September 16, 2023 • 58 mins
In this classic invention-themed episode of Stuff to Blow Your Mind, Robert and Joe explore the origin of surgical gloves, the differing concepts for their composition and the struggle to get surgeons to wear them. (originally published 08/30/2022)
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Episode Transcript
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Speaker 1 (00:06):
Hey you welcome to Stuff to Blow Your Mind.
Speaker 2 (00:07):
My name is Robert Lamb and I am Joe McCormick,
and it's Saturday. Time for an episode from the Vault.
This one originally aired August thirtieth, twenty twenty two, and
it is about the invention of surgical gloves.
Speaker 1 (00:21):
Yeah, yeah, this is a This is a pretty fun one.
Every now and then we'll know, we'll get to that
point where it's like, oh, we got we need to
do a bunch of invention episodes, like the Invention frenzy
overcomes us. So, yeah, this is a this is a
fun exploration.
Speaker 3 (00:37):
Welcome to Stuff to Blow Your Mind production of iHeartRadio.
Speaker 4 (00:47):
Hey, welcome to Stuff to Blow your Mind. My name
is Robert.
Speaker 2 (00:49):
Lamb and I'm Joe McCormick.
Speaker 4 (00:51):
And this weekend Stuff to Blow your Mind. We have
another invention themed episode for everyone, and I think it
should prove an interesting episode because it's one of those
stories that more than it just covers like the need
for an invention and the development of that invention, it
also gets into the acceptance of that invention or the
lack there off concerning a new technology. You know, it's
(01:14):
one thing 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 within a given field, a given culture, etc.
Speaker 2 (01:31):
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 going to be talking about today. Something
that is now a universal standard that people would be
horrified to hear anybody was not using, was in fact
(01:54):
originally one solution among many.
Speaker 4 (01:57):
Right, we're going to be talking about surgical gloves. You
say are just ubiquitous now it's just no matter what
the surgical procedure happens to be, but not only surgical procedures,
but also just any kind of medical checkup, anything in
the medical establishment in general. If you go to the dentist,
if they're going to have medical gloves on, and it's
(02:21):
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 part of the procedure, and most of us
would be somewhat concerned if we go in there and
the gloves are off.
Speaker 2 (02:42):
Or if the gloves were, say made of cotton, then
really juicy.
Speaker 4 (02:46):
Right, Or yeah, you go in and it's like your
dentist is wearing big ski gloves or mittens. So you've
realized something is off. This is not the way things
should be, but.
Speaker 2 (02:57):
It was not always so. So if you went to
to say, a German speaking hospital in the eighteen nineties,
you may be lucky enough 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 asceptic, and does understand that gloves can
(03:19):
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've got their fingers around
in you.
Speaker 4 (03:31):
Now a quick side note on just gloves in general.
Gloves have been with us for a very long time.
It's just a basic way to protect the hand from
where from coal, from heat, from other threats, just a
basic technological advancement in which we realized, hey, we can
take other materials and make a second skin for our
hands are very important but also susceptible to damage. Hands
(03:55):
and some of the oldest gloves that we have that
have survived include a pair of delicate linen child's gloves
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,
(04:19):
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
(04:39):
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
(05:02):
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
(05:23):
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
(05:46):
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
(06:08):
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
(06:30):
these products.
Speaker 2 (06:31):
Oh yeah, that's got to be interesting. Double edged 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 certainly if you're
going to be doing any kinemtical procedure. But also that
repeatedly washing or you're sterilizing your hands has effects beyond
just keeping pathogens away. It also affects the presence of
(06:55):
non harmful microbiota on the surface of your hands.
Speaker 4 (06:59):
Yeah, it's like I get again. You have to think
of your hands as part of your body. They're not
just tools, they're not instruments. They're used by you and
your body. They are part of you. They are also
like yourself multitude. They have populations, and if you regularly
carpet bomb the population, that's going to disrupt. That's not
(07:20):
going to just keep things from living there. It's going
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
(07:43):
the hand in a completely hygienic way.
Speaker 2 (07:47):
Right though, I want to be very clear, well, we
are acknowledging these consequences. This is not a case against
hand washing.
Speaker 4 (07:53):
No, no, No. Hand washing, as we'll discuss, is also
very important here. 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 stuck his hand out, but luckily
he went for the fist bump instead of a handshake,
and it was great. That was that was ideal because
(08:15):
I didn't want to have to be like, sorry, can't
shake your hand right now. Just read a whole bunch
of stuff about about hand germs.
Speaker 2 (08:22):
I thought you were going to he stuck his hand
out so you could kiss it.
Speaker 4 (08:25):
No, no, no, no, no, we have we have at
Our boss is a little better than that.
Speaker 2 (08:30):
Our boss is the Pope. We work at the Vatican.
Speaker 4 (08:33):
But another big thing about all this is that it
comes down to the 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,
(08:53):
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,
(09:14):
of the invisible world, then what can you do?
Speaker 2 (09:16):
Well, yes, and also to acknowledge that the glove itself
would need to be sterilized in order to provide an
advantage there, Just putting on a dirty glove doesn't do
much better than using a dirty hand exactly.
Speaker 4 (09:29):
To give some more stats on some of this. According
to Smith at All in twenty seventeen's Infection Control through
the Ages, even today, quote, approximately one point seven million
healthcare associated infections or HAI's occur in the United States
each year. So even with modern precautions and technologies in place,
(09:51):
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,
(10:11):
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.
Speaker 2 (10:31):
That's a bad health care plan, Yeah, it does.
Speaker 4 (10:34):
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 and weren't cleaned between uses. Cauterization via
hot iron or boiling oil was commonly used. You're looking
at between sixty and eighty percent mortality rates. This is
pretty common during the time period, and even into the
(10:56):
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
(11:20):
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.
Speaker 2 (11:36):
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 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
(12:00):
operated on in an unsanitary way by a doctor. And
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
(12:21):
was doctor doctor Willard Bliss, all right.
Speaker 4 (12:24):
But speaking of this time period, yeah, eventually we'd get
to what Smith at All referred to as the progressive
era of the eighteen nineties through the nineteen twenties, and
we do see a shift here. Quote. This period saw
great advances in hospital infection control. Ignot Simmelweiss was the
first hospital epidemiologist, setting a precedent for step by step
(12:47):
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
(13:07):
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
(13:30):
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,
(13:52):
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
(14:15):
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.
Speaker 2 (14:35):
I think one of the things 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 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
(14:57):
lack of knowledge how things would turn out. Everything always
seems more obvious in retrospect.
Speaker 4 (15:02):
Right, right, And certainly The Nick is a 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,
they're at the hospital and they're just just using it
just so irresponsibly, without really understanding or having any idea
(15:23):
of just how dangerous repeated exposure to the machine would be.
Speaker 2 (15:28):
Well, they're using it unnecessarily, right, They're just like using
it for fun.
Speaker 4 (15:32):
Yeah, it's like you get the kids in here, Oh,
watch watch watch Dad x ray's hand multiple times for
no reason, that sort of thing.
Speaker 1 (15:41):
Uh.
Speaker 4 (15:41):
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 anyway, Simple Device's 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
(16:03):
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. It apparently got pretty ugly, at least
(16:24):
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
(16:46):
some of these ideas, but what can you do?
Speaker 2 (16:49):
Well, Yeah, I think a lot of the hygienic concerns
about medical interventions and especially surgery would get more traction
in the eighteen sixties with Joseph Lister.
Speaker 4 (16:59):
Yeah, Joseph Lister definitely a big one. I mean, there
are 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 Pastur. Now there's but Yeah, Joseph Lister
was a big name. Eighteen twenty seven through nineteen twelve,
he introduced the concept of surgical asepsis, the absence of
(17:21):
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
(17:44):
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.
Speaker 2 (18:00):
Yeah, I think lister especially is known to highlight a
distinction we'll get to in a little bit, the distinction
between asepsis 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.
Speaker 4 (18:23):
Yeah, and also dressings surgical tools. He stress that you
should change dressings on wounds regularly.
Speaker 2 (18:31):
Yeah.
Speaker 4 (18:31):
And again, before lister here and infection were 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 what happens
when the body heals from a wound, all right. So
(18:52):
getting into more into the realm of early surgical gloves,
early medical glove concepts, and the struggle for their acceptance.
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
(19:15):
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
(19:37):
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,
(19:58):
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
(20:21):
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
(20:42):
system standardized in Berlin in eighteen eighty eight by Paul Fubringer.
First soap, then alcohol, and then finally an antiseptic substance.
Speaker 2 (20:53):
Yeah, that three stage process was very common by the
eighteen nineties.
Speaker 4 (20:56):
And again it's great, it's a wonderful advanced in surgery
of the time, but of course it falls just a
little short of actually using gloves, of actually embracing the
standard that now again we just accept when we go
into a medical facility. So the three VAT systems coming
(21:16):
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 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
(21:37):
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,
(21:57):
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.
Speaker 2 (22:13):
Yeah, this Bulletin of History of Medicine article is interesting.
So the author here, Thomas Schlick, is a German Canadian
historian of medicine who's on faculty at McGill University in Montreal.
And Schlick begins his article by illustrating a really strange
moment from the history of surgery where there was so
(22:35):
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
(22:56):
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
(23:17):
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
(23:39):
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.
Speaker 4 (24:01):
Yeah. 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.
Speaker 2 (24:11):
Now today, it's natural for us to look back on
this view as 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 by Schlick explores the
(24:35):
historical discussion and controversy about the introduction of surgical gloves,
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,
(24:57):
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.
Speaker 4 (25:17):
Yeah, I think this is one of the great things
he 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 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
(25:38):
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 all ultimately trying to
crack the same nut to try to improve the mortality
rates for various procedures. And also he seems to stress
(25:59):
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
(26:19):
hill here when you're advocating that medical gloves should not
be used universally, well.
Speaker 2 (26:26):
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 about what the future would be as we are
about our own future in the present right.
Speaker 4 (26:39):
And one thing he stresses here is that these 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 data to
back up what they were arguing. Like there's there's one
guy that he mentioned, surgeon Thomas Spencer Wells, who advocated
the cleanliness cold water school as opposed to and embracing
(27:02):
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
(27:26):
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.
Speaker 2 (27:35):
Yes, And wells would not be the only one. There
are even people making the case at this eighteen ninety
eight 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 blood soaked cotton gloves than
you do of bare hands. So actually you don't need gloves,
(27:59):
you just need clean hands.
Speaker 4 (28:00):
Yeah. Another name you mentioned is Johannes Mikkelish who 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 this one new idea. No, there are these
(28:21):
other seemingly promising new ideas and new technologies that are
also suddenly available.
Speaker 2 (28:26):
Oh that's interesting, And you get these from both sides
about the different solutions, because Mikolch here was one of
the major proponents of gloves at this at this conference,
he was there representing the yes gloves or good side.
Speaker 4 (28:39):
Interesting. Yeah, but then he also has his other thing
as well, 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 Johannes 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
(29:04):
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.
Speaker 2 (29:12):
Yeah, that's another point Schlick actually really highlights in this paper,
which is that, you know, sometimes we have a 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, almost like there is
a sort of a board of medicine that like controls
(29:36):
all of medicine throughout history and they direct the flow
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.
Speaker 4 (29:57):
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 we were talking about with
the physical gloves of the time, this would not have
been a situation where like, we're dealing with modern medical
gloves that are suddenly presented to an audience at this
this gathering. It made me think of a recent episode
(30:21):
of the nineties Outer Limits that I watched. If the
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
(30:42):
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
(31:02):
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.
Speaker 2 (31:14):
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.
Speaker 4 (31:22):
Yeah, so these would not have been modern medical gloves
that they were considering here. The author mentions several of
the different designs that were presented at this conference that
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. There was
(31:43):
also the idea of using leather style military gloves, and
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.
Speaker 2 (32:05):
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.
Speaker 4 (32:16):
Yeah, I have trouble imagining how it would work right,
because if the wax was sealed around the hand, and
if you go with the right wax, that of course
wouldn't be just absolutely scalding to the flesh, then it
would truly become brittle upon trying to move your hand around.
Speaker 2 (32:34):
Yeah, I don't know. It doesn't make a lot of
sense to me, though. I'm also confused about 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
(32:55):
would also think, like, wouldn't that get kind of brittle?
I don't know.
Speaker 4 (32:58):
Yeah, it was like it would be flaying off and
you'd have like little bits of wax. I mean, Fortunately,
as we've pointed out before in the show, like wax
has long been used and so has honey in 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
(33:20):
introduced to a body cavity during a procedure like this.
I don't know about you, but another detail I really
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
(33:40):
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
(34:02):
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.
Speaker 2 (34:11):
There. You almost it's like you become sort of part
of a priestly class. You must maintain purity for all time.
Speaker 4 (34:19):
Yeah, I mean, it's like these are the money makers, right,
I have to keep the gloves on them at all times.
Speaker 2 (34:24):
That these hands are registered with the FBI as lethal weapons,
because I don't wash them before I operate.
Speaker 4 (34:32):
Now, he points out that the material challenges here came
down to the following and these I think were 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
(34:54):
had to be you had to be able to sterilize them.
Speaker 2 (34:57):
They had to be sterilizable, right, meaning you could like
boil them or steam them or something to kill any
thing that might be on them without damaging them so
that they couldn't be used.
Speaker 4 (35:08):
Right. And so given all of these demands of the materials,
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
(35:31):
being difficult with some of the gloves of this time period.
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.
Speaker 2 (35:42):
Oh yeah, so I think by around the time of
World War One, it's generally agreed that's when you are
seeing Okay, now we have pretty much universal acceptance that
impermeable sterile gloves are good for surgery and they should
be used if at all possible.
Speaker 4 (35:58):
I can't help but think of media and this as well,
like cinematic depictions of doctors, like now, like the image
of a doctor, be of them 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
(36:19):
power and ability. You know, there's there's something about it
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.
Speaker 2 (36:36):
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.
Speaker 4 (36:52):
Thing, right, I mean it's enough to where if you
were given the choice between two fraudulent pseudoscientific healers and
they were going to work on you, and one is
using bear hands and one is using gloves, like the
mere presence of the gloves could potentially legitimize it a
little bit in your eyes.
Speaker 2 (37:09):
You know, Wait, no, beb did you mean bear hands
or B E A R hands?
Speaker 4 (37:14):
Oh well I meant I meant B A R E.
But B E R That brings on an entirely different vision, right,
I mean that's then you're in the realm of the shaman.
Speaker 2 (37:23):
I would go with I would go with the quack
that had bear paws over the quack that just had gloves.
Speaker 4 (37:28):
Or what if the the what if the quack had
both a bear head on over their own head, but
they had medical gloves on.
Speaker 2 (37:36):
What if they operated on you wearing the bear costume
from Jack Frost?
Speaker 4 (37:40):
There you go?
Speaker 2 (37:48):
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, the
Shlick paper is interesting because it frames the good things
(38:10):
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,
(38:37):
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
(38:58):
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
(39:19):
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
(39:40):
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
(40:02):
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
(40:22):
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.
(40:42):
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
(41:02):
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
(41:23):
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
(41:45):
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
(42:05):
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
(42:27):
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
(42:50):
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
(43:14):
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
(43:38):
to the surgeon who would receive it with an ungloved
hand and then operate.
Speaker 4 (43:42):
Yeah, I guess one of the things to drive from
here is, you know, the adoption of a new technology
is sometimes a little patchy.
Speaker 2 (43:48):
And the reasoning can be different than what you'd expect.
So they've got by eighteen eighty nine, Halsted's assistants and
nurses are using rubber gloves to protect their hands from
these coustic chemicals. But it wasn't until eighteen ninety six
that rubber gloves to protect the patient during surgery became
standard at Johns Hopkins. It just didn't seem like an
(44:10):
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,
(44:30):
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.
(44:50):
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
(45:12):
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
(45:33):
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.
Speaker 4 (45:43):
Right, right, there's always going to be at least one
little crack in the defenses with this method.
Speaker 2 (45:48):
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,
Johannis van Mikulitch, he tried this interesting solution, beginning with
an operation on Easter eighteen ninety six, which was sterilized
cotton gloves. So hands would go through the regular gauntlet
(46:11):
washing and disinfection, but then after this you would put
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
(46:33):
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.
(46:56):
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
(47:18):
tumor with your bare fingers as quickly as possible, and
then once you found it, you put on a pair
of fresh cotton gloves.
Speaker 4 (47:24):
Yeah, and it's the five second rule of rooting around
in somebody's stomach cavity. Right.
Speaker 2 (47:30):
Yeah, that seems like not a great solution, but at
least you're trying to use something. So Mikolitch 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 acepsis.
I don't know about that last claim, but apparently, according
(47:52):
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
(48:12):
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
(48:33):
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
(48:53):
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
(49:16):
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
(49:37):
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.
Speaker 4 (49:50):
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.
Speaker 2 (49:56):
This seems to be a bigger thing than just zoga.
Speaker 4 (49:58):
Here.
Speaker 2 (49:59):
There's like a general anguish at the time expressed by
multiple surgeons about the idea of hands being non boilable objects. Boiling,
I think, became a kind of metonym for aseptic safety,
so you might at the time, instead of saying something
is aseptic, you might just call it boiled. Whether or
(50:19):
not it had literally been boiled. Now a couple of
other interesting solutions mentioned in the Schlick paper. There was
a guy named George Perthies 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,
(50:40):
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
(51:02):
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,
(51:25):
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
(51:47):
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
(52:07):
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,
(52:29):
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.
(52:53):
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
(53:14):
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.
Speaker 4 (53:23):
Now.
Speaker 2 (53:23):
Eventually, over time there was agreement 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 with the with the
sterile gloves that people use today made of thin materials
such as latex, nitrial are vinyl.
Speaker 4 (53:42):
Yeah, modern medical gloves come in, of course, various sizes.
They are made from a variety of polymers. You get
powdered and unpowdered, or even powdered with corn starch to
cut down on skin irritation. There've been a lot of
efforts towards the elimination of powdered gloves in general, and
there are alternatives for individuals with latex allergies. So, uh, yeah,
(54:02):
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
(54:25):
an alternative.
Speaker 2 (54:26):
But I think it's also good to understand that at
the time, resistance to the to the take up of gloves,
especially impermeable 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.
Speaker 4 (54:46):
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. 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. You know, we need to be able.
It's kind of like getting into the scale issue of inventions, like, okay,
(55:07):
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.
Speaker 2 (55:25):
Yeah.
Speaker 4 (55:25):
Oh, and then to come back to our outer limits
example from earlier, the idea of being able to perform
medical interventions like out in the field, 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 spend some time washing
(55:49):
your hands, or are you going to 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, the efforts
of the historian to place us within that time period
to make sense of it all just all very fascinating
(56:12):
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,
(56:34):
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
(56:56):
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
(57:17):
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.
Speaker 2 (57:24):
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 Stuff to
Blow your Mind dot com.
Speaker 3 (57:46):
Stuff to Blow Your Mind is production of iHeartRadio. For
more podcasts from my Heart Radio, visit the iHeartRadio app,
Apple Podcasts, or wherever you listen to your favorite shows.
Hey you welcome to Stuff to Blow Your Mind.
Speaker 2 (00:07):
My name is Robert Lamb and I am Joe McCormick,
and it's Saturday. Time for an episode from the Vault.
This one originally aired August thirtieth, twenty twenty two, and
it is about the invention of surgical gloves.
Speaker 1 (00:21):
Yeah, yeah, this is a This is a pretty fun one.
Every now and then we'll know, we'll get to that
point where it's like, oh, we got we need to
do a bunch of invention episodes, like the Invention frenzy
overcomes us. So, yeah, this is a this is a
fun exploration.
Speaker 3 (00:37):
Welcome to Stuff to Blow Your Mind production of iHeartRadio.
Speaker 4 (00:47):
Hey, welcome to Stuff to Blow your Mind. My name
is Robert.
Speaker 2 (00:49):
Lamb and I'm Joe McCormick.
Speaker 4 (00:51):
And this weekend Stuff to Blow your Mind. We have
another invention themed episode for everyone, and I think it
should prove an interesting episode because it's one of those
stories that more than it just covers like the need
for an invention and the development of that invention, it
also gets into the acceptance of that invention or the
lack there off concerning a new technology. You know, it's
(01:14):
one thing 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 within a given field, a given culture, etc.
Speaker 2 (01:31):
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 going to be talking about today. Something
that is now a universal standard that people would be
horrified to hear anybody was not using, was in fact
(01:54):
originally one solution among many.
Speaker 4 (01:57):
Right, we're going to be talking about surgical gloves. You
say are just ubiquitous now it's just no matter what
the surgical procedure happens to be, but not only surgical procedures,
but also just any kind of medical checkup, anything in
the medical establishment in general. If you go to the dentist,
if they're going to have medical gloves on, and it's
(02:21):
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 part of the procedure, and most of us
would be somewhat concerned if we go in there and
the gloves are off.
Speaker 2 (02:42):
Or if the gloves were, say made of cotton, then
really juicy.
Speaker 4 (02:46):
Right, Or yeah, you go in and it's like your
dentist is wearing big ski gloves or mittens. So you've
realized something is off. This is not the way things
should be, but.
Speaker 2 (02:57):
It was not always so. So if you went to
to say, a German speaking hospital in the eighteen nineties,
you may be lucky enough 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 asceptic, and does understand that gloves can
(03:19):
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've got their fingers around
in you.
Speaker 4 (03:31):
Now a quick side note on just gloves in general.
Gloves have been with us for a very long time.
It's just a basic way to protect the hand from
where from coal, from heat, from other threats, just a
basic technological advancement in which we realized, hey, we can
take other materials and make a second skin for our
hands are very important but also susceptible to damage. Hands
(03:55):
and some of the oldest gloves that we have that
have survived include a pair of delicate linen child's gloves
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,
(04:19):
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
(04:39):
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
(05:02):
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
(05:23):
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
(05:46):
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
(06:08):
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
(06:30):
these products.
Speaker 2 (06:31):
Oh yeah, that's got to be interesting. Double edged 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 certainly if you're
going to be doing any kinemtical procedure. But also that
repeatedly washing or you're sterilizing your hands has effects beyond
just keeping pathogens away. It also affects the presence of
(06:55):
non harmful microbiota on the surface of your hands.
Speaker 4 (06:59):
Yeah, it's like I get again. You have to think
of your hands as part of your body. They're not
just tools, they're not instruments. They're used by you and
your body. They are part of you. They are also
like yourself multitude. They have populations, and if you regularly
carpet bomb the population, that's going to disrupt. That's not
(07:20):
going to just keep things from living there. It's going
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
(07:43):
the hand in a completely hygienic way.
Speaker 2 (07:47):
Right though, I want to be very clear, well, we
are acknowledging these consequences. This is not a case against
hand washing.
Speaker 4 (07:53):
No, no, No. Hand washing, as we'll discuss, is also
very important here. 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 stuck his hand out, but luckily
he went for the fist bump instead of a handshake,
and it was great. That was that was ideal because
(08:15):
I didn't want to have to be like, sorry, can't
shake your hand right now. Just read a whole bunch
of stuff about about hand germs.
Speaker 2 (08:22):
I thought you were going to he stuck his hand
out so you could kiss it.
Speaker 4 (08:25):
No, no, no, no, no, we have we have at
Our boss is a little better than that.
Speaker 2 (08:30):
Our boss is the Pope. We work at the Vatican.
Speaker 4 (08:33):
But another big thing about all this is that it
comes down to the 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,
(08:53):
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,
(09:14):
of the invisible world, then what can you do?
Speaker 2 (09:16):
Well, yes, and also to acknowledge that the glove itself
would need to be sterilized in order to provide an
advantage there, Just putting on a dirty glove doesn't do
much better than using a dirty hand exactly.
Speaker 4 (09:29):
To give some more stats on some of this. According
to Smith at All in twenty seventeen's Infection Control through
the Ages, even today, quote, approximately one point seven million
healthcare associated infections or HAI's occur in the United States
each year. So even with modern precautions and technologies in place,
(09:51):
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,
(10:11):
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.
Speaker 2 (10:31):
That's a bad health care plan, Yeah, it does.
Speaker 4 (10:34):
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 and weren't cleaned between uses. Cauterization via
hot iron or boiling oil was commonly used. You're looking
at between sixty and eighty percent mortality rates. This is
pretty common during the time period, and even into the
(10:56):
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
(11:20):
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.
Speaker 2 (11:36):
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 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
(12:00):
operated on in an unsanitary way by a doctor. And
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
(12:21):
was doctor doctor Willard Bliss, all right.
Speaker 4 (12:24):
But speaking of this time period, yeah, eventually we'd get
to what Smith at All referred to as the progressive
era of the eighteen nineties through the nineteen twenties, and
we do see a shift here. Quote. This period saw
great advances in hospital infection control. Ignot Simmelweiss was the
first hospital epidemiologist, setting a precedent for step by step
(12:47):
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
(13:07):
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
(13:30):
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,
(13:52):
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
(14:15):
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.
Speaker 2 (14:35):
I think one of the things 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 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
(14:57):
lack of knowledge how things would turn out. Everything always
seems more obvious in retrospect.
Speaker 4 (15:02):
Right, right, And certainly The Nick is a 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,
they're at the hospital and they're just just using it
just so irresponsibly, without really understanding or having any idea
(15:23):
of just how dangerous repeated exposure to the machine would be.
Speaker 2 (15:28):
Well, they're using it unnecessarily, right, They're just like using
it for fun.
Speaker 4 (15:32):
Yeah, it's like you get the kids in here, Oh,
watch watch watch Dad x ray's hand multiple times for
no reason, that sort of thing.
Speaker 1 (15:41):
Uh.
Speaker 4 (15:41):
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 anyway, Simple Device's 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
(16:03):
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. It apparently got pretty ugly, at least
(16:24):
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
(16:46):
some of these ideas, but what can you do?
Speaker 2 (16:49):
Well, Yeah, I think a lot of the hygienic concerns
about medical interventions and especially surgery would get more traction
in the eighteen sixties with Joseph Lister.
Speaker 4 (16:59):
Yeah, Joseph Lister definitely a big one. I mean, there
are 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 Pastur. Now there's but Yeah, Joseph Lister
was a big name. Eighteen twenty seven through nineteen twelve,
he introduced the concept of surgical asepsis, the absence of
(17:21):
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
(17:44):
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.
Speaker 2 (18:00):
Yeah, I think lister especially is known to highlight a
distinction we'll get to in a little bit, the distinction
between asepsis 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.
Speaker 4 (18:23):
Yeah, and also dressings surgical tools. He stress that you
should change dressings on wounds regularly.
Speaker 2 (18:31):
Yeah.
Speaker 4 (18:31):
And again, before lister here and infection were 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 what happens
when the body heals from a wound, all right. So
(18:52):
getting into more into the realm of early surgical gloves,
early medical glove concepts, and the struggle for their acceptance.
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
(19:15):
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
(19:37):
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,
(19:58):
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
(20:21):
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
(20:42):
system standardized in Berlin in eighteen eighty eight by Paul Fubringer.
First soap, then alcohol, and then finally an antiseptic substance.
Speaker 2 (20:53):
Yeah, that three stage process was very common by the
eighteen nineties.
Speaker 4 (20:56):
And again it's great, it's a wonderful advanced in surgery
of the time, but of course it falls just a
little short of actually using gloves, of actually embracing the
standard that now again we just accept when we go
into a medical facility. So the three VAT systems coming
(21:16):
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 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
(21:37):
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,
(21:57):
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.
Speaker 2 (22:13):
Yeah, this Bulletin of History of Medicine article is interesting.
So the author here, Thomas Schlick, is a German Canadian
historian of medicine who's on faculty at McGill University in Montreal.
And Schlick begins his article by illustrating a really strange
moment from the history of surgery where there was so
(22:35):
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
(22:56):
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
(23:17):
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
(23:39):
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.
Speaker 4 (24:01):
Yeah. 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.
Speaker 2 (24:11):
Now today, it's natural for us to look back on
this view as 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 by Schlick explores the
(24:35):
historical discussion and controversy about the introduction of surgical gloves,
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,
(24:57):
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.
Speaker 4 (25:17):
Yeah, I think this is one of the great things
he 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 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
(25:38):
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 all ultimately trying to
crack the same nut to try to improve the mortality
rates for various procedures. And also he seems to stress
(25:59):
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
(26:19):
hill here when you're advocating that medical gloves should not
be used universally, well.
Speaker 2 (26:26):
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 about what the future would be as we are
about our own future in the present right.
Speaker 4 (26:39):
And one thing he stresses here is that these 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 data to
back up what they were arguing. Like there's there's one
guy that he mentioned, surgeon Thomas Spencer Wells, who advocated
the cleanliness cold water school as opposed to and embracing
(27:02):
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
(27:26):
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.
Speaker 2 (27:35):
Yes, And wells would not be the only one. There
are even people making the case at this eighteen ninety
eight 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 blood soaked cotton gloves than
you do of bare hands. So actually you don't need gloves,
(27:59):
you just need clean hands.
Speaker 4 (28:00):
Yeah. Another name you mentioned is Johannes Mikkelish who 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 this one new idea. No, there are these
(28:21):
other seemingly promising new ideas and new technologies that are
also suddenly available.
Speaker 2 (28:26):
Oh that's interesting, And you get these from both sides
about the different solutions, because Mikolch here was one of
the major proponents of gloves at this at this conference,
he was there representing the yes gloves or good side.
Speaker 4 (28:39):
Interesting. Yeah, but then he also has his other thing
as well, 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 Johannes 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
(29:04):
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.
Speaker 2 (29:12):
Yeah, that's another point Schlick actually really highlights in this paper,
which is that, you know, sometimes we have a 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, almost like there is
a sort of a board of medicine that like controls
(29:36):
all of medicine throughout history and they direct the flow
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.
Speaker 4 (29:57):
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 we were talking about with
the physical gloves of the time, this would not have
been a situation where like, we're dealing with modern medical
gloves that are suddenly presented to an audience at this
this gathering. It made me think of a recent episode
(30:21):
of the nineties Outer Limits that I watched. If the
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
(30:42):
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
(31:02):
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.
Speaker 2 (31:14):
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.
Speaker 4 (31:22):
Yeah, so these would not have been modern medical gloves
that they were considering here. The author mentions several of
the different designs that were presented at this conference that
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. There was
(31:43):
also the idea of using leather style military gloves, and
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.
Speaker 2 (32:05):
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.
Speaker 4 (32:16):
Yeah, I have trouble imagining how it would work right,
because if the wax was sealed around the hand, and
if you go with the right wax, that of course
wouldn't be just absolutely scalding to the flesh, then it
would truly become brittle upon trying to move your hand around.
Speaker 2 (32:34):
Yeah, I don't know. It doesn't make a lot of
sense to me, though. I'm also confused about 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
(32:55):
would also think, like, wouldn't that get kind of brittle?
I don't know.
Speaker 4 (32:58):
Yeah, it was like it would be flaying off and
you'd have like little bits of wax. I mean, Fortunately,
as we've pointed out before in the show, like wax
has long been used and so has honey in 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
(33:20):
introduced to a body cavity during a procedure like this.
I don't know about you, but another detail I really
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
(33:40):
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
(34:02):
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.
Speaker 2 (34:11):
There. You almost it's like you become sort of part
of a priestly class. You must maintain purity for all time.
Speaker 4 (34:19):
Yeah, I mean, it's like these are the money makers, right,
I have to keep the gloves on them at all times.
Speaker 2 (34:24):
That these hands are registered with the FBI as lethal weapons,
because I don't wash them before I operate.
Speaker 4 (34:32):
Now, he points out that the material challenges here came
down to the following and these I think were 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
(34:54):
had to be you had to be able to sterilize them.
Speaker 2 (34:57):
They had to be sterilizable, right, meaning you could like
boil them or steam them or something to kill any
thing that might be on them without damaging them so
that they couldn't be used.
Speaker 4 (35:08):
Right. And so given all of these demands of the materials,
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
(35:31):
being difficult with some of the gloves of this time period.
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.
Speaker 2 (35:42):
Oh yeah, so I think by around the time of
World War One, it's generally agreed that's when you are
seeing Okay, now we have pretty much universal acceptance that
impermeable sterile gloves are good for surgery and they should
be used if at all possible.
Speaker 4 (35:58):
I can't help but think of media and this as well,
like cinematic depictions of doctors, like now, like the image
of a doctor, be of them 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
(36:19):
power and ability. You know, there's there's something about it
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.
Speaker 2 (36:36):
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.
Speaker 4 (36:52):
Thing, right, I mean it's enough to where if you
were given the choice between two fraudulent pseudoscientific healers and
they were going to work on you, and one is
using bear hands and one is using gloves, like the
mere presence of the gloves could potentially legitimize it a
little bit in your eyes.
Speaker 2 (37:09):
You know, Wait, no, beb did you mean bear hands
or B E A R hands?
Speaker 4 (37:14):
Oh well I meant I meant B A R E.
But B E R That brings on an entirely different vision, right,
I mean that's then you're in the realm of the shaman.
Speaker 2 (37:23):
I would go with I would go with the quack
that had bear paws over the quack that just had gloves.
Speaker 4 (37:28):
Or what if the the what if the quack had
both a bear head on over their own head, but
they had medical gloves on.
Speaker 2 (37:36):
What if they operated on you wearing the bear costume
from Jack Frost?
Speaker 4 (37:40):
There you go?
Speaker 2 (37:48):
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, the
Shlick paper is interesting because it frames the good things
(38:10):
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,
(38:37):
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
(38:58):
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
(39:19):
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
(39:40):
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
(40:02):
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
(40:22):
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.
(40:42):
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
(41:02):
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
(41:23):
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
(41:45):
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
(42:05):
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
(42:27):
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
(42:50):
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
(43:14):
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
(43:38):
to the surgeon who would receive it with an ungloved
hand and then operate.
Speaker 4 (43:42):
Yeah, I guess one of the things to drive from
here is, you know, the adoption of a new technology
is sometimes a little patchy.
Speaker 2 (43:48):
And the reasoning can be different than what you'd expect.
So they've got by eighteen eighty nine, Halsted's assistants and
nurses are using rubber gloves to protect their hands from
these coustic chemicals. But it wasn't until eighteen ninety six
that rubber gloves to protect the patient during surgery became
standard at Johns Hopkins. It just didn't seem like an
(44:10):
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,
(44:30):
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.
(44:50):
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
(45:12):
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
(45:33):
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.
Speaker 4 (45:43):
Right, right, there's always going to be at least one
little crack in the defenses with this method.
Speaker 2 (45:48):
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,
Johannis van Mikulitch, he tried this interesting solution, beginning with
an operation on Easter eighteen ninety six, which was sterilized
cotton gloves. So hands would go through the regular gauntlet
(46:11):
washing and disinfection, but then after this you would put
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
(46:33):
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.
(46:56):
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
(47:18):
tumor with your bare fingers as quickly as possible, and
then once you found it, you put on a pair
of fresh cotton gloves.
Speaker 4 (47:24):
Yeah, and it's the five second rule of rooting around
in somebody's stomach cavity. Right.
Speaker 2 (47:30):
Yeah, that seems like not a great solution, but at
least you're trying to use something. So Mikolitch 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 acepsis.
I don't know about that last claim, but apparently, according
(47:52):
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
(48:12):
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
(48:33):
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
(48:53):
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
(49:16):
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
(49:37):
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.
Speaker 4 (49:50):
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.
Speaker 2 (49:56):
This seems to be a bigger thing than just zoga.
Speaker 4 (49:58):
Here.
Speaker 2 (49:59):
There's like a general anguish at the time expressed by
multiple surgeons about the idea of hands being non boilable objects. Boiling,
I think, became a kind of metonym for aseptic safety,
so you might at the time, instead of saying something
is aseptic, you might just call it boiled. Whether or
(50:19):
not it had literally been boiled. Now a couple of
other interesting solutions mentioned in the Schlick paper. There was
a guy named George Perthies 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,
(50:40):
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
(51:02):
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,
(51:25):
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
(51:47):
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
(52:07):
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,
(52:29):
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.
(52:53):
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
(53:14):
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.
Speaker 4 (53:23):
Now.
Speaker 2 (53:23):
Eventually, over time there was agreement 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 with the with the
sterile gloves that people use today made of thin materials
such as latex, nitrial are vinyl.
Speaker 4 (53:42):
Yeah, modern medical gloves come in, of course, various sizes.
They are made from a variety of polymers. You get
powdered and unpowdered, or even powdered with corn starch to
cut down on skin irritation. There've been a lot of
efforts towards the elimination of powdered gloves in general, and
there are alternatives for individuals with latex allergies. So, uh, yeah,
(54:02):
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
(54:25):
an alternative.
Speaker 2 (54:26):
But I think it's also good to understand that at
the time, resistance to the to the take up of gloves,
especially impermeable 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.
Speaker 4 (54:46):
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. 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. You know, we need to be able.
It's kind of like getting into the scale issue of inventions, like, okay,
(55:07):
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.
Speaker 2 (55:25):
Yeah.
Speaker 4 (55:25):
Oh, and then to come back to our outer limits
example from earlier, the idea of being able to perform
medical interventions like out in the field, 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 spend some time washing
(55:49):
your hands, or are you going to 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, the efforts
of the historian to place us within that time period
to make sense of it all just all very fascinating
(56:12):
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,
(56:34):
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
(56:56):
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
(57:17):
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.
Speaker 2 (57:24):
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 Stuff to
Blow your Mind dot com.
Speaker 3 (57:46):
Stuff to Blow Your Mind is production of iHeartRadio. For
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