Ants as sutures?

You’ve probably heard of it, or seen pictures of it on various internet feeds. But how many references have you seen in the medical literature? They’re sparse at best, which is part of the reason I haven’t written about them yet.

Does this mean that their use hasn’t been recognized in the medical literature? Far from it. This paper from 1925 discusses much of the history (to that point) of using ant heads as wound closure devices. What may surprise you is how long it has been in the literature. You may also be surprised that it was written by an ichthyologist, who apparently just found this interesting and decided to publish it in JAMA.

The use of ants as sutures likely dates from prehistoric times. It seems fairly easy to go from “this big ant bit me and it pinched the skin” to “lets use this to close wounds”, but most facts that seem simple after being established generally weren’t. Since we have no evidence of the first use, we have to go to the first recorded use. This falls to the Artharva Veda, circa 1000 BC. However, they weren’t using ants for skin wounds, they were using them to suture intestinal wounds after surgeries. It goes without saying that they probably didn’t start with that, so it had likely been in practice for some time prior.

It is possible, then, that the use of ants in surgery in the Mediterranean was learned from the Indian practices. Arabian medicine had translated the Hindu literature by 600 AD, and many recorded uses into the middle ages were from Arabic physicians. From there it spread into parts of Europe. The use in surgery persisted until the early Renaissance.

What made them stop? This article contends that a few high-ranking surgeons decided against them for a myriad of reasons. Theodoric rejected Arabian medicine, de Chauliac felt that they were rejected by the body, di Vigo felt they were obsolete, Fabricius felt the mandibles relaxed too much after the ants died (and were also hard to source in winter), and Purmann ridiculed them in his books. Most of these manuscripts were published (or republished) around 1500. Gut suture had also become more common by then, and was much easier to obtain.

Their use in skin continued in austere environments. As South America was explored, use of ants by native peoples was noted from the 1800s on. Concurrent use was still occurring in Algeria and noted by the French Foreign Legion. Their use was also described in Greece in 1896, as wounds were still being dressed by barbers according to local customs. That one comes from the Journal of the Linnaean Society of London, so you may have missed it on your feedly.

So why don’t we see articles discussing it now? Because it’s an established fact at this point. You’d be hard pressed to get more than a case report out of using ants as sutures, unless you were going to write a review article. And since much of the literature (including this article) isn’t accessible on pubmed, it becomes a scavenger hunt to get enough sources. The author of the paper had to look at the originals at the New York Academy of Medicine. Many are written in other languages, so you have to trust that the translation is correct (or translate the original yourself) before citing it.

Now, if you want to use ants to close a wound, you’ll want the right kind. Generally you would ask locals what they’ve used in the past, as naming species is unlikely to help you. Driver ants, army ants, and bullet ants are a few of the types that have mandibles big enough to close a decent skin wound.

Eciton burchelli ants

The image shows a bunch of the wrong type of ants, and one that is suitable, even though they’re the same species of army ant. Once you’ve found a suitable ant, pinch the wound closed, and hold the ant by the thorax (using something other than your fingers preferentially). You’ll want to be incredibly careful with the bullet ant, as it has the most painful sting of any hymenoptera, hence the name. The mandibles will usually be open in a defensive position if you’re holding it. Once the mandibles are near the skin, the mandibles will clamp shut, holding the wound closed. Then lift up the thorax and pinch off the body, leaving just the head and mandibles. Repeat as needed to close the wound, and there you have it.

You’ll of course want to irrigate the wound with water clean enough to drink prior to closure, as has been discussed before here. Also, don’t try to suture intestines with ants. That is well beyond what I would recommend in the wild.

Further Reading

EBM Gone Wild Wilderness Medicine Justin Hensley, MD