When reviewing the history of medicine – and more specifically, surgery – it is often said that surgical gloves were invented out of love. This is not an exaggerated statement. At the end of the 19th century, Caroline Hampton, a nurse at the Johns Hopkins University Hospital in Baltimore, in the United States, suffered severe skin irritations caused by liquids to disinfect instruments used in operations.
The chief of surgery, William Stewart Halsted, who was in love with her – they would end up marrying – contacted the Goodyear tire company to make gloves that would protect his loved one’s hands, but were also thin enough to allow precise manual work.
Those latex gloves not only put an end to the nurse’s problem, but their widespread use was decisive in preventing infections in the operating rooms and reducing the mortality rate of patients.
Because of this and many other contributions – such as radical mastectomy and the improvement of intestinal suture techniques – Halsted is considered one of the greatest exponents of the so-called “Golden Age of Surgery”, a period that began in 1846, with the arrival of anesthesia, and in which there are spectacular advances in this branch of medicine.
His figure is the one that inspired the television series The Knick (2014-15), directed by Steven Soderbergh and starring Clive Owen, in which a brilliant surgeon addicted to cocaine does not hesitate to push the ethical limits in favor of scientific research.
Gas and anesthesia
Until the beginning of the 19th century, medicine and surgery were separate disciplines, and small interventions, such as tooth extraction or bleeding, had been practiced by barbers since the Middle Ages, a trade that was inherited from father to son.
For the first time in history, both were integrated into the same body of knowledge – acquired in universities – and the surgeon came to be considered a scientist. However, surgical practice had not yet managed to overcome three major barriers: the pain, bleeding and infection.
From its origins, the man has looked for remedies natural pain relievers, such as opium, mandrake, and hashish, but even on the operating table, even drinking alcohol had failed to render the patient unconscious without risking his life.
In 1776, the British chemist and theologian Joseph Priestley discovered nitrous oxide, also known as laughing gas, because it caused a brief blackout followed by euphoria. Hence it became popular at fairs, circuses and parties as a means of entertainment.
In 1844, during a fair in the city of Hartfort, the American dentist Horace Wells witnessed how a man got up laughing after hitting his knee in a fall and decided to investigate the possible medical applications of nitrous oxide. The next day, a tooth was pulled out while inhaling it and did not feel any pain.
He had just discovered the anesthetic properties of gases, which he successfully tested on his patients, although it must also be said that they ruined his life: Wells became addicted to chloroform, whose effectiveness as an anesthetic was tested by the Scottish physician James Young Simpson in 1847, until his mind deteriorated and he ended up committing suicide.
Anesthesia was a real revolution in the fight against pain
A year earlier, in 1846, Wells’s colleague, William TG Morton, had demonstrated the usefulness of ether as an anesthetic during an operation on a patient with a neck tumor at Boston Hospital. This is how this dentist ushered in the era of anesthesia on the operating table, which was a true revolution in the fight against pain.
In subsequent years, less and less toxic anesthetics appeared that were delivered by different routes (inhalation, intravenous or intra-spinal), and also substances that acted locally. Sigmund Freud, the father of psychoanalysis, realized the anesthetic effect of synthetic cocaine when, paradoxically, he treated his morphine-addicted patients with this drug.
Although he was not the first to use cocaine infiltration in the operating room, Halsted, the character we started this article with, perfected the technique by experimenting with hundreds of patients. Including himself, who, like Freud, dragged a strong addiction to this substance until his death.
Despite initial reluctance, surgeons surrendered to the advantages that anesthesia offered, including the possibility of operating on areas that were previously prohibited. The Frenchman Jules-Émile Péan, for example, was among the first to perform abdominal operations. However, the dominance of anesthesia did not prevent further deaths in the operating room due to bleeding.
The most useful weapon against this complication was the identification, in 1901, of blood groups by Karl Landsteiner, which would allow safe blood transfusions. Until then there had been terrible accidents due to lack of blood compatibility. The Austrian biologist received the Nobel Prize in Physiology in 1930.
Elimination of bacteria
Despite the progress, death continued to stalk patients both during the interventions and in the days after. Infections were the order of the day, largely because medical personnel walked through hospitals, and even the operating room, wearing street clothes, and did not wash their hands or the instruments used.
The first basic rules of hygiene in surgery were imposed in the mid-19th century Ignaz Philipp Semmelweis. He succeeded in reducing mortality from puerperal fever – also known as childbirth fever – by having the staff who assisted the women in labor at the Vienna General Hospital wash their hands with a calcium chloride solution. The Hungarian doctor had realized that it was the medical students who transmitted this disease when they went directly from the autopsy room, where they were in contact with corpses, to the delivery room.
The development of antisepsis would not have been possible without the microbial theory of Louis Pasteur. In 1857, the French chemist postulated that infections are related to microorganisms. Building on the work of Semmelweis and Pasteur, the British surgeon Joseph Lister was able to dramatically reduce the number of deaths from infection, affecting between 30% and 50% of patients operated on at the Glasgow Royal Infirmary.
The atmospheric air was the cause of the putrefaction of the wounds
Lister observed that closed fractures healed without too many complications, while open ones ended up suppurating or becoming infected. The atmospheric air, therefore, was the cause of the putrefaction of the wounds, and for that reason it had to be filtered to eliminate the germs. He resorted to carbolic acid to destroy the microorganisms that infected the operative field, spraying it around the room and also directly on the wounds.
In 1867, Lister published the first complete description of his method, considered the first antiseptic treatment in history, in the Lancet, although it would still take a few years for it to become generalized throughout the world.
Antisepsis, or the fight against bacteria, was opening the way to asepsis, which proposed using previously sterilized instruments, bandages, sponges and suture threads. Some specialists were reluctant to introduce this method in the operating rooms, arguing that the continued protection of the patient against germs was more than enough.
Others, on the other hand, realized that the combination of antisepsis and asepsis was what gave the best results. The patient’s skin was thoroughly cleaned with an antiseptic solution, but the surgeon was also required to wash his hands with soap, boiled water, and alcohol for several minutes.
The German surgeon Ernst von Bergmann was the first to introduce heat sterilization of surgical instruments, while the systematic use of a cap, cloth gloves and masks is due to the Polish Johann von Mikulicz. Rubber gloves, as we’ve seen, were driven by Halsted out of love.
Once the pain, bleeding and infection were controlled, the specialists were able to fearlessly approach the treatment of hitherto restricted areas, such as the aforementioned abdomen, chest or brain. The First World War, and later the Second, accelerated the development of technique in general, and, with it, of surgery.
Around the middle of the 20th century, surgeons began to be divided into very specific specialties, and today, thanks to the introduction of supercomputers in medicine and robotic surgery, we can say that we are experiencing a surgical revolution again.