Surgical gloves.
Abstract: Surgeons and obstetricians, over the centuries, were only too aware that accidental open injuries during their work, especially in a septic case, could lead to an infected wound, a fulminating illness and often death. Even before the bacterial nature of infection had been established in the mid 19th century, it was still obvious that this dangerous and often fatal condition was caused by the transfer of some poisonous material or 'miasma' from the patient to his surgeon. As long ago as 1758, an obstetrician named Walbaum protected his hands by covering them with sheep's caecum. Others used gloves of cotton, silk and leather. After Charles Goodyear developed the vulcanisation process to stabilise rubber in 1844, this became the material of choice for these rather crude protective gloves.

KEYWORDS Surgical gloves
Article Type: Report
Subject: Bacterial skin diseases (Risk factors)
Bacterial skin diseases (Prevention)
Gloves (Surgery) (Usage)
Gloves (Surgery) (Health aspects)
Surgeons (Health aspects)
Author: Ellis, Harold
Pub Date: 06/01/2010
Publication: Name: Journal of Perioperative Practice Publisher: Association for Perioperative Practice Audience: Academic Format: Magazine/Journal Subject: Health; Health care industry Copyright: COPYRIGHT 2010 Association for Perioperative Practice ISSN: 1750-4589
Issue: Date: June, 2010 Source Volume: 20 Source Issue: 6
Product: Product Code: 3069750 Rubber Gloves NAICS Code: 326299 All Other Rubber Product Manufacturing SIC Code: 3069 Fabricated rubber products, not elsewhere classified
Geographic: Geographic Scope: United States Geographic Code: 1USA United States
Accession Number: 229896866
Full Text: The introduction of the antiseptic technique by Joseph Lister, first in Glasgow in 1867, then on his move to Edinburgh, and finally at King's College, London resulted in a new hazard to the surgeon and his team. This was the high incidence of severe skin sensitivity to the powerful bactericidal agents used at that time. Initially, crude carbolic acid, (Lister's first agent), and then a whole variety of chemicals, which included picric acid, iodine, bichloride of mercury, permanganate of potash and corrosive sublimate.

It is interesting that the introduction of surgical gloves was precipitated by the need to protect the surgeon from infection and skin irritation rather than to guard the patient from bacteria on the operator's hands. Things have come full circle in that, today, much of the interest in surgical gloves is once again, protection of the medical and nursing staff, now from viral infection from their patients.

Just who first had the idea of using sterilised rubber gloves in the operating theatre is something of a mystery, and one that is unlikely ever to be solved. Certainly one of the early proponents of their use, and one who receives much acknowledgment of his contribution in this field was William Halsted, of the Johns Hopkins Hospital, Baltimore. Although he never published specifically on this subject, he undoubtedly influenced the many visitors to his department from the USA and Europe to adopt his technique. The story is an interesting, indeed, you might say a romantic one! In 1889, Halsted's theatre sister, Miss Caroline Hampton, developed severe eczema of her hands as result of repeatedly soaking her sensitive skin in carbolic acid followed by bichloride of mercury. Halsted tried painting her hands with collodion, but, of course, when she bent her fingers the collodion membrane would split apart. It seemed inevitable that his invaluable aide in theatre would have to give up her work. Which surgeon likes to lose his theatre sister?

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Halsted, on a visit to the autopsy room, saw that his pathologist colleague, Professor William Welch, was performing a postmortem examination wearing a large pair of rather clumsy German-made rubber gloves. Welch explained that his wife had been complaining of the dreadful stench he was bringing home from the pathology department which he had succeeded in overcoming by wearing these gloves--his marriage had been saved! Halsted interested the Goodrich Rubber Company to make sets of rather thinner and less clumsy gloves--although still rather stiff and unwieldy; the gloves were sterilised by boiling, supplied to Miss Hampton, who put them on over wet and soapy hands. The eczema disappeared and, not long afterwards, Halsted married her! Who says that there is no romance in Surgery?

It was Joseph Bloodgood, Halsted's senior resident at Hopkin's, who made the famous statement 'What is sauce for the goose is sauce for the gander, why should not the surgeon use the glove as well as the nurse'? The glove, gradually reduced in both thickness and length, was adopted by the rest of the surgical team. By the end of the 1890's, Halsted was using gloves in operations such as those involving major joints, laparotomy or hernia repair or 'any other operation that does not require a delicate touch or dexterity and where, if suppuration supervened, might be followed by unpleasant results'. When things got difficult, it was not unusual for the operator to tear off his gloves and use his naked fingers.

The numerous visitors to Halsted's clinics and theatre carried the use of gloves to their own practices. Johann Mikulicz of Breslau, Germany, who had trained under Theodor Biflroth of Vienna, and who was a teacher of considerable influence, popularised the use of gloves in mainland Europe, although he also experimented with the use of sterilised cotton gloves; during prolonged procedures, he would change these several times. For some time, nothing was actually published on the subject. Indeed, the first publication on the use of boiled sterile rubber gloves in surgery did not appear until 1897. This was a paper by Werner von Manteuffel, professor of Surgery in Tartu, Estonia in a German surgical journal. Its English title was 'Rubber gloves in surgical practice'; in it he states 'to wear boiled gloves is to operate with boiled hands'!

By the early 20th century, the use of sterilised rubber gloves had spread widely into surgical practice.

Provenance and Peer review: Commissioned by the Editor; Peer reviewed. Accepted for publication September 2009

Further Reading

Ellis H 1990 The Hazards of surgical glove dusting powders Surgery Gynecology &. Obstetrics 171 (6) 521-527

Ellis H 2008 Evolution of the surgical glove Journal of the American College of Surgeons 207 (6) 948-950

Miller JM 1982 William Stewart Halsted and the use of the surgical rubber glove Surgery 92 (3) 541-543

Randers-Pehrson J 1960 The Surgeons Glove Charles C Thomas, Springfield IL

by Professor Harold Ellis

Correspondence address: Department of Anatomy, University of London, Guy's Campus, London, SE1 1UL.

About the author

Professor Harold Ellis CBE, FRCS

Emeritus Professor of Surgery, University of London; Department of Anatomy, Guy's Hospital, London

No competing interests declared

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