The Invention of Surgical Gloves

the the lack they're off concerning a new technology. You know, it's one thing too to have an idea for a new product or a new invention, a new way of doing things, But then if it's going to make a difference, it also has to be accepted by the vast majority of the people and within a given field, given culture, etcetera. Yes, and also the way that a certain invention has to prove its advantages over other solutions to the same problems, which is a major issue with the early adoption of

the technology we're gonna be talking about today. Uh, something that is now a universal standard that people would be horrified to hear anybody was not using was in fact, originally one solution among many. Right, we're gonna be talking about surgical gloves. Would like you say, are just ubiquitous now, It's just it's no matter what the surgical procedure happens to be, but not only surgical procedures, but also just any kind of medical um check up, anything in the

medical establishment in general. If you go to the dentist, if they're going to have the medical gloves on, and it's one of those things where not only do you come to expect it, like you could not ask for it 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 heart of the procedure, and uh, most of us would be somewhat concerned if we go in there and the gloves are off, or if the gloves were say made of cotton and really juicy, right or or yeah, you go in and it's it's like your dentist is wearing a big ski gloves or mittens. Uh, so you've realized something is off. This is not the way things should be, but it was not always so.

So if you went into, say a German speaking hospital in the eighteen nineties, you may be lucky enough to uh to get operated on by a surgeon who has accepted the new science of bacteriology, who does understand that wounds need to be clean, they need to be a septic uh, and does understand that gloves can help with that process, but has not found a way to commit

yet to impermeable gloves. So may well have some cotton gloves on while they get their fingers around in you Now a quick side note on just gloves in general. Loves have been with us for a very long time. It's just a basic way to protect the hand from where, from cold, from heat, from other threats. Uh, just a basic technological advancement in which we realized, hey, we can take other materials and make a second skin for our hands. Are are very important but also um susceptible to damage

hands and UH. Some of the oldest gloves that we have that have survived include a pair of delicate linen child's gloves from the tomb of Too in Common. So those are about three thousand, 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 them, 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. And now when we say bare handed surgery, you have to know that we're not talking about pseudo scientific medical fraud uh psychic surgery um, which

is also you know, quote unquote performed bare handed. Now we're talking about actual surgical procedures of different different scales, performed well without any sort of protective barrier between the surgeon's skin and the patient's flesh. So surgery of different sorts, you know, was practiced in ancient Mesopotamia, ancient Egypt, ancient China, ancient India, and other parts of the ancient world. Ancient surgeries ran the gamut from setting of bones to amputations, trepidations,

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 clean 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 two

thousand fifteen edition of 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 an E. Coli. And this is even more the case in high risk environments, such as among those who handle food or provide healthcare.

And the authors here point of various studies that have also looked into how it enhanced use of hand hygiene products may negatively impact the hand microbiome as well, resulting resulting in greater pathogen carriage, for example. But other studies have demonstrated quote reduced pathogen carriage and or infections with use of these products. Oh yeah, that's gonna be interesting. Double edge sword. So like now that we have you know,

germ theory. We know it's important to wash your hands if you're going to be eating or preparing food, or or certainly if you're gonna be doing any kind of medical procedure, but also that repeatedly washing or you're sterilizing your hands has effects beyond just keeping pathogens away. It also affects the uh, the presence of non harmful microbiota on the surface of your hands. Yeah, it's kind of like I get again. You have to think of your hands as um as part of your body. They're not

just tools. They're not instruments. They're to use by you and your body. They they are part of you. Uh. They are also like yourself multitude. They have uh, they have populations, and if you regularly carpet bomb the population, that's gonna disrupt that's not going to just keep things from living there, it's going to potentially disrupt um the

ratio of what lives there and uh. And so the 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, is pointed out by one of the authors, We're gonna look to you cannot just boil the hand uh to sterilize it and then use the hand in a completely hygienic way. Right though, I want to be very clear, while we are acknowledging these consequences, this is not a case against hand washing. No, no, no.

Hand washing, as we'll discuss, is also very important here. Um. I also have to throw in, while after I was researching a lot of this and had it on my mind, still sort of turning over in my head, I ran into my boss out in the world, and my boss um stuck his hand out, But luckily he went for the fist bump instead of the handshake. I was glad that was that was ideal because I didn't want to have to be like, sorry, I can't shake your hand right now. Just read a whole bunch of stuff about

about hand germs. I thought you were gonna say, he stuck his hand out so you could kiss it. No, no, no, no, no, we have we we have a better. Our boss is a little better than that. Our boss is the Pope.

We work at the Vatican. But the big thing about all this is that it comes down to the to to one of the obvious facts we've discussed before, that without germ theory, without any insight into the invisible world of organisms that are literally at our fingertips, for the vast majority of human history, we just we just didn't know. We just didn't know that. Like we again, we had gloves. It's not like, uh, like we didn't have this idea

that well. And there are some cases where we need to cover our hands to protect our hand from uh some sort of external force or or perhaps in some cases protect the external world from our hands. But if you cannot see the threat, if you, if you, if you have no real concept of of the germs that are out there, of the invisible world, then what can

you do? Well? Yes, and also to acknowledge that the glove itself would need to be sterilized in order to provide an advantage there, like just putting on a dirty glove doesn't do much better than using a dirty hand exactly. UM. To give some more stats on some of this, according to Smith at All in infection control through the ages even today, quote, approximately one point seven million healthcare associated infections or h A eyes occur in the United States

each year. So even with modern UM precautions and technologies in place, that's one of the things about healthcare, I mean, it does put you in close proximity with a doctor. You puts you often puts you in a space where you have other individuals with various health care concerns going on. Um, 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 at 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. That's a bad healthcare plan, it does. It's not a singing endorsement of the hospital you're about to enter. Because of course that the tools were often primitive. They weren't cleaned,

they weren't cleaned between uses. Uh Cauterization via hot iron or boiling oil was commonly used. You're looking at between sixt mortality rates. This is pretty common during the time period, and even into the 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 uh, it was really 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 this is a norm.

There's nothing we can do about it. I was just randomly reminded of something I read recently, which is, so, you know, the famous story about US President James A. Garfield, who was it is sometimes said assassinated, but it is it has been observed by many historians that he was shot, but he survived his bullet wound for a while and was like for months actually, and was repeatedly operated on

in an unsanitary way by a doctor. And it is it is commonly believed that the doctor's unsanitary intervention is 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. But but speaking of this time period, yeah, eventually we get to what Smith at all referred to as the progressive era of the eighteen nineties through the nineteen twice these and we

do see a shift here. Quote this period sell great advances in hospital infection control. Ignance Similvis 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. He saw eleven of twelve consecutive women die of pew eperl or childbed fever, and subsequently required that all providers who attended the patients first washed their hands in a watery solution of chlorinated lime. The mortality rate then dropped dramatically from

eighteen percent to two percent. So simil Vis 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 were 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 Soderbergh's television drama Than Nick, which I know I've 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 like clean white, almost

blinding visual style to the show. You have electronic music by Cliff Martinez uh through throughout the series, and so I think it does a great job of portraying the past as the energetic, promising um present, you know, uh, 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 and past as being completely divorced from what we will know, and it's more about just like the excitement and also the danger of of being there at the bleeding edge of techno oology and innovation. Yeah, I think one of the things that's that's often hard to capture accurately when you're portraying the past is understanding the past as without knowledge of the future, understanding the past as uh, incorporating the full uncertainty of

being a present of its own. Like you say so, not only the excitement of things being new at the time, but also the lack of knowledge how things would turn out. Everything always seems more obvious in retrospect, right, right, And and certainly the nick is the show that doesn't doesn't

shy away from the wrong paths. I think I've mentioned before when we're talking about the invention of the X ray you have there's one episode in particular where they're so excited to have the X ray uh there at the hospital and they're just is just using it just so irresponsibly, uh, without really understanding or having any idea of just how dangerous repeated exposure to the machine would be. Well, they're using it unnecessarily right there, just like using it

for fun. Yeah, It's like I get the kids in here, Aaron, watch watch watch Dad, um x rays hand multiple times for for no reason, that sort of thing. But and they you know, they explore other things as well on the show. You know, various social issues come up, eugenics comes up, you know, all sorts of things of this nature. But um, but anyway, UH, similar vices findings were apparently better received in some countries than compared to others, the

UK and Germany being too. Though. That's interesting because we'll come back to Germany as sort of a center of discussion over the best practices and best use of new medical 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. Uh. It apparently got got pretty ugly from at least from an academic standpoint, and his mental health declined greatly and he eventually died in an asylum. So it's often care aterized as being you know, this this effort where he's he's kind of up against the wall. Maybe didn't have what maybe wasn't the ideal person to 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? Well, Yeah, I think a lot of the hygienic concerns about medical interventions and especially UH surgery would get more traction in the eighteen sixties with Joseph Lister. Yeah, Joseph Lister definitely a big one. I mean, they're various individuals that are working during this time cracking our understanding of the unseen and what we should do about it. And of course you have to acknowledge the work of Louis Pasteur. Now there's but Yeah,

Joseph Lister was a big name. Seven through nineteen twelve. He introduced the concept of surgical accepsis, the absence of all micro organisms within any type of invasive procedure. His work alone was associated, according to Smith at all, with a decrease in post amputation mortality rays from to fift 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, uh, you know, which just won't be necessary to amputate this this many limbs because uh be because we'll be using cleaner tools, etcetera. He argued for the necessity of pre operative hand washing

and the use of disinfectants soaked wound dressings. Yeah. I think Lister especially is known to highlight a distinction, will get to in a little bit of the distinction between a sepsis and anti sepsis, With pioneering the anti sepsis trend, which is the attempt to sterilize the wound itself to prevent infection. So this would typically mean using a disinfectant chemical such as carbolic acid in and around a wound. Yeah, and also dressing surgical tools. He's stressed that you should

change dressings on wounds um regularly. Um. Yeah, and again before lister here, pus and infect and we're just considered part of the healing process. It wasn't. It wasn't necessarily thought that this means things are not going to according to plan. It just means like this is this is what happens when the body heals from a wound. Thank alright. So getting into more into the realm of early surgical gloves,

early medical glove concepts and and the struggle for their acceptance. Um. William Holstaed introduced rubber gloves for use in surgery by around eighteen nine, and by 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 that does a pretty great job of

depicting this time period. If you go back and watch any of this show uh 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're reaching into people's bodies with bare hands.

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

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 uh and and lowering their 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 almost

magical feeling to it. And so I was reading a little bit about about this time period here for this episode in based on my readings of why We're surgical gloves not used earlier by Thomas Schlich, I believe this is the three VAT system standardized in Berlin in eight by Paul Fubringer. First soap, then alcohol, and then finally an antiseptic substance. Yeah, that three stage process was very

common by the eighteen nineties. And again it's it's great, it's a wonderful advancement in the in in in surgery at the time, but of course it falls just a little short of of actually using gloves, of actually embracing the standard. And now again we just accept when we go into a medical facility. Um. So this this, uh, the three VAT systems coming out of Germany. Germany is also where we see a great deal of argument during this period about whether surgeons should have to wear surgical

gloves at all. And uh, I think the first place that I was reading about this this um there was a j Store Daily article that came out from this is by jess Romeo in July, when obviously a lot of this sort of thing was going going on in there in our heads, and there's a lot obvious parallels between the treatment here of gloves and consideration of things like certainly handwashing but also the use of mass um.

The article was the surgeons who said not to gloves And the article from Romeo is citing another article, UH. The source article by Thomas schlich who we just referenced titled Negotiating Technologies in Surgery the controversy about surgical gloves in the eighteen nineties, and this was a two thousand thirteen article from the Bulletin of the History of Medicine. Yeah, this Bulletin of History of Medicine article is is interesting.

So the author here, Thomas Schlick, is a German Canadian historian of medicine who's on faculty at McGill University UH

in Montreal. And Schlick begins his article with by illustrating a really strange moment from the history of surgery where there was so so there was this big conference in it was the seven 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 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, 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. Alla, Sarah Bernhardt referring to like a French actress, uh 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. Uh. 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 pseudo scientific pageantry akin to like, Uh, I think the comparison to Sarah Bernhardt here is he's saying it's like a gaudy fashion show. Yeah, he compares it to just pure costuming. It's like, this is just a costume that these doctors are putting on that there's no real medical rationale for this. Now today, it's natural for us to look back on this view is not only misguided but

absolutely baffling. But it's true that even after the idea of using some kind of impermeable sterile glove for surgery was introduced, it took more than a decade of sort of debate within the medical community before it achieved what could be considered near universal acceptance. And this article Schlick explores the historical discussion and controversy about the introduction of

surgical gloves, specifically in German speaking hospitals in the eighteen nineties. UM. 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. Uh. And actually, once you see all their concerns laid out, 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 what the understanding was at the time, and what the pressures

on surgeons for performing in the operating room. Where Yeah, I think this is one of the great things that does in the paper is really presents this this idea because it's easy to think about this and sort of look at the surface level of the this new technology and its eventual adoption and just look at it as Okay, well here's the new way, and everybody else must have been saying, oh, I just want to do it the old way, where it was really more a situation where

there was the old ways and then there were all these new exciting ways that were uh, you know, all ultimately trying to crack the same nut to try to improve, um the mortality rates for various procedures. And and also he seems to to stress that, you know, we 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 don't know that this is not going to you know, they're on the ultimately on the

losing hill here. When you're advocating that that that medical gloves should not be used universally, well, yeah, this is what I was talking about earlier with like the uncertainty of the present, and you always have to remember that in the past they were just as uncertain and about what the future would be as we are about our

own future in the present. Right. And one thing he stresses here is that the surgeons, often big name surgeons that were engaging in this debate, a lot of them had their own ideas, their own techniques, and in many cases they had they had dated to back up what they were arguing. Um, like, there's there's one guy that he mentioned, surgeon Thomas Spencer Wells, who advocated cleanliness and cold water school as opposed to and embracing Lister's ideas.

So this is more in general about like handwashing and um cleansing of instruments, boiling of instruments, et cetera, as opposed to gloves. But this was a guy that that still had menial had a minimal complication rate. Uh and the therefore he had some data to back up his viewpoint. Uh. So he had He wasn't just standing on a hill

without you know, 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. Yes, and wells would not be the only one. They're even people making the case at this UH Congress of German Society for Surgery who were saying, look, I've done laboratory research that shows that you get way more bacterial penetration of these uh, blood soaked cotton gloves than you do

of of bare hands. So so actually you don't need gloves, you just need clean hands. Yeah. Another naming mentions is Johannes Mikolish who wh who argue that we should be using this preoperative injection of nucleic acid to supposedly increase white blood cell count and boost immune response. So so again it comes back to the idea that it's not just the old ideas and the new uh, this one

new idea. I know they're they're these others seemingly promising new ideas and new technologies that are also suddenly available. Oh that's interesting. And you get these from both sides about the different solutions, because Mikolich here was one of the major proponents of gloves at this at this conference,

he was there representing the yes gloves or good side. Interesting, yeah, but but better better then He also has his other thing as well, that that you could conceivably you're a surgeon, you're listening to all these ideas, you can imagine where you might be like, well, this U Johannes, it seems to have a great technology here. Maybe I can cherry pick a little bit. Maybe I can sort of hold onto my own reservations about gloves and just start using

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

and techniques. Yeah. That's another point Schlick actually really highlights in this paper, which is that, you know, sometimes we have an erroneous tendency to erroneously look at the history of progress in medicine as a kind of unified, top down effort where there's just like okay here, you know, they're almost like there is a sort of uh bore of medicine that like controls all of medicine throughout history, and they direct the flow of 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. Now, another thing we have to mention here is, of course what we're talking about when it comes to materials and what we were talking what we're talking about with the physical gloves of the time, Um, this would not have been a situation where like we're we're dealing with modern medical gloves that are suddenly presented to an audience. Um that this uh, this gathering, Um it made me think of a recent episode of the

nineties Outer Limits that I watched it. The episode is titled Gettysburg. It stars meat Loaf and it also has the guy who played the crazy man on the boat in Jason Takes Manhattan, and it is involved 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 medikit and so there's a great scene where he's he's he's doing some

some some medical intervention on a wounded soldier. And meat Loaf's character, who's a Civil War era UM, I like to forget what he is if he's a he's a colonel. Uh, he's watching on and he doesn't seem to think anything about these modern medical um devices and gloves that are being used by this guy. So um, that's kind of a tangent, but it was, it was. It was weighing

heavily on my mind as I researched this well. To be fair to meet loaf, I mean, if I look at a modern surgery, I'd see a lot of stuff. I don't know what I'm looking at, and it's there's no time travel involved. Yeah, So, so these would not have been modern medical gloves that they were considering here. Um. Uh. The author mentions several of the different designs that were

presented at this conference. They included elbow length fabric gloves of cotton or silk, and of course, if you were to use these during an operation, they would apparently quickly become soaked with blood. H. There was also the idea of using leather style military gloves uh, and these would have, of course been clumsy to use. Wax treated fabric was another idea, and oh, 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. Yeah, and the actual paper Schlick talks. He mentions this as a proposal, but I didn't get the impression anybody ever did it, or at least not. Yeah,

didn't like put it into regular practice. Yeah, I have trouble imagining how it would work, right, because if the wax was sealed around the hand um, and you know, if you were to go with the right wax, that of course wouldn't be just absolutely um scalding to the flesh. Then it would truly become brittle upon trying to move your hand it around. Yeah, I don't know it. It doesn't make a lot of sense to me, though. I'm

also confused about the the wax treated. I mean, I can get into more detail about this later, but one of the proposals is for like a silk glove that you would cover in liquid wax, and that would help make the silk fabric more impermeable. But I would also think, like, wouldn't that get kind of brittle? I don't know, Yeah, it seems like it would be flaking off and you

have like little bits of wax. I mean, unfortunately, as we've pointed out before in the show, like wax has long been used, uh and and and so has honey and various medical treatments. So it's not the worst thing I guess to have in a wound, but it's you want to cut down on the amount of external substances that are introduced to a body cavity during a procedure like this. Um. I don't know about you, but another detail I really liked in article was this bit um quote.

Another strategy, and this is an altern of diptic 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 this surgeon saying, well, I'm I'm of course I'm not gonna wear gloves during a procedure. It gets in the way. I have some

some issues with how hygienic 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. There you almost it's like you become sort of part of a priestly class. You must maintain purity for all time. Yeah, I mean it's like these are the moneymakers, right, and that I have to keep

the gloves on them at all times. That these hands are registered with the FBI as lethal weapons because I don't wash them before I operate. Now, he points out that the material real challenges here came down to the following and these I think we're pointed out by Sergeant Anton Wolfer at the time. They needed to be impermeable, obviously, they needed to be flexible, they needed to be resistant to tears. They couldn't be too tight, they couldn't be too hot, and above all else they had to be

you had to be able to to sterilize them. They had to be sterilizable, right, meaning you could like boil them or steam them or something to to kill any thing that might be on them without damaging them so that they couldn't be used. Right. And so given all of these demands of the materials, uh, it shouldn't come as a surprise that the first surgical gloves that were presented here they were not perfect. They did tear, they did make aspects of surgery, particularly gripping certain tools or

certain parts of the human anatomy more difficult. I think the manipulation of bowels is singled out as being difficult with some of the gloves of this time period. Um. 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. Oh yeah, I think so. I think by around the time of World War One,

it's generally agreed that that's when you you are seeing. Okay, now we have pretty much universal acceptance that impermeable sterile gloves are good for for surgery, and they should be used if at all possible. I can't help to think of of media and all this as well, like cinematic depictions of doctors, uh like now, like the image of a doctor, VI of them a you know, a good

doctor or a mad scientist or something. The taking off or the putting on of surgical gloves or medical gloves at some point some form or another, it is kind of associated with with power and ability. Uh. You know, there's um, there's something about it that like we don't even even doubt, doubt, not only do 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. There's a there's a strong audio visual cue used in media, which is much in the same way you have like an action movie, where a gritty action scene is about to commence, so you get the pump of the shotgun. In the medical scene, you get the snap of the rubber glove.

It's almost exactly the same thing, right, I mean it's enough to where if you were given the choice between two fraudulent pseudo scientific healers and they were gonna work on you, and one is using bare hands and one is using gloves, like the mere presence of the gloves could potentially legitimize it a little bit in your eyes. You know, Wait, no, but did you mean bare hands

or B E A R hands? Oh well, I meant I meant B A R E. But B E A R that brings on an entirely different vision, right, I mean, that's then you're in the realm of the shaman. I would go with I would go with the quack that had bare paws over the quack that just had gloves, or what if the the what if the quack had both a bare head on over their own had, but they had medical gloves on. What if they operated on you wearing the bear costume from Jack Frost. There you go,

Thank you, thank you, thank you. All right, Well, I wanted to come back to that Thomas Schlick paper in the Bulletin of the History of Medicine, the one called Negotiating Technologies and Surgery that was all about the controversy over surgical gloves in German speaking hospitals in the eighteen nineties.

And as I mentioned earlier that the Schlick paper is interesting because it frames the good things about gloves as a sort of you know, existing within a network of trade offs uh and UH, talking about it as one of the types of what Schlick calls control strategies within surgery at the time. And control strategies there were many, but they included things like different instruments UH, lights and operating tables UH, anatomy, atlas is, an esthetics, 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 in the development of surgery in the second half of the nineteenth century. So you've got two schools of thought the 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 a sepsis, which is instead trying to prevent any

germs from ever entering the wound in the first place. Uh. And the primary method here would be trying to make all instruments and objects in the surgical environment sterile before surgery begins, so you would boil your scalpels and so forth. But Schlick describes a growing nervousness among surgeons in the eighteen nineties based on the general feeling that reigning aseptic

practices were not good enough. That you know, the By the eighteen nineties, surgeons in German speaking hospitals were aware of 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. A sepsis had to be what they were, 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 of bres Lau named Johannes van Miklich, and Mikolitch wrote quote, the smallest mistake and wound treatment would come back to haunt the surgeon.

And Mikolitch, together with a collaborator named Carl Fluga who lived eighteen forty seven and nineteen twenty three, UH 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. UH and so one of the ideas that 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 Schlick writes, 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 it was the context of this crisis of aseptic 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 it was very interesting. And 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 and surgery, but they don't know all the ways to plug the holes. And the use of surgical gloves is obvious to us in retrospective, but it was not obvious to everyone at this time and place. So why would

it not have been obvious to them? Uh. 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 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 the Slick points out around here is that carbolic acid and other antiseptic chemicals that were used to to get the hands clean before surgery, these were hard on the skin. Schlick Wrights quote copiously applied the caustic solutions often caused severe skin damage insurgeons 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 Robbie already mentioned Halstead introducing rubber gloves in his practice around this time, but Slick goes on with an interesting detail here quote Subsequently,

such gloves were also used by Halsted's assistants. They put them on when taking instruments out of the corrosive sublimate solution in which the instruments were kept, and passed them on to the operating surgeon, who did not wear gloves. So so the assistance would you'd have like a scalpel, and that would be in a sterilizing, uh, caustic chemical, and the assistance would put gloves on to take the thing out of that chemical, handed to the surgeon who

would receive it with an ungloved hand and then operate. Yeah. I guess that. One of the things to drive home here is, Yeah, the adoption of a new technology is sometimes a little patchy, and the reasoning can be different than what you'd expect. So they've got by eighteen eighty nine, Halstead's assistants and nurses are using rubber gloves to protect their hands from these caustic chemicals. But it wasn't until eighteen nine six that UH that rubber gloves to protect

the patient during surgery became standard at Johns Hopkins. It just didn't seem like an obvious solution until around then. Now, another thing is that 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 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 a little little gland pockets attached to hair follicles that produce sea bum, 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 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 this phrase that was used at the time 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, right, right, and there's always gonna be at least one little crack in the defenses with this method. So to try to get around these problems where you know, sterilizing your hands is not good enough, this is where gloves come in.

And so we mentioned several times this guy, you Haness fun Uh mikolich Uh. He tried this interesting solution, beginning with an operation on Easter eighteen, which was sterilized cotton gloves. So hands would go through the regular gauntlet washing and disinfection, but then after this you would put on the sterilized cotton gloves. They were very big. They had sleeves or gauntlets going all the way up the arm to like 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 sod with blood and you might need to change them out for a new pair. But Mikolitch was was very positive about them. He is like, you know, uh, 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, uh, this is the example given by by Mikolich when um 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 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. And it's the five second rule. Of rooting around in somebody's um the stomach cavity. Right. Yeah, that that seems like not not a great solution, but at least you're you're trying to use something. So Mikolich also tried out early rubber gloves but said they were not tenable because they had they just had major disadvantages for manual dexterity, and they

weren't much better than cotton gloves for asepsis. 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 Verners 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 one, 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. I do love the name the boiled hand. By the way, we were talking about this a little bit before we came in here. Just perfect. This seems

to be a bigger thing than just zoga. Here. There's like a general anguish at the time expressed by multiple surgeons about the idea of hands being a non boilable objects. Boiling, I think, became a kind of metaem for aseptic safety, So you might at the time, instead of saying something is a septic, you might just call it boiled, whether or not it had literally been boiled. Now a couple

of other interesting solutions mentioned in the Schlick paper. There was a guy named George Perth's who lived eighteen sixty eight 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 fifties. Rubber condoms were allegedly made of rather thick material, but they did exist at the time, and perthis suggested that 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 Perthieves

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 we're topped

with with condom rubber or something. But yeah, ultimately we get to this desire that Wolfer articulates that you mentioned earlier, that you've gotta 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 and there were all kinds of interesting debates here about like the actual bacteriological evidence for gloves, like, uh, 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. Uh. So again not not the rubber ones, but taking uh, cotton gloves that have been used in surgery and then squeeze sing out the quote glove juice and then uh doing a culture of that to see what it's 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. Uh. And then this led to a really I think a debate between different evidential standards. So you have some people 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 this is effective or not. Now. Eventually, over time there was agreement that that impermeable gloves were the gold standard and that if you could manufacture them in a way that didn't sacrifice too much manual control, which, of course we did get it with the with the sterile gloves that people use today made of thin materials such as latex, nitrial,

or vinyl. Yeah, modern medical gloves come in, of course, various sizes. They are made from a variety of polymers, yet powdered and unpowdered or even powdered with corn starch to cut down on skin irritation. They've been a lot of efforts towards the elimination of powdered gloves in general, and there are alternatives for individuals with with latex allergies. So uh yeah, modern medical gloves, there's this broad spectrum there.

We've come a long way obviously since uh, 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 the acceptance of of medical and surgical gloves. You again, you would not accept bare fingers and bare hands as an alternative. But I think it's also good to understand that at the time, resistance to the to the take up of gloves, especially in perm obol gloves,

was not just uh, just stubbornness or quackery. There probably was some of that, but a lot of it was also genuine concern for being able to operate effectively. Yeah, I mean when you're you're I think the the example of our promiscuous surgeon, uh is key here though, Yeah, because he's talking like clearly he's weighing. Um, yeah, these are these are bulkier in some cases, but like I need to be able to go from this patient to this patient to this patient. Um, you know, we need

to be able. So it's kind of like getting into the scale issue of inventions, like, okay, I can. It's one thing to create a perfect prototype in isolation. It's one thing to be able to conduct 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. Yeah. Oh, and then to to come back to our outer limits example from earlier, the idea of being able to perform

medical interventions like out in the field. Uh, like, this seems another area where gloves are vital because yes, I mean, you still are going to ideally, you know, have some some sort of cleansing materials, but are you going to have three vats in which to um to spend some time washing your hands, or are you gonna have to essentially snap on some gloves and get in there and try 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, these the efforts of the historian to places within that time period to make sense of it all just 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. Uh. Of course, we'd love to hear from anyone out there who regularly wears medical gloves, surgical gloves as part of your profession. What you know, what are your thoughts on them? What what sort of a history do you have with them? And you have to use a certain variety of glove due to allergies or skin irritations. We'd love to hear some insight from the field.

All right, well, we're gonna go 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 on Tuesdays and Thursdays. And uh oh, we should also mention we we mentioned condoms briefly. We do have an older episode of Invention about the invention of the condom, so uh 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 Monday's we do listener mail episodes, on Wednesdays we do a short form artifact or monster fact, and on Friday's we set aside most serious concerns and just talk about a weird film. Huge thanks as always to our excellent audio producer Seth Nicholas Johnson. If you would like to get in touch with us with feedback on this episode or any other, to suggest a topic for the future, or just to say hello, you can email us at contact at stuff

to Blow your Mind dot com. Stuff to Blow Your Mind is production of I Heart Radio. For more podcasts for my heart Radio, visit the i heart Radio app, Apple Podcasts, or wherever you're listening to your favorite shows.