Transcripts For CSPAN2 Lindsey Fitzharris The Butchering Art 20171210

Good evening everyone. Can anyone hear me well . Good. I am mary mclaughlin, a program coded with the Smithsonian Associates and i like to welcome you to what is promised to be very perfect halloween evening on the crucible of the victorian surgery. Before we begin risley like us everyone to check their cell phones and make sure they are silenced. Im also like to let you know that this program is being filled by cspan to be aired at a later date, so if youve enjoyed tonight program and would like it again, or if you think your friend like to see it, you should check over the next few weeks cspan and see if it is 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 doctor lindsey fitzharris. She tells me as a little girl shes to drag her grandmother trump cemetery to cemetery so that she could hunt ghosts. So some thought she was obsessed with death from an early age. Like to think you simply fascinated with the past, and with the people who lived there. Thats beginner lifelong obsession with history. Dr. Fitzharris received her doctorate in history of science, medicine and technology from the university of oxford. In 2010 she granted a Postdoctoral Research fellowship by the Wellcome Trust which is a medical History Collection in london. She is the author and creator of a popular website, the surgeons apprentice which has received over 2 million hits. She is also a writer and present 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 uk including the garden, new scientist, the huffington post, and medium. She has also appeared on cbs, bbc and national geographic. After debut book, the butchering art which was just publish worldwide on october 17 and a witch tonight 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 the Smithsonian Museum shop at the interest to the lecture hall, and dr. Fitzharris will be happy to sign copies for you at the end of tonight program. So with that said we will get the program underway. Please join me in getting a very warm welcome to dr. Lindsey fitzharris. [applause] thank you for that lovely introduction. Its true, my grandma and i used to come we still go from cemetery to cemetery. I dedicated the book to her and she is my biggest pr campaign or other try to get this book sold. I am so excited to be a tonight at the smithsonian to talk about the brutal and bloody world of the twin surgery, and im so honored that so many of you would come out on halloween night that you give up your halloween night to learn about what it was like to be a patient and the surgeon in the Early Victorian time. Given the fact its halloween, before i get into my talk i want to start with a hollow greendale and its related to what i view as a medical historian. It was halloween 1828 and the one in scotland was murdered, and it turns out that she was the last victim of 16 who were killed i William Burke and william harris. They were bodysnatchers in the 19th century. I use term loosely because they did this to any bodies. They just kill people and they sold those bodies onto the surgeons of the time. There is a great need for bodies because this is a time before people willingly gave over those bodies to medical science. They were apprehended in 1828. At this time theres a a weirdw in britain called murder act unnumbered acts decrease any murder not only be executed for his crimes but also be publicly dissected. In an ironic twist burke in support of a table he had sold his victims onto at that point. This is collect the 19th century and, of course, they have to kick it up a notch. It doesnt end there. Was enough just to execute them pick was enough just to publicly dissected. In fact, they took his skin and the greater all these various trinkets which the then sold on to a bloodthirsty public. One of which itself on display in surgeons hall in edinburgh, a pocketbook bound in the skin of William Burke. I have held a it has been dna tested it feels like leather. It smells like leather and this practice was so, in the 19th century it at the term called anthropogenic bibliography. Its binding books with human skin. It wasnt always related to criminal activity. Sometimes surgeons doctors took the skin from cadavers and the bound medical text with it. If this is something that interests you one of my friends is working with my publisher on this very subject so be looking for that book. I am really excited to see with the book cover will look like for that book coming up. Anyway, i am so excited to talk about the brutal and bloody word of the joint surgery. Im going to run 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 type if you come away from this talk or if you read my book and you think it might even find a live in the 19th century, i have not done my job. Let me tell you we are very, very lucky to live in the 21st century, like you not to have to endure the horrors of preantiseptic surgery, like for 12yearold henry pace. Its going to get bad. I hope cspan is ready for this. For c12 12 euros henry pace was brought in, he was told is going to have to have this leg removed without any anesthetic. When he was told this he asked the surgeon was it would hurt, as children do the assertions that it would hurt no more than having a twofold. Henry pace was there and prepared for what was to come to you was brought into the operating theater, blindfolded, restrained. He was still awake, still loose. He remembered counting strokes of the saw before his leg fell off. We are so lucky not to have to endure at the horse of preantiseptic surgery. I i imagine cspan will blur this one. Like poor stephen in 1820 he 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. Theres a lot of detail in the the butchering art, that might be an incentive or deterrent even know who you are but you been fairly warned. 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 this in front of hundreds of spectators. Thats exactly what happened to stephen in 1828. What should of taken five minutes ended up taking over an hour as stephen struggled against a knife and tried out for the surgeon to please, dear god, stop. And the surgeon shouted back at him that he had a weird anatomy. So you can imagine this struggling scene. It was horrific. He pulled through that die 24 hours later of an effect. That is something features very prominently in the the butchering art. Was revealed on his autopsy report that actually he had normal anatomy and it was the surgeons fault. Let us not forget poor lucy who in 1840s had a mastectomy without any anesthetic. Lucy had this operation in her home. Im going to take by these Early Victorian hospitals but a lot of times the wealthy and middleclass were treated in their home. The surgeons didnt tell the windows going to happen. He told her she needed the operation but it wasnt going to tell her the day because he thought she would focus too much on it. To me that would increase my anxiety. I would want to know that i would want to prepare. He just shows up one day. He walks up the stairs into our bedroom. He opens his hand and shows her the night is going to use and he tells her to prepare her soul for death. This is not very confident inspiring. Im really glad surgeons dont tell us to prepare our souls for death anymore. But, of course, that was necessary in the time because many, many people die. She prepared herself for death but she couldnt prepare for the pain that was about to. Lucy ended up surviving operation. She went on to live a very happy and healthy long life but she wrote to her daughter about whar i want to share that in a letter. She said then came a gash long and deep, first of one side of my breast, then on the other. Deep deprive me of my breakfast. This was followed by extreme faintness. My suffering for no longer local. There was a general feeling of agony throughout my whole system. I felt every inch as though my flesh was fairly. On recollection of the clips i happen to have was the doctors right hand completely covered with blood up to the very rest. He afterwards told me of one time the blood from an artery flew into the ice we couldnt see. So just when you thought things couldnt get worse, now the surgeon is blighted. And she into the letter by saying that it was nearly an hour and half that she was under his hand. An hour and half while he cut away at her cancerous breast. We are very, very lucky to live in the 20 and, of course, we always you to get 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 focus about a surgeon in Joseph Lister, this man by two. Mr. Is known as the father antiseptic surgery. He took the germ theory and he made it to medical practice the development of antisepsis. He saved thousands of lives in his own time and he continues to say peoples lives today because we operate with the knowledge that germs exist. I was excited to start philadelphia because whipple came out on october 17 it was just 135 years ago to the very day that lister came to america to convince american surgeons the existence of germs and of the need to adopt antisepsis. Im going to get a little later tell you about that trip more but there are a few plantings again out of this trip. If youre familiar with lister, it might be because of this product listerine. There was a man in this when he was in philadelphia and this man was inspired by the lectures and excited great this wonderful product that we all know and love today. Wasnt originally a mouthwash. Was just a cure all antisepsis. Effect is most commonly used to cure gonorrhea. So im just hoping to argue with a bunch of random facts that you can horrify people with lid at cocktail parties. If your into it, you go up and julie to some some and there into the it you know you foundr people. But listerine, gonorrhea, sure listerine today would not likele me telling the story but that man in the audience that night. Another man in the audience was named Robert Wood Johnson and he was inspired by by mr. Indica together with his brother to greet the Company Johnson johnson. The first thing to produce or surgical antiseptic dressings. This pamphlet, if you ever come across with at an antique store do that when. They were produced in the late 19th, only 20 century by Johnson Johnson. They are can liken idiots guide on how to operate on your own 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 teach people. That all came out of listers trip. I was very, very excited to be in philadelphia. When mr. Got to philadelphia he took a train trip around america, and he went all the way to the west coast and is trying to convince americans of the existence of germs. He was very much on a mission. This was a very personal thing to do. Wasnt about money. It was about saving peoples lives. In fact, lister had a knack of kicking off his college because he didnt charge is patience. He let them decide how much you want to pay, which was not a popular with his colleagues, needless to say. This would all about america. He was on a mission and i like to think that i am on a mission, not just to sell books although i hope Everybody Knows where to get them. Looking right at you, cspan. But but i am on a mission. My mission is that Joseph Listers name is just as my two people as the name Charles Darwin and sir isaac get comfortable and i think he is just as important. In order to convince you of that i really need to take you back to the priest listerine era, the Early Victorian hospitals. These hospitals were not places that you went to be treated if youre wealthy or middle class. We already talked about lucy a bit. These are places you went if you are poor. They were grimy, dingy, overcrowded. There were not houses appealing. It were houses of death. The best they can be said about the Early Victorian hospital is that they were slight improvement over there 18th century predecessors, which isnt really saying much when you consider about catch was paid more than the surgeon and doctors at this time. This lovely card from the Wellcome Trust in london which is a great medical History Collection, this is an 18th century calling card. Its for a man named andrew cook. I think they should make a movie about this guy. At this point that he makes this he claims to have read 20,000 beds in hospitals of lice. When you consider the art are t 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 as many as 200 patients in a single night. It was overwhelming, overcrowded. There was another population explosion. London was going so rapid and there was no way to keep up. In 1825 at st. Thomas hospital, people that were touring the hospital song wriggling maggots and mushrooms growing in the damp soil sheets of the patient with a compound fracture. What was so crazy about that story is 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. Now that i convinced to these hospitals were really awful places, certainly one would not want to end up in one, you might be surprised to find out they actually were very difficult to get into. Early victorian hospital, you need a ticket to get in. They are really hard to find, these images but this is from 1836, a ticket to get into a hospital. 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. Sometimes it takes weeks, sometimes long before he got your ticket into the hospital of course during which time you could die. When i i say this hospitals wee for the poor, they were really for what historians call the deserving poor. That means they still have have some kind of income to cover the room and board. Some hospitals charged you for your inevitable burial. It was still expected youre going to die. Other hospitals charged extra if they deemed you particularly foul pics i dont know how they determined that, but needless to say if you are absolutely destitute you had no medical options which the course might not of been a bad thing because people are dying heavily as a result of being admitted into these grimy and dingy places. Unsurprisingly infections broke out like crazy. Theres a term that pops up called hospitalist in which refers to the fact are more likely to die as result of being admitted into these Early Victorian hospitals. There were four infections particularly that certain forward about. Hospital gangrene is weird. Medical historians we dont like to retrospectively diagnose things when we reading records if someone says if gangrene, we tend to be more interested in the people contextualize their experiences within rather than how we might look at the past through the lens of our own medical explanations. But hospital gangrene tended, i think its more akin to what we would call necrotizing fasciitis 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 because of course we know about germs and existence of germs we are able to more proactively prevent them and, of course, nancy and when they do break out. The scottish surgeon wrote about the war of hospital gangrene. He says the cry of the sufferers are the same night as in the daytime. If they survive, they also contend you eat down and destroying the muscles, the great vessels are last exposed and eroded and the bleed to death. This was the kind of experience that many patients had in these hospitals. Interestingly enough one of the worst records i came across was in a hospital record. It was a naval record. The 18th century and early 19th 19th century naval ships had similar conditions as you can imagine, very unhygienic, overcrowded. When these infections broke out they were very difficult for naval surgeons to control. On the hms saturn, also appeared on the tip of the penis and have to add a half i spy for this and you should be very happy. And this is where cspan goes blank for a bit. After several days of agonizing pain during which the wound blackened and festered, the oregon finally fell off. This poor man is totally awake and completely aware of whats happening to his body. The surgeon underreported the whole length of the aretha the scrotum leaving the testes and vessels barely covered. What was so crazy about this record when it came across was the fact that the surgical the need to underline the fact that the patient had died. Of course he dies. Somebody should have killed him before i got to that stage. So this was what people were finding in this time it was absolutely awful. This is the world that Joseph Lister stepped into in the 1840s when he became medical school at University College in 1848. And it was so bad in this hospitals that it was very seriously suggested that the only solution would be to burn these buildings down from time to time and start a new which i love the imagery, the idea of them can imagine if thats we control things today, just burn it down . I was in cleveland recently at the cleveland clinic, that huge hospital, just burn it down and start a new. So things were reaching critical mass. Im only going to do one reading from a book and just to give an idea of my stock of what you can expect in the butchering art, although i think youre starting to see what you can expect from this book. I chose a passage from the dead house, the first time Joseph Lister entered we would call today the cadaver lab. Im sure there are many people here tonight or in the medical profession or who have visited a cadaver lab and sell. If you havent you probably have seen what effect it on tv. When im reading this i want you to imagine your experience in the cadaver lab, the sterilizg fibers, those frozen bodies, that smell of formaldehyde or whatever theyre using to preserve these corpses. I want you to think about that because 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. It wouldve died from diseases like smallpox. This was before mass vaccinations, before antibiotics. A lot of the people entered the medical field actions i as result of wanting to help these people. Thats very different today. There are dangers entering medicine today, but they are far fewer than what they were in the past. I want you to think about that as i read the passage, the passage is about six, seven minutes long. I halo of light from the gas and illuminated the corpse lying on the table at the back of the room. The body had already been mutilated beyond recognition. Its abdomen hacked away by the knights of eager students who afterward carelessly tossed the decomposing organs back into the gory cavity. The top of the cadavers skull had been removed and was tested on the stool next to the story. The brain had begun to degrade before. Early in Joseph Lister medical studies he came facetoface with the similar scene at University College london. A central walkway split the dingy dissection of and have with five wooden tables on either side. Cadavers were left with her insides hang over the ages which cause blood to gather in puddles below. A thick layer of sawdust covered the floor making the dead house quiet to those who entered it. Not a sound could be heard even of my own secret is only that dull and growing sense of the traffic in the street which is the cure to london came through the ventilation of the roof a fellow student observed. Although University College london and is hospital were still relatively new in 1847, its dissection room was just as grim as a standard older institutions at harvard all kinds of horrible sights, sounds and smells. When mr. Slice into the abdomen of the cadaver, he released a powerful mixture of smells that would reap the inside of the nostrils for conceivable time after one had quit the scene. To make matters worse the was an open fireplace at the end of the room making it unbearably stuffy during the winter months when anatomy lessons commence. Anatomy was a winter sport because the bodies kept better. Unlike today students cannot escape the dead during their studies and often live sidebyside with the bodies that they dissected. Even those who did not live in meat of the adjacent to an anatomy school, remind them of the gruesome activities because neither gloves or other form of protective gear were worn inside the dissection room. It was not uncommon to see medical student with shreds of flesh, get or brain stuffed his clothing actress lessons were over. The cadaver tested the courage and composure anyone who dared set foot inside the dead house. Even the most seasoned diced sectors could find themselves. James sims, a gynecological surgeon recalled a terrifying instant for mr. Tester his instructor with perform a dissection by candlelight when he accidentally knocked loose the chinos wrapped around the corpse and anchored to the ceiling above the upper end of the table. The cadaver pulled by the weight of its own lower limbs jerked to the floor in the upright position with its own supposedly thrown over that i sectors shoulders. Just then the counter what you been resting on mans chest sputtered out leaving the room in total darkness. For the uninitiated, the dissection room was a nightmare. The french composer and from a medical student jumped out of the window and ran home later recalling it was as though death itself and all his is grossly , heels the first time you stepped into the dissection room. He described an overwhelming revulsion at the site of the quote limbs scattered about the head to smirking, the bloody cesspool underfoot and the repulsive stench of the police. I cannot to stress are words from contemporary people. I do not have to embellish or exaggerate. These would own words coming through the historical records. One of the worst sites was the rest nibbling on bleeding vertebrae in the swamps of sparrows pecking at lung tissue. As a side i didnt put this in the manuscript but hector become so accustomed to dissection that he actually begins to keep pieces of the body off the cadaver and he throws them to these hungry animals that live inside the dead after he thinks this is very humane to feed these poor animals. For those wishing to continue with their degrees there was no avoiding the dissection room are far from doing it as repulsive, most of us ultimately embrace the opportunity to carve up the dead when the time came to commence the anatomical studies and list was of course no exception. Theirs was a centuries old battle between reason and superstition, a chance to shed light whether still scientific darkness. Within the medical profession the anatomist was often hailed as boldly traveled into regions that event unknown to the scientific world, only a half a century earlier. One can to wrote that to dissection the anatomist force the dead human body to disclose its secrets for the living. It was a rite of passage through its one gain membership into the medical fraternity. Little by little student began to view the bodies set before them not as people but as objects. This ability to divorce oneself emotionally came to characterize the mindset of the medical community and, of course, it still does today. Charles darwin described fictional but entirely credible conversation each wing to medical students on a frosty christmas morning. Have you finished the light yet . Nearly, replied the college. Its a very muscular one for a child. Nothing like dissecting to give one an appetite. Everybody does that. Pranks in the dissection room were so common that the time it became medical school they had a profession. They condemned the humor and indifference toward the dead that pervaded the dissection room. Some students overstepped the bounds of decency and use the body parts of their cadavers as weapons, fighting mock duels with severed legs and arms. Others smuggled entrails and secretive them into places where they can shock and horrify the uninitiated when discovered. One surgeon remembered spectators visiting the dissection room when he was a student. The outsiders often received in their tail pockets free donations. But it wasnt all frivolity and this is where i think the very much differ from today. Cutting open dead bodies also brought with it physical risks, some of it fatal. William garner, a professor at the university of glasgow addressed an incoming class with a dire message. Not a single session has passed since i was appointed that has not paid attacks of light to the great reaper whose harvest is always ready, whose sickle is never weary. Jacob bigelow, professor of surgery at Harvard University warned the students about the poisonous effects of a slight wound or crack in the skin by the dissecting member. These countertops were a fast way to an early grave. The dangers were present even forthe most experienced and honest. Often inescapable for those crop trying the hardest to prevent it. Winning in the form of disease patients were also taking a toll on the frontline of medicine. Mortality rates among students and doctors were high, unsurprisingly. Between 1843 and 1859, 41 young men died after contracting infections before ever qualifying as doctors. Those who succumbed in this manner were often utilized as martyrs who had maybe ultimate sacrifice to advanced anatomical knowledge. Even those whose survived suffered some illness during their residency. Indeed, the challenges were so great for those entering the profession that the surgeon John Abernathy included hislectures by uttering bleakly , god help you all, what will become of you. If that gives you an idea of what it was like when lister entered medical school in the 1840s and there wasnt a huge amount of incentive to go into the medical profession. A lot of people asked whatwas the incentive . There wasnt much money to be made. Although you could potentially make money if you became famous enough and you are risking your life as well if you made it through your anatomy lessons, you were eventually let on to the boards and of course the operating theater became central to your experience. Id like to show this image to people on social media and remind them it was called an operating sphere for good reason. You can imagine the hundreds and hundreds of spectators that crowded into these theaters, bringing the dirt and grime of every day victorian life. This was not a steroid environment by any stretch of the imagination and the people you see are necessarily medical students or doctors or anybody who has any reason to be there other than they are curious. Sometimes they were ticketed spectators that came to see the lifeanddeath struggles play out on the stage before then. And remember that the victorians were incest with science and progress so it wasnt always a morbid curiosity although there was an aspect to that, thats why we turn our surgical shows on tv but there was certainly an interest in what was being done, the new progress that wasbeing made in medicine at this time. The surgeon john points out remarks that the russians struggled to get a place in the operating theater was not unlike that in the pit of a playhouse. People were packed like herrings in a basket with those in the back rows jostling for a better view, shouting out heads, kids, whenever their sign of light was blocked. At times the floor could be so crowded that it had to be cleared before the surgeon could proceed. And as you see here, you see theres men sitting right there next to the patient. It just is mindboggling the way that we perform operations today. These photos, these are as sense of antisepsis in the photos although it still is foreign, the way that we run our hospitals today but in the earlier period, it was very different. Surgery was a filthy business fraud with hidden dangers. This isnt actually a surgeon, the butcher but it does give you an idea of what the early tory insurgents would have worn. They wore an apron and it was so assisted with blood it was a marketed profession. More blood on your apron the more operations you have done and of course we rarely wash our hands because why would you wash your hands or instruments when they are just going to get dirty again . You had to get into this Early Victorian mindset because we know that existed and it seems baffling that anybody could then you are donating. If you are going into an operating sphere and you had another patient right after after this person, why would you wash your hands . They are just going to get dirty again. It was said the surgeons carried around a cadaverous smell of rotting flesh which those in theprofession referred to as good old hospital state. So that gives you an idea of the sites and the smell. Now, i want to go into what i call the early butchers and of course referred to as butchers and im calling them the early butchers, these were the men who operated a preanesthetic and preantiseptic era. Im going to tell you about three tonight, all three featured in the butchering arts and all three play a huge role in Joseph Listers life. The first is this man named robert lister, fun with the blood splattered on the slides, i went to count with them to add a little interest. Robert was so interesting i almost wrote the book about Robert Woodson but he doesnt actually push any transformative moments. He wasnt the man for this book but he does feature heavily in it. The reason i wanted to write a book was you was a largerthanlife character. He was in the Early Victorian period, thats still quite cold today and he was so strong he used his left arm as a tourniquet, dont know why he didnt just use a tourniquet but he liked to use his left arm. Hold you down with his left arm and he could take your leg off in under 30 seconds which is a pretty incredible feeds. It was known as the fastest knife in the west end and of course speed was crucial to a patients survival at this time because you could bleed out or you could die of shock. Lister was the guy that you wanted to operate on you. My favorite stories about liston. One time he had a patient who had a bladder removed and we remember Stephen Fuller from the start so we know that was an awful operation, it was granted 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 jumped off the table and he runs to the back of the room and locked himself in a closet. Liston all six foot two of him charges after this poor guy and rips the door off the quadrant and drags him back to the table as he removed the bladder stone so that is dedication to your patients. He survived, he does survive, hes able to remove the stone in a minute and a half. When we consider what poor Stephen Fuller went through with the over an hour operation, certainly you wanted to go to a surgeon was fast. Another one of my favorite stories is he was so fast that when he was changing instruments he would put them in his mouth. Yeah, that happened. Not very hygienic at all and it was certainly how far weve come. He was so fast and he accidentally took off his assistance finger in the middle of this operation. Whats. And as he was changing instruments, need flash the coat of a spectator and it was said that the spectator died right there of. The assistant died of gangrene but the patient died of gangrene and it is teasingly referred to as the only operation with a 300 percent mortality rate so thats my god. This opens the butchering arts. He 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. Liston doesnt believe its going to work. He walks into the operating theater and he would say time me, gentleman and you could almost hear the ripple of pocket watches in your minds eye as people pulled out their pocket watch to time the great Robert Liston to see if he could beat his record. He says time me gentleman and says hes going to try the yankee died cause he believes it was american quackery, that doesnt work. There were a lot of things that were working at this time, mental reason was around, mental or was a plaque that went around hypnotizing patients and it didnt always have to do with operations. He would walk into these rooms and women would faint and he had been under his spell and of course it didnt work. Liston is rightly skeptical about this. He says time me, im going to try the yankee died and it doesnt work. What is incredible about this moment to me is if anybody here tonight had ever thought about surgery which 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. We no longer have patience struggling against the knife and crying out for help and this is liberating for surgeons so a lot of people think it was the discovery of ether that ushered us into the modern day of surgery and i would argue otherwise because what happens is surgeons total understand that germs exist but theyre more willing to pick up the knife and go lord deep into the body than they did before and as a result these operations become slowmoving executions. Postoperative action rises skyhigh and it becomes a much more dangerous period and what was incredible about this moment about liston in december when he performs the first operation under ether in london is that a 17yearold Joseph Lister was in the audience at that day. Joseph lister witnesses this moment and he is the one who ushers i believe surgery into the modern era by germ theory to medical practice. So liston is very much in the book. The next one i want to tell you about is james hine, he becomes the fatherinlaw of justin Joseph Lister. Hes the cousin of liston. Hes very short, always in surgery and liston and him get in a weird fight about the tourniquet. He says just use attorneyand liston says no, use your are and they never talk again. A very weird thing. 19th century was a weird place. But he was to say, he says any people in the audience tonight who are medical professionals for surgeons themselves, you might recognize his name because theres an operation done today that bears his name. He was able to perfect a technique to remove a disease foot at the ankle joint. Before hine comes along if you came in with the disease foot, you would lose your leg both below the knee and the reason this was problematic was remember that peoples livelihoods were connected with their ability to move. There were no social nets if you couldnt work so removing your leg under any of course affected your mobility greater than if you could just move the flex so he invented this technique, still today and it bears his name. I was fearless, he took it to a new level. In 1828 a man came to him named robert penman. He was suffering from a facial tumor for the last eight years. A lot of times when i show these images to people, the first question is why, why would they let it go on so long but remember this is preanesthetic, and people died when they went to visit the surgeon and there was a lot of fear about going into these hospitals or going to consult a surgeon so mister penman let it go on way too long andhe gets to this point. He goes to london first to see Robert Listons cousin because he had made a name for himself by removing a 45 pound scrotal tumor in under four minutes. Im going to repeat that. Just for cspan. 45 pound scrotal tumor in under four minutes. It was an incredible feat. The guy survived and you wonder how did this happen . But it did. So liston was quite famous at this point. Penman goes down to see liston and liston says hes not going to do the operation. This is tantamount to a death sentence at this time because of course if listons not going to do it, who is going to step up and do it. He goes up to edinburgh to see joseph hyman hyman agreed to do the operation. For 24 minutes, mister penman is sat in a chair and he is restrained as crime cuts away the tumor and a lot of issues were sat upright at this time before anesthesia and that, they were sat in chairs like what weve seen, they were usually high so you could see angles. So he was sat upright. This tumor for 25 minutes cut out of his face and was thrown into a bucket at their feet and he survives. Amazing. I cant even have a dental screening without some kind of novocain so it does boggle the mind when you think about what these people went through and find ran into penman many years later as he was so please that penmans face didnt really bear the scars. It was covered under this one curious beard and i found a picture of him. There he is. I show this picture to a friend without any comment and my friend said a scary looking guy. Kind of like an ugly Abraham Lincoln. Not that Abraham Lincoln was a looker, but there he is and clearly, theres something amiss about his face. We can easily say but that said, when you consider what you look like with that facial tumor and the fact that he was literally months away from death, it is incredible that fine was able to save his life. Im teachers heavily in the book, he becomes listers fatherinlaw. He invigorates a passion in surgery for lister after lister has a breakdown and he leaves medical school and he doesnt understand what medicine could do for people. He learns to love surgery so hes featured heavily. The last one i tell you about is john erickson. Hes one of listers instructors at acl and hes famous among medical historians for same history had gone as far as it would go, that the surgery would never go any further and thats incredible when you consider where we are today but you cant blame eric and because he couldnt conceptualize a time when pain would be over. Postoperative infection would be under control. One of the stories i want to share about erickson that i think illustrates how different it was in the 19th century and how much listers own work transformed surgery, i was doing an interview for npr all Things Considered a couple weeks ago with Robert Siegel and i told him this story, he loved it but i heard his producer laughing in the background that you cant say that so you get to hear it tonight and so does the band and unless they cut this out as well but the story is erickson had a patient come into the hospital. Lister was a medical student attending and this woman was asphyxiating on all kinds of blood and eric decides to cut into her neck and all this blood and pus begins to go out. He decides to lower his mouth onto the wound and begins sucking it out. Its like a weird vampire story or halloween. Welcome. And he does this three times, he sucks this blood and pus out of her neck and hes she survives which it wasnt so good for my story but im a historian. Really, they shouldve all died. The infections in the way that surgery is used at this time, again. Its just mindboggling as i go through the record. As i said, my book is about this man named Joseph Lister 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. Louis pastors jury germ theory and applied to medical practice through the development of antiseptics. Hes a quaker. Hes a very quiet individual and he worked tirelessly at what he did to get people to accept germs and im not going to tell you too much about lister which might seem weird because my book is about him but i want you to pick up the butchering art i want you to find out how he figured out the history and how he navigates this briny world and i dont want to mislead you, lister isnt the only one. Theres a lot of people and work thats going on with the hygiene movements and asking questions but he is the one to apply germ theory specifically to medical science. He received a lot of backlash. It seems weird today how could people not believe in germs . Imagine a young man comes along and tells you theres these invisible Little Creatures and they are telling yourpatient. This was a time before the microscope was used in medical practice. A lot of doctors believed that you would stop using a riser trusting your own site and also the other part of that was that lister essentially was telling these Older Persons they had been inadvertently killing their patients all along. I have to say its funny and bigger than life that enough time has passed and it seems so wildly different from our own reality. You have to remember that mutations were real. These surgeons were real and they lived and died with their own failures as well. Imagine going into the operating sphere day in and day out one thing to stay someplace and they keep getting the same result so it was a hard pill to swallow for the older surgeons. That they were inadvertently killing their own patients. But i want you to read the books and i want you to figure out how he navigates that world. Theres no better way for me to illustrate the transformation that did happen. This is the cover you will see if you buy the book tonight which i hope you do. This is a very famous painting from the 19th century via name man named thomas beacon. This is called the gross not because its going gross although there is an element of that. The man in the middle is a samuel rose, an american surgeon and he didnt believe in germs. He didnt believe lister and he would walk into the operating theater and slammed the door and say there, mister listers germs cant get in anymore. And you definitely see that playing out in this image. There he is with his clothes, hes sticking his fingers and instruments into this world. There is a woman to the right of him who is shielding her eyes. Someone told me that his mother, i have no idea why he would bring his mother to this awful Operation Center but this is the painting. Its this famous held in philadelphia and that is the us cover. The book is being published in 15 countries around the world and one of the uk covers is this, he used another painting and this was it done within 10 years. Its been stylized event by my publisher but you get the sense of what it looked like in the 19th century and you can see its still foreign to the way we operate today but theres been a transformation. You get a sense of people understanding that germs exist. Theres some form of cleanliness, women are starting to appear in the operating sphere alongside the men as well in the profession. Though i love that these are in conversation. The last thing i want to leave you with before we only have a lively discussion because i love hearing peoples questions, it helps me as well with my own research but before i do that, i live in the uk. With this very chicago accent and im glad that i wasnt introduced necessarily as hailing all the way from london because i could never recover when the disappointment comes in my american accent pours forth. Ive lived in the uk for 15 years. I have friends or moviemakers and one of my friends and i decided to get together and do a book sale. It is not something many authors do. I originally said do something fun and simple and it became this crazy basically many movie. He had a principal cameraman from game of thrones, and shoot it. We had actors, it was so much fun and for me as a writer. I tried to bring this to life through words so its a pleasure to see it come to life for a brief moment in a visual way so i want to leave you with this clip. Its about five minutes and im super proud of it. I cant claim, it was mostly my moviemaking friends did a brilliant job and i hope you enjoy it as much as i enjoy working on it. Just bear with me a second. Here we go. [music] im going to cut it off. [labored breathing] [screaming] there you are. He died. The doctor we were operating on last night died half an hour ago. Rather unusual. Thats the thing of it, isnt it . Dont you think . Given the bodys remarkable inclination to heal itself, you dont think its odd. Why when we get the opportunity to take away disease, we afforded the chance to grow strong again, why do they die . No, not in so many. Too many are dying. These are strong men, james. They leave harder lives than you or i could tolerate. We offer them ship builders, laborers, the toughest breeds in the land. Number more to this trauma. There has to be more to it than that. Something hidden from our understanding. Its the supernatural then . Gods, monsters . I dont know. We may have to turn the hospital down from time to time. Come on, i dont want to be late. Monsters. [music] and all things were becoming real. Coming to a theater near you, right . I was really pleased with the way that came out. We were lucky, we got to shoot part of it in a place called the old operating theater in london. Its an amazing space. You have to navigate the scary stairs and these old operating theaters do exist, they exist in the acts because this was before electricity and they needed the skylights to operate but we were lucky use that beautiful space. We had to do the blood operation in a film studio because there was no way there were going to let us throw all that blood and magnets around. We had so much fun doing that and i hope you enjoy that. Findthat on my series under the knife and id love to take your questions now about this. There is a mic up here butif you , if people start making their way towards the mic, ill start with your question and repeated so people can hear. Yes, you. Florence nightingale, whether she was an influence on lister, i was wondering about blood transfusions and how you can have operations with any degree of survival. Thats a good question. The first question is about florence nightingale, she is in the butchering artist. She was alert working in parallel with what lister was doing and driving a 19 movement but a lot of people think of nightingale but she didnt believe in germs at first. She thought it was almost a bit hysterical and we didnt need to go that far, we just needed a basic level of hygiene. As im doing interviews around the country, there seems to be a lot of summerlike movies out there and people get angry that i havent mentioned him. He is an austrian physician. You might know him because he was putting together this idea that if you wash your hands, you could reduce postoperative infection and he was right, but he ends up dying in a lunatic asylum, they called him the hand washer. Hes ridiculed by his colleagues. The difference between cellulites and lister was lister was the one that convinces the medical community so keep in mind there are people doing stuff but if their work isnt known or accepted, theyre not the ones that ultimately triumph, so to speak. The other thing is that although hes putting together this idea of handwashing and postoperative infection in the hospital, he doesnt yet know the agent by which disease is spread so thats where lister comes in. Hes taking pasteurs germ theory and making those connections but of course, no scientific or medical achievement is done in a vacuum a lot of these people are mentioned and how they influence or dont influence lister in surprising ways and the second question was about blood transfusions, how could you do these operations if people were doing blood transfusions. One of thefirst blood transfusions within the 20th century and somebody took the blood from a sheep orlando and put it into a human. The idea that the land would somehow, this would work, it did not. It definitely didnt work. But these experiments are going on but of course this is a much Later Development area remember if you are someone like liston taking off someones leg, quickly , tying off the arteries, they had these books that would pull down the arteries and veins. Quickly. Youcould potentially have a chance of surviving. It was often said that either comes along, there was this idea that you needed pain to survive the operation because the pain or the adrenaline as we know it kept you going. So there was this idea that either would make surgery much more dangerous because the patient wasnt only and wouldnt stay alive. But those are Great Questions and theres so much. Theres a wonderful book by a woman named holly tucker calledbloodwork and its about the history of blood transfusions that interest you. Yes. Im doctor john well and i introduced myself to you earlier. Im the Infectious Disease specialist but i also have a perspective on this because the last 20 years ive been reenacting army surgeons, ive spent many simulated amputations using listons knife, even. Not the sharp one. But i wanted to say that one of the things that another legacy i would say of lister and my other medical hero as you mentioned, was the introduction of the rubber gloves in surgery. The reason that lister is indirectly responsible for that is as you know, he introduced the use of carbolic acid for surgeons to , medical personnel that wash their hands during surgery. In the 1890s doctor william hallstead, the father of american surgery had his scrub nurse and her hands were becoming destroyed by the carbolic acid. He asked him if he could devise a pair of rubber gloves that could be sterilized and wasnt any sort of consideration, it was because he didnt want his girlfriend to have ugly forearms. Needs to have those ugly hands . The carbolic acid, it did produce hands so much that he had this habit of putting his hands in his pockets and the operating theater was something he called the donkey theater but to go back to what you said about the liston knife, lister did create a knife known as the liston night and it was used by jack the ripper so another fact for you right there. That would reflect the rumors he might have surgical training as well. Liston was weird about his instruments. He used to put notches and handles every time he removed the leg or a limb and he used to keep them close to him so he kept them warm. I have no idea he felt that the warmth was going to be comforting to the patient when the horrible steel was going through their leg anyway but it was one of his range habits. I have read your book and id say i highly recommend it to the audience. You heard it here tonight. Any other questions . Okay, i see a handout there. Perhaps a little remote but i pictured this all starting with leyland and germs. Hes asking about the early microscopic work in the 17th century and of course 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 was a quaker, interested in science and he used the microscope a lot so lister grew up around the microscope looking through the lens and all this was building on the earlier work in the 17th century, 18th century and so when lister goes to medical school in the 1840s carries this very strange and unusual instrument, a microscope and thats why hes particularly receptive to scientific and the ideas. A lot of that is in the book and certainly important to the knowledge that the microscope had been around for a long time by the time lister begins his work but it was really seen as spit suspicious and medical practice. And doctors really thought using it in their practice. Another question, any on the balcony. You guys up there are a little terrified about what you just heard. Yes, we have a question here. What was the role of alcohol . And the other, [inaudible] she asked about the role of alcohol. Theres this myth that the patients were sort of wildly drunk and therefore they didnt feel anything. Alcohol is in the blood so you dont really get too many actual accounts of patients being given alcohol. Someone else asked me, they had heard that surgeons punched patients out. First of all, can you imagine . Youd have to be a really good boxer just to be able to knock someone out on the first punch and that caused so many other problems for the patient so that definitely didnt happen. I can pretty firmly say. Alcohol used as an antiseptic, there were people using antiseptics before lister comes around with carbolic acid. The difference is and i stress this is that he comes up with a method and not only a method but he has a reason for doing it which is germs and until then it was used haphazardly. Maybe an antiseptic would be done as an instrument and a patient but it wasnt used as any kind of systematic way to prevent and stop the spread of infection. And the secondquestion , remind me again . Oh, about tv and consumption. On listers time, it was called consumption and was deemed to be incurable so you you went to the hospital, you were turnedaway. Theres nothing really , there are, the only disease that i can think of off the top of my head that affected listers ideology and his method and what he was starting to think was cholera because john snow in the 1840s together this, he saw this mystery about how cholera was being spread around london and identifythe source. And you can see the broad palms in london today. That really started to lead to questions about how disease was spread because before then people thought that disease was spread through miasma or bad smells and in colorado, john snow discoveries through that into question. Theres a book called the ghost map which is also a fantastic history tail and thats all about the cholera epidemic in some of thats in there but as far as function and tv, theres nothing that specifically affects listers narrativeand that. You in the middle, yes. So its weird that people cauterize wounds. People took their leg off and sometimes or another. Hes asking about cauterization to stop the bleeding. That didnt certainly happen, some surgeons used that. Everybody tended to be different. Burning the flash also caused problems which could lead to infection. There was no easy way and there certainly was no forward way to provide postoperative infection and as you saw in the movie clip that i showed you, a surgeon would either that the wound would heal completely which meant it didnt heal with infection or that field sourly. And it was so common that wounds would develop plus that they called it laudable plus, they thought it was necessary for the healing process, thats how common this wasnt the time but cauterization, i think it does cause other kinds of issues for the tissue so lister isnt specifically doing it. They are usually showing up at his hospital but its going on at this time too. Sorry. By the time the civil war wascoming , you had wounds with dirt in the civil war. [inaudible] he said no surgeons in the civil war cauterize. My story is a british story so things are developing different on the side of the world for other kinds of reasons. There you go. So nothing good was happening in america. It alwayssurprises me , let it be said today. [laughter] but again, lister comes here in 1876 and youd think surgeons would be receptive to it because of the civil war and the infection rates they were experiencing but there was resistance here. And again, cities adopted in america and some dont and theres no sort of one moment where everything changes unfortunately for the purposes of my book. You had your hand up for a long time. Im talking to the man behind you and ill come to you next. Its hard, i have a spot right here but i saw your hand was for a long time. [inaudible] they should bring the acts back. The first question was about how to come up with staffing rates because 30 seconds wasnt enough for that man up there. They asked, i never really had come across this in the medical records but my friend is the master of the tower of london and he tells me all kind of blood details about the tower. Hes an amazing person and he told me that when they beheaded people with an ax, it wasnt meant to be sharp because it would get stuck in the block. And it was really the weight of the acts that took the head off but the executions were not straightforward by any stretch of theimagination. An ax was a very wheeled the thing to move around so i imagine that winging and ask, people are getting their fingers chopped off already in this period. The acts may have been a step too far in taking a leg off. I dont think that would have worked too well. Your other question, but. An amazing show. If anybody hasnt seen it, its such a great show. What i like about it is it shows the demons that a lot of these surgeons were suffering from. This idea that your patients are dying time after time, it must of been frustrating and keeping in mind that these people were real. That story the knick is at the turnofthecentury so this takes the audience back 50 years to a grimy or, danger and more dangerous time so i like to tell people if you like the knick, this is a gruesome or aspect of that story. I cut you off before. You might have touched on it before but another question. All kinds of transitions here. [inaudible] he asked about the transition between military medicine and the development and bread of the antiseptic method. Military medicine is important to a lot of discoveries because you had so many patients dying in these wars that there was a lot of experiments going on. As far as lister, how does he try on . He knows he cant get to the older generation so if he goes to the younger generation, he sees students in edinburgh and they go out into the world and they spread the gospel of antiseptics. I call it the gospel of antiseptics because he very much created almost a religious atmosphere around. They would have this discussion and bring in the engine and spray the air and clean everything and there was a real almost show to it. It was really those younger surgeons that went out there and were able to spread this message around but there is a real connection between medical advancements and these earlier period and what surgeons are doing in the military to treat these patients. The crimean war for instance is in the butchering art, lister doesnt go to fight in it because hes a quaker and hes not allowed to go treat patients in the crimean war and as a result, he lives. All his colleagues and a dying andes promoted after through the ranks and thank goodness for that. Think about how history turns on a dime and what would it had been had he not been a quaker and going to work . In the surgery world, what was the proportion between people coming for injuries or trauma versus people. [inaudible] she asked the proportions of people coming for trauma versus cancer or other types of internal problems. Surgeons at this time in the early 19th century only treated the outer part of the body. You did things like cancer where the tumor is pretreating but this is still considered treating the outer body. Physicians on the other hand treated the internal body which is why we have that term internal medicine. Physicians were better respected, men who used their minds rather than their hands. The surgeon was like a craftsman trained through apprenticeship and he be illiterate, his skill can vary widely depending on his skills so theyre dealing with the outer body. Theyre dealing with lamps, oils and things like that and its only later that surgery begins to unite together and now the surgeon is at the top of the medical hierarchy. [inaudible] was there euthanasia . She said with all the suffering was there euthanasia . Nothing that ive come across in these records. But certainly theres a very famous story in the 17th century, 16 or 17, Ambrose Perry and he is fighting in a war and he goes into a bar and theres these soldiers, if i remember correctly, theres these soldiers that had been badly wounded and hes looking at horror at these men and suddenly another soldier comes in, walks up to these men and slit their throats. And terry says what are you doing . And confronts him and he says i hope that if i ever am in this position, someone is as humane as me and ends my life you get stories like that but nothing systematically at this time. [inaudible] hes asking when this took the place of antiseptics. You might find out that lister was against a sentence. That is where antiseptics is German Fighting and the reason he was against it was because he never envisioned a hospital to be the center of medical practice, he thought people would continue to be treated in their own homes to some extent so asepsis wouldnt have been practical and he thought it was most dangerous to have this romantic notion that you could have a germ free environment. There is a natural move from antisepsis to asepsis once germ theory is accepted and it begins to be more practical sort of late 19th century and thatswhat we strive to practice today but yes, its weird that he definitely boldly resists asepsis. Can you talk about lister spreading this as a show . How much are telling you rates are they getting the design is . She asked about listers data and how he was convincing surgeons. It is a great question. This is on the cost of medical statistics, still being developed at this time. This is one of the first scientific surgeons, hes publishing data but not necessarily on the large scale that obviously we do today. And he publishes a series of articles in the atlantic and these articles are not just about his statistics, its about showing the surgeon how to do it so its very much like looking over his shoulder and hes explaining how to do it. He is so scientific is always changing his methodology which opens them up to criticism because a lot of surgeons say you were wrong the first time, you change your mind. How are we to know what any of this is if you change your mind not realizing thats how we operate today, of course. Were always tuning our methods and that was very much how lister did it but theres a lot of data out there, its in the butchering art about the data he was showing surgeons but it was a hard, along the road to convince them this was working and remember again, he was essentially slowing everybody down because these methods instead of being fast and an operating theater and moving patients in and out, hes asking them to be due slowmoving things like washing your hands. Theres a whole method that slowed everything down that i think a lot of surgeons irritating in comparison to how they were used to operating at that time. [inaudible] was there any fallout in the fact that the president of the United States died from infection . Hes asking about president garfield. It was said that his, his establishment said he shot the president but his doctors killed him. Because is 12 doctors thought their unsterile fingers and instruments, it takes him 80 or 90 days to die, its a horrific death. He loses 100 pounds during this time and its awful. Im so glad you asked because it allows me to tell you about the garfield house which i visited a few days ago in ohio. It is a wonderful natural historical sites and i came across the guy runs the site is so passionate about James Garfield. He can relate anything on my social media James Garfield. I could put up a self a straw and he tells me did you know James Garfield hes so great and he runs this beautiful site though if you have a chance to get to ohio to visit. I had a chance to visit, its not in the butchering art because theres a wonderful writer named Candace Bullard who wrote a book called death names a republic and she deals with garfields assassination but youre right to say why, why did this happen . Lister comes to america in 1876, surely by 1881 doctors and servants accepted germ theory but its slowly accepted in certain circles. Thats not to say, i think its General Hospital is the first to adopt antiseptic techniques. That happens shortly after listers trip so its happening in various hospitals but unfortunately for James Garfield, his doctors did not believe in germs and he died this or if you. Check them out online because the guy is hilarious. Hes so passionate about James Garfield, its worth it. You mentioned in the operating room there is a link. [inaudible] a question that historians spend years, she wants them into minutes the answer to the appearance of women in the operating room and of course deacons second painting. Such a good question and one that i have to admit i dont fully deal with because it is something happening separately to lister. Lister is very much against women entering medicine, a little bit of half law of his but he cant foresee it, the victorians were like that. Florence nightingale revolutionizes the profession, before that it was seen as inappropriate for a woman to go into nursing because she would be privy to the male body and it was all akin to prostitution. When you come across the term nurse in earlier records, its usually referring to a, nursing a baby. Someone nursing a baby. So she certainly, theres so many books about this. He makes it a respectable profession. She runs her nurses like an army, almost and elevates women. Thats what youre seeing their lister didnt have much to do with it. Your right to think that florence nightingales triumphs led to an acceptance and asepsis because hygiene was a big part of her crusade and theres this hygiene movement. Lister triumphs so much that you dont get listerine, you get all kinds carbolic acid mania so one of my favorites is this avon lady mary kay sort of thing that you can buy and you can go around and you can remove your neighbors hemorrhoids with carbolic acid which seems really dangerous and painful and not at all a good idea. Mister annoyed by all this. He wasnt looking for the fame as so many of these people ultimately are. Theres some of that the book about all these crazy things that come out of the carbolic acid mania. Im sorry, im told one more question and i will be signing books so please come and chat with me. Id love to see the conversation. [inaudible] she said whats the glorious artifact that i have interacted with. I think the book on human skin is pretty disturbing but they do look like a leather so its not just because you know their human skin but there are so many specimens. The mutter museum, i did my book launch at the mutter museum. They had a piece of don wilkes booths throat which is amazing but nothing really creeps me out, it just fascinates me. But i suppose the book on human skin, i should admit that is unsettling on some level. One of my favorite instruments is called the clockwork sign. I like it because it was a massive failure and i love failure in general because it informs success and its something that we ignore, especially talking about scientific and medical achievements. You wound this up and let it go and it was posted continuously. It seemed like a good idea until it took off this guys fingers and they decided maybe were not going to put this into production. Theres one in existence in london. In under the knife i did the First Episode ever on the clockwork side and my friend who shot the trailer, we had a lot of fun and we do way too much for you to, spent hours creating these stupid videos and we made it look like the soft spun off at the end but we had to build the clockwork song which was fun but thats one of my favorite instances. I love talking about failure and medical history so if that interests you, check out my blog. Thank you so much, im looking forward to meeting you out there. [applause] you are watching tv on cspan2, television for serious readers. First up tonight, rude law, advisor to secretary of state Rex Tillerson discusses how extremists in the muslim world use social media then read up van susteren talks about her book on social media. On after words at 9 pm, gold star father keyser con shares worries of his immigration to america and offers his thoughts on what it means to be an american. Hes interviewed by jimmy pineda. 10, journalist helen dorf reports on the assimilation of 22 immigrant teenagers over the course of the 2015 school year in Denver Colorado and we wrap up our programming at 11 pm eastern with Russell Short no. He looks at americas founding through the lives of six people including a caller turned politician, a freed slave, the daughter of a british officer turned American Revolutionary and george washington. That all happens tonight on cspan2s book tv. Tonight on after words, gold star father khizir khan recalls his immigration from pakistan to the United States in his book and American Family a memoir of hope and sacrifice. Hes interviewedby congressman jimmy pineda. This is a common trait, the things common among solitary and mentalities and an audience can draw the conclusion. One is they dont like free press because free press criticizes them. The second thing is rule of law, they do not like judges, they do not like rule of law and that had given me such a perspective of not having any Civil Liberties to having all these dignities and as we speak further, ill tell you what a moment it was when i went to take hold of citizenship under which every american with at least read the board of citizenship. It means so much and it speaks to the dignities that are enshrined in our fusion and our bill of rights. Watch after words tonight at eight eastern on cspan2s book tv