Surgical rubber gloves were introduced 100 years ago at Baltimore's Johns Hopkins Hospital, but not for the reasons one might think.
Love had more to do with it than hygiene.
Their inventor was a towering figure in the history of American medicine and one of its greatest surgeons, William Stewart Halsted. During three decades at Johns Hopkins, he developed a plethora of new operating techniques, including a procedure for hernia, as well as established a training program and residency system for young surgeons that became national models.
Moreover, he managed this record of achievement despite a lifelong struggle with drug addiction that did not become general knowledge until many years after his death in 1922.
Few of his associates, as one of them said later, suspected "the daily battle through which this brave fellow lived for years." His sometimes strange and erratic behavior was accepted as simple eccentricity.
Like most "firsts," the claims made for Halsted as the originator of surgical rubber gloves are not free of challenge. But that hardly matters now. It was unquestionably their use at the prestigious Johns Hopkins Hospital that led to widespread adoption.
Halsted, himself, admitted with some chagrin that it had not occurred to him initially that rubber gloves could be a powerful new weapon against infection. He confessed that his primary concern was protecting the hands of his chief surgical nurse from the harsh disinfectants used in hospital operating rooms at the time.
The object of his attention -- and affection -- was an aristocratic South Carolina woman named Caroline Hampton, whose socially prominent family had been impoverished in the hard times of the post-Civil War period. Halsted noticed she suffered more than most from the occupational dermatitis of the operating room and he interpreted this as a sign of her "gentle blood."
The privileged and equally aristocratic Halstead, a 37-year-old bachelor, and his nurse, 30, were married in June of 1890 shortly after he presented her with two pairs of rubber gloves made to fit plaster casts of her hands. One staff member wrote later that he strongly suspected a romance was in progress when he walked into the Johns Hopkins pathology laboratory and found the normally aloof and reclusive Halsted passionately demonstrating the anatomy of a dried fibula to his future bride. Their engagement was announced within a week.
Halsted's own description of the events leading up to the development of surgical rubber gloves was printed in the Journal of the American Medical Association in 1913:
"In the winter of 1889 and 1890 -- I cannot recall the month -- the nurse in charge of my operating room complained that the solution 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."
Yet neither Halsted nor his associates grasped the significance of the gloves as a means of combatting surgical infections. This is somewhat surprising, since he was one of the leading American advocates and practitioners of Joseph Lister's methods of antiseptic surgery.
Halsted noted that the adoption of rubber gloves was "an evolution rather than an inspiration or happy thought." Engaging in a bit of self-recrimination, he added, "it is remarkable that . . . we could have been so blind as not to have perceived the necessity for wearing them invariably at the operating table."
In the fall of 1890, some of the young doctors who assisted in the operations began using gloves on a regular basis but, again, the purpose was to protect their hands rather than to avoid infecting the patients. In time, working with gloves became almost second nature, and they continued to wear them as surgeons, claiming that "they seemed to be less expert with the bare hands than with the gloved hands."
The older and more established surgeons were slower to change, fearing that operating in gloves might dull their sense of touch and cause a fatal slip with the scalpel. Halsted, himself, used them only occasionally until about 1896. He then sent bronze casts of his hands to the Goodyear Company and ordered gloves that were thin, pliable and close-fitting.
But dissenters remained. One well-known surgeon commented in 1898: "I . . . have arrived at the conclusion that the practical disadvantages of gloves counterbalance their theoretical advantages. Surgeons who were doing first-class work three years ago seem to me to be doing second or third-rate now, on account of the interference made by their gloves."
Fortunately, these arguments were losing force as physicians became increasingly aware that rubber gloves offered more than "theoretical advantages" in reducing the potential for infections. Additionally, most surgeons came to realize -- in Halsted's words -- "how slightly the sense of touch is obtunded by the rubber covering or how unessential it is in most operations that the greatest delicacy of finger perception be preserved."
The scion of a wealthy, old-line New York family, Halsted was one of a team of brilliant young physicians who helped establish Johns Hopkins as the nation's premier medical facility following its opening in May of 1889. He became the hospital's first professor of surgery and surgeon-in-chief.
A graduate of Yale, he received his medical degree from the New York College of Physicians and Surgeons and then spent two years in Europe studying and "walking the wards."
In 1885, his life was destined to change drastically when he and a small group of New York doctors began experimenting with cocaine as a local anesthetic, not fully realizing its addictive qualities. All were devastated by the drug and three of Halsted's associates subsequently died as a result of their addictions.
Halsted spent 18 months in a psychiatric hospital, under an assumed name, trying to conquer his cocaine habit. When he was released and moved to Baltimore in January of 1888, his closest friends believed him to be drug free; in reality, he had only shifted his dependency to morphine.
His drug habit undoubtedly had much to do with his selection of Caroline Hampton as his wife. She was described by one Halsted intimate as a "woman after his own heart and, like himself . . . a little odd." But the marriage worked because each respected the other's privacy. They even maintained separate apartments in their three-story Baltimore row house, he on the second floor and she on the third. The marriage was childless.
"It would be hard to find a couple whose tranquil union depended so completely on their mutual ability each to let the other go off in any suitable direction unaccompanied, physically or emotionally," a Halsted biographer notes. "It was a strange form of congeniality, and an ever stranger form of love. Nevertheless, it suited them both -- and it worked."
Halsted died on Sept. 7, 1922, two weeks shy of his 70th birthday, following gallstone surgery. Caroline Halsted fell ill with pneumonia and died seven weeks later. "Unwilling to live," a biographer wrote, "she responded to none of the efforts of the medical men."
John G. Leyden is a writer in Davidsonville, Md.