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Caroline Hampton was the niece of Confederate General Wade Hampton III, who was later governor of South Carolina and a US senator (Figure (Figure11a). Caroline was born at Woodlands, adjacent to Millwood, Hampton's plantation home near Columbia, South Carolina. Her mother, Sally Baxter of New York (Figure (Figure11c), died of tuberculosis at age 29 in 1862 and her father, Colonel Frank Hampton (Figure (Figure11b), Wade's younger brother, was killed 9 months later at the Battle of Brandy Station in Virginia.
Millwood was burned by Sherman's troops in February 1865, and Caroline was raised by her three aunts (the Hampton sisters) in a small house behind the ruins of Millwood (Figure (Figure22). In 1885, Caroline rebelled against her family and entered nursing school in New York City, graduating from New York Hospital in 1888 (Figure (Figure33). When the Johns Hopkins Hospital opened in 1889, she moved to Baltimore and was appointed chief nurse of the operating room by the famous surgeon Dr. William Halsted (Figure (Figure44).
Caroline became Dr. Halsted's scrub nurse, but she developed a severe contact dermatitis in 1889, as her sensitive hands could not tolerate the disinfectants mercuric chloride and carbolic acid (phenol). As Dr. Halsted explained (as quoted by Sherwin Nuland in Doctors: The Biography of Medicine):
In the winter of 1889 and 1890—I cannot recall the month—the nurse in charge of my operating-room complained that the solutions 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. In the autumn, on my return to town, an assistant who passed the instruments and threaded the needles was also provided with rubber gloves to wear at the operations. At first the operator wore them only when exploratory incisions into joints were made. After a time the assistants became so accustomed to working in gloves that they also wore them as operators and would remark that they seemed to be less expert with the bare hands than with the gloved hands.
This has been called the most famous paragraph ever printed in the surgical literature, not only for its description of the introduction of rubber operating gloves (Figure (Figure55), but also because it represents the beginning of a love affair being recorded in the medical literature. In the words of one of Halsted's assistants, “Venus came to the aid of Aesculapius.” Halsted and Caroline married in June 1890. Dr. William Welch was the best man.
Let us digress and go back around 50 years for the background of antiseptic and aseptic surgery. At that time, hospitals were regarded as “houses of death” which patients tried to avoid, if possible, because of rampant infection. Surgeons would simply roll up their sleeves and work as quickly as possible, wearing the same coat for each operation. (The coats were usually covered with blood and pus and were called “working coats” or “badges of honor.”) Surgical mortality was around 50%.
However, in 1843, Oliver Wendell Holmes in Boston made a presentation “on the contagiousness of puerperal fever,” suggesting that childbirth infection could be transmitted to others and emphasizing the personal cleanliness of doctors. The Hungarian doctor Semmelweiss made the same discovery in 1847 in Vienna and required his students to wash their hands in an antiseptic disinfectant (chlorine) solution before examining patients, and the maternal death rate went from 18% to 1%.
In 1867, Joseph Lister (Figure (Figure66), an English surgeon, published the groundbreaking paper “Antiseptic Principle of the Practice of Surgery” while working at the Glasgow Royal Infirmary. He used 5% carbolic acid solution (or phenol) to spray instruments and wounds and made surgeons wash their hands before and after operations with this solution.
In 1876, Lister traveled to the United States to present his ideas and impressed Dr. William Halsted with his findings. In 1884, Halsted returned to New York City after studying in Germany and refused to perform surgery in the old theater at Bellevue. Instead, he built a tent on the grounds of Bellevue that featured a gas stove to boil instruments. Halsted was sold on Listerian techniques, which were still somewhat controversial until German bacteriologist Robert Koch's postulates in 1882 effectively proved that microorganisms caused disease. (Koch later won the Nobel Prize in 1905.)
Gustav Neuber, a German surgeon who embraced Lister's technique, in 1883 sterilized instruments and the operative field and was the first to require sterile gowns and caps. In 1897, Jan Mikulicz, a Polish Austrian surgeon, was the first to use a surgical mask and also was a pioneer of using gloves during surgery.
At Johns Hopkins, Dr. William Halsted didn't start wearing gloves himself at first. They were used by nurses and assistants but rarely by the doctors (except for the open bone and joint operations). Dr. Joseph Bloodgood, Halsted's protege who came to Hopkins in 1892, was later the director of surgical pathology and started using gloves himself during surgery in 1896 (Figure (Figure77). (“Why shouldn't the surgeon use them as well as the nurse?”) In 1899, Bloodgood published a report on over 450 hernia operations with a near 100% drop in the infection rate by using gloves. Halsted said, “Why was I so blind not to have perceived the necessity for wearing them all the time?” Hunter Robb, a gynecologist at Johns Hopkins Hospital, was another Halsted associate who was a pioneer of aseptic surgery and sterile gowns and one of the first to wear rubber gloves.
After his honeymoon at the Hampton Hunting Lodge in Cashiers, North Carolina, Halsted became enthralled with the beauty of the property and realized it would be a retreat from the heat and humidity of the Baltimore summers. He purchased over 400 acres from Caroline's aunts and called the property “High Hampton,” a name that combined the two families, as the Halsted estate in England had been called “High Halsted.” Later the Halsteds built a cottage (Figure (Figure88).
Thereafter, Dr. Halsted typically left Baltimore on June 1 and returned around October 1. Caroline would arrive in May and stay until Thanksgiving. She was very active running the farm, directing the hired hands and planting the garden and crops. She worked in the fields from morning till night. She loved animals, especially horses and dogs. A very skilled rider, she was known for her horsemanship. Dr. and Mrs. Halsted raised a superb collection of prized dahlias and planted many unusual trees on the property, which eventually grew to around 2200 acres after Halsted bought out the adjacent small farms.
The Halsteds were described as opposites in appearance. “He was a dandy, garbed in European tailored suits and Parisian cobbled boots, who dressed impeccably, even sending his dress shirts to Paris to be laundered” (Figure (Figure99). In contrast, Caroline's style was described as “plain and austere.” Nevertheless, they were remarkably well suited to each other, each being reserved and self-sufficient and somewhat “eccentric.” They were truly devoted to each other. Letters between Halsted and Caroline were warm and personal and playful.
How do you like to get type written letters from me. I should think that it would be such a relief to your mind. The damp weather has not agreed with the machine and it is going very heavy. The wind has been from every point of the compass and has finally settled at the east. Yesterday all the clouds were travelling south and tho' it was cloudy we had hopes. Now there seems no chance for anything but another rain. It is a little cooler but not as cold as I should like to have it. I had an interview with “Eno” this a.m. He says you never mentioned stairs to him. Sweetman says that the good Franklin carpenter is not working for Hayes now and that he only asks $1.75. He is the one who did the very nice inside work of which you spoke. Crow says that he heard that you had paid the Longs something and as they owed him seven or eight dollars he went to collect and they positively denied having received one cent from you. Mrs. Long is reported to have pleurisy and I think that she deserves it. There are so many chestnuts that no one bothers to gather them. How you would enjoy being here and how I would enjoy having you.…
The Halsteds would typically spend 1½ hours at dinner discussing science, medicine, farming, and even etymology. The latter was one of Halsted's longstanding interests. He kept a notebook of unusual words, and he and Caroline would discuss the derivations of words at dinner.
Halsted died in 1922, and Caroline passed away only 2 months after him.
In summary, Caroline was a remarkable lady who introduced rubber gloves in the operating room, ran High Hampton, and lived for 32 years with a complex man who was a creative genius and the father of American surgery.