Surgery's Worst Chapters: Baby Farming, Ego, Ether, and the Making of Modern Medicine

The conversation opens with Doctor Mike asking whether his guest knows what baby farming was in the 19th century, and calling the topic grim. The discussion then moves to how surgical anatomy was learned at the time. Dissection became very important in the early 19th century, and doctors relied on so-called resurrection men, grave robbers who stole bodies.

Doctor Mike contrasts those conditions with modern care, saying that for all the problems in today's health care system they do not come close to what patients used to endure, and he cites surgery without anesthesia as an example. He introduces Dr. Lindsey Fitzharris, a medical historian from Oxford University who studies the dark and brutal history of health care and who is the author of the new book Sleuthhound.

Fitzharris explains that physicians regarded surgery, which they called the cutter's art, as beneath them because it involved working with the hands and touching the patient, something they considered workingclass. Physicians therefore sent patients to barber-surgeons or surgeons. The barbers and surgeons split in England in 1745, after which the poles that identified each trade changed to distinguish them, with barbers pushed out of the medical realm.

The split was accompanied by stories such as Sweeney Todd, a demonic barber who kills his clients and turns their bodies into meat pies. Fitzharris says the surgeons wanted to professionalize and started rumors of this kind to distance themselves from barbering.

Fitzharris argues that one of the most dangerous things in medicine is not ignorance but ego. She describes Semmelweis as the first to recognize the problem, but says he did not understand that germs exist, and that until the explanation is understood it is difficult to get people to change.

The conversation then turns to Joseph Lister, who connected Louis Pasteur's germ theory to surgical infection. Lister noticed that the microorganisms that spoiled wine might also cause postoperative infection. Because he had been trained with a microscope as a child, he was unusual among surgeons. He brought his microscope to medical school, saw germs, and ran trials, but many surgeons did not believe him. The participants agree that convincing surgeons they had been unknowingly killing patients through invisible creatures was a hard leap.

Fitzharris describes how surgery before anesthesia depended on speed because the patient was fully awake, could fight the surgeon, and suffered extreme pain. Surgeons needed to be very good and very courageous to operate on a patient who was conscious. Robert Liston, known as the fastest knife in the West End, could take off a leg in under 30 seconds.

The conversation also addresses the cost to surgeons themselves. Many doctors died early after exposure to infection while handling instruments and bodies. Fitzharris links this to Joseph Bell, the subject of her new book, who devised a pipette to suck diphtheria mucus from a patient's throat, contracted the disease himself, and was nearly killed by it. He was left with a high, discordant voice and an unusual gait.

Doctor Mike and Fitzharris discuss the short memories people have about diseases that once killed children at high rates. Fitzharris says she studies a time when people lost children to diseases that are now preventable. The conversation turns to how medicine should respond to fears about vaccines, which Fitzharris says are stronger now than they have been in the last 20 years even though more data exists.

Fitzharris argues that medicine must communicate more effectively and engage with real fears, acknowledging that communities have been harmed and lied to by doctors in the past. She says the goal is to address fears that are real while responding honestly and transparently to ones that are not, and to admit where the evidence is gray. She also warns against dismissing people's fears and throwing data at them, noting that people do not usually make decisions based on data.

Asked what it meant for a medical idea to go viral in the 19th century, Fitzharris points to anesthesia. Ether was discovered in 1846, and within a month it had spread all around Europe, with doctors trying it quickly because safety procedures and ethics review did not yet apply in the same way.

Fitzharris explains that some doctors worried about being held responsible for killing a patient, so there was concern around ether and chloroform. Chloroform came shortly after ether and was more effective as an anesthetic, but more dangerous. American physicians preferred ether because it was less likely to kill the patient, and in America there was a risk of charges if a patient died, a risk that did not necessarily exist in Britain. Robert Liston performed the first operation under ether in London just weeks later, calling it the Yankee dodge because he did not expect it to work. Earlier claims that mesmerism could make patients lie still and feel no pain had also been tried.

Fitzharris describes her book Sleuthhound as being about Joseph Bell, a Scottish surgeon who had an incredible knack for diagnosis. In Edinburgh, Bell taught medical students to read the human body like a crime scene, where a callus, a stain, or a limp were all clues. In 1878, Arthur Conan Doyle became Bell's medical student, years before he created Sherlock Holmes. Doyle was a doctor before he was a writer.

Fitzharris says Bell had to cut through the petty deceits of patients, since patients did not always tell doctors everything, and 19th-century doctors had fewer diagnostic tools, so they had to look closely. She says Bell had a Sherlockian quality and gives an example from the book: a patient denies being an army man, but Bell can tell from his observations.

Fitzharris explains that Conan Doyle asked permission before sharing Bell's name with a journalist, and Bell initially agreed. Around the same time, Conan Doyle killed off Sherlock Holmes because he could not stand the character and wanted to be a more serious writer. Media attention then turned to Joseph Bell in Scotland.

Fitzharris says the real-life forensic cases Bell worked on had never been fleshed out in a book before, and Sleuthhound is about both Bell as a doctor and the forensic cases he worked on. Later in life, Bell and Conan Doyle teamed up to challenge a murder conviction in New York involving a multimillionaire, William Rice, whose money was willed to his lawyer after his death. Bell and Conan Doyle argued that the conviction could not stand because the body had been embalmed right after death.

Fitzharris describes Eugene Shantrell, a man charming on the outside and sinister on the inside. His wife was found passed out at home, and the household assumed a gas leak, a common occurrence in the Victorian period. Little John, the husband's associate, grew suspicious, and the wife died later in hospital. Fitzharris believes Bell worked on the case, even though his involvement was often unofficial and hard to document.

The evidence for Bell's role comes from Shantrell's execution. On the scaffold, Shantrell scanned the audience, locked eyes with Little John and said, Give my regards to Joe Bell. He did a good job putting the noose around my neck. Fitzharris says this was a Sherlockian moment. Shantrell was also a friend of Robert Louis Stevenson, and he became one of the inspirations for Dr. Jekyll and Mr. Hyde.

Fitzharris explains that during the 19th century, soldiers tore cartridges with their teeth, and there was an idea that an army that could bite could fight. By the First World War, that idea was less important, so surgeons began pulling teeth to improve general health before sending men to the front. Bullets ripped through faces and carried battlefield bacteria, and the mouth already had bacteria.

During the Civil War, surgeons did not fully accept Lister's methods, so postoperative infection rates were high. They focused on restoring function, such as speaking, eating, and breathing, and did not worry about how the face looked. Gillies, by contrast, combined aesthetics with functionality, since a nose in its typical place also works better than one off to the side of the face. Fitzharris notes there were no antibiotics, and although surgeons understood germs, infection rates were high because many battlefield surgeons sewed up wounds quickly to stop hemorrhaging, sealing infection inside.

Fitzharris says the villains in the Ether Wars were unlikable, but the outcome was humanity winning, because the anesthesia could not be patented and so everyone ultimately benefited. She argues that stories should be more complicated, since figures like Gillies, Lister, and Bell were not perfect. Lister, for example, did not believe women should be in medicine, while Bell advocated for women in medicine.

Fitzharris describes Gillies as extraordinary because he could look past disfigurement and see the humanity in his patients, giving them back a life. She mentions the Guinea Pig Club, a group of pilots burned in the Second World War, operated on by Gillies's cousin Mackeson, and notes that Gillies performed the first phalloplasty on a trans man in the 1940s.

Fitzharris says her publisher asked whether the term disfigured could still be used. She kept it because the men were disfigured to the people looking at them at the time, and they had to overcome that. She notes that a disability activist with facial asymmetry calls herself disfigured because that is how people treat her.

Fitzharris emphasizes that the disability community is not a monolith. Guests on her show have had wildly different opinions, some wanting to own terms like autistic and others objecting to being grouped together. She says that even when trying to do the right thing, one can upset a minority or even a majority of people, and that language about these men is part of what the book has to address.

Fitzharris includes photographs in her book, but only for men who completed their reconstruction and appear in the book. For those who died, she uses only photos from before their injuries. She says she felt she could not leave the photos out, but did not want the book to become medical voyeurism.

She explains that the patients could not have imagined a book called The Face Maker, and did not have a choice about how their images would be used later. Gillies had said he wanted to document his work, and the patients agreed on that basis. Fitzharris says some of Gillies's patient images have been used in a game as monsters, based on real patients, and such material spreads online for shock value. She reminds people that these were real men.

Fitzharris says a lucid death used to be seen as a good death, but with the drugs of the late 19th century, a good death increasingly meant a painless one. Katherine Manx, whom she cites, has said that death is not a medical event as much as a social one. Fitzharris agrees that dying at home surrounded by family is the ideal, though some diseases are very painful and must be managed in medical settings.

Fitzharris describes how her grandmother died at home at age 94. Although it was frightening to imagine waking in a hospital surrounded by unfamiliar alarms and lights, she was glad to make a home death possible. She admits that after she medicated her grandmother, she felt she had killed her, and says this is a common reaction for the person in charge of medication. She describes being present in a loved one's final moments as a great gift.

Fitzharris explains that in the 19th century there was great interest in measuring the body to track repeat offenders, since a criminal could previously use an alias on each arrest. The French police officer Alphonse Bertillon developed a system of body measurements, around 13 in total, recorded on index cards. One measurement ran from the middle of the finger to the crook of the arm. He also introduced front and side photographs, which became the mug shot.

Fitzharris notes that Bertillon's system was choreographed, with officers holding subjects in set positions to ensure consistent measurements, but measurement error was a problem, and the system was soon replaced by fingerprinting. The conversation also touches on the 19th-century practice of binding books in human skin, which Fitzharris says was called anthropodermic bibliopathy.

Fitzharris says crime scene photography became important in the 19th century, and that it helped establish evidence, such as a man wearing boots visible in a photograph. She says she is always fascinated by the science behind stories like these, even when such details do not make it into a dramatized series.

Fitzharris describes a belief known as optography, which held that the eyeball acted like the lens of a camera and might capture the last thing a person saw. The belief suggested a criminal might be imprinted. Both speakers find this intriguing given the Whitechapel Ripper crimes, which began in 1888 as Sherlock Holmes was stepping onto the scene. They note the emergence of the bumbling bobby figure next to a doctorly Sherlockian figure who brought orderly thinking to criminal investigations.

Asked when the golden age of medicine was, Fitzharris says we are arguably living in it, given what can now be prevented and survived. She notes that Lister's antiseptic work was a paradigm shift, and that another one could overturn current understanding of disease within 50 years. She gives the example of H. pylori, where Australian doctors proved that a bacterium causes ulcers, overturning the theory that stress causes them. They later won a Nobel Prize.

Fitzharris argues that doctors should study medical history so they recognize that today's status quo may not last. She says what you know today is not going to be what you know tomorrow. She also recalls that in the past people delayed seeing doctors, because a visit did not mean survival, and a case of a 40-pound scrotal tumor illustrates this.

Fitzharris says doctors should study medical history, and Doctor Mike agrees that it should be part of medical school curriculum. He argues that healthcare needs unique minds thinking horizontally across fields, not only science majors. He suggests English majors and improv comics should also be admitted, and says AI innovation could make factual knowledge easier to acquire so more unusual minds can enter healthcare.

Doctor Mike also argues that censoring in healthcare, even censoring someone like RFK, is the wrong move, saying it makes such views more powerful. He says ideas that sound wild can sometimes be true, and that science improves through debate and discourse, which often starts with unusual ideas. Shutting them down is a losing battle in the long run.

Doctor Mike and Fitzharris discuss the human side of medicine, including trust in a doctor who shows they care and who can carry the weight of a mistake because they are human. They argue AI cannot replace a doctor for two reasons: it is not human, so patients will not feel the same trust, and it is not good at dealing with uncertainty, which is part of healthcare. It is good at knowing all the information that exists.

Fitzharris also notes that photography was once thought unable to lie, which is no longer believed. AI is trained by whoever builds it, so biases and human errors can be built in. They say the public should be able to interrogate who controls AI, and that unlike a doctor, a machine cannot be called to the witness stand, so there is no one to hold responsible for harm.

Fitzharris describes her own cancer experience, in which her surgeon told her the radiated breast would age differently, staying up while the other drooped, and explained that radiation causes fatigue, so a second round is avoided unless needed. She says the surgeon showed her evidence about a lumpectomy but made clear that the choice was hers, and that patient choice is important with cancer.

She says she went public with her diagnosis because she writes about illness, and that several women told her her story led them to get mammograms. She says some people fear-monger about mammograms and believe vaccines cause cancer. She concludes that a relationship with a doctor is built on trust and a human aspect of medicine that AI cannot replace.