The story behind surgical gloves

Many historical documents have shown that internal medicine physicians have been unable to use gloves for a long time. Why did everyone ignore such self-evident advantageous technology for a considerable period of time? Even though internal medicine gloves have been presented, have they not been consistently used? If we want to solve this puzzle, we have to mention the story in front of those gloves.

In fact, this nurse later became Halsted's wife, which has become a widely circulated anecdote in medical history. But this also raises the question of why it took seven years for physicians to wear gloves and stop surgery to become a tradition? Even Halsted himself found it strange to recall this incident, as he was so 'conscious and unaware of the importance of wearing gloves as a routine on the operating table'.

It should be noted that Halsted's concern for surgical gloves is not due to carelessness: the director and physician of Johns Hopkins Hospital is known for his meticulous attention to detail in preventing and treating wound infections. Halsted tested the sterilization procedure and found that the sterilizer recommended by Lister cannot completely kill all bacteria on the wound. Can we find a better way to avoid wound infection?

The key to success seems to lie in the condition of the patient's wound and tissue. A clean and well supplied tissue can prevent infection caused by unavoidable wound bacteria. For example, in a plant experiment, Halsted intentionally implanted bacteria into the abdominal cavity of dogs, and found that while being careful to prevent internal damage to tissues, the dogs did not have any adverse conditions. But if he damages the tissue or removes the local blood supply, as he recorded, 'even a small amount of bacteria can multiply and cause fatal peritonitis'.

Halsted believes that preventing infection requires careful and gentle surgical techniques. The circulatory disorder formed by suturing and knotting is an indirect cause of wound infection and suppuration. Therefore, he devoted himself to studying surgical techniques, as his biography states, his skills were "as accurate as numbers, ensuring precise wound healing".

Therefore, Halsted's few measures to prevent infection are reflected in surgical techniques rather than avoiding purification, and gloves have not caught his attention, let alone if he wears gloves, it will greatly affect his precise surgical style!

The 'substitutes' for gloves

In fact, Halsted's meticulous surgical skills are not the only way to replace gloves. In addition to controlling infections, there are also many different hand washing and disinfection measures in advance.

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

Another measure is to ensure hand hygiene during both surgeries, avoiding contact with infectious substances, even outside of tasks - this means maintaining cleanliness throughout the entire group life. In 1899, Theodor Kocher proposed not to touch "any purified liquid or decaying substance" 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 prevent contact with bacteria rather than sterilization. This measure requires separating decaying materials from sterile cases, operating rooms, and surgeons. In 1886, he buried in an old book how he implemented the plan in the hospital.

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

Some doctors believe that the best way to avoid purification is to prevent contact between hands and wounds and to use no touch techniques during surgery. In 1905, British doctor 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 hands, which avoids the bacteria on the hands from causing purification without affecting the skillful technique of the surgeon. 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 used, mainly due to the fact that such "clothes" are not durable during the surgical process.

But this concept continued into the 20th century: in 1943, at the University of Chicago, Benjamin F. Miller and others reported that "cationic cleaners can form a tangible and imperceptible film on the hand, enveloping bacteria inside", a technology that is said to be durable and has a "bactericidal effect".

Another unusual approach is to administer vaccines sporadically. In the decades leading up to World War I, some internists attempted to develop mechanisms that could trigger wound infection specific immunity, perhaps improving patients' preoperative systemic immunity. Johannes Mikulicz， In the 19th century, a famous German physician added masks to surgical instruments, allowing patients to receive nucleic acid injections before surgery to increase their white blood cell count and strengthen their immunity. These methods are similar to the prophylactic use of antibiotics born decades later.

In summary, internal medicine gloves are not the only way to prevent infections. It is rare to not use gloves among various innovations in advance.

Real history

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

Between 1870 and 1880, physicians who had previously advocated Lister sterilization were seen as avant-garde, while others were seen as stubborn opponents of change and innovation. At this point, the targeting is very strong: it seems that history is only mechanically advancing towards established purposes, and the popularization of sterilization has become an inevitable consequence of historical development.

However, historians point out that many internists may not necessarily be interested in Lister's ideas and behaviors - this is not due to their stubbornness and radicalism, but rather because they were busy with their own research and development. As Michael Worboys said, 'Every physician has their own ideas and techniques.'. They are looking for other ways to avoid incision infection.

Worboys has documented that during the same period as Lister, some healthcare professionals "shifted the focus of the public health movement from urban environments to hospitals and patients. As a proponent of public health initiatives, Lister's focus on chemicals itself deviates from the important track of transforming hospitals. But even from a more professional technical perspective, there are still many other ways in advance.

One of the most influential ones is called 'cleanlines and cold water school'. Its leader, Thomas Spencer Wells, has often been described in history as stubbornly excluding Lister's changes, emphasizing the importance of universal hygiene standards 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 have been numerous innovative and intuitive measures to control wound infections in advance, and many have achieved success, even if some innovations are not aimed at wound complications caused by bacterial infections. However, since Lister proposed sterilization underground, history has automatically overlooked the ideal of blooming flowers.

No matter from which perspective the history of medicine is explored, with careful investigation, various different solutions can be found during the same period. If we deepen our discussion, we will have a better understanding of every step of the elders' choices.

There are always various ancient technologies being developed around the world, combining old and new techniques to cure diseases through surgical and non-surgical methods. In this process, the methods that have not been adopted are actually worth exploring and discussing. You can open up a parallel path, narrow alleys, muddy paths, or even narrow paths in medical history. And these explorations also remind us to pay attention to the different ideas and solutions that arise in the industry when facing difficulties.