Speaker 1: Welcome to Stuff to Blow Your Mind production of My
Speaker 1: Heart Radio. Hey are you welcome to Stuff to Blow
Speaker 1: your Mind? My name is Robert Lamb and I'm Joe McCormick.
Speaker 1: And this weekend Stuff to Blow your Mind, we have
Speaker 1: another invention themed episode for everyone, and I think it
Speaker 1: should prove an interesting episode because it's one of those
Speaker 1: stories that more than it just covers like the need
Speaker 1: for an invention and the development of that invention, it
Speaker 1: also gets into the acceptance all of that invention, or
Speaker 1: the the lack they're off concerning a new technology. You know,
Speaker 1: it's one thing too to have an idea for a
Speaker 1: new product or a new invention, a new way of
Speaker 1: doing things, But then if it's going to make a difference,
Speaker 1: it also has to be accepted by the vast majority
Speaker 1: of the people and within a given field, given culture, etcetera. Yes,
Speaker 1: and also the way that a certain invention has to
Speaker 1: prove its advantages over other solutions to the same problems,
Speaker 1: which is a major issue with the early adoption of
Speaker 1: the technology we're gonna be talking about today. Uh, something
Speaker 1: that is now a universal standard that people would be
Speaker 1: horrified to hear anybody was not using was in fact,
Speaker 1: originally one solution among many. Right, we're gonna be talking
Speaker 1: about surgical gloves. Would like you say, are just ubiquitous now,
Speaker 1: It's just it's no matter what the surgical procedure happens
Speaker 1: to be, but not only surgical procedures, but also just
Speaker 1: any kind of medical um check up, anything in the
Speaker 1: medical establishment in general. If you go to the dentist,
Speaker 1: if they're going to have the medical gloves on, and
Speaker 1: it's one of those things where not only do you
Speaker 1: come to expect it, like you could not ask for
Speaker 1: it to be another way. You can't go to the
Speaker 1: dentist and be like, hey, doc, I'm thinking maybe you
Speaker 1: go gloves off this time. I mean, no, it's just
Speaker 1: the gloves are heart of the procedure, and uh, most
Speaker 1: of us would be somewhat concerned if we go in
Speaker 1: there and the gloves are off, or if the gloves
Speaker 1: were say made of cotton and really juicy, right or
Speaker 1: or yeah, you go in and it's it's like your
Speaker 1: dentist is wearing a big ski gloves or mittens. Uh,
Speaker 1: so you've realized something is off. This is not the
Speaker 1: way things should be, but it was not always so.
Speaker 1: So if you went into, say a German speaking hospital
Speaker 1: in the eighteen nineties, you may be lucky enough to
Speaker 1: uh to get operated on by a surgeon who has
Speaker 1: accepted the new science of bacteriology, who does understand that
Speaker 1: wounds need to be clean, they need to be a
Speaker 1: septic uh, and does understand that gloves can help with
Speaker 1: that process, but has not found a way to commit
Speaker 1: yet to impermeable gloves. So may well have some cotton
Speaker 1: gloves on while they get their fingers around in you
Speaker 1: Now a quick side note on just gloves in general.
Speaker 1: Loves have been with us for a very long time.
Speaker 1: It's just a basic way to protect the hand from where,
Speaker 1: from cold, from heat, from other threats. Uh, just a
Speaker 1: basic technological advancement in which we realized, hey, we can
Speaker 1: take other materials and make a second skin for our hands.
Speaker 1: Are are very important but also um susceptible to damage
Speaker 1: hands and UH. Some of the oldest gloves that we
Speaker 1: have that have survived include a pair of delicate linen
Speaker 1: child's gloves from the tomb of Too in Common. So
Speaker 1: those are about three thousand, two hundred years old, and
Speaker 1: these were likely riding gloves. But of course one of
Speaker 1: the things about gloves, when one of the things about
Speaker 1: making yourself a second organic skin is that those tend
Speaker 1: not to survive them, you know, unless they are stuck
Speaker 1: away in a tomb or in some other fashion well
Speaker 1: preserved for a very long period of time. But the
Speaker 1: reality is when it comes to surgery, for most of
Speaker 1: human history, surgical procedures of varying degrees of complexity were
Speaker 1: carried out bare handed. And now when we say bare
Speaker 1: handed surgery, you have to know that we're not talking
Speaker 1: about pseudo scientific medical fraud uh psychic surgery um, which
Speaker 1: is also you know, quote unquote performed bare handed. Now
Speaker 1: we're talking about actual surgical procedures of different different scales,
Speaker 1: performed well without any sort of protective barrier between the
Speaker 1: surgeon's skin and the patient's flesh. So surgery of different sorts,
Speaker 1: you know, was practiced in ancient Mesopotamia, ancient Egypt, ancient China,
Speaker 1: ancient India, and other parts of the ancient world. Ancient
Speaker 1: surgeries ran the gamut from setting of bones to amputations, trepidations,
Speaker 1: blood lettings, and everything in between. But as we've discussed
Speaker 1: on the show before, one of the big obvious realities here.
Speaker 1: Obvious to us now anyway, by virtue of germ theory
Speaker 1: is that human hands carry disease, and even regularly clean
Speaker 1: hands can be a problem. I was looking at some
Speaker 1: of the stats on this in review of human hand
Speaker 1: microbiome research by EDMUNDS. Wilson at All in a two
Speaker 1: thousand fifteen edition of Journal of Dermatological Science. The authors
Speaker 1: here point out that hands are of course a critical
Speaker 1: component of the human microbiome and are quote a conduit
Speaker 1: for exchanging micro organisms between the environment and the body.
Speaker 1: So not all of these are dangerous naturally, but hands
Speaker 1: can harbor pathogenic species like staff an E. Coli. And
Speaker 1: this is even more the case in high risk environments,
Speaker 1: such as among those who handle food or provide healthcare.
Speaker 1: And the authors here point of various studies that have
Speaker 1: also looked into how it enhanced use of hand hygiene
Speaker 1: products may negatively impact the hand microbiome as well, resulting
Speaker 1: resulting in greater pathogen carriage, for example. But other studies
Speaker 1: have demonstrated quote reduced pathogen carriage and or infections with
Speaker 1: use of these products. Oh yeah, that's gonna be interesting.
Speaker 1: Double edge sword. So like now that we have you know,
Speaker 1: germ theory. We know it's important to wash your hands
Speaker 1: if you're going to be eating or preparing food, or
Speaker 1: or certainly if you're gonna be doing any kind of
Speaker 1: medical procedure, but also that repeatedly washing or you're sterilizing
Speaker 1: your hands has effects beyond just keeping pathogens away. It
Speaker 1: also affects the uh, the presence of non harmful microbiota
Speaker 1: on the surface of your hands. Yeah, it's kind of
Speaker 1: like I get again. You have to think of your
Speaker 1: hands as um as part of your body. They're not
Speaker 1: just tools. They're not instruments. They're to use by you
Speaker 1: and your body. They they are part of you. Uh.
Speaker 1: They are also like yourself multitude. They have uh, they
Speaker 1: have populations, and if you regularly carpet bomb the population,
Speaker 1: that's gonna disrupt that's not going to just keep things
Speaker 1: from living there, it's going to potentially disrupt um the
Speaker 1: ratio of what lives there and uh. And so the
Speaker 1: the idea of cleaning the hand completely that is we'll
Speaker 1: discuss that becomes kind of problematic at times, like again,
Speaker 1: it's not an instrument. It is, is pointed out by
Speaker 1: one of the authors, We're gonna look to you cannot
Speaker 1: just boil the hand uh to sterilize it and then
Speaker 1: use the hand in a completely hygienic way. Right though,
Speaker 1: I want to be very clear, while we are acknowledging
Speaker 1: these consequences, this is not a case against hand washing. No, no, no.
Speaker 1: Hand washing, as we'll discuss, is also very important here. Um.
Speaker 1: I also have to throw in, while after I was
Speaker 1: researching a lot of this and had it on my mind,
Speaker 1: still sort of turning over in my head, I ran
Speaker 1: into my boss out in the world, and my boss
Speaker 1: um stuck his hand out, But luckily he went for
Speaker 1: the fist bump instead of the handshake. I was glad
Speaker 1: that was that was ideal because I didn't want to
Speaker 1: have to be like, sorry, I can't shake your hand
Speaker 1: right now. Just read a whole bunch of stuff about
Speaker 1: about hand germs. I thought you were gonna say, he
Speaker 1: stuck his hand out so you could kiss it. No, no, no, no, no,
Speaker 1: we have we we have a better. Our boss is
Speaker 1: a little better than that. Our boss is the Pope.
Speaker 1: We work at the Vatican. But the big thing about
Speaker 1: all this is that it comes down to the to
Speaker 1: to one of the obvious facts we've discussed before, that
Speaker 1: without germ theory, without any insight into the invisible world
Speaker 1: of organisms that are literally at our fingertips, for the
Speaker 1: vast majority of human history, we just we just didn't know.
Speaker 1: We just didn't know that. Like we again, we had gloves.
Speaker 1: It's not like, uh, like we didn't have this idea
Speaker 1: that well. And there are some cases where we need
Speaker 1: to cover our hands to protect our hand from uh
Speaker 1: some sort of external force or or perhaps in some
Speaker 1: cases protect the external world from our hands. But if
Speaker 1: you cannot see the threat, if you, if you, if
Speaker 1: you have no real concept of of the germs that
Speaker 1: are out there, of the invisible world, then what can
Speaker 1: you do? Well? Yes, and also to acknowledge that the
Speaker 1: glove itself would need to be sterilized in order to
Speaker 1: provide an advantage there, like just putting on a dirty
Speaker 1: glove doesn't do much better than using a dirty hand exactly. UM.
Speaker 1: To give some more stats on some of this, according
Speaker 1: to Smith at All in infection control through the ages
Speaker 1: even today, quote, approximately one point seven million healthcare associated
Speaker 1: infections or h A eyes occur in the United States
Speaker 1: each year. So even with modern UM precautions and technologies
Speaker 1: in place, that's one of the things about healthcare, I mean,
Speaker 1: it does put you in close proximity with a doctor.
Speaker 1: You puts you often puts you in a space where
Speaker 1: you have other individuals with various health care concerns going on. Um,
Speaker 1: it's just the reality of it. But if you go
Speaker 1: back in time before germ theory, before these various technologies,
Speaker 1: things obviously get a bit darker. Smith at All point
Speaker 1: out that in medieval times there was a high level
Speaker 1: of illness and death in hospitals, and quote, when a
Speaker 1: sick person entered a hospital, his or her property was
Speaker 1: disposed of, and in some regions a requiem mass was
Speaker 1: held as if he or she had already died. That's
Speaker 1: a bad healthcare plan, it does. It's not a singing
Speaker 1: endorsement of the hospital you're about to enter. Because of
Speaker 1: course that the tools were often primitive. They weren't cleaned,
Speaker 1: they weren't cleaned between uses. Uh Cauterization via hot iron
Speaker 1: or boiling oil was commonly used. You're looking at between
Speaker 1: sixt mortality rates. This is pretty common during the time period,
Speaker 1: and even into the early modern period. Many things had improved,
Speaker 1: but you still had surgeons placing ungloved hands directly into
Speaker 1: wounds and directly into incisions and so forth. And this
Speaker 1: was certainly the norm again for much of human medical history.
Speaker 1: We didn't have the materials and or we didn't know
Speaker 1: about the invisible world of microbes, and other reasons were
Speaker 1: focused on for subsequent infections such as bad air or
Speaker 1: miasma seeping into the wound. And uh, it was really
Speaker 1: read that, you know, until shockingly recently it was things
Speaker 1: like pus and secondary infections were often just thought of
Speaker 1: as well, this is just part of the body healing itself.
Speaker 1: This is just what happens. This is this is a norm.
Speaker 1: There's nothing we can do about it. I was just
Speaker 1: randomly reminded of something I read recently, which is, so,
Speaker 1: you know, the famous story about US President James A. Garfield,
Speaker 1: who was it is sometimes said assassinated, but it is
Speaker 1: it has been observed by many historians that he was shot,
Speaker 1: but he survived his bullet wound for a while and
Speaker 1: was like for months actually, and was repeatedly operated on
Speaker 1: in an unsanitary way by a doctor. And it is
Speaker 1: it is commonly believed that the doctor's unsanitary intervention is
Speaker 1: in fact what killed Garfield. But the thing that I
Speaker 1: found out is that that doctor's name, his given name
Speaker 1: was doctor. His name was doctor Willard Bliss. So he
Speaker 1: was doctor doctor Willard Bliss. All right. But but speaking
Speaker 1: of this time period, yeah, eventually we get to what
Speaker 1: Smith at all referred to as the progressive era of
Speaker 1: the eighteen nineties through the nineteen twice these and we
Speaker 1: do see a shift here. Quote this period sell great
Speaker 1: advances in hospital infection control. Ignance Similvis was the first
Speaker 1: hospital epidemiologist, setting a precedent for step by step analysis
Speaker 1: of an outbreak and for tracing epidemics to a particular
Speaker 1: surgeon or practice e g. Going from the autopsy room
Speaker 1: to the operating room Without washing your hands. He saw
Speaker 1: eleven of twelve consecutive women die of pew eperl or
Speaker 1: childbed fever, and subsequently required that all providers who attended
Speaker 1: the patients first washed their hands in a watery solution
Speaker 1: of chlorinated lime. The mortality rate then dropped dramatically from
Speaker 1: eighteen percent to two percent. So simil Vis here was
Speaker 1: a Hungarian physician who lived from eighteen eighteen through eighteen
Speaker 1: sixty five, so he's a little bit before of this,
Speaker 1: Before this progressive era that Smith at all were talking about.
Speaker 1: But this is a time when we see rapid changes
Speaker 1: in medical knowledge, we see the advent of technologies like
Speaker 1: the X ray. This is a time period that was covered,
Speaker 1: I think just excellently in Steven Soderbergh's television drama Than Nick,
Speaker 1: which I know I've I've mentioned on the show before.
Speaker 1: It's just a great drama, a lot of attention to detail,
Speaker 1: but also they have this very like clean white, almost
Speaker 1: blinding visual style to the show. You have electronic music
Speaker 1: by Cliff Martinez uh through throughout the series, and so
Speaker 1: I think it does a great job of portraying the
Speaker 1: past as the energetic, promising um present, you know, uh,
Speaker 1: something that we sometimes I think lose track of in
Speaker 1: representing the past on film or even reading about the past.
Speaker 1: About thinking about this time period and past as being
Speaker 1: completely divorced from what we will know, and it's more
Speaker 1: about just like the excitement and also the danger of
Speaker 1: of being there at the bleeding edge of techno oology
Speaker 1: and innovation. Yeah, I think one of the things that's
Speaker 1: that's often hard to capture accurately when you're portraying the
Speaker 1: past is understanding the past as without knowledge of the future,
Speaker 1: understanding the past as uh, incorporating the full uncertainty of
Speaker 1: being a present of its own. Like you say so,
Speaker 1: not only the excitement of things being new at the time,
Speaker 1: but also the lack of knowledge how things would turn out.
Speaker 1: Everything always seems more obvious in retrospect, right, right, And
Speaker 1: and certainly the nick is the show that doesn't doesn't
Speaker 1: shy away from the wrong paths. I think I've mentioned
Speaker 1: before when we're talking about the invention of the X
Speaker 1: ray you have there's one episode in particular where they're
Speaker 1: so excited to have the X ray uh there at
Speaker 1: the hospital and they're just is just using it just
Speaker 1: so irresponsibly, uh, without really understanding or having any idea
Speaker 1: of just how dangerous repeated exposure to the machine would be. Well,
Speaker 1: they're using it unnecessarily right there, just like using it
Speaker 1: for fun. Yeah, It's like I get the kids in here, Aaron,
Speaker 1: watch watch watch Dad, um x rays hand multiple times
Speaker 1: for for no reason, that sort of thing. But and
Speaker 1: they you know, they explore other things as well on
Speaker 1: the show. You know, various social issues come up, eugenics
Speaker 1: comes up, you know, all sorts of things of this nature.
Speaker 1: But um, but anyway, UH, similar vices findings were apparently
Speaker 1: better received in some countries than compared to others, the
Speaker 1: UK and Germany being too. Though. That's interesting because we'll
Speaker 1: come back to Germany as sort of a center of
Speaker 1: discussion over the best practices and best use of new
Speaker 1: medical findings and technology. But on the whole, there was
Speaker 1: a lot of criticism of his ideas and a lot
Speaker 1: of his efforts ended up in antagonism. His critics attacked him,
Speaker 1: he attacked back. Uh. It apparently got got pretty ugly
Speaker 1: from at least from an academic standpoint, and his mental
Speaker 1: health declined greatly and he eventually died in an asylum.
Speaker 1: So it's often care aterized as being you know, this
Speaker 1: this effort where he's he's kind of up against the wall.
Speaker 1: Maybe didn't have what maybe wasn't the ideal person to
Speaker 1: to be making these arguments, Like maybe it could have
Speaker 1: been a better pr campaign for some of these ideas,
Speaker 1: but what can you do? Well, Yeah, I think a
Speaker 1: lot of the hygienic concerns about medical interventions and especially
Speaker 1: UH surgery would get more traction in the eighteen sixties
Speaker 1: with Joseph Lister. Yeah, Joseph Lister definitely a big one.
Speaker 1: I mean, they're various individuals that are working during this
Speaker 1: time cracking our understanding of the unseen and what we
Speaker 1: should do about it. And of course you have to
Speaker 1: acknowledge the work of Louis Pasteur. Now there's but Yeah,
Speaker 1: Joseph Lister was a big name. Seven through nineteen twelve.
Speaker 1: He introduced the concept of surgical accepsis, the absence of
Speaker 1: all micro organisms within any type of invasive procedure. His
Speaker 1: work alone was associated, according to Smith at all, with
Speaker 1: a decrease in post amputation mortality rays from to fift
Speaker 1: and he also cut down on the necessity for amputation.
Speaker 1: That was one of the big things he was going
Speaker 1: after two Like he was saying, uh, you know, which
Speaker 1: just won't be necessary to amputate this this many limbs
Speaker 1: because uh be because we'll be using cleaner tools, etcetera.
Speaker 1: He argued for the necessity of pre operative hand washing
Speaker 1: and the use of disinfectants soaked wound dressings. Yeah. I
Speaker 1: think Lister especially is known to highlight a distinction, will
Speaker 1: get to in a little bit of the distinction between
Speaker 1: a sepsis and anti sepsis, With pioneering the anti sepsis trend,
Speaker 1: which is the attempt to sterilize the wound itself to
Speaker 1: prevent infection. So this would typically mean using a disinfectant
Speaker 1: chemical such as carbolic acid in and around a wound. Yeah,
Speaker 1: and also dressing surgical tools. He's stressed that you should
Speaker 1: change dressings on wounds um regularly. Um. Yeah, and again
Speaker 1: before lister here, pus and infect and we're just considered
Speaker 1: part of the healing process. It wasn't. It wasn't necessarily
Speaker 1: thought that this means things are not going to according
Speaker 1: to plan. It just means like this is this is
Speaker 1: what happens when the body heals from a wound. Thank alright.
Speaker 1: So getting into more into the realm of early surgical gloves,
Speaker 1: early medical glove concepts and and the struggle for their acceptance. Um.
Speaker 1: William Holstaed introduced rubber gloves for use in surgery by
Speaker 1: around eighteen nine, and by we see more and more
Speaker 1: doctors wearing gowns, masks and gloves, but the use of
Speaker 1: gloves especially is certainly not instantly accepted by the medical community.
Speaker 1: To come back to the nick for example, which which
Speaker 1: again I think that does a pretty great job of
Speaker 1: depicting this time period. If you go back and watch
Speaker 1: any of this show uh and I did certainly didn't
Speaker 1: have a chance to go back and watch all of it,
Speaker 1: but you pretty much don't see surgical gloves at all.
Speaker 1: There are just lots of scenes of surgeons who again
Speaker 1: are at the bleeding edge of technology and innovation at
Speaker 1: the time, but they're reaching into people's bodies with bare hands.
Speaker 1: They are opening up people's craniums with bare hands, uh,
Speaker 1: and just every other part of the anatomy as well,
Speaker 1: lots of shots of white linens and blood soaked hands.
Speaker 1: Now on the show. They're also frequent scenes of surgeons, though,
Speaker 1: going through a series of hand washings before surgery uh,
Speaker 1: sometimes while engaging in dialogue with each other. But I
Speaker 1: remember being particularly taken by at least one scene in
Speaker 1: which there's kind of a beautiful feeling of almost spiritual
Speaker 1: ritual to the thing of the surgeon washing and uh
Speaker 1: and and lowering their their hands and forearms first into
Speaker 1: one vat, then into a second vat, and then into
Speaker 1: a third vat. Like again, it has kind of almost
Speaker 1: magical feeling to it. And so I was reading a
Speaker 1: little bit about about this time period here for this
Speaker 1: episode in based on my readings of why We're surgical
Speaker 1: gloves not used earlier by Thomas Schlich, I believe this
Speaker 1: is the three VAT system standardized in Berlin in eight
Speaker 1: by Paul Fubringer. First soap, then alcohol, and then finally
Speaker 1: an antiseptic substance. Yeah, that three stage process was very
Speaker 1: common by the eighteen nineties. And again it's it's great,
Speaker 1: it's a wonderful advancement in the in in in surgery
Speaker 1: at the time, but of course it falls just a
Speaker 1: little short of of actually using gloves, of actually embracing
Speaker 1: the standard. And now again we just accept when we
Speaker 1: go into a medical facility. Um. So this this, uh,
Speaker 1: the three VAT systems coming out of Germany. Germany is
Speaker 1: also where we see a great deal of argument during
Speaker 1: this period about whether surgeons should have to wear surgical
Speaker 1: gloves at all. And uh, I think the first place
Speaker 1: that I was reading about this this um there was
Speaker 1: a j Store Daily article that came out from this
Speaker 1: is by jess Romeo in July, when obviously a lot
Speaker 1: of this sort of thing was going going on in
Speaker 1: there in our heads, and there's a lot obvious parallels
Speaker 1: between the treatment here of gloves and consideration of things
Speaker 1: like certainly handwashing but also the use of mass um.
Speaker 1: The article was the surgeons who said not to gloves
Speaker 1: And the article from Romeo is citing another article, UH.
Speaker 1: The source article by Thomas schlich who we just referenced
Speaker 1: titled Negotiating Technologies in Surgery the controversy about surgical gloves
Speaker 1: in the eighteen nineties, and this was a two thousand
Speaker 1: thirteen article from the Bulletin of the History of Medicine. Yeah,
Speaker 1: this Bulletin of History of Medicine article is is interesting.
Speaker 1: So the author here, Thomas Schlick, is a German Canadian
Speaker 1: historian of medicine who's on faculty at McGill University UH
Speaker 1: in Montreal. And Schlick begins his article with by illustrating
Speaker 1: a really strange moment from the history of surgery where
Speaker 1: there was so so there was this big conference in
Speaker 1: it was the seven Congress of the German Society for Surgery,
Speaker 1: and Schlick quotes a report on this meeting by an
Speaker 1: Austrian surgeon named Alexander Frankel, who was just perplexed by
Speaker 1: some of what was going on because a big subject
Speaker 1: of conversation for one whole afternoon at this at this
Speaker 1: conference for surgeons was about gloves. It was about surgical gloves,
Speaker 1: whether or not you should use them, and what types
Speaker 1: of gloves are best? And Frankel, reacting to this, this
Speaker 1: whole discussion says quote, for a whole afternoon, participants discussed
Speaker 1: about the best glove models, marching up all the various
Speaker 1: specimens made from different materials in all sizes and price ranges. Alla,
Speaker 1: Sarah Bernhardt referring to like a French actress, uh and
Speaker 1: whatever the fashionable designs might be called, a whole apparatus
Speaker 1: of pseudoscience was mobilized to inaugurate the new fashion of
Speaker 1: the surgeon in gloves. Uh. So, Frankel here is a respected,
Speaker 1: influential surgeon of the time. How can it be that
Speaker 1: he viewed the idea of surgical gloves as absolutely ridiculous
Speaker 1: pseudo scientific pageantry akin to like, Uh, I think the
Speaker 1: comparison to Sarah Bernhardt here is he's saying it's like
Speaker 1: a gaudy fashion show. Yeah, he compares it to just
Speaker 1: pure costuming. It's like, this is just a costume that
Speaker 1: these doctors are putting on that there's no real medical
Speaker 1: rationale for this. Now today, it's natural for us to
Speaker 1: look back on this view is not only misguided but
Speaker 1: absolutely baffling. But it's true that even after the idea
Speaker 1: of using some kind of impermeable sterile glove for surgery
Speaker 1: was introduced, it took more than a decade of sort
Speaker 1: of debate within the medical community before it achieved what
Speaker 1: could be considered near universal acceptance. And this article Schlick
Speaker 1: explores the historical discussion and controversy about the introduction of
Speaker 1: surgical gloves, specifically in German speaking hospitals in the eighteen nineties. UM. So,
Speaker 1: the question is why did most surgeons hesitate for so
Speaker 1: long before adopting the use of surgical gloves, even after
Speaker 1: we had a bacterial theory of disease and infection. Uh.
Speaker 1: And actually, once you see all their concerns laid out,
Speaker 1: the objections to people who resisted the gloves at the
Speaker 1: time seem a little bit less baffling. It actually makes
Speaker 1: more sense of them when you understand what the what
Speaker 1: the understanding was at the time, and what the pressures
Speaker 1: on surgeons for performing in the operating room. Where Yeah,
Speaker 1: I think this is one of the great things that
Speaker 1: does in the paper is really presents this this idea
Speaker 1: because it's easy to think about this and sort of
Speaker 1: look at the surface level of the this new technology
Speaker 1: and its eventual adoption and just look at it as Okay,
Speaker 1: well here's the new way, and everybody else must have
Speaker 1: been saying, oh, I just want to do it the
Speaker 1: old way, where it was really more a situation where
Speaker 1: there was the old ways and then there were all
Speaker 1: these new exciting ways that were uh, you know, all
Speaker 1: ultimately trying to crack the same nut to try to improve,
Speaker 1: um the mortality rates for various procedures. And and also
Speaker 1: he seems to to stress that, you know, we we
Speaker 1: can't really go into these situations sort of with a
Speaker 1: wrong side of history viewpoint of the past. You know,
Speaker 1: generally in the present, if you're presented with different ideas,
Speaker 1: the ones that are the wrong side of history are
Speaker 1: not labeled, so you don't know that this is not
Speaker 1: going to you know, they're on the ultimately on the
Speaker 1: losing hill here. When you're advocating that that that medical
Speaker 1: gloves should not be used universally, well, yeah, this is
Speaker 1: what I was talking about earlier with like the uncertainty
Speaker 1: of the present, and you always have to remember that
Speaker 1: in the past they were just as uncertain and about
Speaker 1: what the future would be as we are about our
Speaker 1: own future in the present. Right. And one thing he
Speaker 1: stresses here is that the surgeons, often big name surgeons
Speaker 1: that were engaging in this debate, a lot of them
Speaker 1: had their own ideas, their own techniques, and in many
Speaker 1: cases they had they had dated to back up what
Speaker 1: they were arguing. Um, like, there's there's one guy that
Speaker 1: he mentioned, surgeon Thomas Spencer Wells, who advocated cleanliness and
Speaker 1: cold water school as opposed to and embracing Lister's ideas.
Speaker 1: So this is more in general about like handwashing and
Speaker 1: um cleansing of instruments, boiling of instruments, et cetera, as
Speaker 1: opposed to gloves. But this was a guy that that
Speaker 1: still had menial had a minimal complication rate. Uh and
Speaker 1: the therefore he had some data to back up his viewpoint. Uh.
Speaker 1: So he had He wasn't just standing on a hill
Speaker 1: without you know, any reason to make his argument. He
Speaker 1: had seen what seemed at the time like a reasonable argument,
Speaker 1: like saying, look, look what I'm doing seems to be working,
Speaker 1: and I have the data to back it up. Yes,
Speaker 1: and wells would not be the only one. They're even
Speaker 1: people making the case at this UH Congress of German
Speaker 1: Society for Surgery who were saying, look, I've done laboratory
Speaker 1: research that shows that you get way more bacterial penetration
Speaker 1: of these uh, blood soaked cotton gloves than you do
Speaker 1: of of bare hands. So so actually you don't need gloves,
Speaker 1: you just need clean hands. Yeah. Another naming mentions is
Speaker 1: Johannes Mikolish who wh who argue that we should be
Speaker 1: using this preoperative injection of nucleic acid to supposedly increase
Speaker 1: white blood cell count and boost immune response. So so
Speaker 1: again it comes back to the idea that it's not
Speaker 1: just the old ideas and the new uh, this one
Speaker 1: new idea. I know they're they're these others seemingly promising
Speaker 1: new ideas and new technologies that are also suddenly available.
Speaker 1: Oh that's interesting. And you get these from both sides
Speaker 1: about the different solutions, because Mikolich here was one of
Speaker 1: the major proponents of gloves at this at this conference,
Speaker 1: he was there representing the yes gloves or good side. Interesting, yeah,
Speaker 1: but but better better then He also has his other
Speaker 1: thing as well, that that you could conceivably you're a surgeon,
Speaker 1: you're listening to all these ideas, you can imagine where
Speaker 1: you might be like, well, this U Johannes, it seems
Speaker 1: to have a great technology here. Maybe I can cherry
Speaker 1: pick a little bit. Maybe I can sort of hold
Speaker 1: onto my own reservations about gloves and just start using
Speaker 1: this nucleic acid treatment that has been proposed. So, uh, yeah,
Speaker 1: there are a lot of ideas on the table, and
Speaker 1: again it seems like each surgeon had their own ideas
Speaker 1: and techniques. Yeah. That's another point Schlick actually really highlights
Speaker 1: in this paper, which is that, you know, sometimes we
Speaker 1: have an erroneous tendency to erroneously look at the history
Speaker 1: of progress in medicine as a kind of unified, top
Speaker 1: down effort where there's just like okay here, you know,
Speaker 1: they're almost like there is a sort of uh bore
Speaker 1: of medicine that like controls all of medicine throughout history,
Speaker 1: and they direct the flow of of development and progress.
Speaker 1: But in fact, the way Schlick frames it is, you know,
Speaker 1: medicine is just full of individual, little practical solutions to problems.
Speaker 1: Especially in the eighteen nineties here and over time, some
Speaker 1: prove better than others. Now, another thing we have to
Speaker 1: mention here is, of course what we're talking about when
Speaker 1: it comes to materials and what we were talking what
Speaker 1: we're talking about with the physical gloves of the time, Um,
Speaker 1: this would not have been a situation where like we're
Speaker 1: we're dealing with modern medical gloves that are suddenly presented
Speaker 1: to an audience. Um that this uh, this gathering, Um
Speaker 1: it made me think of a recent episode of the
Speaker 1: nineties Outer Limits that I watched it. The episode is
Speaker 1: titled Gettysburg. It stars meat Loaf and it also has
Speaker 1: the guy who played the crazy man on the boat
Speaker 1: in Jason Takes Manhattan, and it is involved time travel
Speaker 1: with Civil War reenactors who are sent back in time
Speaker 1: to the Battle of Gettysburg. And one of them is
Speaker 1: like a medical responder and has a medikit and so
Speaker 1: there's a great scene where he's he's he's doing some
Speaker 1: some some medical intervention on a wounded soldier. And meat
Speaker 1: Loaf's character, who's a Civil War era UM, I like
Speaker 1: to forget what he is if he's a he's a colonel. Uh,
Speaker 1: he's watching on and he doesn't seem to think anything
Speaker 1: about these modern medical um devices and gloves that are
Speaker 1: being used by this guy. So um, that's kind of
Speaker 1: a tangent, but it was, it was. It was weighing
Speaker 1: heavily on my mind as I researched this well. To
Speaker 1: be fair to meet loaf, I mean, if I look
Speaker 1: at a modern surgery, I'd see a lot of stuff.
Speaker 1: I don't know what I'm looking at, and it's there's
Speaker 1: no time travel involved. Yeah, So, so these would not
Speaker 1: have been modern medical gloves that they were considering here. Um. Uh.
Speaker 1: The author mentions several of the different designs that were
Speaker 1: presented at this conference. They included elbow length fabric gloves
Speaker 1: of cotton or silk, and of course, if you were
Speaker 1: to use these during an operation, they would apparently quickly
Speaker 1: become soaked with blood. H. There was also the idea
Speaker 1: of using leather style military gloves uh, and these would have,
Speaker 1: of course been clumsy to use. Wax treated fabric was
Speaker 1: another idea, and oh, I was really this one really
Speaker 1: captured my attention. The idea of wax poured directly over
Speaker 1: the surgeon's hands to form a supposed seal between the
Speaker 1: flesh and the operation. Yeah, and the actual paper Schlick talks.
Speaker 1: He mentions this as a proposal, but I didn't get
Speaker 1: the impression anybody ever did it, or at least not. Yeah,
Speaker 1: didn't like put it into regular practice. Yeah, I have
Speaker 1: trouble imagining how it would work, right, because if the
Speaker 1: wax was sealed around the hand um, and you know,
Speaker 1: if you were to go with the right wax, that
Speaker 1: of course wouldn't be just absolutely um scalding to the flesh.
Speaker 1: Then it would truly become brittle upon trying to move
Speaker 1: your hand it around. Yeah, I don't know it. It
Speaker 1: doesn't make a lot of sense to me, though. I'm
Speaker 1: also confused about the the wax treated. I mean, I
Speaker 1: can get into more detail about this later, but one
Speaker 1: of the proposals is for like a silk glove that
Speaker 1: you would cover in liquid wax, and that would help
Speaker 1: make the silk fabric more impermeable. But I would also think, like,
Speaker 1: wouldn't that get kind of brittle? I don't know, Yeah,
Speaker 1: it seems like it would be flaking off and you
Speaker 1: have like little bits of wax. I mean, unfortunately, as
Speaker 1: we've pointed out before in the show, like wax has
Speaker 1: long been used, uh and and and so has honey
Speaker 1: and various medical treatments. So it's not the worst thing
Speaker 1: I guess to have in a wound, but it's you
Speaker 1: want to cut down on the amount of external substances
Speaker 1: that are introduced to a body cavity during a procedure
Speaker 1: like this. Um. I don't know about you, but another
Speaker 1: detail I really liked in article was this bit um quote.
Speaker 1: Another strategy, and this is an altern of diptic gloves,
Speaker 1: involved keeping one's hands clean between operations and abstaining from
Speaker 1: handling infectious materials even when not on the job, an
Speaker 1: approach that in some cases amounted to a whole regime
Speaker 1: of living. Which this is easy to sort of think
Speaker 1: of almost comedically, where you can imagine this surgeon saying, well,
Speaker 1: I'm I'm of course I'm not gonna wear gloves during
Speaker 1: a procedure. It gets in the way. I have some
Speaker 1: some issues with how hygienic it is. What I'm gonna
Speaker 1: do is I'm going to wear gloves the rest of
Speaker 1: the time when I'm not in the surgery, and therefore
Speaker 1: keep my hands nice and clean and ready to just
Speaker 1: get in there. There you almost it's like you become
Speaker 1: sort of part of a priestly class. You must maintain
Speaker 1: purity for all time. Yeah, I mean it's like these
Speaker 1: are the moneymakers, right, and that I have to keep
Speaker 1: the gloves on them at all times. That these hands
Speaker 1: are registered with the FBI as lethal weapons because I
Speaker 1: don't wash them before I operate. Now, he points out
Speaker 1: that the material real challenges here came down to the
Speaker 1: following and these I think we're pointed out by Sergeant
Speaker 1: Anton Wolfer at the time. They needed to be impermeable, obviously,
Speaker 1: they needed to be flexible, they needed to be resistant
Speaker 1: to tears. They couldn't be too tight, they couldn't be
Speaker 1: too hot, and above all else they had to be
Speaker 1: you had to be able to to sterilize them. They
Speaker 1: had to be sterilizable, right, meaning you could like boil
Speaker 1: them or steam them or something to to kill any
Speaker 1: thing that might be on them without damaging them so
Speaker 1: that they couldn't be used. Right. And so given all
Speaker 1: of these demands of the materials, uh, it shouldn't come
Speaker 1: as a surprise that the first surgical gloves that were
Speaker 1: presented here they were not perfect. They did tear, they
Speaker 1: did make aspects of surgery, particularly gripping certain tools or
Speaker 1: certain parts of the human anatomy more difficult. I think
Speaker 1: the manipulation of bowels is singled out as being difficult
Speaker 1: with some of the gloves of this time period. Um.
Speaker 1: But on the other hand, it does certainly in the
Speaker 1: long term they did make a difference in the spread
Speaker 1: of pathogens through surgical procedure. Oh yeah, I think so.
Speaker 1: I think by around the time of World War One,
Speaker 1: it's generally agreed that that's when you you are seeing. Okay,
Speaker 1: now we have pretty much universal acceptance that impermeable sterile
Speaker 1: gloves are good for for surgery, and they should be
Speaker 1: used if at all possible. I can't help to think
Speaker 1: of of media and all this as well, like cinematic
Speaker 1: depictions of doctors, uh like now, like the image of
Speaker 1: a doctor, VI of them a you know, a good
Speaker 1: doctor or a mad scientist or something. The taking off
Speaker 1: or the putting on of surgical gloves or medical gloves
Speaker 1: at some point some form or another, it is kind
Speaker 1: of associated with with power and ability. Uh. You know,
Speaker 1: there's um, there's something about it that like we don't
Speaker 1: even even doubt, doubt, not only do not doubt the
Speaker 1: importance of gloves, but they have kind of become associated
Speaker 1: with these roles, like it's hard to separate the two,
Speaker 1: and you wouldn't want to separate the two. There's a
Speaker 1: there's a strong audio visual cue used in media, which
Speaker 1: is much in the same way you have like an
Speaker 1: action movie, where a gritty action scene is about to commence,
Speaker 1: so you get the pump of the shotgun. In the
Speaker 1: medical scene, you get the snap of the rubber glove.
Speaker 1: It's almost exactly the same thing, right, I mean it's
Speaker 1: enough to where if you were given the choice between
Speaker 1: two fraudulent pseudo scientific healers and they were gonna work
Speaker 1: on you, and one is using bare hands and one
Speaker 1: is using gloves, like the mere presence of the gloves
Speaker 1: could potentially legitimize it a little bit in your eyes.
Speaker 1: You know, Wait, no, but did you mean bare hands
Speaker 1: or B E A R hands? Oh well, I meant
Speaker 1: I meant B A R E. But B E A
Speaker 1: R that brings on an entirely different vision, right, I mean,
Speaker 1: that's then you're in the realm of the shaman. I
Speaker 1: would go with I would go with the quack that
Speaker 1: had bare paws over the quack that just had gloves,
Speaker 1: or what if the the what if the quack had
Speaker 1: both a bare head on over their own had, but
Speaker 1: they had medical gloves on. What if they operated on
Speaker 1: you wearing the bear costume from Jack Frost. There you go,
Speaker 1: Thank you, thank you, thank you. All right, Well, I
Speaker 1: wanted to come back to that Thomas Schlick paper in
Speaker 1: the Bulletin of the History of Medicine, the one called
Speaker 1: Negotiating Technologies and Surgery that was all about the controversy
Speaker 1: over surgical gloves in German speaking hospitals in the eighteen nineties.
Speaker 1: And as I mentioned earlier that the Schlick paper is
Speaker 1: interesting because it frames the good things about gloves as
Speaker 1: a sort of you know, existing within a network of
Speaker 1: trade offs uh and UH, talking about it as one
Speaker 1: of the types of what Schlick calls control strategies within
Speaker 1: surgery at the time. And control strategies there were many,
Speaker 1: but they included things like different instruments UH, lights and
Speaker 1: operating tables UH, anatomy, atlas is, an esthetics, and of
Speaker 1: course technologies of a sepsis. Now I mentioned earlier the
Speaker 1: difference between a sepsis and anti sepsis, and this is
Speaker 1: an important concept in in the development of surgery in
Speaker 1: the second half of the nineteenth century. So you've got
Speaker 1: two schools of thought the that are in competition. One
Speaker 1: is anti sepsis, which is the idea of disinfecting a
Speaker 1: wound after germs have likely been introduced. And then you've
Speaker 1: got a sepsis, which is instead trying to prevent any
Speaker 1: germs from ever entering the wound in the first place. Uh.
Speaker 1: And the primary method here would be trying to make
Speaker 1: all instruments and objects in the surgical environment sterile before
Speaker 1: surgery begins, so you would boil your scalpels and so forth.
Speaker 1: But Schlick describes a growing nervousness among surgeons in the
Speaker 1: eighteen nineties based on the general feeling that reigning aseptic
Speaker 1: practices were not good enough. That you know, the By
Speaker 1: the eighteen nineties, surgeons in German speaking hospitals were aware
Speaker 1: of of the bacteriological problems. They were trying to be
Speaker 1: a septic however they could. They were washing their hands
Speaker 1: and going through all these procedures we talked about, but
Speaker 1: they were just aware that the current methods were not
Speaker 1: preventing all infection. A sepsis had to be what they were,
Speaker 1: what they thought of as an all or nothing campaign,
Speaker 1: and Schlick quotes an academic surgeon somebody who we've already referenced.
Speaker 1: This was a guy at the University of bres Lau
Speaker 1: named Johannes van Miklich, and Mikolitch wrote quote, the smallest
Speaker 1: mistake and wound treatment would come back to haunt the surgeon.
Speaker 1: And Mikolitch, together with a collaborator named Carl Fluga who
Speaker 1: lived eighteen forty seven and nineteen twenty three, UH spent
Speaker 1: great effort in the eighteen nineties trying to close the gaps,
Speaker 1: basically to find ways that germs could still be getting
Speaker 1: in even with the aseptic practices of the time. UH
Speaker 1: and so one of the ideas that they came up
Speaker 1: with was using face masks to prevent droplet infection, so
Speaker 1: droplets from the doctor's mouth or nose entering the wound
Speaker 1: and introducing germs during surgery. And Schlick writes, quote many
Speaker 1: of today's surgical paraphernalia were introduced at the time as
Speaker 1: part of the bacteriologically supported search for weak points in
Speaker 1: the aseptic all or nothing system of preventing wound infection.
Speaker 1: It was the it was the context of this crisis
Speaker 1: of aseptic surgery that prompted a number of surgeons in
Speaker 1: the eighteen nineties to simultaneously try out surgical gloves within
Speaker 1: their local settings. Now, one of the next things that
Speaker 1: Schlick talks about in this paper, I thought it was
Speaker 1: very interesting. And so if we're looking at German speaking
Speaker 1: hospitals in the eighteen eighties and eighteen nineties, they're aware
Speaker 1: of the fact that they need to improve aseptic practices
Speaker 1: and surgery, but they don't know all the ways to
Speaker 1: plug the holes. And the use of surgical gloves is
Speaker 1: obvious to us in retrospective, but it was not obvious
Speaker 1: to everyone at this time and place. So why would
Speaker 1: it not have been obvious to them? Uh. One thing
Speaker 1: Slick points out is that, first of all, it just
Speaker 1: requires thinking about gloves in a different way. Prior to this,
Speaker 1: gloves were typically used to protect the person wearing them
Speaker 1: rather than to protect someone from the person wearing them.
Speaker 1: So it's kind of like having to just think outside
Speaker 1: the box to reframe something that is already part of
Speaker 1: your mundane existence. So imagine thinking that you would need
Speaker 1: to wear a hat to protect someone else from your head.
Speaker 1: It seems weird, but actually, if you think about it
Speaker 1: in the right context, this is something that people do.
Speaker 1: I've I've worked in restaurants where chefs were required to
Speaker 1: wear either hats or hairnets to keep their hair out
Speaker 1: of the food. If you're not familiar with the context
Speaker 1: like that, it might never occur to you that you
Speaker 1: would wear a hat for somebody else's benefit. But another
Speaker 1: thing that the Slick points out around here is that
Speaker 1: carbolic acid and other antiseptic chemicals that were used to
Speaker 1: to get the hands clean before surgery, these were hard
Speaker 1: on the skin. Schlick Wrights quote copiously applied the caustic
Speaker 1: solutions often caused severe skin damage insurgeons and nurses, forcing
Speaker 1: some of them to abandon operating altogether. The issue was
Speaker 1: the background of the well known story of how in
Speaker 1: eighteen eighty nine, William Halstead at Johns Hopkins introduced rubber
Speaker 1: gloves to protect the hands of his chief operating nurse,
Speaker 1: who later became his wife. Now Robbie already mentioned Halstead
Speaker 1: introducing rubber gloves in his practice around this time, but
Speaker 1: Slick goes on with an interesting detail here quote Subsequently,
Speaker 1: such gloves were also used by Halsted's assistants. They put
Speaker 1: them on when taking instruments out of the corrosive sublimate
Speaker 1: solution in which the instruments were kept, and passed them
Speaker 1: on to the operating surgeon, who did not wear gloves.
Speaker 1: So so the assistance would you'd have like a scalpel,
Speaker 1: and that would be in a sterilizing, uh, caustic chemical,
Speaker 1: and the assistance would put gloves on to take the
Speaker 1: thing out of that chemical, handed to the surgeon who
Speaker 1: would receive it with an ungloved hand and then operate. Yeah.
Speaker 1: I guess that. One of the things to drive home
Speaker 1: here is, Yeah, the adoption of a new technology is
Speaker 1: sometimes a little patchy, and the reasoning can be different
Speaker 1: than what you'd expect. So they've got by eighteen eighty nine,
Speaker 1: Halstead's assistants and nurses are using rubber gloves to protect
Speaker 1: their hands from these caustic chemicals. But it wasn't until
Speaker 1: eighteen nine six that UH that rubber gloves to protect
Speaker 1: the patient during surgery became standard at Johns Hopkins. It
Speaker 1: just didn't seem like an obvious solution until around then. Now,
Speaker 1: another thing is that so Rob earlier you mentioned this
Speaker 1: three VAT process. You've got surgeons who would wash their
Speaker 1: hands with soap and then submerge their hands in alcohol
Speaker 1: and then dip their hands in an antiseptic chemical before
Speaker 1: going into surgery. So you would think, man, you go
Speaker 1: through that kind of procedure, that really should kill all
Speaker 1: the bacteria, right, shouldn't your hands be perfectly clean by then?
Speaker 1: But one of the things that became clear to these
Speaker 1: these surgeons in the eighteen nineties is that this actually
Speaker 1: it was pretty good, but it wasn't good enough because
Speaker 1: even if you could sterilize the outside skin of your hands,
Speaker 1: there were little pockets where germs could camp out and
Speaker 1: still infect a wound. Examples would include the sebaceous glands.
Speaker 1: These are a little little gland pockets attached to hair
Speaker 1: follicles that produce sea bum, which is a waxy or
Speaker 1: oily substance that coats the skin and hair. And then
Speaker 1: also you've got like underneath the fingernails. You know, you're
Speaker 1: just gonna have like little recesses back there where these
Speaker 1: liquids are not getting in deep enough, and germs from
Speaker 1: in there might still get out during surgery, and for
Speaker 1: some reason this reminds me of you remember in our
Speaker 1: Invention episode on the Death Ray, the the idea of
Speaker 1: this time between World War one and two where there
Speaker 1: was terror about the inadequacy of ground based defenses against
Speaker 1: air raids. And there's this this phrase that was used
Speaker 1: at the time time, the bomber always gets through. I
Speaker 1: compared that to the bacterium in this case. Right, there's
Speaker 1: this fear that the bacterium somehow always gets through, right, right,
Speaker 1: and there's always gonna be at least one little crack
Speaker 1: in the defenses with this method. So to try to
Speaker 1: get around these problems where you know, sterilizing your hands
Speaker 1: is not good enough, this is where gloves come in.
Speaker 1: And so we mentioned several times this guy, you Haness
Speaker 1: fun Uh mikolich Uh. He tried this interesting solution, beginning
Speaker 1: with an operation on Easter eighteen, which was sterilized cotton gloves.
Speaker 1: So hands would go through the regular gauntlet washing and disinfection,
Speaker 1: but then after this you would put on the sterilized
Speaker 1: cotton gloves. They were very big. They had sleeves or
Speaker 1: gauntlets going all the way up the arm to like
Speaker 1: the elbow or past the elbow, and you can see
Speaker 1: pictures of these. They kind of look like mummy arms. Now,
Speaker 1: of course they're cotton gloves, so they're not impermeable, so
Speaker 1: over the course of an operation they would become sod
Speaker 1: with blood and you might need to change them out
Speaker 1: for a new pair. But Mikolitch was was very positive
Speaker 1: about them. He is like, you know, uh, they're not
Speaker 1: that bad. And sometimes with cotton gloves you can even
Speaker 1: grip some things better, like holding onto tissues is easier
Speaker 1: with cotton gloves than with the naked hand. But there
Speaker 1: were times when the cotton gloves reportedly caused problems. One
Speaker 1: example would be, uh, this is the example given by
Speaker 1: by Mikolich when um when a surgeon is feeling around
Speaker 1: on the inside of the stomach lining to locate a
Speaker 1: tumor by touch, the cotton would apparently dull the sensitivity
Speaker 1: of the fingers, and Mikolitch wrote that in cases like this,
Speaker 1: you could briefly take off the glove, reach around and
Speaker 1: and feel for the tumor with your bare fingers as
Speaker 1: quickly as possible, and then once you found it, you
Speaker 1: put on a pair of fresh cotton gloves. And it's
Speaker 1: the five second rule. Of rooting around in somebody's um
Speaker 1: the stomach cavity. Right. Yeah, that that seems like not
Speaker 1: not a great solution, but at least you're you're trying
Speaker 1: to use something. So Mikolich also tried out early rubber
Speaker 1: gloves but said they were not tenable because they had
Speaker 1: they just had major disadvantages for manual dexterity, and they
Speaker 1: weren't much better than cotton gloves for asepsis. I don't
Speaker 1: know about that last claim, but apparently, according to Schlick,
Speaker 1: at least the surgeon most responsible for bringing rubber gloves
Speaker 1: into vogue in German speaking hospitals was Verners Zoga von Manteuffel,
Speaker 1: who lived eighteen fifty seven to nineteen twenty six. Zoga
Speaker 1: was especially in search of failsafe aseptic protocols because he
Speaker 1: worked in an environment of a municipal hospital where he
Speaker 1: had to quote operate promiscuously, so he couldn't like specialize
Speaker 1: in one type of surgery and quarantine for that. Instead,
Speaker 1: he had to operate alternately on like infected patients and
Speaker 1: uninfected one, sometimes handling pus or feces or whatever, and
Speaker 1: then immediately having to go operate on a different patient.
Speaker 1: So his solution to this was boiled rubber gloves. There
Speaker 1: were downsides. The rubber gloves were uncomfortable. Sometimes they made
Speaker 1: it hard to move or bend the thumb. Sometimes the
Speaker 1: fingers were too long, which made gripping difficult, and because
Speaker 1: of these conditions, operations with rubber gloves would often take
Speaker 1: longer than the same operation with bare hands. And then,
Speaker 1: to read from Schlick quote, but this Zoga thought was
Speaker 1: outweighed by the gains in aseptic control the absolute safety
Speaker 1: of the quote boiled hand, as he called it. Zoga
Speaker 1: thus explicitly weighed the two kinds of control against each other.
Speaker 1: What also becomes clear in this discussion is the importance
Speaker 1: of the technical details of the gloves for reconciling manual
Speaker 1: and aseptic control. They had to be made in a
Speaker 1: way so that they didn't compromise the surgeon's grasp too much.
Speaker 1: But at the same time we're effective in keeping bacteria out.
Speaker 1: So this is a way of trying to get the
Speaker 1: boiled hand into circulation. You've got to make it so
Speaker 1: that it's worth it to the surgeon that they can
Speaker 1: still do what they need to do. If you've got
Speaker 1: a rubber glove that is boiled and is a septic.
Speaker 1: It's not going to get bacteria in there, but you
Speaker 1: can't really operate effectively with it. That doesn't do you
Speaker 1: any good. I do love the name the boiled hand.
Speaker 1: By the way, we were talking about this a little
Speaker 1: bit before we came in here. Just perfect. This seems
Speaker 1: to be a bigger thing than just zoga. Here. There's
Speaker 1: like a general anguish at the time expressed by multiple
Speaker 1: surgeons about the idea of hands being a non boilable objects. Boiling,
Speaker 1: I think, became a kind of metaem for aseptic safety,
Speaker 1: So you might at the time, instead of saying something
Speaker 1: is a septic, you might just call it boiled, whether
Speaker 1: or not it had literally been boiled. Now a couple
Speaker 1: of other interesting solutions mentioned in the Schlick paper. There
Speaker 1: was a guy named George Perth's who lived eighteen sixty
Speaker 1: eight to nineteen twenty seven. He was a surgeon in
Speaker 1: Leipzig who said that full rubber gloves were too thick
Speaker 1: and difficult to work with, but suggested that surgeons could
Speaker 1: use quote fine finger covers made out of condom rubber quote,
Speaker 1: which have been put on the market recently. And which
Speaker 1: impaired the touch of the finger relatively little, and that's
Speaker 1: kind of surprising. But yes, rubber condoms had existed in
Speaker 1: some form going back to at least the mid nineteenth
Speaker 1: century eighteen fifties. Rubber condoms were allegedly made of rather
Speaker 1: thick material, but they did exist at the time, and
Speaker 1: perthis suggested that that, yeah, this condom rubber could actually
Speaker 1: be useful to the surgeon for having a good compromise
Speaker 1: between being impermeable and being a septic, but also allowing
Speaker 1: the surgeon to feel what they are doing. But Perthieves
Speaker 1: himself favored silk gloves, which you already mentioned. He said,
Speaker 1: you know, they're great for manual control. Silk feels like
Speaker 1: you're wearing nothing at all, But of course they didn't
Speaker 1: have the aseptic advantages of impermeable rubber. There are a
Speaker 1: couple of other things that Schlick mentions, involving the idea
Speaker 1: of thin gloves coated in wax and whether or not
Speaker 1: that would be useful leather gloves that maybe we're topped
Speaker 1: with with condom rubber or something. But yeah, ultimately we
Speaker 1: get to this desire that Wolfer articulates that you mentioned earlier,
Speaker 1: that you've gotta have a surgical glove that has all
Speaker 1: of the following characteristics. It's impermeable, it's flexible, tear resistant,
Speaker 1: not too tight, not too hot, and it can be sterilized.
Speaker 1: And this is what they ended up debating at this
Speaker 1: surgical congress in and there were all kinds of interesting
Speaker 1: debates here about like the actual bacteriological evidence for gloves, like, uh,
Speaker 1: there were some people at this meeting who dissented, arguing
Speaker 1: on the basis of experiments that gloves were not actually useful.
Speaker 1: And there was one experiment that involved testing cotton gloves. Uh.
Speaker 1: So again not not the rubber ones, but taking uh,
Speaker 1: cotton gloves that have been used in surgery and then
Speaker 1: squeeze sing out the quote glove juice and then uh
Speaker 1: doing a culture of that to see what it's germ
Speaker 1: content was. And they were like, look, this glove juice
Speaker 1: is full of germs. These gloves can't be useful. In fact,
Speaker 1: they're picking up because they get soaked with blood, they're
Speaker 1: picking up germs from the air and they're introducing new germs. Uh.
Speaker 1: And then this led to a really I think a
Speaker 1: debate between different evidential standards. So you have some people saying, well, look,
Speaker 1: we've done these lab experiments saying that you know, the
Speaker 1: glove juice is full of bacteria and that's no good.
Speaker 1: But then there are these other people saying, well, yeah,
Speaker 1: but we've used gloves in actual surgeries and we see
Speaker 1: the differences in outcomes, and the outcomes are better when
Speaker 1: you use gloves. And so they were comparing different standards
Speaker 1: of like, how should we measure whether this this is
Speaker 1: effective or not. Now. Eventually, over time there was agreement
Speaker 1: that that impermeable gloves were the gold standard and that
Speaker 1: if you could manufacture them in a way that didn't
Speaker 1: sacrifice too much manual control, which, of course we did
Speaker 1: get it with the with the sterile gloves that people
Speaker 1: use today made of thin materials such as latex, nitrial,
Speaker 1: or vinyl. Yeah, modern medical gloves come in, of course,
Speaker 1: various sizes. They are made from a variety of polymers,
Speaker 1: yet powdered and unpowdered or even powdered with corn starch
Speaker 1: to cut down on skin irritation. They've been a lot
Speaker 1: of efforts towards the elimination of powdered gloves in general,
Speaker 1: and there are alternatives for individuals with with latex allergies.
Speaker 1: So uh yeah, modern medical gloves, there's this broad spectrum there.
Speaker 1: We've come a long way obviously since uh, since these
Speaker 1: these first prototypes were being unveiled, and yeah, it's we're
Speaker 1: we're in a in a totally different age now when
Speaker 1: it comes to the acceptance of of medical and surgical gloves.
Speaker 1: You again, you would not accept bare fingers and bare
Speaker 1: hands as an alternative. But I think it's also good
Speaker 1: to understand that at the time, resistance to the to
Speaker 1: the take up of gloves, especially in perm obol gloves,
Speaker 1: was not just uh, just stubbornness or quackery. There probably
Speaker 1: was some of that, but a lot of it was
Speaker 1: also genuine concern for being able to operate effectively. Yeah,
Speaker 1: I mean when you're you're I think the the example
Speaker 1: of our promiscuous surgeon, uh is key here though, Yeah,
Speaker 1: because he's talking like clearly he's weighing. Um, yeah, these
Speaker 1: are these are bulkier in some cases, but like I
Speaker 1: need to be able to go from this patient to
Speaker 1: this patient to this patient. Um, you know, we need
Speaker 1: to be able. So it's kind of like getting into
Speaker 1: the scale issue of inventions, like, okay, I can. It's
Speaker 1: one thing to create a perfect prototype in isolation. It's
Speaker 1: one thing to be able to conduct one surgery in
Speaker 1: perfect isolation. But if that's just one of many surgeries
Speaker 1: you're performing during a set amount of time, well then
Speaker 1: you're in a slightly different scenario. There are all these
Speaker 1: other factors you have to take into account totally. Yeah. Oh,
Speaker 1: and then to to come back to our outer limits
Speaker 1: example from earlier, the idea of being able to perform
Speaker 1: medical interventions like out in the field. Uh, like, this
Speaker 1: seems another area where gloves are vital because yes, I mean,
Speaker 1: you still are going to ideally, you know, have some
Speaker 1: some sort of cleansing materials, but are you going to
Speaker 1: have three vats in which to um to spend some
Speaker 1: time washing your hands, or are you gonna have to
Speaker 1: essentially snap on some gloves and get in there and
Speaker 1: try and save someone's life that sort of thing. Yeah.
Speaker 1: So anyway, it's a yeah, fascinating topic, I think, especially
Speaker 1: when you get into the adoption of a new technology,
Speaker 1: how we look back on it and how you know,
Speaker 1: these the efforts of the historian to places within that
Speaker 1: time period to make sense of it all just just
Speaker 1: all very fascinating and I think something to keep in
Speaker 1: mind and to think about the next time you're in
Speaker 1: a medical facility or in a checkup of one sort
Speaker 1: or another and you see your doctor or you don't
Speaker 1: see them, snap on those gloves. The gloves are just
Speaker 1: part of it. Uh. Of course, we'd love to hear
Speaker 1: from anyone out there who regularly wears medical gloves, surgical
Speaker 1: gloves as part of your profession. What you know, what
Speaker 1: are your thoughts on them? What what sort of a
Speaker 1: history do you have with them? And you have to
Speaker 1: use a certain variety of glove due to allergies or
Speaker 1: skin irritations. We'd love to hear some insight from the field.
Speaker 1: All right, well, we're gonna go and close out this
Speaker 1: Invention themed episode of Stuff to Blow Your Mind, but
Speaker 1: we love to hear from everyone out there. Just a
Speaker 1: reminder that new episodes of Stuff to Blow Your Mind
Speaker 1: come on Tuesdays and Thursdays. And uh oh, we should
Speaker 1: also mention we we mentioned condoms briefly. We do have
Speaker 1: an older episode of Invention about the invention of the condom,
Speaker 1: so uh we recommend that and of course we've touched
Speaker 1: on medical history topics numerous times over the years, and
Speaker 1: you can find those in the archives. On Monday's we
Speaker 1: do listener mail episodes, on Wednesdays we do a short
Speaker 1: form artifact or monster fact, and on Friday's we set
Speaker 1: aside most serious concerns and just talk about a weird film.
Speaker 1: Huge thanks as always to our excellent audio producer Seth
Speaker 1: Nicholas Johnson. If you would like to get in touch
Speaker 1: with us with feedback on this episode or any other,
Speaker 1: to suggest a topic for the future, or just to
Speaker 1: say hello, you can email us at contact at stuff
Speaker 1: to Blow your Mind dot com. Stuff to Blow Your
Speaker 1: Mind is production of I Heart Radio. For more podcasts
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