SOME 
NEW ASEPTIC APPARATUS 
BY 
WILLIAM P. BOLLES, M.D. 
[Reprinted from Medical and Surgical Reports of the 
Boston City Hospital, 1897] SOME 
NEW ASEPTIC APPARATUS 
BY 
WILLIAM P. BOLLES, M.D. 
[Reprinted from Medical and Surgical Reports of the Boston City Hospital, 1S97J 
BOSTON 
Press of Rockwell and Churchill 
1897 SOME NEW ASEPTIC APPARATUS. 
William P. Bolles, M.D. 
There are two sets of apparatus described in this paper, 
one a sterilizer intended for private practice, and designed 
to secure such asepsis as water and steam at 100° centi- 
grade will effect, and to combine the greatest possible con- 
venience, compactness, and portability in its construction. 
The other is a pouring or irrigating flask for sterile solu- 
tions, designed for use in hospitals, where absolute theoreti- 
cal purity is required, and where an apparatus that shall be 
practically automatic is desirable. 
To take them in order, the first is a portable steam and 
hot-water sterilizer for instruments, dressings, and linen, in 
which all the necessities for ordinary operations can be 
arranged and packed at home or in the office, carried easily 
so packed to the patient's house, and sterilized on the 
kitchen stove while the surgeon is preparing in other ways 
and etherizing the patient. Incidentally, it also furnishes 
all the sterile pans or dishes necessary for the operation, 
and obviates the necessity of borrowing from the patient's 
pantry or carrying a set of trays. 
If filled, on entering the house, with a suitable quantity 
of boiling water and baking soda, the water will boil again 
in from three to five minutes, and at the end of the half hour 
that generally elapses before the patient is ready, its contents 
are as sterile as boiling water and steam can make them, the 
linen thoroughly steamed and dry, the instruments, sutures, 
etc., boiled in alkaline water and wet. 
It consists, in general, of an outside kettle, with cover, 
within which is an inverted box or hood, just enough 
smaller than the other in all directions to leave a space of, SOME NEW ASEPTIC APPARATUS. 
3 
say, one centimetre on all sides and on the top for steam 
and water. Within this hood lie the trays for instruments 
and dressings, piled one on the other. Thus there are an 
outer and inner chamber ; the inner surrounded by the outer, 
excepting on the bottom, where both are bounded by the 
boiling water. By this means the inner chamber is entirely 
protected from cooling and condensation. 
The process of boiling rarefies and expels the air within 
the inner chamber, and forces it out beneath the hood. As 
steam is formed it takes its place, and the excess is also forced 
out in the same way underneath the edge of the hood. The 
water inside is, of course, pressed down to the level of its 
escape, and rises in the outer chamber to near the top of the 
Fig. 1. 
sterilizer. Thus we have a thin layer of water boiling in the 
inner chamber and crowding it with steam, the excess ot 
steam carried out through the column of water at its sides, 
condensing until that water has attained a boiling point, and 
then a continual tlow of fresh, live steam, permeating the 4 
SOME NEW ASEPTIC APPARATUS. 
dressings, and escaping through the outer chamber, until 
the whole sterilizer is one mass of steam and water. 
The condensation that takes place on the outer surface 
drops back into the water, or if it falls on the top of 
the hood is at a boiling point and causes no condensation 
within. 
To describe the sterilizer more in detail, using a particu- 
lar pattern (Fig. 1): The kettle and cover have separate 
Fig. 2. 
handles, as seen at A and B, interlocking in such a way 
as to form a convenient united handle for carrying, and 
at the same time to fasten the cover securely down ; or, 
when open, the handles of the cover can be turned 
hack in such a way that when the cover is inverted 
and laid on the table, they form steadying feet to prevent 
its rocking and keep it from the table (Fig. 2). The kettle 
handles, too, can be carried downwards under the bottom of 
the kettle, as at Fig. 2, C.l, and so form feet which shall 
raise the kettle and its boiling contents, when set upon the 
table, so far from the surface as not to scald or damage 
the table top. The cover is fitted with a deep inside lip, 
and when taken off and inverted upon the table makes 
a convenient sterile dish, the very edges of which are SOME NEW ASEPTIC APPARATUS. 
5 
also clean. This exposes to view the inner inverted box, 
or hood, with two handles connecting with loose peculiarly 
bent wire loops reaching around the bottom of the whole 
contents of the outer kettle in such a manner that every- 
thing can be lifted bodily out of it and placed in a con- 
venient place. The handles of these loops are of wood, are 
sterile, can be handled by the surgeon's sterile hands, and 
no others need touch the apparatus after the cover is otf in the 
course of arranging the trays. In the middle of these handles, 
as will be seen, isa peculiar bend or hook, by means of which 
the contents of the kettle can be rested half-lifted out to drip 
Fig. 3. 
and cool as much as necessary (Fig. 2). After this, by means 
of the same handles, the contents are taken out and laid upon 
the table, and we have the outer kettle containing a quart or 
three pints of boiling water, which may be used for rinsing 
instruments in the course of the operation. The wire loops 
or handles marked I) also serve several other purposes. 
They have already lifted the hood and the three trays en 
masse out of the kettle, and previously, by means of the 6 
SOME NEW ASEPTIC APPARATUS. 
hooks in the middle, have held it half out to drain. Now 
their further usefulness is shown : The steam hood E has 
at its four corners four crooked legs, so bent that the wire 
loops can be slipped into them to the very extreme of the 
length of the hood by simply carrying the handles apart, 
and thus disengage the trays within, which they have so far 
been holding, so that the hood may be lifted completely off 
(Fig. 3), and at the same time, by a little trick of handling, 
Fig. 4. 
inverted and placed in a convenient portion of the table as 
the third sterile receptacle. This exposes the three trays 
FFF, resting one upon another, and separated from each 
other by their feet, which also serve as guides to keep them 
in position. They are perforated on the sides and bottom, 
so as to admit of the free circulation of the steam, and they 
have at the end handles of peculiar construction, so fitted as 
to prevent end motion, and with the feet, to prevent side 
motion, they keep them in a straight and even pile, securely 
locked. The handles also turn out in such a way, as shown 
at G, Fig. 4, that the loops will lock in and hold them, 
and enable the surgeon to lift them off from each other 
and place them in position for the operation. The bottom SOME NEW ASEPTIC APPARATUS. 
7 
tray contains the instruments folded in a towel, which has 
only to be unfolded to show them laid out in order for the 
operation. A perforated plate II, Fig. 5, may be laid 
on the towel enclosing the instruments to prevent water 
being carried into the tray above by the folds of the 
towel. The other two trays are above the water line, 
and contain the dressings, which come out steaming hot, 
but which, as soon as they are cooled or shaken out, are 
absolutely dry. A thermometer placed in a central part 
of the uppermost tray will mark 100 to 100.5 degrees 
centigrade, showing that the extreme temperature of boil- 
ing water has been attained in the thirty minutes that the 
Fig. 5. 
apparatus has been on the stove. This temperature, as 
those who are familiar with the results of bacteriological 
tests know, does not give absolute certainty of freedom from 
spores, but as a matter of practical experience it does kill 
most pathogenic organisms, and those whose persistent 
vitality enables them to withstand it are comparatively rare, 
and as a rule easily avoided by a surgeon in private prac- 
tice, whose instruments and dressings are kept and stored 
clean and in good condition. On the other hand, it does do 
what no other sterilizer of its kind achieves so easily. It does 
reach in all its parts the maximum temperature of boiling 
water rapidly; it is wholly free from the annoying moisture 
of dressings, which is caused by the condensation of water 
on the roofs and sides of sterilizers that are not made with Fig. 6. SOME NEW ASEPTIC APPARATUS. 
9 
a double chamber. It furnishes to a greater extent than any 
other all the vessels needed in an operation. It is simple 
and exact in its construction ; it is theoretically correct, dur- 
able, entirely practicable, and it is impossible that any 
essential part of it shall be forgotten and left at home. It 
can be kept packed, excepting for special instruments, and 
taken at a moment's notice. Ten or twenty grains of 
bicarbonate of soda should be kept in the kettle, dry. 
A simpler form and large size of this apparatus, consist- 
ing of a round deep kettle with hood to tit, and suitable 
wire basket for linen, would answer the needs of small hos- 
pitals whose surgeons did not consider steam under pressure 
essential. In large-sized hoods the circulation of steam 
could be insured by small pipes on the inside, extending 
from near the top to openings near the bottom, so that the 
steam to escape from the hood should rise first to the 
extreme top. By such a structure dressings could be 
prepared more uniformly steamed and more dry than by 
anything now obtainable among the non-pressure steamers. 
The next piece of apparatus, as I said in the beginning, 
is designed especially for hospital use ; namely, the produc- 
tion and preservation of absolutely sterile water or solution 
in a bottle or flask, so fitted that it can be kept indefinitely 
without contamination, and can be poured freely from it in 
any quantity, and that all the ingoing air which takes the 
place of the outflowing liquid shall be strained through a 
layer of sterile cotton, thus insuring no possibility (direct 
fraud excluded) of contamination between the autoclave 
where it is heated and the wound into which it is poured. 
It is made on the general principle of the chemist's wash- 
bottle, with currents inverted. That is, the wash-bottle is 
fitted with a perforated cork containing two tubes, a long one 
reaching to the bottom of the bottle, and a short one reach- 
ing just through the stopper. It is used for forcing out 
small quantities of distilled water and other liquids, and is 
operated by blowing air into the short tube, thus forcing the 
liquid out through the long one, with the flask in an upright 
position. These flushing or pouring flasks, Fig. 8, etc., 
are also fitted with two tubes, a long and a short one, but 
are to be inverted when used, when the water flows out in a 10 
SO3IE NEW' ASEPTIC APPARATUS. 
continuous stream through the short tube, while the air flows 
in equally through the long tube and through the disk of 
sterile cotton which has been tied on to the end of it. The 
principle is thus absolutely simple : the column of water 
passing out through the nozzle of the short tube draw's in an 
equal column of air through the long tube. But the details 
have been worked out by a series of experiments to a con- 
siderable degree of refinement. The size and shape of the 
flask have been such as prove most convenient in hand- 
ling and in furnishing a sufficient quantity of solution. The 
neck is large enough to make an easy grasp for the hand. 
Fig. 7. 
The flask is rounded in such a way that its centre of gravity 
is not much disturbed by its inverted position when placed SOME NEW ASEPTIC APPARATUS. 
11 
in one of the holding cages to be described further on. The 
glass, of course, must be moderately thin, and sufficiently 
well annealed to stand the high variation of temperature. 
The neck is flared just enough to receive the ordinary taper 
of the cork or rubber stopper, and allow it to tit its whole 
length. The two tubes must be unequal in size, at least in 
the inner diameter; the air-tube much smaller than the tube 
for pouring, otherwise drops of water will trickle down and 
leak untidily out from the air-tube. The air-tube should be 
made of what is called barometer tubing, and have an inside 
diameter of not more than two or three millimetres; while 
the inside diameter of the pouring tube should be about 
three times as much. 
In finishing the lower end of the air-tube the glass-blower 
should be very careful not to contract it, while the upper or 
outer end should be expanded to a sort of funnel, in order 
to give a considerable surface for •the air to enter through 
the sterile gauze. At its lower end the air-tube should be 
gently curved toward that side of the flask which is upper- 
most when the flask is inverted for pouring. By this means 
it most readily gets above the surface of the water, and the 
inflowing air is less interrupted. The pouring tube and 
nozzle is made with a little shoulder at the top of the cork, 
to prevent its being pushed too far within, and also another 
shoulder near the end, to assist in retaining the cotton cap 
when it is put on. This end is tapered to tit a rubber tube, 
or to be used itself as an irrigating nozzle. 
For use these bottles are tilled with water or salt solution 
to be sterilized, the corks, with their tubes in, properly in- 
serted, and a little layer of sterile cotton or gauze is folded 
over the end of each tube and fastened there with an elastic 
band, as shown in Figs. 6-10. This is then put into the 
autoclave and sterilized by heating to a proper degree of 
temperature and for a suitable length of time. It is cooled 
slowly, the pressure reduced slowly, to prevent too much 
ebulition, and then is ready for immediate use, or for lay- 
ing aside until needed. The cotton plugs, of course, are 
not to be touched until the instant of use. When the solu- 
tion is wanted, the plug covering the short pouring-tube is 
removed, the flask inverted, and the solution begins to flow 12 
SOME NEW ASEPTIC APPARATUS. 
out. This carries the air in through the other tube, and 
the circulation thus begun is kept steadily up until the 
flask is emptied or is returned 
to a vertical position. The 
gauze or cotton on the air- 
tube is not to be removed, 
but the air allowed to strain 
through it. 
These flasks can be made 
with various nozzles, or con- 
nected with long abdominal 
irrigating tubes, or with the 
usual rubber tubing, as in 
ordinary irrigation. They 
can also be sterilized with a 
hood or "cosey," as the house- 
wives used to call it n4ien 
placed over their tea-kettle, 
fastened over them, in which 
case, the outside of the flask 
being sterile, it can be handled 
by the surgeon himself in ad- 
justing the irrigation exactly 
as he wishes to. 
In a majority of cases, 
pouring-flasks of this kind 
will be used directly on the 
patient; either the water 
poured in a stream from the 
flask, or by means of the long- 
nozzle, mentioned above, in- 
serted into the wound, but 
with the usual rubber irrigating tube they can be used 
exactly as the rubber bags, or irrigators, have heretofore 
been. 
Occasionally, in operations and in ward dressings, it 
will be desirable to use the irrigation a little at a time 
and from a considerable height, and here, as it might 
be inconvenient for the orderly or nurse to always hold 
the bottle at a sufficient height and steadiness, and for 
Fig. 8. - Irrigation flask complete, 
less than one-third linear size. A : Flask 
holding about one and a half litres, fitted 
with twice-bored stopper (of rubber or 
cork). B: Pouring-tube with two shoul- 
ders and suitable nozzle. C : Air-tube of 
small internal diameter. " : 
Sections showing the proper relative sizes 
of the pouring and air tubes inside. SOME NEW ASEPTIC APPARATUS. 
13 
Fia. 9. - Front elevation of the holder. A : Flask holding about one and a half litres, 
fitted with twice-bored stopper (of rubber or cork). B : Pouring-tube with two shoulders 
and suitable nozzle. C: Air-tube of small internal diameter. D: The arms of the cage 
or basket holding the flask. E : Counterpoise. F : Handles. G : Semi-circular stop limit- 
ing the rotation of the cage and flask. H : Striker on the cage bringing up against the 
stop. The neck of the flask and the front arm of the cage are also limited in rotation by 
the stop dividing the shock and preventing breakage. I: Crutch on which the cage and flask 
rotate. K : Bolt forming the axis of rotation screwing into handles and cage, and tightened 
by clamping nut and washer. 
a sufficient length of time, some sort of a stand is desirable. 
There are presented here several patterns. The require- 14 
SOME NEW ASEPTIC APPARATUS. 
ments of such a stand in its highest degree of perfection are, 
that it shall take the Mask easily ; shall hold it securely, with- 
out any danger of losing or breaking it; shall hold it at any 
desired height; shall hold it upright when not in immedi- 
ate use; be capable of inverting it with the greatest ease 
when it is wanted, and returning it again to an upright 
position. The mechanism of such a stand should be 
simple, be durable, and be so constructed as to make it 
impossible to get it out of order or use it wrongly. 
One such stand is shown in Fig. 6. Tt consists of a 
wooden foot on casters, a brass extension standard of two 
tubes held in position by a taper nut, and a frame or cage 
above for holding the flask. This cage will be best under- 
stood by consulting Fig. 7, and consists of a four-armed 
frame, open at one side in such a manner that the flask can 
be inserted at nearly right angles to the axis of the cage, 
and when brought into its position is locked so that it can- 
not fall or shake out. This cage consists of three arms pass- 
ing vertically around the flask and fitting its contour, and a 
fourth arm passing about one-quarter of the way up and then 
turning outwards to form the opening through which the 
flask can be inserted. The cage is suspended (Figs. 6-9- 
10) on its axis somewhere near the centre of its gravity, 
and at the same place are inserted two handles, one on 
each side, by which it is easily inverted. The short arm is 
weighted so as to hold the cage securely in an upright posi- 
tion, and the whole thing is balanced so that when it is 
tipped in such a way as to point the flask downwards to an 
angle of about forty-five degrees it shall balance in that posi- 
tion and not tend to return. In short, the flask will be held 
securely either upright or inverted, according to the will of the 
operator. This whole cage is balanced on t wo crutches rising 
from a pin in the top of the standard, and it is checked in 
its motion by a semi-circle, to which the crutches are welded, 
and whose infolded ends strike the pin projecting down- 
ward from the base of the cage, while the loop formed by 
their inversion offers a rest for the neck of the flask. Thus 
in each position there are two stops, one at the neck of the 
bottle and the other at the bottom of the cage, both of 
which act at the same time, and thereby prevent any undue SOME NEW ASEPTIC APPARATUS. 
15 
wrench or strain upon the cage or flask. These arms, and 
all points of contact, are so made that they can be easily 
Fig. 10. - Side elevation of the holder with the handles removed for the sake of clear- 
ness. F', A : Flask holding about one and a half litres, fitted with twice.bored stopper (of 
rubber or cork). B: Pouring-tube with two shoulders and suitable nozzle. C: Air-tube 
of small internal diameter. D: The arms of the cage or basket holding the flask. D': Short 
arm of the cage allowing placing the bottle and also holding the counterpoise. E: Coun- 
terpoise. G : Semi-circular stop limiting the rotation of the cage and flask. H : Striker 
on the cage bringing up against the stop. The neck of the flask and the front arm of the 
cage are also limited in rotation by the stop dividing the shock and preventing breakage. 
I: Crutch on which the cage and flask rotate. L: Standard on which the entire structure 
rotates. 
protected by slipping rubber tubing of suitable size over 
them. Thus we get in this stand an ability to place the flask 16 
SOME NEW ASEPTIC APPARATUS. 
either inverted or upright, and to have it rest there in per- 
fect security, and so joined that the whole thing can be 
turned in any direction, and a telescoping tube, on which 
the whole is supported, and by means of which it can be 
held at any elevation. The lower loop of the semi-circle 
can be used for coiling the rubber tube on, if desired. 
Instead of placing this cage upon a standard, as in this 
figure, it may have a suspending arm attached to it, by 
means of which it can be fastened to any chain or cord or 
hook projecting downwards from the ceiling, and thus used 
without impairing the floor space of the operating room 
(Fig. 6). Or the same thing could have other fixtures, by 
means of which it could be attached to hospital beds for 
ward use, if desired. 
A simpler form of stand, which answers all practical 
necessities pretty well, is shown in Fig. 7. The cage im- 
mediately enclosing the flask is essentially the same as 
that in Fig. 6, but the handles and revolving portion are 
omitted. Three forms are shown, one standing on the 
top of a pedestal, and one hanging from the ceiling, and 
another adjusted to hang from the head of a hospital bed, 
all three holding the flask in essentially the same position 
of inversion ready to pour, and each having a hook on its 
lower extremity for coiling the rubber tube, if desired. 
In using this apparatus, the nurse, when irrigation is 
called for, takes the flask and adjusts the tube herself, 
inverts the flask* and begins the irrigation. After that 
is well started, the flask is then set in the frame and the 
stream regulated by the stop-cock on the rubber tube. 
For the purpose of keeping these flasks of solution warm 
while in the operating room, a nest of four cylindrical cells or 
pails fitted into a water-bath answers very well.