When reviewing the history of medicine — and, more specifically, surgery — it is often said that surgical gloves were invented out of love. It is not an exaggerated statement. In the late 19th century, Caroline Hampton, ill at Johns Hopkins University Hospital in Baltimore, USA, suffered severe skin irritation due to fluids to disinfect the instruments used in operations.
The head of surgery, William Stewart Halsted, who was in love with her – they would end up getting married – contacted the tire company Goodyear to make gloves that would protect the hands of his beloved, but in the once it was thin enough to allow precise manual work.
William Stewart Halsted.
Those latex gloves not only ended the nurse’s problem, but their widespread use was crucial in preventing infections in operating rooms and reducing the mortality rate of patients.
For this and many other contributions – such as radical mastectomy and the improvement of intestinal suturing techniques – Halsted is considered one of the greatest exponents of the so-called “Golden Age of Surgery”, a period that opened in 1846, with the advent of anesthesia, and in which dramatic advances are being made in this branch of medicine.
Read too
His figure is what inspired the television series The Knick (2014-15), directed by Steven Soderbergh and starring Clive Owen, in which a brilliant cocaine-addicted surgeon does not move the ethical boundaries in favor of scientific research.
Gases and anesthesia
Until the early 19th century, medicine and surgery were separate disciplines, and small interventions, such as tooth extraction or bleeding, have been practiced by barbers since the Middle Ages, a trade that was inherited from parents to children.
For the first time in history, both were integrated into the same body of knowledge – acquired in universities – and the surgeon came to consider himself a scientist. However, surgical practice had not yet managed to overcome three major barriers: pain, bleeding, and infection.
Read too
Since its origins, man has sought natural remedies to relieve pain, such as choice, mandrake and hashish, but at the operating table, not even alcohol intake had managed to harden the patient. to a state of unconsciousness without endangering his life.
In 1776, the British chemist and theologian Joseph Priestley discovered nitrous oxide, also known as laughter gas, because it caused a brief fading followed by euphoria. Hence it is popularized in fairs, circuses and parties as a means of fun.
A portrait of Priestley around 1783.
In 1844, during a fair in the city of Hartfort, the American dentist Horace Wells witnessed a man get up after hitting his knee in a fall and decided to investigate possible medical applications of nitros oxide. The next day, he kind of took it out while inhaling and felt no pain.
He had just discovered the anesthetic properties of the gases, which he successfully tested in his patients, although it must also be said that it would ruin life: Wells wanted to devote himself to chloroform, with its effectiveness as an anesthetic was tested by Scottish physician James Young Simpson in 1847, until his thinking deteriorated and he ended up committing suicide.
Anesthesia is a real revolution in the fight against pain
A year earlier, in 1846, a Wells 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 is a real revolution in the fight against pain.
Fight against hemorrhage
In later years, less and less toxic anesthetics appeared that were supplied by different routes (inhalation, intravenous or intrarachid), as well as supports that acted locally. Sigmund Freud, the father of psychoanalysis, is said to realize the anesthetic effect of synthetic cocaine when, paradoxically, he treats his drug to his morphine-addicted patients.
Sigmund Freud in 1905.
Although he was not the first to use cocaine infiltration in the operating room, Halsted, the character with whom he began his article, perfected the technique by experimenting with hundreds of patients. It includes himself, who, like Freud, dragged a strong addiction to this substance until his death.
Despite initial reluctance, surgeons turn to the ventures that offer anesthesia, including the ability to operate areas banned until then. The Frenchman Jules-Émile Péan, for example, was one of the first to perform abdominal operations. However, the dominance of anesthesia did not prevent further deaths in the operating room due to the hemorrhages.
Read too
The most useful weapon against this complication was the identification, in 1901, of blood groups by Karl Landsteiner, which allowed 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.
The elimination of bacteria
Despite progress, death continues to accompany patients both during interventions and in the days that follow. Infections were the order of the day, in large part because the personal physician went through the hospitals, and even the operating room, in street clothes, and did not wash his hands or the instrument used. .
Medical-surgical briefcase from the 19th century.
The first basic rules of hygiene in surgery were imposed in the mid-nineteenth century by Ignaz Philipp Semmelweis. He managed to reduce mortality from puerperal fever – also known as childbirth fever – by having staff attending the parties at the Vienna General Hospital wash their hands with a chloride solution. The Hungarian doctor had noticed 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 Louis Pasteur’s microbial theory. In 1857, the French chemist postulated that infections are related to microorganisms. Relying on the work of Semmelweis and Pasteur, British surgeon Joseph Lister managed to greatly reduce the number of deaths from infection, affecting 30% and 50% of patients operated on at Glasgow Royal Infirmary.
Atmospheric air was the cause of wound rot
Lister observed that closed fractures healed without too many complications, while open ones ended up suppurating or becoming infected. Atmospheric air, therefore, was the cause of wound rot, and for this reason it should be filtered to remove germs. He resorted to phenolic acid to destroy the microorganisms that infected the operating 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 Lancet magazine, although he would still have to wait a few years for it to become widespread throughout the world.
Surgical revolution
Antisepsis, or the fight against bacteria, was paving the way for asepsis, which proposed using previously sterilized instruments, bandages, sponges and sutures. Some specialists were reluctant to introduce this method in operating rooms, arguing that with the patient’s continued protection against germs it was more than enough.
Others, on the other hand, realized that the combination of antisepsis and asepsis was the one that had the best results. The patient’s skin was wiped to a conscience with an antiseptic solution, but the surgeon was also forced to wash his hands with soap, boiled water, and alcohol for several minutes.
Read too
German surgeon Ernst von Bergmann was the first to introduce heat sterilization of the instrumental surgeon, while the systematic use of hats, cloth gloves and masks was to be done to the Polish Johann von Mikulicz. Rubber gloves, as we have seen, Halsted impulses for love.
Bergmann and his assistants.
Once the pain, hemorrhage and infection were controlled, the specialists were able to tackle without fear the treatment of previously restricted areas, such as the aforementioned abdomen, chest or brain. World War I, and later World War II, accelerated the development of the technique in general, and with it, of surgery.
Towards the middle of the twentieth century, surgeons began to divide 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.