage JJ (2007) Earlier citation: barrel sling technique for ankle traction. Ann R Coll Surg Engl 89:739PubMedCrossRefGoogle Scholar
  8. 8.
    Lyons AS, Petrucelli RJ II (1997) Medicine — An illustrated history. New York: Abradale, AbramsGoogle Scholar
  9. 9.
    Lascaratos J, Assimakopoulos D (1999) From the roots of otology: diseases of the ear and their treatment in Byzantine times (324–1453 A.D.). Am J Otol 20:397–402PubMedGoogle Scholar
  10. 10.
    Baldwin B (1975) The career of Oribasius. Acta Classica 18:85–97PubMedGoogle Scholar
  11. 11.
    Lascaratos J, Voros D (2000) Fatal wounding of the Byzantine Emperor Julian the Apsotate (361–363 A.D.): Approach to the contribution of ancient surgery. World J Surg 24:615–619PubMedCrossRefGoogle Scholar
  12. 12.
    Bussemaker UC, Daremberg C (1851–1876) Oeuvres d’Oribase, Vol 4. Paris: J. B. Bailliere & fils; Imprimerie Nationale, pp 253–270 (plate on p 691)Google Scholar
  13. 13.
    Miller LG (1945) The earliest (?) description of a string figure. Am Anthropol 47:461–462CrossRefGoogle Scholar
  14. 14.
    Day CL (1986) Knots in folklore and in history. In: Beard RO, Hoffman ML Jr (eds), The art of knotting and splicing. Annapolis, MD: Naval Institute Press, pp 1–10Google Scholar
  15. 15.
    Hage JJ (2008) On the origin and evolution of the Roeder knot and loop: A geometrical review. Surg Laparosc Endosc Percutan TechGoogle Scholar
  16. 16.
    Hage JJ (2007) How capsizing, flipping, and flyping of traditional knots can result in new endoscopic knots – A geometrical review. J Am Coll Surg 205:717–723PubMedCrossRefGoogle Scholar
  17. 17.
    Liddell HG, Scott R (1940) Greek-English lexicon, revised and augmented throughout by Sir Henry Stuart Jones with the assistance of Roderick McKenzie. Oxford, UK: Clarendon Press. Also available at http://www.perseus.tufts.edu/cgi-bin/resolveform [accessed July 7, 2007]
  18. 18.
    Boardman J (1979) The karchesion of Herakles. J Hellenic Studies 99:149–151CrossRefGoogle Scholar
  19. 19.
    Rumsey D (2004) The AMICA Library. Available at http://www.davidrumsey.com/amica/amico1285493–32906.html#record [accessed July 7, 2007]
  20. 20.
    Renwick SE (1992) Three traction knots for the orthopedic surgeon. Orthoped Rev 21:649–652Google Scholar
  21. 21.
    Puñal Rodríguez JA (1998) Reliable double-component knots for laparoscopic surgery. Br J Surg 85:16–19CrossRefGoogle Scholar
  22. 22.
    Pier A, Thevissen P, Eikel M, et al. (1994) Laparoskopische Naht- und Knüpftechniken. Chirurg 65:473–483PubMedGoogle Scholar
  23. 23.
    Swain CP, Kadirkamanathan SS, Gong F, et al. (1994) Knot tying at flexible endoscopy. Gastrointest Endosc 40:722–729PubMedGoogle Scholar
  24. 24.
    Shaw AD, Duthie GS (1995) A simple assessment of surgical sutures and knots. J R Coll Surg Edinb 40:388–391PubMedGoogle Scholar
  25. 25.
    Hanemoto T, Ideta H, Kawasaki T (2001) Dislocated intraocular lens fixation using intraocular cowhitch knot. Am J Ophthalmol 131:265–267PubMedCrossRefGoogle Scholar
  26. 26.
    Nakashizuka H, Shimada H, Iwasaki Y, et al. (2004) Pars plana suture fixation for intraocular lenses dislocated into the vitreous cavity using a closed-eye cow-hitch technique. J Cataract Refract Surg 30:302–306PubMedCrossRefGoogle Scholar
  27. 27.
    Suzuki EY, Suzuki B (2007) The Suzuki reef knot for attaching closed-coil springs to miniscrew heads. J Clin Orthod 16:148–151Google Scholar
  28. 28.
    Wharton HR (1896) Minor surgery and bandaging, 3d ed. Philadelphia, PA: Lea Brothers & Co, pp 40–41, 394–395Google Scholar
  29. 29.
    Roeder O (1904) Chirurgische Operationtechnik für Tierärzte und Studierende. Berlin: Paul PareyGoogle Scholar
  30. 30.
    Escamilla JO (2002) A knot for retarded absorbable sutures. Contemp Surg 58:16Google Scholar
  31. 31.
    Escamilla JO (2003) Gynecology knots. Am J Obstet Gynecol 189:900PubMedCrossRefGoogle Scholar
  32. 32.
    Aroujo MB, Andreoni C, Bomfim AC, et al. (2005) The boatman’s knot: A single knot for renal-vein ligation during laparoscopic nephrectomy: Description of technique and evaluation of feasibility and safety. J Endourol 19:1134–1139CrossRefGoogle Scholar
  33. 33.
    Giddings FD (2002) Miller’s knot. In: Giddings FD (eds), Surgical knots and suturing techniques, 2nd ed. Fort Collins, CO: Giddings Studio Publishing, pp 17–21Google Scholar
  34. 34.
    Loutzenheiser TD, Harryman DT II, Yung SW, et al. (1995) Optimizing arthroscopic knots. Arthroscopy 11:199–206PubMedCrossRefGoogle Scholar
  35. 35.
    Mishra DK, Cannon WD Jr, Lucas DJ, et al. (1997) Elongation of arthroscopically tied knots. Am J Sports Med 25:113–117PubMedCrossRefGoogle Scholar
  36. 36.
    Loutzenheiser TD, Harryman DT II, Ziegler DW, et al. (1998) Optimizing arthroscopic knots using braided or monofilament suture. Arthroscopy 14:57–65PubMedCrossRefGoogle Scholar
  37. 37.
    Abbi G, Espinoza L, Odell T, et al. (2006) Evaluation of 5 knots and 2 suture materials for arthroscopic rotator cuff repair: very strong sutures can still slip. Arthroscopy 22:38–43PubMedCrossRefGoogle Scholar
  38. 38.
    Al Fallouji M (1993) Making loops in laparoscopic surgery: State of the art. Surg Laparosc Endosc 3:477–481PubMedGoogle Scholar
  39. 39.
    Croce E, Olmi S (2000) Intracorporeal knot-tying and suturing techniques in laparoscopic surgery: Technical details. JSLS 4:17–22PubMedGoogle Scholar
  40. 40.
    Hasson HM (2000) Interrupted laparoscopic suture secured with the needle-through-the-sliding-loop knot. J Am Assoc Gynecol Laparosc 7:556–561PubMedCrossRefGoogle Scholar
  41. 41.
    Terry C (1977) The differentially adjustable slide knot. Am Intraoc Implant Soc J 3:197–200Google Scholar
  42. 42.
    Dangel ME, Keates RH (1980) The adjustable slide knot - An alternate technique. Ophthalmic Surg 11:843–846PubMedGoogle Scholar
  43. 43.
    Thomson GB (1981) An adjustable slip knot for monofilament sutures. Aust J Ophthalmol 9:170–172PubMedCrossRefGoogle Scholar
  44. 44.
    Jolson AS (1982) A simple method to tie an adjustable slipknot suture to control astigmatism during cataract incision surgery. Ophthalmic Surg 13:659–663PubMedGoogle Scholar
  45. 45.
    Zelt RG, Kerrigan CL (1984) Microvascular suturing with the simple slip. Plast Reconstr Surg 74:839–840PubMedCrossRefGoogle Scholar
  46. 46.
    Eliason EL (1924) Practical bandaging. Philadelphia; PA: Lippincott, pp 48–49, 79–80Google Scholar
  47. 47.
    Ramataju D, Schenk W (2006) Barrel sling technique for ankle traction. Ann R Coll Surg Engl 88:589–590PubMedCrossRefGoogle Scholar
  48. 48.
    Öhrvall H (1916) Nagot om knutar i antiken särskildt hos Oreibasios. Eranos 16:51–81Google Scholar
  49. 49.
    Halsted WS (1913) Ligature and suture material. JAMA 60(15):1119–1126Google Scholar
  50. 50.
    Taylor FW (1938) Surgical knots. Ann Surg 107:458–468PubMedCrossRefGoogle Scholar
  51. 51.
    Trimbos JB (1984) Security of various knots commonly used in surgical practice. Obstet Gynecol 64:274–280PubMedGoogle Scholar
  52. 52.
    Soper NJ, Hunter JG (1992) Suturing and knot tying in laparoscopy. Surg Clin North Am 72:1139–1152PubMedGoogle Scholar
  53. 53.
    Luks FI, Deprest J, Brosens I, et al. (1994) Extracorporeal surgical knot. J Am Coll Surg 179:220–222PubMedGoogle Scholar
  54. 54.
    Dinsmore RC (1995) Understanding surgical knot security: A proposal to standardize the literature. J Am Coll Surg 180:689–696PubMedGoogle Scholar
  55. 55.
    Meng MV, Stolller ML (2002) Laparoscopic intracorporeal square-to-slip knot. Urology 59:932–933PubMedCrossRefGoogle Scholar
  56. 56.
    Ball WWR (1971) Fun with string figures, 1st ed. New York: Dover PublicationsGoogle Scholar
  57. 57.
    Green BE (1972) Use of modified head halter for a Barton bandage. Plast Reconstr Surg 49:466–467PubMedCrossRefGoogle Scholar
  58. 58.
    Kilroy S, Yates LA, Bethune C (2000) First Aid Equipment, Supplies, Rescue, and Transportation. In: Kilroy S, Yates LA, Bethune C (eds), Hospital Corpsman NAVEDTRA 14295, Vol. 2007. Washington, DC: Naval Education and Training Professional Development and Technology Center, Chap 3, p 3.6. Available at http://www.fas.org/irp/doddir/milmed/corpsman-pt1.pdf [accessed July 7, 2007]
  59. 59.
    Pennisi VR (1983) Proclaim your innovations but please acknowledge those of your predecessors. Plast Reconstr Surg 71:731–732CrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2008

Authors and Affiliations

  1. 1.Section of Surgical Oncological Disciplinesthe Netherlands Cancer Institute-Antoni van Leeuwenhoek HospitalAmsterdamThe Netherlands

Personalised recommendations