The 7 Year Stitch: The London Hospital Ligature Department 1919-1970
For a business which was only existence for just over 50 years the London Hospital Ligature Department had a remarkable impact on suturing as well as medical marketing.
The London Hospital Ligature Department developed, manufactured, and marketed surgical catgut sutures. Despite the name, catgut is made from purified collagen taken from the small intestine of ruminants (animals such as cows and sheep) – the Ligature Department used lamb. Catgut sutures offered flexibility and strength, and were absorbed by the body during healing.
The Department was set up in 1919 in response to declining availability of suture stocks, in part caused by the First World War. A high quality, home-grown, option was sought and so the Governors of the London Hospital invited their staff to investigate the possibility of manufacturing suture material.
One of those invited to investigate developing in-house suture production was Henry Morley. As a theatre assistant at the London Hospital he had witnessed the devastating effects of poor quality or non-sterile sutures. Morley developed a manufacturing process which was adopted by the Hospital, pilot production began in 1918. By 1919 twenty, predominantly women, staff were employed producing catgut sutures using the London Hospital’s name and the slogan “Morley’s process”.
Other hospitals put in orders, and Allen & Hanbury’s Ltd, a leading medical supplies supplier was selected as the sole distributor. On 23 June 1922 the London Hospital Ligature Department Ltd. was incorporated.
The growth in orders meant that extra production facilities’ were added at Glasshouse Fields in Stepney in 1933, employing 300 additional staff. The business’ turnover, domestic and export, was equivalent to about 20% of the London Hospital’s entire income and was outselling its main UK competitor.
In the early days the department developed a distinctive branding, making use of the prestigious London Hospital name, and emphasising being a home-grown, British product. When the company’s primary retailer, Allen & Hanbury’s, was taken over by pharma giant Glaxo in 1958 LHC was forced to manage its own marketing and sales. The company’s sales representatives operated nationally and internationally to scope appetite for the sutures. Their reports influenced production and marketing decisions, such as the move to plastic packaging and the use of dispensers. LHC’s marketing distinguished them from their competitors, but the company made sure to keep a close eye on their work by collecting and analysing the competitors’ brochures and adverts.
As with most medical marketing the safety of products is put front and foremost. Because catgut was an animal product there was the risk of contamination and infection. In one instance a patient had died after contracting tetanus from tainted catgut which was reported to have been London Hospital Catgut. In response London Hospital Governor Arthur Elliott wrote a letter to the British Medical Journal to defend the company from what he described as damaging and false accusations that the contaminated sutures were London Hospital.
To assure the sterility of their catgut the Ligature Department photographed the manufacturing process. These photos emphasise the sterile working conditions of the production – the workers wore scrubs and masks, worked at sterile benches, and demonstrate the use of autoclaves and iodine to sterilise the sutures and production equipment.
Another element of the Ligature Department’s branding was the ‘British-ness’ of their product. In 1916 a letter appeared in the British Medical Journal expressing concern that the market was flooded with “German and American produce” when it would be preferable to “keep the trade within the empire”. LHC posters sold the catgut as an “achievement of modern British research made entirely by British labour”. Adverts were produced, “for the British empire and abroad”, using traditional British imagery and connecting the product back to the prestigious London Hospital.
Proving that the sutures were the best on the market was one thing, proving innovation in the field was another. In 1921, to accompany the London Hospital developed catgut, Henry Souttar, director of the London Hospital Surgical Unit, developed an eyeless needle (a needle with a tubular ending into which the catgut was fixed) which made smaller holes when suturing skin.
In the late 1940s the progress of the Ligature Department stumbled, being unable to meet the demands of the post-war market. Orders were running at about double production levels. Despite new purpose built laboratories, London Hospital Catgut was unable to keep up with advancements in product development. They still enclosed their suture products in glass whereas their main competitor, Ethicon, was now offering sutures wrapped in “theatre safe” plastic foil. Ethicon also was in the process of opening an irradiation plant to better sterilise their goods, whilst the Ligature Department was still using chemical based sterilisation.
London Hospital Catgut was manufactured in small glass phials which could either be sawn open using a small file, or snapped in the middle to release the sutures from within. However there were numerous reports in the BMJ of surgeons receiving glass splinters when snapping open the phials and injuring themselves and patients. So, less revolutionary and a little too late, was the development of plastic packaging. This packaging was easier to use during surgery, and safer for surgeons and patients. However, by the time London Hospital Catgut put their product on the market Ethicon had already had their plastic packaging available for more than five years.
The final death knell for the Department came in the form of synthetic sutures. These sutures were made from synthetic polymer and were extruded into threads. Now producers wouldn’t have to worry about the sterility of the ‘catgut’, nor the problems associated with product consistency.
After spending seven years developing a plastic pack, the product was launched in January 1970. But it was too late for London Hospital liagutures to regain market relevancy, and in August 1970 LHC was put into liquidation. Following the eruption of "Mad-Cow Disease" (Bovine Spongiform Encephalopathy) in the 1990s Europe banned the use of catgut sutures in humans.
Explore more of the London Hospital Ligature Department records on the archive catalogue, under the reference RLHLG.