History of Medicine

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

Joseph Lister (Wikipedia)

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.   

     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

Johannes von Mikulicz (Wikipedia)

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).

     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

William Halsted (Wikipedia)

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.

     Despite initial resistance by some, rubber gloves caught on,

Charles McBurney (Wikipedia)

helped by an enthusiastic article by Charles McBurney in 1898. Rubber gloves do seem to be a primarily American innovation.

    

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 2^nd 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.