The Dawn of Modern Infection Control

In this era, women were attending hospitals more often to give birth in a seemingly safer environment than the more traditional birth at home with a midwife. Maternity institutions often provided care to underprivileged women, who then became subjects for the training of doctors and midwives as a method of payment. The rising infection and death rates began to soar, and the maternity institutions tried to address the reasons behind this rise. The miasma theory was the understanding, at that time, of the cause of infection, where illness arose from “bad air” emanating from decaying organic matter.

Amidst these dilemmas, Ignaz Semmelweis, a Hungarian physician, embarked on a journey that would revolutionise infection control. In 1846, he took the role of assistant at the First Obstetrical Clinic of the Vienna General Hospital. It was there that he observed an unsettling disparity in maternal mortality rates. The First Clinic, staffed by doctors and medical students, recorded a significantly higher mortality rate from infection, averaging around 10%, compared to the Second Clinic, where only midwives were trained, which reported rates below 4%. This substantial difference ignited Semmelweis's curiosity, and he embarked on a meticulous investigation into the underlying causes. Through careful observation and analysis, Semmelweis ruled out various potential factors, including overcrowding, climate, and even religious practices. Similar medical techniques were noted as common to both clinics. The consistent divergence in mortality rates, despite comparable conditions and procedures, indicated that a unique element associated with the involvement of medical students in the First Clinic was the case. This conclusion highlighted the power of observational studies in identifying disease aetiologies. 

The tragic death in 1847 of Semmelweis's esteemed friend and colleague, Professor Jakob Kolletschka, was a pivotal moment. Kolletschka died from an infection after an accidental puncture from the scalpel of a student during a post-mortem examination. The autopsy findings from Kolletschka were strangely the same as those of the women who had died from puerperal fever. This similarity led Semmelweis to a groundbreaking deduction: he theorised that he and the medical students performing autopsies were inadvertently transmitting "cadaverous particles" from the autopsy room to the patients in the First Obstetrical Clinic during examinations. In contrast, the midwives in the Second Clinic did not perform autopsies and had no contact with corpses. The direct correlation Semmelweis identified between Kolletschka's death from contamination following autopsy and the symptoms of puerperal fever represented a decisive piece of reasoning, leading him to his revolutionary hypothesis regarding disease transmission.

The introduction of surgical gloves is widely attributed to Dr. William Halsted, a prominent surgeon at Johns Hopkins Hospital in Baltimore, USA. However, the initial impetus behind the innovation of gloves was not primarily focused on preventing infection in patients. In 1889, Dr. Halsted introduced rubber gloves to protect his scrub nurse, Caroline Hampton, from the severe contact dermatitis she developed due to prolonged exposure to the harsh chemical disinfectants, such as mercuric chloride and carbolic acid, which were used for sterilisation. To assist her with the dermatitis, Halsted commissioned the Goodyear Rubber Company to produce custom-made thin rubber gloves with gauntlets. Caroline Hampton, also his fiancée, first donned these rubber gloves in 1889 (See illustration above). The gloves proved to be a successful solution, leading to the provision of additional pairs for the surgeons and other members of the operating theatre staff. By June 1890, the use of surgical gloves had become a common practice in many hospitals. The swift adoption of gloves by surgical teams, initially motivated by personal protection, inadvertently produced a more aseptic surgical environment, leading ultimately to the recognition of their role in reducing infections in surgical patients. 

Early Medical Glove Materials and Manufacturing:

The first surgical gloves were crafted from thin rubber, most likely natural latex, produced by the Goodyear Rubber Company. They were described as "thin with gauntlets". These early gloves were not intended for single use; instead, they were sterilised between surgical procedures, and reused. Sterilisation methods involved boiling the gloves or using chemical agents like carbolic acid. The reliance on reusable rubber gloves provided an early challenge to maintain a consistently sterile surgical environment, as the effectiveness of sterilisation could vary.

A significant advancement in rubber technology came in 1839, with Charles Goodyear's discovery of vulcanisation. This process, which involved treating crude rubber with sulphur and heat, resulted in a stronger, more durable, and less plastic material. Vulcanised rubber quickly became the preferred material for protective medical gloves. Goodyear's innovation was pivotal in making rubber a reliable material for medical applications, enabling it to become an effective barrier rather than a substance susceptible to temperature changes.

Before the advent of rubber gloves, basic forms of hand protection were used in medicine. Historical records show that as early as 1758, an obstetrician named Walbaum used rudimentary gloves made from sheep intestine. Other physicians employed gloves made of cotton, silk, or leather. However, these earlier forms of hand protection were often too bulky and lacked the tactile sensitivity and dexterity of the later rubber gloves. The use of materials like sheep intestine suggests an early awareness of the need for hand protection in medical settings, even before a full and comprehensive understanding of infection transmission. 

Advantages of Early Medical Gloves

The introduction of these early medical gloves brought several key advantages to healthcare practices. Initially, their primary benefit was protecting healthcare workers from the harsh chemical irritants used for disinfection. By creating a physical barrier, these gloves prevented direct contact with disinfectant substances like carbolic acid and mercuric chloride, which caused severe dermatitis. While initially some surgeons believed that gloves would hinder their dexterity, others soon realised that the rubber material could improve their grip on surgical instruments, especially when hands were wet or slippery. The introduction of gloves represented a vital step towards establishing barrier precautions in medical settings. Although the understanding of germ theory was yet to be fully accepted, the introduction of gloves was a significant step towards recognising the importance of preventing direct contact with blood and body fluids. Perhaps most importantly, the use of gloves, in conjunction with the principles of antiseptic surgery, contributed to a significant reduction in post-operative infection rates. The observations made by surgeons like Joseph Bloodgood, who had an obvious decline in infections during hernia operations with the use of gloves, provided the crucial evidence for their effectiveness. This reduction in infection rates helped reinforce the role of medical gloves in surgical practice.

Disadvantages and Limitations of Early Medical Gloves

Despite their emerging benefits, early medical gloves also presented several limitations. One significant issue was the development of skin irritation and latex allergies among healthcare workers. The prolonged use of rubber gloves, especially in a moist environment created by perspiration, often leads to skin irritations. Furthermore, as the use of latex gloves became more widespread, latex allergies emerged as a significant occupational concern for those in healthcare, necessitating the development of alternative glove materials. Initially, some surgeons resisted the adoption of gloves, fearing diminished tactile sensation in delicate surgical procedures. This resistance highlighted the tension between the growing awareness of infection control and the practical demands of surgical techniques.

Early medical gloves were also reused, and while sterilisation methods like boiling and carbolic acid were employed, their effectiveness may not have been consistently reliable, leading to cases of cross-contamination between patients. The later introduction of disposable gloves would address this critical limitation. Furthermore, the early rubber gloves were more susceptible to tearing or punctures, compromising their effectiveness as a barrier. This problem highlighted the need for improvements in material strength and manufacturing quality. Finally, the lack of a complete understanding of germ theory initially hindered the full appreciation of the benefits of gloves in preventing infection, with the primary focus still on protecting the wearer from chemical irritants. 

The Impact of Scientific Advancements on Glove Adoption

The widespread acceptance of the germ theory of disease, from the work of Louis Pasteur and others, provided the scientific rationale for the importance of hand hygiene and barrier protection to prevent infections. Joseph Lister's pioneering work on antiseptic surgery further emphasised the prevention of microbial contamination during surgical procedures. These advancements provided the scientific understanding that promoted the importance of medical gloves in preventing the spread of infection. The mid-20th century witnessed a significant evolution towards sterile and disposable gloves, enhancing safety and convenience further in medical practice. Furthermore, to address the growing issue of latex allergies, the development of alternative glove materials such as nitrile and vinyl provided options for healthcare professionals and patients. These materials offered varying degrees of protection, durability, and tactile sensitivity, catering to specific medical needs.