Medical Historian Answers History of Medicine Questions | Tech Support | WIRED

[00:00] move it back and forth to cut the nerve fibers. Just wait till we get to poop transplants. from the internet.

[00:15] [upbeat music] "So like surgery before anesthesia, what did you do? Well, pretty much the former in fact.

[00:31] various dentists, surgeons start experimenting Now, the first widely publicized and the procedure very, very quickly spreads after that.

[00:46] you pretty much had to grin and bear it. to keep their patients awake. in early surgery isn't pain.

[00:59] if you start drifting off into unconsciousness So there's a sense that pain at least kind of helps and helps to kind of survive this assault on the body,

[01:12] There's a real emphasis on being as quick as possible. while you hack away at their leg. a man called Robert Liston

[01:26] because he could have somebody's leg off for this sometimes is inaccuracy. which may or may not be apocryphal,

[01:40] He accidentally took off the patient's testicles One of the burly surgical assistants That man got an infection and died.

[01:52] to have dropped down dead from fright. in history with a 300% mortality rate. "what in the world is cupping

[02:05] Cupping makes use of little glass burn it inside to create a partial vacuum, The vacuum inside would pull up

[02:19] which could then be left or it could be lacerated Now the ideas behind this are very ancient indeed, and phlegm govern health and disease.

[02:34] to draw out some of these excess humors in the last few decades and especially the kind of the wellness boom.

[02:47] some sort of placebo effect behind it, that it has really any kind of clinical effect. Pasteur might be rolling in his grave

[03:01] in the middle of the 19th century. in the kind of problems that affect French agriculture. that really upset French people, like,

[03:15] on the chemistry of fermentation. or when milk ferments and turns into cheese, and when things go bad,

[03:28] So as part of this, grape juice or wine or beer or milk and as we now say to sterilize it.

[03:41] and does great work to improve the health of many foods, because he very sensibly patents it. He begins his work trying to understand the kind of diseases

[03:59] Pasteur works out that if you identify you can actually use it to make a vaccine. and then you can use those weakened,

[04:11] So in 1881, Pasteur carries out a very large, involving dozens of farm animals. on a human disease, rabies.

[04:24] Not only is there no effective treatment for it, Pasteur starts to, again, to making a vaccine for rabies.

[04:37] is savaged by a rabid dog. Pasteur tries out this experimental vaccine 13 injections into the abdominal

[04:52] So poor Joseph Meister goes through quite a trial, Pasteur really does become a French national hero. The Institut Pasteur still works in France.

[05:04] that the French state can throw at him. Radithor was an American patent medicine and it was immensely popular.

[05:19] You were drinking distilled water mixed Now, why on earth were people doing this? that historians have called the radium craze.

[05:34] it's a great deal of public fascination especially around the idea of radiation. Marie Curie gets the Nobel Prize

[05:48] There's a lot of medical interest in radiation as well, but also through the idea that radioactive substances Probably the most famous victim

[06:01] He seems to have been absolutely addicted to the stuff. of it during his lifetime. which in its very late stages led

[06:14] And it's largely as a result that Radithor was eventually banned in 1932. the expression blowing smoke up your

[06:26] How is the smoke blown? If you think about 18th century Britain, about how to revive sailors who've been washed overboard.

[06:40] Tobacco smoke is seen as a kind of irritant. So some physicians start to experiment that have a sort of little tobacco pipe built into them.

[06:53] the bottom of some poor drowned person and blow it in. left inside this person, And I think it's probably fair to say that it would.

[07:07] "Share your most controversial Nobel Prize winner. I think I'd agree with that. Antonio Egas Moniz was a Portuguese neurologist.

[07:21] Lobotomy literally means lobe cutting or brain cutting. that connect the frontal lobes with a new treatment

[07:37] He very quickly found that people but the procedure caused tremendous problems They very often suffered changes in character.

[07:50] So the question really is why did lobotomy become if it had such terrible consequences for patients? All sorts of new institutions,

[08:04] to the what's seen as a growing problem of insanity But by the early 20th century, for mental illness.

[08:18] psychiatrists don't really have much for treating madness. in the early 20th century,

[08:31] using insulin to put patients the idea that this might This is also the period

[08:43] to be used for certain kinds of conditions, notorious of these heroic therapies. so popular is the work of an American Dr. Walter Freeman.

[08:55] which is called the transorbital lobotomy. you make an incision just above the eyelids, and through that, you can get directly into the brain.

[09:08] States moving from asylum to asylum, in waiting rooms or in doctors' offices. he was banned from medical practice,

[09:22] restrictive kind of psychiatry. you'll know that the lobotomy It's not really a kind of therapy at all.

[09:36] "Were maggots ever purposely cultivated maggots, which are the larvae of certain kinds of flies. but they won't eat live tissue.

[09:50] for what's called debridement, Now, this is a rather kind of counterintuitive idea. this would be a very, very bad thing.

[10:04] in many traditional medical cultures around the world, military surgeons working in Europe start on a battlefield for days,

[10:19] very often that wound will actually stay uninfected in situations where no other kinds Of course, the most important thing is

[10:33] So Wowerful asks, what is the iron lung and how does it work?" looks a little bit like a railway carriage,

[10:46] Now imagine you lie inside that tube so that you're sealed inside it, that's pumping air into the tube and out of the tube.

[11:00] So for patients who've lost the ability to breathe, to inflate and deflate their lungs and keep 'em alive. initially for treating victims of coal gas poisoning.

[11:16] of the early mid 20th century. that largely affects the nervous system. but it can also leave them in a situation

[11:28] So iron lungs became a way of keeping through this epidemic at a great cost You do have cases of people being infected

[11:41] and living decades inside an iron lung. Effective vaccines come along in the 1950s and 1960s. to try and eliminate this disease.

[11:56] sleepymteverest asks, especially in medieval and classical medicine. So if you have too much blood inside your system,

[12:13] fiery kind of overstimulating humor. so it can kind of make you overexcited and feverish. out of your body, it'll calm you down.

[12:27] of bloodletting carried to kind of extraordinary excesses. few days of the life of the first American president, him over and over again,

[12:40] And there's an argument that actually his death not of the disease he was suffering from. Typhoid Mary was Mary Mallon.

[12:54] In the early 20th century, with the households in which Mary had worked. Department investigated this case

[13:07] was what's called an asymptomatic carrier of the disease. for typhoid, but she didn't suffer from the disease herself. she was forcibly quarantined for a while.

[13:20] but in 1915, a further series of outbreaks And sadly enough, She died in quarantine in 1938.

[13:32] a figure of sort of gothic folklore, issues that are very familiar to us in the last 10 years. the COVID lockdown of how do we balance individual freedom

[13:45] There's also a question She was far from the only asymptomatic but she was the only one who was incarcerated for so long.

[13:59] with the fact that she was working class, and the fact that she was a woman "Is trepanning still used today?"

[14:12] It's the idea of cutting or drilling a hole in the skull. techniques that we have evidence for. as the Neolithic have found skulls

[14:26] presumably with quite sort of simple flint tools, some evidence of healing. from these ancient societies,

[14:39] intervention perhaps or to treat some kind of head injury. was perhaps some kind of initiation rite.

[14:52] because there are easier ways Modern surgeons will use it sometimes to try and relieve pressure on the brain

[15:05] or in some other kinds of diseases like brain cancer. 3KCarlo asks, "Yo, how did surgeons learn that stuff? If you're going to learn surgery,

[15:17] the best way to do it is not learning through texts, the way that you learn surgery You'd be apprentice to a master surgeon,

[15:30] so you'd learn very much in practice. of the kind of materiality of the body. the fine detail of movement or circulation of the blood

[15:45] come from getting to grips messy materiality of the body. "What is the oldest example of a plastic surgery

[15:57] So we may think of plastic surgery but in fact, it's a very old idea indeed. we find interventions that are intended not only

[16:10] but also its appearance. The earliest records of this come of the Ayurvedic tradition.

[16:23] or you've suffered some awful disfiguring disease. to try and at least recreate the appearance of a nose, leaving a little strip

[16:37] and kind of fold it down and then attach it And the idea is that the tissue will heal but at least something that that looks like a nose.

[16:53] "Why did it take so long for surgeons to recognize the need It's a very simple question that opens Now, in some ways, there's a paradox here.

[17:06] in about sort of the middle of the 17th century, to look at all sorts of objects and substances. previously unsuspected tiny little dots

[17:20] But it's not until the 19th century and disinfection are kind of central So why did it take two and a half centuries

[17:34] I suppose, is that it's not at all clear to the first observers that germs actually cause disease. that early microscopists look at,

[17:47] So many people say, well, how can they possibly cause disease? immediately of this overwhelming infection?

[17:59] That really only kind of comes There's also a question about the kind of the nature It can be very hard in practice actually

[18:12] So a working surgeon might say, well, Perhaps, it's a consequence of the body trying So there are lots of reasons that it's quite hard

[18:25] connection between cleanliness of surgical instruments JDNelson asks, "Well, barber-surgeons were a thing. but barber surgeons certainly were a thing.

[18:39] who cut your hair might also or 400 years is that both barbers and surgeons You can imagine a barber

[18:55] It's maybe not an enormous step carrying out basic kinds of surgical procedure. historically, there was a very close connection

[19:08] in the old blood and bandages, that you still see outside many modern barbershops. "Was the discovery of penicillin really an accident?"

[19:22] and bacteriologist Alexander Fleming. on the body's natural defenses against bacteria. which the body secretes in things like snot

[19:38] So Fleming is very interested but the discovery of penicillin In the summer of 1928,

[19:51] goes on holiday, comes back about a month later of bacterial cultures that he's been using Now he's about to throw these away,

[20:05] and makes a fortuitous and fantastic discovery. on this Petri dish is clearly secreting the bacteria that were growing on the Petri dish.

[20:19] he tries to extract a drug, and he calls this drug penicillin. kept getting infested with others,

[20:32] and make sure that only the bacteria But in the 1930s, two things happened. antibacterial drug called Prontosil

[20:44] Second, the outbreak of the Second World War. to need effective treatments for battlefield injuries. which essentially kind of combs the literature

[20:58] This project led by Howard Florey They start work on developing penicillin

[21:10] It becomes the world's first successful antibiotic. And Florey, Chain, and Fleming share the 1945 Nobel Prize penicillin turns out

[21:23] Runnerlovejul asks, continuous exposure to mercury "Alice in Wonderland," we all know

[21:37] in the strange way that he does. is the characteristic trade disease of hatters Mercury was used in the preparation

[21:50] So hatters in the course of their work they'd often suffered quite severe neurological damage. even forms of madness from this long exposure to mercury.

[22:05] "Why wasn't measles eradicated like smallpox?" for measles to be eradicated. and there are many global programs associated

[22:17] that are working towards this aim. and this was made much worse by the COVID pandemic. medical resources were diverted elsewhere.

[22:31] After the end of the pandemic, where it had been declining for decades. infectious disease like smallpox.

[22:45] It was a very serious disfiguring, often fatal disease. The English doctor, Edward Jenner, vaccination technique against smallpox.

[22:59] the disease was the subject of one to eradicate a disease, and this was finally successful. Part of the problem with measles

[23:13] We tend to think of it as a kind of childhood disease, But it's a very, very serious disease. It can also leave your immune system

[23:26] And of course, a big problem in the West has been the rise of vaccine skepticism. in 1998 published a paper which claimed

[23:38] and the development of childhood autism. and The Lancet to its great credit but unfortunately, it has very much contributed

[23:51] but if you're lucky enough to live programs against measles, for heaven's sake, get vaccinated. Well, if you think back to algebra

[24:06] and science for the unknown quantity. in 1895 by Wilhelm Roentgen, Now, Roentgen is working

[24:19] vacuum tubes, cathode ray tubes that seem He discovers very quickly that these that they can pass through the human body,

[24:32] which you can capture on a fluorescent screen There's a famous story of Roentgen that she's supposed to have exclaimed,

[24:45] her own mortality for the first time. out of the eye with a fish hook, but when did that start?" such a delicate, sensitive part of the body

[25:00] But actually operations for cataracts are some of the oldest Now, cataracts arise when the lens that sits for focusing light onto the retina and goes cloudy,

[25:12] with cataracts was called couching. from many different traditions. and you just insert it into the eye

[25:26] Now, this restores vision, very, very blurred vision, the European physicians start removing

[25:40] In 1884, an Austrian neurologist, starts to use cocaine as a local anesthetic And this makes cataract surgery

[25:54] and the roots of modern cataract surgery we try and insert an artificial lens An English surgeon called Harold Ridley

[26:06] Many of them had been in bad crashes, and bits of acrylic had got into their eyes. a piece of acrylic in the eye isn't rejected

[26:21] with replacement lenses made out of acrylic. of modern cataract surgery. "Did leeching actually do anything?"

[26:33] and they live by sucking blood from other creatures. and it really had all of the kind of downsides to get a leech that was infected with a disease,

[26:47] And as with bloodletting, it could be done to excess. and compromised by losing too much blood to a leech. Thanks so much for watching History of Medicine Support.