The story behind surgical gloves

Many historical documents feel helpless about surgeons not using surgical gloves for a long time. Why has everyone overlooked such obvious advantageous technologies for a considerable period of time? Even though surgical gloves have appeared before, have they not been consistently used? If we want to solve this puzzle, we have to mention the stories behind those gloves.

Beautiful encounter 

In fact, as early as 1889, Dr. William Halsted from Johns Hopkins Hospital in the United States introduced surgical gloves during surgery, but only for nurses and not for surgeons. In his 1913 article, he recalled that surgical nurses developed hand dermatitis due to exposure to mercuric chloride solvent as a sterilizing agent. In order to protect this highly efficient nurse, Halsted "one day asked Goodyear Rubber Company in New York to experimentally make a pair of thin and long rubber gloves.

In fact, the nurse later became Halsted's wife, which has become a widely circulated anecdote in medical history. However, this also raises the question of why it took a full seven years for surgeons to wear gloves for surgery to become routine? Even Halsted himself found it strange to recall this incident, being so 'blind and unaware of the importance of wearing gloves routinely on the operating table'.

You should know that Halsted's concern for gloves is not due to carelessness: the director and surgeon of Johns Hopkins Hospital is known for his meticulous perfection in preventing and treating wound infections. Halsted tested the sterilization procedure and found that the sterilizer recommended by Lister cannot completely kill all bacteria in the wound. Can a better method be found to prevent wound infection?

The key to the problem seems to lie in the condition of the patient's wound and tissue. A clean and well supplied tissue can prevent infection caused by inevitable wound bacteria. For example, in an animal experiment, Halsted intentionally implanted bacteria into the abdominal cavity of dogs and found that the puppies did not have any adverse effects while being careful not to damage tissues from external trauma. But if he damages the tissue or removes part of the blood supply, as he recorded, 'even a small amount of bacteria can multiply and grow, leading to fatal peritonitis'.

Halsted believes that preventing infection mainly relies on careful and gentle surgical techniques. The circulation obstruction caused by suturing and knotting is the direct cause of wound infection and suppuration. Therefore, he devoted himself to studying surgical techniques, as recorded in his biography, his skills were "as accurate as numbers, ensuring precise wound healing".

Therefore, most of Halsted's measures to prevent infection are reflected in surgical techniques rather than pollution prevention, and gloves have not been taken seriously by him, let alone if he wears gloves, it will greatly affect his precise surgical style!

The picture shows William Halsted undergoing surgery

The 'substitutes' for gloves

In fact, Halsted's meticulous surgical technique is not limited to this one alternative to gloves. In addition to controlling infections, there were also many different hand washing and disinfection measures in place at that time.

In 1888, Paul F ü rbringer of Berlin proposed a standardized procedure in his report. First, wash your hands with soap, then use alcohol and apply disinfectant. The research results of the bacteriology laboratory indicate that this procedure is the gold standard for intraoperative hand disinfection.

Another measure is to ensure hand hygiene during both surgeries, prevent contact with infectious substances, even outside of work - this means maintaining cleanliness throughout one's personal life. In 1899, Theodor Kocher proposed not to touch "any contaminated liquids or decaying substances" and advised doctors to "wear gloves before and after surgery".

The third method is to strictly separate patients, operating rooms, and doctors. This is the aseptic procedure (asepsis) proposed by Gustav Neuber from Germany, which is used to replace Lister's antisepsis - the purpose is to avoid contact with bacteria rather than sterilization. This measure requires separating decaying materials from sterile cases, operating rooms, and surgeons. In 1886, he publicly disclosed in his new book how he implemented the plan in the hospital.

Similar technologies reflect the regional culture of wound disease prevention and treatment around 1900, some of which utilized gloves while others did not.

Some surgeons believe that the best way to prevent contamination is to avoid contact between hands and wounds and to use no touch techniques during surgery. In 1905, British surgeon William Arbuthnot Lane designed a set of long handled instruments specifically for fracture surgery.

In addition, another technique is to put a layer of "clothing" on the surgeon's hands, which prevents contamination caused by bacteria on the hands without affecting the surgeon's dexterity. Some doctors have tried paraffin for this purpose. German doctor Carl Ludwig Schleich once used paraffin wax to create sterile "micro gloves", which have the advantages of being "waterproof, blood proof, and bacteria proof". However, these measures have not been widely applied mainly because such "clothes" are not durable during the surgical process.

However, this concept persisted until the 20th century: in 1943, at the University of Chicago, Benjamin F. Miller et al. reported that "cationic cleaners can form an invisible and imperceptible film on the hand, enveloping bacteria inside." This technology is said to be durable and has a "bactericidal effect.

Another unique approach is systematic vaccination. In the decades leading up to World War II, some surgeons attempted to develop mechanisms that could induce wound infection specific immunity or enhance patients' preoperative systemic immunity. Johannes Mikulicz， In the 19th century, a famous German surgeon added masks to surgical instruments, allowing patients to receive nucleic acid injections before surgery to increase their white blood cell count and enhance their immunity. These methods are similar to the prophylactic use of antibiotics that emerged decades later.

In summary, surgical gloves are not the only method for preventing infections. Among the various innovations at that time, not using gloves was very common.

Real history

After a long period of debate, advanced ideas gradually defeated conservative ideas, and sterilization was finally widely accepted.

Between 1870 and 1880, surgeons who advocated Lister sterilization were seen as avant-garde, while others were seen as stubborn opponents of reform and innovation. At this point, the targeting is very strong: it seems that history is only mechanically developing towards established goals, and the popularization of sterilization has become an inevitable result of historical development.

However, historians point out that many surgeons are not necessarily fond of Lister's ideas and behaviors - this is not due to stubbornness or conservatism, but because they are busy with their own research and development. As Michael Worboys said, 'Every surgeon has their own ideas and techniques.'. They are looking for other ways to prevent incision infection.

Worboys has recorded that during the same period as Lister, some healthcare workers "shifted the focus of the public health movement from urban environments to hospitals and patients. As an advocate for public health, Lister's focus on chemicals itself deviates from the important track of reforming hospitals. However, even from a more professional technical perspective, there were still many other ways at that time.

The influential ones are called 'cleanlines and cold water schools'. Its leader, Thomas Spencer Wells, is often described in history as stubbornly rejecting Lister's reforms, emphasizing the importance of universal hygiene principles and rigorous cleanliness concepts. In the latter half of the 19th century, Wells underwent thousands of intervention surgeries, particularly ovarian incision. According to his multiple literature, even without sterilization, his incidence of surgical complications is extremely low.

In addition to Wells, there were many creative and reasonable improvement measures to control wound infections at that time, and many people achieved success, even if some innovations were not aimed at wound complications caused by bacterial infections. However, since Lister publicly proposed sterilization, history has automatically overlooked the flourishing of the Hundred Schools of Thought in reality.

No matter from which perspective the history of medicine is explored, as long as careful investigation is conducted, various different solutions can be found during the same period. If we delve deeper into it, we will have a better understanding of the choices made by our predecessors at every step.

There are always various modern technologies being developed in the world, which combine old and new technologies to cure diseases through surgical and non-surgical methods. In this process, the methods that were not adopted are actually worth exploring and researching. You may have opened up a parallel path, narrow alleys, muddy paths, or opened up a grand avenue in medical history. And these explorations also remind us to pay attention to the different forms of viewpoints and solutions presented by the industry when facing difficulties.

As David Edgerton once said, 'Search for beautiful flowers after they bloom,' the same applies when facing medical challenges.