Speaker 1: Hey you welcome to Stuff to Blow Your Mind.
Speaker 2: My name is Robert Lamb and I am Joe McCormick,
Speaker 2: and it's Saturday. Time for an episode from the Vault.
Speaker 2: This one originally aired August thirtieth, twenty twenty two, and
Speaker 2: it is about the invention of surgical gloves.
Speaker 1: Yeah, yeah, this is a This is a pretty fun one.
Speaker 1: Every now and then we'll know, we'll get to that
Speaker 1: point where it's like, oh, we got we need to
Speaker 1: do a bunch of invention episodes, like the Invention frenzy
Speaker 1: overcomes us. So, yeah, this is a this is a
Speaker 1: fun exploration.
Speaker 3: Welcome to Stuff to Blow Your Mind production of iHeartRadio.
Speaker 4: Hey, welcome to Stuff to Blow your Mind. My name
Speaker 4: is Robert.
Speaker 2: Lamb and I'm Joe McCormick.
Speaker 4: And this weekend Stuff to Blow your Mind. We have
Speaker 4: another invention themed episode for everyone, and I think it
Speaker 4: should prove an interesting episode because it's one of those
Speaker 4: stories that more than it just covers like the need
Speaker 4: for an invention and the development of that invention, it
Speaker 4: also gets into the acceptance of that invention or the
Speaker 4: lack there off concerning a new technology. You know, it's
Speaker 4: one thing to have an idea for a new product
Speaker 4: or a new invention, a new way of doing things.
Speaker 4: But then if it's going to make a difference, it
Speaker 4: also has to be accepted by the vast majority of
Speaker 4: the people within a given field, a given culture, etc.
Speaker 2: Yes, and also the way that a certain invention has
Speaker 2: to prove its advantages over other solutions to the same problems,
Speaker 2: which is a major issue with the early adoption of
Speaker 2: the technology we're going to be talking about today. Something
Speaker 2: that is now a universal standard that people would be
Speaker 2: horrified to hear anybody was not using, was in fact
Speaker 2: originally one solution among many.
Speaker 4: Right, we're going to be talking about surgical gloves. You
Speaker 4: say are just ubiquitous now it's just no matter what
Speaker 4: the surgical procedure happens to be, but not only surgical procedures,
Speaker 4: but also just any kind of medical checkup, anything in
Speaker 4: the medical establishment in general. If you go to the dentist,
Speaker 4: if they're going to have medical gloves on, and it's
Speaker 4: one of those things where not only do you come
Speaker 4: to expect it, like you could not ask for it
Speaker 4: to be another way. You can't go to the dentist
Speaker 4: and be like, hey, doc, I'm thinking maybe you go
Speaker 4: gloves off this time. I mean no, it's just the
Speaker 4: gloves are part of the procedure, and most of us
Speaker 4: would be somewhat concerned if we go in there and
Speaker 4: the gloves are off.
Speaker 2: Or if the gloves were, say made of cotton, then
Speaker 2: really juicy.
Speaker 4: Right, Or yeah, you go in and it's like your
Speaker 4: dentist is wearing big ski gloves or mittens. So you've
Speaker 4: realized something is off. This is not the way things
Speaker 4: should be, but.
Speaker 2: It was not always so. So if you went to
Speaker 2: to say, a German speaking hospital in the eighteen nineties,
Speaker 2: you may be lucky enough to get operated on by
Speaker 2: a surgeon who has accepted the new science of bacteriology,
Speaker 2: who does understand that wounds need to be clean, they
Speaker 2: need to be asceptic, and does understand that gloves can
Speaker 2: help with that process, but has not found a way
Speaker 2: to commit yet to impermeable gloves. So may well have
Speaker 2: some cotton gloves on while they've got their fingers around
Speaker 2: in you.
Speaker 4: Now a quick side note on just gloves in general.
Speaker 4: Gloves have been with us for a very long time.
Speaker 4: It's just a basic way to protect the hand from
Speaker 4: where from coal, from heat, from other threats, just a
Speaker 4: basic technological advancement in which we realized, hey, we can
Speaker 4: take other materials and make a second skin for our
Speaker 4: hands are very important but also susceptible to damage. Hands
Speaker 4: and some of the oldest gloves that we have that
Speaker 4: have survived include a pair of delicate linen child's gloves
Speaker 4: from the tomb of Tutin Common. So those are about
Speaker 4: three thy two hundred years old, and these were likely
Speaker 4: riding gloves. But of course, one of the things about gloves,
Speaker 4: when one of the things about making yourself a second
Speaker 4: organic skin, is that those tend not to survive, you know,
Speaker 4: unless they are stuck away in a tomb or in
Speaker 4: some other fashion well preserved for a very long period
Speaker 4: of time. But the reality is when it comes to surgery,
Speaker 4: for most of human history, surgical procedures of varying degrees
Speaker 4: of complexity were carried out bare handed. Now, when we
Speaker 4: say bare handed surgery, we do have to note that
Speaker 4: we're not talking about pseudoscientific medical fraud psychic surgery, which
Speaker 4: is also you know, quote unquote performed bare handed. No,
Speaker 4: we're talking about actual surgical procedures of different scales performed
Speaker 4: well without any sort of protective barrier between the surgeon's
Speaker 4: skin and the patient's flow. So surgery of different sorts
Speaker 4: was practiced in ancient Mesopotamia, Ancient Egypt, ancient China, agient India,
Speaker 4: and other parts of the ancient world. Ancient surgeries ran
Speaker 4: the gamut from setting of bones to amputations, trepanations, blood lettings,
Speaker 4: and everything in between. But as we've discussed on the
Speaker 4: show before, one of the big obvious realities here, obvious
Speaker 4: to us now anyway by virtue of germ theory, is
Speaker 4: that human hands carry disease, and even regularly cleaned hands
Speaker 4: can be a problem. I was looking at some of
Speaker 4: the stats on this in review of human hand microbiome
Speaker 4: research by EDMUNDS. Wilson at All in a twenty fifteen
Speaker 4: edition of a Journal of Dermatological Science. The authors here
Speaker 4: point out that hands are of course a critical component
Speaker 4: of the human microbiome and are quote a conduit for
Speaker 4: exchanging micro organisms between the environment and the body. So
Speaker 4: not all of these are dangerous naturally, but hands can
Speaker 4: harbor pathogenic species like staff Any Coli. And this is
Speaker 4: even more the case in high risk environments, such as
Speaker 4: among those who handle food or provide healthcare, and the
Speaker 4: authers here point to various studies that have also looked
Speaker 4: into how it enhanced use of hand hygiene products may
Speaker 4: negatively impact the hand microbiome as well, result resulting in
Speaker 4: greater pathogen carriage for example. But other studies have demonstrated
Speaker 4: quote reduced pathogen carriage and or infections with use of
Speaker 4: these products.
Speaker 2: Oh yeah, that's got to be interesting. Double edged sword. So,
Speaker 2: like now that we have, you know, germ theory, we
Speaker 2: know it's important to wash your hands if you're going
Speaker 2: to be eating or preparing food, or certainly if you're
Speaker 2: going to be doing any kinemtical procedure. But also that
Speaker 2: repeatedly washing or you're sterilizing your hands has effects beyond
Speaker 2: just keeping pathogens away. It also affects the presence of
Speaker 2: non harmful microbiota on the surface of your hands.
Speaker 4: Yeah, it's like I get again. You have to think
Speaker 4: of your hands as part of your body. They're not
Speaker 4: just tools, they're not instruments. They're used by you and
Speaker 4: your body. They are part of you. They are also
Speaker 4: like yourself multitude. They have populations, and if you regularly
Speaker 4: carpet bomb the population, that's going to disrupt. That's not
Speaker 4: going to just keep things from living there. It's going
Speaker 4: to potentially disrupt the ratio of what lives there. And
Speaker 4: so the idea of cleaning the hand completely, that is
Speaker 4: we'll discuss that becomes kind of problematic at times, like again,
Speaker 4: it's not an instrument. It is pointed out by one
Speaker 4: of the authors we're going to look to. You cannot
Speaker 4: just boil the hand to sterilize it and then use
Speaker 4: the hand in a completely hygienic way.
Speaker 2: Right though, I want to be very clear, well, we
Speaker 2: are acknowledging these consequences. This is not a case against
Speaker 2: hand washing.
Speaker 4: No, no, No. Hand washing, as we'll discuss, is also
Speaker 4: very important here. I also have to throw in, while
Speaker 4: after I was researching a lot of this and had
Speaker 4: it on my mind, still sort of turning over in
Speaker 4: my head, I ran into my boss out in the
Speaker 4: world and my boss stuck his hand out, but luckily
Speaker 4: he went for the fist bump instead of a handshake,
Speaker 4: and it was great. That was that was ideal because
Speaker 4: I didn't want to have to be like, sorry, can't
Speaker 4: shake your hand right now. Just read a whole bunch
Speaker 4: of stuff about about hand germs.
Speaker 2: I thought you were going to he stuck his hand
Speaker 2: out so you could kiss it.
Speaker 4: No, no, no, no, no, we have we have at
Speaker 4: Our boss is a little better than that.
Speaker 2: Our boss is the Pope. We work at the Vatican.
Speaker 4: But another big thing about all this is that it
Speaker 4: comes down to the to one of the obvious facts
Speaker 4: we've discussed before that without germ theory, without any insight
Speaker 4: into the invisible world of organisms that are literally at
Speaker 4: our fingertips for the vast majority of human history, we
Speaker 4: just we just didn't know. We just didn't know that.
Speaker 4: Like we again, we had gloves. It's not like, uh,
Speaker 4: like we didn't have this idea that well, there are
Speaker 4: some cases where we need to cover our hands to
Speaker 4: protect our hand from some sort of external force, or
Speaker 4: perhaps in some cases protect the external world from our hands.
Speaker 4: But if you cannot see the threat, if you have
Speaker 4: no real concept of the germs that are out there,
Speaker 4: of the invisible world, then what can you do?
Speaker 2: Well, yes, and also to acknowledge that the glove itself
Speaker 2: would need to be sterilized in order to provide an
Speaker 2: advantage there, Just putting on a dirty glove doesn't do
Speaker 2: much better than using a dirty hand exactly.
Speaker 4: To give some more stats on some of this. According
Speaker 4: to Smith at All in twenty seventeen's Infection Control through
Speaker 4: the Ages, even today, quote, approximately one point seven million
Speaker 4: healthcare associated infections or HAI's occur in the United States
Speaker 4: each year. So even with modern precautions and technologies in place,
Speaker 4: that's one of the things about healthcare. I mean, it
Speaker 4: does put you in close proximity with a doctor, it
Speaker 4: puts you often puts you in a space where you
Speaker 4: have other individuals with various health care concerns going on.
Speaker 4: It's just the reality of it. But if you go
Speaker 4: back in time before germ theory, before these various technologies,
Speaker 4: things obviously get a bit darker. Smith that All point
Speaker 4: out that in medieval times there was a high level
Speaker 4: of illness and death in hospitals, and quote, when a
Speaker 4: sick person entered a hospital, his or her property was
Speaker 4: disposed of, and in some regions a requiem mass was
Speaker 4: held as if he or she had already died.
Speaker 2: That's a bad health care plan, Yeah, it does.
Speaker 4: It's not a singing endorsement of the hospital you're about
Speaker 4: to enter. Because of course that the tools were often primitive,
Speaker 4: they weren't cleaned and weren't cleaned between uses. Cauterization via
Speaker 4: hot iron or boiling oil was commonly used. You're looking
Speaker 4: at between sixty and eighty percent mortality rates. This is
Speaker 4: pretty common during the time period, and even into the
Speaker 4: early modern period. Many things had improved, but you still
Speaker 4: had surgeons placing ungloved hands directly into wounds and directly
Speaker 4: into incisions and so forth, and this was certainly the norm.
Speaker 4: Again for much of human medical history. We didn't have
Speaker 4: the materials and or we didn't know about the invisible
Speaker 4: world of microbes, and other reasons were focused on for
Speaker 4: subsequent infections such as bad air or miasma seeping into
Speaker 4: the wound and read that, you know, until shockingly recently,
Speaker 4: it was things like pus and secondary infections were often
Speaker 4: just thought of as well, this is just part of
Speaker 4: the body healing itself. This is just what happens. This
Speaker 4: is the norm, and there's nothing we can do about it.
Speaker 2: I was just randomly reminded of something I read recently,
Speaker 2: which is so, you know, the famous story about US
Speaker 2: President James A. Garfield, who was it is sometimes said, assassinated,
Speaker 2: But it has been observed by many historians that he
Speaker 2: was shot, but he survived his bullet wound for a
Speaker 2: while and was like for months actually, and was repeatedly
Speaker 2: operated on in an unsanitary way by a doctor. And
Speaker 2: it is commonly believed that the doctor's unsanitary intervention is
Speaker 2: in fact what killed Garfield. But the thing that I
Speaker 2: found out is that that doctor's name, his given name
Speaker 2: was doctor. His name was doctor Willard Bliss. So he
Speaker 2: was doctor doctor Willard Bliss, all right.
Speaker 4: But speaking of this time period, yeah, eventually we'd get
Speaker 4: to what Smith at All referred to as the progressive
Speaker 4: era of the eighteen nineties through the nineteen twenties, and
Speaker 4: we do see a shift here. Quote. This period saw
Speaker 4: great advances in hospital infection control. Ignot Simmelweiss was the
Speaker 4: first hospital epidemiologist, setting a precedent for step by step
Speaker 4: analysis of an outbreak and for tracing epidemics to a
Speaker 4: particular surgeon or practice e g. Going from the autopsy
Speaker 4: room to the operating room without washing your hands uugh
Speaker 4: Eleven of twelve consecutive women die of pweparral or child
Speaker 4: bed fever, and subsequently required that all providers who attended
Speaker 4: the patients first wash their hands in a watery solution
Speaker 4: of chlorinated lime. The mortality rate then dropped dramatically from
Speaker 4: eighteen percent to two percent. So simlweis here was a
Speaker 4: Hungarian physician who lived from eighteen eighteen through eighteen sixty five.
Speaker 4: So he's a little bit before of this, before this
Speaker 4: progressive era that Smith at all are talking about. But
Speaker 4: this is a time when we see rapid changes in
Speaker 4: medical knowledge, we see the advent of technologies like the
Speaker 4: X ray. This is a time period that was covered,
Speaker 4: I think, just excellently in Steven Soderberg's television drama The Nick,
Speaker 4: which I know I've mentioned on the show before. It's
Speaker 4: just a great drama, a lot of attention to detail,
Speaker 4: but also they have this very clean, white, almost blinding
Speaker 4: visual style to the show, have electronic music by Cliff
Speaker 4: Martinez throughout the series, and so I think it does
Speaker 4: a great job of portraying the past as the energetic,
Speaker 4: promising present. You know something that we sometimes I think
Speaker 4: lose track of in representing the past on film or
Speaker 4: even reading about the past, about thinking about this time
Speaker 4: period in past as being completely divorced from what we
Speaker 4: will know, and it's more about just like the excitement
Speaker 4: and also the danger of being there at the bleeding
Speaker 4: edge of technology and innovation. Yeah.
Speaker 2: I think one of the things that's often hard to
Speaker 2: capture accurately when you're portraying the past is understanding the
Speaker 2: past as without knowledge of the future, understanding the past
Speaker 2: as incorporating the full uncertainty of being a present of
Speaker 2: its own. Like you say, so, not only the excitement
Speaker 2: of things being new at the time, but also the
Speaker 2: lack of knowledge how things would turn out. Everything always
Speaker 2: seems more obvious in retrospect.
Speaker 4: Right, right, And certainly The Nick is a show that
Speaker 4: doesn't doesn't shy away from the wrong paths. I think
Speaker 4: I've mentioned before when we're talking about the invention of
Speaker 4: the X ray you have, there's one episode in particular
Speaker 4: where they're so excited to have the X ray. Uh,
Speaker 4: they're at the hospital and they're just just using it
Speaker 4: just so irresponsibly, without really understanding or having any idea
Speaker 4: of just how dangerous repeated exposure to the machine would be.
Speaker 2: Well, they're using it unnecessarily, right, They're just like using
Speaker 2: it for fun.
Speaker 4: Yeah, it's like you get the kids in here, Oh,
Speaker 4: watch watch watch Dad x ray's hand multiple times for
Speaker 4: no reason, that sort of thing.
Speaker 1: Uh.
Speaker 4: But and they you know, they explore other things as
Speaker 4: well on the show. You know, various social issues come up,
Speaker 4: eugenics comes up, you know, all sorts of things of
Speaker 4: this nature. But anyway, Simple Device's findings were apparently better
Speaker 4: received in some countries than compared to others, the UK
Speaker 4: and Germany being too though. That's interesting because we'll come
Speaker 4: back to Germany as sort of a center of discussion
Speaker 4: over the best practices and best use of new medical
Speaker 4: findings and technology. But on the whole, there was a
Speaker 4: lot of criticism of his ideas, and a lot of
Speaker 4: his efforts ended up in antagonism. His critics attacked him,
Speaker 4: he attacked back. It apparently got pretty ugly, at least
Speaker 4: from an academic standpoint, and his mental health declined greatly
Speaker 4: and he eventually died in an asylum. So it's often
Speaker 4: characterized as being, you know, this effort where he's kind
Speaker 4: of up against the wall. Maybe didn't have what, maybe
Speaker 4: wasn't the ideal person to be making these arguments, Like
Speaker 4: maybe it could have been a better pr campaign for
Speaker 4: some of these ideas, but what can you do?
Speaker 2: Well, Yeah, I think a lot of the hygienic concerns
Speaker 2: about medical interventions and especially surgery would get more traction
Speaker 2: in the eighteen sixties with Joseph Lister.
Speaker 4: Yeah, Joseph Lister definitely a big one. I mean, there
Speaker 4: are various individuals that are working during this time cracking
Speaker 4: our understanding of the unseen and what we should do
Speaker 4: about it. And of course you have to acknowledge the
Speaker 4: work of Louis Pastur. Now there's but Yeah, Joseph Lister
Speaker 4: was a big name. Eighteen twenty seven through nineteen twelve,
Speaker 4: he introduced the concept of surgical asepsis, the absence of
Speaker 4: all microorganisms within any type of invasive procedure. His work
Speaker 4: alone was associated, according to Smith at All, with a
Speaker 4: decrease in post amputation mortality rates from forty five percent
Speaker 4: to fifteen percent. And he also cut down on the
Speaker 4: necessity for amputation. That was one of the big things
Speaker 4: he was going after two Like, he was saying, it
Speaker 4: would just won't be necessary to amputate this many limbs
Speaker 4: because because we'll be using cleaner tools, etc. He argued
Speaker 4: for the necessity of pre operative hand washing and the
Speaker 4: use of disinfectant soaked wound dressings.
Speaker 2: Yeah, I think lister especially is known to highlight a
Speaker 2: distinction we'll get to in a little bit, the distinction
Speaker 2: between asepsis and anti sepsis, with pioneering the anti sepsis trend,
Speaker 2: which is the attempt to sterilize the wound itself to
Speaker 2: prevent infection. So this would typically mean using a disinfectant
Speaker 2: chemical such as carbolic acid in and around a wound.
Speaker 4: Yeah, and also dressings surgical tools. He stress that you
Speaker 4: should change dressings on wounds regularly.
Speaker 2: Yeah.
Speaker 4: And again, before lister here and infection were just considered
Speaker 4: part of the healing process. It wasn't. It wasn't necessarily
Speaker 4: thought that this means things are not going to according
Speaker 4: to plan. It just means like this is what happens
Speaker 4: when the body heals from a wound, all right. So
Speaker 4: getting into more into the realm of early surgical gloves,
Speaker 4: early medical glove concepts, and the struggle for their acceptance.
Speaker 4: William Halstead introduced rubber gloves for use in surgery by
Speaker 4: around eighteen ninety, and by nineteen hundred we see more
Speaker 4: and more doctors wearing gowns, masks, and gloves. But the
Speaker 4: use of gloves especially is certainly not instantly accepted by
Speaker 4: the medical community to come back to the nick for example,
Speaker 4: which which again I think does a pretty great job
Speaker 4: of depicting this time period. If you go back and
Speaker 4: watch any of this show, and I did certainly didn't
Speaker 4: have a chance to go back and watch all of it,
Speaker 4: but you pretty much don't see surgical gloves at all.
Speaker 4: There are just lots of scenes of surgeons who again
Speaker 4: are at the bleeding edge of technology and innovation at
Speaker 4: the time, but they are reaching into people's bodies with
Speaker 4: bare hands. They are opening up people's craniums with bare hands,
Speaker 4: and just every other part of the anatomy as well
Speaker 4: lots of shots of white linens and blood soaked hands
Speaker 4: now on the show. There are also frequent scenes of surgeons, though,
Speaker 4: going through a series of hand washings before surgery, sometimes
Speaker 4: while engaging in dialogue with each other. But I remember
Speaker 4: being particularly taken by at least one scene in which
Speaker 4: there's kind of a beautiful feeling of almost spiritual ritual
Speaker 4: to the thing of the surgeon washing and lowering their
Speaker 4: hands and forearms first into one vat, then into a
Speaker 4: second vat, and then into a third vat. Like again,
Speaker 4: it has kind of an almost magical feeling to it.
Speaker 4: And so I was reading a little bit about about
Speaker 4: this time period here for this episode, and based on
Speaker 4: my readings of why were surgical gloves not used earlier
Speaker 4: by Thomas Schlitch, I believe this is the three VAT
Speaker 4: system standardized in Berlin in eighteen eighty eight by Paul Fubringer.
Speaker 4: First soap, then alcohol, and then finally an antiseptic substance.
Speaker 2: Yeah, that three stage process was very common by the
Speaker 2: eighteen nineties.
Speaker 4: And again it's great, it's a wonderful advanced in surgery
Speaker 4: of the time, but of course it falls just a
Speaker 4: little short of actually using gloves, of actually embracing the
Speaker 4: standard that now again we just accept when we go
Speaker 4: into a medical facility. So the three VAT systems coming
Speaker 4: out of Germany. Germany is also where we see a
Speaker 4: great deal of argument during this period about whether surgeons
Speaker 4: should have to wear surgical gloves at all. And I
Speaker 4: think the first place that I was reading about this,
Speaker 4: there was a j Store Daily article that came out
Speaker 4: from this is by jess Romeo in July of twenty twenty,
Speaker 4: when obviously a lot of this sort of thing was
Speaker 4: going going on in our heads. And there's all the
Speaker 4: obvious parallels between the treatment here of gloves and consideration
Speaker 4: of things like certainly hand washing, but also the use
Speaker 4: of mass The article was the surgeons who said no
Speaker 4: to gloves, And the article from Romeo is citing another article,
Speaker 4: a source article by Thomas Schlitch who he just referenced,
Speaker 4: titled Negotiating Technologies in Surgery the controversy about surgical gloves
Speaker 4: in the eighteen nineties, and this was a twenty thirteen
Speaker 4: article from the Bulletin of the History of Medicine.
Speaker 2: Yeah, this Bulletin of History of Medicine article is interesting.
Speaker 2: So the author here, Thomas Schlick, is a German Canadian
Speaker 2: historian of medicine who's on faculty at McGill University in Montreal.
Speaker 2: And Schlick begins his article by illustrating a really strange
Speaker 2: moment from the history of surgery where there was so
Speaker 2: there was this big conference in eighteen ninety eight. It
Speaker 2: was the twenty seventh Congress of the German Society for Surgery,
Speaker 2: and Schlick quotes a report on this meeting by an
Speaker 2: Austrian surgeon named Alexander Frankel, who was just perplexed by
Speaker 2: some of what was going on, because a big subject
Speaker 2: of conversation for one whole afternoon at this conference for
Speaker 2: surgeons was about gloves. It was about surgical gloves, whether
Speaker 2: or not you should use them, and what types of
Speaker 2: gloves are best. And Frankel, reacting to this whole discussion,
Speaker 2: says quote, for a whole afternoon, participants discussed about the
Speaker 2: best glove models, marching up all the various specimens made
Speaker 2: from different materials in all sizes and price ranges. Allas
Speaker 2: Sarah Bernhardt referring to like a French actress and whatever
Speaker 2: the fashionable designs might be called, a whole apparatus of
Speaker 2: pseudoscience was mobilized to inaugurate the new fashion of the
Speaker 2: surgeon in gloves. So Frankel here is a respected, influential
Speaker 2: surgeon of the time, how can it be that he
Speaker 2: viewed the idea of surgical gloves as absolutely ridiculous pseudoscientific pageantry.
Speaker 2: Akin to I think the comparison to Sarah Bernhardt here
Speaker 2: is he's saying it's like a gaudy fashion show.
Speaker 4: Yeah. Yeah, he compares it to just pure costuming. It's like,
Speaker 4: this is just a costume that these doctors are putting
Speaker 4: on that there's no real medical rationale for this.
Speaker 2: Now today, it's natural for us to look back on
Speaker 2: this view as not only misguided but absolutely baffling. But
Speaker 2: it's true that even after the idea of using some
Speaker 2: kind of impermeable sterile glove for surgery was introduced, it
Speaker 2: took more than a decade of sort of debate within
Speaker 2: the medical community before it achieved what could be considered
Speaker 2: near universal acceptance. And this article by Schlick explores the
Speaker 2: historical discussion and controversy about the introduction of surgical gloves,
Speaker 2: specifically in German speaking hospitals in the eighteen nineties. So
Speaker 2: the question is why did most surgeons hesitate for so
Speaker 2: long before adopting the use of surgical gloves, even after
Speaker 2: we had a bacterial theory of disease and infection. And actually,
Speaker 2: once you see all their concerns lay doubt, the objections
Speaker 2: to people who resisted the gloves at the time seem
Speaker 2: a little bit less baffling. It actually makes more sense
Speaker 2: of them when you understand what the understanding was at
Speaker 2: the time and what the pressures on surgeons for performing
Speaker 2: in the operating room were.
Speaker 4: Yeah, I think this is one of the great things
Speaker 4: he does in the paper is really presents this this
Speaker 4: idea because it's easy to think about this and sort
Speaker 4: of look at the surface level of this new technology
Speaker 4: and its eventual adoption and just look at it as Okay,
Speaker 4: well here's the new way, and everybody else must have
Speaker 4: been saying, oh, I just want to do it the
Speaker 4: old way, where it was really more a situation where
Speaker 4: there was the old ways and then there were all
Speaker 4: these new exciting ways that were all ultimately trying to
Speaker 4: crack the same nut to try to improve the mortality
Speaker 4: rates for various procedures. And also he seems to stress
Speaker 4: that you know, weuld we can't really go into these
Speaker 4: situations sort of with a wrong side of history viewpoint
Speaker 4: of the past. You know, generally in the present, if
Speaker 4: you're presented with different ideas, the ones that are the
Speaker 4: wrong side of history are not labeled, so you know,
Speaker 4: you don't know that this is not going to be
Speaker 4: you know that you're on the ultimately on the losing
Speaker 4: hill here when you're advocating that medical gloves should not
Speaker 4: be used universally, well.
Speaker 2: Yeah, this is what I was talking about earlier with
Speaker 2: like the uncertainty of the present, and you always have
Speaker 2: to remember that in the past they were just as
Speaker 2: uncertain about what the future would be as we are
Speaker 2: about our own future in the present right.
Speaker 4: And one thing he stresses here is that these surgeons,
Speaker 4: often big name surgeons that were engaging in this debate,
Speaker 4: a lot of them had their own ideas, their own techniques,
Speaker 4: and in many cases they had they had data to
Speaker 4: back up what they were arguing. Like there's there's one
Speaker 4: guy that he mentioned, surgeon Thomas Spencer Wells, who advocated
Speaker 4: the cleanliness cold water school as opposed to and embracing
Speaker 4: Lister's ideas. So this is more in general about like
Speaker 4: hand washing and cleansing of instruments, boiling of instruments, et cetera,
Speaker 4: as opposed to gloves. But this was a guy that
Speaker 4: still had a minimal complication rate, and therefore he had
Speaker 4: some data to back up his viewpoint. So he had
Speaker 4: he wasn't just standing on a hill without any reason
Speaker 4: to make his argument. He had seen what seemed at
Speaker 4: the time like a reasonable argument, like saying, look, look
Speaker 4: what I'm doing seems to be working, and I have
Speaker 4: the data to back it up.
Speaker 2: Yes, And wells would not be the only one. There
Speaker 2: are even people making the case at this eighteen ninety
Speaker 2: eight Congress of German Society for Surgery who were saying, look,
Speaker 2: I've done laboratory research that shows that you get way
Speaker 2: more bacterial penetration of these blood soaked cotton gloves than
Speaker 2: you do of bare hands. So actually you don't need gloves,
Speaker 2: you just need clean hands.
Speaker 4: Yeah. Another name you mentioned is Johannes Mikkelish who who
Speaker 4: argue that we should be using this preoperative injection of
Speaker 4: nucleic acid to supposedly increase white blood cell count and
Speaker 4: boost immune response. So so again it comes back to
Speaker 4: the idea that it's not just the old ideas and
Speaker 4: the new this one new idea. No, there are these
Speaker 4: other seemingly promising new ideas and new technologies that are
Speaker 4: also suddenly available.
Speaker 2: Oh that's interesting, And you get these from both sides
Speaker 2: about the different solutions, because Mikolch here was one of
Speaker 2: the major proponents of gloves at this at this conference,
Speaker 2: he was there representing the yes gloves or good side.
Speaker 4: Interesting. Yeah, but then he also has his other thing
Speaker 4: as well, that you could conceivably you're a surgeon you're
Speaker 4: listening to all these ideas, you can imagine where you
Speaker 4: might be like, well, this Johannes seems to have a
Speaker 4: great technology here. Maybe I can cherry pick a little bit.
Speaker 4: Maybe I can sort of hold onto my own reservations
Speaker 4: about gloves and just start using this nucleic acid treatment
Speaker 4: that has been proposed. So, yeah, there are a lot
Speaker 4: of ideas on the table, and again it seems like
Speaker 4: each surgeon had their own ideas and techniques.
Speaker 2: Yeah, that's another point Schlick actually really highlights in this paper,
Speaker 2: which is that, you know, sometimes we have a tendency
Speaker 2: to erroneously look at the history of progress in medicine
Speaker 2: as a kind of unified, top down effort where there's
Speaker 2: just like, okay here, you know, almost like there is
Speaker 2: a sort of a board of medicine that like controls
Speaker 2: all of medicine throughout history and they direct the flow
Speaker 2: of development and progress. But in fact, the way Schlick
Speaker 2: frames it is, you know, medicine is just full of individual,
Speaker 2: little practical solutions to problems, especially in the eighteen nineties here,
Speaker 2: and over time some prove better than others.
Speaker 4: Now, another thing we have to mention here is, of
Speaker 4: course what we're talking about when it comes to materials
Speaker 4: and what we were talking we were talking about with
Speaker 4: the physical gloves of the time, this would not have
Speaker 4: been a situation where like, we're dealing with modern medical
Speaker 4: gloves that are suddenly presented to an audience at this
Speaker 4: this gathering. It made me think of a recent episode
Speaker 4: of the nineties Outer Limits that I watched. If the
Speaker 4: episode is titled Gettysburg. It stars Meatloaf and it also
Speaker 4: has the guy who played the crazy man on the
Speaker 4: boat in Jason Takes Manhattan, and it does involve time
Speaker 4: travel with Civil War reenactors who are sent back in
Speaker 4: time to the Battle of Gettysburg, and one of them
Speaker 4: is like a medical responder and has a medkit, and
Speaker 4: so there's a great scene where he's he's he's doing
Speaker 4: some some medical intervention on a wounded soldier, and Meatloaf's character,
Speaker 4: who's a Civil War era I like to forget what
Speaker 4: he is if he's a oh, he's a colonel. He's
Speaker 4: watching and he doesn't seem to think anything about these
Speaker 4: modern medical devices and gloves that are being used by
Speaker 4: this guy. So that's kind of a tangent, But it
Speaker 4: was weighing heavily on my mind as I researched this.
Speaker 2: Well, to be fair to meet loaf, I mean, if
Speaker 2: I look at a modern surgery, I'd see a lot
Speaker 2: of stuff. I don't know what I'm looking at, and
Speaker 2: it's there's no time travel involved.
Speaker 4: Yeah, so these would not have been modern medical gloves
Speaker 4: that they were considering here. The author mentions several of
Speaker 4: the different designs that were presented at this conference that
Speaker 4: included elbow length fabric gloves of cotton or silk, and
Speaker 4: of course if you were to use these during an operation,
Speaker 4: they would apparently quickly become soaked with blood. There was
Speaker 4: also the idea of using leather style military gloves, and
Speaker 4: these would have, of course been clumsy to use. Wax
Speaker 4: treated fabric was another idea, and ooh, I was really
Speaker 4: this one really captured my attention, The idea of wax
Speaker 4: poured directly over the surgeon's hands to form a supposed
Speaker 4: seal between the flesh and the operation.
Speaker 2: Yeah, and the actual paper Schlick talks, he mentions this
Speaker 2: as a proposal, but I didn't get the impression anybody
Speaker 2: ever did it, or at least not. Yeah, didn't like
Speaker 2: put it into regular practice.
Speaker 4: Yeah, I have trouble imagining how it would work right,
Speaker 4: because if the wax was sealed around the hand, and
Speaker 4: if you go with the right wax, that of course
Speaker 4: wouldn't be just absolutely scalding to the flesh, then it
Speaker 4: would truly become brittle upon trying to move your hand around.
Speaker 2: Yeah, I don't know. It doesn't make a lot of
Speaker 2: sense to me, though. I'm also confused about the wax treated.
Speaker 2: I mean, I can get into more detail about this later,
Speaker 2: but one of the proposals is for like a silk
Speaker 2: glove that you would cover in liquid wax, and that
Speaker 2: would help make the silk fabric more impermeable. But I
Speaker 2: would also think, like, wouldn't that get kind of brittle?
Speaker 2: I don't know.
Speaker 4: Yeah, it was like it would be flaying off and
Speaker 4: you'd have like little bits of wax. I mean, Fortunately,
Speaker 4: as we've pointed out before in the show, like wax
Speaker 4: has long been used and so has honey in various
Speaker 4: medical treatments. So it's not the worst thing, I guess
Speaker 4: to have in a wound, but it's you want to
Speaker 4: cut down on the amount of external substances that are
Speaker 4: introduced to a body cavity during a procedure like this.
Speaker 4: I don't know about you, but another detail I really
Speaker 4: liked in Schlich's article was this bit quote. Another strategy,
Speaker 4: and this is an alternative to gloves, involved keeping one's
Speaker 4: hands clean between operations and abstaining from handling infectious materials
Speaker 4: even when not on the job, an approach that in
Speaker 4: some cases amounted to a whole regime of living. Which
Speaker 4: this is easy to sort of think of almost comedically,
Speaker 4: where you can imagine the surgeon saying, well, I'm of
Speaker 4: course I'm not going to wear gloves during a procedure.
Speaker 4: It gets in the way. I have some issues with
Speaker 4: how high it is. What I'm gonna do is I'm
Speaker 4: going to wear gloves the rest of the time when
Speaker 4: I'm not in the surgery, and therefore keep my hands
Speaker 4: nice and clean and ready to just get in there.
Speaker 2: There. You almost it's like you become sort of part
Speaker 2: of a priestly class. You must maintain purity for all time.
Speaker 4: Yeah, I mean, it's like these are the money makers, right,
Speaker 4: I have to keep the gloves on them at all times.
Speaker 2: That these hands are registered with the FBI as lethal weapons,
Speaker 2: because I don't wash them before I operate.
Speaker 4: Now, he points out that the material challenges here came
Speaker 4: down to the following and these I think were pointed
Speaker 4: out by Sergeant Anton Wolfer at the time. They needed
Speaker 4: to be impermeable, obviously, they needed to be flexible, They
Speaker 4: needed to be resistant to tears. They couldn't be too tight,
Speaker 4: they couldn't be too hot. And above all else they
Speaker 4: had to be you had to be able to sterilize them.
Speaker 2: They had to be sterilizable, right, meaning you could like
Speaker 2: boil them or steam them or something to kill any
Speaker 2: thing that might be on them without damaging them so
Speaker 2: that they couldn't be used.
Speaker 4: Right. And so given all of these demands of the materials,
Speaker 4: it shouldn't come as a surprise that the first surgical
Speaker 4: gloves that were presented here they were not perfect. They
Speaker 4: did tear, They did make aspects of surgery, particularly gripping
Speaker 4: certain tools or certain parts of the human anatomy more difficult.
Speaker 4: I think the manipulation of bowels is singled out as
Speaker 4: being difficult with some of the gloves of this time period.
Speaker 4: But on the other hand, it does certainly in the
Speaker 4: long term they did make a difference in the spread
Speaker 4: of pathogens through surgical procedure.
Speaker 2: Oh yeah, so I think by around the time of
Speaker 2: World War One, it's generally agreed that's when you are
Speaker 2: seeing Okay, now we have pretty much universal acceptance that
Speaker 2: impermeable sterile gloves are good for surgery and they should
Speaker 2: be used if at all possible.
Speaker 4: I can't help but think of media and this as well,
Speaker 4: like cinematic depictions of doctors, like now, like the image
Speaker 4: of a doctor, be of them a good doctor or
Speaker 4: a mad scientist or something. The taking off or the
Speaker 4: putting on of surgical gloves or medical gloves at some point,
Speaker 4: some form or another, it is kind of associated with
Speaker 4: power and ability. You know, there's there's something about it
Speaker 4: that like we don't even even doubt doubt. Not only
Speaker 4: do we not doubt the importance of gloves, but they
Speaker 4: have kind of become associated with these roles, Like it's
Speaker 4: hard to separate the two, and you wouldn't want to
Speaker 4: separate the two.
Speaker 2: There's a there's a strong audio visual cue used in media,
Speaker 2: which is much in the same way you have like
Speaker 2: an action movie where a gritty action scene is about
Speaker 2: to commence, so you get the pump of the shotgun.
Speaker 2: In the medical scene, you get the snap of the
Speaker 2: rubber glove. It's almost exactly the same.
Speaker 4: Thing, right, I mean it's enough to where if you
Speaker 4: were given the choice between two fraudulent pseudoscientific healers and
Speaker 4: they were going to work on you, and one is
Speaker 4: using bear hands and one is using gloves, like the
Speaker 4: mere presence of the gloves could potentially legitimize it a
Speaker 4: little bit in your eyes.
Speaker 2: You know, Wait, no, beb did you mean bear hands
Speaker 2: or B E A R hands?
Speaker 4: Oh well I meant I meant B A R E.
Speaker 4: But B E R That brings on an entirely different vision, right,
Speaker 4: I mean that's then you're in the realm of the shaman.
Speaker 2: I would go with I would go with the quack
Speaker 2: that had bear paws over the quack that just had gloves.
Speaker 4: Or what if the the what if the quack had
Speaker 4: both a bear head on over their own head, but
Speaker 4: they had medical gloves on.
Speaker 2: What if they operated on you wearing the bear costume
Speaker 2: from Jack Frost?
Speaker 4: There you go?
Speaker 2: All right? Well, I wanted to come back to that
Speaker 2: Thomas Schlick paper in the Bulletin of the History of Medicine,
Speaker 2: the one called negotiating Technologies and surgery. That was all
Speaker 2: about the controversy over surgical gloves in German speaking hospitals
Speaker 2: in the eighteen nineties. And as I mentioned earlier, the
Speaker 2: Shlick paper is interesting because it frames the good things
Speaker 2: about gloves as a sort of you know, existing within
Speaker 2: a network of trade offs and talking about it as
Speaker 2: one of the types of what Slick calls control strategies
Speaker 2: within surgery at the time, and control strategies that were many,
Speaker 2: but they included things like different instruments, lights and operating tables, anatomy, atlases, anesthetics,
Speaker 2: and of course technologies of a sepsis. Now I mentioned
Speaker 2: earlier the difference between a sepsis and anti sepsis, and
Speaker 2: this is an important concept in the development of surgery
Speaker 2: in the second half of the nineteenth century. So you've
Speaker 2: got two schools of thought that are in competition. One
Speaker 2: is anti sepsis, which is the idea of disinfecting a
Speaker 2: wound after germs have likely been introduced. And then you've
Speaker 2: got acepsis, which is instead trying to prevent any germs
Speaker 2: from ever entering the wound in the first place. And
Speaker 2: the primary method here would be trying to make all
Speaker 2: instruments and objects in the surgical environments sterile before surgery begins,
Speaker 2: so you'd boil your scalpels and so forth. But Schlick
Speaker 2: describes a growing nervousness among surgeons in the eighteen nineties
Speaker 2: based on the general feeling that raining aseptic practices were
Speaker 2: not good enough. By the eighteen nineties, surgeons in German
Speaker 2: speaking hospitals were aware of the bacteriological problems. They were
Speaker 2: trying to be a septic however they could. They were
Speaker 2: washing their hands and going through all these procedures we
Speaker 2: talked about, but they were just aware that the current
Speaker 2: methods were not preventing all infection. Acepsis had to be
Speaker 2: They what they thought of as an all or nothing campaign.
Speaker 2: And Schlick quotes an academic surgeon somebody who we've already referenced.
Speaker 2: This was a guy at the University Breslau named Johannes
Speaker 2: van Mikolch, and Mikolch wrote quote, the smallest mistaken wound
Speaker 2: treatment would come back to haunt the surgeon. And Mikolch,
Speaker 2: together with a collaborator named Carl Fluga, who lived eighteen
Speaker 2: forty seven to nineteen twenty three, spent great effort in
Speaker 2: the eighteen nineties trying to close the gaps, basically to
Speaker 2: find ways that germs could still be getting in even
Speaker 2: with the aseptic practices of the time. And so one
Speaker 2: of the ideas they came up with was using face
Speaker 2: masks to prevent droplet infection, so droplets from the doctor's
Speaker 2: mouth or nose entering the wound and introducing germs during surgery.
Speaker 2: And schlickwrites quote many of today's surgical paraphernalia were introduced
Speaker 2: at the time as part of the bacteriologically supported search
Speaker 2: for weak points in the aseptic all or nothing system
Speaker 2: of preventing wound infection. It was the context of this
Speaker 2: crisis of aseptics surgery that prompted a number of surgeons
Speaker 2: in the eighteen nineties to simultaneously try out surgical gloves
Speaker 2: within their local settings. Now, one of the next things
Speaker 2: that Schlick talks about in this paper I thought was
Speaker 2: very interesting is so if we're looking at German speaking
Speaker 2: hospitals in the eighteen eighties and eighteen nineties, they're aware
Speaker 2: of the fact that they need to improve aseptic practices
Speaker 2: in surgery, but they don't know all the ways to
Speaker 2: plug the holes and the use of surgical gloves is
Speaker 2: obvious to us in retrospect, but it was not obvious
Speaker 2: to everyone at this time and place, So why would
Speaker 2: it not have been obvious to them. One thing Slick
Speaker 2: points out is that, first of all, it just requires
Speaker 2: thinking about gloves in a different way. Prior to this,
Speaker 2: gloves were typically used to protect the person wearing them
Speaker 2: rather than to protect someone from the person wearing them.
Speaker 2: So it's kind of like having to just think outside
Speaker 2: the box to reframe something that is already part of
Speaker 2: your mundane existence. So imagine thinking that you would need
Speaker 2: to wear a hat to protect someone else from your head.
Speaker 2: It seems weird, but actually, if you think about it
Speaker 2: in the right context, this is something that people do.
Speaker 2: I've worked in restaurants where chefs were required to wear
Speaker 2: either hats or hairnets to keep their hair out of
Speaker 2: the food. If you're not familiar with the context like that,
Speaker 2: it might never occur to you that you would wear
Speaker 2: a hat for somebody else's benefit. But another thing that
Speaker 2: Slick points out around here is that carbolic acid and
Speaker 2: other antiseptic chemicals that were used to get the hands
Speaker 2: clean before surgery these were hard on the skin, schlickwrites,
Speaker 2: quote copiously applied, the caustic solutions often caused severe skin
Speaker 2: damage in surgeons and nurses, forcing some of them to
Speaker 2: abandon operating altogether. The issue was the background of the
Speaker 2: well known story of how in eighteen eighty nine William
Speaker 2: Halstead at Johns Hopkins introduced rubber gloves to protect the
Speaker 2: hands of his chief operating nurse, who later became his wife. Now,
Speaker 2: Rob you already mentioned Halsteed introducing rubber gloves in his
Speaker 2: practice around this time, but Slit goes on with an
Speaker 2: interesting detail here quote. Subsequently, such gloves were also used
Speaker 2: by Halstead's assistants. They put them on when taking instruments
Speaker 2: out of the corrosive sublimate solution in which the instruments
Speaker 2: were kept, and pass them on to the operating surgeon
Speaker 2: who did not wear gloves. So the assistance would you'd
Speaker 2: have like a scalpel, and that would be in a
Speaker 2: sterilizing caustic chemical, and the assistance would put gloves on
Speaker 2: to take the thing out of that chemical, hand it
Speaker 2: to the surgeon who would receive it with an ungloved
Speaker 2: hand and then operate.
Speaker 4: Yeah, I guess one of the things to drive from
Speaker 4: here is, you know, the adoption of a new technology
Speaker 4: is sometimes a little patchy.
Speaker 2: And the reasoning can be different than what you'd expect.
Speaker 2: So they've got by eighteen eighty nine, Halsted's assistants and
Speaker 2: nurses are using rubber gloves to protect their hands from
Speaker 2: these coustic chemicals. But it wasn't until eighteen ninety six
Speaker 2: that rubber gloves to protect the patient during surgery became
Speaker 2: standard at Johns Hopkins. It just didn't seem like an
Speaker 2: obvious solution until around then. Now, another thing is that
Speaker 2: so rob earlier you mentioned this three vat process. You've
Speaker 2: got surgeons who would wash their hands with soap and
Speaker 2: then submerge their hands in alcohol and then dip their
Speaker 2: hands in an antiseptic chemical before going into surgery. So
Speaker 2: you would think, man, you go through that kind of procedure,
Speaker 2: that really should kill all the bacteria, right, shouldn't your
Speaker 2: hands be perfectly clean by then? But one of the
Speaker 2: things that became clear to these surgeons in the eighteen
Speaker 2: nineties is that this actually it was pretty good, but
Speaker 2: it wasn't good enough because even if you could sterilize
Speaker 2: the outside skin of your hands, there were little pockets
Speaker 2: where germs could camp out and still infect a wound.
Speaker 2: Examples would include the sebaceous glands. These are little gland
Speaker 2: pockets attached to hair follicles that produce sebum, which is
Speaker 2: a waxy or oily substance that coats the skin and hair.
Speaker 2: And then also you've got like underneath the fingernails. You know,
Speaker 2: you're just gonna have like little recesses back there where
Speaker 2: these liquids are not getting in deep enough, and germs
Speaker 2: from in there might still get out during surgery. And
Speaker 2: for some reason, this reminds me of you remember in
Speaker 2: our invention episode on the death ray, the idea of
Speaker 2: this time between World War one and two where there
Speaker 2: was terror about the inadequacy of ground based defenses against
Speaker 2: air raids. And there's this phrase that was used at
Speaker 2: the time, the bomber always gets through. I compared that
Speaker 2: to the bacterium in this case. Right, there's this fear
Speaker 2: that the bacterium somehow always gets through.
Speaker 4: Right, right, there's always going to be at least one
Speaker 4: little crack in the defenses with this method.
Speaker 2: So to try to get around these problems where you know,
Speaker 2: sterilizing your hands is not good enough. This is where
Speaker 2: gloves come in, and so we mentioned several times this guy,
Speaker 2: Johannis van Mikulitch, he tried this interesting solution, beginning with
Speaker 2: an operation on Easter eighteen ninety six, which was sterilized
Speaker 2: cotton gloves. So hands would go through the regular gauntlet
Speaker 2: washing and disinfection, but then after this you would put
Speaker 2: on these sterilized cotton gloves. They were very big. They
Speaker 2: had sleeves or gauntlets going all the way up the
Speaker 2: arm to the elbow or past the elbow, and you
Speaker 2: can see pictures of these they kind of look like
Speaker 2: mummy arms. Now, of course they're cotton gloves, so they're
Speaker 2: not impermeable, so over the course of an operation they
Speaker 2: would become soaked with blood and you might need to
Speaker 2: change them out for a new pair. But Mikolitch was
Speaker 2: very positive about them. He is like, you know, they're
Speaker 2: not that bad. And sometimes with cotton gloves you can
Speaker 2: even grip some things better, like holding onto tissues is
Speaker 2: easier with cotton gloves than with the naked hand. But
Speaker 2: there were times when the cotton gloves reportedly caused problems.
Speaker 2: One example would be this is the example given by Mikolitch.
Speaker 2: When a surgeon is feeling around on the inside of
Speaker 2: the stomach, lining to locate a tumor by touch, the
Speaker 2: cotton would apparently dull the sensitivity of the fingers, and
Speaker 2: Mikolitch wrote that in cases like this, you could briefly
Speaker 2: take off the glove, reach around and feel for the
Speaker 2: tumor with your bare fingers as quickly as possible, and
Speaker 2: then once you found it, you put on a pair
Speaker 2: of fresh cotton gloves.
Speaker 4: Yeah, and it's the five second rule of rooting around
Speaker 4: in somebody's stomach cavity. Right.
Speaker 2: Yeah, that seems like not a great solution, but at
Speaker 2: least you're trying to use something. So Mikolitch also tried
Speaker 2: out early rubber gloves, but said they were not tenable
Speaker 2: because they had they just had major disadvantages for manual dexterity,
Speaker 2: and they weren't much better than cotton gloves for acepsis.
Speaker 2: I don't know about that last claim, but apparently, according
Speaker 2: to Schlick, at least the surgeon most responsible for bringing
Speaker 2: rubber gloves into vogue in German speaking hospitals was Werner's
Speaker 2: Zoga von Manteuffel, who lived eighteen fifty seven to nineteen
Speaker 2: twenty six. Zoga was especially in search of failsafe aseptic
Speaker 2: protocols because he worked in an environment of a municipal
Speaker 2: hospital where he had to quote operate promiscuously, so he
Speaker 2: couldn't like, specialize in one type of surgery and quarantine
Speaker 2: for that. Instead, he had to operate alternately on like
Speaker 2: infected patients and uninfected ones, sometimes handling pus or feces
Speaker 2: or whatever, and then immediately having to go operate on
Speaker 2: a different patient. So his solution to this was boiled
Speaker 2: rubber gloves. There were downsides. The rubber gloves were uncomfortable.
Speaker 2: Sometimes they made it hard to move or bend the thumb.
Speaker 2: Sometimes the fingers were too long, which made gripping difficult,
Speaker 2: and because of these conditions, operations with rubber gloves would
Speaker 2: often take longer than the same operation with bare hands.
Speaker 2: And then, to read from Schlick quote, but this Zoga
Speaker 2: thought was outweighed by the gains in aseptic control the
Speaker 2: absolute safety of the quote boiled hand, as he called it.
Speaker 2: Zoga thus explicitly weighed the two kinds of control against
Speaker 2: each other. What also becomes clear in this discussion is
Speaker 2: the importance of the technical details of the gloves for
Speaker 2: reconciling manual and aseptic control. They had to be made
Speaker 2: in a way so that they didn't compromise the surgeon's
Speaker 2: grasp too much, but at the same time we're effective
Speaker 2: in keeping bacteria out. So this is a way of
Speaker 2: trying to get the boiled hand into circulation. You've got
Speaker 2: to make it so that it's worth it to the
Speaker 2: surgeon that they can still do what they need to do.
Speaker 2: If you've got a rubber glove that is boiled and
Speaker 2: is a septic, it's not going to get bacteria in there,
Speaker 2: but you can't really operate effectively with it. That doesn't
Speaker 2: do you any good.
Speaker 4: I do love the name the boiled hand. By the way,
Speaker 4: we were talking about this a little bit before we
Speaker 4: came in here. Just perfect.
Speaker 2: This seems to be a bigger thing than just zoga.
Speaker 4: Here.
Speaker 2: There's like a general anguish at the time expressed by
Speaker 2: multiple surgeons about the idea of hands being non boilable objects. Boiling,
Speaker 2: I think, became a kind of metonym for aseptic safety,
Speaker 2: so you might at the time, instead of saying something
Speaker 2: is aseptic, you might just call it boiled. Whether or
Speaker 2: not it had literally been boiled. Now a couple of
Speaker 2: other interesting solutions mentioned in the Schlick paper. There was
Speaker 2: a guy named George Perthies who lived eighteen sixty eight
Speaker 2: to nineteen twenty seven. He was a surgeon in Leipzig
Speaker 2: who said that full rubber gloves were too thick and
Speaker 2: difficult to work with, but suggested that surgeons could use quote,
Speaker 2: fine finger covers made out of condom rubber quote, which
Speaker 2: have been put on the market recently and which impaired
Speaker 2: the touch of the finger relatively little. And that's kind
Speaker 2: of surprising. But yes, rubber condoms had existed in some
Speaker 2: form going back to at least the mid nineteenth century.
Speaker 2: Eighteen f These rubber condoms were allegedly made of rather
Speaker 2: thick material, but they did exist at the time, and
Speaker 2: Perthy suggested that, yeah, this condom rubber could actually be
Speaker 2: useful to the surgeon for having a good compromise between
Speaker 2: being impermeable and being a septic, but also allowing the
Speaker 2: surgeon to feel what they are doing. But Perthy's himself
Speaker 2: favored silk gloves, which you already mentioned. He said, you know,
Speaker 2: they're great for manual control silk feels like you're wearing
Speaker 2: nothing at all, But of course they didn't have the
Speaker 2: aseptic advantages of impermeable rubber. There are a couple of
Speaker 2: other things that Schlick mentions, involving the idea of thin
Speaker 2: gloves coated in wax and whether or not that would
Speaker 2: be useful, leather gloves that maybe were topped with condom
Speaker 2: rubber or something. But yeah, ultimately we get to this
Speaker 2: desire that Wolfer articulates that you mentioned earlier, that you
Speaker 2: got to have a surgical glove that has all of
Speaker 2: the following characteristics. It's impermeable, it's flexible, tear resistant, not
Speaker 2: too tight, not too hot, and it can be sterilized.
Speaker 2: And this is what they ended up debating at this
Speaker 2: Surgical Congress in eighteen ninety eight. And there were all
Speaker 2: kinds of interesting debates here about like the actual bacteriological
Speaker 2: evidence for gloves, Like there were some people at this
Speaker 2: meeting who dissented, arguing on the basis of experiments that
Speaker 2: gloves were not actually useful. And there was one experiment
Speaker 2: that involved testing cotton gloves, so again not the rubber ones,
Speaker 2: but taking cotton gloves that had been used in surgery
Speaker 2: and then squeezing out the quote glove juice and then
Speaker 2: doing a culture of that to see what its germ
Speaker 2: content was, and they were like, look, this glove juice
Speaker 2: is full of germs. These gloves can't be useful. In fact,
Speaker 2: they're picking up because they get soaked with blood, they're
Speaker 2: picking up germs from the air, and they're introducing new germs.
Speaker 2: And then this led to a really i think a
Speaker 2: debate between different evidential standards. So you have some people
Speaker 2: say saying, well, look, we've done these lab experiments saying
Speaker 2: that you know, the glove juice is full of bacteria
Speaker 2: and that's no good. But then there are these other
Speaker 2: people saying, well, yeah, but we've used gloves in actual
Speaker 2: surgeries and we see the differences in outcomes, and the
Speaker 2: outcomes are better when you use gloves. And so they
Speaker 2: were comparing different standards of like how should we measure
Speaker 2: whether this is effective or not.
Speaker 4: Now.
Speaker 2: Eventually, over time there was agreement that impermeable gloves were
Speaker 2: the gold standard and that if you could manufacture them
Speaker 2: in a way that didn't sacrifice too much manual control,
Speaker 2: which of course we did get with the with the
Speaker 2: sterile gloves that people use today made of thin materials
Speaker 2: such as latex, nitrial are vinyl.
Speaker 4: Yeah, modern medical gloves come in, of course, various sizes.
Speaker 4: They are made from a variety of polymers. You get
Speaker 4: powdered and unpowdered, or even powdered with corn starch to
Speaker 4: cut down on skin irritation. There've been a lot of
Speaker 4: efforts towards the elimination of powdered gloves in general, and
Speaker 4: there are alternatives for individuals with latex allergies. So, uh, yeah,
Speaker 4: modern medical gloves, there's this broad spectrum there. We've come
Speaker 4: a long way, obviously since since these these first prototypes
Speaker 4: were being unveiled, and yeah, it's we're we're in a
Speaker 4: in a totally different age now when it comes to
Speaker 4: just the acceptance of of medical and surgical gloves. You again,
Speaker 4: you would not accept bare fingers and bare hands as
Speaker 4: an alternative.
Speaker 2: But I think it's also good to understand that at
Speaker 2: the time, resistance to the to the take up of gloves,
Speaker 2: especially impermeable gloves, was not just uh just stubbornness or quackery.
Speaker 2: There probably was some of that, but a lot of
Speaker 2: it was also genuine concern for being able to operate effectively.
Speaker 4: Yeah, I mean when you're you're I think the the
Speaker 4: example of our promiscuous surgeon uh is Key here though, Yeah,
Speaker 4: because he's talking like clearly he's weighing. Yeah, these are
Speaker 4: these are bulkier in some cases, but like I need
Speaker 4: to be able to go from this patient to this
Speaker 4: patient to this patient. You know, we need to be able.
Speaker 4: It's kind of like getting into the scale issue of inventions, like, okay,
Speaker 4: I can. It's one thing to create a perfect prototype
Speaker 4: in isolation. It's one thing to be able to conduct
Speaker 4: one surgery in perfect isolation. But if that's just one
Speaker 4: of many surgeries you're performing during a set amount of time,
Speaker 4: well then you're in a slightly different scenario. There are
Speaker 4: all these other factors you have to take into account totally.
Speaker 2: Yeah.
Speaker 4: Oh, and then to come back to our outer limits
Speaker 4: example from earlier, the idea of being able to perform
Speaker 4: medical interventions like out in the field, like this seems
Speaker 4: another area where gloves are vital, because yes, I mean,
Speaker 4: you still are going to ideally, you know, have some
Speaker 4: some sort of cleansing materials, but are you going to
Speaker 4: have three vats in which to spend some time washing
Speaker 4: your hands, or are you going to have to essentially
Speaker 4: snap on some gloves and get in there and try
Speaker 4: and save someone's life that sort of thing. Yeah, So anyway,
Speaker 4: it's a yeah, fascinating topic, I think, especially when you
Speaker 4: get into the adoption of a new technology, how we
Speaker 4: look back on it and how, you know, the efforts
Speaker 4: of the historian to place us within that time period
Speaker 4: to make sense of it all just all very fascinating
Speaker 4: and I think something to keep in mind and to
Speaker 4: think about the next time you're in a medical facility
Speaker 4: or in a checkup of one sort or another and
Speaker 4: you see your doctor or you don't see them snap
Speaker 4: on those gloves. The gloves are just part of it.
Speaker 4: Of course, we'd love to hear from anyone out there
Speaker 4: who regularly wears medical gloves, surgical gloves as part of
Speaker 4: your profession. You know, what are your thoughts on them,
Speaker 4: what sort of a history do you have with them,
Speaker 4: and you have to use a certain variety of glove
Speaker 4: due to allergies or scan irritations. We'd love to hear
Speaker 4: some insight from the field. All right, Well, we're going
Speaker 4: to go ahead and close out this Invention themed episode
Speaker 4: of Stuff to Blow Your Mind, but we love to
Speaker 4: hear from everyone out there. Just a reminder that new
Speaker 4: episodes of Stuff to Blow Your Mind come out on
Speaker 4: Tuesdays and Thursdays. And oh, we should also mention we
Speaker 4: mentioned condoms briefly. We do have an older episode of
Speaker 4: Invention about the invention of the condom, so we recommend that.
Speaker 4: And of course we've touched on medical history topics numerous
Speaker 4: times over the years and you can find those in
Speaker 4: the archives. On Mondays we do listener mail episodes. On
Speaker 4: Wednesdays we do short form artifact or monster Fact, and
Speaker 4: on Fridays we set aside most series concerns and just
Speaker 4: talk about a weird film.
Speaker 2: Huge thanks as always to our excellent audio producer Seth
Speaker 2: Nicholas Johnson. If you would like to get in touch
Speaker 2: with us with feedback on this episode or any other,
Speaker 2: to suggest a topic for the future, or just to
Speaker 2: say hello, you can email us at contact Stuff to
Speaker 2: Blow your Mind dot com.
Speaker 3: Stuff to Blow Your Mind is production of iHeartRadio. For
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