Ah, gloves. They come in all colors and sizes, sterile and non-sterile. Need to hang chemo? There’s a specific glove for that. Allergic to one type? No worry, here’s 5 more types that you can try. Every exam room has at least 2-3 boxes… of each size… and one empty box still in the holder. But it wasn’t always this way. In fact, this medical marvel that we take for granted has a really interesting back story.
The first gloves actually go all the way back to the mid 1700’s and used by a German gynecologist (and taxidermist), Dr. Johann Walbaum. Oh, and they were made from sheep intestine. Because, like a lot of good things medical, their humble origins come from animal innards. In the early to mid-1800’s, pathologists would use bulky gloves during their postmortem exams. It wasn’t until hand hygiene became an important interest in the medical world that gloves would start to take center stage.
We’ll go a little more in depth about the origins of hygiene in another article, but here’s a brief summary- in the early to mid-1800’s, medical professionals were noticing that patient mortality in some patient populations was high and felt the need to (finally) investigate more to find the “why”. Enter figures like Florence Nightingale, Ignaz Semmelweis, and Joseph Lister and the common denominator was found- germs on hands. And what’s the answer to keeping germs from spreading? Washing your hands. So that’s where Flo and Ignaz went. Joseph Lister went a step further and invented antiseptic medicine which is what the basis is for modern surgical asepsis used today. Of course, Dr. Lister’s rudimentary pre surgical regimen consisted of harsh chemicals such as carbolic acid to clean hands, equipment, and wounds themselves. I think we can all agree that this is probably not good practice, and someone else that agreed with that sentiment was Miss Caroline Hampton of South Carolina in 1889. This is where our glove story really takes off.
Now, Caroline Hampton wasn’t always destined for the OR at Johns Hopkins. She was born into Southern Aristocracy in 1861, the niece of Wade Hampton, a general for the Confederacy and later governor and US Senator for South Carolina. In 1885, she decided to move to New York and studied nursing at Mount Sinai and, in 1889, went to work in the OR at Johns Hopkins under surgeon William Halsted. Soon after starting to work there, Caroline announced to Dr. Halsted her intentions to resign from her position in his OR because her hands couldn’t take the caustic substances that were being used as part of the aseptic technique. Dr. Halsted didn’t want to lose her as he felt she was exceptionally efficient (also, spoiler alert, she married him a year later- some men buy jewelry, Halstead bought rubber gloves) so he tried to find ways to protect her hands so she could continue her work.
His first suggestion was using collodion. Collodion is nitrocellulose mixture combined with alcohol and ether. When it dries, it becomes a film that acts as a barrier. Or, a Victorian photography technique, depending on who you ask. Unfortunately for Caroline, it cracked when she would move or flex her fingers. The next idea came from Caroline’s “Southern Belle” past…. Her gardening gloves. Was it possible to find a way to make a pair of gloves that could withstand the hand sterilization process, be reused for other surgical procedures, and allow enough dexterity to assist in procedures safely and effectively? Dr. Halsted was going to find out.
Plaster casts of Caroline’s hands were made and sent to the Goodyear Rubber Company in NY. After a short period of time, Caroline had rubber gloves that covered her hands and forearms and withstood the rigors of surgical life. In fact, they worked so well, the rest of the surgical staff purchased their own pairs of gloves. In addition to protecting their hands, the surgical staff discovered that the gloves also helped improve their grip on surgical instruments.
Among those staff in that operating room that quickly obtained gloves of their own was Joseph Bloodgood. Now, we’ll talk about him more at a later time, as his incredible contributions to medicine only begin with the use of gloves. As a resident under Dr. Halsted and later a surgeon in his own right, Dr. Bloodgood was the first to realize the infection control value of gloves. He started using them during his hernia cases and noticed a significant decline in the number of post-surgical infection, down from 17% to a near unheard of for the time of less than 2%.
Of course, this was met by much resistance from other practitioners. Surgeons were worried that they wouldn’t be able to feel differences between healthy and unhealthy tissue or not be able to effectively grip instruments, therefore actually increasing patient mortality due to error. Other surgeons felt that the gloves were a “cheat” and would take away from the hardcore, blood soaked, “I have saved a life!” image of the general surgeon. But soon, gloves were more accepted, widely used and more available.
The next major event for gloves isn’t until 1965. Up to this point, all gloves were reused. Surgeons would finish surgery on their patient, take off the one pair of gloves, which would then be sterilized using Joseph Lister’s 1894 glove sterilization process, and grab another pair. This process wasn’t perfect, and germs where still being spread from patient to patient. Enter the Ansell Rubber Company.
The Ansell Rubber Company had been manufacturing gloves for some time and had a major hand (no pun intended) in the manufacturing and development of the gloves we know and use today. They invented the first glove dipping machine in 1946, therefore making it easier to manufacture large quantities of gloves quickly. But their biggest impact on surgical gloves was the development of a sterilization process using gamma ray technology called Gammex. This is the method of sterilization that is still used to this day. Now, being able to manufacture large quantities of gloves with quick and cost-effective methods of sterilization, gloves went from reusable to completely disposable.
Now, gloves are basically on cruise control again until the 1990’s. Up to then, gloves were primarily made of rubber and a couple of major issues started to come up over time.
One was the fact that rubber gloves didn’t stop other chemicals from seeping through the rubber and being absorbed by the skin. In 1995, Professor Karen Wetterhahn of Dartmouth University founded Dartmouth’s Toxic Metals Superfund Research Program, studying the effects of metals on humans. Her research centered on chromium and mercury. One day, in 1996, while working with mercury, she got some on her hand. No big deal, she was wearing gloves at the time and the gloves were seen as protective from everything. Unfortunately, the mercury seeped through the rubber gloves and she developed mercury poisoning, ultimately succumbing to this in 1997.
Another issue was the discovery of the latex allergy. Though this type of allergy was first documented in 1927, it wasn’t until the 1980’s that the reaction was associated with the rubber used to make latex gloves. Allergic reactions varied, from simple rashes to anaphylaxis, including one death linked to gloves in 1991. The reactions could be instant or, in the case of many healthcare workers, develop over time due to constant exposure. Something needed to be done in order to avoid these issues and still protect people, especially during a time where a mysterious illness was spreading like wildfire but had no name, no obvious route of transmission, and no treatment or cure. The answer? The synthetic rubber materials used today: nitrile, vinyl, and neoprene.
And there you have it. What started as sheep intestine turned into an everyday item that is common to see everywhere you go and use them for pretty much everything. So, the next time you’re at work and you see that empty box of gloves in that wall glove holder, don’t forget there’s plenty more in the supply room. You just slide the empty box out and slide the new one in. It’s ok, I believe in you, you can totally do it.
Want to talk about this? Visit us at https://network.nurseslounge.com/public/lounge/Show-Me-Your-Stethoscope/NVc4 for the official “Interesting History” discussion!