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On Tying Knots

Richard M. Ratzan, MD
JAMA. 1980;244(23):2615-2616. doi:10.1001/jama.1980.03310230017014.
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I WISH nurses, or whoever's been doing it, would stop tying our patients to bedrails and geri-chairs. Since no physician I've spoken to has ever seen the actual tying-on by hands, and no nurse that I've ever asked has confessed to tying them, the knots, like the shoemaker's new shoes, seem to be the work of elves.

There's certainly ample evidence to incriminate physicians themselves as the knot-tying culprits. Pliny the Elder recommends various therapeutic knots in his Natural History, advocating the Hercules knot for "greene wounds." Oribasius, the personal physician of the Emperor Julian, compiled the first textbook on medical knots in the fourth century AD. Entitled Iatrikon Synagogos, it lists nine different knots making up 16 slings for use in surgery and the treatment of fractures. Knots with such colorful names as "The Herdsman Sling," "The Sling Called the Dragon," and "The Genuine Strangling Sling" look, on careful


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