Silenced. Im also delighted to let you know that this program is being filmed by cspan to be aired at a later date, so if you enjoy tonights program and would like to see it again or if you think your friends would like to see it, you should check periodically over the next few weeks to cspan. Org and see if its up. Sometimes it takes a couple of weeks for them to run a show and other times it can be one or two months. So its worth checking periodically. It is my pleasure to introduce our speaker, dr. Lindsay fitzharris. Dr. Fitsharris tells me as a little girl she used to drag her grandmother from cemetery to cemetery so that she could hunt ghosts. So some thought she was obsessed with death from an early age. She likes to think she was simply fascinated with the past and with the people who lived there. Thus began her lifelong obsession with history. Dr. Fitzharris received a doctorate in in science, and technology. In 2010 she was granted a postdoctoral fellowship by the Welcome Trust which is the medical History Collection in london. She is the author and creator of the popular web site the surgeons apprentice which has receive over two to million hits two million hits. She is also the writer and presenter of the youtube series under the knife which takes a humorous look at our medical past. Her articles have appeared in numerous publications both here and in the u. K. Including the guardian, the lancet, the Huffington Post and medium. She has also appeared on pbs, bbc and national geographic. And her debut book, the butchering art, which was just published worldwide on october 17th and on which tonights program is based follows the surgeon Joseph Lister on his quest to transform the brutal and bloody world of victorian surgery. And we have this book available through Smithsonian Museum shops at the entrance to the lecture hall here and dr. Fit zharris will be happy to sign copies for you. Please join me in giving a very warm welcome to dr. Lindsay fifths harris. Thank you for that lovely introduction. Its true, my grandma and i used to go we still go hunting ghosts. I dedicated the book to her, and shes my biggest p. R. Campaigner out there trying to get this book sold. I am so excited to be here tonight at the smithsonian to talk about the brutal and bloody world of victorian surgery, and i am so honored that so many of you would come out on halloween night, that you would give up your halloween night to learn about what it was like to be a patience and a surgeon in a patient and a surgeon in the Early Victorian period. Given the fact that its halloween, i want to start with a halloween tale. And its related to what i do as a medical historian. So it was halloween, 1828, and a woman in the scotland was murdered. And it turns out that she was the last victim of 16 who were killed by William Burke and william herr. Now, they were body snatchers in the 19th century. I use that term rather loosely because, actually, they didnt steal any bodies, they just killed people, and they sold those bodies on to the surgeons and anatomieses of this time. There was a great need, of course, because this was a time before people willingly gave over those bodies to medical science. They were apprehended in 1929 1828. Now, at this time there was a weird law in britain. It was called the murder act, and it decreed that any murderer not only be executed for his crimes, but also be publicly dissected. So in an ironic twist, burke ends up on the very table that he had sold his victims onto at that point. Now, this is scotland in the 19th century and, of course, theyve got to kick it up a notch. It doesnt end there. It wasnt enough just to execute him, it wasnt enough just to publicly dissect him. In fact, they took his skin and they created all these various trinkets which they then sold on to a blood thirsty public, one of which is on display in edinborough. This is a pocketbook bound in the skin of William Burke. I have held it, it has been dna tested. It feels and smells like leather. And this practice was so common in the 19th century, it had a term. It was called anthroto determinic [inaudible] and thats binding books with human skin. It wasnt always related to criminal activity. Sometimes surgeons or doctors took the skin from cadavers, and they bound medical texts with it. If this is something that interests you, one of my friends, megan rosenblum, is looking on this working on this very subject, so be looking for that book. I am really excited to see what the book covers going to look like for that book coming up. [laughter] anyway, i am so excited, im going all around the country right now. I am demolishing any lingering, romantic notions that people might have about what it was like to live in the victorian timings financial you read my book and i you think it might have been fun to live in the 19th century, i have not done my job. [laughter] because, let me tell you, we are very, very lucky to live in the 21st century. Poor 12yearold henry pace its gonna get bad. [laughter] i hope cspans ready for this. Poor 12yearold henry pace, he was brought in in the 18 tos, told he was going to have to have his leg removed without anesthetic, and he asked the surgeon whether it would hurt as children do. And the surgeon said it would hurt no more than having a tooth pulled. He was brought into the operating theater, he was blindfolded, he was restripped, he was so restrained, he was so awake, he was so lucid, he remembers counting six strokes of the saw before his leg fell off into the hands of the surgeon. We are so lucky not to have to endure the horrors of preanesthetic surgery. In 1828, one man had to have a bladder stone removed. Im not going to go into too much detail about how that was done in the 19th century, you have been fairly warned here. Suffice to say, you can tell two very important things from this image. Number one, it hurt a lot. Number two, it was really, really embarrassing. Imagine being tied up like in front of hundreds of spectators. And thats exactly what happened to Stephen Pollard in 1828. Now, what should have taken five minutes ended up taking over an hour as Steven Pollard struggled against the knife and cried out for the surgeon to, please, dear god, stop. And the surgeon shouted back at him that he had weird anatomy. So you can imagine the struggling scene. It was horrific. Now, pollard pulled through, he died 24 hours later of postoperative infection. That features very prominently in the butching art, and it was revealed that it was the surgeons fault. Let us not forget poor Lucy Thurston who had a mastectomy without any anesthetic. She had operation in her home. Im going to tell you about these Early Victorian hospitals, but a lot of times the wealthy and middle class were treated in their home. And the surgeon didnt tell her when it was going to happen. He told her she needed the operation, but he wasnt going to tell her the day because he thought she would focus too much on it. To me, i would want to know, i would want to prepare. So he just shows up one day, he walks up the stairs into her bedroom. He opens her hand and shows her the knife he is going to use, and he tells her to prepare her soul for death. This is not very confidenceinspiring. Im really glad surgeons dont tell us that anymore. But, of course, that was necessary in this time because many, many people died. She prepared her soul for death, but she couldnt prepare for the pain that was about to come. Lucy thurston ended up surviving the operation. She actually went on to live a very happy and healthy, long life. But she wrote to her daughter about it. I want to share that in a letter. She said then came a gash, long and deep. First on one side of my breast, then on the other. Deep sickness seized me and deprived me of my breakfast. This was follow by extreme faintness. My sufferings were no longer local, there was a general feeling of agony throughout my whole system. I felt every inch of me as though my flesh was failing. I myself fully intended to have seen the thing done, but on recollection every glimpse i happened to have was the doctors right hand completely covered with blood up to the very wrist. He afterwards told me that at one time the blood from an artery flew into his eyes so he couldnt see. Just when you thought things couldnt get worse, now the surgeon is blinded. [laughter] and she ended the letter by saying it was nearly an hour and a half that she was under his happened, an hour and a half while he cut away at her cancerous breast. We are v or very lucky to live in the 21st century and, of course, we owe a huge debt to the medical men and women who came before us to get us to this point, which is what this talk is about today. I start my book tour in neville, and i was in philadelphia, and i was really excited to start there because my book is about a british surgeon named Joseph Lister, this man right here. He is known as the father of antiseptic surge. He took Louis Pasteurs germ theory and married it to medical practice. And, of course, he saved thousands of peoples lives in his own time, and he continues to save peoples lives today, because we operate with the knowledge that germs exist. Now, i was excited to start in philadelphia because when my book came out on october 17th, it was nearly 135 years ago to the very day that lister came to america to convince american surgeons of the existence of germs and of the need to adopt ant sepsis. And antisepsis. And later in im going to tell you about that trip a little more. But there were a few things that came out of his trip. If youre familiar with listers name, it might be because of this product, listerine. There was a man in the audience in philadelphia, and he was inspired by listers lectures, and he decided to create this wonderful product that we all know and love today. It was originally a cureall antisepsis, most commonly used to cure gonorrhea. So im just hoping to arm you with a bunch of random facts that you can horrify people with later at cocktail parties. [laughter] you know, if youre really into this and you go up and lay this on someone and theyre into it, you know you have found your people. Im sure listerine would not like me telling that story, but that man was in the audience that night. Another man was in the audience, robert wood johnson, and he too was inspired by lister, and he got together with his brother to create the Company Johnson johnson, and the first thing they produced were surgical antisentive dressings antiseptic dressings. These are funny. They were produced at the late 19th, early 20th centuries by johnson johnson, and theyre kind of an idiots guide on how to operate on your own kitchen table, and its all perfectly safe as long as you use Johnson Johnsons surgical dressings. This was the kind of thing they were trying to promote and teach people, and that all came out of listers trip. So i was very, very excited to begin in philadelphia. When lister got to philadelphia, he took a train trip around america, and he went all the way to the west coast, and he was trying to convince americans of the existence of germs. And he was very much on a mission. This was a very personal thing to him. It wasnt about money, it was about saving peoples lives. In fact, lister or had a knack of lister had a knack of ticking off his colleagues because he didnt actually charge his patients, he let them decide how much they wanted to pay them. He was not very popular with his colleagues, needless to say. Lister went all around america. He was on a mission, and i like to think i, too, am on a mission not just to sell books although i hope Everybody Knows where to get them. Looking right at you, cspan. [laughter] but im on a mission. My mission is that Joseph Listers name is just as familiar to people as the names Charles Darwin and sir isaac newton, people like that, because i think hes just as important. But in order to convince you of that, i really need to take you back to the prelisterian era to the Early Victorian hospitals. Now, these hospitals were not places that you went to be treated if you were wealthy or middle class. Weve already talked about Lucy Thurston a bit. These were places you went if you were poor. They were grimy, dingy, they were overcrowded, they werent houses of healing, they were houses of death. And the best that can be said about these Early Victorian hospitals is that they were a slight improvement over their 18th century predecessors which isnt really saying much when you consider that the bug catcher was paid more than the surgeons and the doctors at this time. So this lovely card from the Welcome Trust in london which is a great medical History Collection, this is an 18th century calling card. Its for a man named andrew cook, the bug destroyer. I really think they should make a movie about guy. And at this point that he makes this, he claims to have rid 20,000 beds in hospitals of lice. When you consider there was that many lice in these hospitals, you can understand why andrew cook was paid so well. But it wasnt just the lice, it was overcrowded. Surgeons often had to treat sometimes upwards of as many as 200 patients in a single night. And it was overwhelming, it was overyouded, of course overcrowded, of course, there was population explosions, london was growing so rapidly, and there was no way to keep up with the demand. In 1825 at st. Thomas hospital, people harp touring that were touring the hospital saw wriggling maggots and mushrooms growing in the sheets of a patient with a compound fracture. And what was so clause crazy about that story was this was so normal that the patient didnt even think to complain about it. Thats what these hospitals were like. So now that ive convinced you that these hospitals were really awful places, you certainly wouldnt want to end up in one in this period, you might be surprised to find out that they actually were very difficult to get into. So Early Victorian hospitals, you needed a ticket to get in. This is fantastic. Theyre really hard to find, these images, but this is from 1836. This is a ticket to get into a hospital. And in order to get a ticket, you had to petition one of the hospital governors. These people didnt have any medical training, and they had no real interest in the patients themselves. These were political positions. And sometimes it took weeks, sometimes longer before you got your ticket into the hospital. Of course, during which time you could die. Now, when i say that these hospitals were for the poor, they were really for what medical historians call the deserving poor. They still had to have some kind of income to cover their room and board. For instance, some hospitals charged you for your inevitable burial, it was so expected that you were going to die there. Other hospitals charged extra if they deem you particularly foul. So i dont know how they determined that. But needless to say, if you were absolutely destitute, you had no medical options in this period which, of course, might not have been a bad thing because people were dying heavily as a result of being admitted into these grimy and dingy places. Unsurprisingly, infections broke out like crazy, and theres a term that pops up in the 19th century called hospitalism. It refers to the fact that you were more likely to die as a result of being admitted into these Early Victorian hospitals. There were four infections particularly that surgeons were worried about. Hospital gangrene, its weird, medical historians dont like to retrospectively diagnose things. When were reading records, be someone says, you know, its gangrene, we tend to be more interested in how people contextualize their experiences within rather than how we might look at the past through the lens of our own medical explanationings. But hospital gangrene tended, i think its more sort of akin to what we would call neck protizing fascitis at this time. It was a very horrible condition which, of course, all of these conditions we suffer from today. Surgeons and doctors fight today. But, of course, because we know about germs and the existence of germs, were able to more proactively prevent them and, of course, manage them when they do break out. The scottish surgeon john bell wrote about the horror of hospital gangrene. He says the cries of the sufferers are same in the night as during the daytime. If they survive are and the ulcers continue to eat down and disjoin the muscles, the great vessels are at last exposed and eroded, and they bleed to death. This was the kind of experience that many patients had in these hospitals. Actually, interestingly enough one of the worst, one of the worst records i came across wasnt a hospital record, it was a naval record. These 18th century and early 19th century naval ships had very similar conditions, as you can imagine, very crowded, very unhygienic. And went these infections when these infections broke out, they were very difficult to control. On the hms stat sat you were, a a malignant ulcer appeared on the tip of a seamans penis, i dont have a photo, and you should be happy. This is where cspan goes blank for a bit. After several agonizing days, the organ finally fell off. This poor man is totally awake and completely aware of whats happening to his body. The surgeon onboard reported that the whole length of the urethra [inaudible] and also the scrotum leaving the testees and vessels barely covered with cellular substance. And what was so crazy about this record when i came across it was the fact that the surgeon felt the need to underline the fact that the patient had died. Of course he died. Somebody should have killed him before it got to that stage. [laughter] so this was what people were fighting in this period, and it was absolutely awful. Now, this is the world that Joseph Lister stepped into in the 1840s when he began medical school at University College in 1848. And it was so bad in these hospitals that it was very seriously suggested that the only solution would be to burn these buildings down from time to time and start anew. Which i love the imagery, the idea of just i mean, can you imagine if thats how we controlled things today, just burn it down . I was in cleveland recently at the cleveland clinic, that huge hospital, just