Catgut

CATGUT, threads produced from the intestinal tract of small cattle. It is used as a suture material in surgery. For the manufacture of catgut, the intestinal wall is taken, cleaned of mucous and serous layers. The intestines cleaned in this way are cut into strips and tightly twisted into threads of various thicknesses. Raw catgut contains pathogenic intestinal flora (sometimes also Bacillus anthracis and tetani), which is why it undergoes further processing for the purpose of disinfection (see below). The use of catgut is based on its property of being absorbed after some time (1–3 weeks) following its immersion in tissues. These properties of catgut were taken into account by surgeons, and at the present time, there is an abundance of the required catgut product on the medical market, prepared by various methods. Before the World War, only products from German, French, and partly English firms were available on the Russian market. The years of the economic blockade acutely posed the question of domestic catgut production before the surgeons of the USSR. The first initiative for the establishment of catgut production in the USSR belongs to Korotnev. The current catgut of Soviet production began to be produced by artisanal means by the worker A. Smirnov. In 1923, catgut of Soviet production appeared for the first time at the agricultural exhibition in Moscow. The "Central Intestinal Product" (now the Main Intestinal Office of Gostorg of the RSFSR—"Kishpromtorg") began to produce catgut at a catgut factory in Simferopol and, during 1924–26, produced 1,003,173 m of catgut, which amounts to 426,260 threads. Catgut of Soviet production is available in the following numbers: 00, 0, 1, 2, 3, 4, 5, and 6 (the thinnest is 00). In the Central Sanitary-Hygienic Laboratory of the Military Sanitary Administration of the Workers' and Peasants' Red Army, Goltsov conducted experiments on the comparative evaluation of Soviet and foreign catgut. These experiments are presented in the table below. On the basis of the test data for catgut, the following conclusions were obtained. Comparative table of the average strength of samples of foreign and Soviet catgut: Foreign wet catgut (solid thread: min 2.46 kg, max 8.80 kg; thread with a knot: min 1.96 kg, max 5.36 kg); Foreign dry catgut (solid thread: min 2.54 kg, max 6.94 kg; thread with a knot: min 1.48 kg, max 5.44 kg); Soviet wet catgut (solid thread: min 2.0 kg, max 6.32 kg; thread with a knot: min 1.82 kg, max 5.46 kg); Soviet dry catgut (solid thread: min 2.16 kg, max 10.28 kg; thread with a knot: min 1.36 kg, max 4.34 kg). 1. Foreign catgut, wet in a solid thread, has a minimum breaking load of 2.46 kg; a maximum of 8.80 kg. The same catgut thread with a knot gives a break at a minimum load of 1.96 kg and a maximum of 5.36 kg. 2. Dry English catgut has a minimum breaking load of 2.54 kg in a solid thread and a maximum of 6.94 kg. The same catgut thread with a knot gives a minimum breaking load of 1.48 kg and a maximum of 5.44 kg. 3. Russian catgut in a wet state gives a minimum strength of 2 kg in a solid thread and a maximum of 6.32 kg. The same thread with a knot gives a minimum load value of 1.82 kg and a maximum of 5.46 kg. 4. Dry Russian catgut in a solid thread has a minimum breaking load of 2.16 kg and a maximum of 10.28 kg. A thread of dry Russian catgut tied in a knot has a breaking load of 1.36 kg and a maximum of 4.34 kg. 5. Samples of foreign catgut treated with a chromium mixture and Lugol's solution retained a sufficiently high degree of strength even after lying for many years in these preservative solutions. 6. In terms of its physical properties: strength (resistance to breaking), ability to withstand sterilization, and strength when breaking a thread equipped with a knot, the catgut produced by Kishpromtorg is equivalent to foreign catgut, and in some of its numbers (grades) even surpasses foreign samples in these qualities. The disinfection of catgut began with Lister (1869), who proposed treating catgut with a 5% solution of carbolic acid in oil, and to the present time, methods of its chemical treatment are the most widespread, most often with iodine, formalin, or chromium in various modifications. Claudius proposed treating catgut with a 1% solution of iodine in a 1% aqueous solution of KI (1.0 Jodi puri, 1.0 Kali jodat., 100.0 Aq. dest.). The solution in the required amount is poured into a vessel with a ground-glass stopper, and the skeins of catgut are suspended in it on a glass stand in such a way that the liquid surrounds them on all sides. Commercial catgut is kept in this solution for 14 days, after which it is transferred to sterile jars, where it is stored. Gubarev uses not an aqueous solution according to Claudius, but an alcoholic one of the same concentration, and recommends using formalin alcohol (1:1,000), pointing out that a small admixture of formalin makes the catgut stronger and it does not absorb as quickly as after treatment according to Claudius. Moszcowicz recommends placing catgut in a 5% solution of iodine in alcohol for 5 days, then, after drying it with a sterile towel, storing it in a sterile vessel. Taking into account cases of suppuration when using iodine catgut, Kuhn proposed starting the sterilization of catgut from the first stages of its factory preparation, and the impregnation with iodine should be carried out even before the twisting of the intestinal strips into threads. He considers catgut prepared in this way to be completely ready for use. Braun applies additional treatment to Kuhn's catgut, placing it for 48 hours in a solution: Jodi puri 1.0, Kali jodat. 2.0, Aq. dest. 100.0. Among the surgeons of the USSR, the method of Sitkovsky, developed in the clinic of Martynov, is widely used. According to this method, catgut is soaked in a 1% solution of KI for as many minutes as the number of the catgut taken (No. 0—30 sec., No. 1—1.5 min., etc.). Then the catgut is dried with a sterile towel and suspended in a glass jar with a ground-glass stopper, on the bottom of which crystalline iodine is poured. After 3 days, the catgut is ready for use. Among the disadvantages of iodine catgut, it is pointed out that it irritates tissues, sometimes absorbs prematurely (Claudius), and sometimes is not strong (Moszcowicz). Therefore, Claudius (1912) began to use chromium salts in the treatment of catgut, recommending placing skeins of catgut for 1 week in a mixture of an aqueous solution of iodine, KI, and potassium dichromate. After this, the catgut is transferred to a 0.5% solution of iodine in KI, where it is preserved. Many surgeons have recommended replacing iodine with formalin when treating catgut. Of the Russian authors, Frenkel (Pokotilo's clinic) recommends formalin treatment. According to Frenkel's method, catgut is kept for 3 days in a 4% aqueous solution of formalin, changing the liquid every day. Hofmeister, after keeping catgut in a 4% formalin solution for a day, washed it thoroughly with water and boiled it for 10–30 min. in water, after which he stored it in alcohol containing 5% Glycerini and 1/1000 mercuric chloride. Thus, Hofmeister added disinfection with high temperature to the chemical treatment. Proposals for mixed treatment using high temperature should be considered few in number. Such is the method of Krönig, who heated catgut at 70° in a drying oven for 2 hours, after which he placed it in a sterilizer with cumene and heated it for 1 hour at a temperature of 155–165°. To the same methods should be attributed the method of Föderl, according to which catgut is boiled in an electric sterilizer with alcohol for 1/2 hour. Cooling must take place slowly, otherwise the catgut becomes brittle. The lid of the sterilizer must be tightly screwed on. Gomenitsky points out that sterilization of catgut by boiling in alcohol (electric sterilizer) is common in medical institutions of the Far East; only there, instead of pure alcohol, they use an alcoholic solution of mercuric chloride (1:1,000), and the boiling continues for 1 hour. To raise the boiling point to 90°, it is recommended to add 10% glycerin to the alcohol. With any of the indicated methods, according to the literature, satisfactory results are obtained from the point of view of asepsis. It should only be borne in mind that with no method can one indicate the exact time of absorption of the catgut threads used during an operation. Therefore, at the most critical moments of surgical intervention (for example: ligation of large vessels, suturing of the aponeurotic layer of the abdominal wall after laparotomy, deep sutures during hernia repair, etc.), many surgeons use non-absorbable threads (silk).

The most remarkable of them are the following: 'Sur l'homme et le developpement de ses facultes, ou essai de physique sociale' (Paris, 1835; 2nd ed., Brussels, 1869; Russian ed. — 'Social Physics', vol. I-II, Kiev, 1913); 'Lettres sur la theorie des probabilites' (Brussels, 1846); 'Du systeme social et des lois qui le regissent' (Paris, 1848; Russian ed. — St. Petersburg, 1886); 'Anthropometrie ou mesure des differentes facultes de l'homme' (Brussels, 1870). Quetelet's merits in the field of statistics consisted in the fact that, unlike his predecessors who viewed statistics as a science of the state, he regarded it as a science intended to investigate all phenomena in human life and to uncover the laws to which these phenomena are subject. In connection with this, Quetelet occupied himself with resolving the most difficult question regarding the essence and significance of the regularities discovered by statistics. To him belongs the merit of establishing a correct methodology for statistical research. In contrast to Süssmilch, who proceeded in the investigation of the same questions by way of deduction (from the premise of a 'divine order'), Quetelet followed the path of inductive methods; he strove to collect observations on masses of phenomena subject to analysis, to bring these observations to the most precise quantitative definitions possible, to express them, where possible, by number, and from these numbers to derive the causal dependence and laws of the phenomena under investigation. Quetelet is also known as a representative of the newest, so-called 'moral' statistics; in his studies of man, he paid attention to the mental and moral sides of his activity and investigated them by the same method as the physical. Standing at the head of Belgian statistics, Quetelet conducted the first national census organized in accordance with scientific principles in 1846, which served as a model for censuses in other countries. On Quetelet's initiative, the first international statistical congress was held in Brussels in 1853. Quetelet was an active participant in all eight congresses that took place during his lifetime. All organizers of statistical institutions in Europe from the mid-19th century were students of Quetelet and utilized his consultation in their activities. In 1880, a monument to Quetelet was erected in Brussels.