From the Vault: The Invention of Surgical Gloves

But then if it's going to make a difference, it also has to be accepted by the vast majority of the people within a given field, a given culture, etc.

to be another way. You can't go to the dentist and be like, hey, doc, I'm thinking maybe you go gloves off this time. I mean no, it's just the gloves are part of the procedure, and most of us would be somewhat concerned if we go in there and the gloves are off.

from the tomb of Tutin Common. So those are about three thy two hundred years old, and these were likely riding gloves. But of course, one of the things about gloves, when one of the things about making yourself a second organic skin, is that those tend not to survive, you know, unless they are stuck away in a tomb or in some other fashion well preserved for a very long period of time. But the reality is when it comes to surgery, for most of human history, surgical procedures of varying degrees

of complexity were carried out bare handed. Now, when we say bare handed surgery, we do have to note that we're not talking about pseudoscientific medical fraud psychic surgery, which is also you know, quote unquote performed bare handed. No, we're talking about actual surgical procedures of different scales performed well without any sort of protective barrier between the surgeon's

skin and the patient's flow. So surgery of different sorts was practiced in ancient Mesopotamia, Ancient Egypt, ancient China, agient India, and other parts of the ancient world. Ancient surgeries ran the gamut from setting of bones to amputations, trepanations, blood lettings,

and everything in between. But as we've discussed on the show before, one of the big obvious realities here, obvious to us now anyway by virtue of germ theory, is that human hands carry disease, and even regularly cleaned hands can be a problem. I was looking at some of the stats on this in review of human hand microbiome research by EDMUNDS. Wilson at All in a twenty fifteen

edition of a Journal of Dermatological Science. The authors here point out that hands are of course a critical component of the human microbiome and are quote a conduit for exchanging micro organisms between the environment and the body. So not all of these are dangerous naturally, but hands can

harbor pathogenic species like staff Any Coli. And this is even more the case in high risk environments, such as among those who handle food or provide healthcare, and the authers here point to various studies that have also looked into how it enhanced use of hand hygiene products may negatively impact the hand microbiome as well, result resulting in

greater pathogen carriage for example. But other studies have demonstrated quote reduced pathogen carriage and or infections with use of these products.

to potentially disrupt the ratio of what lives there. And so the idea of cleaning the hand completely, that is we'll discuss that becomes kind of problematic at times, like again, it's not an instrument. It is pointed out by one of the authors we're going to look to. You cannot just boil the hand to sterilize it and then use the hand in a completely hygienic way.

shake your hand right now. Just read a whole bunch of stuff about about hand germs.

Like we again, we had gloves. It's not like, uh, like we didn't have this idea that well, there are some cases where we need to cover our hands to protect our hand from some sort of external force, or perhaps in some cases protect the external world from our hands. But if you cannot see the threat, if you have no real concept of the germs that are out there, of the invisible world, then what can you do?

that's one of the things about healthcare. I mean, it does put you in close proximity with a doctor, it puts you often puts you in a space where you have other individuals with various health care concerns going on. It's just the reality of it. But if you go back in time before germ theory, before these various technologies,

things obviously get a bit darker. Smith that All point out that in medieval times there was a high level of illness and death in hospitals, and quote, when a sick person entered a hospital, his or her property was disposed of, and in some regions a requiem mass was held as if he or she had already died.

early modern period. Many things had improved, but you still had surgeons placing ungloved hands directly into wounds and directly into incisions and so forth, and this was certainly the norm.

Again for much of human medical history. We didn't have the materials and or we didn't know about the invisible world of microbes, and other reasons were focused on for subsequent infections such as bad air or miasma seeping into the wound and read that, you know, until shockingly recently, it was things like pus and secondary infections were often just thought of as well, this is just part of

the body healing itself. This is just what happens. This is the norm, and there's nothing we can do about it.

in fact what killed Garfield. But the thing that I found out is that that doctor's name, his given name was doctor. His name was doctor Willard Bliss. So he was doctor doctor Willard Bliss, all right.

great advances in hospital infection control. Ignot Simmelweiss was the first hospital epidemiologist, setting a precedent for step by step analysis of an outbreak and for tracing epidemics to a particular surgeon or practice e g. Going from the autopsy room to the operating room without washing your hands uugh Eleven of twelve consecutive women die of pweparral or child bed fever, and subsequently required that all providers who attended the patients first wash their hands in a watery solution

of chlorinated lime. The mortality rate then dropped dramatically from eighteen percent to two percent. So simlweis here was a Hungarian physician who lived from eighteen eighteen through eighteen sixty five. So he's a little bit before of this, before this progressive era that Smith at all are talking about. But this is a time when we see rapid changes in medical knowledge, we see the advent of technologies like the

X ray. This is a time period that was covered, I think, just excellently in Steven Soderberg's television drama The Nick, which I know I've mentioned on the show before. It's just a great drama, a lot of attention to detail, but also they have this very clean, white, almost blinding visual style to the show, have electronic music by Cliff Martinez throughout the series, and so I think it does a great job of portraying the past as the energetic,

promising present. You know something that we sometimes I think lose track of in representing the past on film or even reading about the past, about thinking about this time period in past as being completely divorced from what we will know, and it's more about just like the excitement and also the danger of being there at the bleeding edge of technology and innovation. Yeah.

findings and technology. But on the whole, there was a lot of criticism of his ideas, and a lot of his efforts ended up in antagonism. His critics attacked him, he attacked back. It apparently got pretty ugly, at least from an academic standpoint, and his mental health declined greatly and he eventually died in an asylum. So it's often characterized as being, you know, this effort where he's kind

of up against the wall. Maybe didn't have what, maybe wasn't the ideal person to be making these arguments, Like maybe it could have been a better pr campaign for some of these ideas, but what can you do?

all microorganisms within any type of invasive procedure. His work alone was associated, according to Smith at All, with a decrease in post amputation mortality rates from forty five percent to fifteen percent. And he also cut down on the

necessity for amputation. That was one of the big things he was going after two Like, he was saying, it would just won't be necessary to amputate this many limbs because because we'll be using cleaner tools, etc. He argued for the necessity of pre operative hand washing and the use of disinfectant soaked wound dressings.

William Halstead introduced rubber gloves for use in surgery by around eighteen ninety, and by nineteen hundred we see more and more doctors wearing gowns, masks, and gloves. But the use of gloves especially is certainly not instantly accepted by the medical community to come back to the nick for example, which which again I think does a pretty great job

of depicting this time period. If you go back and watch any of this show, and I did certainly didn't have a chance to go back and watch all of it, but you pretty much don't see surgical gloves at all. There are just lots of scenes of surgeons who again are at the bleeding edge of technology and innovation at the time, but they are reaching into people's bodies with

bare hands. They are opening up people's craniums with bare hands, and just every other part of the anatomy as well lots of shots of white linens and blood soaked hands now on the show. There are also frequent scenes of surgeons, though, going through a series of hand washings before surgery, sometimes

while engaging in dialogue with each other. But I remember being particularly taken by at least one scene in which there's kind of a beautiful feeling of almost spiritual ritual to the thing of the surgeon washing and lowering their hands and forearms first into one vat, then into a second vat, and then into a third vat. Like again, it has kind of an almost magical feeling to it.

And so I was reading a little bit about about this time period here for this episode, and based on my readings of why were surgical gloves not used earlier by Thomas Schlitch, I believe this is the three VAT system standardized in Berlin in eighteen eighty eight by Paul Fubringer. First soap, then alcohol, and then finally an antiseptic substance.

should have to wear surgical gloves at all. And I think the first place that I was reading about this, there was a j Store Daily article that came out from this is by jess Romeo in July of twenty twenty, when obviously a lot of this sort of thing was

going going on in our heads. And there's all the obvious parallels between the treatment here of gloves and consideration of things like certainly hand washing, but also the use of mass The article was the surgeons who said no to gloves, And the article from Romeo is citing another article, a source article by Thomas Schlitch who he just referenced, titled Negotiating Technologies in Surgery the controversy about surgical gloves in the eighteen nineties, and this was a twenty thirteen

article from the Bulletin of the History of Medicine.

there was this big conference in eighteen ninety eight. It was the twenty seventh Congress of the German Society for Surgery, and Schlick quotes a report on this meeting by an Austrian surgeon named Alexander Frankel, who was just perplexed by some of what was going on, because a big subject of conversation for one whole afternoon at this conference for surgeons was about gloves. It was about surgical gloves, whether or not you should use them, and what types of

gloves are best. And Frankel, reacting to this whole discussion, says quote, for a whole afternoon, participants discussed about the best glove models, marching up all the various specimens made from different materials in all sizes and price ranges. Allas Sarah Bernhardt referring to like a French actress and whatever the fashionable designs might be called, a whole apparatus of pseudoscience was mobilized to inaugurate the new fashion of the

surgeon in gloves. So Frankel here is a respected, influential surgeon of the time, how can it be that he viewed the idea of surgical gloves as absolutely ridiculous pseudoscientific pageantry. Akin to I think the comparison to Sarah Bernhardt here is he's saying it's like a gaudy fashion show.

specifically in German speaking hospitals in the eighteen nineties. So the question is why did most surgeons hesitate for so long before adopting the use of surgical gloves, even after we had a bacterial theory of disease and infection. And actually, once you see all their concerns lay doubt, the objections to people who resisted the gloves at the time seem

a little bit less baffling. It actually makes more sense of them when you understand what the understanding was at the time and what the pressures on surgeons for performing in the operating room were.

these new exciting ways that were all ultimately trying to crack the same nut to try to improve the mortality rates for various procedures. And also he seems to stress that you know, weuld we can't really go into these situations sort of with a wrong side of history viewpoint

of the past. You know, generally in the present, if you're presented with different ideas, the ones that are the wrong side of history are not labeled, so you know, you don't know that this is not going to be you know that you're on the ultimately on the losing hill here when you're advocating that medical gloves should not be used universally, well.

Lister's ideas. So this is more in general about like hand washing and cleansing of instruments, boiling of instruments, et cetera, as opposed to gloves. But this was a guy that still had a minimal complication rate, and therefore he had some data to back up his viewpoint. So he had he wasn't just standing on a hill without any reason

to make his argument. He had seen what seemed at the time like a reasonable argument, like saying, look, look what I'm doing seems to be working, and I have the data to back it up.

that has been proposed. So, yeah, there are a lot of ideas on the table, and again it seems like each surgeon had their own ideas and techniques.

of development and progress. But in fact, the way Schlick frames it is, you know, medicine is just full of individual, little practical solutions to problems, especially in the eighteen nineties here, and over time some prove better than others.

episode is titled Gettysburg. It stars Meatloaf and it also has the guy who played the crazy man on the boat in Jason Takes Manhattan, and it does involve time travel with Civil War reenactors who are sent back in time to the Battle of Gettysburg, and one of them is like a medical responder and has a medkit, and so there's a great scene where he's he's he's doing some some medical intervention on a wounded soldier, and Meatloaf's character, who's a Civil War era I like to forget what

he is if he's a oh, he's a colonel. He's watching and he doesn't seem to think anything about these modern medical devices and gloves that are being used by this guy. So that's kind of a tangent, But it was weighing heavily on my mind as I researched this.

these would have, of course been clumsy to use. Wax treated fabric was another idea, and ooh, I was really this one really captured my attention, The idea of wax poured directly over the surgeon's hands to form a supposed seal between the flesh and the operation.

liked in Schlich's article was this bit quote. Another strategy, and this is an alternative to gloves, involved keeping one's hands clean between operations and abstaining from handling infectious materials even when not on the job, an approach that in some cases amounted to a whole regime of living. Which this is easy to sort of think of almost comedically, where you can imagine the surgeon saying, well, I'm of course I'm not going to wear gloves during a procedure.

It gets in the way. I have some issues with how high it is. What I'm gonna do is I'm going to wear gloves the rest of the time when I'm not in the surgery, and therefore keep my hands nice and clean and ready to just get in there.

But on the other hand, it does certainly in the long term they did make a difference in the spread of pathogens through surgical procedure.

that like we don't even even doubt doubt. Not only do we not doubt the importance of gloves, but they have kind of become associated with these roles, Like it's hard to separate the two, and you wouldn't want to separate the two.

in the eighteen nineties. And as I mentioned earlier, the Shlick paper is interesting because it frames the good things about gloves as a sort of you know, existing within a network of trade offs and talking about it as one of the types of what Slick calls control strategies within surgery at the time, and control strategies that were many, but they included things like different instruments, lights and operating tables, anatomy, atlases, anesthetics,

and of course technologies of a sepsis. Now I mentioned earlier the difference between a sepsis and anti sepsis, and this is an important concept in the development of surgery in the second half of the nineteenth century. So you've got two schools of thought that are in competition. One is anti sepsis, which is the idea of disinfecting a wound after germs have likely been introduced. And then you've got acepsis, which is instead trying to prevent any germs

from ever entering the wound in the first place. And the primary method here would be trying to make all instruments and objects in the surgical environments sterile before surgery begins, so you'd boil your scalpels and so forth. But Schlick describes a growing nervousness among surgeons in the eighteen nineties based on the general feeling that raining aseptic practices were not good enough. By the eighteen nineties, surgeons in German

speaking hospitals were aware of the bacteriological problems. They were trying to be a septic however they could. They were washing their hands and going through all these procedures we talked about, but they were just aware that the current methods were not preventing all infection. Acepsis had to be They what they thought of as an all or nothing campaign. And Schlick quotes an academic surgeon somebody who we've already referenced.

This was a guy at the University Breslau named Johannes van Mikolch, and Mikolch wrote quote, the smallest mistaken wound treatment would come back to haunt the surgeon. And Mikolch, together with a collaborator named Carl Fluga, who lived eighteen forty seven to nineteen twenty three, spent great effort in the eighteen nineties trying to close the gaps, basically to find ways that germs could still be getting in even

with the aseptic practices of the time. And so one of the ideas they came up with was using face masks to prevent droplet infection, so droplets from the doctor's mouth or nose entering the wound and introducing germs during surgery. And schlickwrites quote many of today's surgical paraphernalia were introduced at the time as part of the bacteriologically supported search for weak points in the aseptic all or nothing system

of preventing wound infection. It was the context of this crisis of aseptics surgery that prompted a number of surgeons in the eighteen nineties to simultaneously try out surgical gloves

within their local settings. Now, one of the next things that Schlick talks about in this paper I thought was very interesting is so if we're looking at German speaking hospitals in the eighteen eighties and eighteen nineties, they're aware of the fact that they need to improve aseptic practices in surgery, but they don't know all the ways to plug the holes and the use of surgical gloves is obvious to us in retrospect, but it was not obvious to everyone at this time and place, So why would

it not have been obvious to them. One thing Slick points out is that, first of all, it just requires thinking about gloves in a different way. Prior to this, gloves were typically used to protect the person wearing them rather than to protect someone from the person wearing them. So it's kind of like having to just think outside the box to reframe something that is already part of

your mundane existence. So imagine thinking that you would need to wear a hat to protect someone else from your head. It seems weird, but actually, if you think about it in the right context, this is something that people do. I've worked in restaurants where chefs were required to wear either hats or hairnets to keep their hair out of the food. If you're not familiar with the context like that, it might never occur to you that you would wear

a hat for somebody else's benefit. But another thing that Slick points out around here is that carbolic acid and other antiseptic chemicals that were used to get the hands clean before surgery these were hard on the skin, schlickwrites, quote copiously applied, the caustic solutions often caused severe skin damage in surgeons and nurses, forcing some of them to

abandon operating altogether. The issue was the background of the well known story of how in eighteen eighty nine William Halstead at Johns Hopkins introduced rubber gloves to protect the hands of his chief operating nurse, who later became his wife. Now, Rob you already mentioned Halsteed introducing rubber gloves in his practice around this time, but Slit goes on with an interesting detail here quote. Subsequently, such gloves were also used

by Halstead's assistants. They put them on when taking instruments out of the corrosive sublimate solution in which the instruments were kept, and pass them on to the operating surgeon who did not wear gloves. So the assistance would you'd have like a scalpel, and that would be in a sterilizing caustic chemical, and the assistance would put gloves on to take the thing out of that chemical, hand it to the surgeon who would receive it with an ungloved hand and then operate.

so rob earlier you mentioned this three vat process. You've got surgeons who would wash their hands with soap and then submerge their hands in alcohol and then dip their hands in an antiseptic chemical before going into surgery. So you would think, man, you go through that kind of procedure, that really should kill all the bacteria, right, shouldn't your

hands be perfectly clean by then? But one of the things that became clear to these surgeons in the eighteen nineties is that this actually it was pretty good, but it wasn't good enough because even if you could sterilize the outside skin of your hands, there were little pockets where germs could camp out and still infect a wound.

Examples would include the sebaceous glands. These are little gland pockets attached to hair follicles that produce sebum, which is a waxy or oily substance that coats the skin and hair. And then also you've got like underneath the fingernails. You know, you're just gonna have like little recesses back there where these liquids are not getting in deep enough, and germs

from in there might still get out during surgery. And for some reason, this reminds me of you remember in our invention episode on the death ray, the idea of this time between World War one and two where there was terror about the inadequacy of ground based defenses against air raids. And there's this phrase that was used at the time, the bomber always gets through. I compared that to the bacterium in this case. Right, there's this fear that the bacterium somehow always gets through.

on these sterilized cotton gloves. They were very big. They had sleeves or gauntlets going all the way up the arm to the elbow or past the elbow, and you can see pictures of these they kind of look like mummy arms. Now, of course they're cotton gloves, so they're not impermeable, so over the course of an operation they would become soaked with blood and you might need to change them out for a new pair. But Mikolitch was very positive about them. He is like, you know, they're

not that bad. And sometimes with cotton gloves you can even grip some things better, like holding onto tissues is easier with cotton gloves than with the naked hand. But there were times when the cotton gloves reportedly caused problems. One example would be this is the example given by Mikolitch.

When a surgeon is feeling around on the inside of the stomach, lining to locate a tumor by touch, the cotton would apparently dull the sensitivity of the fingers, and Mikolitch wrote that in cases like this, you could briefly take off the glove, reach around and feel for the tumor with your bare fingers as quickly as possible, and then once you found it, you put on a pair of fresh cotton gloves.

I don't know about that last claim, but apparently, according to Schlick, at least the surgeon most responsible for bringing rubber gloves into vogue in German speaking hospitals was Werner's Zoga von Manteuffel, who lived eighteen fifty seven to nineteen

twenty six. Zoga was especially in search of failsafe aseptic protocols because he worked in an environment of a municipal hospital where he had to quote operate promiscuously, so he couldn't like, specialize in one type of surgery and quarantine for that. Instead, he had to operate alternately on like infected patients and uninfected ones, sometimes handling pus or feces or whatever, and then immediately having to go operate on a different patient. So his solution to this was boiled

rubber gloves. There were downsides. The rubber gloves were uncomfortable. Sometimes they made it hard to move or bend the thumb. Sometimes the fingers were too long, which made gripping difficult, and because of these conditions, operations with rubber gloves would often take longer than the same operation with bare hands. And then, to read from Schlick quote, but this Zoga thought was outweighed by the gains in aseptic control the absolute safety of the quote boiled hand, as he called it.

Zoga thus explicitly weighed the two kinds of control against each other. What also becomes clear in this discussion is the importance of the technical details of the gloves for reconciling manual and aseptic control. They had to be made in a way so that they didn't compromise the surgeon's grasp too much, but at the same time we're effective in keeping bacteria out. So this is a way of

trying to get the boiled hand into circulation. You've got to make it so that it's worth it to the surgeon that they can still do what they need to do. If you've got a rubber glove that is boiled and is a septic, it's not going to get bacteria in there, but you can't really operate effectively with it. That doesn't do you any good.

to nineteen twenty seven. He was a surgeon in Leipzig who said that full rubber gloves were too thick and difficult to work with, but suggested that surgeons could use quote, fine finger covers made out of condom rubber quote, which have been put on the market recently and which impaired the touch of the finger relatively little. And that's kind of surprising. But yes, rubber condoms had existed in some form going back to at least the mid nineteenth century.

Eighteen f These rubber condoms were allegedly made of rather thick material, but they did exist at the time, and Perthy suggested that, yeah, this condom rubber could actually be useful to the surgeon for having a good compromise between being impermeable and being a septic, but also allowing the surgeon to feel what they are doing. But Perthy's himself

favored silk gloves, which you already mentioned. He said, you know, they're great for manual control silk feels like you're wearing nothing at all, But of course they didn't have the aseptic advantages of impermeable rubber. There are a couple of other things that Schlick mentions, involving the idea of thin gloves coated in wax and whether or not that would be useful, leather gloves that maybe were topped with condom

rubber or something. But yeah, ultimately we get to this desire that Wolfer articulates that you mentioned earlier, that you got to have a surgical glove that has all of the following characteristics. It's impermeable, it's flexible, tear resistant, not too tight, not too hot, and it can be sterilized. And this is what they ended up debating at this

Surgical Congress in eighteen ninety eight. And there were all kinds of interesting debates here about like the actual bacteriological evidence for gloves, Like there were some people at this meeting who dissented, arguing on the basis of experiments that

gloves were not actually useful. And there was one experiment that involved testing cotton gloves, so again not the rubber ones, but taking cotton gloves that had been used in surgery and then squeezing out the quote glove juice and then doing a culture of that to see what its germ content was, and they were like, look, this glove juice

is full of germs. These gloves can't be useful. In fact, they're picking up because they get soaked with blood, they're picking up germs from the air, and they're introducing new germs. And then this led to a really i think a debate between different evidential standards. So you have some people say saying, well, look, we've done these lab experiments saying that you know, the glove juice is full of bacteria

and that's no good. But then there are these other people saying, well, yeah, but we've used gloves in actual surgeries and we see the differences in outcomes, and the outcomes are better when you use gloves. And so they were comparing different standards of like how should we measure whether this is effective or not.

modern medical gloves, there's this broad spectrum there. We've come a long way, obviously since since these these first prototypes were being unveiled, and yeah, it's we're we're in a in a totally different age now when it comes to just the acceptance of of medical and surgical gloves. You again, you would not accept bare fingers and bare hands as an alternative.

one surgery in perfect isolation. But if that's just one of many surgeries you're performing during a set amount of time, well then you're in a slightly different scenario. There are all these other factors you have to take into account totally.

and save someone's life that sort of thing. Yeah, So anyway, it's a yeah, fascinating topic, I think, especially when you get into the adoption of a new technology, how we look back on it and how, you know, the efforts of the historian to place us within that time period to make sense of it all just all very fascinating and I think something to keep in mind and to think about the next time you're in a medical facility or in a checkup of one sort or another and

you see your doctor or you don't see them snap on those gloves. The gloves are just part of it. Of course, we'd love to hear from anyone out there who regularly wears medical gloves, surgical gloves as part of your profession. You know, what are your thoughts on them, what sort of a history do you have with them, and you have to use a certain variety of glove due to allergies or scan irritations. We'd love to hear

some insight from the field. All right, Well, we're going to go ahead and close out this Invention themed episode of Stuff to Blow Your Mind, but we love to hear from everyone out there. Just a reminder that new episodes of Stuff to Blow Your Mind come out on Tuesdays and Thursdays. And oh, we should also mention we mentioned condoms briefly. We do have an older episode of Invention about the invention of the condom, so we recommend that.

And of course we've touched on medical history topics numerous times over the years and you can find those in the archives. On Mondays we do listener mail episodes. On Wednesdays we do short form artifact or monster Fact, and on Fridays we set aside most series concerns and just talk about a weird film.