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Speaker 1: Welcome to Stuff to Blow Your Mind production of My

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Speaker 1: Heart Radio. Hey are you welcome to Stuff to Blow

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Speaker 1: your Mind? My name is Robert Lamb and I'm Joe McCormick.

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Speaker 1: And this weekend Stuff to Blow your Mind, we have

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Speaker 1: another invention themed episode for everyone, and I think it

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Speaker 1: should prove an interesting episode because it's one of those

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Speaker 1: stories that more than it just covers like the need

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Speaker 1: for an invention and the development of that invention, it

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Speaker 1: also gets into the acceptance all of that invention, or

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Speaker 1: the the lack they're off concerning a new technology. You know,

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Speaker 1: it's one thing too to have an idea for a

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Speaker 1: new product or a new invention, a new way of

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Speaker 1: doing things, But then if it's going to make a difference,

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Speaker 1: it also has to be accepted by the vast majority

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Speaker 1: of the people and within a given field, given culture, etcetera. Yes,

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Speaker 1: and also the way that a certain invention has to

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Speaker 1: prove its advantages over other solutions to the same problems,

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Speaker 1: which is a major issue with the early adoption of

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Speaker 1: the technology we're gonna be talking about today. Uh, something

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Speaker 1: that is now a universal standard that people would be

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Speaker 1: horrified to hear anybody was not using was in fact,

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Speaker 1: originally one solution among many. Right, we're gonna be talking

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Speaker 1: about surgical gloves. Would like you say, are just ubiquitous now,

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Speaker 1: It's just it's no matter what the surgical procedure happens

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Speaker 1: to be, but not only surgical procedures, but also just

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Speaker 1: any kind of medical um check up, anything in the

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Speaker 1: medical establishment in general. If you go to the dentist,

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Speaker 1: if they're going to have the medical gloves on, and

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Speaker 1: it's one of those things where not only do you

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Speaker 1: come to expect it, like you could not ask for

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Speaker 1: it to be another way. You can't go to the

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Speaker 1: dentist and be like, hey, doc, I'm thinking maybe you

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Speaker 1: go gloves off this time. I mean, no, it's just

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Speaker 1: the gloves are heart of the procedure, and uh, most

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Speaker 1: of us would be somewhat concerned if we go in

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Speaker 1: there and the gloves are off, or if the gloves

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Speaker 1: were say made of cotton and really juicy, right or

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Speaker 1: or yeah, you go in and it's it's like your

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Speaker 1: dentist is wearing a big ski gloves or mittens. Uh,

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Speaker 1: so you've realized something is off. This is not the

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Speaker 1: way things should be, but it was not always so.

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Speaker 1: So if you went into, say a German speaking hospital

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Speaker 1: in the eighteen nineties, you may be lucky enough to

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Speaker 1: uh to get operated on by a surgeon who has

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Speaker 1: accepted the new science of bacteriology, who does understand that

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Speaker 1: wounds need to be clean, they need to be a

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Speaker 1: septic uh, and does understand that gloves can help with

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Speaker 1: that process, but has not found a way to commit

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Speaker 1: yet to impermeable gloves. So may well have some cotton

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Speaker 1: gloves on while they get their fingers around in you

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Speaker 1: Now a quick side note on just gloves in general.

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Speaker 1: Loves have been with us for a very long time.

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Speaker 1: It's just a basic way to protect the hand from where,

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Speaker 1: from cold, from heat, from other threats. Uh, just a

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Speaker 1: basic technological advancement in which we realized, hey, we can

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Speaker 1: take other materials and make a second skin for our hands.

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Speaker 1: Are are very important but also um susceptible to damage

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Speaker 1: hands and UH. Some of the oldest gloves that we

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Speaker 1: have that have survived include a pair of delicate linen

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Speaker 1: child's gloves from the tomb of Too in Common. So

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Speaker 1: those are about three thousand, two hundred years old, and

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Speaker 1: these were likely riding gloves. But of course one of

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Speaker 1: the things about gloves, when one of the things about

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Speaker 1: making yourself a second organic skin is that those tend

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Speaker 1: not to survive them, you know, unless they are stuck

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Speaker 1: away in a tomb or in some other fashion well

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Speaker 1: preserved for a very long period of time. But the

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Speaker 1: reality is when it comes to surgery, for most of

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Speaker 1: human history, surgical procedures of varying degrees of complexity were

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Speaker 1: carried out bare handed. And now when we say bare

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Speaker 1: handed surgery, you have to know that we're not talking

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Speaker 1: about pseudo scientific medical fraud uh psychic surgery um, which

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Speaker 1: is also you know, quote unquote performed bare handed. Now

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Speaker 1: we're talking about actual surgical procedures of different different scales,

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Speaker 1: performed well without any sort of protective barrier between the

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Speaker 1: surgeon's skin and the patient's flesh. So surgery of different sorts,

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Speaker 1: you know, was practiced in ancient Mesopotamia, ancient Egypt, ancient China,

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Speaker 1: ancient India, and other parts of the ancient world. Ancient

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Speaker 1: surgeries ran the gamut from setting of bones to amputations, trepidations,

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Speaker 1: blood lettings, and everything in between. But as we've discussed

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Speaker 1: on the show before, one of the big obvious realities here.

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Speaker 1: Obvious to us now anyway, by virtue of germ theory

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Speaker 1: is that human hands carry disease, and even regularly clean

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Speaker 1: hands can be a problem. I was looking at some

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Speaker 1: of the stats on this in review of human hand

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Speaker 1: microbiome research by EDMUNDS. Wilson at All in a two

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Speaker 1: thousand fifteen edition of Journal of Dermatological Science. The authors

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Speaker 1: here point out that hands are of course a critical

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Speaker 1: component of the human microbiome and are quote a conduit

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Speaker 1: for exchanging micro organisms between the environment and the body.

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Speaker 1: So not all of these are dangerous naturally, but hands

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Speaker 1: can harbor pathogenic species like staff an E. Coli. And

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Speaker 1: this is even more the case in high risk environments,

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Speaker 1: such as among those who handle food or provide healthcare.

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Speaker 1: And the authors here point of various studies that have

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Speaker 1: also looked into how it enhanced use of hand hygiene

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Speaker 1: products may negatively impact the hand microbiome as well, resulting

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Speaker 1: resulting in greater pathogen carriage, for example. But other studies

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Speaker 1: have demonstrated quote reduced pathogen carriage and or infections with

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Speaker 1: use of these products. Oh yeah, that's gonna be interesting.

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Speaker 1: Double edge sword. So like now that we have you know,

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Speaker 1: germ theory. We know it's important to wash your hands

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Speaker 1: if you're going to be eating or preparing food, or

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Speaker 1: or certainly if you're gonna be doing any kind of

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Speaker 1: medical procedure, but also that repeatedly washing or you're sterilizing

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Speaker 1: your hands has effects beyond just keeping pathogens away. It

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Speaker 1: also affects the uh, the presence of non harmful microbiota

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Speaker 1: on the surface of your hands. Yeah, it's kind of

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Speaker 1: like I get again. You have to think of your

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Speaker 1: hands as um as part of your body. They're not

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Speaker 1: just tools. They're not instruments. They're to use by you

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Speaker 1: and your body. They they are part of you. Uh.

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Speaker 1: They are also like yourself multitude. They have uh, they

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Speaker 1: have populations, and if you regularly carpet bomb the population,

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Speaker 1: that's gonna disrupt that's not going to just keep things

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Speaker 1: from living there, it's going to potentially disrupt um the

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Speaker 1: ratio of what lives there and uh. And so the

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Speaker 1: the idea of cleaning the hand completely that is we'll

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Speaker 1: discuss that becomes kind of problematic at times, like again,

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Speaker 1: it's not an instrument. It is, is pointed out by

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Speaker 1: one of the authors, We're gonna look to you cannot

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Speaker 1: just boil the hand uh to sterilize it and then

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Speaker 1: use the hand in a completely hygienic way. Right though,

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Speaker 1: I want to be very clear, while we are acknowledging

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Speaker 1: these consequences, this is not a case against hand washing. No, no, no.

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Speaker 1: Hand washing, as we'll discuss, is also very important here. Um.

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Speaker 1: I also have to throw in, while after I was

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Speaker 1: researching a lot of this and had it on my mind,

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Speaker 1: still sort of turning over in my head, I ran

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Speaker 1: into my boss out in the world, and my boss

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Speaker 1: um stuck his hand out, But luckily he went for

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Speaker 1: the fist bump instead of the handshake. I was glad

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Speaker 1: that was that was ideal because I didn't want to

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Speaker 1: have to be like, sorry, I can't shake your hand

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Speaker 1: right now. Just read a whole bunch of stuff about

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Speaker 1: about hand germs. I thought you were gonna say, he

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Speaker 1: stuck his hand out so you could kiss it. No, no, no, no, no,

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Speaker 1: we have we we have a better. Our boss is

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Speaker 1: a little better than that. Our boss is the Pope.

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Speaker 1: We work at the Vatican. But the big thing about

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Speaker 1: all this is that it comes down to the to

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Speaker 1: to one of the obvious facts we've discussed before, that

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Speaker 1: without germ theory, without any insight into the invisible world

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Speaker 1: of organisms that are literally at our fingertips, for the

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Speaker 1: vast majority of human history, we just we just didn't know.

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Speaker 1: We just didn't know that. Like we again, we had gloves.

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Speaker 1: It's not like, uh, like we didn't have this idea

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Speaker 1: that well. And there are some cases where we need

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Speaker 1: to cover our hands to protect our hand from uh

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Speaker 1: some sort of external force or or perhaps in some

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Speaker 1: cases protect the external world from our hands. But if

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Speaker 1: you cannot see the threat, if you, if you, if

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Speaker 1: you have no real concept of of the germs that

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Speaker 1: are out there, of the invisible world, then what can

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Speaker 1: you do? Well? Yes, and also to acknowledge that the

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Speaker 1: glove itself would need to be sterilized in order to

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Speaker 1: provide an advantage there, like just putting on a dirty

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Speaker 1: glove doesn't do much better than using a dirty hand exactly. UM.

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Speaker 1: To give some more stats on some of this, according

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Speaker 1: to Smith at All in infection control through the ages

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Speaker 1: even today, quote, approximately one point seven million healthcare associated

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Speaker 1: infections or h A eyes occur in the United States

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Speaker 1: each year. So even with modern UM precautions and technologies

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Speaker 1: in place, that's one of the things about healthcare, I mean,

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Speaker 1: it does put you in close proximity with a doctor.

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Speaker 1: You puts you often puts you in a space where

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Speaker 1: you have other individuals with various health care concerns going on. Um,

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Speaker 1: it's just the reality of it. But if you go

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Speaker 1: back in time before germ theory, before these various technologies,

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Speaker 1: things obviously get a bit darker. Smith at All point

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Speaker 1: out that in medieval times there was a high level

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Speaker 1: of illness and death in hospitals, and quote, when a

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Speaker 1: sick person entered a hospital, his or her property was

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Speaker 1: disposed of, and in some regions a requiem mass was

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Speaker 1: held as if he or she had already died. That's

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Speaker 1: a bad healthcare plan, it does. It's not a singing

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Speaker 1: endorsement of the hospital you're about to enter. Because of

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Speaker 1: course that the tools were often primitive. They weren't cleaned,

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Speaker 1: they weren't cleaned between uses. Uh Cauterization via hot iron

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Speaker 1: or boiling oil was commonly used. You're looking at between

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Speaker 1: sixt mortality rates. This is pretty common during the time period,

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Speaker 1: and even into the early modern period. Many things had improved,

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Speaker 1: but you still had surgeons placing ungloved hands directly into

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Speaker 1: wounds and directly into incisions and so forth. And this

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Speaker 1: was certainly the norm again for much of human medical history.

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Speaker 1: We didn't have the materials and or we didn't know

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Speaker 1: about the invisible world of microbes, and other reasons were

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Speaker 1: focused on for subsequent infections such as bad air or

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Speaker 1: miasma seeping into the wound. And uh, it was really

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Speaker 1: read that, you know, until shockingly recently it was things

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Speaker 1: like pus and secondary infections were often just thought of

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Speaker 1: as well, this is just part of the body healing itself.

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Speaker 1: This is just what happens. This is this is a norm.

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Speaker 1: There's nothing we can do about it. I was just

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Speaker 1: randomly reminded of something I read recently, which is, so,

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Speaker 1: you know, the famous story about US President James A. Garfield,

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Speaker 1: who was it is sometimes said assassinated, but it is

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Speaker 1: it has been observed by many historians that he was shot,

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Speaker 1: but he survived his bullet wound for a while and

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Speaker 1: was like for months actually, and was repeatedly operated on

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Speaker 1: in an unsanitary way by a doctor. And it is

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Speaker 1: it is commonly believed that the doctor's unsanitary intervention is

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Speaker 1: in fact what killed Garfield. But the thing that I

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Speaker 1: found out is that that doctor's name, his given name

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Speaker 1: was doctor. His name was doctor Willard Bliss. So he

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Speaker 1: was doctor doctor Willard Bliss. All right. But but speaking

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Speaker 1: of this time period, yeah, eventually we get to what

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Speaker 1: Smith at all referred to as the progressive era of

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Speaker 1: the eighteen nineties through the nineteen twice these and we

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Speaker 1: do see a shift here. Quote this period sell great

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Speaker 1: advances in hospital infection control. Ignance Similvis was the first

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Speaker 1: hospital epidemiologist, setting a precedent for step by step analysis

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Speaker 1: of an outbreak and for tracing epidemics to a particular

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Speaker 1: surgeon or practice e g. Going from the autopsy room

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Speaker 1: to the operating room Without washing your hands. He saw

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Speaker 1: eleven of twelve consecutive women die of pew eperl or

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Speaker 1: childbed fever, and subsequently required that all providers who attended

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Speaker 1: the patients first washed their hands in a watery solution

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Speaker 1: of chlorinated lime. The mortality rate then dropped dramatically from

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Speaker 1: eighteen percent to two percent. So simil Vis here was

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Speaker 1: a Hungarian physician who lived from eighteen eighteen through eighteen

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Speaker 1: sixty five, so he's a little bit before of this,

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Speaker 1: Before this progressive era that Smith at all were talking about.

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Speaker 1: But this is a time when we see rapid changes

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Speaker 1: in medical knowledge, we see the advent of technologies like

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Speaker 1: the X ray. This is a time period that was covered,

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Speaker 1: I think just excellently in Steven Soderbergh's television drama Than Nick,

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Speaker 1: which I know I've I've mentioned on the show before.

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Speaker 1: It's just a great drama, a lot of attention to detail,

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Speaker 1: but also they have this very like clean white, almost

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Speaker 1: blinding visual style to the show. You have electronic music

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Speaker 1: by Cliff Martinez uh through throughout the series, and so

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Speaker 1: I think it does a great job of portraying the

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Speaker 1: past as the energetic, promising um present, you know, uh,

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Speaker 1: something that we sometimes I think lose track of in

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Speaker 1: representing the past on film or even reading about the past.

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Speaker 1: About thinking about this time period and past as being

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Speaker 1: completely divorced from what we will know, and it's more

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Speaker 1: about just like the excitement and also the danger of

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Speaker 1: of being there at the bleeding edge of techno oology

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Speaker 1: and innovation. Yeah, I think one of the things that's

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Speaker 1: that's often hard to capture accurately when you're portraying the

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Speaker 1: past is understanding the past as without knowledge of the future,

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Speaker 1: understanding the past as uh, incorporating the full uncertainty of

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Speaker 1: being a present of its own. Like you say so,

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Speaker 1: not only the excitement of things being new at the time,

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Speaker 1: but also the lack of knowledge how things would turn out.

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Speaker 1: Everything always seems more obvious in retrospect, right, right, And

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Speaker 1: and certainly the nick is the show that doesn't doesn't

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Speaker 1: shy away from the wrong paths. I think I've mentioned

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Speaker 1: before when we're talking about the invention of the X

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Speaker 1: ray you have there's one episode in particular where they're

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Speaker 1: so excited to have the X ray uh there at

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Speaker 1: the hospital and they're just is just using it just

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Speaker 1: so irresponsibly, uh, without really understanding or having any idea

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Speaker 1: of just how dangerous repeated exposure to the machine would be. Well,

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Speaker 1: they're using it unnecessarily right there, just like using it

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Speaker 1: for fun. Yeah, It's like I get the kids in here, Aaron,

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Speaker 1: watch watch watch Dad, um x rays hand multiple times

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Speaker 1: for for no reason, that sort of thing. But and

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Speaker 1: they you know, they explore other things as well on

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Speaker 1: the show. You know, various social issues come up, eugenics

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Speaker 1: comes up, you know, all sorts of things of this nature.

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Speaker 1: But um, but anyway, UH, similar vices findings were apparently

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Speaker 1: better received in some countries than compared to others, the

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Speaker 1: UK and Germany being too. Though. That's interesting because we'll

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Speaker 1: come back to Germany as sort of a center of

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Speaker 1: discussion over the best practices and best use of new

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Speaker 1: medical findings and technology. But on the whole, there was

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Speaker 1: a lot of criticism of his ideas and a lot

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Speaker 1: of his efforts ended up in antagonism. His critics attacked him,

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Speaker 1: he attacked back. Uh. It apparently got got pretty ugly

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Speaker 1: from at least from an academic standpoint, and his mental

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Speaker 1: health declined greatly and he eventually died in an asylum.

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Speaker 1: So it's often care aterized as being you know, this

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Speaker 1: this effort where he's he's kind of up against the wall.

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Speaker 1: Maybe didn't have what maybe wasn't the ideal person to

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Speaker 1: to be making these arguments, Like maybe it could have

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Speaker 1: been a better pr campaign for some of these ideas,

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Speaker 1: but what can you do? Well, Yeah, I think a

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Speaker 1: lot of the hygienic concerns about medical interventions and especially

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Speaker 1: UH surgery would get more traction in the eighteen sixties

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Speaker 1: with Joseph Lister. Yeah, Joseph Lister definitely a big one.

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Speaker 1: I mean, they're various individuals that are working during this

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Speaker 1: time cracking our understanding of the unseen and what we

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Speaker 1: should do about it. And of course you have to

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Speaker 1: acknowledge the work of Louis Pasteur. Now there's but Yeah,

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Speaker 1: Joseph Lister was a big name. Seven through nineteen twelve.

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Speaker 1: He introduced the concept of surgical accepsis, the absence of

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Speaker 1: all micro organisms within any type of invasive procedure. His

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Speaker 1: work alone was associated, according to Smith at all, with

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Speaker 1: a decrease in post amputation mortality rays from to fift

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Speaker 1: and he also cut down on the necessity for amputation.

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Speaker 1: That was one of the big things he was going

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Speaker 1: after two Like he was saying, uh, you know, which

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Speaker 1: just won't be necessary to amputate this this many limbs

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Speaker 1: because uh be because we'll be using cleaner tools, etcetera.

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Speaker 1: He argued for the necessity of pre operative hand washing

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Speaker 1: and the use of disinfectants soaked wound dressings. Yeah. I

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Speaker 1: think Lister especially is known to highlight a distinction, will

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Speaker 1: get to in a little bit of the distinction between

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Speaker 1: a sepsis and anti sepsis, With pioneering the anti sepsis trend,

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Speaker 1: which is the attempt to sterilize the wound itself to

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Speaker 1: prevent infection. So this would typically mean using a disinfectant

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Speaker 1: chemical such as carbolic acid in and around a wound. Yeah,

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Speaker 1: and also dressing surgical tools. He's stressed that you should

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Speaker 1: change dressings on wounds um regularly. Um. Yeah, and again

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Speaker 1: before lister here, pus and infect and we're just considered

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Speaker 1: part of the healing process. It wasn't. It wasn't necessarily

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Speaker 1: thought that this means things are not going to according

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Speaker 1: to plan. It just means like this is this is

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Speaker 1: what happens when the body heals from a wound. Thank alright.

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Speaker 1: So getting into more into the realm of early surgical gloves,

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Speaker 1: early medical glove concepts and and the struggle for their acceptance. Um.

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Speaker 1: William Holstaed introduced rubber gloves for use in surgery by

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Speaker 1: around eighteen nine, and by we see more and more

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Speaker 1: doctors wearing gowns, masks and gloves, but the use of

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Speaker 1: gloves especially is certainly not instantly accepted by the medical community.

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Speaker 1: To come back to the nick for example, which which

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Speaker 1: again I think that does a pretty great job of

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Speaker 1: depicting this time period. If you go back and watch

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Speaker 1: any of this show uh and I did certainly didn't

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Speaker 1: have a chance to go back and watch all of it,

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Speaker 1: but you pretty much don't see surgical gloves at all.

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Speaker 1: There are just lots of scenes of surgeons who again

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Speaker 1: are at the bleeding edge of technology and innovation at

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Speaker 1: the time, but they're reaching into people's bodies with bare hands.

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Speaker 1: They are opening up people's craniums with bare hands, uh,

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Speaker 1: and just every other part of the anatomy as well,

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Speaker 1: lots of shots of white linens and blood soaked hands.

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Speaker 1: Now on the show. They're also frequent scenes of surgeons, though,

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Speaker 1: going through a series of hand washings before surgery uh,

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Speaker 1: sometimes while engaging in dialogue with each other. But I

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Speaker 1: remember being particularly taken by at least one scene in

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Speaker 1: which there's kind of a beautiful feeling of almost spiritual

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Speaker 1: ritual to the thing of the surgeon washing and uh

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Speaker 1: and and lowering their their hands and forearms first into

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Speaker 1: one vat, then into a second vat, and then into

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Speaker 1: a third vat. Like again, it has kind of almost

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Speaker 1: magical feeling to it. And so I was reading a

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Speaker 1: little bit about about this time period here for this

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Speaker 1: episode in based on my readings of why We're surgical

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Speaker 1: gloves not used earlier by Thomas Schlich, I believe this

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Speaker 1: is the three VAT system standardized in Berlin in eight

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Speaker 1: by Paul Fubringer. First soap, then alcohol, and then finally

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Speaker 1: an antiseptic substance. Yeah, that three stage process was very

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Speaker 1: common by the eighteen nineties. And again it's it's great,

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Speaker 1: it's a wonderful advancement in the in in in surgery

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Speaker 1: at the time, but of course it falls just a

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Speaker 1: little short of of actually using gloves, of actually embracing

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Speaker 1: the standard. And now again we just accept when we

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Speaker 1: go into a medical facility. Um. So this this, uh,

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Speaker 1: the three VAT systems coming out of Germany. Germany is

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Speaker 1: also where we see a great deal of argument during

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Speaker 1: this period about whether surgeons should have to wear surgical

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Speaker 1: gloves at all. And uh, I think the first place

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Speaker 1: that I was reading about this this um there was

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Speaker 1: a j Store Daily article that came out from this

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Speaker 1: is by jess Romeo in July, when obviously a lot

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Speaker 1: of this sort of thing was going going on in

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Speaker 1: there in our heads, and there's a lot obvious parallels

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Speaker 1: between the treatment here of gloves and consideration of things

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Speaker 1: like certainly handwashing but also the use of mass um.

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Speaker 1: The article was the surgeons who said not to gloves

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Speaker 1: And the article from Romeo is citing another article, UH.

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Speaker 1: The source article by Thomas schlich who we just referenced

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Speaker 1: titled Negotiating Technologies in Surgery the controversy about surgical gloves

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Speaker 1: in the eighteen nineties, and this was a two thousand

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Speaker 1: thirteen article from the Bulletin of the History of Medicine. Yeah,

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Speaker 1: this Bulletin of History of Medicine article is is interesting.

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Speaker 1: So the author here, Thomas Schlick, is a German Canadian

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Speaker 1: historian of medicine who's on faculty at McGill University UH

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Speaker 1: in Montreal. And Schlick begins his article with by illustrating

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Speaker 1: a really strange moment from the history of surgery where

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Speaker 1: there was so so there was this big conference in

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Speaker 1: it was the seven Congress of the German Society for Surgery,

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Speaker 1: and Schlick quotes a report on this meeting by an

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Speaker 1: Austrian surgeon named Alexander Frankel, who was just perplexed by

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Speaker 1: some of what was going on because a big subject

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Speaker 1: of conversation for one whole afternoon at this at this

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Speaker 1: conference for surgeons was about gloves. It was about surgical gloves,

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Speaker 1: whether or not you should use them, and what types

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Speaker 1: of gloves are best? And Frankel, reacting to this, this

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Speaker 1: whole discussion says quote, for a whole afternoon, participants discussed

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Speaker 1: about the best glove models, marching up all the various

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Speaker 1: specimens made from different materials in all sizes and price ranges. Alla,

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Speaker 1: Sarah Bernhardt referring to like a French actress, uh and

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Speaker 1: whatever the fashionable designs might be called, a whole apparatus

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Speaker 1: of pseudoscience was mobilized to inaugurate the new fashion of

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Speaker 1: the surgeon in gloves. Uh. So, Frankel here is a respected,

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Speaker 1: influential surgeon of the time. How can it be that

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Speaker 1: he viewed the idea of surgical gloves as absolutely ridiculous

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Speaker 1: pseudo scientific pageantry akin to like, Uh, I think the

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Speaker 1: comparison to Sarah Bernhardt here is he's saying it's like

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Speaker 1: a gaudy fashion show. Yeah, he compares it to just

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Speaker 1: pure costuming. It's like, this is just a costume that

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Speaker 1: these doctors are putting on that there's no real medical

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Speaker 1: rationale for this. Now today, it's natural for us to

399
00:23:38,920 --> 00:23:41,199
Speaker 1: look back on this view is not only misguided but

400
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Speaker 1: absolutely baffling. But it's true that even after the idea

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Speaker 1: of using some kind of impermeable sterile glove for surgery

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00:23:48,680 --> 00:23:52,320
Speaker 1: was introduced, it took more than a decade of sort

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Speaker 1: of debate within the medical community before it achieved what

404
00:23:56,040 --> 00:24:00,399
Speaker 1: could be considered near universal acceptance. And this article Schlick

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00:24:00,640 --> 00:24:04,879
Speaker 1: explores the historical discussion and controversy about the introduction of

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Speaker 1: surgical gloves, specifically in German speaking hospitals in the eighteen nineties. UM. So,

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Speaker 1: the question is why did most surgeons hesitate for so

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Speaker 1: long before adopting the use of surgical gloves, even after

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Speaker 1: we had a bacterial theory of disease and infection. Uh.

410
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Speaker 1: And actually, once you see all their concerns laid out,

411
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Speaker 1: the objections to people who resisted the gloves at the

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Speaker 1: time seem a little bit less baffling. It actually makes

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Speaker 1: more sense of them when you understand what the what

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Speaker 1: the understanding was at the time, and what the pressures

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Speaker 1: on surgeons for performing in the operating room. Where Yeah,

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Speaker 1: I think this is one of the great things that

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Speaker 1: does in the paper is really presents this this idea

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Speaker 1: because it's easy to think about this and sort of

419
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Speaker 1: look at the surface level of the this new technology

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Speaker 1: and its eventual adoption and just look at it as Okay,

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Speaker 1: well here's the new way, and everybody else must have

422
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Speaker 1: been saying, oh, I just want to do it the

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Speaker 1: old way, where it was really more a situation where

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Speaker 1: there was the old ways and then there were all

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Speaker 1: these new exciting ways that were uh, you know, all

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Speaker 1: ultimately trying to crack the same nut to try to improve,

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Speaker 1: um the mortality rates for various procedures. And and also

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Speaker 1: he seems to to stress that, you know, we we

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Speaker 1: can't really go into these situations sort of with a

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Speaker 1: wrong side of history viewpoint of the past. You know,

431
00:25:33,240 --> 00:25:37,320
Speaker 1: generally in the present, if you're presented with different ideas,

432
00:25:37,560 --> 00:25:39,199
Speaker 1: the ones that are the wrong side of history are

433
00:25:39,240 --> 00:25:42,919
Speaker 1: not labeled, so you don't know that this is not

434
00:25:42,960 --> 00:25:45,240
Speaker 1: going to you know, they're on the ultimately on the

435
00:25:45,280 --> 00:25:50,040
Speaker 1: losing hill here. When you're advocating that that that medical

436
00:25:50,040 --> 00:25:52,800
Speaker 1: gloves should not be used universally, well, yeah, this is

437
00:25:52,800 --> 00:25:55,200
Speaker 1: what I was talking about earlier with like the uncertainty

438
00:25:55,240 --> 00:25:57,239
Speaker 1: of the present, and you always have to remember that

439
00:25:57,359 --> 00:26:00,480
Speaker 1: in the past they were just as uncertain and about

440
00:26:00,480 --> 00:26:03,120
Speaker 1: what the future would be as we are about our

441
00:26:03,160 --> 00:26:06,159
Speaker 1: own future in the present. Right. And one thing he

442
00:26:06,200 --> 00:26:09,720
Speaker 1: stresses here is that the surgeons, often big name surgeons

443
00:26:09,720 --> 00:26:11,840
Speaker 1: that were engaging in this debate, a lot of them

444
00:26:11,840 --> 00:26:15,400
Speaker 1: had their own ideas, their own techniques, and in many

445
00:26:15,440 --> 00:26:17,960
Speaker 1: cases they had they had dated to back up what

446
00:26:18,040 --> 00:26:20,960
Speaker 1: they were arguing. Um, like, there's there's one guy that

447
00:26:21,000 --> 00:26:25,960
Speaker 1: he mentioned, surgeon Thomas Spencer Wells, who advocated cleanliness and

448
00:26:26,040 --> 00:26:29,679
Speaker 1: cold water school as opposed to and embracing Lister's ideas.

449
00:26:29,680 --> 00:26:32,439
Speaker 1: So this is more in general about like handwashing and

450
00:26:32,880 --> 00:26:35,639
Speaker 1: um cleansing of instruments, boiling of instruments, et cetera, as

451
00:26:35,640 --> 00:26:39,000
Speaker 1: opposed to gloves. But this was a guy that that

452
00:26:39,200 --> 00:26:42,600
Speaker 1: still had menial had a minimal complication rate. Uh and

453
00:26:42,640 --> 00:26:47,560
Speaker 1: the therefore he had some data to back up his viewpoint. Uh.

454
00:26:47,600 --> 00:26:50,240
Speaker 1: So he had He wasn't just standing on a hill

455
00:26:50,320 --> 00:26:53,800
Speaker 1: without you know, any reason to make his argument. He

456
00:26:53,840 --> 00:26:56,840
Speaker 1: had seen what seemed at the time like a reasonable argument,

457
00:26:56,880 --> 00:26:59,520
Speaker 1: like saying, look, look what I'm doing seems to be working,

458
00:26:59,560 --> 00:27:01,560
Speaker 1: and I have the data to back it up. Yes,

459
00:27:01,600 --> 00:27:03,359
Speaker 1: and wells would not be the only one. They're even

460
00:27:03,800 --> 00:27:08,040
Speaker 1: people making the case at this UH Congress of German

461
00:27:08,359 --> 00:27:11,879
Speaker 1: Society for Surgery who were saying, look, I've done laboratory

462
00:27:11,960 --> 00:27:16,360
Speaker 1: research that shows that you get way more bacterial penetration

463
00:27:16,480 --> 00:27:20,200
Speaker 1: of these uh, blood soaked cotton gloves than you do

464
00:27:20,440 --> 00:27:25,240
Speaker 1: of of bare hands. So so actually you don't need gloves,

465
00:27:25,240 --> 00:27:28,240
Speaker 1: you just need clean hands. Yeah. Another naming mentions is

466
00:27:28,359 --> 00:27:32,639
Speaker 1: Johannes Mikolish who wh who argue that we should be

467
00:27:32,720 --> 00:27:37,480
Speaker 1: using this preoperative injection of nucleic acid to supposedly increase

468
00:27:37,520 --> 00:27:41,520
Speaker 1: white blood cell count and boost immune response. So so

469
00:27:41,600 --> 00:27:43,280
Speaker 1: again it comes back to the idea that it's not

470
00:27:43,359 --> 00:27:46,120
Speaker 1: just the old ideas and the new uh, this one

471
00:27:46,160 --> 00:27:49,000
Speaker 1: new idea. I know they're they're these others seemingly promising

472
00:27:49,160 --> 00:27:52,639
Speaker 1: new ideas and new technologies that are also suddenly available.

473
00:27:52,800 --> 00:27:55,399
Speaker 1: Oh that's interesting. And you get these from both sides

474
00:27:55,400 --> 00:27:58,280
Speaker 1: about the different solutions, because Mikolich here was one of

475
00:27:58,320 --> 00:28:02,119
Speaker 1: the major proponents of gloves at this at this conference,

476
00:28:02,160 --> 00:28:06,560
Speaker 1: he was there representing the yes gloves or good side. Interesting, yeah,

477
00:28:06,600 --> 00:28:08,560
Speaker 1: but but better better then He also has his other

478
00:28:08,600 --> 00:28:12,600
Speaker 1: thing as well, that that you could conceivably you're a surgeon,

479
00:28:12,640 --> 00:28:15,400
Speaker 1: you're listening to all these ideas, you can imagine where

480
00:28:15,440 --> 00:28:17,879
Speaker 1: you might be like, well, this U Johannes, it seems

481
00:28:17,880 --> 00:28:20,359
Speaker 1: to have a great technology here. Maybe I can cherry

482
00:28:20,359 --> 00:28:22,680
Speaker 1: pick a little bit. Maybe I can sort of hold

483
00:28:22,720 --> 00:28:27,560
Speaker 1: onto my own reservations about gloves and just start using

484
00:28:27,600 --> 00:28:32,200
Speaker 1: this nucleic acid treatment that has been proposed. So, uh, yeah,

485
00:28:32,200 --> 00:28:33,879
Speaker 1: there are a lot of ideas on the table, and

486
00:28:33,920 --> 00:28:37,000
Speaker 1: again it seems like each surgeon had their own ideas

487
00:28:37,000 --> 00:28:40,760
Speaker 1: and techniques. Yeah. That's another point Schlick actually really highlights

488
00:28:40,760 --> 00:28:44,520
Speaker 1: in this paper, which is that, you know, sometimes we

489
00:28:44,560 --> 00:28:48,760
Speaker 1: have an erroneous tendency to erroneously look at the history

490
00:28:48,800 --> 00:28:53,600
Speaker 1: of progress in medicine as a kind of unified, top

491
00:28:53,720 --> 00:28:56,360
Speaker 1: down effort where there's just like okay here, you know,

492
00:28:56,720 --> 00:28:59,840
Speaker 1: they're almost like there is a sort of uh bore

493
00:29:00,360 --> 00:29:03,959
Speaker 1: of medicine that like controls all of medicine throughout history,

494
00:29:04,000 --> 00:29:08,160
Speaker 1: and they direct the flow of of development and progress.

495
00:29:08,480 --> 00:29:11,480
Speaker 1: But in fact, the way Schlick frames it is, you know,

496
00:29:11,560 --> 00:29:18,400
Speaker 1: medicine is just full of individual, little practical solutions to problems.

497
00:29:18,480 --> 00:29:21,720
Speaker 1: Especially in the eighteen nineties here and over time, some

498
00:29:21,880 --> 00:29:25,040
Speaker 1: prove better than others. Now, another thing we have to

499
00:29:25,320 --> 00:29:28,480
Speaker 1: mention here is, of course what we're talking about when

500
00:29:28,480 --> 00:29:30,520
Speaker 1: it comes to materials and what we were talking what

501
00:29:30,560 --> 00:29:33,880
Speaker 1: we're talking about with the physical gloves of the time, Um,

502
00:29:33,880 --> 00:29:36,960
Speaker 1: this would not have been a situation where like we're

503
00:29:37,000 --> 00:29:40,080
Speaker 1: we're dealing with modern medical gloves that are suddenly presented

504
00:29:40,360 --> 00:29:45,120
Speaker 1: to an audience. Um that this uh, this gathering, Um

505
00:29:45,160 --> 00:29:47,680
Speaker 1: it made me think of a recent episode of the

506
00:29:47,760 --> 00:29:50,720
Speaker 1: nineties Outer Limits that I watched it. The episode is

507
00:29:50,720 --> 00:29:55,080
Speaker 1: titled Gettysburg. It stars meat Loaf and it also has

508
00:29:55,160 --> 00:29:57,520
Speaker 1: the guy who played the crazy man on the boat

509
00:29:57,600 --> 00:30:01,160
Speaker 1: in Jason Takes Manhattan, and it is involved time travel

510
00:30:01,360 --> 00:30:05,320
Speaker 1: with Civil War reenactors who are sent back in time

511
00:30:05,400 --> 00:30:08,040
Speaker 1: to the Battle of Gettysburg. And one of them is

512
00:30:08,280 --> 00:30:11,440
Speaker 1: like a medical responder and has a medikit and so

513
00:30:11,480 --> 00:30:15,000
Speaker 1: there's a great scene where he's he's he's doing some

514
00:30:15,000 --> 00:30:18,280
Speaker 1: some some medical intervention on a wounded soldier. And meat

515
00:30:18,320 --> 00:30:22,080
Speaker 1: Loaf's character, who's a Civil War era UM, I like

516
00:30:22,080 --> 00:30:24,760
Speaker 1: to forget what he is if he's a he's a colonel. Uh,

517
00:30:25,160 --> 00:30:27,719
Speaker 1: he's watching on and he doesn't seem to think anything

518
00:30:27,720 --> 00:30:32,239
Speaker 1: about these modern medical um devices and gloves that are

519
00:30:32,280 --> 00:30:34,960
Speaker 1: being used by this guy. So um, that's kind of

520
00:30:34,960 --> 00:30:38,200
Speaker 1: a tangent, but it was, it was. It was weighing

521
00:30:38,240 --> 00:30:40,600
Speaker 1: heavily on my mind as I researched this well. To

522
00:30:40,600 --> 00:30:42,120
Speaker 1: be fair to meet loaf, I mean, if I look

523
00:30:42,120 --> 00:30:44,280
Speaker 1: at a modern surgery, I'd see a lot of stuff.

524
00:30:44,320 --> 00:30:46,560
Speaker 1: I don't know what I'm looking at, and it's there's

525
00:30:46,600 --> 00:30:49,040
Speaker 1: no time travel involved. Yeah, So, so these would not

526
00:30:49,080 --> 00:30:53,360
Speaker 1: have been modern medical gloves that they were considering here. Um. Uh.

527
00:30:53,440 --> 00:30:57,360
Speaker 1: The author mentions several of the different designs that were

528
00:30:57,360 --> 00:31:01,960
Speaker 1: presented at this conference. They included elbow length fabric gloves

529
00:31:01,960 --> 00:31:04,360
Speaker 1: of cotton or silk, and of course, if you were

530
00:31:04,360 --> 00:31:06,760
Speaker 1: to use these during an operation, they would apparently quickly

531
00:31:06,800 --> 00:31:10,200
Speaker 1: become soaked with blood. H. There was also the idea

532
00:31:10,200 --> 00:31:13,840
Speaker 1: of using leather style military gloves uh, and these would have,

533
00:31:13,840 --> 00:31:17,320
Speaker 1: of course been clumsy to use. Wax treated fabric was

534
00:31:17,360 --> 00:31:20,320
Speaker 1: another idea, and oh, I was really this one really

535
00:31:20,360 --> 00:31:24,400
Speaker 1: captured my attention. The idea of wax poured directly over

536
00:31:24,440 --> 00:31:29,479
Speaker 1: the surgeon's hands to form a supposed seal between the

537
00:31:29,520 --> 00:31:33,080
Speaker 1: flesh and the operation. Yeah, and the actual paper Schlick talks.

538
00:31:33,120 --> 00:31:35,959
Speaker 1: He mentions this as a proposal, but I didn't get

539
00:31:35,960 --> 00:31:38,960
Speaker 1: the impression anybody ever did it, or at least not. Yeah,

540
00:31:39,600 --> 00:31:42,800
Speaker 1: didn't like put it into regular practice. Yeah, I have

541
00:31:42,880 --> 00:31:45,760
Speaker 1: trouble imagining how it would work, right, because if the

542
00:31:45,800 --> 00:31:49,320
Speaker 1: wax was sealed around the hand um, and you know,

543
00:31:49,520 --> 00:31:51,360
Speaker 1: if you were to go with the right wax, that

544
00:31:51,400 --> 00:31:56,320
Speaker 1: of course wouldn't be just absolutely um scalding to the flesh.

545
00:31:56,720 --> 00:31:59,640
Speaker 1: Then it would truly become brittle upon trying to move

546
00:31:59,680 --> 00:32:02,120
Speaker 1: your hand it around. Yeah, I don't know it. It

547
00:32:02,160 --> 00:32:03,840
Speaker 1: doesn't make a lot of sense to me, though. I'm

548
00:32:03,840 --> 00:32:07,320
Speaker 1: also confused about the the wax treated. I mean, I

549
00:32:07,320 --> 00:32:09,840
Speaker 1: can get into more detail about this later, but one

550
00:32:09,840 --> 00:32:13,000
Speaker 1: of the proposals is for like a silk glove that

551
00:32:13,080 --> 00:32:17,000
Speaker 1: you would cover in liquid wax, and that would help

552
00:32:17,160 --> 00:32:22,320
Speaker 1: make the silk fabric more impermeable. But I would also think, like,

553
00:32:22,320 --> 00:32:24,840
Speaker 1: wouldn't that get kind of brittle? I don't know, Yeah,

554
00:32:24,920 --> 00:32:26,600
Speaker 1: it seems like it would be flaking off and you

555
00:32:26,760 --> 00:32:30,160
Speaker 1: have like little bits of wax. I mean, unfortunately, as

556
00:32:30,200 --> 00:32:32,280
Speaker 1: we've pointed out before in the show, like wax has

557
00:32:32,360 --> 00:32:35,800
Speaker 1: long been used, uh and and and so has honey

558
00:32:35,880 --> 00:32:39,040
Speaker 1: and various medical treatments. So it's not the worst thing

559
00:32:39,080 --> 00:32:42,240
Speaker 1: I guess to have in a wound, but it's you

560
00:32:42,640 --> 00:32:46,280
Speaker 1: want to cut down on the amount of external substances

561
00:32:46,360 --> 00:32:49,200
Speaker 1: that are introduced to a body cavity during a procedure

562
00:32:49,240 --> 00:32:52,200
Speaker 1: like this. Um. I don't know about you, but another

563
00:32:52,280 --> 00:32:57,719
Speaker 1: detail I really liked in article was this bit um quote.

564
00:32:57,760 --> 00:33:01,120
Speaker 1: Another strategy, and this is an altern of diptic gloves,

565
00:33:01,160 --> 00:33:04,960
Speaker 1: involved keeping one's hands clean between operations and abstaining from

566
00:33:05,000 --> 00:33:08,680
Speaker 1: handling infectious materials even when not on the job, an

567
00:33:08,680 --> 00:33:11,960
Speaker 1: approach that in some cases amounted to a whole regime

568
00:33:12,040 --> 00:33:15,680
Speaker 1: of living. Which this is easy to sort of think

569
00:33:15,680 --> 00:33:19,000
Speaker 1: of almost comedically, where you can imagine this surgeon saying, well,

570
00:33:19,000 --> 00:33:20,880
Speaker 1: I'm I'm of course I'm not gonna wear gloves during

571
00:33:20,880 --> 00:33:23,880
Speaker 1: a procedure. It gets in the way. I have some

572
00:33:23,880 --> 00:33:27,360
Speaker 1: some issues with how hygienic it is. What I'm gonna

573
00:33:27,360 --> 00:33:29,880
Speaker 1: do is I'm going to wear gloves the rest of

574
00:33:29,920 --> 00:33:33,880
Speaker 1: the time when I'm not in the surgery, and therefore

575
00:33:33,960 --> 00:33:36,440
Speaker 1: keep my hands nice and clean and ready to just

576
00:33:36,520 --> 00:33:39,320
Speaker 1: get in there. There you almost it's like you become

577
00:33:39,400 --> 00:33:42,360
Speaker 1: sort of part of a priestly class. You must maintain

578
00:33:42,520 --> 00:33:46,360
Speaker 1: purity for all time. Yeah, I mean it's like these

579
00:33:46,360 --> 00:33:48,040
Speaker 1: are the moneymakers, right, and that I have to keep

580
00:33:48,080 --> 00:33:50,880
Speaker 1: the gloves on them at all times. That these hands

581
00:33:50,960 --> 00:33:54,680
Speaker 1: are registered with the FBI as lethal weapons because I

582
00:33:54,720 --> 00:33:59,320
Speaker 1: don't wash them before I operate. Now, he points out

583
00:33:59,360 --> 00:34:03,280
Speaker 1: that the material real challenges here came down to the

584
00:34:03,320 --> 00:34:05,320
Speaker 1: following and these I think we're pointed out by Sergeant

585
00:34:05,360 --> 00:34:11,080
Speaker 1: Anton Wolfer at the time. They needed to be impermeable, obviously,

586
00:34:11,200 --> 00:34:14,480
Speaker 1: they needed to be flexible, they needed to be resistant

587
00:34:14,600 --> 00:34:17,960
Speaker 1: to tears. They couldn't be too tight, they couldn't be

588
00:34:18,000 --> 00:34:21,160
Speaker 1: too hot, and above all else they had to be

589
00:34:21,560 --> 00:34:23,520
Speaker 1: you had to be able to to sterilize them. They

590
00:34:23,520 --> 00:34:26,840
Speaker 1: had to be sterilizable, right, meaning you could like boil

591
00:34:26,920 --> 00:34:29,560
Speaker 1: them or steam them or something to to kill any

592
00:34:29,719 --> 00:34:32,239
Speaker 1: thing that might be on them without damaging them so

593
00:34:32,280 --> 00:34:36,200
Speaker 1: that they couldn't be used. Right. And so given all

594
00:34:36,239 --> 00:34:40,080
Speaker 1: of these demands of the materials, uh, it shouldn't come

595
00:34:40,120 --> 00:34:42,440
Speaker 1: as a surprise that the first surgical gloves that were

596
00:34:42,440 --> 00:34:45,960
Speaker 1: presented here they were not perfect. They did tear, they

597
00:34:46,040 --> 00:34:50,600
Speaker 1: did make aspects of surgery, particularly gripping certain tools or

598
00:34:50,640 --> 00:34:53,439
Speaker 1: certain parts of the human anatomy more difficult. I think

599
00:34:53,719 --> 00:34:57,640
Speaker 1: the manipulation of bowels is singled out as being difficult

600
00:34:57,680 --> 00:35:00,600
Speaker 1: with some of the gloves of this time period. Um.

601
00:35:00,640 --> 00:35:03,279
Speaker 1: But on the other hand, it does certainly in the

602
00:35:03,320 --> 00:35:05,959
Speaker 1: long term they did make a difference in the spread

603
00:35:06,000 --> 00:35:09,279
Speaker 1: of pathogens through surgical procedure. Oh yeah, I think so.

604
00:35:09,320 --> 00:35:11,680
Speaker 1: I think by around the time of World War One,

605
00:35:11,840 --> 00:35:15,040
Speaker 1: it's generally agreed that that's when you you are seeing. Okay,

606
00:35:15,120 --> 00:35:19,280
Speaker 1: now we have pretty much universal acceptance that impermeable sterile

607
00:35:19,320 --> 00:35:22,279
Speaker 1: gloves are good for for surgery, and they should be

608
00:35:22,400 --> 00:35:24,839
Speaker 1: used if at all possible. I can't help to think

609
00:35:24,880 --> 00:35:27,560
Speaker 1: of of media and all this as well, like cinematic

610
00:35:27,600 --> 00:35:31,560
Speaker 1: depictions of doctors, uh like now, like the image of

611
00:35:31,560 --> 00:35:33,759
Speaker 1: a doctor, VI of them a you know, a good

612
00:35:33,800 --> 00:35:37,000
Speaker 1: doctor or a mad scientist or something. The taking off

613
00:35:37,080 --> 00:35:39,840
Speaker 1: or the putting on of surgical gloves or medical gloves

614
00:35:39,840 --> 00:35:42,560
Speaker 1: at some point some form or another, it is kind

615
00:35:42,560 --> 00:35:47,520
Speaker 1: of associated with with power and ability. Uh. You know,

616
00:35:47,760 --> 00:35:51,200
Speaker 1: there's um, there's something about it that like we don't

617
00:35:51,200 --> 00:35:53,520
Speaker 1: even even doubt, doubt, not only do not doubt the

618
00:35:53,560 --> 00:35:57,080
Speaker 1: importance of gloves, but they have kind of become associated

619
00:35:57,520 --> 00:36:00,120
Speaker 1: with these roles, like it's hard to separate the two,

620
00:36:00,160 --> 00:36:02,440
Speaker 1: and you wouldn't want to separate the two. There's a

621
00:36:02,560 --> 00:36:05,919
Speaker 1: there's a strong audio visual cue used in media, which

622
00:36:06,000 --> 00:36:08,399
Speaker 1: is much in the same way you have like an

623
00:36:08,440 --> 00:36:11,440
Speaker 1: action movie, where a gritty action scene is about to commence,

624
00:36:11,440 --> 00:36:14,080
Speaker 1: so you get the pump of the shotgun. In the

625
00:36:14,120 --> 00:36:16,680
Speaker 1: medical scene, you get the snap of the rubber glove.

626
00:36:16,800 --> 00:36:19,879
Speaker 1: It's almost exactly the same thing, right, I mean it's

627
00:36:20,000 --> 00:36:22,680
Speaker 1: enough to where if you were given the choice between

628
00:36:22,760 --> 00:36:27,200
Speaker 1: two fraudulent pseudo scientific healers and they were gonna work

629
00:36:27,200 --> 00:36:29,000
Speaker 1: on you, and one is using bare hands and one

630
00:36:29,040 --> 00:36:31,760
Speaker 1: is using gloves, like the mere presence of the gloves

631
00:36:32,280 --> 00:36:35,240
Speaker 1: could potentially legitimize it a little bit in your eyes.

632
00:36:35,320 --> 00:36:37,920
Speaker 1: You know, Wait, no, but did you mean bare hands

633
00:36:38,040 --> 00:36:41,000
Speaker 1: or B E A R hands? Oh well, I meant

634
00:36:41,000 --> 00:36:43,719
Speaker 1: I meant B A R E. But B E A

635
00:36:43,920 --> 00:36:46,839
Speaker 1: R that brings on an entirely different vision, right, I mean,

636
00:36:46,880 --> 00:36:49,200
Speaker 1: that's then you're in the realm of the shaman. I

637
00:36:49,280 --> 00:36:51,080
Speaker 1: would go with I would go with the quack that

638
00:36:51,120 --> 00:36:54,040
Speaker 1: had bare paws over the quack that just had gloves,

639
00:36:54,360 --> 00:36:56,359
Speaker 1: or what if the the what if the quack had

640
00:36:56,400 --> 00:37:00,360
Speaker 1: both a bare head on over their own had, but

641
00:37:00,480 --> 00:37:03,640
Speaker 1: they had medical gloves on. What if they operated on

642
00:37:03,680 --> 00:37:07,279
Speaker 1: you wearing the bear costume from Jack Frost. There you go,

643
00:37:12,440 --> 00:37:15,040
Speaker 1: Thank you, thank you, thank you. All right, Well, I

644
00:37:15,080 --> 00:37:17,799
Speaker 1: wanted to come back to that Thomas Schlick paper in

645
00:37:17,880 --> 00:37:20,359
Speaker 1: the Bulletin of the History of Medicine, the one called

646
00:37:20,440 --> 00:37:24,440
Speaker 1: Negotiating Technologies and Surgery that was all about the controversy

647
00:37:24,560 --> 00:37:28,560
Speaker 1: over surgical gloves in German speaking hospitals in the eighteen nineties.

648
00:37:29,040 --> 00:37:31,719
Speaker 1: And as I mentioned earlier that the Schlick paper is

649
00:37:31,760 --> 00:37:37,640
Speaker 1: interesting because it frames the good things about gloves as

650
00:37:37,680 --> 00:37:40,759
Speaker 1: a sort of you know, existing within a network of

651
00:37:40,800 --> 00:37:44,719
Speaker 1: trade offs uh and UH, talking about it as one

652
00:37:44,960 --> 00:37:50,280
Speaker 1: of the types of what Schlick calls control strategies within

653
00:37:50,360 --> 00:37:53,200
Speaker 1: surgery at the time. And control strategies there were many,

654
00:37:53,280 --> 00:37:58,279
Speaker 1: but they included things like different instruments UH, lights and

655
00:37:58,360 --> 00:38:03,880
Speaker 1: operating tables UH, anatomy, atlas is, an esthetics, and of

656
00:38:03,920 --> 00:38:08,160
Speaker 1: course technologies of a sepsis. Now I mentioned earlier the

657
00:38:08,480 --> 00:38:11,960
Speaker 1: difference between a sepsis and anti sepsis, and this is

658
00:38:12,000 --> 00:38:16,000
Speaker 1: an important concept in in the development of surgery in

659
00:38:16,040 --> 00:38:19,000
Speaker 1: the second half of the nineteenth century. So you've got

660
00:38:19,000 --> 00:38:21,719
Speaker 1: two schools of thought the that are in competition. One

661
00:38:21,760 --> 00:38:24,600
Speaker 1: is anti sepsis, which is the idea of disinfecting a

662
00:38:24,680 --> 00:38:28,120
Speaker 1: wound after germs have likely been introduced. And then you've

663
00:38:28,120 --> 00:38:31,200
Speaker 1: got a sepsis, which is instead trying to prevent any

664
00:38:31,239 --> 00:38:34,759
Speaker 1: germs from ever entering the wound in the first place. Uh.

665
00:38:34,760 --> 00:38:36,919
Speaker 1: And the primary method here would be trying to make

666
00:38:36,960 --> 00:38:41,000
Speaker 1: all instruments and objects in the surgical environment sterile before

667
00:38:41,040 --> 00:38:44,360
Speaker 1: surgery begins, so you would boil your scalpels and so forth.

668
00:38:44,680 --> 00:38:48,520
Speaker 1: But Schlick describes a growing nervousness among surgeons in the

669
00:38:48,560 --> 00:38:53,839
Speaker 1: eighteen nineties based on the general feeling that reigning aseptic

670
00:38:53,880 --> 00:38:57,120
Speaker 1: practices were not good enough. That you know, the By

671
00:38:57,160 --> 00:39:01,160
Speaker 1: the eighteen nineties, surgeons in German speaking hospitals were aware

672
00:39:01,200 --> 00:39:04,560
Speaker 1: of of the bacteriological problems. They were trying to be

673
00:39:04,640 --> 00:39:07,120
Speaker 1: a septic however they could. They were washing their hands

674
00:39:07,160 --> 00:39:09,799
Speaker 1: and going through all these procedures we talked about, but

675
00:39:09,840 --> 00:39:13,400
Speaker 1: they were just aware that the current methods were not

676
00:39:13,480 --> 00:39:16,800
Speaker 1: preventing all infection. A sepsis had to be what they were,

677
00:39:16,800 --> 00:39:19,600
Speaker 1: what they thought of as an all or nothing campaign,

678
00:39:20,320 --> 00:39:24,600
Speaker 1: and Schlick quotes an academic surgeon somebody who we've already referenced.

679
00:39:24,600 --> 00:39:26,760
Speaker 1: This was a guy at the University of bres Lau

680
00:39:26,960 --> 00:39:31,640
Speaker 1: named Johannes van Miklich, and Mikolitch wrote quote, the smallest

681
00:39:31,800 --> 00:39:35,160
Speaker 1: mistake and wound treatment would come back to haunt the surgeon.

682
00:39:36,040 --> 00:39:40,200
Speaker 1: And Mikolitch, together with a collaborator named Carl Fluga who

683
00:39:40,239 --> 00:39:43,560
Speaker 1: lived eighteen forty seven and nineteen twenty three, UH spent

684
00:39:43,719 --> 00:39:47,279
Speaker 1: great effort in the eighteen nineties trying to close the gaps,

685
00:39:47,320 --> 00:39:51,000
Speaker 1: basically to find ways that germs could still be getting

686
00:39:51,040 --> 00:39:55,759
Speaker 1: in even with the aseptic practices of the time. UH

687
00:39:55,800 --> 00:39:57,799
Speaker 1: and so one of the ideas that they came up

688
00:39:57,840 --> 00:40:01,879
Speaker 1: with was using face masks to prevent droplet infection, so

689
00:40:02,200 --> 00:40:05,400
Speaker 1: droplets from the doctor's mouth or nose entering the wound

690
00:40:05,480 --> 00:40:09,799
Speaker 1: and introducing germs during surgery. And Schlick writes, quote many

691
00:40:09,880 --> 00:40:13,839
Speaker 1: of today's surgical paraphernalia were introduced at the time as

692
00:40:13,920 --> 00:40:17,759
Speaker 1: part of the bacteriologically supported search for weak points in

693
00:40:17,840 --> 00:40:22,000
Speaker 1: the aseptic all or nothing system of preventing wound infection.

694
00:40:22,400 --> 00:40:25,080
Speaker 1: It was the it was the context of this crisis

695
00:40:25,160 --> 00:40:28,400
Speaker 1: of aseptic surgery that prompted a number of surgeons in

696
00:40:28,400 --> 00:40:32,439
Speaker 1: the eighteen nineties to simultaneously try out surgical gloves within

697
00:40:32,560 --> 00:40:35,440
Speaker 1: their local settings. Now, one of the next things that

698
00:40:35,440 --> 00:40:37,600
Speaker 1: Schlick talks about in this paper, I thought it was

699
00:40:37,680 --> 00:40:39,800
Speaker 1: very interesting. And so if we're looking at German speaking

700
00:40:39,800 --> 00:40:43,080
Speaker 1: hospitals in the eighteen eighties and eighteen nineties, they're aware

701
00:40:43,120 --> 00:40:46,520
Speaker 1: of the fact that they need to improve aseptic practices

702
00:40:46,560 --> 00:40:49,239
Speaker 1: and surgery, but they don't know all the ways to

703
00:40:49,280 --> 00:40:52,520
Speaker 1: plug the holes. And the use of surgical gloves is

704
00:40:52,560 --> 00:40:55,600
Speaker 1: obvious to us in retrospective, but it was not obvious

705
00:40:55,680 --> 00:40:58,959
Speaker 1: to everyone at this time and place. So why would

706
00:40:58,960 --> 00:41:01,719
Speaker 1: it not have been obvious to them? Uh. One thing

707
00:41:01,760 --> 00:41:03,719
Speaker 1: Slick points out is that, first of all, it just

708
00:41:03,800 --> 00:41:06,840
Speaker 1: requires thinking about gloves in a different way. Prior to this,

709
00:41:07,120 --> 00:41:11,200
Speaker 1: gloves were typically used to protect the person wearing them

710
00:41:11,320 --> 00:41:14,799
Speaker 1: rather than to protect someone from the person wearing them.

711
00:41:15,160 --> 00:41:17,520
Speaker 1: So it's kind of like having to just think outside

712
00:41:17,520 --> 00:41:21,640
Speaker 1: the box to reframe something that is already part of

713
00:41:21,680 --> 00:41:25,000
Speaker 1: your mundane existence. So imagine thinking that you would need

714
00:41:25,040 --> 00:41:29,080
Speaker 1: to wear a hat to protect someone else from your head.

715
00:41:29,560 --> 00:41:31,560
Speaker 1: It seems weird, but actually, if you think about it

716
00:41:31,560 --> 00:41:34,480
Speaker 1: in the right context, this is something that people do.

717
00:41:34,560 --> 00:41:37,480
Speaker 1: I've I've worked in restaurants where chefs were required to

718
00:41:37,520 --> 00:41:40,200
Speaker 1: wear either hats or hairnets to keep their hair out

719
00:41:40,200 --> 00:41:42,719
Speaker 1: of the food. If you're not familiar with the context

720
00:41:42,840 --> 00:41:44,960
Speaker 1: like that, it might never occur to you that you

721
00:41:45,000 --> 00:41:49,240
Speaker 1: would wear a hat for somebody else's benefit. But another

722
00:41:49,280 --> 00:41:52,400
Speaker 1: thing that the Slick points out around here is that

723
00:41:52,560 --> 00:41:56,400
Speaker 1: carbolic acid and other antiseptic chemicals that were used to

724
00:41:56,400 --> 00:41:59,919
Speaker 1: to get the hands clean before surgery, these were hard

725
00:42:00,040 --> 00:42:04,120
Speaker 1: on the skin. Schlick Wrights quote copiously applied the caustic

726
00:42:04,200 --> 00:42:08,800
Speaker 1: solutions often caused severe skin damage insurgeons and nurses, forcing

727
00:42:08,880 --> 00:42:12,279
Speaker 1: some of them to abandon operating altogether. The issue was

728
00:42:12,320 --> 00:42:14,560
Speaker 1: the background of the well known story of how in

729
00:42:14,680 --> 00:42:19,920
Speaker 1: eighteen eighty nine, William Halstead at Johns Hopkins introduced rubber

730
00:42:19,920 --> 00:42:23,560
Speaker 1: gloves to protect the hands of his chief operating nurse,

731
00:42:23,840 --> 00:42:27,600
Speaker 1: who later became his wife. Now Robbie already mentioned Halstead

732
00:42:27,680 --> 00:42:30,680
Speaker 1: introducing rubber gloves in his practice around this time, but

733
00:42:31,160 --> 00:42:34,919
Speaker 1: Slick goes on with an interesting detail here quote Subsequently,

734
00:42:34,960 --> 00:42:38,560
Speaker 1: such gloves were also used by Halsted's assistants. They put

735
00:42:38,600 --> 00:42:42,400
Speaker 1: them on when taking instruments out of the corrosive sublimate

736
00:42:42,480 --> 00:42:45,920
Speaker 1: solution in which the instruments were kept, and passed them

737
00:42:46,000 --> 00:42:49,280
Speaker 1: on to the operating surgeon, who did not wear gloves.

738
00:42:50,280 --> 00:42:53,800
Speaker 1: So so the assistance would you'd have like a scalpel,

739
00:42:53,880 --> 00:42:57,320
Speaker 1: and that would be in a sterilizing, uh, caustic chemical,

740
00:42:57,920 --> 00:43:01,400
Speaker 1: and the assistance would put gloves on to take the

741
00:43:01,480 --> 00:43:04,919
Speaker 1: thing out of that chemical, handed to the surgeon who

742
00:43:05,000 --> 00:43:09,080
Speaker 1: would receive it with an ungloved hand and then operate. Yeah.

743
00:43:09,120 --> 00:43:10,920
Speaker 1: I guess that. One of the things to drive home

744
00:43:10,960 --> 00:43:13,239
Speaker 1: here is, Yeah, the adoption of a new technology is

745
00:43:13,280 --> 00:43:16,400
Speaker 1: sometimes a little patchy, and the reasoning can be different

746
00:43:16,400 --> 00:43:19,640
Speaker 1: than what you'd expect. So they've got by eighteen eighty nine,

747
00:43:19,640 --> 00:43:23,720
Speaker 1: Halstead's assistants and nurses are using rubber gloves to protect

748
00:43:23,760 --> 00:43:27,240
Speaker 1: their hands from these caustic chemicals. But it wasn't until

749
00:43:27,719 --> 00:43:31,600
Speaker 1: eighteen nine six that UH that rubber gloves to protect

750
00:43:31,680 --> 00:43:35,080
Speaker 1: the patient during surgery became standard at Johns Hopkins. It

751
00:43:35,200 --> 00:43:39,040
Speaker 1: just didn't seem like an obvious solution until around then. Now,

752
00:43:39,080 --> 00:43:42,000
Speaker 1: another thing is that so Rob earlier you mentioned this

753
00:43:42,120 --> 00:43:45,239
Speaker 1: three VAT process. You've got surgeons who would wash their

754
00:43:45,239 --> 00:43:48,200
Speaker 1: hands with soap and then submerge their hands in alcohol

755
00:43:48,360 --> 00:43:52,440
Speaker 1: and then dip their hands in an antiseptic chemical before

756
00:43:52,560 --> 00:43:55,000
Speaker 1: going into surgery. So you would think, man, you go

757
00:43:55,080 --> 00:43:58,080
Speaker 1: through that kind of procedure, that really should kill all

758
00:43:58,120 --> 00:44:01,399
Speaker 1: the bacteria, right, shouldn't your hands be perfectly clean by then?

759
00:44:01,680 --> 00:44:03,640
Speaker 1: But one of the things that became clear to these

760
00:44:03,680 --> 00:44:06,760
Speaker 1: these surgeons in the eighteen nineties is that this actually

761
00:44:07,120 --> 00:44:09,600
Speaker 1: it was pretty good, but it wasn't good enough because

762
00:44:09,640 --> 00:44:12,600
Speaker 1: even if you could sterilize the outside skin of your hands,

763
00:44:13,000 --> 00:44:15,600
Speaker 1: there were little pockets where germs could camp out and

764
00:44:15,680 --> 00:44:19,280
Speaker 1: still infect a wound. Examples would include the sebaceous glands.

765
00:44:19,400 --> 00:44:23,359
Speaker 1: These are a little little gland pockets attached to hair

766
00:44:23,480 --> 00:44:26,960
Speaker 1: follicles that produce sea bum, which is a waxy or

767
00:44:27,000 --> 00:44:30,399
Speaker 1: oily substance that coats the skin and hair. And then

768
00:44:30,480 --> 00:44:32,960
Speaker 1: also you've got like underneath the fingernails. You know, you're

769
00:44:33,000 --> 00:44:35,759
Speaker 1: just gonna have like little recesses back there where these

770
00:44:35,800 --> 00:44:39,120
Speaker 1: liquids are not getting in deep enough, and germs from

771
00:44:39,160 --> 00:44:42,400
Speaker 1: in there might still get out during surgery, and for

772
00:44:42,440 --> 00:44:45,040
Speaker 1: some reason this reminds me of you remember in our

773
00:44:45,080 --> 00:44:48,480
Speaker 1: Invention episode on the Death Ray, the the idea of

774
00:44:48,520 --> 00:44:51,879
Speaker 1: this time between World War one and two where there

775
00:44:52,000 --> 00:44:55,920
Speaker 1: was terror about the inadequacy of ground based defenses against

776
00:44:55,920 --> 00:44:59,560
Speaker 1: air raids. And there's this this phrase that was used

777
00:44:59,600 --> 00:45:03,080
Speaker 1: at the time time, the bomber always gets through. I

778
00:45:03,120 --> 00:45:05,560
Speaker 1: compared that to the bacterium in this case. Right, there's

779
00:45:05,640 --> 00:45:10,239
Speaker 1: this fear that the bacterium somehow always gets through, right, right,

780
00:45:10,320 --> 00:45:12,840
Speaker 1: and there's always gonna be at least one little crack

781
00:45:12,880 --> 00:45:15,400
Speaker 1: in the defenses with this method. So to try to

782
00:45:15,400 --> 00:45:18,080
Speaker 1: get around these problems where you know, sterilizing your hands

783
00:45:18,120 --> 00:45:20,239
Speaker 1: is not good enough, this is where gloves come in.

784
00:45:20,320 --> 00:45:22,840
Speaker 1: And so we mentioned several times this guy, you Haness

785
00:45:22,840 --> 00:45:28,240
Speaker 1: fun Uh mikolich Uh. He tried this interesting solution, beginning

786
00:45:28,239 --> 00:45:33,879
Speaker 1: with an operation on Easter eighteen, which was sterilized cotton gloves.

787
00:45:34,520 --> 00:45:38,359
Speaker 1: So hands would go through the regular gauntlet washing and disinfection,

788
00:45:38,920 --> 00:45:41,920
Speaker 1: but then after this you would put on the sterilized

789
00:45:41,960 --> 00:45:45,560
Speaker 1: cotton gloves. They were very big. They had sleeves or

790
00:45:45,560 --> 00:45:47,839
Speaker 1: gauntlets going all the way up the arm to like

791
00:45:47,880 --> 00:45:50,359
Speaker 1: the elbow or past the elbow, and you can see

792
00:45:50,400 --> 00:45:54,279
Speaker 1: pictures of these. They kind of look like mummy arms. Now,

793
00:45:54,320 --> 00:45:57,520
Speaker 1: of course they're cotton gloves, so they're not impermeable, so

794
00:45:57,640 --> 00:46:00,240
Speaker 1: over the course of an operation they would become sod

795
00:46:00,280 --> 00:46:02,600
Speaker 1: with blood and you might need to change them out

796
00:46:02,640 --> 00:46:06,120
Speaker 1: for a new pair. But Mikolitch was was very positive

797
00:46:06,160 --> 00:46:08,560
Speaker 1: about them. He is like, you know, uh, they're not

798
00:46:08,640 --> 00:46:11,279
Speaker 1: that bad. And sometimes with cotton gloves you can even

799
00:46:11,320 --> 00:46:14,560
Speaker 1: grip some things better, like holding onto tissues is easier

800
00:46:14,560 --> 00:46:18,319
Speaker 1: with cotton gloves than with the naked hand. But there

801
00:46:18,320 --> 00:46:22,120
Speaker 1: were times when the cotton gloves reportedly caused problems. One

802
00:46:22,160 --> 00:46:25,239
Speaker 1: example would be, uh, this is the example given by

803
00:46:25,320 --> 00:46:29,080
Speaker 1: by Mikolich when um when a surgeon is feeling around

804
00:46:29,160 --> 00:46:31,799
Speaker 1: on the inside of the stomach lining to locate a

805
00:46:31,840 --> 00:46:35,680
Speaker 1: tumor by touch, the cotton would apparently dull the sensitivity

806
00:46:35,680 --> 00:46:39,680
Speaker 1: of the fingers, and Mikolitch wrote that in cases like this,

807
00:46:39,840 --> 00:46:43,120
Speaker 1: you could briefly take off the glove, reach around and

808
00:46:43,120 --> 00:46:45,719
Speaker 1: and feel for the tumor with your bare fingers as

809
00:46:45,800 --> 00:46:48,239
Speaker 1: quickly as possible, and then once you found it, you

810
00:46:48,239 --> 00:46:51,040
Speaker 1: put on a pair of fresh cotton gloves. And it's

811
00:46:51,040 --> 00:46:53,799
Speaker 1: the five second rule. Of rooting around in somebody's um

812
00:46:54,360 --> 00:46:57,440
Speaker 1: the stomach cavity. Right. Yeah, that that seems like not

813
00:46:57,440 --> 00:47:01,160
Speaker 1: not a great solution, but at least you're you're trying

814
00:47:01,160 --> 00:47:05,120
Speaker 1: to use something. So Mikolich also tried out early rubber

815
00:47:05,120 --> 00:47:07,279
Speaker 1: gloves but said they were not tenable because they had

816
00:47:07,320 --> 00:47:11,120
Speaker 1: they just had major disadvantages for manual dexterity, and they

817
00:47:11,160 --> 00:47:14,560
Speaker 1: weren't much better than cotton gloves for asepsis. I don't

818
00:47:14,560 --> 00:47:18,840
Speaker 1: know about that last claim, but apparently, according to Schlick,

819
00:47:18,880 --> 00:47:22,360
Speaker 1: at least the surgeon most responsible for bringing rubber gloves

820
00:47:22,440 --> 00:47:28,000
Speaker 1: into vogue in German speaking hospitals was Verners Zoga von Manteuffel,

821
00:47:28,080 --> 00:47:31,960
Speaker 1: who lived eighteen fifty seven to nineteen twenty six. Zoga

822
00:47:32,040 --> 00:47:35,960
Speaker 1: was especially in search of failsafe aseptic protocols because he

823
00:47:36,000 --> 00:47:39,920
Speaker 1: worked in an environment of a municipal hospital where he

824
00:47:39,960 --> 00:47:44,640
Speaker 1: had to quote operate promiscuously, so he couldn't like specialize

825
00:47:44,640 --> 00:47:47,760
Speaker 1: in one type of surgery and quarantine for that. Instead,

826
00:47:47,760 --> 00:47:52,320
Speaker 1: he had to operate alternately on like infected patients and

827
00:47:52,520 --> 00:47:56,920
Speaker 1: uninfected one, sometimes handling pus or feces or whatever, and

828
00:47:56,960 --> 00:47:59,760
Speaker 1: then immediately having to go operate on a different patient.

829
00:48:00,440 --> 00:48:04,799
Speaker 1: So his solution to this was boiled rubber gloves. There

830
00:48:04,800 --> 00:48:08,120
Speaker 1: were downsides. The rubber gloves were uncomfortable. Sometimes they made

831
00:48:08,160 --> 00:48:12,279
Speaker 1: it hard to move or bend the thumb. Sometimes the

832
00:48:12,360 --> 00:48:17,080
Speaker 1: fingers were too long, which made gripping difficult, and because

833
00:48:17,200 --> 00:48:20,399
Speaker 1: of these conditions, operations with rubber gloves would often take

834
00:48:20,480 --> 00:48:23,759
Speaker 1: longer than the same operation with bare hands. And then,

835
00:48:23,800 --> 00:48:27,359
Speaker 1: to read from Schlick quote, but this Zoga thought was

836
00:48:27,400 --> 00:48:31,719
Speaker 1: outweighed by the gains in aseptic control the absolute safety

837
00:48:31,840 --> 00:48:36,120
Speaker 1: of the quote boiled hand, as he called it. Zoga

838
00:48:36,200 --> 00:48:39,439
Speaker 1: thus explicitly weighed the two kinds of control against each other.

839
00:48:39,840 --> 00:48:43,160
Speaker 1: What also becomes clear in this discussion is the importance

840
00:48:43,200 --> 00:48:46,719
Speaker 1: of the technical details of the gloves for reconciling manual

841
00:48:46,840 --> 00:48:49,759
Speaker 1: and aseptic control. They had to be made in a

842
00:48:49,800 --> 00:48:53,040
Speaker 1: way so that they didn't compromise the surgeon's grasp too much.

843
00:48:53,280 --> 00:48:56,560
Speaker 1: But at the same time we're effective in keeping bacteria out.

844
00:48:57,040 --> 00:48:59,239
Speaker 1: So this is a way of trying to get the

845
00:48:59,320 --> 00:49:01,759
Speaker 1: boiled hand into circulation. You've got to make it so

846
00:49:01,800 --> 00:49:04,200
Speaker 1: that it's worth it to the surgeon that they can

847
00:49:04,239 --> 00:49:06,879
Speaker 1: still do what they need to do. If you've got

848
00:49:07,480 --> 00:49:10,200
Speaker 1: a rubber glove that is boiled and is a septic.

849
00:49:10,320 --> 00:49:12,719
Speaker 1: It's not going to get bacteria in there, but you

850
00:49:12,800 --> 00:49:15,600
Speaker 1: can't really operate effectively with it. That doesn't do you

851
00:49:15,640 --> 00:49:18,200
Speaker 1: any good. I do love the name the boiled hand.

852
00:49:18,280 --> 00:49:19,680
Speaker 1: By the way, we were talking about this a little

853
00:49:19,719 --> 00:49:23,200
Speaker 1: bit before we came in here. Just perfect. This seems

854
00:49:23,200 --> 00:49:25,359
Speaker 1: to be a bigger thing than just zoga. Here. There's

855
00:49:25,440 --> 00:49:29,360
Speaker 1: like a general anguish at the time expressed by multiple

856
00:49:29,360 --> 00:49:35,000
Speaker 1: surgeons about the idea of hands being a non boilable objects. Boiling,

857
00:49:35,040 --> 00:49:38,560
Speaker 1: I think, became a kind of metaem for aseptic safety,

858
00:49:39,640 --> 00:49:42,880
Speaker 1: So you might at the time, instead of saying something

859
00:49:42,960 --> 00:49:45,479
Speaker 1: is a septic, you might just call it boiled, whether

860
00:49:45,560 --> 00:49:48,640
Speaker 1: or not it had literally been boiled. Now a couple

861
00:49:48,640 --> 00:49:51,920
Speaker 1: of other interesting solutions mentioned in the Schlick paper. There

862
00:49:52,000 --> 00:49:56,080
Speaker 1: was a guy named George Perth's who lived eighteen sixty

863
00:49:56,120 --> 00:49:58,920
Speaker 1: eight to nineteen twenty seven. He was a surgeon in

864
00:49:59,400 --> 00:50:02,439
Speaker 1: Leipzig who said that full rubber gloves were too thick

865
00:50:02,560 --> 00:50:05,439
Speaker 1: and difficult to work with, but suggested that surgeons could

866
00:50:05,480 --> 00:50:11,080
Speaker 1: use quote fine finger covers made out of condom rubber quote,

867
00:50:11,120 --> 00:50:13,680
Speaker 1: which have been put on the market recently. And which

868
00:50:13,719 --> 00:50:17,919
Speaker 1: impaired the touch of the finger relatively little, and that's

869
00:50:17,960 --> 00:50:21,480
Speaker 1: kind of surprising. But yes, rubber condoms had existed in

870
00:50:21,560 --> 00:50:24,400
Speaker 1: some form going back to at least the mid nineteenth

871
00:50:24,400 --> 00:50:28,399
Speaker 1: century eighteen fifties. Rubber condoms were allegedly made of rather

872
00:50:28,480 --> 00:50:31,400
Speaker 1: thick material, but they did exist at the time, and

873
00:50:31,440 --> 00:50:34,920
Speaker 1: perthis suggested that that, yeah, this condom rubber could actually

874
00:50:34,960 --> 00:50:38,320
Speaker 1: be useful to the surgeon for having a good compromise

875
00:50:38,360 --> 00:50:43,240
Speaker 1: between being impermeable and being a septic, but also allowing

876
00:50:43,239 --> 00:50:46,720
Speaker 1: the surgeon to feel what they are doing. But Perthieves

877
00:50:46,800 --> 00:50:51,600
Speaker 1: himself favored silk gloves, which you already mentioned. He said,

878
00:50:51,680 --> 00:50:54,320
Speaker 1: you know, they're great for manual control. Silk feels like

879
00:50:54,360 --> 00:50:56,520
Speaker 1: you're wearing nothing at all, But of course they didn't

880
00:50:56,520 --> 00:51:00,360
Speaker 1: have the aseptic advantages of impermeable rubber. There are a

881
00:51:00,360 --> 00:51:04,440
Speaker 1: couple of other things that Schlick mentions, involving the idea

882
00:51:04,480 --> 00:51:07,960
Speaker 1: of thin gloves coated in wax and whether or not

883
00:51:08,080 --> 00:51:12,000
Speaker 1: that would be useful leather gloves that maybe we're topped

884
00:51:12,040 --> 00:51:16,200
Speaker 1: with with condom rubber or something. But yeah, ultimately we

885
00:51:16,239 --> 00:51:20,280
Speaker 1: get to this desire that Wolfer articulates that you mentioned earlier,

886
00:51:20,320 --> 00:51:22,680
Speaker 1: that you've gotta have a surgical glove that has all

887
00:51:22,719 --> 00:51:27,640
Speaker 1: of the following characteristics. It's impermeable, it's flexible, tear resistant,

888
00:51:27,760 --> 00:51:31,560
Speaker 1: not too tight, not too hot, and it can be sterilized.

889
00:51:32,080 --> 00:51:33,799
Speaker 1: And this is what they ended up debating at this

890
00:51:33,840 --> 00:51:37,280
Speaker 1: surgical congress in and there were all kinds of interesting

891
00:51:37,280 --> 00:51:42,319
Speaker 1: debates here about like the actual bacteriological evidence for gloves, like, uh,

892
00:51:42,360 --> 00:51:45,920
Speaker 1: there were some people at this meeting who dissented, arguing

893
00:51:45,960 --> 00:51:49,680
Speaker 1: on the basis of experiments that gloves were not actually useful.

894
00:51:49,680 --> 00:51:54,040
Speaker 1: And there was one experiment that involved testing cotton gloves. Uh.

895
00:51:54,080 --> 00:51:57,040
Speaker 1: So again not not the rubber ones, but taking uh,

896
00:51:57,280 --> 00:51:59,480
Speaker 1: cotton gloves that have been used in surgery and then

897
00:51:59,560 --> 00:52:03,560
Speaker 1: squeeze sing out the quote glove juice and then uh

898
00:52:03,760 --> 00:52:05,920
Speaker 1: doing a culture of that to see what it's germ

899
00:52:06,000 --> 00:52:08,640
Speaker 1: content was. And they were like, look, this glove juice

900
00:52:08,640 --> 00:52:11,919
Speaker 1: is full of germs. These gloves can't be useful. In fact,

901
00:52:11,920 --> 00:52:14,919
Speaker 1: they're picking up because they get soaked with blood, they're

902
00:52:14,920 --> 00:52:19,440
Speaker 1: picking up germs from the air and they're introducing new germs. Uh.

903
00:52:19,480 --> 00:52:22,360
Speaker 1: And then this led to a really I think a

904
00:52:22,360 --> 00:52:26,600
Speaker 1: debate between different evidential standards. So you have some people saying, well, look,

905
00:52:26,600 --> 00:52:28,960
Speaker 1: we've done these lab experiments saying that you know, the

906
00:52:29,000 --> 00:52:32,720
Speaker 1: glove juice is full of bacteria and that's no good.

907
00:52:33,080 --> 00:52:35,040
Speaker 1: But then there are these other people saying, well, yeah,

908
00:52:35,080 --> 00:52:38,080
Speaker 1: but we've used gloves in actual surgeries and we see

909
00:52:38,120 --> 00:52:41,319
Speaker 1: the differences in outcomes, and the outcomes are better when

910
00:52:41,360 --> 00:52:44,680
Speaker 1: you use gloves. And so they were comparing different standards

911
00:52:44,719 --> 00:52:47,520
Speaker 1: of like, how should we measure whether this this is

912
00:52:47,560 --> 00:52:51,400
Speaker 1: effective or not. Now. Eventually, over time there was agreement

913
00:52:51,480 --> 00:52:54,640
Speaker 1: that that impermeable gloves were the gold standard and that

914
00:52:54,719 --> 00:52:56,880
Speaker 1: if you could manufacture them in a way that didn't

915
00:52:56,880 --> 00:52:59,759
Speaker 1: sacrifice too much manual control, which, of course we did

916
00:52:59,800 --> 00:53:02,960
Speaker 1: get it with the with the sterile gloves that people

917
00:53:03,040 --> 00:53:06,920
Speaker 1: use today made of thin materials such as latex, nitrial,

918
00:53:07,080 --> 00:53:10,399
Speaker 1: or vinyl. Yeah, modern medical gloves come in, of course,

919
00:53:10,480 --> 00:53:13,319
Speaker 1: various sizes. They are made from a variety of polymers,

920
00:53:13,880 --> 00:53:16,880
Speaker 1: yet powdered and unpowdered or even powdered with corn starch

921
00:53:17,000 --> 00:53:20,279
Speaker 1: to cut down on skin irritation. They've been a lot

922
00:53:20,320 --> 00:53:22,840
Speaker 1: of efforts towards the elimination of powdered gloves in general,

923
00:53:22,920 --> 00:53:26,759
Speaker 1: and there are alternatives for individuals with with latex allergies.

924
00:53:26,800 --> 00:53:31,800
Speaker 1: So uh yeah, modern medical gloves, there's this broad spectrum there.

925
00:53:32,239 --> 00:53:35,000
Speaker 1: We've come a long way obviously since uh, since these

926
00:53:35,040 --> 00:53:39,439
Speaker 1: these first prototypes were being unveiled, and yeah, it's we're

927
00:53:39,480 --> 00:53:41,640
Speaker 1: we're in a in a totally different age now when

928
00:53:41,640 --> 00:53:46,120
Speaker 1: it comes to the acceptance of of medical and surgical gloves.

929
00:53:46,200 --> 00:53:50,439
Speaker 1: You again, you would not accept bare fingers and bare

930
00:53:50,520 --> 00:53:53,120
Speaker 1: hands as an alternative. But I think it's also good

931
00:53:53,120 --> 00:53:56,920
Speaker 1: to understand that at the time, resistance to the to

932
00:53:57,040 --> 00:54:00,800
Speaker 1: the take up of gloves, especially in perm obol gloves,

933
00:54:01,360 --> 00:54:05,880
Speaker 1: was not just uh, just stubbornness or quackery. There probably

934
00:54:06,040 --> 00:54:07,840
Speaker 1: was some of that, but a lot of it was

935
00:54:07,880 --> 00:54:12,399
Speaker 1: also genuine concern for being able to operate effectively. Yeah,

936
00:54:12,440 --> 00:54:15,680
Speaker 1: I mean when you're you're I think the the example

937
00:54:15,680 --> 00:54:18,920
Speaker 1: of our promiscuous surgeon, uh is key here though, Yeah,

938
00:54:18,920 --> 00:54:22,480
Speaker 1: because he's talking like clearly he's weighing. Um, yeah, these

939
00:54:22,520 --> 00:54:25,040
Speaker 1: are these are bulkier in some cases, but like I

940
00:54:25,120 --> 00:54:26,680
Speaker 1: need to be able to go from this patient to

941
00:54:26,719 --> 00:54:29,440
Speaker 1: this patient to this patient. Um, you know, we need

942
00:54:29,480 --> 00:54:31,000
Speaker 1: to be able. So it's kind of like getting into

943
00:54:31,040 --> 00:54:34,399
Speaker 1: the scale issue of inventions, like, okay, I can. It's

944
00:54:34,440 --> 00:54:36,839
Speaker 1: one thing to create a perfect prototype in isolation. It's

945
00:54:36,880 --> 00:54:39,480
Speaker 1: one thing to be able to conduct one surgery in

946
00:54:39,719 --> 00:54:43,480
Speaker 1: perfect isolation. But if that's just one of many surgeries

947
00:54:43,480 --> 00:54:46,319
Speaker 1: you're performing during a set amount of time, well then

948
00:54:46,320 --> 00:54:48,560
Speaker 1: you're in a slightly different scenario. There are all these

949
00:54:48,560 --> 00:54:51,640
Speaker 1: other factors you have to take into account totally. Yeah. Oh,

950
00:54:51,719 --> 00:54:53,760
Speaker 1: and then to to come back to our outer limits

951
00:54:53,760 --> 00:54:57,640
Speaker 1: example from earlier, the idea of being able to perform

952
00:54:57,719 --> 00:55:00,960
Speaker 1: medical interventions like out in the field. Uh, like, this

953
00:55:01,000 --> 00:55:04,759
Speaker 1: seems another area where gloves are vital because yes, I mean,

954
00:55:04,760 --> 00:55:07,480
Speaker 1: you still are going to ideally, you know, have some

955
00:55:07,480 --> 00:55:10,640
Speaker 1: some sort of cleansing materials, but are you going to

956
00:55:10,760 --> 00:55:14,080
Speaker 1: have three vats in which to um to spend some

957
00:55:14,160 --> 00:55:17,200
Speaker 1: time washing your hands, or are you gonna have to

958
00:55:17,280 --> 00:55:19,719
Speaker 1: essentially snap on some gloves and get in there and

959
00:55:19,760 --> 00:55:22,160
Speaker 1: try and save someone's life that sort of thing. Yeah.

960
00:55:22,480 --> 00:55:25,040
Speaker 1: So anyway, it's a yeah, fascinating topic, I think, especially

961
00:55:25,080 --> 00:55:27,640
Speaker 1: when you get into the adoption of a new technology,

962
00:55:28,000 --> 00:55:30,080
Speaker 1: how we look back on it and how you know,

963
00:55:30,520 --> 00:55:33,640
Speaker 1: these the efforts of the historian to places within that

964
00:55:33,680 --> 00:55:37,080
Speaker 1: time period to make sense of it all just just

965
00:55:37,200 --> 00:55:39,200
Speaker 1: all very fascinating and I think something to keep in

966
00:55:39,239 --> 00:55:42,319
Speaker 1: mind and to think about the next time you're in

967
00:55:42,360 --> 00:55:44,960
Speaker 1: a medical facility or in a checkup of one sort

968
00:55:45,080 --> 00:55:48,200
Speaker 1: or another and you see your doctor or you don't

969
00:55:48,200 --> 00:55:50,640
Speaker 1: see them, snap on those gloves. The gloves are just

970
00:55:50,719 --> 00:55:53,319
Speaker 1: part of it. Uh. Of course, we'd love to hear

971
00:55:53,320 --> 00:55:56,880
Speaker 1: from anyone out there who regularly wears medical gloves, surgical

972
00:55:56,880 --> 00:55:59,319
Speaker 1: gloves as part of your profession. What you know, what

973
00:55:59,360 --> 00:56:01,920
Speaker 1: are your thoughts on them? What what sort of a

974
00:56:02,040 --> 00:56:03,520
Speaker 1: history do you have with them? And you have to

975
00:56:03,600 --> 00:56:06,320
Speaker 1: use a certain variety of glove due to allergies or

976
00:56:06,360 --> 00:56:11,440
Speaker 1: skin irritations. We'd love to hear some insight from the field.

977
00:56:12,040 --> 00:56:14,000
Speaker 1: All right, well, we're gonna go and close out this

978
00:56:14,480 --> 00:56:17,560
Speaker 1: Invention themed episode of Stuff to Blow Your Mind, but

979
00:56:18,239 --> 00:56:20,480
Speaker 1: we love to hear from everyone out there. Just a

980
00:56:20,480 --> 00:56:23,560
Speaker 1: reminder that new episodes of Stuff to Blow Your Mind

981
00:56:23,560 --> 00:56:26,959
Speaker 1: come on Tuesdays and Thursdays. And uh oh, we should

982
00:56:27,000 --> 00:56:29,040
Speaker 1: also mention we we mentioned condoms briefly. We do have

983
00:56:29,080 --> 00:56:32,080
Speaker 1: an older episode of Invention about the invention of the condom,

984
00:56:32,520 --> 00:56:35,080
Speaker 1: so uh we recommend that and of course we've touched

985
00:56:35,120 --> 00:56:39,400
Speaker 1: on medical history topics numerous times over the years, and

986
00:56:39,520 --> 00:56:42,440
Speaker 1: you can find those in the archives. On Monday's we

987
00:56:42,480 --> 00:56:45,120
Speaker 1: do listener mail episodes, on Wednesdays we do a short

988
00:56:45,200 --> 00:56:47,839
Speaker 1: form artifact or monster fact, and on Friday's we set

989
00:56:47,840 --> 00:56:50,360
Speaker 1: aside most serious concerns and just talk about a weird film.

990
00:56:50,760 --> 00:56:53,560
Speaker 1: Huge thanks as always to our excellent audio producer Seth

991
00:56:53,640 --> 00:56:56,120
Speaker 1: Nicholas Johnson. If you would like to get in touch

992
00:56:56,160 --> 00:56:58,319
Speaker 1: with us with feedback on this episode or any other,

993
00:56:58,360 --> 00:57:00,480
Speaker 1: to suggest a topic for the future, or just to

994
00:57:00,520 --> 00:57:03,320
Speaker 1: say hello, you can email us at contact at stuff

995
00:57:03,360 --> 00:57:13,080
Speaker 1: to Blow your Mind dot com. Stuff to Blow Your

996
00:57:13,080 --> 00:57:16,000
Speaker 1: Mind is production of I Heart Radio. For more podcasts

997
00:57:16,040 --> 00:57:18,120
Speaker 1: for my heart Radio, visit the i heart Radio app,

998
00:57:18,320 --> 00:57:29,480
Speaker 1: Apple Podcasts, or wherever you're listening to your favorite shows.