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Speaker 1: Bit by bit, teaspoon by teaspoon, the archaeologists shoveled away

2
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Speaker 1: the dirt. Their work had taken the team to a

3
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Speaker 1: remote region of Indonesia to a cave named Liang Tabou.

4
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Speaker 1: The soft limestone showed evidence of human occupation, including paintings

5
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Speaker 1: that clocked in it over forty thousand years old. The

6
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Speaker 1: spot was a favorite for archaeologists, and they had come

7
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Speaker 1: to look for more prehistoric signs of life, so you

8
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Speaker 1: can imagine their excitement when they came across simple stone

9
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Speaker 1: markers on the ground of the cave's largest chamber. They

10
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Speaker 1: had an idea about what this might be, and slowly, methodically,

11
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Speaker 1: and meticulously began to upturn the earth. At almost five

12
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Speaker 1: feet down, they found it an ancient grave. The skeleton

13
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Speaker 1: appeared to be a young person around twenty years old.

14
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Speaker 1: It was almost fully intact. Almost finding bones in the

15
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Speaker 1: ground isn't, in principle uncommon, but there were many things

16
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Speaker 1: that made this find spectacular. Archaeologist determined that this person

17
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Speaker 1: died over thirty thousand years ago. The age of the

18
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Speaker 1: skeleton and its intentional burial felt astonishing to them. It

19
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Speaker 1: was one of the oldest examples of this ever found.

20
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Speaker 1: The skeleton was missing its foot, but they found no

21
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Speaker 1: evidence of infection nor blunt force trauma on its own.

22
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Speaker 1: This might not seem very spectacular, but the team discovered

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Speaker 1: something that made this not just a grape vine but

24
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Speaker 1: a revolutionary one. You see, there was a considerable amount

25
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Speaker 1: of new bone growth evidence of healing. This and the

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Speaker 1: meticulous intentional way in which the bones seemed to have

27
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Speaker 1: been removed led archaeologists to conclude that this limb had

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Speaker 1: been deliberately surgically amputated, making this the oldest evidence of

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Speaker 1: ancient surgery ever discovered. Scholars have long assumed that prehistoric

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Speaker 1: societies had very basic surgical skills. We've found evidence of dentistry, suturine,

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Speaker 1: and cranial trepination, among other things, but evidence of a

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Speaker 1: complete and successful amputation suggests something else. That these people

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Speaker 1: had well developed knowledge of anatomy, vascular systems, and remedies

34
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Speaker 1: for infection. They knew how to stave off further harm

35
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Speaker 1: to the body, and continued care in the postoperative time.

36
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Speaker 1: The long standing assumption has been that surgical knowledge and

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Speaker 1: technology really only developed after humans began to shift from

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Speaker 1: hunting and foraging to farming. A pivot that began around

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Speaker 1: ten thousand years ago. The discovery of a successful amputation

40
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Speaker 1: from over thirty thousand years ago, in which the patient

41
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Speaker 1: not only didn't die, but went on to live for

42
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Speaker 1: many years afterwards, completely changes how surgical knowledge and processes

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Speaker 1: are thought to have developed and places them in a

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Speaker 1: much earlier period. Have we ever originally thought? If you

45
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Speaker 1: think about the past one hundred years, our medical technology

46
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Speaker 1: has evolved at a staggering pace. We hope for the

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Speaker 1: best at hospitals and can often trust that we might

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Speaker 1: leave there better than when we arrived. We revere doctors

49
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Speaker 1: in white coats and defer to their best judgment and dexterous,

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Speaker 1: steady hands. Many of us only have the vaguest idea

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Speaker 1: of what goes on inside of our bodies and how

52
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Speaker 1: all of the puzzle pieces are put together. We hope

53
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Speaker 1: that they have a better idea than we do, but

54
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Speaker 1: they haven't always. In fact, surgical amputation only became a

55
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Speaker 1: norm within the last century. At one time, amputation would

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Speaker 1: be done as a last ditch effort to save someone's life.

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Speaker 1: While it might and often did kill a patient, they

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Speaker 1: most certainly would die if the offensive body part was

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Speaker 1: left intact. The history of surgery is a long and

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Speaker 1: fascinating one, chuck full of curiosity and ham fisted cleaverers.

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Speaker 1: It's been misguided at times and totally astonishing in others,

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Speaker 1: and with plenty of bloodshed along the way. I'm Aaron Manky,

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Speaker 1: and welcome to bedside Manners. You've heard me say this before,

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Speaker 1: but I'll say it once again. Archaeology isn't an exact science.

65
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Speaker 1: It's a discipline of best guesses. A field filled with

66
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Speaker 1: detectives covered in dirt figuratively a field, but also sometimes

67
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Speaker 1: literally in a field. Before the twenty twenty two discovery

68
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Speaker 1: in Indonesia, some of the oldest surgical discoveries were believed

69
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Speaker 1: to have come from about ten thousand years ago. The

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Speaker 1: Neolithic period, as it was known, was the time period

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Speaker 1: in which humans began to take up farming. When people

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Speaker 1: did this, they also started to store their dead and

73
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Speaker 1: shared locations. Burying our dead is one of the oldest

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Speaker 1: expressions of our humanity, and we've been at it for

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Speaker 1: over one hundred thirty thousand years. As ancient people created communities,

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Speaker 1: they created burial sites too, and it's in these burial

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Speaker 1: sites across the globe that archaeologists have found over fifteen

78
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Speaker 1: hundred skulls that bear evidence of trefination, the act of

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Speaker 1: drilling a hole into the skull of a living person

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Speaker 1: in the hopes of curing sickness. There is a chance

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Speaker 1: that this practice existed far before these people lived, but

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Speaker 1: we can imagine that the intentional placement and preservation of

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Speaker 1: these bodies had something to do with our ability to

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Speaker 1: make this discovery. The question, though, is why, and the

85
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Speaker 1: truth is will probably never know, but one guess is that,

86
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Speaker 1: like a lot of medicine up until the past few

87
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Speaker 1: hundred years, healing and spirituality were deeply intertwined. Were these

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Speaker 1: ancient neurosurgeons trying to relieve patients of physical symptoms such

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Speaker 1: as headaches or seizures, or to provide an escape hatch

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Speaker 1: for voices and demons that may have affected the person.

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Speaker 1: What we do know is that these people went on

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Speaker 1: to live hopefully healed, as evidenced by bone regrowth. And

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Speaker 1: we know too that Neolithic surgeons were operating on head

94
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Speaker 1: injuries and seemingly successfully at times. As civilizations developed thousands

95
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Speaker 1: of years later, Babylon, Egypt, China, and Greece among them,

96
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Speaker 1: the great thinkers across the ancient world tried their hands

97
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Speaker 1: at understanding what it meant to be a healer and

98
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Speaker 1: how that's squared with cutting into the body. Different social

99
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Speaker 1: mores across cultures dictated what was allowable For thousands of years.

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Speaker 1: Health and healing were directly tied to these supernatural in

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Speaker 1: some ways, and in some places it still is. Before

102
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Speaker 1: the advent of modern science and medicine, humans believe that

103
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Speaker 1: sickness was caused by unseen forces, and they were kind

104
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Speaker 1: of right. But it wasn't the invisible spirits they had

105
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Speaker 1: to fear, but microscopic germs invisible to the naked eye.

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Speaker 1: It was the ancient Egyptians who first peered into the

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Speaker 1: human skull with the idea that it was the brain

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Speaker 1: that was the command center of the body. They were

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Speaker 1: right far before anyone else was. But not everyone was

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Speaker 1: so gung ho as they were about internal investigations. In

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Speaker 1: ancient China and Greece, religious and spiritual beliefs dictated that

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Speaker 1: the body was sacred, and as you learned in our

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Speaker 1: previous episodes, human dissection was outlawed for a very long time.

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Speaker 1: In fact, the original Hippocratic oath, which is still taken

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Speaker 1: by doctors today, specifically forbade them from cutting. It said,

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Speaker 1: and I quote, I will not use a knife, not

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Speaker 1: even on sufferers from stone, but will withdraw in favor

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Speaker 1: of such men as are engaged in this work. The Oath,

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Speaker 1: of course, also set out to create two distinct classes

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Speaker 1: of healers, sally physicians and tradesman surgeons. Following the rise

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Speaker 1: of the Roman Empire, Greek healers and their knowledge were

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Speaker 1: absorbed into the social fabric. Hippocratic beliefs spread throughout the territory,

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Speaker 1: and the demand for care often outpaced supply. Interestingly, it's

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Speaker 1: here that we saw more and more enslaved people and

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Speaker 1: servants take on more surgical responsibilities for their households and communities.

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Speaker 1: The physician Galen, who wrote a great deal about anatomy

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Speaker 1: and surgical procedures, likely never performed or even witnessed the

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Speaker 1: dissection of a human because of the Roman outlaw of

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Speaker 1: the practice. However, he had been a surgeon to gladiators,

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Speaker 1: where spilled blood and guts were all in a day's work.

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Speaker 1: Most of his surgical knowledge, though, was just based on

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Speaker 1: animal dissection, which could only help so much when it

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Speaker 1: came to understanding the human body, he became the leading

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Speaker 1: authority on the matter. But what he didn't understand he

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Speaker 1: made up, If you'll pardon the pun, he took a

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Speaker 1: stab at it with best guesses as to how the

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Speaker 1: human body worked. And yet his word was taken as

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Speaker 1: fact for a very long time, until sensibility shifted into

139
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Speaker 1: a place where intentional slicing was not only acceptable but

140
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Speaker 1: absolutely necessary in moving knowledge forward. King Louis the fourteenth

141
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Speaker 1: would meet a bad end, but November eighteenth of sixteen

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Speaker 1: eighty six wasn't going to be that day. That said,

143
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Speaker 1: he was certainly in for a bit of suffering due

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Speaker 1: to his well his other bad end. By early morning

145
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Speaker 1: of that day, our king was flanked by his closest advisers,

146
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Speaker 1: faced down, prostrate and pantless in bed. His people held

147
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Speaker 1: his legs apart and firmly to the bed. As Charles

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Speaker 1: Francois Felix began, the king was suffering from an anal fistula.

149
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Speaker 1: For months. He had tried lansings and laxatives, leeches and irons,

150
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Speaker 1: but no physician could relieve the king's suffering, and by

151
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Speaker 1: the spring of that year he was growing desperate. So

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Speaker 1: he called for a surgeon. Louis summoned Charles Francois and

153
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Speaker 1: pleaded for help. But knowing that one wrong step or

154
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Speaker 1: slice could mean the end of Charles Francois's career and

155
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Speaker 1: possibly the end of him, the surgeon implored the king

156
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Speaker 1: to give him a few more months of time to

157
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Speaker 1: study and figure out a way to help his condition. So,

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Speaker 1: with a deep breath and probably a few prayers, Charles

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Speaker 1: Francois took his special made metal protractor, his knife shaped

160
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Speaker 1: like a scythe, and got to work in the candlelight,

161
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Speaker 1: without any antiseptic and without any pain relief. The king

162
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Speaker 1: soldiered on through the morning. By lunchtime, the operation was over,

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Speaker 1: and you know what, it was a success. And with

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Speaker 1: that the new year of sixteen eighty six was deemed

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Speaker 1: the year of the Fistula by the crown. He filled

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Speaker 1: fountains with wine and saying his own praises of bravery

167
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Speaker 1: in the face of adversity. The king rewarded Charles Francois

168
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Speaker 1: with a heavy sum of francs and a large estate,

169
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Speaker 1: making him a celebrity in his own right. In a

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Speaker 1: strange twist, the surgery became somew fashionable, with folks clamoring

171
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Speaker 1: for a cure when there was no problem to begin with.

172
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Speaker 1: This moment helped to change the public's view of surgeons.

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Speaker 1: In the collective imaginations, they evolved from simple tradesmen to

174
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Speaker 1: skillful healers. As you've heard by now, barber surgeons were

175
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Speaker 1: long considered to be well barbarous, knife wielders and blood letters.

176
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Speaker 1: They occupied a distinctly different social space than the refined

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Speaker 1: minds of the academy. Their job meant getting down and dirty,

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Speaker 1: while the physicians preferred to look but not touch. In

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Speaker 1: the Middle Ages, there were various attempts to unify physicians

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Speaker 1: and surgeons and have them work together rather than in opposition,

181
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Speaker 1: but as you can imagine, this was sometimes a fraud endeavor.

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Speaker 1: With the Renaissance came a turn in the story for surgeons,

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Speaker 1: as they finally moved into positions of respectability within the

184
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Speaker 1: healing business. They were starting to be viewed as innovators,

185
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Speaker 1: not quacks or buffoons. They held sharp clinical skills and

186
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Speaker 1: an understanding of the body's interior geography based on hands

187
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Speaker 1: on experience and observation rather than just old theories. By

188
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Speaker 1: the eighteen hundreds, London and Paris had become the epicenters

189
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Speaker 1: of surgical development, serving both the needs of science and entertainments.

190
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Speaker 1: I've been at this for a good number of years,

191
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Speaker 1: and I've read my fair share about the Victorian culture.

192
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Speaker 1: But one of the most striking discoveries that one makes

193
00:11:18,760 --> 00:11:22,199
Speaker 1: when reading into their history is their love of the macabre.

194
00:11:22,679 --> 00:11:25,120
Speaker 1: For example, this was the time when crime scenes, the

195
00:11:25,200 --> 00:11:29,520
Speaker 1: ghastlier the better, became tourist attractions. True crime stories became

196
00:11:29,559 --> 00:11:32,240
Speaker 1: all the rage. People wanted to look but not touch.

197
00:11:32,400 --> 00:11:34,640
Speaker 1: They wanted to step close to danger and be able

198
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Speaker 1: to walk away. It's not that different from the way

199
00:11:37,400 --> 00:11:40,880
Speaker 1: that we still experience true horror podcasts and scary movies.

200
00:11:41,200 --> 00:11:45,720
Speaker 1: It's voyeurism. It's safe, and to them, these surgical procedures,

201
00:11:45,720 --> 00:11:49,800
Speaker 1: often bloody and grotesque, didn't look much different than crime scenes.

202
00:11:50,160 --> 00:11:53,440
Speaker 1: Public operations and dissections became not just the means by

203
00:11:53,480 --> 00:11:56,280
Speaker 1: which a budding surgeon could learn new skills, but they

204
00:11:56,320 --> 00:11:59,240
Speaker 1: also doubled as entertainment for folks who headed out for

205
00:11:59,280 --> 00:12:03,000
Speaker 1: a night on the public operating theaters where bodies were

206
00:12:03,040 --> 00:12:06,560
Speaker 1: center stage were happy to take their money. Even into

207
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Speaker 1: the mid nineteenth century, invasive surgeries were very rare and

208
00:12:10,320 --> 00:12:13,840
Speaker 1: very risky. They were generally avoided except as an absolute

209
00:12:13,920 --> 00:12:17,200
Speaker 1: last resort, So people came to catch a glimpse of

210
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Speaker 1: these rare events when they could, sort of like when

211
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Speaker 1: the circus might come to town, a once in a

212
00:12:22,040 --> 00:12:26,200
Speaker 1: while event, a spectacle ripe for public consumption. But hey,

213
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Speaker 1: if that isn't morbid enough, let me remind you that

214
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Speaker 1: hospitals were known as houses of death. Think mushrooms and

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Speaker 1: maggots in the bedsheets, wailing in the hallways, and rodents

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Speaker 1: nibbling on discarded limbs. They were fetid and squalid places,

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Speaker 1: filled with the lingering stench of blood, custs, and the

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Speaker 1: undigested food and fecal matter that still slashed around inside

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Speaker 1: the stomachs of dissected cadavers, and those corpses were often

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Speaker 1: less strewn about, dripping blood onto the floors where it

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Speaker 1: congealed and dried. Students and practitioners wore aprons that had

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Speaker 1: been passed down to them by professor and former staff,

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Speaker 1: which had never been washed. In fact, they were worn

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Speaker 1: as badges of honor. And hey, if I've captivated you

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Speaker 1: thus far, and maybe even ruined your breakfast, then there's

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Speaker 1: one more surgeon you just have to meet, because he

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Speaker 1: so very infamously cemented himself into the history books for

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Speaker 1: reasons you might find hard to believe. Robert Liston walked

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Speaker 1: into the operating room, flanked by his assistance. He was

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Speaker 1: an imposing fellow, his apron starched with blood and tissue.

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Speaker 1: He was a vision, part angel and part butcher, with

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Speaker 1: the skills of both. Pulling up next to the operating table,

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Speaker 1: he looked at his audience. Time me, gentlemen, he said,

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Speaker 1: time me. Then he made a cut. Screams filled the theater,

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Speaker 1: and everyone looked on in wrapped fascination. If history remembers

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Speaker 1: the fastest gun in the West, it could certainly remember

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Speaker 1: the fastest knife. With a custom made amputation fourteen inches

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Speaker 1: long and one and a quarter inches wide, Robert's amputation

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Speaker 1: knife was also one of the sharpest. While his emphasis

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Speaker 1: on speed may strike you was a bit reckless, it

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Speaker 1: was an appreciated skill. His work, which also happened to

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Speaker 1: be highly accurate, gave patients peace of mind at a

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Speaker 1: time when anesthesia didn't exist. The shorter, the suffering, the better.

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Speaker 1: Standing At an imposing six foot two inches tall, Robert

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Speaker 1: was a full eight inches taller than the average Brits

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Speaker 1: of his day. He was brutish and abrasive, vain and bombastic,

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Speaker 1: but he was always charitable to the poor and warm

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Speaker 1: to his sick patients. He was one of the very

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Speaker 1: best surgeons of his time, with only about one in

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Speaker 1: ten patients dying on his table. Nearby hospitals weren't as lucky,

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Speaker 1: with a mortality rate of about one in four cases.

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Speaker 1: But although his patients came willingly, it doesn't mean that

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Speaker 1: they stayed happily. The unlucky or lucky, depending on how

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Speaker 1: you think about it, were often strapped to blood encrusted

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Speaker 1: operating tables, held down by attendance, and over with agony.

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Speaker 1: He could amputate limbs in just a few strokes in

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Speaker 1: less than a minute. The hope was that the pain

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Speaker 1: he caused his patients would only be a temporary state,

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Speaker 1: and that they would go on to live functional lives.

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Speaker 1: Until the eighteen forties, surgical practice remained a superficial art.

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Speaker 1: Little could be done deep inside the body's cavities. As

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Speaker 1: we've seen, surgery carried a lot of risks, even as

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Speaker 1: it became a relatively more commonplace part of medicine. Robert Liston, though,

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Speaker 1: would prove to be a cut above the rest. As

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Speaker 1: a young man, he had come to London to study

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Speaker 1: surgery and anatomy, before bouncing between the city and Edinburgh, Scotland.

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Speaker 1: He was brilliant and provocative, prone to disagreements that severed

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Speaker 1: professional relationships and made him rather insufferable to work with.

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Speaker 1: Even so, he was ahead of his time. He found

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Speaker 1: hospital conditions to be deplorable, and in a time before

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Speaker 1: germ theory worked toward cleanliness, he was adamant about clean

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Speaker 1: simple bandage, dressings and washing sponges and surgical tools. He

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Speaker 1: had returned to London in eighteen thirty for as an

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Speaker 1: instructor at one of the new teaching hospitals, playing a

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Speaker 1: major role in the transformation of surgery into a modern specialty.

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Speaker 1: His staff was small and money was thin, but here

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Speaker 1: he saw the opportunity before him. Because medical specialties didn't

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Speaker 1: exist yet, Robert did it all. He set fractures and

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Speaker 1: did facial reconstructions, performed amputations and removed tumors. He could

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Speaker 1: use his bare hands as a tourniquet. He invented tools

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Speaker 1: that we still use today, and he carried his knife

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Speaker 1: up his sleeve to always keep it warm. His trademark speed, though,

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Speaker 1: sometimes came at a price. As the legend goes, there

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Speaker 1: was one surgery that, for all of his successes, Robert's

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00:16:40,880 --> 00:16:43,960
Speaker 1: celebrity hasn't been able to live down. Whether it's true

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Speaker 1: or not depends on the sources you consult and the

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00:16:46,400 --> 00:16:50,080
Speaker 1: people you ask as primary source. Documents couldn't be turned up,

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Speaker 1: but it's a good story, so I'm going to tell

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00:16:52,400 --> 00:16:55,080
Speaker 1: it to you anyway. Like any other day in the office,

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Speaker 1: Robert don his starched and sticky surgical garb and set

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Speaker 1: out to conduct a leg amputation. Famously, he once amputated

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Speaker 1: a young boy's leg with an easy six strokes, so

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00:17:05,440 --> 00:17:09,280
Speaker 1: this shouldn't have proven to be a difficult case. But somewhere, somehow,

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Speaker 1: things went fatally wrong. In the midst of the surgical spectacle,

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00:17:13,960 --> 00:17:17,520
Speaker 1: someone moved carelessly with his blade. He sliced off the

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Speaker 1: fingers of his surgical assistant and then went on to

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Speaker 1: cut off a spectator's coattails. It said that neither the

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Speaker 1: patient nor the assistant fared well, and both soon died

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Speaker 1: from infection. And while coattails being cut isn't a fatal injury,

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00:17:32,080 --> 00:17:34,479
Speaker 1: the spectator is said to have died from shock from

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00:17:34,520 --> 00:17:38,080
Speaker 1: the whole incident, earning list in the ignoble achievement of

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00:17:38,160 --> 00:17:41,840
Speaker 1: performing a single surgical procedure with a three hundred percent

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00:17:42,000 --> 00:17:45,520
Speaker 1: mortality rate. Now, of course, why someone would make up

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00:17:45,600 --> 00:17:48,439
Speaker 1: this story, if it indeed isn't true, is something to

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00:17:48,480 --> 00:17:53,400
Speaker 1: wonder about. His professional peers simultaneously loathed and admired him,

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00:17:53,640 --> 00:17:56,639
Speaker 1: and his students adored him. But in many ways he

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00:17:56,680 --> 00:17:59,760
Speaker 1: seemed larger than life in both his stature and his

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Speaker 1: contributions to his community. So I guess it would make

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Speaker 1: sense that a bit of mythology was bound to take

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Speaker 1: roots about him. One thing that I think we can

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00:18:08,160 --> 00:18:10,720
Speaker 1: all agree on, though, is that we're all pretty fortunate

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Speaker 1: that we'll never have to meet him in the operating

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Speaker 1: theater and find out if it's true for ourselves. Robert

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00:18:23,960 --> 00:18:26,760
Speaker 1: Liston brought speed to the surgical tables at a time

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Speaker 1: when that skill was paramount, But soon there would be

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00:18:29,800 --> 00:18:34,399
Speaker 1: something else that would usurp its, rendering his trademark clip unnecessary.

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Speaker 1: For thousands of years, up until this point, we had

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Speaker 1: been working through gradual stages to arrive at a place

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Speaker 1: where surgery could be both safe and painless. First we

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00:18:43,720 --> 00:18:46,199
Speaker 1: had to understand the body's anatomy. Then we had to

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Speaker 1: learn to control bleeding. A third point arrived around eighteen

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Speaker 1: forty six, when we learned to control consciousness. Anesthesia had

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Speaker 1: arrived in Europe under Robert's watch. As history tells us,

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Speaker 1: the winter of eighteen forty six brought with it a

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Speaker 1: patient by the name of Frederick Churchill. After many years

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00:19:02,680 --> 00:19:06,320
Speaker 1: of bouncing from physician to physician looking for cure after cure,

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00:19:06,600 --> 00:19:08,679
Speaker 1: it became obvious to all that the only thing to

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00:19:08,720 --> 00:19:11,800
Speaker 1: do for his knee pain was to remove the limb entirely.

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Speaker 1: He lay in Robert's candlelit operating room, surely aware of

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Speaker 1: the spectacle that was about to befall the audience, then

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Speaker 1: the starring role that he had at center stage. But

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00:19:21,640 --> 00:19:24,840
Speaker 1: when Robert walked in, he brandished only an empty looking

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00:19:24,920 --> 00:19:27,520
Speaker 1: jar and a whole lot of bravado. He held it

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00:19:27,600 --> 00:19:29,520
Speaker 1: up to the audience and announced that he was going

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00:19:29,560 --> 00:19:33,399
Speaker 1: to use ether to make his patient insensible. The idea

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00:19:33,480 --> 00:19:36,440
Speaker 1: came to him after hearing stories about dentists in America

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00:19:36,520 --> 00:19:38,159
Speaker 1: using it, and he was going to give it a

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00:19:38,240 --> 00:19:41,040
Speaker 1: try here. And with that, Robert had the patient Frederick

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00:19:41,119 --> 00:19:43,679
Speaker 1: stick a rubber tube attached to the jar into his

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00:19:43,800 --> 00:19:47,359
Speaker 1: mouth and inhale. It took all of twenty eight seconds

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00:19:47,400 --> 00:19:50,359
Speaker 1: for Robert to slice off his leg, full minutes before

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Speaker 1: Frederick would stir again. Both the ether and the surgery

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Speaker 1: had been successful with time to spare, so successful, in fact,

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Speaker 1: that when Frederick woke up he asked when the surgery

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Speaker 1: would begin. The audience, without a doubt, was astounded. They

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00:20:05,160 --> 00:20:08,840
Speaker 1: had witnessed something new that in time would become commonplace

347
00:20:09,280 --> 00:20:12,960
Speaker 1: surgery as we had once known it had pivoted indefinitely,

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Speaker 1: all under the watchful knife of Robert Liston. It's easy

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Speaker 1: to believe, after listening to the grizzly history of surgery,

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Speaker 1: that the procedures performed often ended or severely ruined lives. Certainly,

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Speaker 1: the stories about speed surgeons like Robert Liston do a

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00:20:33,640 --> 00:20:36,240
Speaker 1: good job of making us wonder if those wielding the

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Speaker 1: knife truly had their patient's best interest in mind. But

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Speaker 1: some procedures have done more than saved lives. In fact,

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00:20:42,960 --> 00:20:46,280
Speaker 1: one saved a man's career and in the process set

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Speaker 1: him on a course to change history. And if you

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Speaker 1: stick around through this brief sponsor break my teammate Robin

358
00:20:52,160 --> 00:21:01,720
Speaker 1: Miniter will tell you all about it. Alan Shephard thought

359
00:21:01,760 --> 00:21:04,760
Speaker 1: his career was over. He was mad, he was grieving,

360
00:21:05,160 --> 00:21:06,720
Speaker 1: and he was said by some to be the most

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Speaker 1: disgruntled employee working at NASA. It hadn't always been this way, though,

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00:21:11,240 --> 00:21:13,639
Speaker 1: you see. Alan had been the first American in space.

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Speaker 1: He had been a hero, a national icon, and he

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00:21:16,680 --> 00:21:20,480
Speaker 1: was now what a paper pusher. Sitting at his desk

365
00:21:20,520 --> 00:21:23,280
Speaker 1: as the new chief of the Astronaut Office, Alan couldn't

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Speaker 1: help but feel like he was now just riding the bench.

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Speaker 1: He had been one of the original seven astronauts in

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Speaker 1: Project Mercury before he fell out of ranks. Alan had

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Speaker 1: been reassigned after was determined that he was no longer

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00:21:34,320 --> 00:21:37,399
Speaker 1: fit for flight. The problem, you see, was that Alan

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00:21:37,520 --> 00:21:40,360
Speaker 1: was found to be suffering from something called Meniere's disease,

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00:21:40,600 --> 00:21:44,359
Speaker 1: an inner ear problem that causes dysregulation and balance. It's

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Speaker 1: known to trigger spontaneous bouts of vertigo into nitis attacks,

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00:21:48,000 --> 00:21:51,320
Speaker 1: which left Alan dizzy and vomiting. You can imagine how

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00:21:51,359 --> 00:21:54,960
Speaker 1: catastrophic this might be for somebody piloting a rocket. But

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00:21:55,040 --> 00:21:56,879
Speaker 1: he had heard of a new procedure that might be

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00:21:56,920 --> 00:21:58,720
Speaker 1: able to cure him, and he found a doctor. In

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Speaker 1: early nineteen sixty he had decided to go to Los

379
00:22:01,960 --> 00:22:04,960
Speaker 1: Angeles and Chances of Surgery in the hopes of salvaging

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00:22:05,000 --> 00:22:08,560
Speaker 1: everything that he had worked for. Scientific testing to determine

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00:22:08,560 --> 00:22:10,639
Speaker 1: if a procedure is going to be effective is a

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00:22:10,680 --> 00:22:14,400
Speaker 1: pretty murky business. There's conflict between the ethics of research

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00:22:14,480 --> 00:22:18,280
Speaker 1: and the ethics of clinical practice. The former balances benefit

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00:22:18,359 --> 00:22:21,000
Speaker 1: and harm an individual level and the hopes of serving

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00:22:21,040 --> 00:22:25,200
Speaker 1: the broader good. Medicine's hippocratic oath fundamentally does not condone

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00:22:25,240 --> 00:22:28,920
Speaker 1: causing harm, however minimal it may be. The problem, then,

387
00:22:29,080 --> 00:22:31,840
Speaker 1: is that medical practitioners can't know if something is going

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00:22:31,880 --> 00:22:35,400
Speaker 1: to be effective until it's been subjected to scientific testing.

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00:22:35,920 --> 00:22:39,040
Speaker 1: And if a treatment becomes commonplace and people believe it

390
00:22:39,080 --> 00:22:42,240
Speaker 1: to be effective, the medical professionals are sometimes worried that

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00:22:42,320 --> 00:22:45,560
Speaker 1: conducting tests to see whether or not something might indeed

392
00:22:45,680 --> 00:22:50,120
Speaker 1: be effective will deny patient's potential help should it be shelved.

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00:22:50,760 --> 00:22:53,240
Speaker 1: The important thing to note here is a necessity of

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Speaker 1: belief on the part of the patient that something might

395
00:22:56,160 --> 00:22:59,520
Speaker 1: be effective. Time and time again, those in medicine have

396
00:22:59,640 --> 00:23:03,040
Speaker 1: run to what's known as the placebo effect. For whatever reason,

397
00:23:03,080 --> 00:23:05,640
Speaker 1: It's been found in double blind trials that even the

398
00:23:05,640 --> 00:23:09,360
Speaker 1: theater of pills and procedures seemed to alleviate chronic ailments.

399
00:23:09,800 --> 00:23:12,280
Speaker 1: There's a perceived effectiveness, either on the part of the

400
00:23:12,280 --> 00:23:16,400
Speaker 1: patient or their doctor that is undeniable, though it's all subjective.

401
00:23:16,880 --> 00:23:19,480
Speaker 1: Alan arrived in Los Angeles ready to be operated on.

402
00:23:20,040 --> 00:23:22,600
Speaker 1: His surgeon placed a tiny silicone tube with his ear,

403
00:23:22,720 --> 00:23:26,320
Speaker 1: allowing excess fluids to drain if need be. The surgeon's

404
00:23:26,320 --> 00:23:29,720
Speaker 1: handiwork appeared to have been just the ticket. Following the procedure,

405
00:23:29,840 --> 00:23:32,760
Speaker 1: Alan reported a full recovery and a total cure from

406
00:23:32,800 --> 00:23:35,960
Speaker 1: the mysterious Maniaire's disease that had taken him out of commission.

407
00:23:36,520 --> 00:23:38,719
Speaker 1: So he was put back on the flight team and

408
00:23:38,880 --> 00:23:41,600
Speaker 1: as the commander of the Apollo fourteen mission, he got

409
00:23:41,600 --> 00:23:45,200
Speaker 1: his flight to the Moon, but his story doesn't end there.

410
00:23:45,880 --> 00:23:49,240
Speaker 1: Years later, this procedure went to testing. It was found

411
00:23:49,400 --> 00:23:52,040
Speaker 1: not to have any kind of therapeutic benefit, but it

412
00:23:52,119 --> 00:23:56,439
Speaker 1: was still found to cure Manierre's disease. Patience. In what

413
00:23:56,640 --> 00:24:00,119
Speaker 1: is called a double blind, random placebo controlled test, a

414
00:24:00,119 --> 00:24:03,320
Speaker 1: group of patients were all operated on externally. You couldn't

415
00:24:03,320 --> 00:24:05,720
Speaker 1: discern them from one another. But over the course of

416
00:24:05,760 --> 00:24:08,119
Speaker 1: three years it was found that over two thirds of

417
00:24:08,160 --> 00:24:11,280
Speaker 1: the patients had made a complete recovery, both of those

418
00:24:11,280 --> 00:24:14,000
Speaker 1: who have the real procedure and a placebo one healed,

419
00:24:14,320 --> 00:24:18,159
Speaker 1: suggesting that the procedure is essentially meaningless. It's possible that

420
00:24:18,200 --> 00:24:20,879
Speaker 1: Alan's chair was in the belief that he would be cured.

421
00:24:21,359 --> 00:24:23,800
Speaker 1: But this is indeed a slippery slope of logic, as

422
00:24:23,840 --> 00:24:26,399
Speaker 1: one can quickly come to blame someone for being sick.

423
00:24:26,880 --> 00:24:28,879
Speaker 1: But the mind is a powerful tool, and we can

424
00:24:28,920 --> 00:24:32,640
Speaker 1: all wonder if believing is the key to healing. Perhaps

425
00:24:32,720 --> 00:24:35,680
Speaker 1: just as much as the salves and the knives, as

426
00:24:35,680 --> 00:24:38,280
Speaker 1: we've seen in prior episodes, think that we know to

427
00:24:38,320 --> 00:24:41,359
Speaker 1: be somewhat harmful, such as bloodletting, were believed to be

428
00:24:41,400 --> 00:24:45,320
Speaker 1: therapeutic by practitioners and their patients, and in the century

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Speaker 1: since leeching bellad of fashion, we've seen placebo remedies come

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Speaker 1: and go. One scholar made a great suggestion that with

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Speaker 1: every operation, the surgeon should ponder whether the patient has

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Speaker 1: been healed because of the surgery or in spite of it.

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Speaker 1: Grim and Mild Presents Bedside Manners was executive produced by

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Speaker 1: Aaron Manky and narrated by Aaron Manky and Robin Minater.

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Speaker 1: Writing for this season was provided by Robin Minater, with

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Speaker 1: research by Sam Alberty, Taylor Haggerdorn, and Robin Minater. Production

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Speaker 1: assistance was provided by Josh Thayne, Jesse Funk, Alex Williams,

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Speaker 1: and Matt Frederick. You can learn more about this show,

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Speaker 1: the Grim and Mild team, and all the other podcasts

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Speaker 1: that we make over at Grimm and miild dot com and,

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Speaker 1: as always, thanks for listening