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, we 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 could be one or two months, so its worth checking periodically. It is my pleasure to introduce our speaker, dr. Lindsey fitzharris. Dr. Fitzharris tells me as a little girl she used to drag her grandmother fromet cemetery to cemetery so that she could hunt ghosts. Though some thought she was obsessed with death from an early age, she like ared to think she was simply fascinated with the t past and with the people who lived there. Thus began her lifelong on to session with history. On to session with history. Dr. Fitzharris received a doctorate in the fields of science, med kin and technology from the university of oxford. In 2010 she was granted a post Doctoral Research 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 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 new medium. She has appeared on bbc and mask gee graphic. And her debut book, the butchering art, which was just publish bedded on october 17th, follows the surgeon Joseph Lister on his quest to transform the brutal and bloody world of victorian surgery. And we have inwe this book availableil through Smithsonian Museum shops at the entrance to theo lecture hall here, and dr. Fitzharris will be happy to sign copies for you at the end of tonights program. So with that said, well get the Program Underway please join me in giving a very warm welcome to dr. Lindsey fitzharris. [applause] thank you for that lovely introduction. Its true, my grandma and i used to go we still go from cemetery to cemetery hunting ghosts. I dedicated the book to her, and shes my biggest pr campaigner out there trying to get this book sold. I am so excited to be here, 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 patient and a surgeon in the Early Victorian period. Given the fact that its halloween, before i get into my talk i want to start with a halloween tale. And its related to what i to as a medical historian. So it wasso halloween, 1828, ana woman in scotland was murdered. And it turns out that she was the last victim of 16 who were killed by William Burke and william h rex r. Now, they were body snatchers in 19th century. I use that term loosely because, actually with, they just killed people, and they sold those bodies on to the surgeons and anatomieses of this time. There was a great need for bodies because this was a time when people willingly gave over bodies to medical science. Herr turned kings evidence and he went free while his friend swung for the crime. There was a weird law in britain, it was called the murder act. Any murder not only be execute for his crimes but also publicly dissected. So inwi an ironic twist, burke ends up on the table that he had sold his victims onto. Now, this is scotland in the 18th century, and it doesnt end there. It wasnt enough just to execute or publicldissect him. In fact, they took his skin and krised these various flynn or created these various or or object toes. This is a pocketbook. I have held it. It has been dna tested. It feels like leather, it smells like leather, and this practice was so common in the 19th century, it was called binding books with human skin. It wasnt always related to criminal activity. Sometimesiv 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, meg taliban rosenbloom, is working on this very subject, so be looking for that book. [laughter] 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 to be talking about the brutal and bloody world of victorian surgery. I am demolishing any lingering, romantic notions that people may have about what it was like to live in victorian times. If you come away from this talk thinking it might have been fun toto live in the 19th century, i have not done my job. [laughter] let me tell you, we are lucky not to have to entour the horrors ebb door the horrors of preantiseptic surgery. Like poor 12yearold henry pace. Its gonna get bad. [laughter] ii hope cspans ready for this. Poor henryug pace, he was told e was going to have to have his leg removed without an set thick an nettic, and he asked the surgeon if it would hurt. And the surgeon said it would hurton no more than having a toh pulled. Henry pace was very underprepared for what was to come. He was brought in, he was blindfolded, he was 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 thewe surgeon. We are so lucky, i imagine that cspans going to blur this one. [laughter] like poor Steven Pollard. In 1828, he had to have a bladder stone removed. Im not going to go into too much detail, this is a lot in the butchering art. That might be an incentive or deterrent depending who you are, but you have been fairly warned here. But suffice to say you can tell one or you could tell two very important things from this image. Number i one, it hurt a lot. Number two with, it was really, really embarrassing. Imagine being tied up like this in front of hundreds of spectators. Ands thats exactly what happend to Steven Pollard in 1828. Now, what should have take then tiermi minutes ended up taking over an hour as he struggled against the knife and cried out for the surgeonon to, please, dr god, stop. And the surgeon shouted back at him that he had weird anatomy. So you can imagine this struggling scene. It was horrific. Pollard pulled through, he died 24 hours later of postoperative infection. Im going to get back to that later. It was revealed on his autopsy report that, actually, he had normal anatomy and it was the surgeons fault. And relate us not let us not forget poor Lucy Thurston who in the 1840s had a mastectomy without any an net isic. She had this operation in her home, a lot of times the wealthy and the middle class were treated in their home. And a 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 shed focus too much on it. To me, that would increase my anxiety. So he just shows up one day, he walks up the stairs into her bedroom, he opens his hand and shows her the knife he is going to use, and he tells her to prepare her soul for death. This was not very confidenceinspiring. Im really glad that surgeons dont tell us to prepare our souls for death anymore. Many, many people died. She prepared 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, longfe life, but she wrote to her daughter about it. I want to share that in a letter. She said thenle came a gash, log 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 followed by extreme faintness. My sufferings werefe 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 every glimpse was the doctors right hand completely covered with blood up to the very wrist. He afterwards told me at one time the blood from an artery flew intoo his eyes so he couldnt see. Now the surgeon is blinded. And she ended the letter by saying it was nearly an hour and a half that she was urn his hand, an hour and a half while he cut away at her cancerous breast. We are very, 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 started my book tour in philadelphia, and i was really excited to start there because my book iss about a british surgeon named jost lister Joseph Lister, known today as the father of antiseptic surgery. 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 becauseph 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 antiaccept is sis. And im antisepsis. And im going to tell you about that trip a little more, but there were a few fun things that came out of his trip. And if youre familiar with lust listers name, it might be because of listerine. There was aer man in the audien, and this man 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, in fact, most commonly used to cure gonorrhea. Im just hoping to arm you with a bunch of random facts that you can horrify people with at cocktail parties. If you find someone really into it, you know youve found your people. Im sure listerine today would not like me telling that story, but that manat was in the audience. Another man was in the audience, his name was robert wood johnson, if 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 antiseptic dressings. These are really funny, if you ever come across one, do pick one up. They were produced in the late 19th, early 20th centuries by Johnson Johnson, and theyre kind of like an idiots guide to operate on your kitchen table, and its all perfectly safe as long as you use Johnson Johnson surgical dressings. This was the kind of thing they were trying to promote, and that all came out of listers trip. So i was 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 ofca 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 had a knack of ticking off his colleagues because with he didnt actually charge his patients, he let them decide how much they wanted to pay him. He was not popular with his colleagues, needless to say. But lister went all around america. He was on a mission, and i like to think i too am on a mission not just the sell books, although im hoping where everyone knows where to get them [laughter] looking right at you, cspan. [laughter] but im on a mission. My mission is that Joseph Listers name is just as familiar 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, iba really need to take yu back 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 that 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 reallyg 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 or 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. At this point that he makes this, he claims to have rid 20,000 beds in hospitals of lice. So 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 there were just, it was overcrowd. Surgeons often had to treat sometimes upwards of as many as 200 patients in a single night. And it was overwhelming, it was overcrowded, of course, there was population explosions all over in the victorian period. London was growing so rapidly, and there was no way to really keep up with the demand. In 1825 at st. Thomas hospital, people that were touring the hospital saw wriggling maggots and mushrooms growing in the damp soiled sheets of a patient with a compound fracture. And what was so crazy about that story was that this was so expected, it 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 hadic 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 called the deserving poor. They still had to have some kind of income to cover their room and board. For instance, some is hospitals charged you for your inevitable burial, it was so expected you were going to die there. Others charged extra if they deemed you particularly foul. I dont know how they determined that. But needless to say, if you were absolutely destitute, this was you had no medical options in this period which, of course, mighte, 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 outke 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 h four infections particularly that surgeon ises were worried about. They were [inaudible] hospital gangrene. And hospital gangrene, its weird. Medical historians, we dont like to retrospectively diagnose things. You know, when were reading records if someone says 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 explanations. T but hospital gangrene tended, i think its more akin to what we would call neck protizing fascitis at this time. It was a horrible condition which, of course, all of these conditionsns we suffer from tody 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 said the crimes of the sufferers are exhausted in the course of a week and die, or if they survive 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 thatth many patients had in thee hospitals. Actually, interestingly enough one of the worst records i came across wasntsn a hospital reco, it was a naval record. These 18th century and early 19th century naval ships had very similar conditions, as you can imagine, very unhygienic, very crowded, and when these kinds of infections twroak out broke out, they were very difficult for naval surgeons to control. A malignant appeared on the tip of a seamans penis, and i dont have a slide for this, and you should be very happy. After several days of agonizeing pain during which the wound blackened and festered, the organ finally fell off. This poor man is totally awake and completely aware of whats happening to his body. Thee surgeon onboard reported that the whole length of the urethra to the [inaudible] and also the scrotum leafing the testeesan barely covers, and wht was so impressive was the fact that the surgeon felt the need to underline the fact that the patient had died. Of course he died. [laughter]ho somebody should have killed him before it gotge to that stage. So this was what people were fighting in thisfi period, and t 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 theseth 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 thingsro today, just burn it do. I was in cleveland recently at the cleveland clinic, that huge hospital. Just burn itt down, just start anew. So things were reaching critical mass. No now, im only going to do reading from my book tonight just to give you an idea of my style and what you can expect in the butchering art, although i think youre starting to see what you can expect from this book. But i chose a passage from the deade house. The firstst time that Joseph Lister enters what we today would call the cadaver lab. Now, im sure that there are many people here tonight who are ini