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Speaker 1: Hey you welcome to Stuff to Blow Your Mind.

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Speaker 2: My name is Robert Lamb and I am Joe McCormick,

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Speaker 2: and it's Saturday. Time for an episode from the Vault.

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Speaker 2: This one originally aired August thirtieth, twenty twenty two, and

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Speaker 2: it is about the invention of surgical gloves.

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Speaker 1: Yeah, yeah, this is a This is a pretty fun one.

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Speaker 1: Every now and then we'll know, we'll get to that

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Speaker 1: point where it's like, oh, we got we need to

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Speaker 1: do a bunch of invention episodes, like the Invention frenzy

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Speaker 1: overcomes us. So, yeah, this is a this is a

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Speaker 1: fun exploration.

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Speaker 3: Welcome to Stuff to Blow Your Mind production of iHeartRadio.

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Speaker 4: Hey, welcome to Stuff to Blow your Mind. My name

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Speaker 4: is Robert.

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Speaker 2: Lamb and I'm Joe McCormick.

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Speaker 4: And this weekend Stuff to Blow your Mind. We have

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Speaker 4: another invention themed episode for everyone, and I think it

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Speaker 4: should prove an interesting episode because it's one of those

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Speaker 4: stories that more than it just covers like the need

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Speaker 4: for an invention and the development of that invention, it

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Speaker 4: also gets into the acceptance of that invention or the

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Speaker 4: lack there off concerning a new technology. You know, it's

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Speaker 4: one thing to have an idea for a new product

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Speaker 4: or a new invention, a new way of doing things.

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Speaker 4: But then if it's going to make a difference, it

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Speaker 4: also has to be accepted by the vast majority of

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Speaker 4: the people within a given field, a given culture, etc.

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Speaker 2: Yes, and also the way that a certain invention has

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Speaker 2: to prove its advantages over other solutions to the same problems,

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Speaker 2: which is a major issue with the early adoption of

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Speaker 2: the technology we're going to be talking about today. Something

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Speaker 2: that is now a universal standard that people would be

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Speaker 2: horrified to hear anybody was not using, was in fact

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Speaker 2: originally one solution among many.

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Speaker 4: Right, we're going to be talking about surgical gloves. You

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Speaker 4: say are just ubiquitous now it's just no matter what

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Speaker 4: the surgical procedure happens to be, but not only surgical procedures,

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Speaker 4: but also just any kind of medical checkup, anything in

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Speaker 4: the medical establishment in general. If you go to the dentist,

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Speaker 4: if they're going to have medical gloves on, and it's

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Speaker 4: one of those things where not only do you come

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Speaker 4: to expect it, like you could not ask for it

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Speaker 4: to be another way. You can't go to the dentist

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Speaker 4: and be like, hey, doc, I'm thinking maybe you go

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Speaker 4: gloves off this time. I mean no, it's just the

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Speaker 4: gloves are part of the procedure, and most of us

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Speaker 4: would be somewhat concerned if we go in there and

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Speaker 4: the gloves are off.

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Speaker 2: Or if the gloves were, say made of cotton, then

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Speaker 2: really juicy.

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Speaker 4: Right, Or yeah, you go in and it's like your

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Speaker 4: dentist is wearing big ski gloves or mittens. So you've

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Speaker 4: realized something is off. This is not the way things

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Speaker 4: should be, but.

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Speaker 2: It was not always so. So if you went to

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Speaker 2: to say, a German speaking hospital in the eighteen nineties,

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Speaker 2: you may be lucky enough to get operated on by

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Speaker 2: a surgeon who has accepted the new science of bacteriology,

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Speaker 2: who does understand that wounds need to be clean, they

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Speaker 2: need to be asceptic, and does understand that gloves can

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Speaker 2: help with that process, but has not found a way

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Speaker 2: to commit yet to impermeable gloves. So may well have

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Speaker 2: some cotton gloves on while they've got their fingers around

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Speaker 2: in you.

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Speaker 4: Now a quick side note on just gloves in general.

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Speaker 4: Gloves have been with us for a very long time.

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Speaker 4: It's just a basic way to protect the hand from

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Speaker 4: where from coal, from heat, from other threats, just a

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Speaker 4: basic technological advancement in which we realized, hey, we can

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Speaker 4: take other materials and make a second skin for our

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Speaker 4: hands are very important but also susceptible to damage. Hands

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Speaker 4: and some of the oldest gloves that we have that

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Speaker 4: have survived include a pair of delicate linen child's gloves

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Speaker 4: from the tomb of Tutin Common. So those are about

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Speaker 4: three thy two hundred years old, and these were likely

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Speaker 4: riding gloves. But of course, one of the things about gloves,

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Speaker 4: when one of the things about making yourself a second

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Speaker 4: organic skin, is that those tend not to survive, you know,

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Speaker 4: unless they are stuck away in a tomb or in

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Speaker 4: some other fashion well preserved for a very long period

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Speaker 4: of time. But the reality is when it comes to surgery,

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Speaker 4: for most of human history, surgical procedures of varying degrees

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Speaker 4: of complexity were carried out bare handed. Now, when we

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Speaker 4: say bare handed surgery, we do have to note that

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Speaker 4: we're not talking about pseudoscientific medical fraud psychic surgery, which

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Speaker 4: is also you know, quote unquote performed bare handed. No,

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Speaker 4: we're talking about actual surgical procedures of different scales performed

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Speaker 4: well without any sort of protective barrier between the surgeon's

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Speaker 4: skin and the patient's flow. So surgery of different sorts

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Speaker 4: was practiced in ancient Mesopotamia, Ancient Egypt, ancient China, agient India,

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Speaker 4: and other parts of the ancient world. Ancient surgeries ran

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Speaker 4: the gamut from setting of bones to amputations, trepanations, blood lettings,

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Speaker 4: and everything in between. But as we've discussed on the

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Speaker 4: show before, one of the big obvious realities here, obvious

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Speaker 4: to us now anyway by virtue of germ theory, is

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Speaker 4: that human hands carry disease, and even regularly cleaned hands

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Speaker 4: can be a problem. I was looking at some of

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Speaker 4: the stats on this in review of human hand microbiome

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Speaker 4: research by EDMUNDS. Wilson at All in a twenty fifteen

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Speaker 4: edition of a Journal of Dermatological Science. The authors here

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Speaker 4: point out that hands are of course a critical component

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Speaker 4: of the human microbiome and are quote a conduit for

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Speaker 4: exchanging micro organisms between the environment and the body. So

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Speaker 4: not all of these are dangerous naturally, but hands can

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Speaker 4: harbor pathogenic species like staff Any Coli. And this is

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Speaker 4: even more the case in high risk environments, such as

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Speaker 4: among those who handle food or provide healthcare, and the

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Speaker 4: authers here point to various studies that have also looked

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Speaker 4: into how it enhanced use of hand hygiene products may

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Speaker 4: negatively impact the hand microbiome as well, result resulting in

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Speaker 4: greater pathogen carriage for example. But other studies have demonstrated

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Speaker 4: quote reduced pathogen carriage and or infections with use of

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Speaker 4: these products.

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Speaker 2: Oh yeah, that's got to be interesting. Double edged sword. So,

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Speaker 2: like now that we have, you know, germ theory, we

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Speaker 2: know it's important to wash your hands if you're going

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Speaker 2: to be eating or preparing food, or certainly if you're

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Speaker 2: going to be doing any kinemtical procedure. But also that

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Speaker 2: repeatedly washing or you're sterilizing your hands has effects beyond

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Speaker 2: just keeping pathogens away. It also affects the presence of

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Speaker 2: non harmful microbiota on the surface of your hands.

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Speaker 4: Yeah, it's like I get again. You have to think

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Speaker 4: of your hands as part of your body. They're not

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Speaker 4: just tools, they're not instruments. They're used by you and

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Speaker 4: your body. They are part of you. They are also

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Speaker 4: like yourself multitude. They have populations, and if you regularly

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Speaker 4: carpet bomb the population, that's going to disrupt. That's not

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Speaker 4: going to just keep things from living there. It's going

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Speaker 4: to potentially disrupt the ratio of what lives there. And

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Speaker 4: so the idea of cleaning the hand completely, that is

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Speaker 4: we'll discuss that becomes kind of problematic at times, like again,

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Speaker 4: it's not an instrument. It is pointed out by one

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Speaker 4: of the authors we're going to look to. You cannot

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Speaker 4: just boil the hand to sterilize it and then use

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Speaker 4: the hand in a completely hygienic way.

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Speaker 2: Right though, I want to be very clear, well, we

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Speaker 2: are acknowledging these consequences. This is not a case against

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Speaker 2: hand washing.

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Speaker 4: No, no, No. Hand washing, as we'll discuss, is also

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Speaker 4: very important here. I also have to throw in, while

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Speaker 4: after I was researching a lot of this and had

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Speaker 4: it on my mind, still sort of turning over in

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Speaker 4: my head, I ran into my boss out in the

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Speaker 4: world and my boss stuck his hand out, but luckily

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Speaker 4: he went for the fist bump instead of a handshake,

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Speaker 4: and it was great. That was that was ideal because

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Speaker 4: I didn't want to have to be like, sorry, can't

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Speaker 4: shake your hand right now. Just read a whole bunch

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Speaker 4: of stuff about about hand germs.

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Speaker 2: I thought you were going to he stuck his hand

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Speaker 2: out so you could kiss it.

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Speaker 4: No, no, no, no, no, we have we have at

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Speaker 4: Our boss is a little better than that.

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Speaker 2: Our boss is the Pope. We work at the Vatican.

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Speaker 4: But another big thing about all this is that it

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Speaker 4: comes down to the to one of the obvious facts

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Speaker 4: we've discussed before that without germ theory, without any insight

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Speaker 4: into the invisible world of organisms that are literally at

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Speaker 4: our fingertips for the vast majority of human history, we

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Speaker 4: just we just didn't know. We just didn't know that.

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Speaker 4: Like we again, we had gloves. It's not like, uh,

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Speaker 4: like we didn't have this idea that well, there are

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Speaker 4: some cases where we need to cover our hands to

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Speaker 4: protect our hand from some sort of external force, or

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Speaker 4: perhaps in some cases protect the external world from our hands.

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Speaker 4: But if you cannot see the threat, if you have

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Speaker 4: no real concept of the germs that are out there,

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Speaker 4: of the invisible world, then what can you do?

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Speaker 2: Well, yes, and also to acknowledge that the glove itself

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Speaker 2: would need to be sterilized in order to provide an

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Speaker 2: advantage there, Just putting on a dirty glove doesn't do

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Speaker 2: much better than using a dirty hand exactly.

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Speaker 4: To give some more stats on some of this. According

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Speaker 4: to Smith at All in twenty seventeen's Infection Control through

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Speaker 4: the Ages, even today, quote, approximately one point seven million

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Speaker 4: healthcare associated infections or HAI's occur in the United States

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Speaker 4: each year. So even with modern precautions and technologies in place,

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Speaker 4: that's one of the things about healthcare. I mean, it

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Speaker 4: does put you in close proximity with a doctor, it

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Speaker 4: puts you often puts you in a space where you

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Speaker 4: have other individuals with various health care concerns going on.

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Speaker 4: It's just the reality of it. But if you go

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Speaker 4: back in time before germ theory, before these various technologies,

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Speaker 4: things obviously get a bit darker. Smith that All point

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Speaker 4: out that in medieval times there was a high level

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Speaker 4: of illness and death in hospitals, and quote, when a

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Speaker 4: sick person entered a hospital, his or her property was

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Speaker 4: disposed of, and in some regions a requiem mass was

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Speaker 4: held as if he or she had already died.

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Speaker 2: That's a bad health care plan, Yeah, it does.

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Speaker 4: It's not a singing endorsement of the hospital you're about

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Speaker 4: to enter. Because of course that the tools were often primitive,

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Speaker 4: they weren't cleaned and weren't cleaned between uses. Cauterization via

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Speaker 4: hot iron or boiling oil was commonly used. You're looking

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Speaker 4: at between sixty and eighty percent mortality rates. This is

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Speaker 4: pretty common during the time period, and even into the

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Speaker 4: early modern period. Many things had improved, but you still

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Speaker 4: had surgeons placing ungloved hands directly into wounds and directly

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Speaker 4: into incisions and so forth, and this was certainly the norm.

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Speaker 4: Again for much of human medical history. We didn't have

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Speaker 4: the materials and or we didn't know about the invisible

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Speaker 4: world of microbes, and other reasons were focused on for

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Speaker 4: subsequent infections such as bad air or miasma seeping into

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Speaker 4: the wound and read that, you know, until shockingly recently,

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Speaker 4: it was things like pus and secondary infections were often

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Speaker 4: just thought of as well, this is just part of

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Speaker 4: the body healing itself. This is just what happens. This

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Speaker 4: is the norm, and there's nothing we can do about it.

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Speaker 2: I was just randomly reminded of something I read recently,

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Speaker 2: which is so, you know, the famous story about US

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Speaker 2: President James A. Garfield, who was it is sometimes said, assassinated,

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Speaker 2: But it has been observed by many historians that he

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Speaker 2: was shot, but he survived his bullet wound for a

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Speaker 2: while and was like for months actually, and was repeatedly

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Speaker 2: operated on in an unsanitary way by a doctor. And

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Speaker 2: it is commonly believed that the doctor's unsanitary intervention is

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Speaker 2: in fact what killed Garfield. But the thing that I

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Speaker 2: found out is that that doctor's name, his given name

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Speaker 2: was doctor. His name was doctor Willard Bliss. So he

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Speaker 2: was doctor doctor Willard Bliss, all right.

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Speaker 4: But speaking of this time period, yeah, eventually we'd get

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Speaker 4: to what Smith at All referred to as the progressive

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Speaker 4: era of the eighteen nineties through the nineteen twenties, and

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Speaker 4: we do see a shift here. Quote. This period saw

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Speaker 4: great advances in hospital infection control. Ignot Simmelweiss was the

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Speaker 4: first hospital epidemiologist, setting a precedent for step by step

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Speaker 4: analysis of an outbreak and for tracing epidemics to a

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Speaker 4: particular surgeon or practice e g. Going from the autopsy

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Speaker 4: room to the operating room without washing your hands uugh

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Speaker 4: Eleven of twelve consecutive women die of pweparral or child

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Speaker 4: bed fever, and subsequently required that all providers who attended

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Speaker 4: the patients first wash their hands in a watery solution

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Speaker 4: of chlorinated lime. The mortality rate then dropped dramatically from

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Speaker 4: eighteen percent to two percent. So simlweis here was a

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Speaker 4: Hungarian physician who lived from eighteen eighteen through eighteen sixty five.

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Speaker 4: So he's a little bit before of this, before this

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Speaker 4: progressive era that Smith at all are talking about. But

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Speaker 4: this is a time when we see rapid changes in

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Speaker 4: medical knowledge, we see the advent of technologies like the

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Speaker 4: X ray. This is a time period that was covered,

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Speaker 4: I think, just excellently in Steven Soderberg's television drama The Nick,

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Speaker 4: which I know I've mentioned on the show before. It's

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Speaker 4: just a great drama, a lot of attention to detail,

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Speaker 4: but also they have this very clean, white, almost blinding

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Speaker 4: visual style to the show, have electronic music by Cliff

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Speaker 4: Martinez throughout the series, and so I think it does

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Speaker 4: a great job of portraying the past as the energetic,

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Speaker 4: promising present. You know something that we sometimes I think

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Speaker 4: lose track of in representing the past on film or

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Speaker 4: even reading about the past, about thinking about this time

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Speaker 4: period in past as being completely divorced from what we

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Speaker 4: will know, and it's more about just like the excitement

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Speaker 4: and also the danger of being there at the bleeding

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Speaker 4: edge of technology and innovation. Yeah.

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Speaker 2: I think one of the things that's often hard to

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Speaker 2: capture accurately when you're portraying the past is understanding the

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Speaker 2: past as without knowledge of the future, understanding the past

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Speaker 2: as incorporating the full uncertainty of being a present of

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Speaker 2: its own. Like you say, so, not only the excitement

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Speaker 2: of things being new at the time, but also the

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Speaker 2: lack of knowledge how things would turn out. Everything always

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Speaker 2: seems more obvious in retrospect.

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Speaker 4: Right, right, And certainly The Nick is a show that

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Speaker 4: doesn't doesn't shy away from the wrong paths. I think

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Speaker 4: I've mentioned before when we're talking about the invention of

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Speaker 4: the X ray you have, there's one episode in particular

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Speaker 4: where they're so excited to have the X ray. Uh,

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Speaker 4: they're at the hospital and they're just just using it

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Speaker 4: just so irresponsibly, without really understanding or having any idea

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Speaker 4: of just how dangerous repeated exposure to the machine would be.

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Speaker 2: Well, they're using it unnecessarily, right, They're just like using

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Speaker 2: it for fun.

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Speaker 4: Yeah, it's like you get the kids in here, Oh,

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Speaker 4: watch watch watch Dad x ray's hand multiple times for

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Speaker 4: no reason, that sort of thing.

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Speaker 1: Uh.

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Speaker 4: But and they you know, they explore other things as

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Speaker 4: well on the show. You know, various social issues come up,

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Speaker 4: eugenics comes up, you know, all sorts of things of

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Speaker 4: this nature. But anyway, Simple Device's findings were apparently better

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Speaker 4: received in some countries than compared to others, the UK

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Speaker 4: and Germany being too though. That's interesting because we'll come

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Speaker 4: back to Germany as sort of a center of discussion

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Speaker 4: over the best practices and best use of new medical

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Speaker 4: findings and technology. But on the whole, there was a

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Speaker 4: lot of criticism of his ideas, and a lot of

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Speaker 4: his efforts ended up in antagonism. His critics attacked him,

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Speaker 4: he attacked back. It apparently got pretty ugly, at least

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Speaker 4: from an academic standpoint, and his mental health declined greatly

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Speaker 4: and he eventually died in an asylum. So it's often

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Speaker 4: characterized as being, you know, this effort where he's kind

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Speaker 4: of up against the wall. Maybe didn't have what, maybe

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Speaker 4: wasn't the ideal person to be making these arguments, Like

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Speaker 4: maybe it could have been a better pr campaign for

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Speaker 4: some of these ideas, but what can you do?

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Speaker 2: Well, Yeah, I think a lot of the hygienic concerns

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Speaker 2: about medical interventions and especially surgery would get more traction

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Speaker 2: in the eighteen sixties with Joseph Lister.

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Speaker 4: Yeah, Joseph Lister definitely a big one. I mean, there

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Speaker 4: are various individuals that are working during this time cracking

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Speaker 4: our understanding of the unseen and what we should do

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Speaker 4: about it. And of course you have to acknowledge the

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Speaker 4: work of Louis Pastur. Now there's but Yeah, Joseph Lister

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Speaker 4: was a big name. Eighteen twenty seven through nineteen twelve,

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Speaker 4: he introduced the concept of surgical asepsis, the absence of

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Speaker 4: all microorganisms within any type of invasive procedure. His work

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Speaker 4: alone was associated, according to Smith at All, with a

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Speaker 4: decrease in post amputation mortality rates from forty five percent

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Speaker 4: to fifteen percent. And he also cut down on the

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Speaker 4: necessity for amputation. That was one of the big things

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Speaker 4: he was going after two Like, he was saying, it

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Speaker 4: would just won't be necessary to amputate this many limbs

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Speaker 4: because because we'll be using cleaner tools, etc. He argued

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Speaker 4: for the necessity of pre operative hand washing and the

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Speaker 4: use of disinfectant soaked wound dressings.

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Speaker 2: Yeah, I think lister especially is known to highlight a

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Speaker 2: distinction we'll get to in a little bit, the distinction

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Speaker 2: between asepsis and anti sepsis, with pioneering the anti sepsis trend,

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Speaker 2: which is the attempt to sterilize the wound itself to

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Speaker 2: prevent infection. So this would typically mean using a disinfectant

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Speaker 2: chemical such as carbolic acid in and around a wound.

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Speaker 4: Yeah, and also dressings surgical tools. He stress that you

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Speaker 4: should change dressings on wounds regularly.

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Speaker 2: Yeah.

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Speaker 4: And again, before lister here and infection were just considered

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Speaker 4: part of the healing process. It wasn't. It wasn't necessarily

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Speaker 4: thought that this means things are not going to according

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Speaker 4: to plan. It just means like this is what happens

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Speaker 4: when the body heals from a wound, all right. So

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Speaker 4: getting into more into the realm of early surgical gloves,

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Speaker 4: early medical glove concepts, and the struggle for their acceptance.

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Speaker 4: William Halstead introduced rubber gloves for use in surgery by

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Speaker 4: around eighteen ninety, and by nineteen hundred we see more

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Speaker 4: and more doctors wearing gowns, masks, and gloves. But the

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Speaker 4: use of gloves especially is certainly not instantly accepted by

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Speaker 4: the medical community to come back to the nick for example,

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Speaker 4: which which again I think does a pretty great job

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Speaker 4: of depicting this time period. If you go back and

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Speaker 4: watch any of this show, and I did certainly didn't

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Speaker 4: have a chance to go back and watch all of it,

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Speaker 4: but you pretty much don't see surgical gloves at all.

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Speaker 4: There are just lots of scenes of surgeons who again

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Speaker 4: are at the bleeding edge of technology and innovation at

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Speaker 4: the time, but they are reaching into people's bodies with

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Speaker 4: bare hands. They are opening up people's craniums with bare hands,

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Speaker 4: and just every other part of the anatomy as well

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Speaker 4: lots of shots of white linens and blood soaked hands

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Speaker 4: now on the show. There are also frequent scenes of surgeons, though,

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Speaker 4: going through a series of hand washings before surgery, sometimes

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Speaker 4: while engaging in dialogue with each other. But I remember

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Speaker 4: being particularly taken by at least one scene in which

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Speaker 4: there's kind of a beautiful feeling of almost spiritual ritual

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Speaker 4: to the thing of the surgeon washing and lowering their

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Speaker 4: hands and forearms first into one vat, then into a

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Speaker 4: second vat, and then into a third vat. Like again,

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Speaker 4: it has kind of an almost magical feeling to it.

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Speaker 4: And so I was reading a little bit about about

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Speaker 4: this time period here for this episode, and based on

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Speaker 4: my readings of why were surgical gloves not used earlier

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Speaker 4: by Thomas Schlitch, I believe this is the three VAT

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Speaker 4: system standardized in Berlin in eighteen eighty eight by Paul Fubringer.

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Speaker 4: First soap, then alcohol, and then finally an antiseptic substance.

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Speaker 2: Yeah, that three stage process was very common by the

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Speaker 2: eighteen nineties.

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Speaker 4: And again it's great, it's a wonderful advanced in surgery

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Speaker 4: of the time, but of course it falls just a

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Speaker 4: little short of actually using gloves, of actually embracing the

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Speaker 4: standard that now again we just accept when we go

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Speaker 4: into a medical facility. So the three VAT systems coming

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Speaker 4: out of Germany. Germany is also where we see a

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Speaker 4: great deal of argument during this period about whether surgeons

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Speaker 4: should have to wear surgical gloves at all. And I

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Speaker 4: think the first place that I was reading about this,

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Speaker 4: there was a j Store Daily article that came out

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Speaker 4: from this is by jess Romeo in July of twenty twenty,

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Speaker 4: when obviously a lot of this sort of thing was

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Speaker 4: going going on in our heads. And there's all the

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Speaker 4: obvious parallels between the treatment here of gloves and consideration

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Speaker 4: of things like certainly hand washing, but also the use

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Speaker 4: of mass The article was the surgeons who said no

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Speaker 4: to gloves, And the article from Romeo is citing another article,

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Speaker 4: a source article by Thomas Schlitch who he just referenced,

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Speaker 4: titled Negotiating Technologies in Surgery the controversy about surgical gloves

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Speaker 4: in the eighteen nineties, and this was a twenty thirteen

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Speaker 4: article from the Bulletin of the History of Medicine.

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Speaker 2: Yeah, this Bulletin of History of Medicine article is interesting.

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Speaker 2: So the author here, Thomas Schlick, is a German Canadian

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Speaker 2: historian of medicine who's on faculty at McGill University in Montreal.

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Speaker 2: And Schlick begins his article by illustrating a really strange

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Speaker 2: moment from the history of surgery where there was so

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Speaker 2: there was this big conference in eighteen ninety eight. It

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Speaker 2: was the twenty seventh Congress of the German Society for Surgery,

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Speaker 2: and Schlick quotes a report on this meeting by an

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Speaker 2: Austrian surgeon named Alexander Frankel, who was just perplexed by

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Speaker 2: some of what was going on, because a big subject

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Speaker 2: of conversation for one whole afternoon at this conference for

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Speaker 2: surgeons was about gloves. It was about surgical gloves, whether

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Speaker 2: or not you should use them, and what types of

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Speaker 2: gloves are best. And Frankel, reacting to this whole discussion,

400
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Speaker 2: says quote, for a whole afternoon, participants discussed about the

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Speaker 2: best glove models, marching up all the various specimens made

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Speaker 2: from different materials in all sizes and price ranges. Allas

403
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Speaker 2: Sarah Bernhardt referring to like a French actress and whatever

404
00:23:31,200 --> 00:23:34,720
Speaker 2: the fashionable designs might be called, a whole apparatus of

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Speaker 2: pseudoscience was mobilized to inaugurate the new fashion of the

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Speaker 2: surgeon in gloves. So Frankel here is a respected, influential

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Speaker 2: surgeon of the time, how can it be that he

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Speaker 2: viewed the idea of surgical gloves as absolutely ridiculous pseudoscientific pageantry.

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Speaker 2: Akin to I think the comparison to Sarah Bernhardt here

410
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Speaker 2: is he's saying it's like a gaudy fashion show.

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Speaker 4: Yeah. Yeah, he compares it to just pure costuming. It's like,

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Speaker 4: this is just a costume that these doctors are putting

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Speaker 4: on that there's no real medical rationale for this.

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Speaker 2: Now today, it's natural for us to look back on

415
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Speaker 2: this view as not only misguided but absolutely baffling. But

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Speaker 2: it's true that even after the idea of using some

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Speaker 2: kind of impermeable sterile glove for surgery was introduced, it

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Speaker 2: took more than a decade of sort of debate within

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Speaker 2: the medical community before it achieved what could be considered

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Speaker 2: near universal acceptance. And this article by Schlick explores the

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Speaker 2: historical discussion and controversy about the introduction of surgical gloves,

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Speaker 2: specifically in German speaking hospitals in the eighteen nineties. So

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Speaker 2: the question is why did most surgeons hesitate for so

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Speaker 2: long before adopting the use of surgical gloves, even after

425
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Speaker 2: we had a bacterial theory of disease and infection. And actually,

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Speaker 2: once you see all their concerns lay doubt, the objections

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Speaker 2: to people who resisted the gloves at the time seem

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Speaker 2: a little bit less baffling. It actually makes more sense

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Speaker 2: of them when you understand what the understanding was at

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Speaker 2: the time and what the pressures on surgeons for performing

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Speaker 2: in the operating room were.

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Speaker 4: Yeah, I think this is one of the great things

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Speaker 4: he does in the paper is really presents this this

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Speaker 4: idea because it's easy to think about this and sort

435
00:25:27,080 --> 00:25:31,160
Speaker 4: of look at the surface level of this new technology

436
00:25:31,240 --> 00:25:35,240
Speaker 4: and its eventual adoption and just look at it as Okay,

437
00:25:35,280 --> 00:25:37,600
Speaker 4: well here's the new way, and everybody else must have

438
00:25:37,640 --> 00:25:38,919
Speaker 4: been saying, oh, I just want to do it the

439
00:25:38,960 --> 00:25:41,639
Speaker 4: old way, where it was really more a situation where

440
00:25:41,920 --> 00:25:44,360
Speaker 4: there was the old ways and then there were all

441
00:25:44,359 --> 00:25:48,920
Speaker 4: these new exciting ways that were all ultimately trying to

442
00:25:49,440 --> 00:25:53,840
Speaker 4: crack the same nut to try to improve the mortality

443
00:25:53,920 --> 00:25:59,280
Speaker 4: rates for various procedures. And also he seems to stress

444
00:25:59,280 --> 00:26:01,800
Speaker 4: that you know, weuld we can't really go into these

445
00:26:02,000 --> 00:26:05,520
Speaker 4: situations sort of with a wrong side of history viewpoint

446
00:26:05,520 --> 00:26:09,800
Speaker 4: of the past. You know, generally in the present, if

447
00:26:09,800 --> 00:26:12,359
Speaker 4: you're presented with different ideas, the ones that are the

448
00:26:12,359 --> 00:26:15,159
Speaker 4: wrong side of history are not labeled, so you know,

449
00:26:15,640 --> 00:26:17,399
Speaker 4: you don't know that this is not going to be

450
00:26:17,400 --> 00:26:19,719
Speaker 4: you know that you're on the ultimately on the losing

451
00:26:19,760 --> 00:26:24,840
Speaker 4: hill here when you're advocating that medical gloves should not

452
00:26:24,920 --> 00:26:26,520
Speaker 4: be used universally, well.

453
00:26:26,440 --> 00:26:28,159
Speaker 2: Yeah, this is what I was talking about earlier with

454
00:26:28,240 --> 00:26:30,639
Speaker 2: like the uncertainty of the present, and you always have

455
00:26:30,680 --> 00:26:33,440
Speaker 2: to remember that in the past they were just as

456
00:26:33,640 --> 00:26:36,640
Speaker 2: uncertain about what the future would be as we are

457
00:26:36,720 --> 00:26:39,400
Speaker 2: about our own future in the present right.

458
00:26:39,600 --> 00:26:42,399
Speaker 4: And one thing he stresses here is that these surgeons,

459
00:26:42,640 --> 00:26:45,119
Speaker 4: often big name surgeons that were engaging in this debate,

460
00:26:45,440 --> 00:26:48,520
Speaker 4: a lot of them had their own ideas, their own techniques,

461
00:26:49,040 --> 00:26:51,439
Speaker 4: and in many cases they had they had data to

462
00:26:51,440 --> 00:26:54,600
Speaker 4: back up what they were arguing. Like there's there's one

463
00:26:54,640 --> 00:26:59,120
Speaker 4: guy that he mentioned, surgeon Thomas Spencer Wells, who advocated

464
00:26:59,320 --> 00:27:02,879
Speaker 4: the cleanliness cold water school as opposed to and embracing

465
00:27:02,920 --> 00:27:05,439
Speaker 4: Lister's ideas. So this is more in general about like

466
00:27:05,800 --> 00:27:09,560
Speaker 4: hand washing and cleansing of instruments, boiling of instruments, et cetera,

467
00:27:09,600 --> 00:27:12,200
Speaker 4: as opposed to gloves. But this was a guy that

468
00:27:13,320 --> 00:27:18,200
Speaker 4: still had a minimal complication rate, and therefore he had

469
00:27:18,440 --> 00:27:22,240
Speaker 4: some data to back up his viewpoint. So he had

470
00:27:22,400 --> 00:27:25,760
Speaker 4: he wasn't just standing on a hill without any reason

471
00:27:26,720 --> 00:27:29,320
Speaker 4: to make his argument. He had seen what seemed at

472
00:27:29,320 --> 00:27:31,840
Speaker 4: the time like a reasonable argument, like saying, look, look

473
00:27:32,000 --> 00:27:33,919
Speaker 4: what I'm doing seems to be working, and I have

474
00:27:33,960 --> 00:27:35,000
Speaker 4: the data to back it up.

475
00:27:35,440 --> 00:27:37,080
Speaker 2: Yes, And wells would not be the only one. There

476
00:27:37,119 --> 00:27:40,160
Speaker 2: are even people making the case at this eighteen ninety

477
00:27:40,200 --> 00:27:44,880
Speaker 2: eight Congress of German Society for Surgery who were saying, look,

478
00:27:44,920 --> 00:27:48,520
Speaker 2: I've done laboratory research that shows that you get way

479
00:27:48,560 --> 00:27:53,880
Speaker 2: more bacterial penetration of these blood soaked cotton gloves than

480
00:27:53,920 --> 00:27:59,320
Speaker 2: you do of bare hands. So actually you don't need gloves,

481
00:27:59,320 --> 00:28:00,479
Speaker 2: you just need clean hands.

482
00:28:00,800 --> 00:28:05,280
Speaker 4: Yeah. Another name you mentioned is Johannes Mikkelish who who

483
00:28:05,440 --> 00:28:09,040
Speaker 4: argue that we should be using this preoperative injection of

484
00:28:09,119 --> 00:28:13,320
Speaker 4: nucleic acid to supposedly increase white blood cell count and

485
00:28:13,600 --> 00:28:16,600
Speaker 4: boost immune response. So so again it comes back to

486
00:28:16,600 --> 00:28:18,639
Speaker 4: the idea that it's not just the old ideas and

487
00:28:18,720 --> 00:28:21,760
Speaker 4: the new this one new idea. No, there are these

488
00:28:21,800 --> 00:28:25,480
Speaker 4: other seemingly promising new ideas and new technologies that are

489
00:28:25,480 --> 00:28:26,680
Speaker 4: also suddenly available.

490
00:28:26,880 --> 00:28:29,480
Speaker 2: Oh that's interesting, And you get these from both sides

491
00:28:29,520 --> 00:28:32,359
Speaker 2: about the different solutions, because Mikolch here was one of

492
00:28:32,400 --> 00:28:36,200
Speaker 2: the major proponents of gloves at this at this conference,

493
00:28:36,240 --> 00:28:38,960
Speaker 2: he was there representing the yes gloves or good side.

494
00:28:39,920 --> 00:28:42,840
Speaker 4: Interesting. Yeah, but then he also has his other thing

495
00:28:43,200 --> 00:28:46,920
Speaker 4: as well, that you could conceivably you're a surgeon you're

496
00:28:46,960 --> 00:28:49,560
Speaker 4: listening to all these ideas, you can imagine where you

497
00:28:49,640 --> 00:28:52,120
Speaker 4: might be like, well, this Johannes seems to have a

498
00:28:52,160 --> 00:28:55,120
Speaker 4: great technology here. Maybe I can cherry pick a little bit.

499
00:28:55,520 --> 00:28:59,040
Speaker 4: Maybe I can sort of hold onto my own reservations

500
00:28:59,080 --> 00:29:03,080
Speaker 4: about gloves and just start using this nucleic acid treatment

501
00:29:04,160 --> 00:29:06,720
Speaker 4: that has been proposed. So, yeah, there are a lot

502
00:29:06,720 --> 00:29:09,560
Speaker 4: of ideas on the table, and again it seems like

503
00:29:09,600 --> 00:29:11,680
Speaker 4: each surgeon had their own ideas and techniques.

504
00:29:12,080 --> 00:29:15,520
Speaker 2: Yeah, that's another point Schlick actually really highlights in this paper,

505
00:29:16,120 --> 00:29:20,000
Speaker 2: which is that, you know, sometimes we have a tendency

506
00:29:20,040 --> 00:29:24,720
Speaker 2: to erroneously look at the history of progress in medicine

507
00:29:25,240 --> 00:29:29,160
Speaker 2: as a kind of unified, top down effort where there's

508
00:29:29,240 --> 00:29:32,000
Speaker 2: just like, okay here, you know, almost like there is

509
00:29:32,040 --> 00:29:36,320
Speaker 2: a sort of a board of medicine that like controls

510
00:29:36,400 --> 00:29:39,600
Speaker 2: all of medicine throughout history and they direct the flow

511
00:29:40,280 --> 00:29:44,400
Speaker 2: of development and progress. But in fact, the way Schlick

512
00:29:44,440 --> 00:29:48,680
Speaker 2: frames it is, you know, medicine is just full of individual,

513
00:29:49,160 --> 00:29:54,240
Speaker 2: little practical solutions to problems, especially in the eighteen nineties here,

514
00:29:54,560 --> 00:29:57,160
Speaker 2: and over time some prove better than others.

515
00:29:57,680 --> 00:30:00,280
Speaker 4: Now, another thing we have to mention here is, of

516
00:30:00,320 --> 00:30:03,600
Speaker 4: course what we're talking about when it comes to materials

517
00:30:03,640 --> 00:30:05,360
Speaker 4: and what we were talking we were talking about with

518
00:30:05,400 --> 00:30:08,800
Speaker 4: the physical gloves of the time, this would not have

519
00:30:08,800 --> 00:30:12,560
Speaker 4: been a situation where like, we're dealing with modern medical

520
00:30:12,560 --> 00:30:17,680
Speaker 4: gloves that are suddenly presented to an audience at this

521
00:30:17,680 --> 00:30:21,360
Speaker 4: this gathering. It made me think of a recent episode

522
00:30:21,480 --> 00:30:24,240
Speaker 4: of the nineties Outer Limits that I watched. If the

523
00:30:24,280 --> 00:30:28,880
Speaker 4: episode is titled Gettysburg. It stars Meatloaf and it also

524
00:30:28,960 --> 00:30:31,320
Speaker 4: has the guy who played the crazy man on the

525
00:30:31,360 --> 00:30:34,800
Speaker 4: boat in Jason Takes Manhattan, and it does involve time

526
00:30:34,880 --> 00:30:39,000
Speaker 4: travel with Civil War reenactors who are sent back in

527
00:30:39,080 --> 00:30:41,640
Speaker 4: time to the Battle of Gettysburg, and one of them

528
00:30:42,040 --> 00:30:45,400
Speaker 4: is like a medical responder and has a medkit, and

529
00:30:45,440 --> 00:30:48,160
Speaker 4: so there's a great scene where he's he's he's doing

530
00:30:48,200 --> 00:30:53,040
Speaker 4: some some medical intervention on a wounded soldier, and Meatloaf's character,

531
00:30:53,160 --> 00:30:56,640
Speaker 4: who's a Civil War era I like to forget what

532
00:30:56,680 --> 00:30:59,440
Speaker 4: he is if he's a oh, he's a colonel. He's

533
00:30:59,480 --> 00:31:02,400
Speaker 4: watching and he doesn't seem to think anything about these

534
00:31:02,440 --> 00:31:07,080
Speaker 4: modern medical devices and gloves that are being used by

535
00:31:07,080 --> 00:31:11,920
Speaker 4: this guy. So that's kind of a tangent, But it

536
00:31:11,960 --> 00:31:14,000
Speaker 4: was weighing heavily on my mind as I researched this.

537
00:31:14,360 --> 00:31:15,920
Speaker 2: Well, to be fair to meet loaf, I mean, if

538
00:31:15,960 --> 00:31:18,000
Speaker 2: I look at a modern surgery, I'd see a lot

539
00:31:18,040 --> 00:31:19,840
Speaker 2: of stuff. I don't know what I'm looking at, and

540
00:31:19,960 --> 00:31:21,880
Speaker 2: it's there's no time travel involved.

541
00:31:22,080 --> 00:31:25,080
Speaker 4: Yeah, so these would not have been modern medical gloves

542
00:31:25,080 --> 00:31:29,360
Speaker 4: that they were considering here. The author mentions several of

543
00:31:29,400 --> 00:31:33,520
Speaker 4: the different designs that were presented at this conference that

544
00:31:33,600 --> 00:31:37,680
Speaker 4: included elbow length fabric gloves of cotton or silk, and

545
00:31:37,720 --> 00:31:39,680
Speaker 4: of course if you were to use these during an operation,

546
00:31:39,760 --> 00:31:42,960
Speaker 4: they would apparently quickly become soaked with blood. There was

547
00:31:43,000 --> 00:31:47,480
Speaker 4: also the idea of using leather style military gloves, and

548
00:31:47,520 --> 00:31:50,240
Speaker 4: these would have, of course been clumsy to use. Wax

549
00:31:50,280 --> 00:31:53,480
Speaker 4: treated fabric was another idea, and ooh, I was really

550
00:31:53,880 --> 00:31:57,320
Speaker 4: this one really captured my attention, The idea of wax

551
00:31:57,360 --> 00:32:01,800
Speaker 4: poured directly over the surgeon's hands to form a supposed

552
00:32:01,880 --> 00:32:04,640
Speaker 4: seal between the flesh and the operation.

553
00:32:05,000 --> 00:32:08,120
Speaker 2: Yeah, and the actual paper Schlick talks, he mentions this

554
00:32:08,280 --> 00:32:10,959
Speaker 2: as a proposal, but I didn't get the impression anybody

555
00:32:11,000 --> 00:32:14,200
Speaker 2: ever did it, or at least not. Yeah, didn't like

556
00:32:14,280 --> 00:32:16,040
Speaker 2: put it into regular practice.

557
00:32:16,480 --> 00:32:18,960
Speaker 4: Yeah, I have trouble imagining how it would work right,

558
00:32:19,040 --> 00:32:23,600
Speaker 4: because if the wax was sealed around the hand, and

559
00:32:23,600 --> 00:32:25,760
Speaker 4: if you go with the right wax, that of course

560
00:32:25,800 --> 00:32:31,120
Speaker 4: wouldn't be just absolutely scalding to the flesh, then it

561
00:32:31,120 --> 00:32:34,560
Speaker 4: would truly become brittle upon trying to move your hand around.

562
00:32:34,840 --> 00:32:37,000
Speaker 2: Yeah, I don't know. It doesn't make a lot of

563
00:32:37,000 --> 00:32:40,320
Speaker 2: sense to me, though. I'm also confused about the wax treated.

564
00:32:40,400 --> 00:32:43,080
Speaker 2: I mean, I can get into more detail about this later,

565
00:32:43,120 --> 00:32:45,920
Speaker 2: but one of the proposals is for like a silk

566
00:32:46,120 --> 00:32:50,120
Speaker 2: glove that you would cover in liquid wax, and that

567
00:32:50,160 --> 00:32:55,560
Speaker 2: would help make the silk fabric more impermeable. But I

568
00:32:55,560 --> 00:32:57,840
Speaker 2: would also think, like, wouldn't that get kind of brittle?

569
00:32:58,080 --> 00:32:58,520
Speaker 2: I don't know.

570
00:32:58,680 --> 00:33:00,600
Speaker 4: Yeah, it was like it would be flaying off and

571
00:33:00,640 --> 00:33:03,920
Speaker 4: you'd have like little bits of wax. I mean, Fortunately,

572
00:33:04,120 --> 00:33:06,240
Speaker 4: as we've pointed out before in the show, like wax

573
00:33:06,280 --> 00:33:10,600
Speaker 4: has long been used and so has honey in various

574
00:33:10,920 --> 00:33:13,480
Speaker 4: medical treatments. So it's not the worst thing, I guess

575
00:33:13,560 --> 00:33:17,440
Speaker 4: to have in a wound, but it's you want to

576
00:33:17,480 --> 00:33:20,680
Speaker 4: cut down on the amount of external substances that are

577
00:33:20,720 --> 00:33:23,640
Speaker 4: introduced to a body cavity during a procedure like this.

578
00:33:25,120 --> 00:33:27,120
Speaker 4: I don't know about you, but another detail I really

579
00:33:27,160 --> 00:33:32,880
Speaker 4: liked in Schlich's article was this bit quote. Another strategy,

580
00:33:32,960 --> 00:33:36,280
Speaker 4: and this is an alternative to gloves, involved keeping one's

581
00:33:36,280 --> 00:33:40,720
Speaker 4: hands clean between operations and abstaining from handling infectious materials

582
00:33:40,960 --> 00:33:43,840
Speaker 4: even when not on the job, an approach that in

583
00:33:43,880 --> 00:33:47,280
Speaker 4: some cases amounted to a whole regime of living. Which

584
00:33:48,520 --> 00:33:50,880
Speaker 4: this is easy to sort of think of almost comedically,

585
00:33:50,920 --> 00:33:53,520
Speaker 4: where you can imagine the surgeon saying, well, I'm of

586
00:33:53,560 --> 00:33:55,560
Speaker 4: course I'm not going to wear gloves during a procedure.

587
00:33:56,360 --> 00:33:58,600
Speaker 4: It gets in the way. I have some issues with

588
00:33:59,520 --> 00:34:02,320
Speaker 4: how high it is. What I'm gonna do is I'm

589
00:34:02,320 --> 00:34:05,000
Speaker 4: going to wear gloves the rest of the time when

590
00:34:05,040 --> 00:34:08,680
Speaker 4: I'm not in the surgery, and therefore keep my hands

591
00:34:08,800 --> 00:34:11,280
Speaker 4: nice and clean and ready to just get in there.

592
00:34:11,640 --> 00:34:13,960
Speaker 2: There. You almost it's like you become sort of part

593
00:34:14,000 --> 00:34:17,920
Speaker 2: of a priestly class. You must maintain purity for all time.

594
00:34:19,080 --> 00:34:21,400
Speaker 4: Yeah, I mean, it's like these are the money makers, right,

595
00:34:21,680 --> 00:34:23,760
Speaker 4: I have to keep the gloves on them at all times.

596
00:34:24,000 --> 00:34:28,080
Speaker 2: That these hands are registered with the FBI as lethal weapons,

597
00:34:28,200 --> 00:34:30,560
Speaker 2: because I don't wash them before I operate.

598
00:34:32,160 --> 00:34:36,040
Speaker 4: Now, he points out that the material challenges here came

599
00:34:36,160 --> 00:34:38,760
Speaker 4: down to the following and these I think were pointed

600
00:34:38,760 --> 00:34:42,440
Speaker 4: out by Sergeant Anton Wolfer at the time. They needed

601
00:34:42,480 --> 00:34:47,359
Speaker 4: to be impermeable, obviously, they needed to be flexible, They

602
00:34:47,360 --> 00:34:50,839
Speaker 4: needed to be resistant to tears. They couldn't be too tight,

603
00:34:51,480 --> 00:34:54,839
Speaker 4: they couldn't be too hot. And above all else they

604
00:34:54,880 --> 00:34:57,440
Speaker 4: had to be you had to be able to sterilize them.

605
00:34:57,480 --> 00:35:00,239
Speaker 2: They had to be sterilizable, right, meaning you could like

606
00:35:00,640 --> 00:35:03,520
Speaker 2: boil them or steam them or something to kill any

607
00:35:03,800 --> 00:35:06,319
Speaker 2: thing that might be on them without damaging them so

608
00:35:06,400 --> 00:35:07,520
Speaker 2: that they couldn't be used.

609
00:35:08,160 --> 00:35:12,440
Speaker 4: Right. And so given all of these demands of the materials,

610
00:35:13,480 --> 00:35:15,960
Speaker 4: it shouldn't come as a surprise that the first surgical

611
00:35:16,000 --> 00:35:18,640
Speaker 4: gloves that were presented here they were not perfect. They

612
00:35:18,680 --> 00:35:23,600
Speaker 4: did tear, They did make aspects of surgery, particularly gripping

613
00:35:23,719 --> 00:35:27,120
Speaker 4: certain tools or certain parts of the human anatomy more difficult.

614
00:35:27,200 --> 00:35:31,000
Speaker 4: I think the manipulation of bowels is singled out as

615
00:35:31,040 --> 00:35:33,480
Speaker 4: being difficult with some of the gloves of this time period.

616
00:35:34,719 --> 00:35:37,360
Speaker 4: But on the other hand, it does certainly in the

617
00:35:37,400 --> 00:35:40,080
Speaker 4: long term they did make a difference in the spread

618
00:35:40,120 --> 00:35:42,280
Speaker 4: of pathogens through surgical procedure.

619
00:35:42,560 --> 00:35:44,759
Speaker 2: Oh yeah, so I think by around the time of

620
00:35:44,880 --> 00:35:48,440
Speaker 2: World War One, it's generally agreed that's when you are

621
00:35:48,480 --> 00:35:51,839
Speaker 2: seeing Okay, now we have pretty much universal acceptance that

622
00:35:51,960 --> 00:35:56,200
Speaker 2: impermeable sterile gloves are good for surgery and they should

623
00:35:56,280 --> 00:35:57,800
Speaker 2: be used if at all possible.

624
00:35:58,120 --> 00:36:00,840
Speaker 4: I can't help but think of media and this as well,

625
00:36:00,880 --> 00:36:05,560
Speaker 4: like cinematic depictions of doctors, like now, like the image

626
00:36:05,560 --> 00:36:08,319
Speaker 4: of a doctor, be of them a good doctor or

627
00:36:08,320 --> 00:36:11,319
Speaker 4: a mad scientist or something. The taking off or the

628
00:36:11,360 --> 00:36:14,439
Speaker 4: putting on of surgical gloves or medical gloves at some point,

629
00:36:14,760 --> 00:36:18,840
Speaker 4: some form or another, it is kind of associated with

630
00:36:19,120 --> 00:36:24,200
Speaker 4: power and ability. You know, there's there's something about it

631
00:36:24,239 --> 00:36:26,879
Speaker 4: that like we don't even even doubt doubt. Not only

632
00:36:26,880 --> 00:36:29,319
Speaker 4: do we not doubt the importance of gloves, but they

633
00:36:29,320 --> 00:36:33,080
Speaker 4: have kind of become associated with these roles, Like it's

634
00:36:33,120 --> 00:36:34,960
Speaker 4: hard to separate the two, and you wouldn't want to

635
00:36:35,000 --> 00:36:35,799
Speaker 4: separate the two.

636
00:36:36,160 --> 00:36:39,720
Speaker 2: There's a there's a strong audio visual cue used in media,

637
00:36:39,760 --> 00:36:42,120
Speaker 2: which is much in the same way you have like

638
00:36:42,160 --> 00:36:45,080
Speaker 2: an action movie where a gritty action scene is about

639
00:36:45,080 --> 00:36:47,480
Speaker 2: to commence, so you get the pump of the shotgun.

640
00:36:47,960 --> 00:36:50,040
Speaker 2: In the medical scene, you get the snap of the

641
00:36:50,120 --> 00:36:52,600
Speaker 2: rubber glove. It's almost exactly the same.

642
00:36:52,400 --> 00:36:55,560
Speaker 4: Thing, right, I mean it's enough to where if you

643
00:36:55,560 --> 00:37:00,600
Speaker 4: were given the choice between two fraudulent pseudoscientific healers and

644
00:37:00,640 --> 00:37:01,880
Speaker 4: they were going to work on you, and one is

645
00:37:01,960 --> 00:37:04,360
Speaker 4: using bear hands and one is using gloves, like the

646
00:37:04,400 --> 00:37:08,360
Speaker 4: mere presence of the gloves could potentially legitimize it a

647
00:37:08,400 --> 00:37:09,320
Speaker 4: little bit in your eyes.

648
00:37:09,400 --> 00:37:12,040
Speaker 2: You know, Wait, no, beb did you mean bear hands

649
00:37:12,120 --> 00:37:13,720
Speaker 2: or B E A R hands?

650
00:37:14,160 --> 00:37:16,359
Speaker 4: Oh well I meant I meant B A R E.

651
00:37:16,560 --> 00:37:20,680
Speaker 4: But B E R That brings on an entirely different vision, right,

652
00:37:20,719 --> 00:37:22,920
Speaker 4: I mean that's then you're in the realm of the shaman.

653
00:37:23,280 --> 00:37:25,000
Speaker 2: I would go with I would go with the quack

654
00:37:25,080 --> 00:37:28,120
Speaker 2: that had bear paws over the quack that just had gloves.

655
00:37:28,480 --> 00:37:30,480
Speaker 4: Or what if the the what if the quack had

656
00:37:30,520 --> 00:37:34,440
Speaker 4: both a bear head on over their own head, but

657
00:37:34,560 --> 00:37:35,680
Speaker 4: they had medical gloves on.

658
00:37:36,160 --> 00:37:39,400
Speaker 2: What if they operated on you wearing the bear costume

659
00:37:39,560 --> 00:37:40,640
Speaker 2: from Jack Frost?

660
00:37:40,840 --> 00:37:47,799
Speaker 4: There you go?

661
00:37:48,560 --> 00:37:50,160
Speaker 2: All right? Well, I wanted to come back to that

662
00:37:50,640 --> 00:37:53,800
Speaker 2: Thomas Schlick paper in the Bulletin of the History of Medicine,

663
00:37:53,800 --> 00:37:56,799
Speaker 2: the one called negotiating Technologies and surgery. That was all

664
00:37:56,840 --> 00:38:01,440
Speaker 2: about the controversy over surgical gloves in German speaking hospitals

665
00:38:01,440 --> 00:38:04,920
Speaker 2: in the eighteen nineties. And as I mentioned earlier, the

666
00:38:04,920 --> 00:38:10,600
Speaker 2: Shlick paper is interesting because it frames the good things

667
00:38:10,600 --> 00:38:14,120
Speaker 2: about gloves as a sort of you know, existing within

668
00:38:14,160 --> 00:38:18,399
Speaker 2: a network of trade offs and talking about it as

669
00:38:18,560 --> 00:38:23,400
Speaker 2: one of the types of what Slick calls control strategies

670
00:38:24,080 --> 00:38:27,279
Speaker 2: within surgery at the time, and control strategies that were many,

671
00:38:27,360 --> 00:38:37,160
Speaker 2: but they included things like different instruments, lights and operating tables, anatomy, atlases, anesthetics,

672
00:38:37,600 --> 00:38:41,680
Speaker 2: and of course technologies of a sepsis. Now I mentioned

673
00:38:41,719 --> 00:38:45,719
Speaker 2: earlier the difference between a sepsis and anti sepsis, and

674
00:38:45,760 --> 00:38:50,000
Speaker 2: this is an important concept in the development of surgery

675
00:38:50,040 --> 00:38:52,920
Speaker 2: in the second half of the nineteenth century. So you've

676
00:38:52,920 --> 00:38:55,799
Speaker 2: got two schools of thought that are in competition. One

677
00:38:55,840 --> 00:38:58,719
Speaker 2: is anti sepsis, which is the idea of disinfecting a

678
00:38:58,760 --> 00:39:02,200
Speaker 2: wound after germs have likely been introduced. And then you've

679
00:39:02,200 --> 00:39:05,720
Speaker 2: got acepsis, which is instead trying to prevent any germs

680
00:39:05,760 --> 00:39:09,000
Speaker 2: from ever entering the wound in the first place. And

681
00:39:09,120 --> 00:39:11,279
Speaker 2: the primary method here would be trying to make all

682
00:39:11,320 --> 00:39:16,120
Speaker 2: instruments and objects in the surgical environments sterile before surgery begins,

683
00:39:16,120 --> 00:39:19,440
Speaker 2: so you'd boil your scalpels and so forth. But Schlick

684
00:39:19,600 --> 00:39:23,600
Speaker 2: describes a growing nervousness among surgeons in the eighteen nineties

685
00:39:23,680 --> 00:39:28,919
Speaker 2: based on the general feeling that raining aseptic practices were

686
00:39:28,960 --> 00:39:33,600
Speaker 2: not good enough. By the eighteen nineties, surgeons in German

687
00:39:33,640 --> 00:39:37,879
Speaker 2: speaking hospitals were aware of the bacteriological problems. They were

688
00:39:38,000 --> 00:39:40,239
Speaker 2: trying to be a septic however they could. They were

689
00:39:40,360 --> 00:39:42,840
Speaker 2: washing their hands and going through all these procedures we

690
00:39:42,920 --> 00:39:46,800
Speaker 2: talked about, but they were just aware that the current

691
00:39:46,800 --> 00:39:49,960
Speaker 2: methods were not preventing all infection. Acepsis had to be

692
00:39:50,320 --> 00:39:53,680
Speaker 2: They what they thought of as an all or nothing campaign.

693
00:39:54,400 --> 00:39:58,680
Speaker 2: And Schlick quotes an academic surgeon somebody who we've already referenced.

694
00:39:58,680 --> 00:40:01,920
Speaker 2: This was a guy at the University Breslau named Johannes

695
00:40:02,000 --> 00:40:06,760
Speaker 2: van Mikolch, and Mikolch wrote quote, the smallest mistaken wound

696
00:40:06,800 --> 00:40:11,000
Speaker 2: treatment would come back to haunt the surgeon. And Mikolch,

697
00:40:11,080 --> 00:40:14,960
Speaker 2: together with a collaborator named Carl Fluga, who lived eighteen

698
00:40:15,000 --> 00:40:18,560
Speaker 2: forty seven to nineteen twenty three, spent great effort in

699
00:40:18,600 --> 00:40:22,000
Speaker 2: the eighteen nineties trying to close the gaps, basically to

700
00:40:22,120 --> 00:40:25,880
Speaker 2: find ways that germs could still be getting in even

701
00:40:26,040 --> 00:40:30,680
Speaker 2: with the aseptic practices of the time. And so one

702
00:40:30,680 --> 00:40:33,200
Speaker 2: of the ideas they came up with was using face

703
00:40:33,280 --> 00:40:37,600
Speaker 2: masks to prevent droplet infection, so droplets from the doctor's

704
00:40:37,600 --> 00:40:41,840
Speaker 2: mouth or nose entering the wound and introducing germs during surgery.

705
00:40:42,320 --> 00:40:46,600
Speaker 2: And schlickwrites quote many of today's surgical paraphernalia were introduced

706
00:40:46,640 --> 00:40:50,720
Speaker 2: at the time as part of the bacteriologically supported search

707
00:40:50,840 --> 00:40:54,200
Speaker 2: for weak points in the aseptic all or nothing system

708
00:40:54,520 --> 00:40:58,480
Speaker 2: of preventing wound infection. It was the context of this

709
00:40:58,680 --> 00:41:02,400
Speaker 2: crisis of aseptics surgery that prompted a number of surgeons

710
00:41:02,440 --> 00:41:06,240
Speaker 2: in the eighteen nineties to simultaneously try out surgical gloves

711
00:41:06,280 --> 00:41:09,399
Speaker 2: within their local settings. Now, one of the next things

712
00:41:09,440 --> 00:41:11,680
Speaker 2: that Schlick talks about in this paper I thought was

713
00:41:11,800 --> 00:41:13,880
Speaker 2: very interesting is so if we're looking at German speaking

714
00:41:13,880 --> 00:41:17,160
Speaker 2: hospitals in the eighteen eighties and eighteen nineties, they're aware

715
00:41:17,239 --> 00:41:20,640
Speaker 2: of the fact that they need to improve aseptic practices

716
00:41:20,680 --> 00:41:23,360
Speaker 2: in surgery, but they don't know all the ways to

717
00:41:23,360 --> 00:41:26,560
Speaker 2: plug the holes and the use of surgical gloves is

718
00:41:26,680 --> 00:41:29,760
Speaker 2: obvious to us in retrospect, but it was not obvious

719
00:41:29,800 --> 00:41:33,080
Speaker 2: to everyone at this time and place, So why would

720
00:41:33,080 --> 00:41:36,160
Speaker 2: it not have been obvious to them. One thing Slick

721
00:41:36,239 --> 00:41:38,440
Speaker 2: points out is that, first of all, it just requires

722
00:41:38,520 --> 00:41:40,960
Speaker 2: thinking about gloves in a different way. Prior to this,

723
00:41:41,239 --> 00:41:44,879
Speaker 2: gloves were typically used to protect the person wearing them

724
00:41:45,400 --> 00:41:48,839
Speaker 2: rather than to protect someone from the person wearing them.

725
00:41:49,239 --> 00:41:51,600
Speaker 2: So it's kind of like having to just think outside

726
00:41:51,600 --> 00:41:55,719
Speaker 2: the box to reframe something that is already part of

727
00:41:55,760 --> 00:41:59,120
Speaker 2: your mundane existence. So imagine thinking that you would need

728
00:41:59,160 --> 00:42:03,200
Speaker 2: to wear a hat to protect someone else from your head.

729
00:42:03,640 --> 00:42:05,640
Speaker 2: It seems weird, but actually, if you think about it

730
00:42:05,640 --> 00:42:08,560
Speaker 2: in the right context, this is something that people do.

731
00:42:08,880 --> 00:42:11,799
Speaker 2: I've worked in restaurants where chefs were required to wear

732
00:42:11,840 --> 00:42:14,360
Speaker 2: either hats or hairnets to keep their hair out of

733
00:42:14,400 --> 00:42:17,239
Speaker 2: the food. If you're not familiar with the context like that,

734
00:42:17,480 --> 00:42:19,640
Speaker 2: it might never occur to you that you would wear

735
00:42:19,680 --> 00:42:23,680
Speaker 2: a hat for somebody else's benefit. But another thing that

736
00:42:24,040 --> 00:42:27,799
Speaker 2: Slick points out around here is that carbolic acid and

737
00:42:27,880 --> 00:42:31,360
Speaker 2: other antiseptic chemicals that were used to get the hands

738
00:42:31,400 --> 00:42:35,799
Speaker 2: clean before surgery these were hard on the skin, schlickwrites,

739
00:42:35,880 --> 00:42:40,160
Speaker 2: quote copiously applied, the caustic solutions often caused severe skin

740
00:42:40,280 --> 00:42:43,560
Speaker 2: damage in surgeons and nurses, forcing some of them to

741
00:42:43,600 --> 00:42:47,360
Speaker 2: abandon operating altogether. The issue was the background of the

742
00:42:47,400 --> 00:42:50,640
Speaker 2: well known story of how in eighteen eighty nine William

743
00:42:50,680 --> 00:42:55,279
Speaker 2: Halstead at Johns Hopkins introduced rubber gloves to protect the

744
00:42:55,360 --> 00:43:00,160
Speaker 2: hands of his chief operating nurse, who later became his wife. Now,

745
00:43:00,239 --> 00:43:03,120
Speaker 2: Rob you already mentioned Halsteed introducing rubber gloves in his

746
00:43:03,239 --> 00:43:06,160
Speaker 2: practice around this time, but Slit goes on with an

747
00:43:06,200 --> 00:43:10,560
Speaker 2: interesting detail here quote. Subsequently, such gloves were also used

748
00:43:10,560 --> 00:43:14,480
Speaker 2: by Halstead's assistants. They put them on when taking instruments

749
00:43:14,560 --> 00:43:18,440
Speaker 2: out of the corrosive sublimate solution in which the instruments

750
00:43:18,440 --> 00:43:21,719
Speaker 2: were kept, and pass them on to the operating surgeon

751
00:43:21,920 --> 00:43:26,959
Speaker 2: who did not wear gloves. So the assistance would you'd

752
00:43:26,960 --> 00:43:28,960
Speaker 2: have like a scalpel, and that would be in a

753
00:43:29,000 --> 00:43:34,239
Speaker 2: sterilizing caustic chemical, and the assistance would put gloves on

754
00:43:34,360 --> 00:43:37,960
Speaker 2: to take the thing out of that chemical, hand it

755
00:43:38,000 --> 00:43:41,360
Speaker 2: to the surgeon who would receive it with an ungloved

756
00:43:41,360 --> 00:43:42,520
Speaker 2: hand and then operate.

757
00:43:42,920 --> 00:43:45,040
Speaker 4: Yeah, I guess one of the things to drive from

758
00:43:45,080 --> 00:43:47,160
Speaker 4: here is, you know, the adoption of a new technology

759
00:43:47,280 --> 00:43:48,920
Speaker 4: is sometimes a little patchy.

760
00:43:48,840 --> 00:43:51,360
Speaker 2: And the reasoning can be different than what you'd expect.

761
00:43:51,360 --> 00:43:55,600
Speaker 2: So they've got by eighteen eighty nine, Halsted's assistants and

762
00:43:55,719 --> 00:43:58,560
Speaker 2: nurses are using rubber gloves to protect their hands from

763
00:43:58,600 --> 00:44:03,040
Speaker 2: these coustic chemicals. But it wasn't until eighteen ninety six

764
00:44:03,160 --> 00:44:07,600
Speaker 2: that rubber gloves to protect the patient during surgery became

765
00:44:07,680 --> 00:44:10,600
Speaker 2: standard at Johns Hopkins. It just didn't seem like an

766
00:44:10,640 --> 00:44:14,400
Speaker 2: obvious solution until around then. Now, another thing is that

767
00:44:14,680 --> 00:44:17,440
Speaker 2: so rob earlier you mentioned this three vat process. You've

768
00:44:17,440 --> 00:44:20,399
Speaker 2: got surgeons who would wash their hands with soap and

769
00:44:20,440 --> 00:44:23,480
Speaker 2: then submerge their hands in alcohol and then dip their

770
00:44:23,520 --> 00:44:27,799
Speaker 2: hands in an antiseptic chemical before going into surgery. So

771
00:44:27,880 --> 00:44:30,320
Speaker 2: you would think, man, you go through that kind of procedure,

772
00:44:30,880 --> 00:44:33,600
Speaker 2: that really should kill all the bacteria, right, shouldn't your

773
00:44:33,600 --> 00:44:36,360
Speaker 2: hands be perfectly clean by then? But one of the

774
00:44:36,360 --> 00:44:39,200
Speaker 2: things that became clear to these surgeons in the eighteen

775
00:44:39,280 --> 00:44:42,279
Speaker 2: nineties is that this actually it was pretty good, but

776
00:44:42,360 --> 00:44:45,080
Speaker 2: it wasn't good enough because even if you could sterilize

777
00:44:45,120 --> 00:44:48,200
Speaker 2: the outside skin of your hands, there were little pockets

778
00:44:48,200 --> 00:44:50,880
Speaker 2: where germs could camp out and still infect a wound.

779
00:44:50,960 --> 00:44:55,800
Speaker 2: Examples would include the sebaceous glands. These are little gland

780
00:44:55,880 --> 00:45:00,279
Speaker 2: pockets attached to hair follicles that produce sebum, which is

781
00:45:00,320 --> 00:45:03,479
Speaker 2: a waxy or oily substance that coats the skin and hair.

782
00:45:04,200 --> 00:45:06,839
Speaker 2: And then also you've got like underneath the fingernails. You know,

783
00:45:06,880 --> 00:45:09,600
Speaker 2: you're just gonna have like little recesses back there where

784
00:45:09,640 --> 00:45:12,840
Speaker 2: these liquids are not getting in deep enough, and germs

785
00:45:12,920 --> 00:45:16,279
Speaker 2: from in there might still get out during surgery. And

786
00:45:16,360 --> 00:45:18,960
Speaker 2: for some reason, this reminds me of you remember in

787
00:45:19,000 --> 00:45:22,600
Speaker 2: our invention episode on the death ray, the idea of

788
00:45:22,640 --> 00:45:26,000
Speaker 2: this time between World War one and two where there

789
00:45:26,080 --> 00:45:29,920
Speaker 2: was terror about the inadequacy of ground based defenses against

790
00:45:30,000 --> 00:45:33,839
Speaker 2: air raids. And there's this phrase that was used at

791
00:45:33,840 --> 00:45:37,719
Speaker 2: the time, the bomber always gets through. I compared that

792
00:45:37,800 --> 00:45:40,360
Speaker 2: to the bacterium in this case. Right, there's this fear

793
00:45:40,440 --> 00:45:43,040
Speaker 2: that the bacterium somehow always gets through.

794
00:45:43,719 --> 00:45:46,359
Speaker 4: Right, right, there's always going to be at least one

795
00:45:46,400 --> 00:45:48,600
Speaker 4: little crack in the defenses with this method.

796
00:45:48,800 --> 00:45:51,120
Speaker 2: So to try to get around these problems where you know,

797
00:45:51,160 --> 00:45:53,560
Speaker 2: sterilizing your hands is not good enough. This is where

798
00:45:53,600 --> 00:45:56,359
Speaker 2: gloves come in, and so we mentioned several times this guy,

799
00:45:56,400 --> 00:46:02,440
Speaker 2: Johannis van Mikulitch, he tried this interesting solution, beginning with

800
00:46:02,480 --> 00:46:06,360
Speaker 2: an operation on Easter eighteen ninety six, which was sterilized

801
00:46:06,680 --> 00:46:11,040
Speaker 2: cotton gloves. So hands would go through the regular gauntlet

802
00:46:11,320 --> 00:46:14,719
Speaker 2: washing and disinfection, but then after this you would put

803
00:46:14,719 --> 00:46:18,640
Speaker 2: on these sterilized cotton gloves. They were very big. They

804
00:46:18,640 --> 00:46:21,239
Speaker 2: had sleeves or gauntlets going all the way up the

805
00:46:21,360 --> 00:46:24,040
Speaker 2: arm to the elbow or past the elbow, and you

806
00:46:24,080 --> 00:46:26,480
Speaker 2: can see pictures of these they kind of look like

807
00:46:26,600 --> 00:46:29,959
Speaker 2: mummy arms. Now, of course they're cotton gloves, so they're

808
00:46:29,960 --> 00:46:33,319
Speaker 2: not impermeable, so over the course of an operation they

809
00:46:33,320 --> 00:46:35,880
Speaker 2: would become soaked with blood and you might need to

810
00:46:35,960 --> 00:46:39,480
Speaker 2: change them out for a new pair. But Mikolitch was

811
00:46:39,560 --> 00:46:42,520
Speaker 2: very positive about them. He is like, you know, they're

812
00:46:42,560 --> 00:46:45,080
Speaker 2: not that bad. And sometimes with cotton gloves you can

813
00:46:45,120 --> 00:46:48,200
Speaker 2: even grip some things better, like holding onto tissues is

814
00:46:48,239 --> 00:46:52,000
Speaker 2: easier with cotton gloves than with the naked hand. But

815
00:46:52,280 --> 00:46:55,239
Speaker 2: there were times when the cotton gloves reportedly caused problems.

816
00:46:56,040 --> 00:47:00,120
Speaker 2: One example would be this is the example given by Mikolitch.

817
00:47:00,160 --> 00:47:04,160
Speaker 2: When a surgeon is feeling around on the inside of

818
00:47:04,160 --> 00:47:07,560
Speaker 2: the stomach, lining to locate a tumor by touch, the

819
00:47:07,600 --> 00:47:11,000
Speaker 2: cotton would apparently dull the sensitivity of the fingers, and

820
00:47:11,120 --> 00:47:14,800
Speaker 2: Mikolitch wrote that in cases like this, you could briefly

821
00:47:14,960 --> 00:47:17,960
Speaker 2: take off the glove, reach around and feel for the

822
00:47:18,000 --> 00:47:21,239
Speaker 2: tumor with your bare fingers as quickly as possible, and

823
00:47:21,280 --> 00:47:23,080
Speaker 2: then once you found it, you put on a pair

824
00:47:23,160 --> 00:47:24,440
Speaker 2: of fresh cotton gloves.

825
00:47:24,719 --> 00:47:27,040
Speaker 4: Yeah, and it's the five second rule of rooting around

826
00:47:27,040 --> 00:47:29,560
Speaker 4: in somebody's stomach cavity. Right.

827
00:47:30,080 --> 00:47:34,279
Speaker 2: Yeah, that seems like not a great solution, but at

828
00:47:34,360 --> 00:47:38,320
Speaker 2: least you're trying to use something. So Mikolitch also tried

829
00:47:38,360 --> 00:47:40,760
Speaker 2: out early rubber gloves, but said they were not tenable

830
00:47:40,800 --> 00:47:44,359
Speaker 2: because they had they just had major disadvantages for manual dexterity,

831
00:47:44,760 --> 00:47:48,080
Speaker 2: and they weren't much better than cotton gloves for acepsis.

832
00:47:48,360 --> 00:47:52,560
Speaker 2: I don't know about that last claim, but apparently, according

833
00:47:52,560 --> 00:47:55,400
Speaker 2: to Schlick, at least the surgeon most responsible for bringing

834
00:47:55,520 --> 00:47:59,960
Speaker 2: rubber gloves into vogue in German speaking hospitals was Werner's

835
00:48:00,160 --> 00:48:04,240
Speaker 2: Zoga von Manteuffel, who lived eighteen fifty seven to nineteen

836
00:48:04,320 --> 00:48:08,719
Speaker 2: twenty six. Zoga was especially in search of failsafe aseptic

837
00:48:08,760 --> 00:48:12,680
Speaker 2: protocols because he worked in an environment of a municipal

838
00:48:12,719 --> 00:48:17,200
Speaker 2: hospital where he had to quote operate promiscuously, so he

839
00:48:17,239 --> 00:48:20,960
Speaker 2: couldn't like, specialize in one type of surgery and quarantine

840
00:48:21,040 --> 00:48:24,640
Speaker 2: for that. Instead, he had to operate alternately on like

841
00:48:25,120 --> 00:48:30,440
Speaker 2: infected patients and uninfected ones, sometimes handling pus or feces

842
00:48:30,560 --> 00:48:32,920
Speaker 2: or whatever, and then immediately having to go operate on

843
00:48:33,000 --> 00:48:37,120
Speaker 2: a different patient. So his solution to this was boiled

844
00:48:37,200 --> 00:48:41,480
Speaker 2: rubber gloves. There were downsides. The rubber gloves were uncomfortable.

845
00:48:41,520 --> 00:48:45,120
Speaker 2: Sometimes they made it hard to move or bend the thumb.

846
00:48:45,800 --> 00:48:49,040
Speaker 2: Sometimes the fingers were too long, which made gripping difficult,

847
00:48:49,680 --> 00:48:53,920
Speaker 2: and because of these conditions, operations with rubber gloves would

848
00:48:53,960 --> 00:48:57,120
Speaker 2: often take longer than the same operation with bare hands.

849
00:48:57,600 --> 00:49:00,680
Speaker 2: And then, to read from Schlick quote, but this Zoga

850
00:49:00,719 --> 00:49:04,480
Speaker 2: thought was outweighed by the gains in aseptic control the

851
00:49:04,640 --> 00:49:09,279
Speaker 2: absolute safety of the quote boiled hand, as he called it.

852
00:49:09,920 --> 00:49:13,040
Speaker 2: Zoga thus explicitly weighed the two kinds of control against

853
00:49:13,120 --> 00:49:16,560
Speaker 2: each other. What also becomes clear in this discussion is

854
00:49:16,600 --> 00:49:19,440
Speaker 2: the importance of the technical details of the gloves for

855
00:49:19,520 --> 00:49:23,640
Speaker 2: reconciling manual and aseptic control. They had to be made

856
00:49:23,719 --> 00:49:26,120
Speaker 2: in a way so that they didn't compromise the surgeon's

857
00:49:26,200 --> 00:49:28,960
Speaker 2: grasp too much, but at the same time we're effective

858
00:49:29,000 --> 00:49:32,319
Speaker 2: in keeping bacteria out. So this is a way of

859
00:49:32,360 --> 00:49:35,239
Speaker 2: trying to get the boiled hand into circulation. You've got

860
00:49:35,280 --> 00:49:37,360
Speaker 2: to make it so that it's worth it to the

861
00:49:37,400 --> 00:49:39,960
Speaker 2: surgeon that they can still do what they need to do.

862
00:49:40,360 --> 00:49:43,440
Speaker 2: If you've got a rubber glove that is boiled and

863
00:49:43,640 --> 00:49:46,040
Speaker 2: is a septic, it's not going to get bacteria in there,

864
00:49:46,360 --> 00:49:49,440
Speaker 2: but you can't really operate effectively with it. That doesn't

865
00:49:49,480 --> 00:49:50,200
Speaker 2: do you any good.

866
00:49:50,760 --> 00:49:52,719
Speaker 4: I do love the name the boiled hand. By the way,

867
00:49:52,760 --> 00:49:54,239
Speaker 4: we were talking about this a little bit before we

868
00:49:54,280 --> 00:49:56,200
Speaker 4: came in here. Just perfect.

869
00:49:56,840 --> 00:49:58,920
Speaker 2: This seems to be a bigger thing than just zoga.

870
00:49:58,960 --> 00:49:59,160
Speaker 4: Here.

871
00:49:59,200 --> 00:50:02,839
Speaker 2: There's like a general anguish at the time expressed by

872
00:50:03,040 --> 00:50:09,080
Speaker 2: multiple surgeons about the idea of hands being non boilable objects. Boiling,

873
00:50:09,120 --> 00:50:12,719
Speaker 2: I think, became a kind of metonym for aseptic safety,

874
00:50:13,719 --> 00:50:16,960
Speaker 2: so you might at the time, instead of saying something

875
00:50:17,040 --> 00:50:19,719
Speaker 2: is aseptic, you might just call it boiled. Whether or

876
00:50:19,760 --> 00:50:22,799
Speaker 2: not it had literally been boiled. Now a couple of

877
00:50:22,800 --> 00:50:26,160
Speaker 2: other interesting solutions mentioned in the Schlick paper. There was

878
00:50:26,200 --> 00:50:30,359
Speaker 2: a guy named George Perthies who lived eighteen sixty eight

879
00:50:30,360 --> 00:50:34,120
Speaker 2: to nineteen twenty seven. He was a surgeon in Leipzig

880
00:50:34,280 --> 00:50:36,719
Speaker 2: who said that full rubber gloves were too thick and

881
00:50:36,800 --> 00:50:40,200
Speaker 2: difficult to work with, but suggested that surgeons could use quote,

882
00:50:40,560 --> 00:50:45,480
Speaker 2: fine finger covers made out of condom rubber quote, which

883
00:50:45,520 --> 00:50:48,240
Speaker 2: have been put on the market recently and which impaired

884
00:50:48,239 --> 00:50:52,239
Speaker 2: the touch of the finger relatively little. And that's kind

885
00:50:52,239 --> 00:50:55,839
Speaker 2: of surprising. But yes, rubber condoms had existed in some

886
00:50:56,000 --> 00:50:58,960
Speaker 2: form going back to at least the mid nineteenth century.

887
00:50:59,480 --> 00:51:02,520
Speaker 2: Eighteen f These rubber condoms were allegedly made of rather

888
00:51:02,560 --> 00:51:05,480
Speaker 2: thick material, but they did exist at the time, and

889
00:51:05,560 --> 00:51:09,120
Speaker 2: Perthy suggested that, yeah, this condom rubber could actually be

890
00:51:09,239 --> 00:51:12,840
Speaker 2: useful to the surgeon for having a good compromise between

891
00:51:13,560 --> 00:51:17,400
Speaker 2: being impermeable and being a septic, but also allowing the

892
00:51:17,440 --> 00:51:21,360
Speaker 2: surgeon to feel what they are doing. But Perthy's himself

893
00:51:21,600 --> 00:51:25,920
Speaker 2: favored silk gloves, which you already mentioned. He said, you know,

894
00:51:25,960 --> 00:51:28,880
Speaker 2: they're great for manual control silk feels like you're wearing

895
00:51:28,920 --> 00:51:30,880
Speaker 2: nothing at all, But of course they didn't have the

896
00:51:30,920 --> 00:51:34,759
Speaker 2: aseptic advantages of impermeable rubber. There are a couple of

897
00:51:34,800 --> 00:51:39,160
Speaker 2: other things that Schlick mentions, involving the idea of thin

898
00:51:39,280 --> 00:51:42,520
Speaker 2: gloves coated in wax and whether or not that would

899
00:51:42,520 --> 00:51:47,080
Speaker 2: be useful, leather gloves that maybe were topped with condom

900
00:51:47,160 --> 00:51:51,000
Speaker 2: rubber or something. But yeah, ultimately we get to this

901
00:51:51,400 --> 00:51:54,719
Speaker 2: desire that Wolfer articulates that you mentioned earlier, that you

902
00:51:54,800 --> 00:51:56,880
Speaker 2: got to have a surgical glove that has all of

903
00:51:56,920 --> 00:52:01,960
Speaker 2: the following characteristics. It's impermeable, it's flexible, tear resistant, not

904
00:52:02,080 --> 00:52:05,640
Speaker 2: too tight, not too hot, and it can be sterilized.

905
00:52:06,160 --> 00:52:07,880
Speaker 2: And this is what they ended up debating at this

906
00:52:07,960 --> 00:52:10,560
Speaker 2: Surgical Congress in eighteen ninety eight. And there were all

907
00:52:10,640 --> 00:52:14,000
Speaker 2: kinds of interesting debates here about like the actual bacteriological

908
00:52:14,040 --> 00:52:17,799
Speaker 2: evidence for gloves, Like there were some people at this

909
00:52:18,400 --> 00:52:21,799
Speaker 2: meeting who dissented, arguing on the basis of experiments that

910
00:52:22,160 --> 00:52:24,880
Speaker 2: gloves were not actually useful. And there was one experiment

911
00:52:25,360 --> 00:52:29,759
Speaker 2: that involved testing cotton gloves, so again not the rubber ones,

912
00:52:29,800 --> 00:52:33,280
Speaker 2: but taking cotton gloves that had been used in surgery

913
00:52:33,320 --> 00:52:37,400
Speaker 2: and then squeezing out the quote glove juice and then

914
00:52:37,880 --> 00:52:40,040
Speaker 2: doing a culture of that to see what its germ

915
00:52:40,120 --> 00:52:42,720
Speaker 2: content was, and they were like, look, this glove juice

916
00:52:42,760 --> 00:52:45,960
Speaker 2: is full of germs. These gloves can't be useful. In fact,

917
00:52:46,000 --> 00:52:49,000
Speaker 2: they're picking up because they get soaked with blood, they're

918
00:52:49,040 --> 00:52:52,680
Speaker 2: picking up germs from the air, and they're introducing new germs.

919
00:52:53,560 --> 00:52:56,440
Speaker 2: And then this led to a really i think a

920
00:52:56,480 --> 00:52:59,799
Speaker 2: debate between different evidential standards. So you have some people

921
00:52:59,840 --> 00:53:02,400
Speaker 2: say saying, well, look, we've done these lab experiments saying

922
00:53:02,440 --> 00:53:05,600
Speaker 2: that you know, the glove juice is full of bacteria

923
00:53:05,680 --> 00:53:08,279
Speaker 2: and that's no good. But then there are these other

924
00:53:08,280 --> 00:53:11,040
Speaker 2: people saying, well, yeah, but we've used gloves in actual

925
00:53:11,080 --> 00:53:14,319
Speaker 2: surgeries and we see the differences in outcomes, and the

926
00:53:14,360 --> 00:53:17,120
Speaker 2: outcomes are better when you use gloves. And so they

927
00:53:17,120 --> 00:53:20,280
Speaker 2: were comparing different standards of like how should we measure

928
00:53:20,360 --> 00:53:22,440
Speaker 2: whether this is effective or not.

929
00:53:23,440 --> 00:53:23,600
Speaker 4: Now.

930
00:53:23,600 --> 00:53:27,440
Speaker 2: Eventually, over time there was agreement that impermeable gloves were

931
00:53:27,440 --> 00:53:30,080
Speaker 2: the gold standard and that if you could manufacture them

932
00:53:30,080 --> 00:53:32,920
Speaker 2: in a way that didn't sacrifice too much manual control,

933
00:53:32,960 --> 00:53:35,560
Speaker 2: which of course we did get with the with the

934
00:53:35,920 --> 00:53:39,160
Speaker 2: sterile gloves that people use today made of thin materials

935
00:53:39,160 --> 00:53:41,640
Speaker 2: such as latex, nitrial are vinyl.

936
00:53:42,120 --> 00:53:45,400
Speaker 4: Yeah, modern medical gloves come in, of course, various sizes.

937
00:53:45,440 --> 00:53:48,160
Speaker 4: They are made from a variety of polymers. You get

938
00:53:48,160 --> 00:53:51,160
Speaker 4: powdered and unpowdered, or even powdered with corn starch to

939
00:53:51,200 --> 00:53:54,440
Speaker 4: cut down on skin irritation. There've been a lot of

940
00:53:54,480 --> 00:53:57,080
Speaker 4: efforts towards the elimination of powdered gloves in general, and

941
00:53:57,160 --> 00:54:02,000
Speaker 4: there are alternatives for individuals with latex allergies. So, uh, yeah,

942
00:54:02,239 --> 00:54:06,680
Speaker 4: modern medical gloves, there's this broad spectrum there. We've come

943
00:54:06,719 --> 00:54:10,279
Speaker 4: a long way, obviously since since these these first prototypes

944
00:54:10,320 --> 00:54:13,920
Speaker 4: were being unveiled, and yeah, it's we're we're in a

945
00:54:14,400 --> 00:54:16,120
Speaker 4: in a totally different age now when it comes to

946
00:54:16,120 --> 00:54:20,759
Speaker 4: just the acceptance of of medical and surgical gloves. You again,

947
00:54:20,800 --> 00:54:25,120
Speaker 4: you would not accept bare fingers and bare hands as

948
00:54:25,160 --> 00:54:25,880
Speaker 4: an alternative.

949
00:54:26,160 --> 00:54:28,319
Speaker 2: But I think it's also good to understand that at

950
00:54:28,360 --> 00:54:32,920
Speaker 2: the time, resistance to the to the take up of gloves,

951
00:54:33,200 --> 00:54:39,160
Speaker 2: especially impermeable gloves, was not just uh just stubbornness or quackery.

952
00:54:39,239 --> 00:54:41,680
Speaker 2: There probably was some of that, but a lot of

953
00:54:41,719 --> 00:54:45,919
Speaker 2: it was also genuine concern for being able to operate effectively.

954
00:54:46,280 --> 00:54:49,279
Speaker 4: Yeah, I mean when you're you're I think the the

955
00:54:49,360 --> 00:54:53,000
Speaker 4: example of our promiscuous surgeon uh is Key here though, Yeah,

956
00:54:53,000 --> 00:54:56,799
Speaker 4: because he's talking like clearly he's weighing. Yeah, these are

957
00:54:56,840 --> 00:54:59,359
Speaker 4: these are bulkier in some cases, but like I need

958
00:54:59,400 --> 00:55:00,920
Speaker 4: to be able to go from this patient to this

959
00:55:00,960 --> 00:55:03,960
Speaker 4: patient to this patient. You know, we need to be able.

960
00:55:04,120 --> 00:55:07,320
Speaker 4: It's kind of like getting into the scale issue of inventions, like, okay,

961
00:55:07,360 --> 00:55:10,080
Speaker 4: I can. It's one thing to create a perfect prototype

962
00:55:10,120 --> 00:55:12,160
Speaker 4: in isolation. It's one thing to be able to conduct

963
00:55:12,160 --> 00:55:16,680
Speaker 4: one surgery in perfect isolation. But if that's just one

964
00:55:16,680 --> 00:55:20,040
Speaker 4: of many surgeries you're performing during a set amount of time,

965
00:55:20,080 --> 00:55:22,360
Speaker 4: well then you're in a slightly different scenario. There are

966
00:55:22,360 --> 00:55:24,920
Speaker 4: all these other factors you have to take into account totally.

967
00:55:25,000 --> 00:55:25,520
Speaker 2: Yeah.

968
00:55:25,600 --> 00:55:27,840
Speaker 4: Oh, and then to come back to our outer limits

969
00:55:27,880 --> 00:55:31,760
Speaker 4: example from earlier, the idea of being able to perform

970
00:55:31,800 --> 00:55:35,400
Speaker 4: medical interventions like out in the field, like this seems

971
00:55:35,520 --> 00:55:38,839
Speaker 4: another area where gloves are vital, because yes, I mean,

972
00:55:38,880 --> 00:55:41,560
Speaker 4: you still are going to ideally, you know, have some

973
00:55:41,560 --> 00:55:44,759
Speaker 4: some sort of cleansing materials, but are you going to

974
00:55:44,840 --> 00:55:49,400
Speaker 4: have three vats in which to spend some time washing

975
00:55:49,400 --> 00:55:51,760
Speaker 4: your hands, or are you going to have to essentially

976
00:55:51,800 --> 00:55:54,040
Speaker 4: snap on some gloves and get in there and try

977
00:55:54,040 --> 00:55:57,000
Speaker 4: and save someone's life that sort of thing. Yeah, So anyway,

978
00:55:57,040 --> 00:55:59,400
Speaker 4: it's a yeah, fascinating topic, I think, especially when you

979
00:55:59,440 --> 00:56:02,360
Speaker 4: get into the adoption of a new technology, how we

980
00:56:02,400 --> 00:56:05,560
Speaker 4: look back on it and how, you know, the efforts

981
00:56:05,560 --> 00:56:08,480
Speaker 4: of the historian to place us within that time period

982
00:56:08,840 --> 00:56:12,279
Speaker 4: to make sense of it all just all very fascinating

983
00:56:12,280 --> 00:56:14,239
Speaker 4: and I think something to keep in mind and to

984
00:56:14,280 --> 00:56:17,520
Speaker 4: think about the next time you're in a medical facility

985
00:56:17,760 --> 00:56:20,120
Speaker 4: or in a checkup of one sort or another and

986
00:56:20,960 --> 00:56:22,960
Speaker 4: you see your doctor or you don't see them snap

987
00:56:23,000 --> 00:56:25,319
Speaker 4: on those gloves. The gloves are just part of it.

988
00:56:26,480 --> 00:56:28,200
Speaker 4: Of course, we'd love to hear from anyone out there

989
00:56:28,200 --> 00:56:31,759
Speaker 4: who regularly wears medical gloves, surgical gloves as part of

990
00:56:31,800 --> 00:56:34,520
Speaker 4: your profession. You know, what are your thoughts on them,

991
00:56:34,960 --> 00:56:37,239
Speaker 4: what sort of a history do you have with them,

992
00:56:37,239 --> 00:56:39,280
Speaker 4: and you have to use a certain variety of glove

993
00:56:39,360 --> 00:56:43,359
Speaker 4: due to allergies or scan irritations. We'd love to hear

994
00:56:44,120 --> 00:56:46,920
Speaker 4: some insight from the field. All right, Well, we're going

995
00:56:46,960 --> 00:56:50,160
Speaker 4: to go ahead and close out this Invention themed episode

996
00:56:50,239 --> 00:56:52,759
Speaker 4: of Stuff to Blow Your Mind, but we love to

997
00:56:52,800 --> 00:56:56,319
Speaker 4: hear from everyone out there. Just a reminder that new

998
00:56:56,360 --> 00:56:57,960
Speaker 4: episodes of Stuff to Blow Your Mind come out on

999
00:56:58,040 --> 00:57:01,600
Speaker 4: Tuesdays and Thursdays. And oh, we should also mention we

1000
00:57:01,880 --> 00:57:04,080
Speaker 4: mentioned condoms briefly. We do have an older episode of

1001
00:57:04,120 --> 00:57:08,320
Speaker 4: Invention about the invention of the condom, so we recommend that.

1002
00:57:08,400 --> 00:57:11,960
Speaker 4: And of course we've touched on medical history topics numerous

1003
00:57:12,000 --> 00:57:14,400
Speaker 4: times over the years and you can find those in

1004
00:57:14,440 --> 00:57:17,840
Speaker 4: the archives. On Mondays we do listener mail episodes. On

1005
00:57:17,880 --> 00:57:21,040
Speaker 4: Wednesdays we do short form artifact or monster Fact, and

1006
00:57:21,080 --> 00:57:23,320
Speaker 4: on Fridays we set aside most series concerns and just

1007
00:57:23,360 --> 00:57:24,640
Speaker 4: talk about a weird film.

1008
00:57:24,840 --> 00:57:27,640
Speaker 2: Huge thanks as always to our excellent audio producer Seth

1009
00:57:27,720 --> 00:57:30,200
Speaker 2: Nicholas Johnson. If you would like to get in touch

1010
00:57:30,240 --> 00:57:32,400
Speaker 2: with us with feedback on this episode or any other,

1011
00:57:32,480 --> 00:57:34,600
Speaker 2: to suggest a topic for the future, or just to

1012
00:57:34,600 --> 00:57:37,480
Speaker 2: say hello, you can email us at contact Stuff to

1013
00:57:37,520 --> 00:57:45,880
Speaker 2: Blow your Mind dot com.

1014
00:57:46,440 --> 00:57:49,360
Speaker 3: Stuff to Blow Your Mind is production of iHeartRadio. For

1015
00:57:49,440 --> 00:57:52,240
Speaker 3: more podcasts from my Heart Radio, visit the iHeartRadio app,

1016
00:57:52,400 --> 00:58:11,720
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