Stories of Sterile Gloves

Faustus!

From the man-devil who wrote of “boiled hands” as clean as the prevailing sterilization method of the time to a beloved act of kindness, the stories of how sterile gloves came to use for modern surgical procedures have an engaging ring to them.

Perspectives

Why were surgical gloves not used earlier?

We can find a whole landscape of creative and rational innovations
for controlling wound disease at the time; many of them
were quite successful, even among those innovations which
did not interpret wound complications as caused by infection
through living germs. However, historiography lost sight
of this diversity once Lister had been declared the founding
figure of all of the different methods of avoiding wound
infection in the late 19th century.

At closer examination such alternatives emerge wherever
one looks in the history of medicine. If we take them seriously,
we can better understand the choices made by historical
actors. Whole worlds of alternative versions of modern
medicine open up, comprising old or new technologies,
surgical and non-surgical solutions to problems. It is worth
examining these paths not taken to explore the many parallel
roads, narrow trails, and dirt tracks, as well the main highways
of medical history. Such explorations also put us in a better
position to take notice of alternative forms of understanding
and solving problems today, and to beware of what historian
of technology David Edgerton has called “overblown claims
of a one best way” of dealing with medical challenges.

Thomas Schlich
Department of Social Studies of Medicine, McGill University,
Montreal, Quebec H3A 1X1, Canada

INTRODUCTION OF THE SURGICAL GLOVE

It is difficult to credit a single individual with discovering the value of rubber surgical gloves; rather, the use of rubber surgical gloves appears to have been a developing idea that was gradually adopted by surgeons between 1890 and 1910.

The first suggestion of using gloves to reduce the risk of infection was made by Adam Elias von Siebold in 1813. Von Siebold suggested that physicians use swine or horse bladders as gloves or fat-impregnated linen gloves during delivery of infants to women with infections to reduce the risk of the physician acquiring infection from the patient.4 In a series of lectures from 1840 to 1842, Sir Thomas Watson suggested that it should be possible and valuable to invent a “pliant” glove that physicians could use to protect their hands.4 Thomas Hancock received patents for clothing items, including gloves, made of rubber as early as 1830, but the instability of rubber remained a problem until 1843 when Charles Goodyear and Nathaniel Hayward in the United States and Thomas Hancock in England almost simultaneously discovered the process of vulcanization. By 1852, a French surgical catalogue listed rubber anatomic gloves to prevent infection.4 In 1878 the first patent for rubber surgical gloves was granted to T. Forster. One of the pioneers in the study of surgical infections was Dr William S. Halsted at Johns Hopkins Hospital. Because of the dermatitis produced by the mercuric chloride solutions used to disinfect hands and instruments, Dr Halsted was in danger of losing one of his operating room nurses. He therefore requested two pairs of thin rubber gloves with gauntlets for his nurse from the Goodyear Rubber Company in 1889. However, the first doctor at Johns Hopkins reported to regularly use rubber gloves was Joseph Bloodgood, an intern of Dr Halsted in 1892. In 1899, Dr Bloodgood reported a case series demonstrating a reduction in postoperative infections when all members of the surgical team wore rubber gloves.4 The first written document suggesting that all members of a surgical team should wear rubber gloves to prevent infection was authored by Zoege von Manteuffel of Dorpat in 1897. In the United States, Dr Charles McBurney presented a paper on the value of surgical gloves to the New York Surgical Society on March 9, 1898. By the early 1900s, surgeons in both Europe and the United States were beginning to adopt the use of rubber gloves.4 Although the use of latex gloves in surgery became routine after World War I, gloves were not consistently used in other areas of patient care until the onset of the AIDS epidemic. The Centers for Disease Control–proposed universal precautions of 1987 and 1989 produced a dramatic increase in the use of latex gloves in all areas of patient care.5,6 The use of latex gloves in other areas of everyday life, such as food handling, also appeared to increase after 1987.

NATURAL RUBBER LATEX SENSITIVITY| VOLUME 110, ISSUE 2, SUPPLEMENT , S27-S32, AUGUST 01, 2002

A history of latex allergy
Dennis R. Ownby, MD
DOI:https://doi.org/10.1067/mai.2002.125336

REFERENCES
4 Randers-Pehrson J. The surgeon’s glove. Springfield (IL): Charles C.
Thomas; 1960.
5 Centers for Disease Control and Prevention. Recommendations for prevention of HIV transmission in health-care settings. MMWR Morb Mortal Wkly Rep 1987;36(suppl):35-185.
6 Centers for Disease Control and Prevention. Guidelines for prevention of
transmission of human immunodeficiency virus and hepatitis B virus to
health-care and public safety workers. MMWR Morb Mortal Wkly Rep
1989;38(S-6):1-37.

The first paper on sterile gloves in 1897: WZ von Manteuffel

Werner Maximilian Friedrich Zoege von Manteuffel
[Historical] Figure:
Werner Maximilian Friedrich Zoege von Manteuffel 

Werner Zoege von Manteuffel was born in 1857 in northern Estonia and became professor of surgery at Tartu University, Estonia, in 1899. He was the first surgeon to advocate the use of boiled, sterilised rubber gloves to protect the patient from infection during surgery and published the first paper on sterilised rubber surgical gloves in 1897. At that time most surgeons were operating with their bare hands, although some had experimented with silk or cotton gloves, which proved impossible to sterilise. To wear boiled rubber gloves, he said, was to have “boiled hands.”

British Medical Journal 1998;317:1330 Dr I Käbin, medical historian, Stockholm, Sweden

Google Scholar Manteuffel WZ (1897) Gummihandschuhe in der chirurgischen praxis (rubber gloves in surgical practice). Zentralbl Chir 24:553–556
A commemorative postcard of von Manteuffel

Today, sterile disposable gloves are in common use by doctors, nurses and medical aides; dentists, dental hygienists and dental assistants; emergency medical technicians and ambulance drivers; firefighters and the police; venipuncturists (blood drawers) and lab techs; trainers in boxing, ice hockey and many other sports; ad infinitum.

It was not always so. Until late in the 19th century, most surgeons operated with their bare hands. A few doctors tried cotton or silk gloves but they proved impractical and impossible to sterilize.

The first surgeon to advocate the use of gloves that could be effectively sterilized was Werner Zoege von Manteuffel. He published an article on sterilized rubber surgical gloves to protect patients undergoing surgery from infection. The article appeared in 1897.

You have not heard of Werner Zoege von Manteuffel? He was born in 1857 in northern Estonia and was around 40 when his pioneering paper on sterilized rubber gloves came out. Two years later, in 1899, he became professor of surgery at the university in Tartu, the second largest city of Estonia (the first being the capital, Tallinn).

That is all we know of Werner Zoege von Manteuffel, except for one thing. To wear boiled rubber gloves, he used to say, was to have “boiled hands.”

https://www.medicinenet.com/script/main/art.asp?articlekey=7332

Glove conquers all: Caroline and William’s story

Though William Stewart Halsted began using rubber gloves for surgery in 1890, it was initially intended for protection for the staff, not the patient.

In 1890, American surgeon William Halsted began using rubber gloves to protect his scrub nurse’s hands from a dermatitis. He later admitted that he was surprised it took such a long a time for anyone, including himself, to realize the importance of rubber gloves to offer protection against secondary contamination.

SOURCE: The Surgeon’s Glove: A Centennial
Ljunggren, Bengt; Käbin, Ilo; Ganslandt, Oliver; Buchfelder, Michael; Bruyn, George

Caroline Hampton Halsted: the first to use rubber gloves in the operating room

S. Robert Lathan, MD

Read full text and the follow up: 

Caroline Hampton in 1889
Caroline Hampton in 1889. Reprinted with permission of the Alan Mason Chesney Medical Archives of The Johns Hopkins Medical Institutions.

 In 1885, Caroline rebelled against her family and entered nursing school in New York City, graduating from New York Hospital in 1888 (Figure 3). When the Johns Hopkins Hospital opened in 1889, she moved to Baltimore and was appointed chief nurse of the operating room by the famous surgeon Dr. William Halsted (Figure 4).

Venus came to the aid of Aesculapius.

Figure 4 William Halsted in 1880, soon to become the first surgeon in chief when Johns Hopkins Hospital opened. Reprinted with permission of the Alan Mason Chesney Medical Archives of The Johns Hopkins Medical Institutions.

Caroline became Dr. Halsted’s scrub nurse, but she developed a severe contact dermatitis in 1889, as her sensitive hands could not tolerate the disinfectants mercuric chloride and carbolic acid (phenol). As Dr. Halsted explained (as quoted by Sherwin Nuland in Doctors: The Biography of Medicine):

In the winter of 1889 and 1890—I cannot recall the month—the nurse in charge of my operating-room complained that the solutions of mercuric chloride produced a dermatitis of her arms and hands. As she was an unusually efficient woman, I gave the matter my consideration and one day in New York requested the Goodyear Rubber Company to make as an experiment two pair of thin rubber gloves with gauntlets. On trial these proved to be so satisfactory that additional gloves were ordered. In the autumn, on my return to town, an assistant who passed the instruments and threaded the needles was also provided with rubber gloves to wear at the operations. At first the operator wore them only when exploratory incisions into joints were made. After a time the assistants became so accustomed to working in gloves that they also wore them as operators and would remark that they seemed to be less expert with the bare hands than with the gloved hands.

Dr. Halsted in Doctors: The Biography of Medicine

This has been called the most famous paragraph ever printed in the surgical literature, not only for its description of the introduction of rubber operating gloves (Figure 5), but also because it represents the beginning of a love affair being recorded in the medical literature. In the words of one of Halsted’s assistants, “Venus came to the aid of Aesculapius.” Halsted and Caroline married in June 1890. Dr. William Welch was the best man.

Figure 5 One of the original rubber surgical gloves, which belonged to J. M. T. Finney. It was encased in lucite for the Johns Hopkins Hospital centennial. Reprinted with permission of the Alan Mason Chesney Medical Archives of The Johns Hopkins Medical Institutions.
Figure 5 One of the original rubber surgical gloves, which belonged to J. M. T. Finney. It was encased in lucite for the Johns Hopkins Hospital centennial. Reprinted with permission of the Alan Mason Chesney Medical Archives of The Johns Hopkins Medical Institutions.


THE HISTORY OF ASEPTIC SURGERY

Let us digress and go back around 50 years for the background of antiseptic and aseptic surgery. At that time, hospitals were regarded as “houses of death” which patients tried to avoid, if possible, because of rampant infection. Surgeons would simply roll up their sleeves and work as quickly as possible, wearing the same coat for each operation. (The coats were usually covered with blood and pus and were called “working coats” or “badges of honor.”) Surgical mortality was around 50%.

However, in 1843, Oliver Wendell Holmes in Boston made a presentation “on the contagiousness of puerperal fever,” suggesting that childbirth infection could be transmitted to others and emphasizing the personal cleanliness of doctors. The Hungarian doctor Semmelweiss made the same discovery in 1847 in Vienna and required his students to wash their hands in an antiseptic disinfectant (chlorine) solution before examining patients, and the maternal death rate went from 18% to 1%.

In 1867, Joseph Lister (Figure 6), an English surgeon, published the groundbreaking paper “Antiseptic Principle of the Practice of Surgery” while working at the Glasgow Royal Infirmary. He used 5% carbolic acid solution (or phenol) to spray instruments and wounds and made surgeons wash their hands before and after operations with this solution.

Figure 6
Figure 6 Joseph Lister

Figure 6 Joseph Lister, an important contributor to the understanding and application of antiseptic techniques during surgery. Photo by Emery Walker, obtained from the National Library of Medicine Images from the History of Medicine (image ID 182797).

In 1876, Lister traveled to the United States to present his ideas and impressed Dr. William Halsted with his findings. In 1884, Halsted returned to New York City after studying in Germany and refused to perform surgery in the old theater at Bellevue. Instead, he built a tent on the grounds of Bellevue that featured a gas stove to boil instruments. Halsted was sold on Listerian techniques, which were still somewhat controversial until German bacteriologist Robert Koch’s postulates in 1882 effectively proved that microorganisms caused disease. (Koch later won the Nobel Prize in 1905.)

Gustav Neuber, a German surgeon who embraced Lister’s technique, in 1883 sterilized instruments and the operative field and was the first to require sterile gowns and caps. In 1897, Jan Mikulicz, a Polish Austrian surgeon, was the first to use a surgical mask and also was a pioneer of using gloves during surgery.

Figure 7
Figure 7 Dr. Joseph Bloodgood. From the Alan Mason Chesney Medical Archives of The Johns Hopkins Medical Institutions

At Johns Hopkins, Dr. William Halsted didn’t start wearing gloves himself at first. They were used by nurses and assistants but rarely by the doctors (except for the open bone and joint operations). Dr. Joseph Bloodgood, Halsted’s protege who came to Hopkins in 1892, was later the director of surgical pathology and started using gloves himself during surgery in 1896 (Figure 7). (“Why shouldn’t the surgeon use them as well as the nurse?”) In 1899, Bloodgood published a report on over 450 hernia operations with a near 100% drop in the infection rate by using gloves. Halsted said, “Why was I so blind not to have perceived the necessity for wearing them all the time?” Hunter Robb, a gynecologist at Johns Hopkins Hospital, was another Halsted associate who was a pioneer of aseptic surgery and sterile gowns and one of the first to wear rubber gloves.


More interesting reading from a century ago:

On the Value of Gloves in Operative Work, with a Note on the Cleansing of the Hands [PDF] from nih.gov JL Thomas – British Medical Journal, 1899 – bmj.com

IV. The Use of Rubber Gloves in Operative Surgery
C McBurney – Annals of Surgery, 1898Download

More to come from library book scans in progress :)

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