SURGEON’S
GLOVES
The craft of surgery is an ancient one, reaching back to well before the
days of Hippocrates. But of quite recent origin is one of the most important
aides to the surgeon – his gloves.
The first use of gloves in medicine, in fact, seems to have been to
protect the doctor, not the patient. One of the fathers of dermatology, the
Viennese physician Josef Jacob Plenck, possibly remembering the surgeon John
Hunter’s 1767 inoculation experiment with gonorrhea/syphilis, in 1808 recommended
gloves to protect midwives who had a cut or sore on their hand while examining
a patient with venereal disease. Occasional others recommended the same. Early
gloves were made from animal bladder or colon. Postmortem exams were dangerous
too for physicians, and crude gloves were sometimes used in that setting. At
Hopkins William Welch used a pair imported from Germany for autopsies before they
were used in surgery.
Protecting the patient began with hand washing. Oliver Wendell Holmes in
the U.S., Robert Storrs in England (both in 1843), and Semmelweiss in Vienna
(1847-8), all recommended hand disinfection to protect birthing mothers from
puerperal fever. Thomas Watson at Kings College, (1840-43), first suggested
rubber gloves for this purpose, saying, ”a glove…might be devised which should
be impervious to fluids, and yet so thin and pliant as not to interfere
materially with the delicate sense of touch required…” Gloves were only used
sporadically, however, until germ theory came of age.
That age dawned as Joseph Lister developed a system of “antiseptic
surgery”, first described in
1867, employing large amounts of
carbolic acid as the antiseptic. Surgeons took up antisepsis but soon considered
“asepsis” a preferred approach, using antiseptic washes to clear the surgical
field and instruments of bacteria before operating. Wound infection rates fell,
but not to zero. The impossibility of sterilizing hands was a stumbling block.
Joseph Lister (Wikipedia) |
Typical was the clinic of Ernst von Bergmann, at the University of
Berlin. One of his staff, Kurt Schimmelbusch, published an authoritative “Anleitung
zur Aseptischem Wundbehandlung” (“Guide to Aseptic Wound Treatment”) in 1892.
Instruments were sterilized and personnel wore sterile gowns but no masks. For
the hands: one minute of brushing with soap and hot water, wipe dry with
sterile towel, clean under nails, rub with gauze soaked in 80% alcohol for one
minute, rinse with dilute mercuric chloride solution, then rub off. Gloves are
not mentioned, but an antiseptic paste (especially to cover the nail ends) was
discussed, only to dismiss it as impractical. Ironically, Schimmelbusch died of
sepsis acquired from an infection in a hand, acquired during surgery.
Johannes von Mikulicz, at the University of Breslau,
worked
with bacteriologist Carl Flügge to solve the problem. First masks were
introduced. Then gloves. Mikulicz used sterile finely woven white cotton
gloves, sold by the dozen as “fine servant’s gloves” (presumably those that
butlers wore). Knowing that when the gloves were wet bacteria could get through
from the skin, he changed gloves at intervals during longer operations. If
delicate tactile sense was needed at a certain point, he simply took off the
gloves for the maneuver, then put on a fresh pair. After three months he asserted
that he had no surgical infections (1897).
Johannes von Mikulicz (Wikipedia) |
Georg Perthes (also in 1897) in Leipzig used finely woven silk gloves
that reached to the elbow, admitting that bacteria got through when wet. Anton
Wöfler in Prague used military leather gloves. The first to use rubber gloves
in Europe seems to be Werner Zoege von Manteuffel in Dorpat (now in Estonia),
publishing also in 1897. (Vulcanized rubber, lending flexibility and better
temperature tolerance, was invented in 1845.) Working from a city hospital
where contaminated cases were common, he admitted that rubber gloves were not
comfortable and that he lost some tactile sensitivity but felt the lower
infection rate was worth it. Arguments raged over how much importance to attach
to bacteriologic counts from hands or gloves during operations. Did the counts
really predict infection rates? The subject was thrashed out in 1898 at an important
Surgical Congress in Germany, with
no new conclusions.
In the U.S., rubber was used from the start. William Halsted at
Johns
Hopkins had a pair of rubber gloves made (by Charles Goodyear) for his nurse
and wife-to-be, in the winter of 1889-90, to protect her skin against
irritating antiseptics. Next the assistants who handled the instruments wore
them for the same reason. Halsted later indicated that wearing rubber gloves
was not a uniform practice in the hospital until late 1893 or early 1894, saying
only that, considering the barrier to bacteria they offered, he had no
explanation for the delay. The Hopkins gynecology surgeon, Hunter Robb, in a
text of 1894, recommended routine use of rubber gloves. Halsted’s house
surgeon, Dr. Joseph Bloodgood (called by the staff “Bloodclot”), said he was
the first to use gloves routinely in clean cases, in 1896. Halsted, after he
converted, had gloves specially made over a mold of his hands (not unlike his
tailored suits and shirts). Halsted filled his sterilized gloves with 1:1000
mercuric chloride before putting them on, a practice not adopted by most
others. Mikulicz was aware of the use of rubber gloves at Hopkins but the ones
he tried were too cumbersome compared to the cotton. Of interest is a
photograph of what is believed to be the first operation where rubber gloves
were worn by the operator, taken at Johns Hopkins in 1893 (see Mitchell, below). Masks,
hats, and covering gowns are conspicuously absent.
William Halsted (Wikipedia) |
Despite initial resistance by some, rubber gloves caught on,
helped by
an enthusiastic article by Charles McBurney in 1898. Rubber gloves do seem to
be a primarily American innovation.
Charles McBurney (Wikipedia) |
SOURCES:
Randers-Pehrson, R. The
Surgeon’s
Glove. Charles Thomas Pub.,
1960.
Imber, Gerald. Genius on the Edge:
The Bizarre Double Life
of Dr.
William Halsted. Kaplan Pub.,
2010.
Schlich, Thomas. “Negotiating Technologies in Surgery: The
Controversy about Surgical Gloves in the 1890s”. Bull
Hist
Med 87: 170, 2013.
Halsted, W. “Ligature and Suture Material…..Also an Account
of
the Introduction of Gloves, Gutta-Percha Tissue and Silver
Foil”. JAMA 60: 1119, 1913.
McBurney, C. “The Use of Rubber Gloves in Operative
Surgery”.
Ann Surg 28: 108, 1898.
Bloodgood, J C. “Operations on 459 cases of hernia in the
Johns
Hopkins Hospital from June 1889 to January 1899”. Johns
Hopkins Hosp Repts 7: 223, 1899.
Schimmelbusch, K. The
Aseptic treatment of Wounds (Eng trans
from 2nd edition), 1894. p 54.
Brieger, G H. “American Surgery and the Germ Theory of
Disease”. Bull Hist Med 40:135,1966
Holmes, O W. “The Contagiousness of Puerperal Fever”. N
Eng
Quart J Med Surg, April 1843, p 503.
Mikulicz, J. “Über Versuche, die ‘aseptische’ Wundbehandlung
zu
einer wirklich keimfreien
Methode zu vervollkommen”.
Deutsche
Medicinische Wochenschrift.
1897. v 23, p. 409.
Watson, Thomas. Lectures
on the Principles and Practice of
Physic; Delivered at King’s College,
London. 1845, V23,
p.349.
Proskauer, C. “Development and Use of the Rubber Glove in
Surgery and Gynecology. J Hist Med All Sci.
1958, 13: 373-
381.
Mitchell, J. “The Introduction of Rubber Gloves for Use in
Surgical
Operations”. Ann Surg
1945, 122: 902.