From Medical America in the Nineteenth Century: Readings from the Literature, Gert H. Brieger, ed. (Baltimore:  Johns Hopkins University Press:  1972), 198-200.

Editor's Note:  ON THE ANTISEPTIC TREATMENT OF WOUNDS AND ITS RESULTS (1877)

After Lister's appearance before the International Medical Congress in Philadelphia in September 1876 and his tour of eastern cities, more and more surgeons became converts to the new system. Robert F. Weir was one of these. He was born in New York in 1838, received his M.D. degree from the College of Physicians and Surgeons in 1859 and soon became a leader among the surgeons of the city. He was a prodigious contributor of articles to medical journals and held several teaching positions in the medical colleges of New York City. Part of his long discussion of the antiseptic system, its rationale, and his results, are included in the following selection. . .  .

 Erichsen in 1874 reported that antisepsis was not used much by American surgeons because their hospitals and their operating habits were generally cleaner than those in Europe. In 1876 Samuel Gross voiced similar sentiments when he said, "Little, if any faith, is placed by any enlightened or experienced surgeon on this side of the Atlantic in the so-called carbolic acid treatment of Professor Lister, apart from the care which is taken in applying the dressing." 1 Admittedly, acceptance of antisepsis in the United States was rather slow, but Gross's statement must be read with caution. 2

1 "A century of American medicine," Am. J. Med Sci. 71 (1876): 431-84,483.

 2 See my "American surgery and the germ theory of disease," Bull. Hist. Med 40 (1966): 135-45.

 It is only lately that in America attention has been given practically to the teachings of Lister in respect to the treatment of wounds. In fact, aside from an article by Schuppert in the New Orleans Medical and Surgical Journal, little or nothing has appeared in our medical journals relative to the results of the so-called antiseptic method. Within the past year, however, a change has occurred, due probably both to the interest excited by the personal expositions of Lister at our late Medical Congress at Philadelphia, and also to the satisfactory results that have ensued from this treatment in the practice of many German surgeons with large hospital experience. The reason why American surgeonsÐwho justly have the reputation of being eager to seize upon any improvement in their artÐhave been tardy in testing the success of this mode of treatment may, perhaps, be stated at follows: 1. That the treatment, as enunciated by Mr. Lister, has been repeatedly changed in its details; 2. That it was too complicated, and demanded the supervision of the surgeon himself, or, in a hospital, of a carefully-trained staff of assistants; 3. That many who had tried it had been unsuccessful in the cases where the essay had been made. But the most weighty objection which was asserted or entertained, was the positiveness of the enunciation of the germ-theory in explanation of the process of decomposition in the secretions of a wound. Only the latter reason requires any attention at present, and, as a clearer conception of the intent of the many minutiae of the dressing may come from a synopsis of this theory, it will be succinctly given, notwithstanding the purpose of this evening's paper is to present the subject as far as possible from a clinical point of view.

 It is, in a few words, this: 1. That in the dust of the atmosphere, and in matter with which it is in contact, there are the germs of minute organisms, which under favorable circumstances induce putrefaction in fluids and solids capable of that change, in the same manner as the yeast-plant occasions the alcoholic fermentation in a saccharine solution; 2. That putrefaction is not occasioned by the chemical action of oxygen or other gas, but by the fermentative agency of these organisms; 3. That the vitality or potency of the germs can be destroyed by heat or by various chemical substances, which are called, in surgery, "antiseptics."1 The very definition of the "antiseptic system," as given in the words of Lister himself, is "the dealing with surgical cases in such a way as to prevent the introduction of putrefactive influences into wounds."2 Nothing need here be added to these statements, in their verification or otherwise (though analogy and accumulating facts seem to lend support to them), except that from the standpoint adopted two important statements need to be referred to. I mean those of Thompson,3 Weitzelbaum,4 and others, that they had found living bacteria in the carbolic solutions as used by Lister, and of Linhart,5 Fischer,6 Ranke,7 Schuller,8 and Volkmann,9 who, in several hundred observations, have found bacteria in the discharges of wounds that had been most carefully and satisfactorily treated by the antiseptic method. It was noticed, however, that the presence or absence of these bacteria (and such were only considered as present when chain-bacteria were found) did not influence the progress of the wounds; and Fischer gives the opinion, in which many of his countrymen join, that the object of the dressing is not so much to keep the germs away as to keep the secretions in such a condition as to be as unfavorable as possible to the development of bacteria and thus prevent decomposition taking place.

 It is only justice to append the remarks of Mr. Lister at the Congress in respect to these observations, or rather, correctly speaking, of Ranke's. They are, textually: "The statement that cell forms have been found beneath antiseptic dressings must be received with caution. I have," continues he, "recently met a gentleman who was with Ranke in Halle when he found, as he supposed, these organisms beneath antiseptic coverings; and when the gentleman pointed out to me the bacteria which he called putrefactive, I at once recognized them as of the non-putrefactive variety, and the gentleman was forced to admit that they differed from those found in decomposing masses."10

 Passing from these facts (?) of the laboratory, let us consider those to be used and acquired at the bedside. In practicing this method, in order to form a proper judgment of its merits, it is essential that Mr. Lister's plan should be thoroughly known and be carried out even to its minutes" particular. The chorus on this point is unanimous among surgeons who have successfully used it. Hagedorn, of Magdeburg, says that in every failure the surgeon himself is to blame and not the method; and Lindpaintner, 11 representing the experience of Munich with nearly a thousand cases treated antiseptically, states that it must be considered a precept that the minutes" directions must be followed, and that he who does not get the result (desired) must certainly have made some mistake. This opinion is reiterated by all who have achieved success by the method, and the number of such is already large and increasing. 12 A second condition, which really should have come first, is that they who use the method should at least provisionally accept the theory on which the dressing is based; they should, so to speak, act as if they saw germs on everything. This, however, is not so imperative as the one just spoken of.

 "For," remarks Lister, "those who are unwilling to accept the theory in its entirety, and choose to assume that the septic material is not of the nature of living organisms, but a so-called chemical ferment destitute of vitality, yet endowed with the power of self-multiplication.... such a notion, unwarranted though I believe it to be by any scientific evidence, will, in a practical point of view, be equivalent to the germ-theory, since it will inculcate precisely the same methods of antiseptic management. It is important that this should be clearly understood." . . .

 
New York Med J. 26 (1877): 561-80; 27 (1878): 31-51. Read before the New York County Medical Society at their meeting on November 26, 1877.

1 T. Smith, Lancet, March 25,1876.
2 "Transactions of the International Medical Congress," Philadelphia, 1876.
3 Medical Times and Gazette, November 6,1875.
4 Wiener Med Presse, 1876, Nos. 10 and 11.
5 Schmidt's "Jahrbucher," vol.174, 4.
6 Deut Zeitschr. f. Chirur., vol. vi.,p.319.
7 Idem, vol. vi., p. 63.
8 Idem,vol.vii., 1876, pp.5,6.
9 Schmidts ``Jahrbucher," vol.174, 2,1877.
10 Transactions of the International Congress," 1875, p. 540.
11 Deut. Zeitschr. .1: Chirur., vol. vii., p. 18.
12 See Schmidt's Jahrbucher, vol. 172, 4, and Hirsch's Jahresbericht, 1877, for an interesting summary of the antiseptic treatment.