Transcripts For CSPAN2 Lindsey Fitzharris The Butchering Art 20171202

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 burn it down, just start anew. And this, so things were reaching critical mass. Now, im only going to do one 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 its, i chose a passage from the dead house. The first time that Joseph Lister or enters today what we would call the cadaver lab. Now, im sure that there are many people here tonight who are in the medical profession or who have visited a cadaver lab themselves, if if you havent, you probably have seen one depicted on tv. I want you to imagine your experience in the cadaver lab, that sterilized environment, those frozen bodies, that smell of formaldehyde or whatever theyre using now to preserve these corpses. I want you to think about that because, of course, what Joseph Lister was experiencing was very, very different. These were bodies that were sometimes plucked from the grave. They were in advanced states of decomposition. They would have died from diseases like smallpox potentially. This is before mass vaccinations, before antibiotics. So a lot of people who entered the medical field actually died as a result of wanting to help these people. And thats very different to today. Of course, there are dangers of entering medicine today, but theyre far fewer than what they were in the past. So i want you to think about that as i i read this passage. The passage is about six, seven minutes long. Lets get it here. Light from a gas lamp illuminated the corpses line on the table. The abdomen hacked a away by the knives of eager students who afterward carelessly tossed the decomposing organs back into the gory cavity. The skull was sitting on a stool next to its deceased owner. The brain had begun to degrade days before. Early in Joseph Listers medical studies, he came face to face with such a scene. Five wooden tables on either side, cadavers were left with their incised heads hanging over the edges which caused blood to gather in puddles below. A thick layer of sawdust covered the floor making the deadhouse disconcertingly quiet to those who entered it. Not a sound could be heard each of my own feet, only that dull and rolling sound of traffic in the streets which is peculiar to london. Although University College of london and its hospital were still relatively new in 1847, its dissection room was just as grim as those found in older institutions. It harbored all kinds of horrible sights, sounds and smells. When lister sliced into the abdomen of a cadaver, its recesses turgid with a thick soup of undie jested food and fecal matter [inaudible] for a considerable time after one had quit the scene. To make matters worse, there was an open fireplace at the end of the room, making it unbearably stuffy during the winter months, and, of course, anatomy was very much a winter sport because bodies be kept better. Unlike today, students could not escape the dead during their studies and often lived side by side with the bodies that they dissected. Even those who did not live immediately adjacent to an Anatomy School carried with them reminders because neither gloves, nor other forms of protective gear were worn inside the dissection room. It was not up common to see a student with flesh, guts or brain stuck to his clothing after the lessons were over. The cadaver tested the courage and composure of anyone who set foot inside the dead house. James marion simms, an illustrious gynecological surgeon, recalled an incident from his student days, his instructor was performing a dissection one evening when he accidentally knocked loose a chain that was an to haved to the ceiling above the upper end of the table. The cadaver, pulled by the weight of its own limbs, jerked to the floor in the upright position. Just then the candle, which had been resting on the dead mans chest sputteredded out leaving the room in total darkness. The dissection room was a waking nightmare. The french composer and former composer persian rlios jumps occupant of a window and jumped out of a window and ran home. He described an overwhelming feeling of revulsion at the sight of the, quote, limbs scattered about, the heads smirking, the skulls gaping, the bloody access pool underfoot. And, again, i have so to stress that these are words from contemporary people. I do not have to embellish or exaggerate. These were their own words coming through the historical records. One of the worst sight ises, he thought, was of rats nibbling on bleeding vertebrae. The profession was not for everyone, can be also as a side note, i didnt actually put in the manuscript, but berliose becomes so accustomed to dissection, that he begins to pick pieces off the body off the cadaver and throws them to these hungry animals, and he thinks this is very humane, to field these poor animals feed these poor animals. For those wishing to continue with their degrees, there was no avoiding the dissection room. Far from viewing it as repulsive, most students embraced the opportunity to carve up the dead, and lister was, of course, no exception. Theirs was a centuriesold battle between reason and superstition, a chance to shed light where there was still scientific darkness. The anatomies was often hailed as an explorer. Only a half a century earlier. One contemporary wrote that through dissection the anatomist forced the human body to disclose its secret for the living. It was a rite of passage. Little by little, students began to view the bodies set before them not as people, but as objects. This ability to divorce ones self emotionally characterized the mindset of the medical community and, of course, does today. Darwin described a credible conversation between two medical students on a frosty christmas morning. Have you finished the leg yet . Nearly, replies his colleague. Its a very muscular one for a chailds. Nothing like dissecting to give one an an appetite. As medical students became desensitized, they also becamer rev represent, much to the publics horror. Now, these images, these are are late 19th century dissection photos. Theres a fantastic book out there that is a collection of these photos. Of course, photography was new and the students had fun with it, needless to say. So if that interests you, just google late 19th century dissection photos. [laughter] as one does, right . Everybody does that. Pranks in the dissection room were so common that by the time lister entered medical school, they had become mark of the profession. Some students completely overstepped the bounds of decency and used the rotting body parts of their allotted cadavers as weapons, fighting mock duels with the severed legs and arms. Others smuggled entrails out of the room is and secreted them into places where they could shock and horrify the uninitiated when discovered. One surgeon remembered curious spectators visiting the dissection room when he was a student, often received in their tail pockets free donations. But it wasnt all frivolity, and this is where i think things very much differ from today. Cutting open dead bodies also carried with it many physical risks, some of which were fatal. A professor at the university of glasgow addressed an incoming class with this dire message not a single session has passed over our heads since i was appointed amongst you that has not paid its great tax of life to the grim reaper whose sickle is never wary. Those who succumb to the matter made ultimate sacrifice in order to advance anatomical knowledge chose who survive suffered an illness during residency indeed challenges so great for those entering the profession that surgeon frequently concluded his lectures by uttering bleakly god help you all what will become of you so that gives you an idea of what it was like in the 1840s and there wasnt a huge amount of incentive really to go into the medical profession a lot of people ask is the this what was incentive this wasnt much money to be made unless you were the bug catcher. Although you could potentially make money if you became famous enough. And of course you were risking your with life as well. But if you made it through, your anatomy lesson you were led on to words, of course, the operating threat or became center to your experience. I like to show this this image to people on social media, and i like to remind them that it was called operating theater for good reason. You can imagine the hundreds and hundreds of spectators that crowded into these theaters bringing with them the dirt and grime of everyday victorian life. This was not a sterile environment by any stretch of the imagination and people that you see in these images arent necessarily medical students or even doctors or anybody who really has any reason to be there other than theyre cure use sometimes they were just ticketed spectators that came to see the life and death struggle play out on the stage before them. And remember that the victorians were obsessed with science and progress, so it wasnt always just a morbid curiosity even though there waseses pect to that. Thats why we all turn up these surgical shows on tv. But there was there was certainly an interest in what was being done the new progress that was being made in medicine at this time. The surgeon south remarked that the russian scuffle to get a place in the operating theater wases not unlike that or for a seat in the pit or gallery of a play house. People were packed like herring in a basket with those in the back rows constantly gus ling for a better view shouting out heads whenever they line of sight was blocked at times floor of operating theater like this could be so crowded that it had to be cleared before the surgeon could proceed as you see here theres men sitting right there right next to the patient that just is mind boggling with way that we obl perform operations today. Now these photos just keep in mind these are later 19th century so theres a sense in the photo theres a sense of germs in photo although it is foreign to the way that we run our hospitals today. But in the earlier period, you know, it was very, very different. Surgery was a facilitiy business fought with hidden dangers this isnt a surgeon but a butcher. But it does give you an idea of actually what the Early Victorian surgeons would have worn. They wore with an apron and it was so stiff with blood it was a mark of the profession the more blood the more operations you had done, the higher up you were in the hospital. And of course they rarely washed their hands or their strum ises because why wash your hands or instrument when is theyre going to get dirty again. You have to really get into this Early Victorian mindset because we know that germs exist and it seems so baffling to us today that anybody could think that germs dont exist. If youre going into an operating theater and youre about to operate on someone, and you had another patient after the person why would you wash your hands theyre going to get dirty again, and it was said that the surgeons carried around with them a cadaver smell of rotting flesh which those in the profession cheerily refer to as good old hospital stink, so so that gives you sort of an idea of this sight and smells. Now, it sort of i want to go into what i call the early butcher of course they werent referred to as butches but im calling them so early butches. These were the men who operated in a preantiseptic area tell you about three all three are featured heavily in the butchering arts, and all three play a huge role in josephs life the first one is had man named robert also by the way, have fun with the blood splatters that i put on flies i kind of went to town with them. I had a little interest, i almost wrote the book about him but the problem with him is that he doesnt actually push any transformative moment. So he wasnt, he wasnt man for this book. But he does feature heavily many it. Reason i wanted to write a book about him because he was a larger than life krk and 62 in Early Victorian pored and quite tall today. And it was said that he was so strong he use his left arm as a tourniquet i dont know why he didnt just use a tourniquet but liked to use his left arm he use his left article as a tourniquet and hold you down with left arm and take your leg off in under 30 seconds. Which is incredible feet known as the fastest knife in the west end. And obvious, speed was very, very crucial to a patients survival at this time. Because you could bleed out or you could die of shock. So with him was the guy you wanted to operate on you. Some of my favorite stories about zlitan one time he had a patient ho came in to have a bladder stone we remember steven from the start. So we know that that was an a awful operation it was really dreaded, and this patient got on the table. And he decided quite rationally i think that he was not going to go through with it. So he jumps off the table and he runs to the become of the room and he locks himself in a closet. And listen all 62 of him charges after this poor guy, and he rips the door off the closes and drags him back and removes bladder stone so that is dedication to your patient. [laughter] he survived he does survive able to remove stone in about a minute and a half. Which is pretty impressive again when we consider what poor steven went through with the overan hour operation so certainly you wanted to go to a surgeon who was fast at this time. Another one of my favorite stories about listen is he was so fast, when he was changing instruments he would put them in his mouth so [laughter] yeah. That was that happened. [laughter] not very hygienic at all again illustrates certainly how far we have come. He was moving so fast and he accidentally took off his assistance finger in the middle of the operation. Whoops. [laughter] and as he was change whatting instruments, he slashed the coat of a spectator, and it was said that the spectator died right there of fright. That the assistant died of gang green that the patient died of gang grown and teasingly referred to as only operation with a 300 mortality rate. So thats my guy listen he opens butchers art. He actually performs the very first operation in britain under ether so ether is discovered in america. A few weeks or months before hand, and it makes its way over to london. Now, listen doesnt believe it is going to work he walk into the operating theater and he often would say, time me gentleman, and you can almost here the ripple of pocket watchers in your minds eye as people pulled out their pocket watch to tile the great robert to see if he could beat his record. And he walk in and he says time me gentleman and he says hes going to try to yankee dodge because he believed that it was american crack rei that it wasnt going to work there were a lot of things that were not working at this time mesmerizing was around and it was a quack that went around hypnotizing patients. And it didnt always have to do with operations he would walk into these rules and women would faint and have them under his spell, of course, it didnt work and so hes rightly skeptical about this and he walks in says time me i am a going to try the yankee dodge and it does work. It does work, and what is incredible about this moment to me is if anybody here tonight has ever thought about the history of surgery which it is possible youve never thought about it quite frankly but if you have you might think of this moment. You might think about the age of agony being over we have conquered pain and of course this is very liberate for surgeons. So a lot of people think it was the discovery of eat tear that really ushered us into modern day of surgery but i would argue otherwise because what happens is surgeons still dont understand that germs exist. But theyre more willing to pick up a knife and willing to go deep entire the bodies than they did before and as a result these operations become slow moving executions. Post operative infection rises, sky high and it just becomes a much more dangerous period. And what was credible about this moment and in december 1846 when he performs first operation o under ether in london is that a 17yearold joseph was in the audience that day. Joseph witnesses this monumental moment, and he is the one who really ushered i believe surgery into the mods earn era by applying germ theory to medical practice. So he is very much in the book next one i want to tell you about this is this guy named james who becomes fatherinlaw of joseph hes up in scotland hes the cousin built very differently, though, and short and of surgery and he gets in a weird fight again about the tourniquet he says just use a tourniquet and he says no use your arm and they never talk again so very, very weird thing. 19th century was a weird place, but needless to say, he was up there. If theres any people in the audience tonight who are medical professionals or surgeons themselves, you might recognize the naming because theres an operation that is still done today that bares his name. He was able to invent and perfect a technique to remove a diseased foot at the ankle joint. Now before im calls along if you came in with a diseased foot you would lose your leg below the knee and reason why this was problematic is because again remember that peoples livelihoods were connected with their ability to move. There were really no social nets to catch people if you couldnt work. So removing your leg undermete the knee, of course, affected your mobility a lot greater than if you just removed foot so he invented this technique uses this and bares his name if you think he was fearless he took it to a new level in 1828 a man came to him named robert penman. Robert had been suffering from a facial tumor for the past eight years. Now a lot of time when is i show these kinds of images to people, the first question is why . Why would they let it go on so long . But remember, this is precertainly preantiseptic and people died when they went to visit surgeon and there was a lot of fear about going into these hospital os or even just going to consult a surgeon. And in 1828 he goes down to london first to see robert the cousin because he had just made a name for himself by removing 45 pound tumor a 45 pound tumor in under 4 minutes it was an incredible feet the guy survived and you wonder how did this happen but it did so he was famous at this point he goes down to see listen and he say hes not going to do the operation. This was out to a death sentence at this time. Because, of course, if hes not going to do it who will step up and do it . Well, he goes up to see james and he agrees to do the operation. For 24 minutes he is sat in a chair and hes restrained and sime kets cuts away at the tumor and a lot of patients were actually sat upright before anesthesia and that was they werent sat in chairs like what we think but they were high so your feet dangling so you couldnt brace against the knife or surgeon so he was sat upright this tumor for 24 minutes was cut out of his face it was thrown into a bucket at their feet and he survived. Amazing. I mean i cant even have a tooth i cant have a dental cleaning without some kind of novocain so it does boggle mind when you think about what people went through, and actually he ran into penman many, many years later and he was so pleased that penmans face didnt really bare scars it was covered under a beard, afound a picture of him and there he is. [laughter] i showed this picture to a friend without any any comment and any friend said well thats a scary looking guy. Hes kind of like an ugly Abraham Lincoln. Not that Abraham Lincoln was a looker but there he is and clearly, i mean, theres something amiss about his face. I think we can easily say but that said when you consider what he looked like with that facial tumor and fact that he was literally probably months away from death, it is incredible that sime was able to save his life. He feoffs heavily in the book as i said becomes the fatherinlaw, he reinvigorates a passion in surgery after he has a mental break down and his brother dies of a brain tumor and he leaves medical school he doesnt understand or know what medicine could do for people. And he he learns to love surgery again with him so hes featured heavily in butchering art. Last one i want to tell you about is guy name ad John Eric Erickson one of the instructors at ucl and hes kind of famous amongst medical historian for saying that surgery and a 1840s had gone as far as it would ever go that surgeon knife would never go any further and incredible when you consider where we are today but you cant blame erickson because he couldnt conception allize when operation would be under control. Now one of the stories that i want to share with you tonight o about erickson that i think really illustrates hour different it was in the 19th century and how much his own work transforms surgery, i was doing a prerecorded interviewer for npr all Things Considered couple of weeks ago with Robert Stegall and i told him a story he loved it. But i heard his producer laughing in the background and he was like you cant say that. So you can see it here tonight and so does cspan unless they cut this out as well but story is erickson had a patient come into the hospital he was a medical student he was attending, and this wol woman had puss and blood into her chest and he had cut into the neck and it begins to spill out and he decides to lower his mouth on to the wound and begin sucking out. Kind of like a weird vampire story for halloween. So youre welcome. He does this three time and sucks this puss and blood out of her neng and im a historian i have to stick to the facts really they should have all died really the infection and the way that surgery sorry diseases were spread at this time it just again, its just mind boggling to me as i go through these records. Now, my book is about joseph and i like to tell people that my story is a love story between science and medicine. He was the first to take a scientific principle and apply it to medical practice he took louie germ theory and applied it to medical practice through development seated there to the left he was a quaker very quiet individual, and he worked tirelessly at what he did to get people to accept germs and in im not going to tell you too much about him which might seem weird because my book is about hmm but i want you to pick up butchers art and how he figures out the mystery, and how he navigates this grimy world and he isnt the only one. A lot of peoples work that is going on with the Hygiene Movement that hes building upon. And asking questions. But he is the one to apply germ theory specifically to medical science of course he received a lot of backlash it seems qeerd to us today. How could people not believe in germs . Well imagine this young man comes along and he tells you there are invisible creatures that are kill your patient a time before the microscope was used in medical practice. It was seen as very suspicious, a lot of doctors believed that it would make for lazy that you would stop using your eye or trusting your own sight. And also the orr part of that was that had it essentially was tell these older surgeons that they have been killing their patients all along. And you know, i have to say its sort of funny and bigger than life all of this seems because enough time passes seems to different from our own reality you have to remember that, these patients were real. These surgeons were real, and these surgeons often lived and died with their own failures as well. Imagine going into the operating theater, day in and day out wanting to save someones life and you keep getting same result so it was a hard pill to swallow for older surgeons certainly that they were killing their patients. But i want you to read the butchering art i want you to figure out how he navigates navt world o theres no better way for me to illustrate the transfer that did happen. This is cover that youll see if you buy the book tonight which i hope you do. This is a very famous paipghting from a 19th century by a man named thomas. This is called gross clinic not because it is gross although theres an element of that. [laughter] but the man in the middle is samuel gross he was an american surgeon and he so didnt believe in germs he so didnt believe him that he would walk into the operate oing theater he would slal the door, and he would say there his germs cant get in anymore. And you definitely see that playing out in this image. There he is in his street clothes. Hes sticking his dirty fingers and instruments into this wound theres a woman to the right of him who is shielding her eyes someone told me thats his mother i have no idea why he would bring his mother to this awful, awful operation what a jerk. But this is paipghting that you can see payments this is in philadelphia and that is the u. S. Cover. Now the book is being published in 15 countries around the world. And one of the the u. K. Cover is this. We used another painting this was done within 10 years and as you can see stylized by my publisher but you can get the sense of the 19th industry as you can see it is still foreign to the way we operate today but there has been a transforms. You get a sense that the people here understand that germs exist, their wearing white theres some kind of form of cleanliness women are starting to appear in the operating theater. Alongside the men as well in the profession. So i love that these two covers are in kftion. Conversation. Now the last thing i want to leave you with before we hopefully have a lively discussion because i always love hearing peoples questions about this period. It really helps me as well with my own research. But before i do that, my friends i was in the u. K. Despite this very chicago accent, and im glad [laughter] that i wasnt with introduced necessarily as a haley all the way from london because then i can never recover when disappointment comes and my american accent poor forth but i do live in london lived in u. K. For is 15 years i have friends o are movie makers one of my friends alex and i decided to get together and do a book trailer it is not something many authors do o. I originally said lets just, you know, do something fun, and simple and it just became this crazy basically mini movie we have the principal camera man from game of thrones shoot it and we had actors. It was so much fun and for me as a writer i very much tried to bring the threl to life to words and so it is just such a pleasure to see it come to life in a brief moment in a visual way so i want to leave you with a clip that is five minute and im superproud of it i cant claim i did much it was mostly my movie making trends they did a bril i dont job and i hope that you enjoy it as much as enjoyed working on it. Bear with me a second as i there we go. The wound i need to cut it off. [screaming] you come in. He died. That doctor we operating upon last night. Died half an hour ago. Well, unusual no. Thats the thing had of it, isnt it . Its odd. Dont you think giving bodies remarkable inclination to heal itself you dont think it is odd why when we give it the opportunity . We take away disease. We afford it the changes to grow strong again. Why do they die . Throw them no. No not in so many too many are dying. These are strong men, james. Men who lead harder lives than you or i could tolerate ship the toughest breeds in the land, no. Its more to this than trauma there has to be more to it than that. Something hidden from our understanding. Supernatural monster [laughter] i dont know. Take a peek. Hey, we might have to burn the hospital down triplet. Come on. I dont to be late. Monsters. [inaudible conversations] james we thought we were helping in the making of history. All right coming to a theater near you right i was really pleased with the way that cam out. We were really lucky we got it shoot it on part of it in a place called old operating theater in london if you ever get to london it is an amazing space you have to navigate pretty scare stairs these operating theaters exist they exist in attic and need skylights to operate but we were lucky to use that beautiful space, of course, he had to do the bloody operation in a film studio because there was no way to throw all of that blood and maggots around but we had so much fun doing that and i hope you enjoy that. You can find that on youtube series under the knife and i would love to take your questions now about this period also theres a mic up here. But if you if people start making themselves to the mic but ill start with your question and repeat it so people can hear. Yeah, you. Yeah. Who introduced scientific nursing whether she was influence and i was wondering blood transfusion how could you have operation any survival even if you knew the theory without blood transfusion . A really good question so the first question was about florence in the butchering art. Of course she was working in parallel with what he was doing and driving a Hygiene Movement. But its a strange thing because a lot of people think of her but she didnt believe in germs at first but thought he was hysterical and that we didnt need to quoit go that far we needed to basic level of hygiene also doing interviews arranged country there so manies to be a lot of groupies out there and a lot of people get angry that i havent mentioned him in interviews. He is also in the book hes an austrian physician you might know him back because he was putting together this idea that if you wash your hands, that you could reduce post operative infection and of courses he was right. But he ends up dying in a lunatic asylum they call him hand washer ridiculed by colleagues and difference between him well number one lister convincing medical community so keep in mind again that there are people l doing stuff. But if their work isnt known or accepted theyre not one who ultimately try on, so to speak, other thing is hes putting together this idea of hand wash and post operative infection or infection in general in the hospitals he doesnt yet know the agent by which disease is spread. And so thats where lister comes in hes taking the germ theory and hes making those connections. But of course no scientific or medical achievement is done in a value you mean so a lot of these people are mentioned and how they influence or dont influence lister. And very surprising ways and the second question was about blood transfusion how could you do these operation os if people wrnght one of the first blood transfusion i believe in the 17th century and someone took the blood from a sheep or a lam. And idea that it was pure and work and it did not spoiler alert it definitely didnt work. And these speerts experiments are going on but this is a much Later Development but remember if youre someone like lister taking off someones leg, it quickly enough and tieing off arteries they have these lings hooks that would pull down the artery and veins to tie them off very, very quickly. You could potentially have a chance of surviving. It was often said too eat or coming along there was this idea that you needed feign to survive the operation because the pain or the adrenaline as we would know it kept you going. And so there was a idea that ether would make surgery much more dangerous because patient wasnt awake and wouldnt stay alive through it. But those are great question, and theres so much theres actually a really wonderful book by a woman named holly tucker called blood work the history of blood transfusion if that interest you. Yes. Im doctor john well and i introduce myself to you earlier. I im Infectious Disease specialist but i also have unique perspective on this because last 20 years ive been reenacting army surgeon and ive actually done many, many had simulate haded amputations using his knife even. Not a sharp one. But but i wanted to say that one of the things that another legacy i would say of of lister in well my other medical hero as you mention is the introduction of the rubber gloves and to surgery and reason thats lister is indirectly responsible for that is as you know he introduced the use of carbolic acid for surgeons to medical personnel to wash their hands with and surgery. Well in hopkins in 1980s dr. William the father of modern american surgery had his scrub nurse later became his wife Carolyn Hampton and hands and forearms becoming destroyed by that acid so he went to goodyear and asked if he would devise a pair of rubber gloves to be sterilized because he didnt want his girlfriend to have ugly forearms rubber gloves. Lister actually is the carbolic acid what he used it did corrode his hands so much that he had this habit later in life to put his hands in his pocket os of course he was praying operate oing theet we are something he called donkey minimum wage to spray the air but to go back to what you said about lister knife he did create a knife which was later known as the lister knife used by jack so another little halloween fact for you right there. [laughter] which led to rurals that he might have surgical training as well. Lister was weird about his instruments used to put notches in handles every time he removed a leg or a limb. And he had used to keep them very close to him, so he kept them warm i have no idea why he felt, you know, that the warmth was going to be comforting to patient when the horrible steel was going through their leg anyway. But it was one of his strange habits. I havent read your book and i would say i highly recommend it to the audience. [laughter] you heard it here tonight. Any other question . Come on there must be some questions okay i see a hand out there. Do you think you can ysh yep a remote but i picture this all starting with leelan and seeing germs. I was talking about earlier microscopic work in 17th century and, of course, that that does that does play a big role the microscope is a huge part of the butchering art. And the reason that lister seems to be particularly receptive to germ theory is because his own father was a quaker he was interested in science and he used microscope a lot so he grew up around microscope looking through the lens and all of this was building upon earlier work from started in the 17th century, 18th century. And so when lister goes to medical school in the 1840s he carries with him this very strange unusual instrument, the microscope, and thats why hes particularly receptive to scientific ideas. Again, a lot of that is in the book and certainly important to acknowledge that microscope has been arranged for a very long time by the time lister begins his work. But again it was it was really seen as suspicious in medical practice at this time. And doctors really fought using it in their practice. Other questions any other in the balcony. I heard you guys up there a little terrified about what you just heard. Yes. Theres a question right here. [inaudible conversations] so one about the role of alcohol and anesthetic and antiseptic and other wonder if that played. So she asked about role of alcohol theres sort of this myth that people, that patientss were wildly drunk and therefore they didnt feel anything, of course, alcohol thins blood you dont really get too many actual counts historically of patients being given alcohol on if someone else asked me they had heard that, that surgeon punched a patient out first of all can you imagine you have to be really good boxer to just be able to knock someone out on the first punch and secondly that could cause so many other problems with a patient. So that definitely didnt happen. I can pretty firmly say. Alcohol uses an antiseptic there were people using antiseptics before lister cools arranged with carbolic acid difference is and i stress this in butchering art he comes up with a method not only a method but he has a reason for doing it which is germs. And until then it was just sort of used half hazardly sometimes maybe angst septic dabbed on instrument or patient but not systemic way to both prevent and to stop the spread of infection. And the second question remind me again sorry that was about tv and consumption in listers time on tuberculosis called consumption deemed to be incurable if you went into the hospital you were turned away. Theres nothing really there are the only disease that i can think of off the top of my head that affected lister ideology and method and what he was starting to think was cholera because jon snow . 1840s puts together this he solve this is mystery about how cholera is spread around london and he identifies the source as being this pump. You can actually see the broad street pump in london today and that really started to lead to questions about how disease was spread because before then people thought that disease was spread through bad smell and cholera, jon snow discovers really threw that into question. Theres a book called ghost map which is also a fantastic history tale all about the cholera epidemic and some of that is in there but as far as consumption i cant really theres nothing that specifically affects lister narrative in that. Yes some questions up there. Yeah you in the middle, yes. Like to say yeah so thanks. Kind of weird see people why didnt they cut a leg off and saying modernization and to stop bleeding that did certainly happen some surgeons use that. Everybody tended to be a little bit different. Obviously burning the flesh also caused a lot of problems which could lead to infection as well. There was really no easy way theres serge was no straightforward way to prevent post a are ative infection and say that a wound healed sweetly which meant it didnt heal with any infection or it healed sourly. And it was so common that wounds would develop puss and separate that they called it lottable fuss that they thought it was necessary to the healing process thats how common it was at that time but cotterrization it happens i think cause other kinds of issues to the tissue and so lister is not specifically doing it but usually sog up in his hospital but it was certainly beginning on at this time too. Yes. Sorry. Civil war also attacking wounds with dirts in civil war. No surgery in civil war remember that my story is a british story so things are developing slightly different over on the side of the world for other kiengdz of reason ares. There you go so nothing good was happening in america. It always surprises me [laughter] might still be said today. [laughter] but but yeah lister in 1876 and you think that surgeons would be receptive to it because of the civil war and because of the mass infection rates they were experiencing but theres a lot of resistance here and again you know some cities adopted in mearng some dont, and theres no sort of one mommy where everything changes. Unfortunately for the purposes of my book, you up there youve had your hand up for a long time. Sorry i was talking to man right behind you ill come to you next, sorry it is hard i have a spotlight here but ive seen your hand was up for a long time. Why is [inaudible conversations] [laughter] and number two we solved it they should bring the ax back. [laughter] that life of new york at the hospital. So the first question was about how did they not come up with faster ways because 30 seconds wasnt fast enough for that man up there. But no, the ax actually that you know i never really come across a suggestion in medical records but my friend is raven master at the power of london he tells me blood tales about tower hes a beefeater an amazing person and he told me when beheaded with an ax it wasnt meant to be sharp because it would get stuck in the block and it was really weight of the ax that took the head off. But the executions were not straightforward by any stretch of the imagination. An ax is a very unwieldily thing to move arranged so i imagine that, you know, swinging an ax people were get their fingers chop off and ax may have been a little step too far in taking a leg off. I dont think that would have worked too well. And to your your own question the nick, yes. An amazing show if anybody hangt seen it. Its such a great show what i really like about it too is it shows the demons that a lot of these surgeons were suffering from again this idea that your patientses are dying time after time it must have been very frustrating and always keeping in mind that people were real. That story the nick, though, at the turn of the 20 9 century so my book takes that audience back 50 years to an even grimier more dangerous time. And so i like to tell people that its if you like the nick this is an even kind of grosser aspect of that. Story [laughter] and yes and you and i cut you off before. [inaudible conversations] thats a really good question about the relationship between military medicine and the development, and spread of antiseptic methods, of course, military medicine was really important to a lot of discoveries because youd so many patients. You know dying in these wars and there was a lot of experiments going on. Its listers how did you he he most he cant get to older generation so he goes to Younger Generation he is teaching students and they go out into the world and they spread the gospel of antiseptic and i kind of call it like the gospel because he very much like created will a religious atmosphere around it like they would have this procession and bring in the donkey engine and they would spray the air and they would clean everything, and there was a real sort of almost show to it and it was really younger surgeons that within the out there, and were able to spread this message around. But yeah theres theres a real connection between medical advancements in the earlier period and what surgeons are doing in the military to treat these these patients the crimean war feoffs in the art and lister doesnt fight it because hes a quaker and hes not allowed to treat patients in the war, and as a result he lives actually all of his colleagues end up dying hes promoted faster through rings and thank goodness for that so, i mean, you think about how his return on a dime and what would it have been had he gone off to war and not been a quaker if yes right there. Sorry [inaudible conversations] [inaudible conversations] show asked what the proportion of patients were coming to surgeons for trauma, versus cancer or other kiengdz of internal problems. Actually surgeons at this time especially in the early 19th century really only treated the outer part of the body now of course you get Breast Cancer with the tumor is protuding and breast needs to be taken off. But this is still considering treating the outer body. Physicians on the other hand treated inner body with that internal medicine and physician were better respected they were men who used their minds rather than their hands. The surgeon was like a craftsman often trained u through apprenticeship, and his he could be illiterate depend on master skill so really theyre dealing with outer body theyre dealing with boils and thing like that. And its only later that medicine and surgery begin to unite together and, of course, now the surgeon is at the top of the medical hierarchy. Right there. All of is this suffering was there oh. Interest question she said with all of the suffering was there euthanasia nothing that ive come across in these records. But certainly theres a very sort of famous story of 17th century surgeon 16th or 17th early surgeon perry, and he is fighting in a war. And he goes into a barn and theres these soldiers if i can remember correctly soldiers who have been very badly wounded. And hes looking at horror at these men, and suddenly another soldier cools in walks up to three men and splits their throats. And harry says what are you doing . You know, and confronts them and he says i hope if i ever am in in position someone is as humane as me and ends my life. So you do kind of get stories like that. But nothing systemically certainly at this time. Start to take the place much resistance it that it than there was so when he took the place actually you might be surprised to find out that lister was against that. So that is germ free where that is germ fighting he never envisioned hospital to be the feet entirely of medical practice, of course, he thought that people would continue to be treated in their own homes to some extent so it wouldnt have been practical and he thought almost dangerous to kind of have this romantic notion that you could have a germ free environment. There is a very natural move from that to asepsis once that is accepted and begin to be more practiced late 19th century of course thats what we strive to practice today. But yeah its qeerd that he definitely vocally reaccept asepsis so yeah back there. Talk about lister kind of spreading this as a show. How much data did he have and mortality rate and get people to buy into this . She asked about lister data and convincing surgeons it is such a great question this is sort of on the cusp of medical statistics. Still being developed at this time lister is one with of the first scientific surgeons hes collecting data hes publishing it. But not necessarily on large scale that we, obviously, do today, and he publishes a series article it is in the lance and these articles are not just about his statistics its about showing the surgeon how to do it. So it is very much like looking over his shoulder and hes explaining how to do it. Hes so scientific in his meths hes always changing. His methodology which opens him up to criticism at this time because a lot of surgeons say well you were wrong the first time youve changed your mind. How will we to know what any of this is if you keep changing your mind not realizing thats how we operate today, of course, were refining and fine tuning our meths thats how list or did it but theres a lot of data out there in butchering art as well on data that he was showing surgeons buts it was a hard, it was a hard, long road to convince them that this was working. And remember again, like he was essentially slowing everybody down because these methods instead of being fast in an operating theater and just moving patients in and out hes asking them to do very particularly slow moving thing like washing your hands, instruments theres a whole method to it that really just slowed everything down that i think a lot of surgeons found irritating. In comparison to how they were used to operating at that had time. You there. Garfield was shot 81 and shots died of the infection, and doctor refused to clean with the hand. Was there any fallout from the fact that president of the United States died from infection or do people not recognize that . So asking about president garfield who is fascinated in 1881 said that he that his had assassin said he shot the president but his doctors killed him. Because his 12 doctors stuck their unsterilized fingers and instruments into a wound and septic and takes 80, 90 days to die and loses 100 pounds during this time and it is just really awful im glad because it allows me to tell you about garfield house which i visited a few days ago a site and i came across it because guy who runs site is so passionate about James Garfield, i mean, he can remit anything on my social media to James Garfield i can put up did you know that james i dont know how he does it. Its his had magical power his name is todd hes so great. And he runs this beautiful site so if you have a chance to get to ohio do visit it. I went there because of this story that you told it is very relevant it is not in the butcher art because theres a wonderful writer named candice who wrote a book called des thy of the republic that deals with garfield assassination but youre right youre right to say why . Why did this happen . Lister comes to america and 1876 surely doctors and surgeons accepting germ theory but, of course, it is slow to be accepted and certain circles thats not to say i think its Massachusetts General Hospital the first to actually adopt antiseptic technique that what is shortly after lister trip so it is happening in various hospitals but unfortunately for James Garfield his doctors did not believe in jerls and he does die this horrific death do check it out o. Check them out onis line too because the guy is hilarious hes so passionate about James Garfield it is worth it. [laughter] yes. Women in the operate oing room a link between hygiene and full hard questions that historian take their life to she wants in two minutes the answer to the appearance of women in the operating room and of course you start to see this in second painting that is such a good question on and one that i dont i have to admit i dont fully deal with because it is happening separately to lister. Lister actually is very much against women entering medicine a little bit of a flaw of his. But he cant foresee the victorians were very much like that. Florence revolutionizing profession before then seen as inproarpght for a woman to go into nursing because she would be pretty to the male body almost akin of prostitution in earlier periods and, in fact, when you come across the term nurse, this earlier records it usually is referring to a nurse nursing a baby. Someone who is nursing a baby. So she certainly and theres so many books about this she make it is a respectable profession and she runs her nurses like an army almost. And she really elevates women and so thats when youre seeing there. But lister didnt have much to do with it but youre right to think that florence triumph also led to an acceptance ultimately of that because hygiene was a big part of her crusade as well and theres a huge Hygiene Movement in 19th century lister triumph so much that you dont just get listerine but or carbolic acid mania one of my favorites favorites is avon lady on mary kay kit that you can buy, and you can go around and you can remove your neighbors hemorrhoid with carbolic acid. [laughter] which seems really dangerous and painful and not at all a good idea so lister he kind of gets annoyed by all of this he lives in his own fame and wasnt looking for the fame and so many of the people ultimately arent yeah theres so many that is at the end of the book about crazy things that cool out of the carbolic acid mania. Right here. One more sorry im told one more question and then is i will be signing books so please do come to chat with me. I would love to hear to continue the conversation. Yes. Yes. Lister thats a goods one to end on what is goriest art fact that i have interacted with. I think that book is pretty disturbing but they do look like leather so theyre not just because you know that theyre human skin. But there are so many specimens the museum i did my book launch at the museum an amazing collection they have the weirdest stuff like a piece of John Wilkes Booth throat in the collection which is Pretty Amazing but nothing really nothing creeps me out but fascinates me. But yeah i suppose the book on human skin i should admit that is unsettling on some level. One of my favorite instruments from the Museum Collection is clock work saw it i like it because it was a massive failure and i love failure in general. Because it informs success and it is something that i think that we ignore especially when were talking about scientific and medical achievement the clock work in 1 9th century you wound it up, and then you let it go and it was supposed to just spin continuously. Seemed like a good idea until it just took off this guys i think ers and they decided maybe were not going to put this into production pep and theres only one in existence in london i did my youtube series called under the knife i did the First Episode ever on the clock work thought and my friend alex we have a lot of fun and we do way top than we should for youtube recreate new stupid videos and we made it look like the saw spun of a the desks and we have to rebuild clock work with saw that was fun and thats one of my favorite instruments i love failure and talking about failure in medical history. So if that interest you also check out my blog the surgeon apprentice. Thank you guys so much im looking forward to meet you out there. [applause] [inaudible conversations] oh, no heres a look at the some of the best books of the year according to publishers weekly. In ants among elephants describeses her Family History and upbringing in india. Peter curator of religion at Smithsonian National museum of American History recalls the life of william, a photographer and a post civil war america known for his spirit photography in the a City University of new york professor Ashley Dawson explores how cities could be affected by Climate Change in extreme cities. In fear city, New York University kim thrips fine recalls the fiscal collapse of new york city in 1975. And how the citys brush with bankruptcy reshaped ideas about government. And wrapping up our look at publishers weeklys best books of 2017, is the color of law, richards reports on how local, state, and federal legislation is responsible for americans segregated cities. Today those homes sell for 300, 400,000 heres your question. The africanamerican family who prohibited from moving into those homes rented apartments in the city did not gain 200, 300,000 in equity over o the next two generations. White families gained that equity from and today those holes are unaffordable to working class people. 100,000 in 1940 in our materials in 1947 was twice National Media income working class families couldnt afford to buy homes for twice the income with fha mortgage today those sell five times National Media income, working class families and you all know this middle class families kangts afford to move to those suburbs that were credited in enclave in 40s and 50s. So today nationwide, we have a a ratio in income africanamerican income on average is about 60 of white income. Africanamerican wealth is 5 to 7 of white wealth most families in this country gain their wealth through housing i could. Equity this enormous difference between 60 income ratio and 5 wealth ratio is almost entirely attributable to unconstitutional federal housing policy to practice in the 1930s, 40s and into the 50s so wealth gap is attributable to this. Some of the authors appearing on booktv watch them on our website booktv. Org. Andrew jackson why is he special . Stunningly orphan at 13 older brother in the revolutionary war and other brother taken prisoner, the older brother had one year older at 14 dice because of his wounds suffered after his capture jackson and mom are left. Jackson mom goes to help an aunt next thing you know she dice how does he know . Because a trunk arrives at his house with her stuff in it. So at 13 years old, about Andrew Jackson is raised by his county his country if you want a guy who is patriotic you saw what the country did for him he saw what everyone did so he could successful and he wantd revenge and pay become to his krkt he bled red, white, and blue so what did he had become . Instead of an excuse to become a rebel and criminal he became a attorney general in 1971 and elected house to representatives in 1797 to senate served as judge from 98 and Major General and add last thing to his resuee two president of the United States are to me i think will resonate i hope it does because this is the american dream. When you talk about columbus and when you talk about jackson to me not because hes perfect but because of what he accomplished in every way. [inaudible conversations] hi everybody. Thank you so much for being out here today on this beautiful saturday. My name is emily and im the manager here at politics and