Why didnt surgical gloves be used earlier?

Why didn't surgical gloves be used earlier?

Surgical gloves are essential instruments in today's surgical process, and both surgeons and ordinary people consider this to be common knowledge. However, in the 19th century, when it was just invented, its use and popularization experienced quite a few setbacks. Even after being put into clinical practice, it took nearly 10 years for it to be widely accepted. Many historical records show confusion about the slow acceptance and use of gloves by surgeons: 'It took so long to think that gloves could be used, which is a puzzle in itself'. Some historians believe that surgical gloves are not noticed by surgeons because they lack the "mysterious allure and complex beauty".

Is that really the case? Is it just such a simple reason that delays the application of surgical gloves in surgical operations? The history of medicine has something to say.

1. Sterilization method

In 1867, Joseph Lister published papers on sterilization, and in the following twenty years, this method of using sterilizing agents for disinfection was widely accepted by surgeons worldwide. Between 1870 and 1880, surgeons who quickly accepted the Lister sterilization method were seen as pioneers, while those who did not accept it so quickly were seen as backward and conservative. In fact, before World War I, many doctors were researching wound sterilization techniques, and they did not pay attention to or adopt Lister's plan, mostly because they were developing their own plans. However, in the 20 years after the popularization of sterilization methods, other surgical sterilization research gradually declined. In 1888, Paul F ü rbring of Berlin proposed that washing hands in the order of soap, alcohol, and disinfectant could be used as a surgical sterilization solution. This program was supported by data from the microbiology laboratory and quickly became the gold standard for hand sterilization in the surgical field.

2. Avoid contact

There are two ways to avoid hand contact: one is to avoid contact with sources of contamination, and the other is to simply avoid contact with surgical wounds.

One proposal was published in 1899 in the Journal of the American Surgical Association, in which Theodore Kocher recommended avoiding contact with "any infectious fluids or carriers" by hand and advised surgeons to "wear gloves before and between surgeries". Gustav Neuber from Germany proposed "aseptic operation" (he coined the term) - replacing sterilization with avoiding contact with bacteria - his methods include isolating infected and sterilized boxes, preventing bacteria, and operators.

　　第二种方案的提议者们发展出了不直接接触患者的手术技术。1905年英国的外科医生WilliamArbuthnotLane设计了一套有超长手柄的工具来进行骨折的手术治疗。也有人想到了用某种物质来包住外科医生的手，这种物质必须要能够避免手传播细菌污染伤口，同时又不影响外科操作的灵敏性。1899年，德国外科医生使用了一种蜡胶，作为灭菌“显微手套”，“防水、防血液以及防菌”，他写道。这种方式没有被广泛接受，主要原因恐怕是它无法持续足够长的时间来完成手术。1934年，芝加哥大学的BenjaminFMiller等人观察到“阳离子去污剂能在手上生成看不见感觉不到的薄膜，能够将细菌隔离在薄膜下”，而且理论上能够持续足够长的时间并具有“灭菌能力”。


　　3、免疫法


　　也有医生想到了提高病人自身的抗菌能力来提高手术的成功率。一次世界大战前10年，有些外科医生试图制造针对伤口感染的疫苗或者提高患者在术前的整体免疫能力。比如JohnnesMikulicz，19世纪的德国外科医生，在术前给患者注射核苷酸，以提高他们的白细胞技术，增强免疫反应，提高抗菌能力，减少伤口感染的发生。这种想法和几十年后使用抗生素预防感染的方案类似。


　　4、细致的手术技巧


　　一个把手套引入手术室的医生，约翰霍普金斯医院的WilliamHalsted，就并不关注手套的防菌作用。他发现李斯特灭菌法无法完全消除伤口的细菌，但是认为灭菌的关键在于患者的伤口和组织。他认为，干净的伤口，健康和循环良好的组织能够让那些不可避免的出现在伤口中的细菌不引起感染。在动物实验中，Halsted有意将细菌引入狗的腹腔，他观察到，只要不对组织产生机械性损伤，就不会引发感染。但是，如果造成了组织瘀伤或者阻断某些部分的血供，“哪怕仅仅一个细菌……也能增殖和造成致命的腹膜炎”。因此，Halsted预防感染手段主要依靠小心仔细的手术技术，他集中注意力追求手术的细致和精准——这更耽误了他对外科手套的使用，因为手套会影响到操作的灵敏度。


　　5、外科手套的起初引入


　　1890年代，使用手套保护患者不受感染的思路几乎无人察觉。那个年代，戴手套是为了保护佩戴手套的人。1899年，Halsted把外科橡胶手套引入手术室，仅仅是为了保护护士的手和胳膊不受灭菌剂氯化汞的伤害，而外科医生却并不佩戴手套。


　　毕竟，在那个时期，有众多的替代灭菌方案可以选择，不选择使用手套并不奇怪。即便手套已经进入手术室，戴到了外科医生的手上，外科界也依然为此争论了很长一段时间。手套本质上是种复杂的技术，有着不同的原材料，不同的样式，不同的使用体验，它所联系的不同知识，甚至到底需要佩戴几副都是问题。


　　所以，外科医生们并非“不思考”才想不到使用手套，而是想法太多。并且，与历史学家所说的“手套缺乏神秘的诱惑和复杂的美感”相反，外科手套临床应用的一再拖延，正是由于它的情况复杂而医生们对它了解甚少。