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Negotiating Technologies in Surgery: The Controversy about Surgical Gloves in the 1890s

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This article examines the controversial discussions about surgical gloves in the German-language countries in the 1890s. Analyzing the controversy as a contradiction between two important strategies of modern surgery, manual control and aseptic control, it looks at the various ways surgeons dealt with the conflict. Most important, they tried to resolve the problem by designing gloves that reconciled the two conflicting control strategies. This perspective helps to better understand the lengthy process of negotiation and the detailed discussions in the decades before surgical gloves became a standard element of modern operating equipment.
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170 Bull. Hist. Med., 2013, 87 : 170–197
Negotiating Technologies in Surgery:
The Controversy about Surgical Gloves
in the 1890s
thomas schlich
: This article examines the controversial discussions about surgical
gloves in the German-language countries in the 1890s. Analyzing the controversy
as a contradiction between two important strategies of modern surgery, manual
control and aseptic control, it looks at the various ways surgeons dealt with the
conict. Most important, they tried to resolve the problem by designing gloves
that reconciled the two conicting control strategies. This perspective helps to
better understand the lengthy process of negotiation and the detailed discussions
in the decades before surgical gloves became a standard element of modern
operating equipment.
: history of surgery, surgical gloves, asepsis, antisepsis, bacteriology
The session felt like a commercial fair, not like a scientic meeting bet-
ting the dignity and importance of the occasion, the Austrian surgeon
Alexander Fraenkel wrote in his report of the Twenty-Seventh Congress of
the German Society for Surgery in 1898: “For a whole afternoon partici-
pants discussed about the best glove models,” he continued, “marching up
all the various specimens made from different materials, in all sizes and
price ranges—à la Sarah Bernhardt and whatever the fashionable designs
might be called. A whole apparatus of pseudoscience was mobilized to
inaugurate the new fashion of the surgeon in gloves.” For Fraenkel, who
wrote for the renowned Wiener klinische Wochenschrift, the use of gloves
I would like to thank Nick Whiteld and Kate Frohlich for critically reading a previous
version of this article. I presented a version of this article at Cambridge University as the
“Seventeenth Annual Hans Rausing Lecture on the History of Technology” in May 2012 and
would like to thank the discussants at this event for their useful comments and suggestions.
I would also like to thank Debra Scarborough at the American College of Obstetricians &
Gynecologists, Washington, D.C., and Sumiko Hiki, Tokyo, Japan, for granting permission
to use the images in this article.
The Controversy about Surgical Gloves 171
was a bizarre aberration, part of the equally bizarre “surgical costume”
with bonnet, mask, and veil that some of his colleagues had thought up
to achieve the erroneous goal of complete sterility in operations.
1
For some historians of medicine, however, not using surgical gloves at
that time was a bizarre aberration. Many historical accounts show deep
impatience with past surgeons’ hesitation to adopt surgical gloves. One
of them, for example, nds it “curious that it took lively minds so long
to come around with the notion of an impermeable glove in surgery,”
and “even more curious that, when the proposal was nally made in the
eighteen-nineties, it required more than a decade of passionate argument
before nal universal acceptance could be achieved.” As an explanation,
the author suggests that it was the simplicity, the lack of “the enticement
of mystery or the charm of complexity” that made surgeons blind to the
benet of gloves and that “the human mind does always dart straight to
the obvious.”
2
In this article I examine the discussions around the introduction of
surgical gloves in the German-speaking countries in the 1890s. I explore
their historical context and explain why most surgeons hesitated for so
long before using this part of aseptic technology. We will see that the
seemingly bizarre discussion at that afternoon session of the Twenty-
Seventh Congress of the German Society for Surgery had a very rational
background, as did the surgeons’ debate about the usefulness of surgical
gloves in the rst place.
Control and Aseptic Surgery
From a more general point of view, the controversies about gloves were
situated at a point where two signicant control strategies of modern
surgery clashed. Looking at such control strategies is a useful means for
better understanding the striking increase in effectiveness and safety of
surgery in the modern period.
3
These strategies helped make the body’s
1. Alexander Fraenkel, “Congresseindrücke vom 27. Congress der deutschen Gesellschaft
für Chirurgie in Berlin,” Wiener klinische Wochenschrift 21 (1898): 419–21.
2. Justine Randers-Pehrson, The Surgeon’s Glove (Springeld, Ill.: Charles C Thomas,
1960), 3, 14, 30.
3. Thomas Schlich, “Surgery, Science and Modernity: Operating Rooms and Laboratories
as Spaces of Control,” Hist. Sci. 45 (2007): 231–56, and Thomas Schlich, “Ein Netzwerk von
Kontrolltechnologien: Eine neue Perspektive auf die Entstehung der modernen Chirurgie,”
NTM J. Hist. Sci. Technol. Med. 16 (2008): 333–61.
172  
living material controllable and manipulable by the surgeon’s hands and
eyes. They resulted in what can be called a “network” of control technolo-
gies made up of diverse elements. The components of the surgical control
network—instruments, lights and operating tables, anatomy atlases, anes-
thetics, technologies of asepsis, etc.—enabled visibility and manipulability
in many ways. The assemblage of all these items over the course of mainly
the nineteenth century has resulted in a set of material arrangements and
ritualized behaviors that are typical for the modern operating room. It
was the emergence of this network of control technologies that triggered
and maintained the dynamic process of rapid development in surgery that
has been so typical of the modern period. However, this network was not
the result of a conscious and long-term strategy. Instead, its conguration
was shaped by a diverse range of practical problems and the various ways
surgeons tried to solve them.
Probably the most important form of control in surgery is manual con-
trol. Manual control includes the basic functions of grasping, holding,
cutting, and connecting body structures in purposeful ways. Scalpels, for
example, enable the surgeon to cut body structures in a precise and con-
trolled way, forceps make it possible to hold them, and so on.
4
But there
are other kinds of control too. One of them became particularly important
for protecting the patient’s body from the consequences of the surgeon’s
intervention into its integrity. It consisted of keeping the agents of wound
infection out of the patient’s body. In the 1860s the British surgeon Joseph
Lister (1827–1912) suggested killing germs in and around the wound with
disinfectant substances, for the most part carbolic acid. In the second half
of the nineteenth century, a variety of antigerm practices became gradu-
ally integrated into surgical routine. However, the process of integration
was controversial, and the technology itself changed considerably in the
course of its spread. It was actually asepsis, rather than antisepsis,
5
that
became the standard in the 1880s and 1890s.
6
Asepsis consisted of pre-
4. On the historiography of surgical instruments and its problems, see Ghislaine Law-
rence, “The Ambiguous Artifact: Surgical Instruments and the Surgical Past,” in Medical
Theory, Surgical Practice: Studies in the History of Surgery, ed. Christopher Lawrence (London:
Routledge, 1992), 295–314.
5. The relationship between practices and terminologies was actually more complicated
than I can present it here; for this discussion, see Thomas Schlich, “Asepsis and Bacteriology:
A Realignment of Surgery and Laboratory Science,” Med. Hist. 56 (2012): 308–34.
6. Thomas P. Gariepy, “The Introduction and Acceptance of Listerian Antisepsis in the
United States,” J. Hist. Med. & Allied Sci. 49 (1994): 167–206, see 205. For Britain, see, e.g.,
Michael Worboys, Spreading Germs: Disease Theories and Medical Practice in Britain, 1865–1900
(Cambridge: Cambridge University Press, 2000) , 172–92; on the United States, see also Gert
Brieger, “American Surgery and the Germ Theory of Disease,” Bull. Hist. Med. 40 (1966):
135–45, see 140.
The Controversy about Surgical Gloves 173
venting any germs from entering the wound in the rst place. For the
purpose of asepsis, all objects in the surgical environment that could get
into contact with the wound had to be made germfree. The new strategy
of germ control thus entailed a considerable increase in time and effort
and made control much more precarious than in antisepsis.
Asepsis as a consciously applied, formalized concept originated in the
German-speaking countries, where antisepsis had already been taken up
with particular enthusiasm in the 1870s.
7
A number of specic conditions
help explain this development. These conditions are also interesting for
our argument here because they provided the context of the discussions
about surgical gloves. In the German-speaking world, elite surgeons
worked at large university hospitals, which were also the centers of surgi-
cal innovation. In these large, hierarchically structured institutions, young
surgeons went through training periods of several years. The resulting
continuity enabled them to acquire a thorough familiarity with complex
new techniques—a structural feature that British and American schools
did not offer at that time.
8
Also, training at these academic centers was
more research-oriented than was the case at their contemporary American
and British counterparts. In the German lands, where university or state-
run laboratories had become an acknowledged source of new medical
knowledge early on,
9
laboratory science was given a privileged position
7. On the popularity of Lister’s antisepsis in Germany, see Worboys, Spreading Germs (n.
6), 98–99; Thomas Schlich, “Farmer to Industrialist: Lister’s Antisepsis and the Making of
Modern Surgery in Germany,”Notes & Records of the Royal Soc. 67 (2013) (forthcoming).
8. Contemporary commentators were aware of this, and some of them used the German
system as a model to emulate, e.g., William Halsted at Johns Hopkins; see William George
MacCallum, William Stewart Halsted, Surgeon (Baltimore: Johns Hopkins University Press,
1930), 23–24, 84. Another example is Alfred Theodore Rake in Britain, who translated
Schimmelbusch’s guide to aseptic surgery (see further down) and identied a structural
obstacle to establishing a practice as complicated as asepsis in British hospitals, where the
house surgeons wouldn’t stay long enough to be able to learn it properly; see Curt Schim-
melbusch, The Aseptic Treatment of Wounds, translated from the second German edition by
Alfred Theodore Rake (London: Lewis, 1894), ii–viii; for a similar line of argument, see
also Worboys, Spreading Germs (n. 6), 189.
9. John V. Pickstone, “Ways of Knowing: Towards a Historical Sociology of Science, Tech-
nology and Medicine,” Brit. J. Hist. Sci. 26 (1993): 433–58; Arleen Tuchman, Science, Medicine,
and the State in Germany: The Case of Baden, 1815–1871 (New York: Oxford University Press,
1993); Timothy Lenoir, “Laboratories, Medicine and Public Life in Germany, 1830–1849:
Ideological Roots of the Institutional Revolution,” and Richard L. Kremer, “Building Insti-
tutes for Physiology in Prussia, 1836–1846: Contexts, Interests, and Rhetoric,” both in The
Laboratory Revolution in Medicine, ed. Andrew Cunningham and Perry Williams (Cambridge:
Cambridge University Press, 1992), 14–71, 72–109. Innovation was also easier in Germany at
the time because “the values of Lehrfreiheit...meant that recognized teachers could teach
what they wanted.” William F. Bynum, Science and the Practice of Medicine in the Nineteenth
Century (Cambridge: Cambridge University Press, 1994), 219.
174  
in the training of academic surgeons. During their long training periods,
surgical trainees also conducted scientic research, usually some kind of
laboratory research.
10
This often meant bacteriological research in the
1880s and 1890s—a time period when Koch’s new bacteriology spread
and his students took on professorships at many German-language uni-
versities,
11
and bacteriology was being taken up by German academic
surgery as a resource and as an authority. The typical pattern was that
surgical trainees—assistants as they were called—were charged with the
laboratory work, while the head surgeon was responsible for the trans-
fer of the newly produced knowledge into clinical surgery. In this way, a
whole generation of bacteriologically trained academic surgeons arose
in the 1880s and 1890s.
12
The proponents of asepsis propagated the approach as a new stage of
control in surgery. This new stage was to be achieved by applying Robert
Koch’s laboratory methods of controlling microorganisms to the surgical
environment in the operating room.
13
In particular, the surgical university
hospital in the Ziegelstrasse in Berlin acquired the reputation of being the
“cradle of the aseptic method” and the “institution where the technique
was executed in an exemplary manner.”
14
As part of his strategy of using
laboratory science as a resource for improving surgical outcomes, the
hospital’s head surgeon Ernst von Bergmann (1836–1907) systematically
hired assistants who were able to combine surgical talent with bacteriologi-
cal expertise. One of them, Kurt Schimmelbusch (1860–95), integrated
and standardized the various innovations of the previous decade into a
formalized system, based on Kochian bacteriology. His Guide to Aseptic
Wound Treatment, rst published in 1892 and subsequently translated
into several European languages, rapidly became the authoritative refer-
10. Another element that Halsted adopted for Johns Hopkins; MacCallum, Halsted (n.
8), 23–24, 58–71.
11. About Koch’s students, see Silvia Berger, Bakterien in Krieg und Frieden. Eine Geschichte
der medizinischen Bakteriologie in Deutschland 1890–1933 (Göttingen: Wallstein, 2009), 12.
12. Schlich, “Asepsis” (n. 5).
13. See ibid. The most important programmatic statements to that effect are Ernst von
Bergmann, “Die Gruppierung der Wundkrankheiten,” Berliner klinische Wochenschrift 19
(1882): 677–79, 701–3; and Ernst von Bergmann, “Ueber antiseptische Wundbehandlung,”
Deutsche medizinische Wochenschrift 8 (1882): 559–61, 571–72.
14. J. Mikulicz, “Ueber Versuche, die ‘aseptische’ Wundbehandlung zu einer wirklich
keimfreien Methode zu vervollkommnen,” Deutsche medizinische Wochenschrift 33 (1897):
409–13, see 409. See also Paul Leopold Friedrich, Das Verhältnis der experimentellen Bakteri-
ologie zur Chirurgie. Antrittsvorlesung gehalten am 10. Juli 1897 in der Aula der Universität Leipzig
(Leipzig: Wilhelm Engelmann, 1897), 26–27.
The Controversy about Surgical Gloves 175
ence work for the new technology.
15
Beyond Berlin, a whole generation
of German-speaking surgeons was shaped by the new alliance between
surgery and bacteriology. This new generation shared Bergmann’s strat-
egy of using the laboratory as a resource for nding new ways of improv-
ing their surgical results. Asepsis became the standard of good surgery,
and many surgeons were working on its further perfection. However, the
efforts of improving asepsis were locally based and little standardized,
so that we can see a range of “local cultures of asepsis” developing. The
existence of these local cultures points to the above-mentioned fact that
the introduction of laboratory-inspired control principles in surgical prac-
tice was not an implementation of a preconceived plan, but consisted of,
as I have phrased it in another article, “a process of tinkering, trial and
error and constant adaptation, in which surgeons grappled with the con-
crete problem of contamination and wound infection.”
16
As I show here,
the local and unplanned character of the spread of asepsis is central for
understanding the uneven adoption of surgical gloves before World War I.
In order to see that surgical gloves were a reaction to a concrete and
unexpected problem rather than a part of an aseptic master plan, it is
essential to situate the discussions about them in their concrete context.
It is not by chance that surgeons in Dorpat, Breslau, Prague, and Leipzig
came up with the idea at the same time. The background was a perceived
crisis of aseptic surgery in the late 1890s. At that time, commentators
noted a growing nervousness among surgeons, who, with increasing
demands on the perfection of wound treatment, started feeling insecure
about their practices.
17
Since the publication of Schimmelbusch’s seminal
work at the beginning of the decade, surgeons had noticed that even his
aseptic system could not guarantee that the operation wound stayed germ-
free, as Johannes von Mikulicz (1850–1905) put it in 1898.
18
Even worse,
the author added, the transition from antisepsis to asepsis had actually not
15. Curt Schimmelbusch, Anleitung zur Aseptischen Wundbehandlung (Berlin: Hirschwald,
1892). On Schimmelbusch’s success, see Ernst von Bergmann, “Nachruf an Dr. Kurt Schim-
melbusch,” Berliner klinische Wochenschrift 32 (1895): 730–31.
16. Schlich, “Asepsis” (n. 5), 330.
17. Professor Dr. Landerer, “Die Ursachen des Misslingens der Asepsis,” Verhandlungen
der Deutschen Gesellschaft für Chirurgie 27 Kongress (1898): 38–45, see 38. The Leipzig surgeon
Georg Perthes, e.g., was also struck by the parallel introduction of gloves in several places
during the past year; see Herr Perthes (Leipzig), “Zur Frage der Operationshandschuhe,”
Verhandlungen der Deutschen Gesellschaft für Chirurgie 27 (1898): 8–10.
18. J. Mikulicz, “Ueber der neuesten Bestrebungen, die aseptische Wundbehandlung
zu vervollkommnen,” Verhandlungen der deutschen Gesellschaft für Chirurgie 27 (1898): 1–37.
176  
improved the outcome of wound treatment. Even at Bergmann’s depart-
ment in Berlin, he argued, one could see occasional failures.
19
Because of
these problems, many investigators were assiduously searching for weak
points in the current methods of wound treatment.
20
Mikulicz had been head of the surgery department of the University of
Breslau since 1890 and belonged to the generation of academic surgeons
who had grown up with bacteriology.
21
In several publications in 1897 and
1898, he discussed how the switch from antisepsis to asepsis increased the
stakes in surgery. Antisepsis had been relatively forgiving, since antisep-
tic substances killed germs indiscriminately. Asepsis, with its much more
targeted approach, by contrast, followed the all-or-nothing principle:
“The smallest mistake in wound treatment would come back to haunt the
surgeon,” he stressed.
22
Confronted with this risk, Mikulicz felt he might
even have to give up the aseptic principle altogether and return to the old
antiseptic practices. He decided to stick to the new approach and work
on the renement of asepsis “to its uttermost consequences”
23
in order
to reach absolute certainty about the perfect sterility of everything that
was involved in an operation. To achieve that goal, Mikulicz, like many
other academic surgeons at the time, worked in close cooperation with a
bacteriological expert. His collaborator was Carl Flügge (1847–1923), the
local hygienist at Breslau.
24
Trying to nd ways of closing potential gaps
in asepsis by inventing new hygienic measures, the two men came up with
the idea of face masks to prevent what Flügge called “droplet infection”
from the surgeon’s mouth, a procedure that was much later adopted
generally all over the world. Many of today’s surgical paraphernalia were
introduced at that time as part of the bacteriologically supported search
for weak points in the aseptic all-or-nothing system of preventing wound
infection. It was the context of this crisis of aseptic surgery that prompted
a number of surgeons in the 1890s to simultaneously try out surgical gloves
within their local settings.
For historians of medicine, the ensuing controversy provides a privi-
leged access point for analyzing the dynamics of the surgical control
19. Mikulicz, “Versuche” (n. 14), 409.
20. Mikulicz, “Bestrebungen” (n. 18), 3.
21. H. Killian and G. Krämer, Meister der Chirurgie und die Chirurgenschulen im Deutschen
Raum (Stuttgart: Thieme, 1951), 187.
22. Mikulicz, “Versuche” (n. 14), 411.
23. Ibid., 411.
24. Ibid., 412; Mikulicz, “Bestrebungen” (n. 18), 3; Johann Mikulicz, “Das Operiren in
sterilisirten Zwirnhandschuhen und mit Mundbinde,” Centralblatt für Chirurgie 24 (1897):
713–19, see 716. On Flügge, see Berger, Bakterien (n. 11), 45–46. Flügge’s compendium, Dr.
C. Flügge, Grundriss der Hygiene für Studierende und Praktische Ärzte, Medicinal- und Verwaltungs-
beamte (Leipzig: Veit, 1889), was completely based on Kochian bacteriology.
The Controversy about Surgical Gloves 177
network more generally. As we will see, the case shows to what degree
the network was the outcome of an open-ended process of adjustment.
As historians, we can follow how, in the course of the negotiations about
contradictory goals and strategies, the values of different kinds of knowl-
edge (clinical observations and laboratory results) were also renegotiated,
and we can describe how the adjustment of objects and practices played
a central role in the emergence of the network.
Gloves
In the 1880s and 1890s, using gloves for the protection of the patient, not
the surgeon, was not obvious. As an article of clothing, gloves are normally
worn to protect the person who wears them. This is how gloves were rst
used in surgery, too. Catching an infection from a patient, for example,
was a very real danger. Schimmelbusch’s early death at age thirty-ve was
due to a septic infection caught in the operating room, and his was not an
isolated case.
25
In his memoirs, Anton von Eiselsberg (1860–1939) from
Vienna gives a vivid account of surgeons’ struggles with the problem of
patient-induced local hand infections. Eiselsberg also wrote about another,
related, reason for the early use of gloves, namely the risk of contamina-
tion from handling corpses in autopsies and training courses, for which
thick rubber gloves were worn in the 1880s.
26
Another problem came
from the use of antiseptics. Copiously applied, the caustic solutions often
caused severe skin damage in surgeons and nurses, forcing some of them
to abandon operating altogether.
27
This issue was the background of the
well-known story of how in 1889 William Halsted (1852–1922) at Johns
Hopkins introduced rubber gloves to protect the hands of his chief operat-
ing nurse, who later became his wife. Subsequently, such gloves were also
used by Halsted’s assistants. They put them on when taking instruments
out of the corrosive sublimate solution in which the instruments were
kept and passed them on to the operating surgeon (who did not wear
gloves).
28
But using them for the whole surgical team in order to protect
25. The British pioneer of asepsis, Charles B. Lockwood (1856–1914), also died from an
infection he had contracted in an operation on a patient with peritonitis. T. H. Pennington,
“Listerism, Its Decline and Its Persistence: The Introduction of Aseptic Surgical Techniques
in Three British Teaching Hospitals, 1890–99,” Med. Hist. 39 (1995): 35–60, see 56.
26. Anton von Eiselsberg, Lebensweg eines Chirurgen (Innsbruck: Tyrolia Verlag, 1938),
67, 164, 549.
27. Ibid., 71.
28. W. S. Halsted, “The Treatment of Wounds,” Johns Hopkins Hosp. Rep. 2, no. 5 (March
1891): 304–13, see 307–10; W. W. Keen, “Transactions of the Section on General Surgery of
the College of Physicians of Philadelphia,” Ann. Surg. 27, no. 2 (1898): 209–27, see 224; J. M.
T. Finney, A Surgeon’s Life: The Autobiography of J.M.T. Finney (New York: Putnam, 1940), 90.
178  
the patient wasn’t obvious at Johns Hopkins either. This became standard
practice there only in 1896.
29
In the German-language surgical literature, a couple of studies had
called attention to the surgeon’s hands as a potential source of wound
contamination already in the 1880s. Hermann Kümmel (1852–1937) in
Hamburg published a bacteriological study in 1886 on contact infection
in surgery and characterized the hands as the “objects that are the most
difcult to disinfect.”
30
In 1888 Paul Fürbringer (1849–1930) in Berlin
reported a standardized procedure in which he rst washed his hands
with soap, then alcohol, and nally an antiseptic substance. Supported by
bacteriological laboratory studies, the procedure was quickly adopted as
the gold standard of hand disinfection in surgery.
31
In his guide of 1892,
Schimmelbusch, for example, put great emphasis on thorough hand dis-
infection following Fürbringer’s method.
32
For Mikulicz, too, the surgeon’s hands constituted the most important
gap in asepsis. This was the more dangerous as the hand got into contact
with the wound much more frequently and more intensively than the ster-
ilized instruments. Moreover, it was virtually impossible to know whether
one’s hands were indeed adequately disinfected or not.
33
In contrast to
former belief, the surgeon’s hands could not be disinfected sufciently,
he stated. Even Fürbringer’s method was insufcient because the skin’s
sebaceous glands went too deep to be entirely disinfected, and the space
beneath the ngernails could not be completely reached by disinfectants
either. He based his claim on bacteriological studies he had conducted
in Breslau, which had shown that the quality of hand disinfection varied
not only from person to person, but even from day to day for the same
person. For Mikulicz, this kind of inconsistency stood in stark contrast to
29. William Stewart Halsted, “Ligature and Suture Material,” J. Amer. Med. Assoc. 60
(1913): 1119–26, see 1123; Joseph Colt Bloodgood, “Halsted Thirty-Six Years Ago,” Amer. J.
Surg. 14 (1931): 89–148, see 93.
30. H. Kümmel, “Die Bedeutung der Luft- und Contactinfection für die praktische
Chirurgie,” Archiv für klinische Chirurgie 33 (1886): 531–47.
31. Paul Fürbringer, Untersuchungen und Vorschriften über die Desinfektion der Hände des
Arztes nebst Bemerkungen über den bakteriologischen Charakter des Nagelschmutzes (Wiesbaden: J.
F. Bergmann, 1888), 3; Paul Fürbringer, “Zur Desinfection der Hände des Arztes,” Deutsche
medizinische Wochenschrift 14 (1888): 985–87; Paul Fürbringer and Dr. Freyhan in Berlin,
“Neue Untersuchungen über die Desinfection der Hände,” Deutsche medizinische Wochenschrift
23 (1897): 81–85. On Fürbringer, see J. Pagel, Biographisches Lexikon hervorragender Ärzte des
neunzehnten Jahrhunderts (Berlin: Urban & Schwarzenberg, 1901), 567–68.
32. Schimmelbusch, Anleitung (n. 15), 48–50.
33. Mikulicz, “Das Operiren” (n. 24), 714.
The Controversy about Surgical Gloves 179
surgeons’ newly acquired attitude of taking on full responsibility for the
outcome of their operations.
34
To x the hand problem, Mikulicz started operating with sterilized cot-
ton gloves at Easter 1896; and from March 1, 1897, all aseptic operations in
his clinic were performed with gloves, a practice that, as he claimed, had
already led to striking success (he did not support this claim with numbers
though). Of course, hands still had to be thoroughly cleaned and, if pos-
sible, disinfected before putting on gloves, since the gloves used were not
impermeable. For short interventions only one pair of gloves was needed.
During longer operations, especially when the gloves were soaked with
blood, he recommended changing them once or twice (see Figure 1).
35
Figure 1. Johannes von Mikulicz in the operating theatre in 1899. Note the
elbow-length cotton gloves. Source: Sumiko Hiki and Yoshiki Hiki, “Professor von
Mikulicz-Radecki, Breslau: 100 Years since His Death,” Langenbeck’s Arch. Surg. 390
(2005): 182–85, 183. Reproduced with kind permission of Sumiko Hiki, Tokyo,
Japan.
34. Mikulicz, “Versuche” (n. 14), 411.
35. Mikulicz, “Das Operiren” (n. 24), 715.
180  
In his article, Mikulicz explicitly addressed the danger of losing manual
control as the main problem of this new technology. But he gave it a posi-
tive spin: “Those who have not yet operated with gloves or have seen oth-
ers operating with them,” he explained, “might believe that this addition
will make all manipulations in operating more difcult, such as feeling
one’s way in the wound, grasping structures, sewing and other things like
that. But this is not all the case. One gets used to them in a few days and
even misses the purely mechanical advantages of operating with gloves.
Grasping and holding tissues is much easier with gloves than with the
naked hand.”
36
Concerning “occasions when one cannot do without the
ner sensation of the ends of one’s ngers, for example when palpating
the interior surface of the stomach in search of a small tumor,” he sug-
gested a compromise: “For this purpose one just pulls off the glove and
replaces it with a new one once the examination is completed.”
37
From
today’s perspective this compromise is unacceptable. For the author it was
a viable way of preserving manual control, even if it was at the expense
of aseptic control. Mikulicz had also tested rubber gloves but found their
disadvantages in terms of manual dexterity outweighed their minimal
advantages in terms of asepsis.
38
The surgeon who is credited with introducing rubber gloves in the
German-speaking world is Werner Zoege von Manteuffel (1857–1926) in
Dorpat.
39
In his article of 1897 he argued that surgeons were not yet in a
position to disinfect their hands in a way that met strict bacteriological cri-
teria.
40
This did not always lead to problems since, in the majority of cases,
the vital qualities of the patient’s body tissue—in other words the body’s
defense mechanisms—were able to deal with those germs that were left.
But, as he added, these mechanisms could not always be relied on. This
means that Zoege requested a degree of certainty and control that could
not be achieved by leaving things up to nature. What’s worse, the surgeon
himself could be the source of loss of control, because, as he explained,
the body’s compensatory mechanism failed altogether when surgeons
had touched infectious material such as feces or pus before an aseptic
operation. This was a common situation in Zoege’s work environment, a
36. Mikulicz, “Versuche” (n. 14), 412.
37. Mikulicz, “Das Operiren” (n. 24), 716.
38. Mikulicz, “Versuche” (n. 14), 412; Mikulicz, “Das Operiren” (n. 24), 716.
39. E.g., Theodor Kocher, Chirurgische Operationslehre, 5th rev. ed. (Jena: Fischer, 1907),
100n1. Zoege was a Baltic German. Dorpat was the German name for Tartu in Estonia. From
1802 to 1893, German was the language of instruction at its university, which was counted
among thirty German-language universities, of which only twenty-three were inside the
German Empire.
40. W. Zoege von Manteuffel, “Gummihandschuhe in der chirurgischen Praxis,” Cen-
tralblatt für Chirurgie 24 (1897): 553–56.
The Controversy about Surgical Gloves 181
municipal hospital, where he was forced to operate “promiscuously,” as he
wrote, on pure and septic patients. These local circumstances prompted
him to look for ways of protecting his hands from contamination and to
try out boiled rubber gloves. Their protective effect became immediately
clear in one of Zoege’s assistants. This colleague had been struggling
continuously with operation furuncles. This is a form of bacterial skin
infection incurred from patients. The gloves got rid of the problem. But
the protection would also work in favor of the patient, for example, when
Zoege saved a patient’s life in the case of a bleeding injury and no time
for proper hand disinfection. With his sterile gloves the surgeon was able
to stop the bleeding and save the patient without exposing the patient’s
wounds to germs. Zoege’s use of rubber gloves was thus initially provoked
by specic local conditions, even though, as we will see, it was subsequently
taken up in other places and eventually became quite universal.
Zoege also addressed the obvious disadvantage of wearing gloves in
terms of manual control, admitting that operating with gloves was, “of
course,” somewhat uncomfortable. This was less important in septic
operations, which were usually not so technically demanding. However,
in aseptic operations, if the glove was too tight, he explained, diminished
blood supply caused premature fatigue of the hand. In addition, the gloves
available on the market were usually cut in a way that they left insufcient
space for the ball of the thumb, which made it difcult to abduct the
thumb. In addition, sometimes the ngers of rubber gloves were exces-
sively long, preventing the quick grasping of instruments with scissor-like
handles. But even with well-tted gloves, operations would take a bit lon-
ger than with bare hands. But this, Zoege thought, was outweighed by the
gains in aseptic control, the absolute safety of the “boiled hand,” as he
called it. Zoege thus explicitly weighed the two kinds of control against
each other. What also becomes clear in this discussion is the importance
of the technical details of the gloves for reconciling manual and aseptic
control. They had to be made in a way so that they didn’t compromise
the surgeon’s grasp too much but at the same time were effective in keep-
ing bacteria out.
The conict between these two objectives induced surgeons to nd
their own, individual solutions. Georg Perthes (1868–1927) in Leipzig
suggested using ne nger covers (Fingerüberzüge) made of condom
rubber, “which have been put on the market recently, and which impair
the touch of the nger relatively little.”
41
He used them in septic cases
to protect his hands from contamination. Whole gloves made of rubber
he rejected: “Since it is technically impossible to makes gloves from ne
41. Georg Perthes, “II. Operationshandschuhe,” Centralblatt für Chirurgie 24 (1897):
717–19, quotation on 718.
182  
(blown) condom rubber we depend on gloves glued out of rubber sheets.
These however, are, as my own tests have shown, too uncomfortable and
too thick, to allow for condent operating and ne touch. Knotting a
ne silk thread is a laborious task for a hand in rubber gloves. Zoege-
Manteuffel has experienced himself that operating with rubber gloves is
onerous.”
42
To what extent manual and aseptic control stood in contra-
diction with each other thus depended on the details of the gloves, their
material, their design, even the way they were manufactured. Perthes did
use gloves though. But his were of ne silk tissue. They were made to reach
up to the elbow and, as he claims, were hardly noticeable in operating:
“Handling the instruments and knotting ne threads makes no difcul-
ties in these smoothly tting silk gloves.”
43
This compromise, as he had
to admit, was achieved at the expense of aseptic safety, since silk gloves
did not offer complete protection from bacteria and could not replace
the usual hand disinfection.
More and more surgeons joined in with Mikulicz’s demand of closing
this gap in aseptics. Thus, the gynecologist Carl Menge (1864–1945) called
Fürbringer’s standard method of hand disinfection “pseudo-disinfection”
since it just reduced germs, but did not eliminate them, as measured by
Robert Koch’s standard bacteriological methods. These bacteriological
ndings were in line with the clinical observation that occasionally wound
infections occurred in aseptic operations even after disinfection with Für-
bringer’s method. The only way to avoid this was the use of gloves, Menge
claimed. But he also admitted that gloves caused an impairment of touch,
nger mobility, and manual dexterity. These drawbacks became particu-
larly relevant in situations of bad visibility, when the surgeon could not
rely on the eye’s guidance in his operation (a remark that points to the
issue of visual versus manual haptic control in terms of body structures,
which I cannot pursue in this article). Like Mikulicz, Menge suggested
putting the gloves temporarily aside in such cases, thus privileging manual
control over aseptic control. However, Menge also turned to the gloves
themselves as a locus for compromise between the two control strategies.
He suggested using a pair of very thin and densely woven gloves made of
half silk and impregnated with parafn xylol or parafn ether. The sur-
geon would don these gloves, douse them with the uid, and let it dry.
This procedure resulted in a protective layer, making the gloves relatively
impermeable without impairing the hand’s touch and mobility too much.
One could do the same thing even with one’s naked hands, he remarked.
42. Ibid., 718.
43. Ibid., 718.
The Controversy about Surgical Gloves 183
Other surgeons suggested other substances, such as wax and gutta-percha,
for covering one’s hands with a temporarily impermeable layer, but the
idea never took off.
44
In his article, Paul Leopold Friedrich (1864–1916) took the perspec-
tive of a surgeon with a high-level double qualication in bacteriology
and surgery. He warned his colleagues about “touching the wound with”
what he called “non-boilable objects (hands).” His choice of words is
interesting because boiling had become the emblematic feature of aseptic
surgery that set it apart from the older technology of antisepsis, which
had employed only chemical means of disinfection. But boiling was, of
course, something that could not be done with the surgeon’s hands.
Therefore hands were often referred to as being “non-boilable” in the
discussions about asepsis. Like others, Friedrich pointed out that “the
fact of the imperfect sterilibility of hand lls us with a certain unease.”
45
He added that the persistence of this problem was also an obstacle to the
spread and the standardization of aseptic surgery more generally: “It is
exactly the uncertainty of skin sterilization under which the generalizabil-
ity of the method [asepsis] and the trust set into it by its students suffers
signicantly. Almost every clinic has its own procedure.” Friedrich thus
characterized the local character of the different attempts at hand disin-
fection as a liability for the aseptic method in general. The multiplicity of
the different methods used at the same time prevented any one of them
from being truly effective, he concluded, and added that it was still not
quite clear if sterilized gloves were the solution to this problem.
46
The specic association between gloves and asepsis (as opposed to
antisepsis) was further emphasized by Anton Wöler’s article of 1897.
Aseptic wound treatment, the Prague surgeon argued, was aficted with
uncertainty as to the absence of pathogenic germs.
47
This made it dif-
ferent from antisepsis, which was dened and identied by the presence
of something, namely the antiseptic agent. In antisepsis, surgeons knew
when they had disinfected an object. It was an active act and thus easy
44. C. Menge, “Zur Vorbereitung der Hände vor aseptischen Operationen,” Münchener
medizinische Wochenschrift 45 (1898): 104–8. Carl Menge is an example of the fact that gyne-
cology was included in the realignment of surgery and bacteriology; see, e.g., C. Menge and
B. Krönig, Bakteriologie des weiblichen Genitalkanales (Leipzig: Arthur Georgi, 1897). On other
substances, see Carl S. Haegler, Händereinigung, Händedesinfektion und Händeschutz (Basel:
Schwabe, 1900), 167–74.
45. Friedrich, Das Verhältnis (n. 14), 28.
46. Ibid., 28–29.
47. A. Wöler, “Ueber Operations-Handschuhe,” Beiträge zur klinischen Chirurgie 19
(1897): 255–59, see 255.
184  
to control. Asepsis, by contrast, consisted of the absence of germs, and it
was much harder to be sure whether this condition had been achieved
or not. The solution lay in a further increase of control: “Since mistakes
during an operation can no longer be atoned for by antiseptic sprinkling
as in the past, we must strive to take ever stricter precautionary measures
with regard to contact and air infection. One of these prophylactic mea-
sures is certainly wearing gloves during operations.”
48
We can see how the
elusiveness of asepsis provided the context in which gloves made sense.
At the time of the publication, Wöler had used gloves for ten years
for operating on dead bodies and septic cases. His gloves were made of a
silk tissue covered with rubber on the outside. The company P. Mangold,
Berlin, Linienstrasse 153, made them for him in a way that allowed for
them to be closed with an elastic band above the wrist in order to avoid
gaps. For working in the abdominal cavity, he used gloves reaching up to
his elbows. In April 1897 he had started using gloves in aseptic operations
too. For that purpose he chose military gloves made of leather, “which
were more comfortable than rubber gloves and which in wet condition t
so well on the ngers that one forgets that one works with gloves during
the operation.”
49
“Only for the ner touch during the operations they are
too dense,” he reported. He worked around the problem by using gloves
from which he had cut off the tip of the thumb and the index nger. “If
I anticipate that I will need a nger for touching, I cover my thumb and
index nger with a condom nger cot and wear the gloves with the cut-off
ngers on top.”
50
Since adjustments in the glove’s design, material, and use
was a way of reconciling manual and aseptic control, such reports had to
be very detailed. Wöler’s account is also a nice example of the ingenious
improvisation surgeons resorted to in order to reach that reconciliation.
Presenting the kind of generalized anecdotal evidence that was typical at
this stage of the discussion about surgical gloves, Wöler claimed a bet-
ter rate of wound healing in his patients since he began using gloves in
aseptic operations, though the time period was still too short to come to
a denitive judgment as to their causal role.
51
Wöler hoped for a technical solution to the problem in the form of
a glove that enabled both modes of control, manual and aseptic. The
ideal glove had to fulll ve conditions. It had to be (1) impermeable,
(2) exible, and (3) tear-resistant, (4) it had to not squeeze the skin too
tightly and not get too hot, and (5) it had to be sterilizable.
52
Wöler’s
48. Ibid., 256.
49. Ibid., 257–58.
50. Ibid., 258.
51. Ibid., 258.
52. Ibid., 258.
The Controversy about Surgical Gloves 185
ve conditions were often referred to later on in the discussions. They
formalized the reconciliation between the different kinds of control
embodied in the gloves.
The Surgical Congress of 1898:
I. The Role of the Laboratory
On April 13, 1898, the Twenty-Seventh Congress of the German Society for
Surgery devoted an afternoon session to the topic of gloves. It started off
with a keynote speech by Mikulicz.
53
He used it to situate the issue within
the general strategy of enhancing the surgeon’s active control, as opposed
to the traditional more passive and reserved approach of setting one’s trust
in the healing force of nature. Like Zoege, he emphasized the limitations
of the protective power of the patient’s body tissue: “the less we expect
of it, the surer we can be of success, the more powerful operative surgery
will be.”
54
The dominant conceptual theme in the discussions, however,
was the role of the laboratory in surgical innovation, in particular with
regard to the correct representation of surgical reality in the laboratory.
At this date, Mikulicz was able to present the rst results of the bacterio-
logical studies conducted by one of his assistants in Breslau. In these inves-
tigations, surgeons’ hands were submitted to bacteriological tests under
different conditions—with and without cotton gloves, with and without
disinfection, before and after operating. The germ count of the cotton
gloves stayed low as long as the gloves were dry. Gloves that got soaked
during an operation, by contrast, were full of bacteria, which Mikulicz
guessed came from the surgeon’s skin. However, he found fewer bacte-
ria on the gloves than on surgeons’ bare hands. In addition, he reported
that his clinical results had measurably improved since he had started
operating with gloves, the rate of smooth healing going up from 83 to 94
percent. For these reasons, Mikulicz kept recommending cotton gloves,
but with the additional advice of changing them several times during an
operation. The best solution would be impermeable gloves, he argued.
The only problem was that the available models did not meet the require-
ments of surgical practice, as formalized in Wöler’s ve conditions.
55
Georg Perthes also expected clarication of the benets of gloves
through laboratory science. He had subjected his silk gloves to bacterio-
logical tests “in order to determine what the method can really achieve for
the asepsis of the hands and whether it will prevent the entry of bacteria
53. Mikulicz, “Bestrebungen” (n. 18), 1–37.
54. Ibid., 37.
55. Ibid., 33–34.
186  
sticking to one’s hands into the wound.”
56
For these tests, the experimental
subjects’ hands were intentionally contaminated with Bacillus pyocyaneus.
As a substitute for an operation, the subjects were then asked to tie six
knots with sterilized silk thread with dry and wet hands, with and with-
out gloves. As a result, Perthes found that permeable silk gloves did not
prevent the transmission of bacteria. Based on these ndings, he recom-
mended using rubber gloves in emergency situations when there was not
enough time for thorough hand disinfection.
Perthes’s experiments are also interesting because of his attempts to
model a central aspect of manual control. He suggested the use of rubber-
covered silk gloves with a special design detail for improving manual con-
trol: “The silk lining is absent in the nger tips so that the touch is only
very little impaired in that area of smoothly tting rubber.” To examine
the benet of this special design, he performed sensitivity tests, as, he
explained, they were used in internal medicine. These tests showed that
with his special gloves, the sense of touch at the ngertips was as good as
with ne silk gloves. The touch of a ne hair pencil, for example, was very
well discernible. His gloves, which reached up to the elbow, were loosely
tailored, allowing for full mobility. Even sophisticated operations such as
a herniotomy and a circular bowel suture could be carried out without
particular difculties, he claimed.
For some surgeons laboratory results provided the basis of their
rejection of gloves. The gynecologist and obstetrician Albert Döderlein
(1860–1941) from Tübingen thought it impossible to eliminate the prob-
lem of contamination through a simple technological x. There was no
cutting through the Gordian knot, he proclaimed. This error could have
arisen only because so far nobody had really examined what happened
bacteriologically during an operation with cotton gloves. Therefore, he
had made it his task to follow “the bacteriological fate of the gloves in the
course of the operation,” as he phrased it. In his experiments, he squeezed
uid out of cotton gloves at different times during operations. He then
used this “glove juice” to inoculate suitable culture media in order “to
determine the presence or absence of microbes in the culture.” His rst
experiment took place in an aseptic ovariotomy. The blood-drenched
gloves turned out to be “permeated with germs to an unimagined extent.”
“I was shocked to the extreme when I discovered the culture result on the
subsequent day,” as he dramatically described this unexpected loss of asep-
tic control.
57
He then started a larger study and methodically examined
56. Perthes, “Zur Frage der Operationshandschuhe” (n. 17), 8–9.
57. Herr Döderlein (Tübingen), “Bacteriologische Untersuchungen über die Operation-
shandschuhe,” Verhandlungen der Deutschen Gesellschaft für Chirurgie 27 (1898): 10–13, see 11.
The Controversy about Surgical Gloves 187
hands and gloves during one hundred abdominal operations and as many
vaginal operations over the course of the winter, taking a large number
of samples and cultivating them bacteriologically, in some operations up
to one hundred individual samples.
58
Before the operation he found the
gloves to be germfree. He then took samples from them in intervals of
ten minutes and saw that the germ count increased with time. “Without
exception, the result was that bacteria had always accumulated in totally
surprising numbers in those gloves during the operations, the more, the
damper, which means the more bloody, those gloves had become,” he
explained. To check whether the germs came from the surgeon’s hand,
he performed the same experiment once more, just without the opera-
tion, making his test subjects wear gloves, which were subjected to bacte-
riological tests at particular intervals. The result was that no bacteria were
found in the gloves in the rst thirty minutes and only very few later on.
In a next step, he did the same with impermeable rubber gloves, which
his experimental subjects put on after having disinfected their hands
with the Fürbringer method. In this case, the interior of the gloves stayed
germfree indenitely. Even the gloves’ exterior showed fewer germs than
cotton gloves, since no blood and uid got stuck on them.
Döderlein’s conclusion was that the sticky, blood-imbued cotton gloves
had caught bacteria from the surrounding air, retained them in their
material, and seeded them out into the wound. He recommended not
using gloves at all but sticking to Fürbringer’s hand disinfection instead.
Even rubber gloves were only a stopgap measure for conditions when
there was not enough time for proper hand disinfection. Fürbringer’s
method would render the surgeon’s hands germfree in 85 percent of
cases, as documented by his rubber gloves experiments. However, this
claim stood in direct contradiction to earlier claims by his colleagues say-
ing that human skin could not be sterilized.
Döderlein’s way of resolving this contradiction is an interesting exam-
ple of the negotiations about the meaningful modeling of surgical real-
ity in the laboratory. The gynecologist explained the difference between
his test results and the ones from his predecessors by pointing to the fact
that most of the other researchers had followed Robert Koch’s recom-
mendation of using the absence of anthrax spores as a general and safe
standard of sterility in bacteriological tests in general.
59
The elimination
58. I am also using his more detailed account: A. Döderlein, “Bakteriologische Unter-
suchungen über die Operationshandschuhe,” Beiträge zur Geburtshilfe und Gynaekologie 1
(1898): 15–30.
59. Robert Koch, “Ueber Desinfection,” Mittheilungen aus dem Kaiserlichen Gesundheitsamte
1 (1881): 234–83.
188  
of anthrax had become a standard for sterility that was commonly used
in bacteriological tests as the maximum measure of sterility: if a given
method killed anthrax spores, one could be sure that any other germs
were eliminated, too. Schimmelbusch’s inuential guide to aseptic sur-
gery, for example, had adopted this standard.
60
Anthrax, however, did not
play a role in surgical wound infection, as Döderlein emphasized. Using
its elimination as the standard for successful disinfection in surgery was
therefore unnecessarily strict; in fact, it was a distortion of surgical reality.
For this reason he did not check for anthrax, with the consequence that
his experiments, as he pointed out, represented surgical reality much
better than the overly strict standards of his predecessors.
We can see how Döderlein renegotiated the validity of a particular way
of experimental representation without, however, casting doubt on the
laboratory approach more generally. Just the opposite: in reply to Miku-
licz’ criticism of his study,
61
Döderlein argued for the primacy of labora-
tory science over clinical experience. “[C]linical experience cannot have
the last word,” he said, “...it is our intention to operate ‘germfree’ and
this can only be determined by bacteriological tests.”
62
He defended his
experiments by demanding of his critics to rst repeat them and if their
results differed from the ones he obtained, he would accept objections.
The validity of laboratory tests for surgical practice was also discussed
by Gustav Adolf Neuber (1850–1932) from Kiel. Neuber is of particular
interest because he had been the rst German surgeon to suggest replac-
ing antisepsis by asepsis two decades earlier, but his approach had never
become part of the aseptic mainstream because of his rejection of the
laboratory as a place of authoritative knowledge production.
63
In keep-
ing with his strictly aseptic (as opposed to antiseptic) principles, Neuber
not even disinfected his hands before his operations. He just washed and
scrubbed them with extreme care. Achieving sterility he thought to be not
only impossible but also irrelevant. It didn’t matter very much, he claimed,
whether a bacteriologist found some germs on the surgeon’s hand or not,
as long as his surgical results were good. He reported having tried out
gloves himself but abandoned them because they were uncomfortable.
64
60. Schimmelbusch, Anleitung (n. 15), 27–44.
61. Herr Mikulicz (Breslau), “Contribution to the Discussion,” Verhandlungen der Deutschen
Gesellschaft für Chirurgie 27 (1898): 21–22.
62. Herr Döderlein (Tübingen), “Contribution to the Discussion,” Verhandlungen der
Deutschen Gesellschaft für Chirurgie 27 (1898): 25–27, see 26.
63. See Schlich, “Asepsis” (n. 5).
64. Herr Neuber (Kiel), “Contribution to the Discussion,” Verhandlungen der Deutschen
Gesellschaft für Chirurgie 27 (1898): 19–21.
The Controversy about Surgical Gloves 189
Neuber was not alone in making this kind of criticism. The standards of
sterility for surgical purposes remained controversial, as did the exact role
of bacteriology in setting these standards. Some surgeons suggested dis-
tinguishing between “surgical” and “bacteriological” asepsis, since wound
infections were quite rare, even in cases where bacteriological tests had
shown the presence of germs.
65
The question of the representation of sur-
gical reality came up on a regular basis in the surgeons’ discussions and
required the constant readjustment of experimental designs.
66
The Surgical Congress 1898: II. Mundane Matters
Apart from the role of laboratory, most of the discussions that afternoon
dealt with a variety of rather mundane details. Perthes, for example,
stressed that the question of the routine use of gloves in aseptic opera-
tions depended completely on technical issues. Therefore, he felt justi-
ed, as he said, to dwell on these technical details in his presentation and
to report how “after many futile attempts” the company Philipp Penin
in Leipzig-Plagwitz had made a glove for him (the one with the sensitive
ngertips mentioned above) “which is still not ideal but which is more
advantageous than all the other ones we know.”
67
As to the material, the general tendency was in favor of rubber. Even
Mikulicz admitted that he had lost his enthusiasm for cotton gloves. He
claimed he would immediately switch to impermeable gloves, as soon as
a viable model became available, promising to try out all the models that
had been presented in the meeting.
68
Friedrich conrmed that, from a
bacteriological point of view, only impermeable gloves made any sense at
all.
69
But he acknowledged the mechanical problems that they posed and
recommended them only for special circumstances, such as conducting an
aseptic operation at a time when the surgeon has an infectious wound on
his ngers. Friedrich went on to show the audience a pair of his gloves that
65. Herr Prutz (Königsberg), “Contribution to the Discussion,” Verhandlungen der
Deutschen Gesellschaft für Chirurgie 27 (1898): 14–15; Herr Bunge (Königsberg), “Contribution
to the Discussion,” Verhandlungen der Deutschen Gesellschaft für Chirurgie 27 (1898): 13–14; Herr
Helferich (Greifswald), “Contribution to the Discussion,” Verhandlungen der Deutschen Gesell-
schaft für Chirurgie 27 (1898): 23–25; Landerer, “Die Ursachen des Misslingens” (n. 17), 38.
66. On this theme more generally, see also Schlich, “Asepsis” (n. 5).
67. Perthes, “Zur Frage der Operationshandschuhe” (n. 17), 9.
68. Herr Mikulicz (Breslau), “Contribution to the Discussion,” Verhandlungen der Deutschen
Gesellschaft für Chirurgie 27 (1898): 21–22.
69. Herr Friedrich (Leipzig), “Contribution to the Discussion,” Verhandlungen der
Deutschen Gesellschaft für Chirurgie 27 (1898): 18–19.
190  
he had brought along. They were manufactured from thin but resistant
natural rubber without added zinc oxide or cinnabar, were impermeable,
were easy to sterilize, and kept their elasticity, even when sterilized for
four to ve hours in streaming vapor. He demonstrated how the gloves’
extraordinary elasticity coefcient allowed them to be stretched up to ten
times their original size. This part of the discussion was completely focused
on the material dimension, including the handling and demonstration
of the objects themselves.
Zoege von Manteuffel also endorsed rubber gloves once more. They
were preferable not only in terms of asepsis, but also in terms of manual
control, since they tended not, as their cotton counterparts, to form cum-
bersome pockets at the ngertips and get soaked with blood.
70
However,
one needed to pay attention to technical details of their manufacturing
process: “[I]n the same way as in Wöler’s gloves, the thumb needs to
be cut from one piece of volar and one piece of the dorsal surface.”
71
Those models in which the gloves’ thumb was attached to the glove’s
body were useless. They were so tight that the surgeon’s thumb would
become anemic within fteen minutes. In addition, they impaired the
surgeon’s sense of touch “and they can only be put on with the help of
sterile oil or glycerin.”
72
Availability was another mundane but signicant issue in the discussion
on surgical gloves. After the publication of his rst article on the topic in
the Centralblatt, Zoege reported, many colleagues had written to him and
asked him about the kind of rubber gloves he had used. It was the same
type of gloves chemists and pharmacists used for handling acid, he said.
These gloves were easily available in any pharmacy or drugstore.
73
In addi-
tion to availability, affordability was also important. In his rst publication
on surgical gloves, Mikulicz had reported that his gloves were made of
twisted cotton of the cheapest variety. One could get them by the dozen
in all sizes under the name “ne servants’ gloves.” In Breslau the dozen
came to 2.70 Marks. They were easy to wash, could be subjected to heat
sterilization, and could be reused a dozen times. Thus the additional cost
per operation was only 10 to 15 Pfennige.
74
In his contribution, Wöler
predicted that the currently high price of impermeable gloves would
70. Herr von Zoege-Manteuffel (Dorpat), “Contribution to the Discussion,” Verhandlungen
der Deutschen Gesellschaft für Chirurgie 27 (1898): 15–16.
71. Ibid., 15.
72. Ibid., 15–16.
73. Ibid., 15–16.
74. Mikulicz, “Das Operiren” (n. 24), 715.
The Controversy about Surgical Gloves 191
decrease once they were more often used and that increasingly better
gloves would become available.
75
The impermeable gloves presented by
Friedrich were not only extraordinarily elastic but also, at only 1.50 Marks
a pair, reasonably priced, as he claimed. Like Perthes, he passed on the
name and address of the company that made them (“Zieger&Wiegandt,
Leipzig, Neu-Schleussig, Seumestrasse 10”) and added that orders had to
include the purchaser’s glove size.
76
We can see how even such mundane details were of importance. The
viability of surgical gloves depended on a whole range of variables that
included the raw material used, the manufacturing process, their distribu-
tion and availability, their price, the exact way they were employed, and
so on, even if this looked ridiculous and undignied to contemporary
critics like Alexander Fraenkel.
After 1898
It was this afternoon session at the Surgical Congress that had prompted
Fraenkel to write the scathing report with which I began this article.
Fraenkel was by no means a marginal gure. He had become editor of
the renowned journal Wiener klinische Wochenschrift in 1896 and was an
important voice in contemporary discussions on surgery but also on
other current topics in medicine. For him, the discussions about technical
minutiae were a sign of what he called “the prevalent stagnation in surgi-
cal innovation.” Surgeons, he thought, were too focused on their aseptic
paraphernalia, for example, their surgical gloves—an element of “a whole
surgical costume with a bonnet, mouth mask and veil,” as he phrased it,
“devised under the slogan of total wound sterility.”
77
For him the use of
gloves for keeping the wound germfree represented a temporary aber-
ration about which “the verdict has been spoken at the surgical congress
so that the use of impermeable gloves remains limited to prophylactic
purposes, in unclean operations, in the case of injuries on the surgeon’s
hands, in short, to the way they have been used for the last 15 years now.”
78
75. Herr Wöler (Prag), “Contribution to the Discussion,” Verhandlungen der Deutschen
Gesellschaft für Chirurgie 27 (1898): 18.
76. Herr Friedrich (Leipzig), “Contribution to the Discussion,” Verhandlungen der
Deutschen Gesellschaft für Chirurgie 27 (1898): 18–19.
77. Fraenkel, “Congresseindrücke” (n. 1), 420–21.
78. Ibid., 420. For the reference to Hueppe, see Alexander Fraenkel, “Einige Bemerkun-
gen über Neuerungen der ‘aseptischen’ Technik,” Wiener klinische Wochenschrift 10 (1897):
653–55. On Hueppe as a dissident, see Berger, Bakterien (n. 11), 92–96; for more details,
see also Schlich, “Asepsis” (n. 5).
192  
What bothered him was the exclusive emphasis on germs embodied
in these precautions. This emphasis seemed to be unscientic to him. To
him, germs were not all-important. Reiterating the argument that wounds
could heal perfectly despite the presence of enormous amounts of bacte-
ria, he emphasized the role of the “disposition for infection,” inuenced
by the general state of health of the host organism and, more specically,
local wound conditions. It was therefore wrong to just look at germs in the
laboratory and neglect clinical observation as a valid source of knowledge.
Echoing the distinction between “bacteriological” and “surgical asepsis,”
he redened the term “asepsis,” which, as he posited, “means that wounds
healed without pus, but not necessarily without germs.”
79
Fraenkel’s criti-
cal report was thus part of the discussions regarding the signicance of
bacteriological knowledge from laboratory science for surgical practice.
With his skeptical position he was very much in accordance with the lat-
est development in bacteriological science, where Koch’s focus on the
germ as an omnipotent invader was questioned in favor of a more com-
plex explanatory model, which included variations in host susceptibility
as well as in bacterial virulence.
80
He identied himself as a critic of the
old bacteriology by referring to Ferdinand Hueppe (1852–1938), one of
the most important bacteriological dissidents of this time. The changes
in bacteriology had started to enter the surgical eld too. The surgeon
and bacteriologist Paul Leopold Friedrich, for example, who, as we have
seen, participated in the gloves discussion, also criticized the Kochian
approach as being too simplistic and suggested new experimental setups
to better reect the complex clinical reality.
81
Surgeons kept discussing the sense of bacteriologically dened sterility
for their work,
82
and continued weighing the aseptic gain of wearing gloves
(and using other aseptic paraphernalia) against the loss of convenience
and manual control.
83
In practice, the use of gloves varied from place to
79. Fraenkel, “Congresseindrücke” (n. 1), 420.
80. Berger, Bakterien (n. 11); for surgery, see also Friedrich, Das Verhältnis (n. 14).
81. Professor Dr. P. L. Friedrich, “Die aseptische Versorgung frischer Wunden, unter
Mittheilung von Thier-Versuchen über die Auskeimungszeit von Infectionserregern in
frischen Wunden,” Verhandlungen der Deutschen Gesellschaft für Chirurgie 27 (1898): 46–68;
see also Schlich, “Asepsis” (n. 5).
82. E.g., Peter Poppert, “Ueber die Seidenfadeneiterung nebst Bemerkungen zur asep-
tischen Wundbehandlung,” Deutsche medizinische Wochenschrift 23 (1897): 777–80. I am not
following the further course of the discussion about different standards and denitions for
asepsis and their signicance for surgical practice in this article. It is an issue that, to my
knowledge, has never been completely resolved.
83. E.g., L. Rydygier, “Einige Bemerkungen über die auf unserer Klinik geübte Methode
der Anti- und Asepsis,” Wiener klinische Wochenschrift 11 (1898): 993–96.
The Controversy about Surgical Gloves 193
place and from surgeon to surgeon, depending on local aseptic cultures.
Eiselsberg, for example, at that time head surgeon in Königsberg, adopted
Mikulicz’s cotton gloves, though not the face mask.
84
Even Bergmann’s
surgical clinic in Berlin was an example of such a local culture, despite
its reputation of being the place where the standard aseptic technology
had originated and the fact that the methods used there had indeed
shaped surgeons’ habits through the spread of Schimmelbusch’s guide.
In a celebratory 1906 painting, Bergmann is depicted in an operation
with many of the appurtenances of aseptic surgery, such as an autoclave
and surgical gowns (Figure 2). However, surgical gloves were not among
84. Herr von Eiselsberg (Königsberg), “Contribution to the Discussion,” Verhandlungen
der Deutschen Gesellschaft für Chirurgie 27 (1898): 27.
Figure 2. The local culture of asepsis at Ernst von Bergmann’s hospital in Berlin
(see also Schlich, “Asepsis” [n. 5]). Franz Skarbina(1849–1910), “An operation
before the students,” 1906. Source: bpk, Berlin/painting missing since 1945/
copyright: Art Resource, NY, image reference ART422595.
194  
them. Nor were there masks or bonnets shown in the painting. In addi-
tion, the scene was set in a semipublic amphitheatre with an audience
of dozens of onlookers in street clothes.
85
This was at a time when other
surgeons had restricted access to their operating venues and wore gloves
and masks religiously. The Ziegelstrasse Clinic was by no means unusual.
In many places surgeons combined different elements of the aseptic
apparatus as they saw t.
Another example is Theodor Kocher (1841–1917) in Berne. His case
is of particular interest because he was generally known as a paragon of
perfection and thoroughness in wound treatment.
86
He not only was the
rst surgeon to be awarded the Nobel Prize in 1909, but also had been
one of the earliest proponents of Lister’s antisepsis on the Continent and
subsequently a pioneer of asepsis,
87
who, as one of his students reported,
designed every operation to be a bacteriological experiment. However,
this did not prevent him, in 1899, from warning his colleagues not to give
too much weight to bacteriological tests vis-à-vis clinical results.
88
Kocher
had adopted Mikulicz’s cotton gloves for his aseptic operations. Like oth-
ers, he found bacteria on the gloves, which he thought came from the
deeper layers of the surgeon’s hands. In practice, however, the presence
of bacteria “did not interfere with quick and perfect healing of even large
wounds.”
89
With the enthusiasm for thorough and extensive numerical
documentation he was famous for, Kocher registered the same low infec-
tion rate in his operations irrespective of his use of gloves.
90
Gloves were
thus not indispensable for him. His advice was to keep one’s hands uncon-
taminated between operations and to clean them thoroughly before an
operation, “and if you wish to be very careful, put cotton, silk or, best,
rubber gloves on when you touch the threads for ligatures and sutures
and when you have much to tear the tissues and to rub your ngers in
the depth of a wound” (see Figure 3).
91
85. Painting of 1906 by Franz Skarbina (1849–1910), commissioned for Ernst von
Bergmann’s twenty-fth anniversary as chief surgeon at the Ziegelstrasse Clinic in Berlin;
painting missing since 1945.
86. Paragon: Mikulicz, “Versuche” (n. 14), 410; see also N. Senn, “Lucerne, Berne and
Geneva,” J. Amer. Med. Assoc. 9, no. 12 (1887): 379–82, 380.
87. Ulrich Tröhler, Der Nobelpreisträger Theodor Kocher 1841–1917. Auf dem Weg zur physi-
ologischen Chirurgie (Basel: Birkhäuser, 1984), 31–35.
88. Theodore Kocher, “On Some Conditions of Healing by First Intention, with Special
References to Disinfection of Hands,” Trans. Amer. Surg. Assoc. 17 (1899): 116–42, see 116.
89. Ibid., 123.
90. Ibid., 119–20.
91. Ibid., 130.
The Controversy about Surgical Gloves 195
Figure 3. Theodor Kocher wearing rubber gloves in July 1914. His assistant on
the right wears cotton gloves on top of his rubber gloves. The photograph was
taken on a European tour organized by the American Gynecological Club.
i
Source: Richard R. Smith, [American Gynecological Club second European
tour] scrapbook, July 1914 (Grand Rapids, Mich.: R. R. Root, 1914), collec-
tion of the J. Bay Jacobs Library in the Resource Center of the American
College of Obstetricians & Gynecologists, Washington D.C. Reprinted with
kind permission of the American College of Obstetricians & Gynecologists,
Washington, D.C.
i. See Michael W. Eby and Lawrence D. Longo, “Furthering the Pro-
fession: The Early Years of the American Gynecological Club and Its First
European Tours,” Obstet. Gyn. 99, no. 2 (February 2002): 308–15.
In his 1907 textbook, Kocher observed that the use of impermeable
surgical gloves had become widespread. They were now much cheaper,
more durable, and made of thinner rubber than before. For routine
use, however, they were too expensive because the whole team had to be
equipped with them. In addition, rubber gloves were easily torn by instru-
ments and bone edges, and they still impaired surgeons’ sense of touch
and thus their certainty in ad hoc diagnosis during the operation. Their
slipperiness made it difcult to grasp and hold smooth organs such as the
196  
bowels.
92
Kocher was still using cotton gloves, which he thought absorbed
the hand’s germs so that they wouldn’t enter the wound, as long as one
changed them often enough to stay dry during an operation.
93
In 1906 a
French colleague was impressed by seeing Kocher change his gloves no
fewer than six times during one operation.
94
Kocher was also mentioned in the report the Toronto surgeon Alex-
ander Primrose (1886–1944) published about his recent visit of eight
well-known German and Swiss surgical clinics in 1909. Concerning the
use of gloves, at Kocher’s clinic “the custom varied,” he wrote, according
to the operation that was performed: “In a case of excision of the knee,
the operator and the assistants all wore rubber gloves with linen ones
over that. In a case of gastro-enterostomy, Kocher alone wore gloves, his
assistants had none.” Primrose’s report provides a useful snapshot of the
wide variety in the use of surgical gloves in the German-speaking world ten
years after the discussions at the surgeons’ conference: In some hospitals
gloves were not used at all. In others, everybody involved in an operation
wore them. At one place only nurses were wearing rubber gloves during
the operations, whereas in another operating room everybody but the
nurses wore them. Some surgeons used cotton gloves, others preferred
rubber, still others wore linen gloves on top of rubber gloves.
95
Primrose’s observations t in with the claim that many German-lan-
guage surgeons operated with uncovered hands until World War I.
96
They
show that gloves were an element in some local aseptic cultures, but not
in others. But they also show the astonishing variations in their material
and design, the ways they were used (for instance, taken off for certain
procedures or changed several times in an operation), and the kinds of
circumstances in which they were thought to be benecial (septic opera-
tions, emergencies).
97
Conclusion
Considering that surgeons had to deal with conicting strategies of asep-
tic and manual control, they had good reasons to hesitate in introduc-
ing rubber gloves into their work routine. If we also consider that one of
92. Kocher, Chirurgische Operationslehre (n. 39), 100–101.
93. Ibid., 101–2.
94. René Leriche, Souvenirs de ma vie morte (Paris: Éditions du Seuil, 1956), 170.
95. Alexander Primrose, “Notes on a Recent Visit to Surgical Clinics in Germany and
Switzerland,” Can. Practit. Rev. 34 (1906): 199–217; for a summary about gloves, see 216.
96. Randers-Pehrson, Surgeon’s Glove (n. 2), 46–47, found that most German surgeons
did not use gloves before World War I.
97. To what degree and how asepsis was standardized after this period and how the use
of gloves became part of that standard are not within the purview of the present article.
The Controversy about Surgical Gloves 197
the best chances of resolving the conict lay in variations in the gloves’
make, we can understand why surgeons spent a whole afternoon on the
1898 surgical meeting talking about different glove models, even if that
looked strange to some contemporary observers. We can even see why,
in this situation, it was important to actually bring along different models
and to exchange the addresses of their manufacturers.
As it turns out, gloves were actually quite a complex technology, not a
simple one, as it might seem in retrospect. There were numerous varia-
tions in the material object itself, in the practice of using it, and in the
tacit and explicit knowledge linked to it. Consensus as to their optimal
combination was not easy to reach. It is thus not surprising that a whole
range of local cultures of glove use emerged, and that it was not clear
which elements of these cultures would persist. Surgeons at the time knew
that very well. “You have to keep in mind,” Mikulicz told his colleagues in
1898 about the provisional character of all aseptic technology, “that this
is an issue that is still in full development and won’t be terminated for a
long time. Many of the measures now proposed might be exaggerated
and may probably be dropped later on. Many a measure is—and that we
can already say now—erroneous and will have to be replaced by a better
one.”
98
As we know today, the use of gloves was one of those technologies
that was not dropped. But that was not obvious at the time.
The mix of supposedly progressive and backward technical elements in
these local cultures of asepsis points to the fact that the spread of today’s
aseptic ritual did not happen as one big triumphal and unied project.
It is the result of a more open-ended process that included introduc-
ing, abandoning, and adjusting different practices and objects as part of
surgeons’ attempts of dealing with contamination and wound infection,
while at the time trying not to lose manual control of the living tissues as
their working material.
T S is James McGill Professor in the History of Medicine in the
Department of the Social Studies of Medicine at McGill University. His research
interests include the history of modern medicine and science (eighteenth to
twenty-rst centuries), medicine and technology, and body history. He is the
author of The Origins of Organ Transplantation: Surgery and Laboratory Science,
1880–1930 (Rochester, N.Y.: University of Rochester Press, 2010). He is cur-
rently working on a monograph on the development of modern surgery. E-mail:
thomas.schlich@mcgill.ca.
98. Mikulicz, “Bestrebungen” (n. 18), 36.
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This paper examines the origins of aseptic surgery in the German-speaking countries. It interprets asepsis as the outcome of a mutual realignment of surgery and laboratory science. In that process, phenomena of surgical reality were being modelled and simplified in the bacteriological laboratory so that they could be subjected to control by the researcher’s hands and eyes. Once control was achieved, it was being extended to surgical practice by recreating the relevant features of the controlled laboratory environment in the surgical work place. This strategy can be seen in the adoption of Robert Koch’s bacteriology by German-speaking surgeons, and the resulting technical changes of surgery, leading to a set of beliefs and practices, which eventually came to be called ‘asepsis’.
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Die »Ausrottung« aller »unsichtbaren Feinde« des Menschen durch die medizinische Bakteriologie: Aufstieg und Fall einer Leitwissenschaft der Moderne. Als die WHO 1980 den »Tod der Pocken« verkündete, rückte die Vision einer Welt ohne Infektionskrankheiten in greifbare Nähe. Das Auftauchen neuer und die Rückkehr überwunden geglaubter Erreger machten jedoch wenig später klar, dass dies eine Illusion war. Silvia Berger beschäftigt sich mit der Geschichte jener Wissenschaft, durch deren Leistungen ­ allen voran der Entdeckung der pathogenen Bakterien ­ die »Ausrottung« der Seuchen erstmals möglich schien: die medizinische Bakteriologie. Die Autorin zeigt mit Blick auf Deutschland zwischen 1890 und 1933, dass der Glaube an die Beherrschbarkeit von Infektionskrankheiten nicht erst in neuester Zeit erschüttert wurde. Bereits nach dem Ersten Weltkrieg erfuhr die Bakteriologie eine tiefgreifende Krise. Der von Militärbakteriologen zwischen 1914 und 1918 rigoros verfolgte Traum von der Vernichtung aller »unsichtbaren Feinde« und der Herstellung »reiner« Körper und Territorien rückte in weite Ferne. Die einstige Renommierwissenschaft musste in den 1920er Jahren eingestehen, dass sie mit ihren Denkfiguren das komplexe Zusammenspiel von Mikro- und Makroorganismen nicht mehr erklären konnte. Statt als »Krieg« konzipierte man nun das Verhältnis zwischen Bakterien und Menschen mit Begriffen wie »Gleichgewicht« oder »Symbiose«, einer Art friedlichen Koexistenz. Die Studie wurde 2008 mit dem Henry-E.-Sigerist-Preis für Nachwuchsförderung in der Geschichte der Medizin und Naturwissenschaften ausgezeichnet und 2009 mit dem Förderpreisder Deutschen Gesellschaft für Geschichte der Medizin, Naturwissenschaft und Technik.
Article
For a number of years I have had it in mind to call attention to the particular method of employing silk ligatures and sutures which has been practiced in the surgical clinic of the Johns Hopkins University since the opening of the Johns Hopkins Hospital in 1889, but have hesitated and also been eager to do so for the same reason, namely, that our school seems to be almost alone in its advocacy of the use of this material. Theodor Kocher, however, has for many years employed silk quite to the exclusion of catgut and our position is greatly strengthened by the support of such eminent authority. Surgeons, old and young, those who have been active and masterful in the marvelous period of development of antiseptic surgery, and the medical student who takes for granted the healing of wounds per primam and the achievements of modern surgery as he does
Article
For a number of years I have had it in mind to call attention to the particular method of employing silk ligatures and sutures which has been practiced in the surgical clinic of the Johns Hopkins University since the opening of the Johns Hopkins Hospital in 1889, but have hesitated and also been eager to do so for the same reason, namely, that our school seems to be almost alone in its advocacy of the use of this material.Theodor Kocher, however, has for many years employed silk quite to the exclusion of catgut and our position is greatly strengthened by the support of such eminent authority.Surgeons, old and young, those who have been active and masterful in the marvelous period of development of antiseptic surgery, and the medical student who takes for granted the healing of wounds per primam and the achievements of modern surgery as he does