The Worst Surgeries Of All Time | Dr. Lindsey Fitzharris

0:00Dr. Lindsey Fitzharris: Do you know what baby farming was in the 19th century? I know, this was grim. Okay, so this chapter opens. Baby farming. Baby farming.

0:08Doctor Mike: Back then, how were they learning anatomy?

0:10Dr. Lindsey Fitzharris: Dissection became very important in the early 19th century. You had these people called resurrection men. They were grave robbers. They would go out and they would steal the body. They started to do things to protect people. Trip wires. They had coffee.

0:21Doctor Mike: Like explosive trip wires? Yeah.

0:23Dr. Lindsey Fitzharris: I mean, they weren't super common. And there is a story of a grieving father accidentally setting one off and dying. I know. Oh my God. Horrible, right? Robert Liston, who was the fastest knife in the West End, he could hold you down, take off your leg in under 30 seconds. And when he was switching knives, he would often put them in his mouth.

0:41Doctor Mike: These bloody knives. If you're afraid to go to the doctor today, you have no idea how good you have it. Believe me, for all the problems we have with our current healthcare system, they don't even come close to what patients used to put up with. Prior authorizations and switching insurance providers certainly is a headache, but it's not as bad as sucking diphtheria out of someone's throat with a straw or performing a mastectomy with a fork, all without anesthesia, by the way. It's all so horrible, you might be wondering why anyone would wanna talk about this stuff, let alone get a PhD in it. Well, allow me to introduce you to Dr.

1:17Doctor Mike: Lindsay Fitzharris, a medical historian from Oxford University, who specializes in the dark and brutal history of healthcare. She's also the author of a new book called Sleuth Hound. It's the true story of a man named Dr. Joseph Bell, whose student named Arthur Conan Doyle used as direct inspiration for a little character named Sherlock Holmes. I've had the privilege of working with Lindsay for a few years, as she's been our fact checker on a bunch of our historical videos. I've been waiting for her to make a visit to New York so we could sit down face to face and talk about some of medicine's most gruesome history, today's that day.

1:55Doctor Mike: So I started by asking Lindsay a question that everyone seems to have these days. Given wars, politics, social media, you know, everything 2026, it's a pretty scary time to be alive, right?

2:06Dr. Lindsey Fitzharris: I'm not gonna agree with you on that.

2:07Doctor Mike: Oh, it's not a scary time.

2:09Dr. Lindsey Fitzharris: It's not as scary as it was in the past. So my superpower as a medical historian is I can make you feel good about living in 2026.

2:16Doctor Mike: You can.

2:17Dr. Lindsey Fitzharris: I can.

2:18Doctor Mike: Can you help me because I'm struggling right now really bad?

2:21Dr. Lindsey Fitzharris: I mean, one of the things is, is that I always tell people, even if you don't like history, you might like medical history because everybody knows what it's like to be sick, to be scared, to have to wait for results, right? And I, as a medical historian, tell you what that experience was like 50 years ago, 100 years ago, 150. And let me tell you, if you were in the 19th century and you needed to have, for instance, an amputation, it was a pretty brutal experience.

2:46Doctor Mike: So you help us put into perspective the things that we think are bad now are actually not so bad.

2:51Dr. Lindsey Fitzharris: Yeah, I mean, I can't speak to the politics of the day and all of that, but medically, I always say that today is the best day to be alive and tomorrow is going to be a little bit better. Right. So if you're diagnosed, I went through breast cancer in 2022 and people, and I was very public about that and people will come to me with their own diagnoses. And I always try to tell them that like, it's amazing how much we've progressed, especially with cancer care. So yeah, that's what I do as a medical historian. I try to make people feel a little bit better about living in 2026, which isn't always easy.

3:22Dr. Lindsey Fitzharris: But like I said, that experience in the 19th century, I always think of teeth, especially like there wasn't much you could do for teeth.

3:30Doctor Mike: But did you need to do a lot for teeth because folks weren't living as long?

3:35Dr. Lindsey Fitzharris: So that's a little bit of a myth. So one of the, yeah. So the, so the, the, the numbers are a little bit skewed because you had a high childhood mortality rates, right? So children were dying at high rates. So if you count that in the mean age is, is, is pretty young. But if you got past the, the childhood, the dangerous childhood period, you could live to a pretty good, healthy, long life. So what was like? Like in your, in your, in your seven, you could make it your seventies, eighties. Yeah, you could. Yeah. I mean, it wasn't.

4:04Doctor Mike: In the 1800s making it into your seventies? You could, you could.

4:06Dr. Lindsey Fitzharris: Yeah. So, I mean, it wasn't, I don't, I, I'm trying to think now, but like, I think, um, I think George Washington was well, it was in his sixties when he died.

4:15Doctor Mike: Um, but he could have lived longer if they didn't mess him up.

4:18Dr. Lindsey Fitzharris: Yeah. if they hadn't bloodlet him and hastened his death. I mean, he had an upper respiratory illness, so he probably likely would have died anyway. But yeah, Washington, he lived a pretty good life. So if you take out the childhood mortality rates and you got past that period, you could live a rather long life. So teeth, you know, they couldn't do much for your teeth. I mean, they would fall out, they would rot. And I always think of, do you remember Castaway? Tom Hanks.

4:45Doctor Mike: Sure, we had to coconut his thing out.

4:47Dr. Lindsey Fitzharris: Right. Everybody was just so, we were so tense. Like we knew that tooth was going to become a problem, like right at the beginning of the movie. And that's what I think about in the past. Like if you had a toothache, what could you do? You could go to the barber surgeon that could pull the tooth perhaps.

5:01Doctor Mike: Barber surgeon?

5:01Dr. Lindsey Fitzharris: Yeah, the barber surgeon. Yes. So the barber surgeons in the 18th century, so they were kind of like this combination of surgeons and barbers. And so you would go, you could get shaved, you could get your wig tended to, but then also they did things like pick lice out of your hair. They did minor surgical procedures and they bloodlet, which was the big thing in the 18th century and went well into the 19th century.

5:23Doctor Mike: And was this like a wellness procedure where people doing it, like they would see their barber if they had an illness?

5:28Dr. Lindsey Fitzharris: Yes. Yeah. They would go in. So people believed that illness was caused by an imbalance of the humors. And so it was believed that if you had an excess of blood, for instance, that it needed to be let out to restore that balance. And so they would go to the barber surgeon. And the barber surgeon was very much a man who worked with his hands. He was lesser than the physician. The physician was somebody who used his mind to make money. He went to university. And that's where we get that idea of internal medicine. He dealt with the internal disorders. But the barber surgeon dealt with the external disorders, the warts and all the external things that needed to be removed.

6:03Dr. Lindsey Fitzharris: and bloodletting was big on his tasks. And in fact, that barber's pole is red and white because the pole was the rod that you held to bulge out the veins. And then the ball at the top was the bowl that caught the blood. And then he would wrap his bloody bandages around this pole and it would whip around and form that spiral. And it was like an advertisement, like your barber can bloodlet you, you can come in and get a good bloodletting.

6:30Doctor Mike: Were those the grifters of the time Or were doctors being like, oh, you got to go get your bloodletting done?

6:37Dr. Lindsey Fitzharris: They did. Yeah. Physicians considered it the cutter's art, they called it. They considered it below them, again, because they were not men who worked with their hands. They did not lay their hands on the patient. That was seen to be very kind of working class. And so they would send you to the barber surgeon or to the surgeon. And the barbers and the surgeons split in England in 1745. and then suddenly you have blue and white poles and you have red and white poles to signify whether it's a surgeon or whether it's a barber. And the barbers then are kind of pushed out of the medical realm. And you get all these crazy stories, like Sweeney Todd, you know that story.

7:10Doctor Mike: I've heard the name and obviously there's a movie, but take me through it.

7:13Dr. Lindsey Fitzharris: Oh, you should walk. It's such a great story. So Sweeney Todd is this barber who's a demonic barber. He kills people, he slashes their throat, and then Mrs. Lovett makes their bodies into pies, meat pies, and sells them to unsuspecting. And actually, if you think about barbering, it's such a strange, there is a lot of trust involved, right? Of course.

7:33Doctor Mike: Like your neck is open, carotid is easily accessible.

7:36Dr. Lindsey Fitzharris: A hundred percent. And you're like covered in a cloak and you're trusting your barber not to kill you and make you into a meat pie. But the other aspect of this was.

7:44Doctor Mike: Never thought about that, but now I will.

7:46Dr. Lindsey Fitzharris: Now you will when you go to the barber. So the surgeons really wanted to separate from barbering because they wanted to professionalize. So they start rumors. And one of the rumors is the demonic barber who kills his his clients and makes them into meat pies. So this is kind of like the beef, the beef right between the physicians and the surgeons. And you also get the sort of sexually ambiguous barber. So you get the barber of Seville who's got you get who gets involved in his client's sex lives and stuff. So you get these two kind of emerging views of the barber. And they're both really there to discredit the barber as a medical practitioner.

8:23Wow.

8:25Doctor Mike: Wow.

8:26Dr. Lindsey Fitzharris: You didn't know there was beef in the 18th century, did you?

8:28Doctor Mike: I did not know that there was this much beef. And I also, I'm fascinated by the fact that this has been completely reversed. Right. Where now procedural medical specialties, dermatology, plastic surgery, all the surgery fields, cardiothoracic, like I'm going through orthopedics, they're the highest paid specialties. And med students vie to get those positions. Yeah. Whereas the traditional doctor is now under fire from RFK Jr. nonstop.

8:55Dr. Lindsey Fitzharris: Yeah. And that's the thing, too, is that in the past, if you were specialized, you were almost seen to be a quack because you didn't know everything. Right. And so those specialties really start to emerge at the end of the 19th century. You start to get more professionalization around medicine and surgeons in particular. But, yeah, it's completely different now. Like the surgeons are sort of at the top of the food chain. Right. I always think of scrubs and like the kind of dynamic between the physicians and the surgeons. but surgeons in the past, like I said, they were sometimes illiterate. They were trained by apprenticeship in the early parts of the 19th century.

9:27Dr. Lindsey Fitzharris: And then you start to get this professionalization in the later in the century. And that's really when that shift starts to happen.

9:34Doctor Mike: At this point, was any kind of medical research being done to say, the barbers are doing a good job, bad job. They're great at doing these procedures terribly. Was there any record keeping of this? Was there any trials? Population-wise studies.

9:48Dr. Lindsey Fitzharris: Let me tell you. So a lot of times doctors, so a lot of the wars fought in medicine were done in The Lancet, for instance, the medical journal. And it was a war of wards, really. And so a lot of doctors didn't admit to failure at the time. But I wrote a book called The Butchering Art, which is about Joseph Lister, who applies germ theory to medical practice and probably saves more lives than any other person to ever live, transforms surgery. and he's unusual because he does admit when patients die in his care. So you do start to get a bit of record keeping, but you don't really get hospital statistics until the end of the 19th century.

10:24Dr. Lindsey Fitzharris: So again, people will say, well, mortality rates were really high like at the beginning of the century, but it's difficult to know. And a lot of it depended. If you went in for an amputation, your chance of survival very much depended on when you fell in the line of patients. So if you were the first, remember your surgeon's not washing his hands or his instruments, right? So, so this is, so you want to be first.

10:50Doctor Mike: Not even for bacteria's sake. They didn't want to just, you know, a little wipe.

10:53Dr. Lindsey Fitzharris: Why would you do it? Because your hands are just going to get dirty with the next patient. If you don't understand germs, it doesn't really make sense to do that.

11:00Doctor Mike: It's hard to put myself in that perspective because I'm so used to being like,

11:03Dr. Lindsey Fitzharris: it's such a world we occupy now. Oh my God, I touched my face.

11:06Doctor Mike: I need to re-sterilize.

11:07Dr. Lindsey Fitzharris: Yeah, I know. You just want to pull out that. We shook hands and you had to pull out that. No, but I mean, this is the thing is we occupy a paradigm now where we understand germs. But back. Well, not all of us. Not all of us.

11:21Doctor Mike: Some of us are not afraid of germs and like to do cocaine off of toilet seats.

11:25Dr. Lindsey Fitzharris: I know that is true. And I was tagged in a lot of when those quotes came out by RFK, I was tagged in a lot of that, you know. Oh, he doesn't believe in germs and washing hands. And it's crazy because there's a story about a guy named Semmelweis. Do you know this story?

11:37Doctor Mike: Ignis Semmelweis. Semmelweis, university. They emailed me to speak there not too long ago.

11:41Dr. Lindsey Fitzharris: Oh, really? Oh, that would be fascinating to go there.

11:44Doctor Mike: Yeah, tough to just find time to go to Hungary.

11:47Dr. Lindsey Fitzharris: And just shoot the breeze and talk about it. Well, Semmelweis, everybody mentions him to me because, of course, Lister's the one who ultimately sort of wins and gets the credit for germ theory. But Semmelweis, obviously, he was putting together this idea that if you wash your hands before you go on to the maternity wards, the mortality rates were going down. These doctors were dissecting bodies and going right onto the maternity wards. So you can imagine they were carrying a lot of bad stuff onto the wards. They don't believe him. They call him the hand washer. Like the hand washer. What a nickname.

12:19Dr. Lindsey Fitzharris: Oh, my God. That should be the next tattoo, the hand washer. Yeah, the hair washer. And they put him in an insane asylum, and he dies in this insane asylum. But people say, well, he was the first. And I mean, it's a complicated story, but the problem with Semmelweis is he doesn't understand germs exist. And until you understand the explanation, it's difficult to get people to change. Right. So one of the most dangerous things in medicine is not ignorance, it's ego. And I think that, you know, the story of Joseph Lister, when he comes up with this idea of germ theory, he reads Louis Pasteur's germ theory.

12:56Dr. Lindsey Fitzharris: So Louis Pasteur is working on this problem of why the wine is spoiling. It's a very French problem. Like, why is the wine spoiling? And he talks about the microorganisms. And when wine spoils, it gets sour, that smell. And Lister's thinking, well, when the wound sours, because that's what surgeons would say, it has a smell, right? And he wondered if the microorganisms that was causing the wine to spoil might also be causing the postoperative infection. So he starts piecing this together. But Lister is very unusual because he was trained as a child with a microscope. His father was an amateur scientist, but at the time it wasn't used in medicine.

13:33Dr. Lindsey Fitzharris: So he goes to medical school. I call it his lightsaber, right? He brings his microscope. He sees the germs. He starts doing the trials. But people didn't believe him. And I think it was a hard pill to swallow to convince these surgeons that they had actually been inadvertently killing their patients all along.

13:49Doctor Mike: And to say that, oh, something you can't see.

13:51Dr. Lindsey Fitzharris: Right. Right. Where that as a concept didn't exist.

13:55Doctor Mike: Little creatures that are moving around are hurting your patients.

13:58Dr. Lindsey Fitzharris: Yeah. And that was, that was, that was very, that was a big leap, right?

14:01Doctor Mike: On a surface, it sounds made up.

14:03Dr. Lindsey Fitzharris: Yeah. And, and, and people ask me like, how could you not wash your hands? Like, I mean, it also just feels gross as well. Like, like you're just like, you know, elbows up into guts. I mean, Robert Liston, who was the fastest knife in the West end, he could hold you down, take off your leg in under 30 seconds. And when he was switching knives, he would often put them in his mouth, these bloody knives, right? And there is this story that probably isn't true, but it's a very famous, funny story about how he was moving so fast that he took off his assistant's finger. And as he was switching blades, he cut the coat of a spectator.

14:36Dr. Lindsey Fitzharris: And it was said that the patient died of gangrene, that the assistant died of gangrene, and that the spectator died of fright. And it's the only operation with a 300 % mortality rate. So it was a crazy, it was a crazy time. But I also, I want to make the case that doctors and surgeons in the 19th century were some of the most compassionate people in the room.

14:58Doctor Mike: Were they? They don't sound like it.

15:00Dr. Lindsey Fitzharris: I know Robert Liston and his bombastic ways. You know, there's another story about how a patient sees him. He walks in. He was very striking. He was six, two. And the patient just thinks, oh, hell no, I'm getting out of here. He jumps off the table, runs into the closet, Liston chases him, tears off the door, drags this poor guy back. But listen, he was committed to saving lives and he had to go in there and do this time. I mean, could you imagine going in there and doing this time and again and also losing patients? You're in the business of saving lives and your patients are dying and you had to be steely for them, right?

15:36Dr. Lindsey Fitzharris: Because you're holding them down, essentially. I mean, somebody asked me once on tour, didn't they punch them out? And I was like, wow, you'd have to be really good to be able to just punch somebody out.

15:47Doctor Mike: Not everyone is a doctor and a professional boxer.

15:49Dr. Lindsey Fitzharris: Yeah, exactly, exactly, right? You would be good at that. But I was like, no, I've never heard that. And also that would cause other issues. Like they were not punching them out. They were not drunk usually because that created other problems with bleeding. So there was very little before the dawn of anesthesia. And you just had to grit it. And, you know, the patient, I mean, how terrifying to go into that 19th century operating theater, which, by the way, was filled with spectators. Sometimes they bought tickets.

16:15Doctor Mike: What?

16:16Dr. Lindsey Fitzharris: Yeah, tickets to the operating theater, which people will say, listen, they were so morbid back then. But, hey, we love the pit. I know you love the pit. Yeah, I love the pit.

16:24Doctor Mike: My God, people were like stub hubbing. Yeah. Oh, my God, it gives new meaning to scalping tickets.

16:30Dr. Lindsey Fitzharris: Yeah, it does. And it's the theater, right? The operating theater. We call it a room mostly now, but it really was a theater in the sense. And they were carrying the grime and dirt of everyday life into that.

16:41Doctor Mike: So like if you get the news that you need to go in for surgery, are you just dreading it deathly afraid?

16:46Dr. Lindsey Fitzharris: I would imagine that it was a pretty terrible experience. And keep in mind, a lot of the patients that are featured in my books, you only went into the hospital if you were very poor in Britain. if you were wealthy you would have your own operation on your own like dining table because it was safer than going into these hospitals because so many more germs and so many which they didn't know that but they called them houses of death you know they were just terrible places so you went in there to the hospital if you were really desperate and sometimes the hospitals made you prepay for your burial because it was so expected that you were going to die once you were admitted.

17:23Dr. Lindsey Fitzharris: So it was, it was not a good, you know, now 2026 looking pretty good, right? Dr.

17:28Doctor Mike: Mike, I'm thinking like, okay, maybe I'm being too spiritualistic, but bear with me. Epigenetically speaking.

17:36Dr. Lindsey Fitzharris: Yeah.

17:36Doctor Mike: Do you think, uh, I have a lot of patients that are very afraid to go for surgery during which they will be sedated. They're not going to remember anything. They're not going to feel pain. And sometimes day of the surgery, they cancel and they decide the anxiety is too hot. Are they carrying the epigenetic wounds of their ancestors who are getting butchered on their dining tables?

17:58Dr. Lindsey Fitzharris: It could be that. I think that, you know, the loss of control is very scary. Oh yeah. So my next book is going to be called Ether Wars. And it's about the moment that ether is discovered in 1846. What's ether? Ether was the first anesthetic. And it was - Yeah, it's inhaled. And, you know, if doctors actually they were they were once it was discovered, they were experimenting with it and they would have ethereal experiences. Right. That's where we get that term. And so so ether is discovered in 1846 by a dentist in America. and then all of these other people step forward to claim priority over this and it kind of ruins everybody's life and it's it's a story about the first attempt at medical capitalism but also what happens when something so powerful comes along that changes the world who gets to own it who gets to profit from it which I think is very you know relevant today but interestingly Harriet Tubman when I was working on the proposal Harriet Tubman who is you know an enslaved woman she has to undergo brain surgery not brain surgery sorry surgery on her head her skull and she refuses the anesthesia this is in the 1890s and because that idea of the loss of control was very scary for some people and so and also anesthesia comes along and not everybody is given anesthesia in fact in my proposal and I probably shouldn't even be talking about this because I'm not quite up to date so if you're listening and some of this you know feels like you know she's missed out a point I'm getting to it like it takes four or five years to write a book but there was there was a story in 1982 the year I was born there was an infant who underwent cardiac surgery with no anesthesia just a paralytic and because it was believed that infants didn't feel pain what in this 1982 right that's not that long ago yeah it's not that long thank you it's not that long ago but but also it's it so it's a story about this amazing thing that happens but also not everybody's given access to it.

19:57Dr. Lindsey Fitzharris: There are still a lot of myths around pain that persist. Maybe women don't feel pain as much or pain is necessary in childbirth. That's one of the things in the 19th century. So it's very much a story about this thing that changes medicine forever, but also it's a very complicated story as well.

20:13Doctor Mike: It's very complicated. And this idea of feeling pain during a procedure, you mentioned something earlier about the fastest knife.

20:22Dr. Lindsey Fitzharris: Yes.

20:22Doctor Mike: I mean, so did you go in instead of asking like how often do people die? How quick are you? Was that a valuable trait?

20:30Dr. Lindsey Fitzharris: It was. Yeah, absolutely. So Robert Liston, he would walk into the operating theater and he would say, time me, gentlemen. And you can almost hear the pocket watches all come out, right? And it was a real showmanship to some extent. And so they were always trying to beat their records. But you would want your surgeon to be fast, of course, because, you know, it's extremely painful. And we talked about off camera how the old operating theater in London, which is the second oldest in the world, has this Victorian table and it looks very small and very low. But you'd want it low because you'd want to use your weight to kind of take that leg off.

21:04Dr. Lindsey Fitzharris: And it had to be fast. And the patient is fighting you. I mean, everything you had to be very good and very courageous, I think, to go into that operating theater and have to operate on a patient fully awake.

21:17Doctor Mike: Yeah, the moral trauma. Were these doctors burning out because they were hurting so many people? Or was this like a heroic thing that they were doing?

21:25Dr. Lindsey Fitzharris: I mean, a lot of doctors died early too. Really? Because they were exposed to tuberculosis. They were eating or holding knives with E.

21:32Doctor Mike: coli on them.

21:32Dr. Lindsey Fitzharris: Exactly, it wasn't a good situation. And in fact, in my new book, Sleuth Hound, which is about this guy named Joe Bell who inspired the character of Sherlock Holmes, diphtheria, you obviously know what it is, right? Do you still see it?

21:44Doctor Mike: Well, we also vaccinate against it, so we don't see it.

21:47Dr. Lindsey Fitzharris: Right. Okay. So diphtheria, for people who don't know, you kind of you get this like leathery membrane over the trachea. And so you slowly suffocate. And it was a big problem in the 19th century with children. And one of the patients comes in and Joe Bell, one of the ways you would get air to the passage was to do a tracheotomy. But of course, infection rates could be very high in these hospitals. And so he devises a pipette and he sucks the mucus out of the patient's throat, which and then he gets diphtheria himself. and almost dies from it. And afterwards, he had this kind of high discordant voice, which also Sherlock Holmes is described as having.

22:26Dr. Lindsey Fitzharris: And he has this very peculiar gait as well. Like it affects his walking. So doctors were trying to do everything they could to save patients. And they were dying sometimes, you know, in the process.

22:37Doctor Mike: And now patients are like, oh, I'm going to have a sore arm. This is such a big deal for this vaccine. Meanwhile, that was the reality. We have short memories.

22:45Dr. Lindsey Fitzharris: Yeah, we have very short memories. I try to tell people, you know, I am a medical historian and I study a time when people lost their kids at high rates. You know, these are preventable diseases now. And, you know, you have to you read the diaries of these parents who are losing child after child. It's horrible.

23:02Doctor Mike: How do you as a medical historian wrap your head around the anti-vaccine movement as it exists today?

23:07Dr. Lindsey Fitzharris: Well, it doesn't surprise me because anti-vax sentiments have always existed. So, you know, you get Edward Jenner in the 18th century creating the smallpox vaccine. He calls it a vaccine. So a lot of people in the comments are going to be like, vaccines existed before Edward Jenner. But that was inoculation. And at the time, inoculation and vaccination were two different terms. Inoculation used the smallpox virus, which was dangerous because you could become contagious. And Jenner uses the cowpox virus, which is less dangerous and confers immunity for smallpox. He calls it a vaccine. It's from the Latin word meaning of the cow.

23:42Dr. Lindsey Fitzharris: So that's what vaccine means. And when he came up with this, there was a lot of fears around it. Like there's a lot of satirical cartoons in the 18th century of people sort of turning into cows and like growing horns and things like that. And people burn effigies of him. They were they were very afraid in the early 19th century. There's some vaccine that vaccines become mandatory and there's a real pushback against that. So these fears are not new. There's they're slightly different now today.

24:11Doctor Mike: a 5G cell tower. Right. Yeah, exactly. Yeah. They're not that different even. I know it's

24:16Dr. Lindsey Fitzharris: like a new modern sort of take on it. And in a lot of it, you know, I mean, you've done such a good job at, at talking about in videos, the harm that medicine's done and acknowledging that. And I think that we have to communicate with people and you do, you are doing all of that, right? You have to communicate with people and try to address those fears. Because I think when people feel like they're not being heard. That just makes it worse, doesn't it? Sure.

24:42Doctor Mike: It's a fine line because you want to admit fears that are real, but also talk back to things that are not real as honestly and transparently as possible. And then in the areas where it's great, admit that it's great. And sometimes what we do in medicine too often is we're just quick to write off all the people's fears and just throw data at them in hopes that we're robots and are going to just listen to full-on data when the reality is folks don't really love data. That's not what drives decisions. In fact, the anti-vaccine movement is stronger now than it's been in the last 20 years. And we have more data and AI can give you those answers and yet people are not going to AI.

25:22Dr. Lindsey Fitzharris: Yeah, I mean, and again, it's wrapped up in ego. I think the medical profession has to get a bit better at communicating and to engaging with people who have real fears. And there are people who've been, like communities of people who've been harmed by medicine in the past been lied to right by by doctors and so we have it's that fine line of you know as a medical historian i never want to turn people off medicine i think medicine has done amazing things but you know sometimes there's these flashes of brilliance but sometimes medicine causes harm and i think you have to tell that whole story and only once we acknowledge that can we kind of move forward so i'm hopeful with anti-vax movement today that we will move forward because we go through these periods where there is these intense fears and also like technology and medicine's moving so fast.

26:07Dr. Lindsey Fitzharris: And I mean, even when railways were, uh, railroads start to come into existence and trains, there was this thing called railway spine. People thought that if you were moving too fast, you could get all these disorders. And by the way, these trains were not actually moving that fast. They thought like your uterus could like fly out of your body. And I mean, And so there's all these. So so as the world changes and moves and like the rise of A.I. and all this, it's a scary world. And I think people become insular and they and they have a reaction against that. We see that time and again in medicine is just one of those things that kind of gets the flack.

26:40Dr. Lindsey Fitzharris: But I think people like you talking and trying to have a really genuine conversation about the fears that people have around vaccines is so helpful, I think.

26:50Doctor Mike: You know, it's interesting. We're talking about doctors making mistakes historically. Balancing the humors is probably the biggest one that comes to mind for me because we've talked about it on this channel. Yeah. George Washington. Yeah. Probably lost his life earlier than he should have because they were -

27:04Dr. Lindsey Fitzharris: Maybe a few hours, but yeah. To some degree. It didn't help. It didn't help, did it? Yeah.

27:08Doctor Mike: So they would make people bleed, vomit, have diarrhea, what have you. And I think about snake oil salespeople at the time. And while they were also selling maybe some inert substances that didn't do anything, they also sold some toxic substances that hurt people. but a lot of times they were anti the allopathic form of medicine.

27:27Dr. Lindsey Fitzharris: Right.

27:27Doctor Mike: Yeah. Was there ever a time that snake oil salespeople were actually right simply on the notion of not forcing people to balance their heat?

27:38Dr. Lindsey Fitzharris: I mean, that's such a great question. And there must have been examples of quack medicines that did do something. In the 19th century, you get the patent medicines and the growth of this. And that term quack, I think there's a couple of different theories about it. But one of them is that they would carry sort of like a loud device and they would go into villages. And the quack was somebody you can get medical advice for cheap, right? Like going to the physician was very expensive. So the quack would come in and have, you know, the loud instrument. You go out and you would get your potions and stuff.

28:09Dr. Lindsey Fitzharris: But we still have quack medicine today. Like I think a lot of like the health pills and things, you know, even like, I don't know, you might have views on this. but all the vitamins you take, right? Oh, yeah, big time. Like, do you need, because I think the body doesn't absorb, like it will only absorb as much as it needs, right?

28:27Doctor Mike: Yeah, there's a lot of false thoughts when it comes to vitamins of people thinking more is always better.

28:32Dr. Lindsey Fitzharris: Right.

28:33Doctor Mike: When in many instances, even when it comes to healthy things like antioxidants, more can sometimes be worse and they can have a pro-inflammatory effect as opposed to their initial anti-inflammatory effect.

28:43Dr. Lindsey Fitzharris: And people don't share that information because they don't think it's like -

28:45Doctor Mike: Well, you can't sell that.

28:46Dr. Lindsey Fitzharris: Right, yeah, yeah. That's the issue. Yeah.

28:48Doctor Mike: And then they'll take some nugget of truth of something that happens in a petri dish or an early lab model, animal model, and then sell that to humans. There's a lot of that happening right now. And I don't know, at least that's based on some evidence. Because you can't say vitamins are bad for you or not good for you because they are. You need them to live. They're essential. The question is, do you get them naturally in your diet?

29:12Dr. Lindsey Fitzharris: Right.

29:12Doctor Mike: And if you don't, how much extra do you need? How do you get it? All these. It's a nuanced point.

29:17Dr. Lindsey Fitzharris: It's expensive, too. Very expensive. Like, there's a lot of money to be made. Huge. My mom loves vitamins. And I'm always like, mom, if you just ate, like, a balanced diet, right, you would get the vitamins. And so I think that, you know, there is some quackery still, of course, today. And people want short, you know, anything that's kind of positioned as a cure-all, I think, is always, like, a suspicious thing, right? Like, if it's, you know, and in the 19th century, they were the masters at this. Like, you know, take this pill and you're going to live for 120 years and all this kind of stuff.

29:47Doctor Mike: So they were more direct about it. There was no FTC, FDA being like, I can't make that claim.

29:51Dr. Lindsey Fitzharris: Yeah. And that's an important part too, is that medicine did harm, but now we have, I mean, some of those institutes are under attack, but we do have institutes that make things safer. So when medicine rolls something out, it's been tried and tested and there's trials and research and not just do your research on Google while you're sitting on the toilet kind of research, like real medical research. And so we're safer in that sense. And I think that that has to be communicated to people, too, that are nervous about, you know, being treated medically.

30:23Doctor Mike: I'm trying to think of the through line here. Now, if something is a potential cure or will help your health, it goes viral. What did it mean to go viral in the 19th century?

30:34Dr. Lindsey Fitzharris: That's such a good question. Gosh, I'm trying to think who would have sort of gone viral like I would consider to have gone viral. I mean, obviously the dawn of anesthesia. Right. So it's discovered in 1846, and within a month, I mean, it has gone all around Europe, and everybody's trialing it. Because remember, again, you don't have to go through safety procedures and things like that.

30:55Doctor Mike: Right, no ethics reviewed. Yeah, exactly.

30:56Dr. Lindsey Fitzharris: Although I think that, again, to this date, I've only written British histories, and I'm going to be writing my first American medical history with Ether Wars. But I think that there was a sense that the doctor could be held responsible for killing a patient. So there was a little bit concern around ether and chloroform. Chloroform actually is a little bit more dangerous in that sense. Chloroform comes about shortly after ether, but it's more effective as an anesthetic. So ether can make you kind of giddy as well as sort of sedate you. But American physicians and surgeons liked ether because there was less likely that you were going to die.

31:33Dr. Lindsey Fitzharris: And there was a risk in America if your patient died that you could be pulled up on charges where that didn't necessarily exist in Britain. So but it travels so fast. So you have ether and they print this. The age of agony is over. And then you have Robert Liston, the fastest knife in the West End, just weeks later in London. And he performs the first operation under ether. he doesn't think it's going to work. He calls it the Yankee Dodge because so many things didn't work, right? They had mesmerism. What's mesmerism? So mesmer came along in the 19th century and he claimed he could hypnotize patients so that they would just lie still and not feel any pain, which would you want to go through that?

32:14Doctor Mike: I mean, it sounds amazing, but yeah, that would be amazing

32:16Dr. Lindsey Fitzharris: if it worked and it obviously did not work. And so mesmerism. So Liston walks into this thinking, this is like another mesmerism. He calls it the Yankee Dodge. He doesn't think it's going to work. He walks into that operating theater and he says, time me, gentlemen. And the pocket watches come out and it works. And it's a miracle. The patient didn't feel a thing. And what I loved about that scene in London in 1846 was that a young 17 year old Joseph Lister was in the audience. And so here you have anesthesia and then you have the man who's ultimately going to solve the biggest mystery of all time, which is what was killing patients after they cut into the patient.

32:55Dr. Lindsey Fitzharris: And that was really important to making surgery modern so that we could operate with hope rather than resignation, that we can control the post-operative infection afterwards.

33:07Doctor Mike: And now I'm mixing probably names in my head. Lister, Listerine, any relation? Yes.

33:13Dr. Lindsey Fitzharris: Yeah. So people do know him through Listerine, but he did not create it. It was named for him, but not by him. And in fact, that was when he came to America in 1876. He came, he was invited by doctors who did not believe in germ theory. They kind of set him up, right? And he comes into this very hostile environment and he gives this big speech. And one of them was a man named Dr. Samuel Gross, a Dr. Gross. Now, if you've been to Philadelphia, you will maybe have seen the Gross Clinic painting. It's very famous. And if I showed it to you, you would recognize it. And Samuel Gross is at the center and he's dressed in his street clothes.

33:52Dr. Lindsey Fitzharris: And he would so not believe in Lister, he would walk into the operating theater, he would slam the door and say, there, Mr. Lister's germs can't get in anymore. And so he just, in this painting, you could really see this playing out. He's sticking his dirty fingers into the wound. There's a woman in the back. She's wearing black. She's the mother of the patient. She expects her son to die. Thomas Akins, who painted it within 15 years, paints another one called the Agnew Clinic. And the doctors are wearing white. There is a sense that they understand antisepsis and germs. And there's women. There's a woman in the form of a nurse there.

34:26Dr. Lindsey Fitzharris: It's a very different painting. And you can really see that pre and post Listerian moment. But it took a while because ego.

34:34Doctor Mike: Is Listeria tied to this in any way? Or now am I just putting L words together? No, I think it is.

34:38Dr. Lindsey Fitzharris: I mean, again, he didn't have anything to do with it, but I think it was named after him. But he's such a huge figure. And I always say he saved more lives than any other doctor who ever lived. And he was a very humble man as well. He was a Quaker. And his Quaker upbringing really kind of fed into what he ultimately was able to. He has a mental breakdown during medical school, leaves medical school. And his father says, you know, this is where you're meant to be. And he ends up going back. And thank goodness that Lister goes back and he changes the paradigm.

35:10Doctor Mike: And what was his practice? Like, what was his day-to-day?

35:13Dr. Lindsey Fitzharris: So he goes up to Attenborough. He trains in Attenborough. He was working in London for a short period. He goes up to Attenborough, thinking like this book now is about 10 years old. So I'm trying to think. So Attenborough. And then he goes to Glasgow where he does his first experiments with antisepsis. There's this little boy that is brought to him, James Greenlees. His leg has been shattered by a cart. So crossing the street was pretty dangerous in the 19th century. and if you think about it all the dirt let me think about what that wound was like it was a compound fracture yeah and it took hours to just get him to the hospital at this point any normal surgeon would be like we're amputating but Lister wants to see if this is going to work so he starts cleaning the wound out he resets the leg he cleans the wound out with carbolic acid which is the antiseptic of his choice and lo and behold James Greenlee survives and he walks out of the hospital on two legs, which was extraordinary too, because if you, if you think about it, if you're very poor in the 19th century and if you lose your leg, there's no social network to keep you right now, you can't work possibly.

36:15Dr. Lindsey Fitzharris: There's all kinds of challenges that you would have. So being disabled in the past was, was very, very serious. And so he, he saves this boy's life in so many different ways. And this carboxyl, carbolic acid, carbolic acid, was this the first like antiseptic disinfectant? I mean, people were using, they experiment with different kinds of antiseptics, but he had read in a newspaper article that it was being used to sanitize the smell of garbage. And he thought, again, that smell of rotting, like could this work? So he starts experimenting. He starts with James Greenleaf. He realized it's very corrosive.

36:52Dr. Lindsey Fitzharris: So he starts mixing it with olive oil. And he goes through different stages of how to, like, because you don't want to cause inflammation around the wound from just the antisepsis. So he does have to kind of experiment to get that correct. But it was said that his hands were so corroded that he would hold them in his pockets later in life because they just look so awful. And I think there is a story. I don't know where this comes from. And I do think it's true, but I would have to fact check it. But the doctor who created the surgical gloves was in love with a nurse and her hands were getting eaten up by this carbolic acid.

37:26Dr. Lindsey Fitzharris: And so he creates the surgical gloves to kind of save her hands.

37:30Doctor Mike: But yeah, the carbolic acid. Yeah, very romantic. Spent on the surgical glass.

37:34Dr. Lindsey Fitzharris: Exactly. But yeah, carbolic acid was the choice. And then because Lister lives into his own fame, there's all kinds of offshoots. Like people create toothpaste out of it. There's all kinds of carbolic acid offshoots because it becomes very famous as the antiseptic of choice.

37:50Doctor Mike: You mentioned his sense of smell. What are some examples historically of physicians or the field of medicine using senses to either create products or create cures?

38:00Dr. Lindsey Fitzharris: Well, that is a great question because Sleuth Hound is very much about, I like the T up there. So Sleuth Hound, which is my new book, is about Joe Bell, who was a Scottish surgeon. And like I said, he had this incredible knack at scene. And he was up in Edinburgh, he was teaching medical students how to read a human body like a crime scene. Everything was, you know, a callus, a stain, a limp. All of these were clues to Bell if you only knew how to see them. And in 1878, Arthur Conan Doyle becomes his medical student. I don't know if you know this, but Arthur Conan Doyle was a doctor before he was a writer, before he created Sherlock Holmes.

38:39Dr. Lindsey Fitzharris: And I've been going on a lot of medical podcasts, and I always say to doctors, are you surprised that the original Sherlock Holmes was a doctor?

38:46Doctor Mike: I'm not surprised at all.

38:48Dr. Lindsey Fitzharris: Right. Yeah.

38:48Doctor Mike: Because it feels like it is a doctor.

38:50Dr. Lindsey Fitzharris: Yeah, exactly. So what Bell had to do was cut through the petty deceits of his patients in the 19th century. Because you know, patients lie to you still today, right? Or maybe lies too strong, but they don't tell you about all the vitamins. They don't tell you all that stuff. And so, of course, in the 19th century, you didn't have as many diagnostic tools, so you had to really look. And he just had this very Sherlockian quality. He could tell everything. So the book opens with Bell in the operating theater and the patient is brought before him and he says he's an army man. And the patient immediately denies this.

39:25Dr. Lindsey Fitzharris: And Bell thinks this is very strange because he's usually right. So he has the patient stripped to the waist. And lo and behold, there is a D on his chest for deserter, which means he was an army deserter. So Joe Bell would be bested by no one. So he had this incredible knack and all of these stories sort of abound. And Arthur Conan Doola became his outpatient clerk and had a front row seat to all these amazing performances, if you want to call them that. But he became known as the demon of diagnosis in his hospital.

39:52Doctor Mike: What a great nickname. I know. I want that nickname.

39:55Dr. Lindsey Fitzharris: Yeah. Well, I don't know. Dr. Mike, we were talking about this. You're like Cher, right?

39:58Doctor Mike: Like you're known only. I mean. But demon of diagnosis.

40:01Dr. Lindsey Fitzharris: The demon of diagnosis. That would be cool. You're thinking of it as a tattoo, aren't you? Yeah, everything's a tattoo now. It just makes such a great tattoo. Yeah, the demon of diagnosis. is he was very famous for this. There was, I mean, you'll love this story. So there was this older woman in town and she was very wealthy and she was kind of prone to these exaggerations. And she calls on him one day and says, I've lost my sight. I woke up and I'm blind. So he goes there, he sits at the bottom of her bed, listens to her for a half hour. And at the end of it, he puts his thumb on his nose and he wiggles his fingers.

40:31Dr. Lindsey Fitzharris: And she says, how dare you? Which meant that she did not, in fact, go blind. right so he was he was good at cutting through the petty deceits wow and they were doing that

40:42Doctor Mike: as a form of malingering or what was the benefit of them doing that what you mean the the way he was diagnosing well no the way that people would lie so often like what was the i think people just

40:52Dr. Lindsey Fitzharris: lie i think people still do that right or maybe they don't they don't i mean now i feel like a

40:57Doctor Mike: lot of people learn their lesson that like if i'm honest it's better for me yeah i mean it helps the

41:02Dr. Lindsey Fitzharris: doctor, right? Get to the, you know, I mean, another woman is brought before him and he says, show me your cutty pipe, which was a kind of smoking pipe. And she, what is he asking? And, and she's very embarrassed because smoking isn't a very feminine habit in the 19th century. And then he says, show me the pipe. And she brings it out. He ushers her out of the room. He has an assistant usher out of the room. He asks his students, how did I know? Well, she had a superficial burn on her cheek and she had a cancerous sore on her lip which you only get from a lifetime of smoking so he he really you know unlike um the butchering art bell doesn't create a single technique or a paradigm shift but he does teach us a way of looking at the world which then is passed on into this character of sherlock holmes and kind of lives on in crime scenes.

41:53Dr. Lindsey Fitzharris: And what I learned about Bell was that he wasn't just the inspiration. He was doing what Holmes was doing. He was working unofficially with a police surgeon named Henry Duncan Littlejohn on some of the biggest cases of the 19th century. And this is the moment that forensics becomes professionalized. This is the moment that medicine enters the courtroom, that the doctor can testify not just on the basis of his own personal experience with the case, but you could actually get the expert for hire. So if you're a doctor, you could review the autopsy and the postmortem notes and you could go and testify.

42:27Dr. Lindsey Fitzharris: That's a change in the end of the 19th century. So Bell and Little John are working on all these cases like Jack the Ripper. And also, by the way, there is a ballistics expert in this book named Dr. Watson. I kid you not. And as a nonfiction writer, I was like, this is the book I have to write. So wow.

42:44Doctor Mike: A lot of similarities happening all at once.

42:46Dr. Lindsey Fitzharris: So many. And he was different, though. He was different from Holmes. He was very empathetic. empathetic. He was a family man. His wife dies in her 30s. And he really holds the torch for her the rest of his life. He raises his three children alone. So there are differences. And I really wanted to bring that medical history lens to his story. Because I think people only sort of remember him as this Sherlockian figure. And I think that bothered him at the end of his life. But he helps reform nursing in the 19th century. He's friends with Florence Nightingale. He's an advocate for women in medicine.

43:19Dr. Lindsey Fitzharris: So there's a lot of interesting things about him that have nothing to do with Holmes as well.

43:23Doctor Mike: What, uh, I've heard rumors about this. Yeah. Is House MD based on Sherlock Holmes?

43:29Dr. Lindsey Fitzharris: Yes, it is. It's yeah. It's kind of like returning to the roots, right? Cause here you go, you have the doctor and also like, he's very Sherlockian, like in the way that he's sort of emotionally detached. Um, and he also assumes everyone's

43:41Doctor Mike: lying.

43:42Dr. Lindsey Fitzharris: Yes. Yes. Yeah. And so I think that House MD, he, I think that character is very much, you know, based on like Bell in a sense, because of course, Conan Doyle is taking the essence of Bell and then applying it to Sherlock Holmes. Now, I don't know if you know much about Sherlock Holmes, but Conan Doyle hated the character. Like he could not stand it. And right around the time that he outs Bell, and I joke that he sort of does a modern doxing of Bell because he puts, he dedicates the Holmes tales to Bell and he puts like Bell's address at the front. I was like, Like, wow, that was like a whole.

44:16Dr. Lindsey Fitzharris: But he did ask permission if he could share Bell's name with a journalist. And Bell does agree initially. But Bell, so right around the time he outs him, he kills off Sherlock Holmes. Because he couldn't stand the character. He just thought he wanted to be a more serious writer. So he kills off Holmes. And suddenly it's like Sherlock Holmes is dead. Long live Sherlock Holmes. All the media attention turns to Joseph Bell in Scotland. And right at that time, this murder case falls into a lap. that involves a country mansion, a death dressed up as an accident, and Dr. Watson, the ballistics expert.

44:50Dr. Lindsey Fitzharris: And it's just this amazing case. And so Bell lives into this fame as kind of the inspiration for this character. None of what I'm saying there is new, but there had never been a book about Bell that really fleshed him out and fleshed out his forensic cases and things like that. So the book is about him as a doctor, but it's also a book about the forensic cases that he worked on. And he even teams up with Conan Doyle at the end of his life to overturn a murder conviction in New York of a guy who is on death row and going to be electrocuted. What? Yeah.

45:22Doctor Mike: So it's like for criminals and against criminals. Yeah. Yeah.

45:27Dr. Lindsey Fitzharris: Well, and it's a weird case because my editor was like, I don't understand. So do you know the Rice University in Texas?

45:34Doctor Mike: I've heard of the Rice University.

45:35Dr. Lindsey Fitzharris: So William Rice was this multimillionaire at the end of the 19th century, and his money was used to found that university eventually. But what happened was he was a very old man. he ends up dead and lo and behold all of the money is willed to his lawyer which seems a little bit suspicious doesn't it so this guy is put up for murder now the and he's convicted on the basis of this now the problem is conan doyle and bell stepped forward to say that this conviction cannot stand because the body had been embalmed right after he died so none of the forensic evidence was sound. So this is kind of like the, if the glove doesn't fit, you must acquit moment.

46:15Dr. Lindsey Fitzharris: And it's the ultimate test of the forensic scientist, right? You might think he's guilty, but the evidence was corrupted. You can't hold the conviction. I won't tell you if they, if they succeed in this, but it's an interesting case. But my editor was kind of like, I don't know, this guy sounds guilty.

46:32Doctor Mike: I don't understand why Conan Doyle.

46:34Dr. Lindsey Fitzharris: And I said, yeah, It's an interesting case because really, I think it's the ultimate test. If you're going to stand behind your science, you can't convict on the basis, even if you have like the vibes, you know, oh, this guy seemed like he was guilty.

46:47Doctor Mike: Well, it's like the people who stand behind law theory, where it's like, even if your client is very obviously guilty, you still give them the best defense possible.

46:54Dr. Lindsey Fitzharris: Exactly. And I mean, have you watched a killer story on HBO? It's like, it's a wild documentary. and at the end, I kind of did think that this woman was guilty, but she was really just convicted on vibes. Like the evidence wasn't there. And the juries are kind of scary like that. Actually, in Scotland in the 19th century, there were three options, guilty, not guilty, or not proven, which I like that.

47:18Doctor Mike: What do you do with the non-proven?

47:19Dr. Lindsey Fitzharris: Not proven is still an acquittal, but think about, again, O.J. Simpson would not proven have landed a little bit better, you know and one of the problems i i keep that would mean like on vibes it feels like you did it but we can't prove it yes okay exactly so like a not guilty would be like we actually think this person didn't didn't commit it not proven as like well there's not enough evidence it could go either way and i and um you know it's it's just a fascinating time and i i do think of the oj simpson case a lot because i'm of the age where i kind of grew up with that case but do you remember how much testimony on DNA, because DNA was new at the time.

47:56Dr. Lindsey Fitzharris: And it backfired because it was like, it got really boring and technical. And I think of Bell and Little John, and I think about how all of forensics was new at the time. And they had to be very good at communicating that to juries and to breaking down, because these juries had no baseline forensic knowledge, and they had to kind of go in. And Little John was fascinating. He kept everything. He kept the murder weapons. He kept the nooses that, you know, hanged the people he helped get convicted. And he was he was kind of a showman himself. And there's one case in the book that I have to tell you about because it's such an intriguing case.

48:31Dr. Lindsey Fitzharris: Because Joe Bell worked unofficially like Sherlock Holmes, it was difficult sometimes to find evidence of which cases he had worked on. And there's a case of a man named Eugene Chanterelle. He's very charming on the outside, kind of sinister on the inside. His wife turns up. She's passed out in their home. They think it's a gas leak, which was a common thing that happened in the Victorian period. And what happens is Little John's a bit suspicious. She dies later at the hospital. He starts to investigate. I think Bell worked on the case. And the reason I think he worked on the case was because when Sean Terrell was convicted, he got up onto the scaffold.

49:07Dr. Lindsey Fitzharris: He scanned the audience. He locked eyes with Little John and he said give my regards to Joe Bell he did a good job putting the noose around my neck and I thought this is such a Sherlocking moment you could heal the you could hear the trap door fall the neck snap and how did he know but another intriguing thing about Chanterelle is that he was friends with Robert Louis Stevenson and he becomes one of the inspirations for Dr. Jekyll and Mr. Hyde so you have the real Sherlock Holmes Dr. Jekyll and it's just such a great time 19th century Edinburgh was a wonderful time. And the medical school was brilliant.

49:40Dr. Lindsey Fitzharris: And there were so many advances happening at that time.

49:42Doctor Mike: There's also so much trauma, I imagine, that happened with the wars and the damage that human bodies faced. As you said, being disabled during that time was kind of like a non-starter in terms of being able to care for yourself. There were no disability activists at the time. Maintaining work was hard. Was there any work being done to correct the disfigurements and disabilities that were happening?

50:04Dr. Lindsey Fitzharris: Well, now you've entered my other wheelhouse. So my second book was called The Facemaker. So a lot of people think of plastic surgery as cosmetic surgery, which is a big part of plastic surgery. But another big part of plastic surgery, even today, is reconstructive surgery. And so during the First World War, there was an incredible number of advances in weaponry. So many, in fact, that a company of just 300 men could deploy equivalent firepower as a 60 ,000 strong army just previously in the previous century. So this is severe damage. Medicine is trying to keep up with this. You know, you have the invention of the tank, for instance.

50:43Dr. Lindsey Fitzharris: And this presents new challenges and injuries to medical teams. And in the midst of this is this man named Harold Gillies. And Gillies was this extraordinary figure. He he goes to France and he meets this man named Vladier. He's this French American dentist. He's kind of bigger than life. This guy had a Rolls Royce that he retrofitted with a dental chair and he literally drove it to the front under a hail of bullets. What?

51:08Doctor Mike: I know

51:09Dr. Lindsey Fitzharris: it's it's a crazy. I mean, he deserves a Netflix series all on his own. Like it's such a crazy. And Vladia was, as I said, he was a dentist. And so he was working on these men who were getting these facial injuries. And he shows Harold Gillies this desperate need for facial reconstruction. And Gillies very interestingly takes a very multidisciplinary approach when he starts to work on faces. He brings the dentists in. The dentists were not necessarily respected by surgeons at the time. Again, there was that kind of split. But Gillies doesn't do that. He takes a multidisciplinary approach. and he he starts working on their faces he opens a hospital called the queen's hospital in sidcup it's the first dedicated to plastic surgery and facial reconstruction and he's able to give these men back an identity you know it's it's a story about what does it mean to have a face and to lose a face and to gain a new kind of face right because you kind of have to make peace with it and and he does extraordinary work and it's just it's one of these these powerful stories and And in disfigurement, you know, people will say we've come so far.

52:12Dr. Lindsey Fitzharris: But have we? Because Hollywood villains, right? There's still, I mean, Darth Vader, Voldemort, all the Bond villains, I feel like are disfigured on some level. I could be wrong about that. But there's a lot of disfigurement. It's like it's a lazy trope for evilness. And and so, you know, what Gillies is able to do is it's not medicine isn't just about surviving. It's about what your life is after surviving. Right. And so he's able to do that. And he's a particularly interesting character. He's very funny. He pulls a lot of pranks. And he really connects with the patients on a real level. Now, keep in mind, unlike a trauma surgeon at the front, he is working with these patients sometimes for years, right?

52:51Dr. Lindsey Fitzharris: So he's developing relationships with them. But it is an extraordinary tale. And I always say that there were a lot of advances that came out of the First World War. But we also have to acknowledge that as doctors got better at patching them up, they were being sent right back to the front. And imagine how frustrating that was for Gillies.

53:07Doctor Mike: So literally you'd get a plastic surgery-esque dentist procedure and they would say, okay,

53:14Dr. Lindsey Fitzharris: yeah. If you were, if you were good enough to go back, you went back. I mean, he did lose patience sometimes, you know, where there was one patient he sent back to the front and then he died in the same clearing station from, I think he got shot in the knee and he, I mean, it was, it was a horrific time. The other thing I learned while researching that is most people didn't have toothbrushes at the start of this war. And so their teeth were in terrible, terrible repair. Some of them just had a lot of their teeth pulled before they joined the army. It used to be that you had to have good teeth to be in the army because in the 19th century, you'd have to tear off the cartridges with your teeth.

53:48Dr. Lindsey Fitzharris: So there was this idea that the army that can bite can fight. That is not as important in World War I. So they start pulling people's teeth just to kind of get them into general health and sending them off to the front. But as you can imagine, like these bullets are ripping through the face. they have the bacteria of the battlefield. Then you have already bacteria in the mouth.

54:08Doctor Mike: That's almost like how in the Civil War they had to have clean uniforms. Yes. Similar principle, right? Yes, yeah.

54:12Dr. Lindsey Fitzharris: I mean, and also in the Civil War they have a little bit of facial reconstruction. I don't know if you've ever Googled. You probably haven't Googled facial reconstruction. No, from the Civil War, no. You're going to do that immediately. Actually, last Sunday I was, I had some free time. You were like, I got to look. It doesn't look good. And there's good reason for this because in the Civil War surgeons still didn't believe Lister necessarily. So post-operative infection rates were high. So they really just went in. They made something, they restored function, right? So like your ability to speak or to eat or to breathe.

54:43Dr. Lindsey Fitzharris: And they got in, they got out. So it doesn't look good. And with Gillies, it's very different. He marries that aesthetics with functionality. So something that is in a typical place, like if your nose is where it should be, it's going to function better than if it's off to the side of the face. So he marries the aesthetics with the functionality, and that is for the improvement of the patient. But to put all this together, I mean, there was no antibiotics. And although they do understand germs, infection rates could be very high because a lot of battlefield surgeons, they just wanted to stop the hemorrhaging.

55:16Dr. Lindsey Fitzharris: So they would just quickly sew up the face, and they would sew in the battlefield infection. Yeah, and so Gillies would have to pick this apart if these men ever made it to him. but there are some extraordinary stories the book opens with private Percy Clare who was shot in the face very early in the war and he writes this beautiful diary about his experiences a lot of these men didn't talk publicly about it so that's why I used his case and then we kind of follow him through the face maker like he gets sent to the wrong hospital originally and just how hard it was to survive but there's another man named private Walter Ashworth and he lays on a battlefield for three days unable to scream for help because he's got no jaw.

55:55Dr. Lindsey Fitzharris: And eventually he's given quite, I think quite a good face. There's photos in the face maker. Um, but when he's discharged from the army, he goes back to work and his, his boss says he has to work at the back of the shop because he didn't want, uh, him to, uh, frighten the customers. And so, you know, not all wounds were inflicted on the battlefield in the first world war. It was a, it was really terrible. um and the and also these men sorry i'm like i get so excited about this like these men were forced to sit on brightly painted blue benches so that the public knew not to look at them

56:26Doctor Mike: so it was extremely isolating wait wait where would they sit on benches so like there would

56:30Dr. Lindsey Fitzharris: be in the park like outside the hospital like if you took to the air or whatever like people they had these brightly painted blue benches and then you knew you didn't you know if you shouldn't look at them because they had these disfigurements and it was a time when losing a limb made you a hero, but losing a face made you a monster. And it was a very terrible injury in that sense. It didn't disable you necessarily in the same way of losing limbs, but it was incredibly disabling socially. You probably have seen Boardwalk Empire.

56:59Doctor Mike: Yeah, I remember the - Yeah, the tin mask.

57:02Dr. Lindsey Fitzharris: And whenever I post images of these masks, so Gillies, he employed mask makers, he hated the masks because they reminded him of his limitations as a surgeon. But sometimes he would use them, especially in between surgeries, because obviously you would be in his care for a long time. And there was one man who would who would wear one of these and he would go out into London and he would come back to the hospital and he would hold up one, two, three, four or five fingers to indicate how many people had reacted negatively to him when he took the mask off, because ultimately they weren't comfortable.

57:33Dr. Lindsey Fitzharris: Imagine wearing a tin mask over a face that hadn't been so and they and they didn't grow old they didn't show emotion so when you look at somebody in a still photo they tend to go viral because they do look very realistic but if you were sitting across and moving around yeah exactly talking and i think that's why boardwalk empire is so that character is so unsettling is that that kind of it's like the temporaries yeah yeah so that that's all happening in in the first world war and then i always say it's ironic that gillies who sort of births modern plastic surgery to help these men in their identities.

58:10Dr. Lindsey Fitzharris: Also, plastic surgery now makes us all hyper aware of how we look.

58:15Doctor Mike: It's like one of those. What's the statement that you live long enough to see yourself become the villain? Yeah, yeah, definitely. Either die a hero or.

58:22Dr. Lindsey Fitzharris: I definitely think actually the man who read the audio book is Daniel Gillies. He's an actor. He was in the Vampire Diaries. He's a really good looking guy. and he is the great great nephew of Harold Gillies and so I joked to him on Twitter like you should read the audiobook so he did it and he it was it was such a joy to see him learn about I mean he knew about Harold Gillies but he didn't know all the ins and outs and he said that actually the stories he heard about his great great uncle was after the war just trying to make plastic surgery into a discipline and sort of having to move into that cosmetic realm because there just wasn't enough.

58:58Dr. Lindsey Fitzharris: There wasn't enough injuries, right? And there were stories about Gillies. Women would inject paraffin wax into their face.

59:07Doctor Mike: Not so different than what we're doing today.

59:10Dr. Lindsey Fitzharris: Not a great idea. And it would migrate. And so there was a patient that he had to remove all this wax. And of course, her face looked horrible because it often looks worse before it looks better. And the husband came in with a gun and it just threatened his life. I know the problems with being a plastic surgeon. He said, it's going to get better. It's going to get better. But he, there was another patient of his. So another thing that they used to do was to remove facial hair from women with x-rays. Not good. Not good. Right. Not something that Dr. Mike would endorse. And of course, like women were getting cancer.

59:44Dr. Lindsey Fitzharris: And so one woman, she had a terrible cancer from this and he had to just cut really deep into her face.

59:52Doctor Mike: It's like the birth of the Mohs procedure.

59:54Dr. Lindsey Fitzharris: Yeah, it was it was horrible. And he said that all the nurses in the room, he felt they wanted to kill him afterwards because he had to take so much of the face. But there was there was no getting around it.

1:00:04Doctor Mike: Was there guidance that he was following about how much to take off? Like, where did he know?

1:00:09Dr. Lindsey Fitzharris: It was all kind of, he was just kind of making it up as he went, which is a little bit, I know. That's so awful. But remember, like, so when I talk about the Civil War, there was fewer than 50 plastic operations done in the Civil War. Now, in World War I, there were 280 ,000 men who had some kind of facial injury. so the kind of unpleasant aspect of this is that it provided an extraordinary opportunity to experiment right and so now he's got all these patients he can try these different methods and sometimes it didn't work and i tell those stories in the face maker because they're important people died in his care and he took it there was one um patient who came in was terribly burned and he had been in a different hospital for up to a year and and he was all scarred he was he was addicted to opium and he was he was in a lot of pain and he begged gillies to do the surgery as quickly as possible and what happens is gillies tries to lift an entire flap of skin from his chest up to the face and his body just gives out and he dies but this is really important to plastic surgery because he learns that if you're rebuilding the face you have to do it in piecemeal the body will get too overwhelmed so i included it in the face maker because it's an important story to plastic surgery, but it was a terrible personal story.

1:01:29Dr. Lindsey Fitzharris: And when I decided to put the photos in, I only include photos of men who completed their reconstruction and also were featured in the book. I didn't want it to become like medical voyeurism, but there's plenty of photos of his work out there that goes beyond Facemaker. But there was an exception. If they died in his care, I only included pre-injury photos. And he was an early pilot. These pilots, they would go up into these, this was just years after the Wright brothers, they would carry pistols, not to shoot at each other, but to shoot themselves if their plane was crashing, to save themselves from the burns and the disfigurement that would follow because it was so feared.

1:02:07Dr. Lindsey Fitzharris: But some of them did survive. And he was a pilot. He crashed his plane on his graduation day. He never even made it into war. And he was severely burned and dies as a result. So these stories are important to tell, I think.

1:02:20Doctor Mike: These stories are, it seems like of people who were good actors doing the right thing, wanting to push the field forward, help patients ultimately carry the burden when something went wrong. Are there stories of like evil bros doing this?

1:02:34Dr. Lindsey Fitzharris: There are. I mean, I think like, and I wouldn't say Ether Wars is going to be that, but I think those, the people in Ether Wars who try to patent Ether are sort of deeply unlikable. And when I went to sell the book, my editor was like, oh, they're like so unlikable. And like, you know, you write these like really uplifting stories. But ultimately, the story, and I hope once I get to write it, it's a story about thank God they didn't succeed because anesthesia changes everything. So humanity wins, right? Like they can't patent it. They can't benefit from it. So everybody ultimately benefits from it.

1:03:07Dr. Lindsey Fitzharris: But I do think that we need to tell more complicated stories. And and even, you know, people like Gillies. I mean, they weren't perfect, right? I mean, Lister was difficult to get a sense of, because in the 19th century, it's always kind of difficult to get a sense of a real personality. Joe Bell in Sleuthhound, I mean, there's just so many great stories about him. But like, I'll go back to Lister. Lister did not believe women should be in medicine. Not particularly noteworthy in the 19th century, but Joe Bell, who's his colleague, does advocate for women in medicine. So you have this kind of interesting dynamic of these two men operating in the same space.

1:03:40Dr. Lindsey Fitzharris: So I do try to acknowledge some of those, quote, flaws, if we would call them that. But Gillies was, he really was extraordinary in the sense that he could look past the disfigurement. And if you could imagine what these faces looked like, I mean, this was all new. These kinds of injuries were all new. And so people didn't have experience with it. And he just had this great relationship with his patients. And he was able to really look past it to see the humanity in them and to really give them back a life. You might know, have you ever heard of the Guinea Pig Club? So in Britain, they're very famous.

1:04:15Dr. Lindsey Fitzharris: So World War II, there was a surgeon named McIndoe who operated on the pilots of World War II who were severely burned. And they became known as the Guinea Pig Club. And they became very famous. There was a lot of media around them. But McIndoe is the cousin of Harold Gillies. So Gillies teaches him. And a lot of the World War I soldiers were like, we were the original Guinea Pig Club, right? We were the guys that were being experimented on. And he's extraordinary. He also does the first ever phalloplasty on a trans man in the 1940s. A lot of people don't think that this, they think this is a modern surgery.

1:04:50Dr. Lindsey Fitzharris: He invents a technique that is still used today. And Michael Dillon, the trans man that he operated on, is outed by the British press and driven from Britain. But Gillies really stood behind him. He thought that people had a right to control their identity. and who was he to say no to whatever people wanted to change about themselves. And so people often say, oh, would he have been judgmental about plastic surgery? I don't think he would have because he did do cosmetic procedures, but also I think he just felt if it bothered you, then it was okay to change. Like it's not for him to say.

1:05:26Doctor Mike: Was body dysmorphia even discussed at that point? Or did that not exist because like people were having true deformities that they were being bothered?

1:05:34Dr. Lindsey Fitzharris: I mean, people, there's very early plastic surgeries that really have to do with survival, like changing the nose, right, for anti-Semitism. So you get some very early examples of this. There's a Jewish-German surgeon in World War I who really learns how to do this because it's a way of protecting oneself against the anti-Semitism. So there wasn't body dysmorphia, but people were changing aspects of their body, sometimes to just blend into society for safety reasons. but you do I mean people that doesn't seem irrational I wouldn't even think that it's not

1:06:08Doctor Mike: right yeah because the idea of body dysmorphia is not even that you have to have a true issue with your irrational belief right it's that there is no end right yeah like it seems like those patients were trying to do something a little bit logical that may not make yeah I don't think that would

1:06:26Dr. Lindsey Fitzharris: consider but I you know like the woman who did the paraffin wax oh yeah that she was such a great beauty. And then, you know, she does this ruins her face. And so I think there was always pressure to, to look good. Now that change, like the aesthetics change. Right. And this is what I always tell young people because they're on Instagram and there's plastic surgeons that are advertising, which is fine, but we're getting bombarded with like images of beautiful people. And I always point to eyebrows because I grew up in the eighties and nineties when the thin eyebrow was in, but now like the bigger eyebrow.

1:06:57Dr. Lindsey Fitzharris: And I always say to people, listen, if the eyebrows change, everything can change, right? So young kids think, well, that body type is the ideal body type and that's always been, but it changes. And so if you undergo surgery, you know, you have to be prepared for the fact that the aesthetics change as well. So, you know, it's complicated. We have a very complicated relationship now, you know, and I'm not one to talk. Like I get, I have to put my slap on, as they call it in Britain. We're all a little bit paranoid in the age of social media. I even worry about going on podcasts, like what people say about you physically.

1:07:39Dr. Lindsey Fitzharris: You're always sort of on display. It's very vulnerable. I don't want to blame Gillies for it, but it kind of started with the birth of modern plastic surgery and our ability to sort of change ourselves. And now my husband's a caricaturist, and he kind of hates all the plastic surgery because everybody's starting to look the same. And he just delights in how the face is different. And he says, you know, it's not about making fun of somebody. It's about celebrating what makes their face, their face. Right. And you were showing me pictures with your shaved head. Right. And you get like that real sense of like your face being a little bit longer.

1:08:15Dr. Lindsey Fitzharris: I mean, that's a good thing. Right.

1:08:16Doctor Mike: I mean, I don't know.

1:08:18Dr. Lindsey Fitzharris: But it depends who's looking at it.

1:08:19Doctor Mike: Right. Yeah.

1:08:20Dr. Lindsey Fitzharris: You get a sense of like your face and and how different it is and why you look the way you look right i do think though the shaved uh head look it's like conan o 'brien recently did you see this like on his podcast he his hair was wet oh and people freaked out because he didn't like have that the poof the poof yeah and so people get really i they get dedicated to the look and i can see that's a problem for you if you have to shave your head well it's just it's

1:08:46Doctor Mike: such a drastic change because you normally don't see your scalp so when you see it like whoa

1:08:50Dr. Lindsey Fitzharris: yeah and that and every like you know you don't know what that's going to be do you like exactly It could be a weird shaped head, but it's always a surprise. It's always a surprise.

1:08:58Doctor Mike: I'm curious, how did syphilis play into that equation of faces? Because one of the late stage changes in syphilis is pot marks, issues in bone. Did that ever enter the field of aesthetic surgery early on?

1:09:12Dr. Lindsey Fitzharris: Yeah. I mean, so saddle nose, it's like when the nose kind of collapses into the face, the cartilage, as you know, just gets eaten away. And in fact, there was no nose clubs in the 19th century. Like people actually gathered around and they would celebrate the fact that they had no nose. And, you know, it was this kind of silly thing that they would do. But syphilis was rife and there was nothing that anybody could really do about it until antibiotics come along. They would try things like mercury treatments, but it didn't work. And as you can imagine, the mercury treatments were worse. The side effects were worse than the disease.

1:09:43Doctor Mike: Were people judging people with syphilis? Oh, yeah.

1:09:45Dr. Lindsey Fitzharris: And here's the thing about disfigurement in World War I. And I talk about this a bit in The Face Maker is that there's such a stigma associated with disfigurement because of the fact that it's associated with social diseases like syphilis. And also there were certain crimes in earlier periods that came with purposeful disfigurement like prostitution. They would literally cut off the nose or they would disfigure the woman. What? So people were really, the disfigurement carry that kind of idea that there was something corrupt about you, that your face was, yeah, disfigured that there was something wrong with you.

1:10:19Dr. Lindsey Fitzharris: And so during the Napoleonic Wars, French soldiers who received facial disfigurements were sometimes killed purposely by their own comrades to spare them from what they considered the fate worse than death, the disfigured face. It was awful. And so that's what Gillies is kind of walking into in the First World War, like overcoming, you know, that that severe. And we still have problems. Like I said, Hollywood still has a huge problem with disfigurement. And you see it all the time in the villains. And it's so ingrained in us. You don't even think about it like the Joker. And, you know, it's it's just this kind of lazy trope for evil.

1:10:54Dr. Lindsey Fitzharris: Darth Vader also kind of inexplicably. They take his helmet off and you're like, oh, he's disfigured as well. Like, why did we have to do that? He was scary enough, but that that has really been ingrained.

1:11:05Doctor Mike: How would you change it if you had if you had the power? I hope would you start making really handsome?

1:11:12Dr. Lindsey Fitzharris: Well, here's what I hope. So somebody has optioned the face maker. And I said to this filmmaker, I said, you have to show the faces. When the book came out, there was a big piece in the Wall Street Journal and they didn't run the photos. They ran a photo of me. And I said to them, I was like, what the heck? I said to the reviewer, I was like, why didn't you run the photos? And they said, we almost did, but we pulled them at the last minute. So people still are very scared to show that. And I said to this filmmaker, I said, you need to show the disfigurement and you need to show these men as the heroes of their own story.

1:11:43Dr. Lindsey Fitzharris: I think we need to change that dialogue around disfigurement because think about what they had to overcome. And by the way, disfigured is maybe not a term we would necessarily use today. I worked with a disability activist who is she calls herself disfigured. She has Crouzon's syndrome.

1:11:59Doctor Mike: Oh, I don't know what that is.

1:12:00Dr. Lindsey Fitzharris: It's like an asymmetry. But she calls herself disfigured because she says that's how people treat her. But now you might say facial difference. And we talked about language in The Face Maker, but I felt very strongly that disfigured, these men were disfigured to the people that were looking at them at the time. And they had to overcome that. So I didn't want to lessen that by using modern language. And so even in the subtitle, it has disfigured. And I remember Penguin, my UK publisher, was like, ooh, is that a term we can use? So like people, you know, language matters. And today, the other thing you have to remember, and I'm not a disability spokesperson, but it's not a monolith, right?

1:12:41Dr. Lindsey Fitzharris: The community is not a monolith. Absolutely not.

1:12:43Doctor Mike: We've had multiple people on the show from different sides of that spectrum have wildly

1:12:49Dr. Lindsey Fitzharris: different opinions.

1:12:51Doctor Mike: Some want to own the terminology and say, I absolutely am autistic and I'm not a person with autism. and then other people are completely like, why are you grouping me in? So it's interesting how even when you're trying to do the right thing, you can upset a minority or even a majority of people.

1:13:08Dr. Lindsey Fitzharris: Yeah, and that's important too. And so even with the face maker, I was aware of, I have a note at the beginning to talk about this and about language. And we can discuss how do we talk about these men. The other thing is, of course, I include the photos. I felt like I could not put them on the metaphorical blue bench in 2022 when the book came out. But I didn't want it to become medical voyeurism. And in fact, Gillies' patients...

1:13:34Doctor Mike: Take me through this medical voyeurism. I'm familiar with the concept, but what exactly are you afraid of?

1:13:39Dr. Lindsey Fitzharris: Well, you know, these men could not conceive of a book called The Facemaker, right? And they didn't have a choice necessarily on how their images would be used later. they agreed to those photos because gillies you know had had said he wanted to document his work but then of course i'm using the photos in very different contexts the images of gillies patients are also used in a a game uh a game um it's uh i can't remember the name of it but basically they're presented as monsters in this game yeah and it was based off some of his real patients and and so this material kind of gets out and people put it up on the internet for the shock value but I always like to remind people these were real men they had no concept that you know Lindsay Fitzharris and all her sequins was going to come and write the facemaker and by the way when I go and talk about the facemaker I'm usually a little bit more toned down I'm like the PT Barnum of medical history I'm doing sleuth hound right now which is 19th century forensics and I get to be kind of that weird person I am but but facemaker it's a serious book and so I didn't want people to, I didn't want it to be sensationalized.

1:14:48Dr. Lindsey Fitzharris: And there's an interest amongst doctors like yourself in seeing more of that material because there's an interest of like, how did he do it? But you can find that stuff. You can go to Gilly's published books on this. And so you can find it out there. I thought only the photos of the men whose stories I tell should be included in the face maker because I could give it context of how they were injured and what they went through. I didn't really want to go beyond that. I feel like if I included just a bunch of other material, it would be medical voyeurism, like just the sake of looking for looking.

1:15:19Doctor Mike: What was the doctor viewed like in the 19th century? Like, were they respected? Were they admired? Were they kind of like their douchebags? Were they viewed as gods? Did they view themselves as gods? No, it is a good question.

1:15:32Dr. Lindsey Fitzharris: I mean, it depends when you're talking in the 19th century. So again, they start to professionalize in the latter half of the 19th century. And even people like Belle and Littlejohn, they teach their students how to dress for court so that they are taken seriously. Like, you know, you dress somberly. You leave your umbrella and your hat outside the courtroom like you are not a showman. You go in there and you are a serious expert. So so it's it kind of varies in that sense. But I think doctors certainly at the end of the 19th century were becoming more like the gods, like an authority. Right. That you would defer to the doctor.

1:16:07Dr. Lindsey Fitzharris: but certainly in the early part of the century. I mean, you could go to the quack, you could go to your barber, you could get medical advice in all different kinds of ways. So perhaps not as respected in the earlier part of the century.

1:16:18Doctor Mike: Yeah, because the reason I think about it is how professionalism is changing in this day and age with med students and residents that I'll teach them. They'll be coming into wards. And I'm wondering, what is their view of professionalism? Because professionalism initially was used in this very practical manner of saying, we want people to take you seriously during a court case, right? There's like a reason for that. Then it started to get weaponized a bit to say, professionalism because we want to remove personality from this. We don't want any people who are different than us. We don't want women in the field.

1:16:53Doctor Mike: And then it was weaponized for a long period of time. And now there's this movement against professionalism where it's like, what do you mean? I'm a human. I want to self-identify the way that I want. I could still be a serious doctor. So I'm curious how the history of that has changed.

1:17:09Dr. Lindsey Fitzharris: I mean, you're asking somebody too. I did my PhD at Oxford and I just assume Oxford's going to revoke my PhD at some point. They're like, that's not what we gave you that PhD to do. I was always a storyteller. So I just kind of fell into that. I started a blog called The Surgeon's Apprentice. I used the antiquated spelling of surgeon. So nobody knew how to pronounce it. That was my first marketing fail. But I've always wanted to connect with people. And like I say, even if you don't like history, you might like medical history. I wanted to speak to people who had that lived experience, but maybe not the vocabulary.

1:17:41Dr. Lindsey Fitzharris: And I wanted to tell them what that was like in the past. But doctors certainly, you know, there was, as I said, there was a period where they were not taken possibly as seriously. But also keep in mind, if you were poor, you didn't see a physician because they were very expensive. So your experience with medical practitioners was lower. you might go to the barber surgeon in the 18th century. You certainly weren't just going right to the physician. So people had views about doctors and certainly probably some negative views. The doctor starts to appear at the bedside of the dying in the late 19th century when we're able to administer pain medication suddenly.

1:18:21Dr. Lindsey Fitzharris: But before that, it was seen wrong for him to profit from death. But you get these caricatures of him like in the 19th century, like when he starts to appear at the bedside of the dying. It's like the doctor, it's a character of the doctor, like riding, you know, on the back of Satan, holding the money, right? And profiting from this kind of awful thing. Because death for a long time, a lucid death, was a good death. Because you wanted to be lucid at the moment that, you know, God and Satan are fighting for your soul. So there was this real idea that, you know, you had to be very present for that death.

1:18:58Dr. Lindsey Fitzharris: But then with the introduction of these drugs at the end of the 19th century, suddenly a good death shifts into a painless death and the doctor becomes more important. And now, I don't know how you feel about this, but now it's almost like an over-medicalization of death, right?

1:19:13Doctor Mike: Yeah.

1:19:13Dr. Lindsey Fitzharris: I mean, a significant minority of healthcare funds are spent in the last year of life. Yeah.

1:19:20Doctor Mike: And that's not to say from a healthcare financial standpoint that that's bad. It's bad because it's not the right move. You're not actually prolonging life. You're not helping people live a better quality of life. You're over medicalizing this last year where perhaps focusing on comfort and ease of ending your life should be the conversation or the ease of the end of your life.

1:19:45Dr. Lindsey Fitzharris: I mean, when my grandma died a couple years ago, we had a home death and you know you have to you do have to be prepared as a layman what you're seeing um there's a woman named katherine manix in the uk who wrote a book called with the end in mind and it's she's a palliative care doctor and she talks about her patients who are dying and she did a great ted talk and i watched that while my grandmother was dying because i wanted to know what i was seeing was normal because it seemed like the labored breathing like there's a lot of things that happen to the body and you think this is very scary. But, you know, Catherine has said death is not a medical event as much as it is a social event.

1:20:25Dr. Lindsey Fitzharris: And if you can die at home surrounded by your family, that's the ideal death. If you can manage that. Not everybody can. You know, some diseases are very painful. They do need to be managed in a medical setting. But I think a lot of people now that they are brought into the hospital because we over medicalized it. And that sort of began in the 19th century. But I was so glad that we could give my grandmother, you know, a home death because it's also scary, you know, waking up in a hospital, you're dying, like everything, right? Nothing's familiar. Nothing's familiar.

1:20:56Doctor Mike: Alarms, lights.

1:20:57Dr. Lindsey Fitzharris: And you might not even recall being moved to that setting, right? And so suddenly you wake up in it. So it was really important for me to make that possible if we could do that. But one of the things that happen is, you know, I was in charge of medicating her. And after she died, I thought, oh my gosh, I've killed her. And I read that this is a very common reaction when you are, you know, the point person to medicate. And of course, I mean, she was dying. She was 94. But it's just this reaction to everything that's happening around you. But I have to say, if anybody's listening, if you have the chance to be with somebody who is dying, a loved one, it is the greatest gift really to be there in the final moments.

1:21:42Dr. Lindsey Fitzharris: And so I was lucky that I had been, you know, I know people who work in those fields and I felt comfortable enough. But yes, this kind of medicalization really started in the 19th century.

1:21:55Doctor Mike: Yeah. Religion obviously plays a big role there. I'm curious, over the last 200 or so years, what role has religion played in healthcare?

1:22:05Dr. Lindsey Fitzharris: Wow, that is a big exam question. The sweat's starting to come now, and I'm like, oh my gosh. I mean, that's definitely not my forte about the intersection of religion and medicine. I mean, you get a lot more issues in earlier centuries, the church kind of interfering with dissection, Although some of that is a myth too, I believe. But you're right that, again, there is that component of religion. And even like with Lister's story, he's a Quaker and there is this sort of spiritual aspect. He feels that he's on a mission. And his Quakerism is really why he ends up solving this mystery because Quakers in the 19th century weren't allowed to partake in other forms of entertainment like dancing and music.

1:22:48Doctor Mike: Oh, interesting.

1:22:49Dr. Lindsey Fitzharris: Which is weird, yeah. But he was able to study nature. And so his father was an amateur scientist, and he showed the little lister how to use the microscope. And so he really grew up around, quote, science. And so when he becomes a medical student, it's that kind of merging of science and medicine, which were very separate at the time. And so he starts reading Louis Pasteur's work. And in fact, when he brings Pasteur's theory and applies it to medical practice, he doesn't tell Pasteur. I think Pasteur learns about this many years later and then starts corresponding with Lister. And they do meet.

1:23:25Dr. Lindsey Fitzharris: And it's this sort of extraordinary moment. And Pasteur is being honored. And I think at that point he'd had two of three strokes. So he lost the ability to speak. But Lister honored him and said that he had changed humanity. And you could say the same about Lister himself. But I know his Quakerism played a big role in what he ultimately was able to accomplish.

1:23:47Doctor Mike: all of these individuals had to study medicine in some way. My medical school education was pretty typical. We get two years of in-classroom learning, labs, and then two years clinical in the hospital, and then we do our internship residency. Back then, how were they learning anatomy? Were they dissecting bodies?

1:24:05Dr. Lindsey Fitzharris: Oh, well, now you've opened up the question. I mean, they were dissecting bodies. Dissection became very important in the early 19th century. It was said that the bodies were so valuable that you could pay for your medical school with the bodies because, right, like they needed bodies. The only legal bodies in Britain at the time were those of hanged murderers. And although people were being hanged for murder, there wasn't quite enough to kind of fuel, right, the anatomy schools. And so one of my favorite stories is Burke and Hare. A lot of people will know the story, but Burke and Hare, they, so you had these people called resurrection men.

1:24:41Dr. Lindsey Fitzharris: They were grave robbers. They would go out and they would steal the body. Interestingly, the body itself was not, it wasn't illegal to steal. The body was worthless. So the resurrection men would go in, they would strip the body of all of its possessions, throw it back into the grave, because if they were caught with the burial clothes or items, they could be brought up on theft. Because the items. Right. The body itself had no value at the time in legal discourse. And so they were stealing these bodies. They were very good at it. They could steal as many as, you know, 12 bodies in a single night.

1:25:13Dr. Lindsey Fitzharris: People were very afraid of this because, again, it was associated with criminals. You know, criminals were dissected.

1:25:19Doctor Mike: They were afraid of the criminals or they were afraid of doing it.

1:25:22Dr. Lindsey Fitzharris: They were afraid of their bodies being stolen or the bodies of their loved ones. In fact, there's a story in 19th, early 19th century Britain of a village. They discover that a body's been stolen and all of the villagers go to the graveyard, dig up their relatives and bring them back home until the cemetery could be made safe. I know people because they had a literal view of the resurrection. So it was important that your body, there's a religion. Yeah. And again, it was also associated with with criminals that were murderers who were dissected. It was like an additional punishment. So so great.

1:25:56Dr. Lindsey Fitzharris: So resurrection men were crawling all over these graveyards. They started to do things to protect people. Graveyard cemetery guns, for instance, with tripwires. They had like explosive trip.

1:26:09Doctor Mike: Yeah.

1:26:10Dr. Lindsey Fitzharris: I mean, they weren't super common. And there is a story of somebody of a grieving father accidentally setting one off and dying. I know. Oh, horrible. Right. I mean, it was it was a wild time. They had coffin collars. So this would go around the corpse and it would be nailed into the back of the casket or the coffin. And so because usually what happens was the body snatcher would open up just like the front of the grave. They wouldn't dig up the whole thing. Right. And then they use their instruments to break open the coffin lid and then they would pull the body out with chains. So if you're anchored in there, it would be harder to kind of remove you.

1:26:46Dr. Lindsey Fitzharris: So there was all kinds of things that sort of happened. But Burke and Hare were up in Edinburgh, you know, my favorite place in the 19th century. And they decide, you know what, we're going to cut out the middleman. Going in these graveyards, no, we're just going to kill people and we're going to sell their bodies to the anatomists. And so they were selling these suspiciously fresh, I mean, amazingly fresh bodies. And they were eventually caught after they had killed 16 people. So they had killed quite a few before they were caught. Hare ends up turning King's evidence and testifying against Burke.

1:27:16Dr. Lindsey Fitzharris: He goes free. Burke swings for the crime. And because it's Scotland in the 19th century, they kick it up a notch. They publicly dissect him. They flay him and they create various trinkets, one of which is a pocketbook bound in his human skin. I have held it up at Surgeon's Hall in Edinburgh. It feels like leather because it is leather, right? And it was so prevalent in the 19th century, they called it anthropodermic bibliopathy, binding books with human skin. And in fact, in Sleuth Hound, I talk about one of the big issues was repeat criminals, how to identify them. So if you go and commit a crime in the early 19th century, nothing's stopping you when you get caught again from using an alias.

1:27:56Dr. Lindsey Fitzharris: How do we know that you had so there was all this interest in how to measure the body. And so you have things that did a lot of harm, like phrenology that was now we know was based in racism, but it was really a science at the time and did a lot of harm. but you have this French police officer named Alphonse Bertillon and he develops a system of measuring so he takes like one of the measurements is from the middle of the finger to the crook of the arm and it's a series I think it's 13 measurements and he puts them all on index cards he also creates the photo the front photo and the side photo right the mug shot and so Alphonse Bertillon is very interested in how do you track criminals and so he's in sleuth hound And then very shortly after his system comes, we get fingerprinting, which sort of replaces that.

1:28:41Dr. Lindsey Fitzharris: Yeah, it makes it a bit easier.

1:28:42Doctor Mike: And I also imagine the margin of error of this is probably significant. Well, okay, yes.

1:28:46Dr. Lindsey Fitzharris: So he had this choreographed way. Like the police officer doing the measurements had to hold themselves in a certain way. And the person, like if they were measuring the foot, obviously there's ways you can cramp up your foot. So there was all kinds of choreographed ways to ensure that the measurements would be. I know there probably is no way. My staff measures babies. Right.

1:29:04Doctor Mike: And sometimes I go and I go, what happened to the baby's head circumference? Right.

1:29:09Dr. Lindsey Fitzharris: So there's no way to kind of like standardize. That's interesting. But it's funny because he in Sleuth Hound, he also then he takes like. So if you have a tattoo on your right arm, you could go to the index cards, you know, like right arm tattoo anchor, you know, and this was a way to kind of quickly go through and decide if somebody was a repeat criminal. but he has this way of then taking all this information and then put taking these abbreviations and it was just I I showed my husband and he was like oh what a dick you know like it just it was so complicated it felt ridiculously complicated but of course it was it was better than anything that had existed at that point they had rogues gallery before that but it was it was very hit and miss on how to identify criminals and there was a real you know concern especially in Britain because around this time, Australia stops accepting Britain's criminals.

1:30:00Dr. Lindsey Fitzharris: And so now suddenly Britain is a little bit interested in being able to identify these repeat criminals. So all of this is happening around Belle and Little John at this time. And, you know, you have Lizzie Borden, who's sort of back in the news with this Netflix series. And I always say, and I've not seen the series, but I don't think that they deal with this because I asked somebody else. There's photos. It's some of the first crime scene photos ever used in court. and Lizzie Borden says when she comes home she takes her father's boots off and puts his slippers on but you can see very clearly in the crime scene photos he's wearing boots and so this became part of the evidence and so I'm always fascinated in the in the science bits and the kind of you know not that it doesn't make it into the Netflix series but I'm always interested in that kind of aspect of the story so crime scene photography becomes important as well at this time yeah even if you think about right now, I'm pretty sure there's like a gang tattoo database that police

1:30:56Doctor Mike: use to mark who's part of what gang to understand affiliations, which can help safety in prisons because you don't want to put people in certain positions where they can be hurt or attack somebody else. So there's a lot of that.

1:31:09Dr. Lindsey Fitzharris: The one thing about photography in the 19th century, because there was a lot of interest in the lens of the eye acting like a camera, and there was this belief, it was called optography, that the eyeball acted like the lens of a camera and that it might capture the last thing a person saw and that the criminal might be imprinted, right? So this is very intriguing, especially with the Ripper crimes, because you think, well, they never caught Ripper. And Ripper is so important to Sleuth Hound because Ripper starts killing in 1888. At the time, Sherlock Holmes is sort of stepping on the scene and you get this idea of the bumbling Bobby, You know, the officer who can't solve the crime.

1:31:47Dr. Lindsey Fitzharris: And then you have this like Sherlockian figure who's bringing this doctorly, orderly way of looking at the world to criminal investigations, which we now think of as purely belonging sort of to the police and forensic investigations. But it wasn't always the case. So it's fascinating. There's also a baby farmer. Do you know what baby farming was in the 19th century? I know this was grim. Okay. So this chapter - Baby farming. Baby farming. So what happened was if there was no contraceptive, right? And so women were having child after child -

1:32:18Doctor Mike: Wait, what about the French envelope?

1:32:19Dr. Lindsey Fitzharris: Yeah, I know. You did learn about the French envelope in that video. Yeah. But nonetheless, like, right, there's no contraceptive.

1:32:27Doctor Mike: Effective. No, no effective.

1:32:28Dr. Lindsey Fitzharris: Like the reusable condom is there, but yeah. And so women are having babies and they can't afford it. So, and there's no legal route to adoption. So they would go to the baby farmer and they would pay a fee.

1:32:43Doctor Mike: I'm trying to use my doctor poker face, but when you say baby farmer. You looked very compact,

1:32:47Dr. Lindsey Fitzharris: like you were like, yeah, you did put the doctor's face on and then I said baby farmer and you just lost it. But yeah, the baby farmer, you would pay the baby farmer a small fee and they would farm the child out to a family who could afford to feed it and care for it.

1:32:59Doctor Mike: It seems less evil now.

1:33:00Dr. Lindsey Fitzharris: Yeah, but it did kind of become evil because sometimes like Burke and Hare, the baby farmer cut out the middleman, took the fee and then killed the infants. And so one of the baby farmers, Jesse King and Sleuth Hound, is one of the cases that Belle and Little John work on. And it begins with these little boys finding this bundle of rags and using it as a football and kicking it around. And then they get curious and they open it up and there is a decomposing infant in there. And thus begins the investigation into Jesse King. But it's really a story. You I bring up this point that forensics was built often on the brutalized bodies of women in the 19th century who received no kind of justice.

1:33:39Dr. Lindsey Fitzharris: And there's that part I think we have to acknowledge. You know, there's a there's a woman who is killed. Her husband kicks her in the stomach. She's pregnant. And the court says or his defense lawyer says he didn't intend to kill her because he wasn't wearing his boots when he kicked her. And he gets off as is for culpable homicide. Also, no man in Scotland was convicted of murdering his wife between 1872 and 1892 when the wife was seen to be drunk or nagging, which, of course, that's a broad term. Right. And so usually those men were found guilty of culpable homicide, which came with a lesser, like a 10-year sentence.

1:34:20Dr. Lindsey Fitzharris: It didn't come with a death penalty. So there's some sobering. I mean, it's a story about Sherlock Holmes and Conan Doyle and, you know, my God, Holmes, how did you know that? And there's an element of that. But there is also this kind of darker element. And even Jesse King, the baby farmer, tells us about the experience of women in the 19th century who were desperate. You know, they could not feed their children. They went in with good faith to the baby farmer. And then could you imagine they only find out that these children of theirs have died once the investigation begins? It would have been terrible.

1:34:52Dr. Lindsey Fitzharris: So there's all those kinds of stories. You know, I spent so I spent years in the old operating theaters of Victorian Britain. I then spent years in the trenches of World War I. I decided I needed to write something lighter. So I wrote a book about murder and baby farmers. Yeah. So it was heavy in its own way, but it's, it's, it's a good romp through Victorian forensics.

1:35:13Doctor Mike: When you go to a, see a doctor these days, are you thinking about any of this stuff that you've learned? Always. Really? Like what, give me a practical example. Okay.

1:35:22Dr. Lindsey Fitzharris: So in, in 2022, I got diagnosed with breast cancer. I caught it really early. I said I was the luckiest unlucky person and I caught it because my friend Tom Peterson, who I dedicate sleuth hound to, was dying of a glioblastoma. And I saw him in LA and he just kind of put it in my head. Like you reach an age where you, you always think you're too young to die. Like I, I feel like no matter what, like I'm 44 now, but I, you know, you always feel you're younger than you are. And he was only in his early fifties. And I, I just started to think about it. I went back to Britain. I felt a lump. I now in Britain, you don't get mammograms till 50.

1:35:58Dr. Lindsey Fitzharris: I went, I pushed for the mammogram. The thing I felt was nothing. They found a completely hidden cancer, which is why mammograms at 40 is probably a good idea. Right. Yeah. And so I ended up being treated at the King Edward, the seventh hospital in London. And my surgeon had read the face maker and he had reached out and I got excellent care. I'm like his agent now, like I go around talking about him. But he, but it was, it was really excellent care, but I would go into the hospital and kind of share like these terrible stories. I was telling you at lunch about Abigail Adams, right, who had her mastectomy in the early 19th century.

1:36:32Dr. Lindsey Fitzharris: And they essentially took what was a fork. I mean, I call it a fork. There was probably a name for this, but they they stabbed the breast. They lifted it up and they removed her breast. It took about 30 minutes. No anesthesia. Absolutely horrific. Joseph Lister.

1:36:47Doctor Mike: And she chose to go for She wasn't forced.

1:36:50Dr. Lindsey Fitzharris: Yeah, she wasn't forced, but it was said pretty much that you're going to die if we don't remove this breast. And like you said, I mean, there was no way to know. I mean, it could have been a cyst. I mean, who knows, right? But women generally, like you only underwent the mastectomy if it was very dire. And Joseph Lister's sister is diagnosed with breast cancer. Nobody will operate on her because there is a sense that you're going to have this gaping wound. It's going to get infected. so he operates on his own sister on his own dining room table with his new antiseptic method and he said he would never want to do anything like that again because operating on your own family member but he she ends up surviving the surgery and goes on to live for several years before the cancer returns so he he does give her some extra years but um and at that point he's using anesthesia but abigail adams let's spare a thought there was also a woman named lucy thurston who's in the butchering art and she's the her doctors say the breast has to come off they're not going to tell her the day that they come because they don't want her to fixate on it i mean that would make me more

1:37:54Doctor Mike: anxious like what you know yeah that means every day is they're going to show up yeah so they do

1:37:58Dr. Lindsey Fitzharris: obviously show up they go up the stairs the surgeon goes up the stairs into her bedroom he opens his hand and shows her the knife he's going to use and he says she needs to prepare her soul for death. So not, not the, that wouldn't give, don't tell your patients to prepare their souls for death. No bedside manner.

1:38:15Doctor Mike: But of course, to be honest, I don't know what is the approach there. You know, you're going to cause tremendous pain. What do you say? Do you lie?

1:38:24Dr. Lindsey Fitzharris: I feel like you do have to prepare the pain. I think that is the kind way of saying this could end badly.

1:38:29Doctor Mike: It was the old form of informed consent.

1:38:31Dr. Lindsey Fitzharris: Right. Yeah.

1:38:31Doctor Mike: Like this is going to suck.

1:38:32Dr. Lindsey Fitzharris: This is going to be horrible. And so with Abigail Adams, the other thing is the operating table, as we think of it, really starts to become important when anesthesia comes about because you're laying the patient down, you're administering anesthesia. But a lot of times before that, you were sat in a chair. And often a chair that was quite high, so your feet would dangle so you couldn't brace against the knife. And you might be tied to that chair. So Abigail Adams is sat up in a chair. and all of these doctors, these male doctors come in to perform this mastectomy. It must have been absolutely awful.

1:39:08Dr. Lindsey Fitzharris: I can't imagine. And so when I got breast cancer, you know, I'm telling my surgeon and my team all these stories and they're like, yeah, keep your voice down.

1:39:15Doctor Mike: You're freaking out all the other patients. You're freaking everybody out,

1:39:17Dr. Lindsey Fitzharris: including us. Like that stuff doesn't happen anymore. But I always think of this and this is why I have that superpower. I can make you feel good about living in 2026. No fork in the breast now, right?

1:39:29Doctor Mike: Yeah, there's no, I mean, we're having very important discussions about when we're doing like, let's see, like a colposcopy about how we should talk about doing, not sedation, anesthesia or pre-procedural anesthesia. So these are conversations that we ought to have.

1:39:52Dr. Lindsey Fitzharris: Yeah. And not prepare your soul for death. Yeah, not prepare your soul for death.

1:39:57Doctor Mike: My goodness.

1:39:57Dr. Lindsey Fitzharris: I mean, it was a difficult time, certainly. And, you know, people, there's a story in the butchering art about a man who has like a 40-pound scrotal tumor. And people will say, how did it get that far? But of course, first of all, people don't see the doctors when they should. You know that, right? They'll put things off. We still do that today. But going to the surgeon or going to the doctor in the 19th century did not mean you were going to survive that experience. So people really did just turn the other eye. I mean, the scrotal tumor would have been insane. I mean, can you imagine 40 pounds?

1:40:27Dr. Lindsey Fitzharris: But at some point - But it makes sense.

1:40:30Doctor Mike: People go see me and the worst thing that happens in that visit is a blood test or a vaccine or something like minor. And back then it was like, I could just not come home today.

1:40:41Dr. Lindsey Fitzharris: That's not a thing that

1:40:42Doctor Mike: happens now.

1:40:44Dr. Lindsey Fitzharris: But medically speaking, like I said, when I got cancer, I thought I don't have a lot of medical anxiety and I have a lot of trust in my doctors. And so for me, it was more like, how long is this going to take? That sounds like a weird kind of reaction, but I thought, you know, am I going to have to do chemo? Like it's, it's a process. You got to take it one step at a time. And, but I knew I was going to come through it. I knew I'd caught it early. I knew I was very lucky in that sense. Um, but, but you know, that was, there was a time pretty recently where that was not a guarantee. And so for me, today is the best day to get sick.

1:41:20Dr. Lindsey Fitzharris: And also the scariest thing I think I could tell people is feeling good does not mean you are well.

1:41:27Doctor Mike: Right.

1:41:27Dr. Lindsey Fitzharris: Get your checks. You know, a mammogram can save your life. You know, my husband, he's also spoken openly about this. He's very British. He hadn't gone to see the doctor in 10 years, a very British thing. And when he turned 50, I said, you need to go get a blood test. And And lo and behold, he had prostate cancer, had no symptoms. He's come through everything with a full recovery. The advances we've made in treating these cancers is extraordinary. And even with breast cancer, it's not your grandmother's breast cancer. That's important to tell patients. And so, yeah, today's the best day to be alive.

1:42:00Dr. Lindsey Fitzharris: And tomorrow's going to be even a little bit better. So hanging on to that optimism, you're writing a book in 10 years called The Golden Age of Medicine. I know where this is going.

1:42:10Doctor Mike: What is The Golden Age?

1:42:11Dr. Lindsey Fitzharris: Oh, I mean, it's like comparing apples and oranges, right?

1:42:16Doctor Mike: Well, you're in charge. This is your subjective take.

1:42:20Dr. Lindsey Fitzharris: Okay, so I'm looking backwards and I have to make an assessment. Yeah, you're looking back and you're like,

1:42:23Doctor Mike: over the last humanity's reign, when was the golden age of medicine?

1:42:29Dr. Lindsey Fitzharris: I mean, again, I think it's like we're kind of living in it. Like, look what we can do. Like, we're surviving. We can prevent diseases. I mean, it's extraordinary.

1:42:36Doctor Mike: Well, because before they were like making progress where there was no progress to build off. Right. So it was like the beginnings. Yeah. So some might say that. Yeah.

1:42:42Dr. Lindsey Fitzharris: Well, I mean, also keep in mind, like when Lister comes along, there's a paradigm shift, right? Like the way we understand. But there's nothing that's stopping us. Like in 50 years, we might have another paradigm shift. And suddenly everything we understand about disease is going to be thrown into question. So, you know, it's always changing. I always say to doctors, what you know today isn't going to be what you know tomorrow. You have to, and this is why medical history is important, you have to know where you came from because it's empowering to know that that's not always going to be the status quo.

1:43:15Dr. Lindsey Fitzharris: Again, ego is very deadly compared to even ignorance, right? And holding on to ideas that aren't working, you have to be open. and oftentimes the paradigm shift comes from a doctor or from somebody on the outside sort of fringe right they're thinking creatively there was this um experiment that was done my my oxford tutor told me this years ago where they took people in the sciences and people in the arts and they asked them a question and the question was what do you do with a brick and people in the sciences mostly said you use it to build things and people in the arts would say well you could use it as a paperweight you could use it as a weapon you could use it to build you know So they were thinking laterally, like they were thinking in different ways maybe than people who are in the sciences think.

1:44:00Doctor Mike: And it's about like how do we marry that creative approach to medicine and also make sure that doctors remain open-minded to new solutions.

1:44:09Dr. Lindsey Fitzharris: I mean ulcers are a really good example. Those Australian doctors who proved – I think they won the Nobel Prize, right? I think it was in the early 2000s, they swallowed a bacteria that they proved caused ulcers.

1:44:23Doctor Mike: Was it H. pylori?

1:44:24Dr. Lindsey Fitzharris: Yes. Yeah. And before that, it was like this idea like stress caused. There was all kinds of. And again, they were sort of coming at this problem from a very different angle. And they were able to shatter the paradigm of how we understand ulcers. So I think it's important for doctors to study medical history. If only so, I could sell more books. But also because I do think it's important.

1:44:47Doctor Mike: I'm 100 % on the same page with you. I think more people need to study. I think it needs to be part of med school curriculum. I have two takeaways from some stuff you just said. First is the idea of having unique minds thinking about healthcare. So they're not just thinking vertically, they're thinking horizontally across all fields. Meaning like we used to just take science majors into medical school, but we need to get English majors in there. We need to get improv comics in healthcare. We need people to live life outside of just studying the textbook. And I'm hopeful with AI innovation, it can make studying easier and getting factual knowledge easier so that we can have more unique minds in healthcare.

1:45:27Doctor Mike: I've always advocated for that. And the second thing, this is probably going to be the only pro-RFK thing I've ever said.

1:45:34Dr. Lindsey Fitzharris: Oh, my God. This is it. This is the moment where the whole podcast blows up.

1:45:39Doctor Mike: And we get canceled.

1:45:40Dr. Lindsey Fitzharris: And you get canceled.

1:45:43Doctor Mike: I think censoring in healthcare, in medicine, even censoring someone like RFK is the wrong move.

1:45:49Dr. Lindsey Fitzharris: Yeah. It gets more powerful if you censor them. Yeah.

1:45:53Doctor Mike: Yes. That's not even why. Okay. As you've said, ideas that sound wild can sometimes be true. And the beauty of science is that it gets better through debate and discourse.

1:46:06Dr. Lindsey Fitzharris: Right.

1:46:06Doctor Mike: And that sometimes starts with wild ideas coming in.

1:46:09Dr. Lindsey Fitzharris: Yes.

1:46:10Doctor Mike: So when someone comes in with a wild idea, you need to come up with a better idea to either debunk it or stand firm or open up your mind and test that idea. But just shutting it down is a losing battle long-term.

1:46:24Dr. Lindsey Fitzharris: I mean, look at Semmelweis.

1:46:25Doctor Mike: Yes, exactly. You could put him in the insane asylum,

1:46:27Dr. Lindsey Fitzharris: but ultimately a good idea is going to come out.

1:46:30Doctor Mike: Because if you think about instead of doing that, if they said, let's just hear it out. If one person said that, if one department said that, They would see that there was value to this idea.

1:46:40Dr. Lindsey Fitzharris: It is about communication. I think medicine has to be about communication and stories. Even the time of Joe Bell, you had patient stories, like the patient's history meant something. And then you get this sort of shift where doctors start to see patients as the disease. And I think we have to humanize that experience again to build that trust.

1:47:00Doctor Mike: Sure. And by the way, I don't want to end it by me saying we shouldn't censor R.F.K. so he should be head of health and human services.

1:47:07Dr. Lindsey Fitzharris: Yeah, you don't want to get canceled. No, no, meaning like we shouldn't censor him,

1:47:11Doctor Mike: but he also shouldn't be making the decisions. No, he should not, yeah. Because he has very radical ideas, some of which have been very visibly disproven in ways that we have studied them. So yeah, while we shouldn't censor him, we also shouldn't put him in a position of power.

1:47:25Dr. Lindsey Fitzharris: Yeah, like it is especially that kind of position where he's got so much influence and power. But you're right that we need to keep having that dialogue and, you know, people were going to come from there's inevitably somebody is going to come from the outside, challenge something that we understand about the body today. You know, what is it going to be? I always think chemo, you know, in hopefully 10, 15, 20 years is going to be eradicated, be replaced with something better. I mean, chemo is brutal on the body. It's effective at killing cancer, but it has a lot of other side effects. And so, you know, people will laugh at the things that people believed in the 19th century, the bloodletting, et cetera.

1:48:01Dr. Lindsey Fitzharris: But what is it that we are going to look at in 50 years time and say, wow, I can't believe doctors used to do that. Okay.

1:48:09Doctor Mike: Colonoscopy.

1:48:10Dr. Lindsey Fitzharris: Oh, you shoved the camera in your butt?

1:48:12Doctor Mike: Yeah. We have a device that can see through the human body and show you everything inside of it. It's true.

1:48:16Dr. Lindsey Fitzharris: Why is that still persist? I had one recently. It's not pleasant.

1:48:20Doctor Mike: Is it like the drinking of the - Well, you guys in the UK don't get anesthesia.

1:48:24Dr. Lindsey Fitzharris: But I went private. I'm too American. Yeah, I was too American. I was like, no way. And also, here's another thing. They do not do colonoscopies as a matter of, you know, here you start at 45 to screen. They don't do that in the UK. What do they do? You have to become symptomatic to get one.

1:48:41Doctor Mike: There is no preventive colonoscopy screening in the NHS? No.

1:48:44Dr. Lindsey Fitzharris: They do now. They started rolling out like the poop test. Like, yeah. But I mean, that's not. That's not.

1:48:50Doctor Mike: So the poop test is interesting. Yeah. it's for catching active cancers. It's pretty good, actually. It's good sensitivity. Catching pre-cancerous adenomas, not good. Nothing, right? Yeah.

1:49:01Dr. Lindsey Fitzharris: And if they're in the colonoscopy, they're up there. They just take them out.

1:49:03Doctor Mike: Take them out. Yeah. So it's a preventive thing. Exactly, yeah. So that's the big benefit.

1:49:06Dr. Lindsey Fitzharris: So I made my British husband get one recently. I was like, you're 52. Like, you're well beyond when we should have started this. And he was fine. He said he had the colon of a 20-year-old. And I'm like, wow, I guess that 20-year-old didn't need that colon anymore. But anyway.

1:49:20Doctor Mike: What if you have a family history?

1:49:22Dr. Lindsey Fitzharris: That might be, but I mean, it all comes down to cost.

1:49:26Doctor Mike: Wait, what's the test that you think in whatever number of years we're going to look back on how we're doing bloodletting right now?

1:49:33Dr. Lindsey Fitzharris: Or what's the procedure? I mean, chemo. Like I would say chemo. Yeah, I do think chemo is going to be radiation. I went through radiation for breast cancer, and that is the gift that keeps on giving, doesn't it? And by the way, this is, I mean, you might end up deciding to cut this, But my surgeon said, oh, your radiated breast will be your Dorian gray breast. It will not age. And I was like, really? And he's like, yeah. And it's happening. So like the other breast starts to like droop. And that one just like just stays up there.

1:50:03Doctor Mike: I don't know physiologically why that is.

1:50:05Dr. Lindsey Fitzharris: But it definitely happens. And he says that patients will say, oh, can you just radiate the other? And they're like, no, no, you don't want more radiation than you need. But but radiation, you know, it makes you very tired. I didn't have too many side effects, but it does keep, you know, I was speaking at a plastic surgery conference and they said, oh, if the cancer comes back in that breast, we have to take it off because it's been radiated. And the idea is like the cells are damaged on some level. So if they went in and just cut out more cancer, there's a chance that you wouldn't heal properly and stuff.

1:50:36So all these kinds of things that you learn when you become the patient.

1:50:40Dr. Lindsey Fitzharris: But I, when I got diagnosed, I decided to go public because I write about people's experiences of illness in the past. And I felt like I needed to share that. But really powerfully for me, there's been several women who have come to me and said, I went and got a mammogram because of your story. And I was, I have early breast cancer. But again, cancer doesn't have to be fatal or scary.

1:51:02Doctor Mike: And there's people fearmongering about mammograms trying to get people not to do them.

1:51:06Dr. Lindsey Fitzharris: Well, and people think that the vaccine causes cancer. I mean, I know somebody who's convinced that I got cancer because of the vaccine. So one of the things you have to get used to is like the anxiety of the post-cancer experience. But the one thing I always say is like I am the most like they look after me so well. So if anything's going wrong, they're going to catch that very, very early, hopefully. But but yeah, it's a it's a you know, you you come face to face with your mortality and that is, you know, harrowing on some level. and you realize, yeah, this could happen to anybody. It's the human side of medicine.

1:51:42Doctor Mike: The fact that they're looking out for you, that means a lot. You trust this individual because you see how they interact with others in their everyday life and how they would carry the baggage of making a mistake because they're a human, which is why it kind of ties nicely to the point of AI not becoming the doctor.

1:51:58Dr. Lindsey Fitzharris: A couple of reasons.

1:51:59Doctor Mike: It's not human. You're not going to feel that trust. Second, it's also not good at dealing with uncertainty. Yeah. It's good at knowing all the information that exists, but uncertainty is part of health care.

1:52:11Dr. Lindsey Fitzharris: And here's the other thing, right? Like with photography and it good to go back to Sleuthhound, there was a period where where people thought photography couldn't lie. But we we know that's not true now. Right. AI is being trained. It depends who's training that AI. Right. There are biases being built into it. And of course, we are wrong as humans. So some of that is being built into as well. These errors.

1:52:33Doctor Mike: Right.

1:52:34Dr. Lindsey Fitzharris: So you can't trust it. It's not just this kind of thing that exists in a vacuum.

1:52:38Doctor Mike: That's perfect, right? So if you feel like your doctor is biased, you can interrogate the doctor, right? You can ask them. You can ask nurses, how's that doctor? You could ask other patients. You could ask that doctor for their financial disclosures. Can we interrogate who is controlling the slider on empathy or evidence? Or if Sam Altman wants to say vaccines don't exist because he wants more vaccine preventable. And this is because he's, again, I'm making this up for you. I know, but it could be true. We don't know. Yeah, I know. There is no one to interrogate.

1:53:11Dr. Lindsey Fitzharris: And you can't call AI to the witness stand. There's nobody to hold, you know, ultimately. I think that there's going to be, unfortunately, some terrible things that happen. People are going to get hurt. And then there will be this sense that nobody is being held responsible because you can't call a machine to the witness stand. And we and also your doctor does more than just spits out an answer, even if that was just like what we were looking for. It is. It's you know, you have Gillies building men's faces and making them feel good about who they are in their new bodies. Even my breast surgeon, you know, he did.

1:53:48Dr. Lindsey Fitzharris: He I remember he was like drawing all over me. And by the way, my husband, again, the caricatrice is like standing there and he goes at one point, he goes, oh, it's like what I do. And I'm like, what? I was like, this is. And my surgeon goes, oh, I'm sorry. are you a doctor? I'm like, nope, he's a professional silly man. I have no idea why he would say that. But I remember at one point he was, he was holding my breast and he goes, look down. And I go, oh, it's going to be smaller than the other. He goes, no, I'm going to do both. And I remember thinking, oh, thank God he's thinking of this. Like he's thinking about the body I have to occupy after.

1:54:18Dr. Lindsey Fitzharris: That's so important when you go through cancer. Like you, you know, it's not vanity. It's about feeling like yourself, like you're not this damaged person. And in Gillies, he builds these relationships with these men. You're not getting that from AI. You have to have a relationship with your doctor. It is built on trust. There is a human aspect to medicine. And that's why I love medical history too, because it is about the people. Lister, he doesn't come up with these ideas in a vacuum. He's a Quaker whose father gives him the lightsaber, which is the microscope. He comes up with this idea because of who he is essentially he is he is a product of his upbringing and ai is not that like it's being trained by god knows who and we don't know the biases that are in it it's like photography in the 19th century where we just assume oh well this is an unbiased machine and but we know that that's not true none of this is in a vacuum and and medicine needs to remain deeply human yeah because if your

1:55:16Doctor Mike: breast surgeon came to you and said okay this is the cancer you have here's the textbook yeah yeah You could read it and get the information, but that is furthest from the same thing.

1:55:24Dr. Lindsey Fitzharris: And he's explained, and he's, you know, there's, there's an element of him, you know, like

1:55:27Doctor Mike: putting me at ease and reading your body language and all these things.

1:55:30Dr. Lindsey Fitzharris: And even, you know, when he said the lumpectomy and he, he showed me all this evidence, he said, but it is your choice. If you want to have the mastectomy, we can talk about that. And inpatient choice is so important, especially with cancer. Like when my husband was given all these options, he, he was like, well, what, what, what would you just tell me what to do? And his surgeon said, actually, we find that people are happier with the outcomes when they are participating in that decision making. Right. And so it was it was all an important process. You can't do that with AI. It's very scary that people are just I mean, I'm a writer, so I'm always going to be like writers and artists.

1:56:06Dr. Lindsey Fitzharris: We're scared to death about this. But there is something deeply human about what we do when we write books, we produce art. And when we practice medicine, and like I said, those ideas are very much about your upbringing. I mean, you have an incredible backstory with your father being an immigrant and stuff. And that all has affected how you practice medicine as well. And it makes you a better doctor and a different kind of doctor. You're not going to get that from Claude.

1:56:32Doctor Mike: Well, people can go and choose doctors with unique backgrounds that may represent them culturally. Right. That's true. Like, okay, maybe you prefer a sports medicine doctor to take care of you who used to be an athlete because you feel like they relate to you. And you can choose that because they're a human.

1:56:49Dr. Lindsey Fitzharris: Yeah.

1:56:50Doctor Mike: When you see Claude, Grock, whatever it is, it's just like it's a mishmash of whatever is out there.

1:56:56Dr. Lindsey Fitzharris: I mean, you know, my husband says 99 % of caricature is crap. And AI is trained on it. So it's all really bad caricature. And that's the same thing. It's like, what's being fed into these machines? What is it missing? Remember, patients lie as well. So if you're lying to Claude, let's just say Claude or Grock or whatever, it can get to the diagnosis. If you are not disclosing information, Claude's not asking you actively necessarily about the additional information that they might need to know or family history or just so many things that might be relevant that Bell would see, right?

1:57:31Doctor Mike: Those people would be like, oh my God, but doctors miss stuff all the time too.

1:57:35Dr. Lindsey Fitzharris: And that's an acceptable mistake because it's the art of the human that's taking care of you.

1:57:41Doctor Mike: It's different when your parent makes a mistake than when a stranger who's in charge of you makes a mistake.

1:57:46Dr. Lindsey Fitzharris: And also, again, doctors are held culpable for mistakes, right? Which AI, you can't. AI is going to kill people. This is ramping up. AI is going to kill people. But I mean, they told us it's going to kill us all by the end of the decade. So, I mean, you know, it's been nice knowing you. But but yeah, it is going to be responsible if it isn't already. I think there are some cases where, you know, it gives you false information or you ask it something, you know, how to yourself or whatever. It's dangerous. It's a dangerous technology. It needs to be reined in. I'm not saying that AI can't do good.

1:58:20Dr. Lindsey Fitzharris: There is, MIA is a system up in Scotland which reads mammograms, can read more mammograms than any doctor in like three lifetimes or something. Very good at catching early stage breast cancer. These are good diagnostic tools, but there is still, it's scary how reliant we've become on technology. We have to keep the human at the center of everything we do, including in medicine.

1:58:44Doctor Mike: I can't think of a better bow tie for an awesome conversation. It was so great. That was really beautiful. I know. I loved it. Thank you so much for having me on the show. Yeah, this was so fun. Yeah, it has. Yeah. I mean, very enlightening, part scary. Part scary, yeah. And also now I'm very grateful to be alive now.

1:59:00Dr. Lindsey Fitzharris: That, I've done my job then. I've done my job. You feel good about 2026.

1:59:03Doctor Mike: I'm sure the audience does as well.

1:59:05Dr. Lindsey Fitzharris: Yeah, exactly.

1:59:06Doctor Mike: So folks are going to read Sleuth Hound. Where else do you want them to follow along the journey?

1:59:09Dr. Lindsey Fitzharris: So I just got my old YouTube channel back. It's called Under the Knife. It's a dumb show. I have a magical bucket and objects from medical history come through. I love telling stories through objects. So you can find me on Under the Knife Show. And I'm on Instagram and I'm on Blue Sky. I'm on all these different platforms. You can't escape it. It's like I'm just out there hitting you with medical history facts, whether you want them or not.

1:59:31Doctor Mike: Amazing. Well, I look forward to continuing to follow and support the journey. And for you to help keep us in check with your amazing fact checking work of our history videos.

1:59:41Dr. Lindsey Fitzharris: Thank you so much. Thank you.

1:59:42Doctor Mike: Be sure to follow the links below to pick up a copy of Lindsay's new book, Sleuth Hound, and follow her on social media to learn more about the dark origins of medicine. If you want another recommendation for another great video, check out my interview with hospice nurse Julie, where she talks about the time that she spent in the final hours, minutes with so many of her patients and the interesting facts she has to share. If you enjoyed this episode, don't hesitate to give us a five-star review. Perhaps drop a comment letting me know who else you'd like to see on the show. and as always, stay happy and healthy.