Improvements in or relating to the Sterilizing or Rendering Antiseptic of Materials used for Surgical Purposes.
Year: 1892

page_text: Date of Application, 15th Mar., 1892
Complete. Specification Left, 16th Jan., 1893-Accepted, 18th Feb., 1893
PROVISIONAL SPECIFICATION.
Improvements in or relating to the Sterilizing or Rendering
Antiseptic of Materials used for Surgical Purposes.
I, Dr. ALFRED DÜHRSSEN, M.D., of Rathenower Strasse 106 Berlin in the
Empire of Germany, do hereby declare the nature of this invention to be as
follows:-
The various materials used for purposes of surgery and gynecology, in dressing
wounds and the like, such as iodoform gauze, lint, pads, bandages &c. have hitherto
been sterilized or made antiseptic by the following method only,-large quantities
of articles of each kind are separately submitted to the action of antiseptic gases
or vapours, after which each class of articles is packed separately, mostly in card-
board cases, which are not opened till the materials they contain are required for
use. Whenever it happened that the surgeon or operator required more than one
kind of dressing material in the course of an operation, he had to keep in readiness
and carry about him from place to place a corresponding number of separate
packets or cases. The consequence of such a course was, on the one hand, that an
equal degree of sterilization of all the material used for one operation could not
be guaranteed, for the fact of their being contained in separate cases or receptacles
made it just likely that one or other of these receptacles was not quite closed and
its contents, by exposure to air, have been more or less deprived of their antiseptic
properties or have received from the atmosphere germs which by entering the
wounds to be dressed, make the whole antiseptic treatment futile.
On the other hand the effect may be that as the receptacles containing the
dressing material are not wholly emptied at each operation and that as the box
remains open during the operation, the remaining part of the lint or the like is
continually exposed to the air and thus becomes unfit for a fresh operation as a
sterilized article.
As moreover it is generally not till after the receptacle has been opened that it
can be ascertained whether it has been hermetically closed or not, there was this
additional inconvenience resulting from placing the sterilized material in separate
cases, according to each kind of class, that the operator opening as he does each
case at the last moment, has little or not time during the operation to make sure
whether the dressing material he is about to employ is thoroughly antiseptic or
not. The object of this invention is to remedy these drawbacks.
The inventor has found that contrary to what has been supposed hitherto, a number
of different classes of dressing material may be simultaneously treated with a view
to sterilizing in one chamber or vessel, notwithstanding the different degrees of density
or porosity of the different articles or the unequal degrees of resistance opposed by
each to the antiseptic gases or vapours tending to pass through it. The applicant
has found that in spite of these variations all the material, of whatever description,
may be uniformly and thoroughly sterilized in one vessel common to all. For this
purpose he packs all those articles which are usually employed in the course of
surgical operations, in the quantities in which they are ordinarily required, in one
receptacle and submits it to the action of the sterilizing gases or vapours. The
assortment of material being thus packed together, it is quite easy to ascertain
whether the receptacle is tightly closed, and as it is no longer necessary to open a
number of cases in a hurry, just before proceeding with the operation, the opening
may be effected leisurely and any defect in the closing timely discovered. All the
dressing material of the different classes being by this process uniformly sterilized
beforehand and kept in the sterilized condition up to the time of the operation, it
can never happen that the action of one imperfectly sterilized article should

page_text: neutralize or interfere with the antiseptic action of the other articles employed in
conjunction with it. Besides, waste of material is also avoided by this method as
each receptacle may thus be prepared for a certain class of operations, the
quantities of the different materials being beforehand proportioned to the -actual
requiremerits.
The process further relates to the peculiar arrangement of the different kinds of
antiseptic material in the receptacles and to the provision of a removable cover for
each receptacle. If the different classes of material were arranged side by side
the result of the removal of the cover would be to expose all or most of them to
the air in an equal degree so that while one kind of material is being used the
others would be allowed to lose more or less of the antiseptic properties. The
present invention consists in placing the different kinds of material one over
the other in the order of succession in which they are to be employed in a given
operation. Thus in dressing a wound the material lying uppermost in the recep-
tacle is used first, then that which lies underneath it and so forth, the layer next
succeeding the one which is being employed always protecting all the material
over which it is laid from contact with air. This receptacle, owing to the
peculiar arrangement of its contents may during the operation be placed and kept
in almost immediate proximity to the wound or cut to be dressed so that no
time is lost in taking the required material out of it and placing it on to the
wound.
The receptacle or case may be made of sheet metal (especially if intended for
shipping) or of cardboard or the like. The cover may be retained upon it by
means of a strip of metal or indiarubber passed over and around the lower edge of
the cover and it is provided at the top with openings or perforations through which
the sterilized gases are admitted. After sterilizing, these openings are closed by
means of solder or the like. The receptacle when adapted for dressing wounds or
sores in the head or neck, may contain the following materials succeeding each
other in the downward direction:-Two gr. of iodoform powder (a) 6 gr. of
bandages of iodoform gauze (b) consisting each of 4 sheets or layers; 2 sheets or
layers of lint (c) 1 cambric bandage (d) and 1 starch bandage (e).
Receptacle 11 may be employed in forming a
6 tampon or dressing pad for
wounds or sores in the uterus. The succession of the materials in the downward
direction may be as follows,-2 strips of gauze containing 20% of iodoform, (^),
30 gr. of salicylic wadding at 4% (c).
"
The size and shape of the dressing receptacles and also the number and quantities
of the materials they contain may obviously vary according to the special purpose
for which they are required.
Dated this 15th day of March 1892
W. P. THOMPSON & BOULT,
Agents for the Applicant.
COMPLETE SPECIFICATION.
Improvements in or relating to the Sterilizing or Rendering
Antiseptic of Materials used for Surgical Purposes.
I, ALFRED DÜHRSSEN, M.D., of Klopstockstrasse 24, Berlin in the Empire of
Germany, do hereby declare the nature of this invention and in what manner the
same is to be performed, to be particularly described and ascertained in and by
the following statement :-
The various materials used for purposes of surgery and gynecology, in dressing
wounds and the like, such as gauze lint, bandages, etc., have been hitherto sterilized 5
or made antiseptic by the following method only,-largo quantities of dressing
material enveloped in parchment or packed in cardboard or sheet-metal cases were
each separately submitted to the action of a current of steam. By this method the
dressing materials in question were indeed momentarily sterilized and freed from

page_text: noxious germs; but their packing was not calculated to protect them from sub-
sequent access of, or contact with, dangerous impurities or germs. Where the
packing consists of cardboard or parchment-paper, for example, moisture may
either permeate the packing itself, or enter through the interstices which such
packing invariably presents; thereby destroying the purity of the dressing
material. Where sheet-metal boxes are employed, their contents are still less
protected from exterior influences, than in the case of paste-board or paper, for
metal boxes of this description have to be provided with perforations for the
sterilizing steam to pass through, in addition to which they have a cover or lid,
readily removable and forming no air-tight joint. The consequence is, as is daily
found by practical experience, that boxes or cases of dressing material, in being
carried from place to place either by rail or on dusty roads, as the physician or
surgeon frequently has to do, receive and absorb considerable quantities of dust and
with it necessarily certain organic germs.
Besides it frequently happens that the practitioner himself in surgical operations,
where he has a number of open boxes of dressing material to keep in readiness,
spoils their contents more or less by contact with his hands soiled with blood or pus
and as generally rather large quantities of material are packed in one box and
sterilized together, it is not practicable to throw away all the material remaining
in a box without serious pecuniary loss.
These two drawbacks viz. the danger of the dressing-material becoming impure
again, both before and during the surgical operation, after having been sterilized
by the usual process, are, of course, most serious, inasmuch as the ultimate success
of the whole operation may be said to depend on the purity and wholesomeness of
the dressing material which if infected by germs, is alone sufficient to cause the
death of the patient.
These serious defects, then, the applicant avoids by combining the various kinds
of dressing material which can possibly be required for a given surgical operation,
and enclosing and sterilizing them in a separate sheet-metal or tin box or case,
which, after the sterilizing operation, is made absolutely air-tight and damp-proof
the perforations through which the sterilizing gases have been conducted being
immediately afterwards closed by solder.
The sterilizing operation itself may take place in any suitable manner either by
means of hot gases or vapours or by simply submitting the material to be purified
to predétermined high temperatures, a current of steam being preferred.
Owing to the method of packing just stated, the practitioner is absolutely certain
that each bandage or dressing made by him with materials so packed is absolutely
aseptic or free from germs; and this certainty will remain unshaken until the very
last remnant of the material contained in the box is exhausted, whereas up to the
present time such certainty would only have been justified, even in the most
favourable circumstances, as far as the first supply, taken out of each box by the
surgeon, was concerned.
Besides the applicant does not propose only to sterilize in the manner stated such
material as the usual gauze or muslin of a spongy nature or simply lint, but also to
introduce a further improvement by firstly treating the gauze or lint with some
suitable antiseptic, such as iodoform or salicylic acid and secondly combining with
these as much iodoform powder contained in a small cardboard box as may be
required for one dressing. All these materials together are sterilized in the
manner stated by a current of steam and then made damp-proof and air-tight by
solder. It has been observed hitherto that when gauze, lint, wool or the like
impregnated with iodoform or salicylic acid were submitted for hours together to
the action of steam, the consequence was that the antiseptics incorporated in the
dressing material were decomposed or volatilized. To remedy this the applicant
has found convenient means of preserving the antiseptic agents contained in the
dressing material by impregnating it with glycerine and by enveloping it after it
has been made antiseptic, either with ordinary cotton-wool or parchment paper.
In this condition the antiseptic agents and properties will be preserved in the
.:

page_text: material during the sterilizing or steaming process. This enables highly inflamed
wounds or sores to be thoroughly disinfected and the introduction of dangerous
fungi into the wound to be avoided which according to the researches and
experiments of Dr. V. Eiselberg of Vienna and Dr. Schlange of Berlin it has not
hitherto been possible to do as all dressing materials impregnated with antiseptice
but not sterilized by a current of steam have by them been found to contain
pernicious growths.
In the accompanying drawings two such boxes provided with a full set of
dressing-materials are represented by way of example. The containing-receptacle
may be a tin sheet-metal or other suitable box provided with a lid which is retained
in place by a strip o' soldered around and over the lower edge of the lid. The lid
is provided with an aperture o at the top and the bottom of the box is similarly
perforated. Through both these apertures which are closed by solder after
sterilization, the sterilizing current of steam or other gas is conveyed.
The receptacle may however be made of any suitable material as parchment-
paper, cardboard, papier-maché, etc., may be employed if preferred, instead of
metal. In lieu of solder, size or putty may be used to close the openings, or any
other suitable closing-device adapted to render the receptacle perfectly hermetic.
Receptacle No. I for example is intended for use in bandaging up wounds in the
head or neck, and, accordingly, contains preferably the following materials super-
posed and ready for use in succession (beginning from the top),-
(a) 2 grammes of iodoform powder; (b) 6 compresses of iodoform gauze, each
consisting of four sheets or layers; (e) 2 sheets of wool; (d) one cambric
bandage; and (e) one starch bandage.
Receptacle No. II is designed to serve for preparing "tampons" for purposes of
midwifery or the gynecological treatment of the uterus or womb, also for filling up
cavities of ulcers or the like in ordinary surgery, the materials packed therein
(taken successively from the top downwards) being preferably as follows,-
(61) 2 strips of iodoform gauze; and
(e) 30 grammes of wool with 4 per cent. of salicylic acid.
It will be understood that the size and shape of the receptacles as well as the
number and quantity of the wound-dressing materials depend on the special purpose
for which they are intended.
Having now particularly described and ascertained the nature of the said
invention and in what manner the same is to be performed, I declare that
what I claim is,―
1. The method of preserving in a sterilized condition the various materials used
in dressing wounds consisting in combining and packing in one receptacle, such as
a tin sheet-metal or other suitable box all the various materials constituting a
complete dressing for a definite surgical purpose in quantities so proportioned as to
answer that purpose such completo dressing being sterilized separately whereupon
the receptacle containing it is immediately made damp proof and air tight by any
suitable closing device with a view to reliably keeping the dressing free from
germs until it is to be used so as to avoid introducing dangerous impurities into the
wound along with the dressing material substantially as described.
2. The employment of the wound-dressing materials as described for the purpose
of disinfecting inflamed sores without imparting to them any fresh germs of
infection.
3. A package of wound dressing materials consisting of the requisite bandage
appliances contained in an air-tight case hermetically closed after the contents have
been sterilized.
Dated this 16th day of January 1803.
W. P. THOMPSON & BOULT,
Agents for the Applicant.