WEBVTT - Bedside Manners 5: Slice ‘n Dice 0:00:05.160 --> 0:00:09.920 Bit by bit, teaspoon by teaspoon, the archaeologists shoveled away 0:00:09.960 --> 0:00:12.400 the dirt. Their work had taken the team to a 0:00:12.440 --> 0:00:16.280 remote region of Indonesia to a cave named Liang Tabou. 0:00:16.600 --> 0:00:20.640 The soft limestone showed evidence of human occupation, including paintings 0:00:20.640 --> 0:00:23.360 that clocked in it over forty thousand years old. The 0:00:23.440 --> 0:00:26.439 spot was a favorite for archaeologists, and they had come 0:00:26.480 --> 0:00:29.360 to look for more prehistoric signs of life, so you 0:00:29.360 --> 0:00:32.520 can imagine their excitement when they came across simple stone 0:00:32.560 --> 0:00:35.400 markers on the ground of the cave's largest chamber. They 0:00:35.400 --> 0:00:38.960 had an idea about what this might be, and slowly, methodically, 0:00:38.960 --> 0:00:42.560 and meticulously began to upturn the earth. At almost five 0:00:42.560 --> 0:00:47.040 feet down, they found it an ancient grave. The skeleton 0:00:47.080 --> 0:00:49.800 appeared to be a young person around twenty years old. 0:00:49.960 --> 0:00:53.720 It was almost fully intact. Almost finding bones in the 0:00:53.760 --> 0:00:56.880 ground isn't, in principle uncommon, but there were many things 0:00:56.880 --> 0:01:01.120 that made this find spectacular. Archaeologist determined that this person 0:01:01.160 --> 0:01:04.040 died over thirty thousand years ago. The age of the 0:01:04.080 --> 0:01:07.840 skeleton and its intentional burial felt astonishing to them. It 0:01:07.920 --> 0:01:10.240 was one of the oldest examples of this ever found. 0:01:10.600 --> 0:01:13.480 The skeleton was missing its foot, but they found no 0:01:13.560 --> 0:01:17.080 evidence of infection nor blunt force trauma on its own. 0:01:17.160 --> 0:01:20.080 This might not seem very spectacular, but the team discovered 0:01:20.120 --> 0:01:22.080 something that made this not just a grape vine but 0:01:22.200 --> 0:01:25.840 a revolutionary one. You see, there was a considerable amount 0:01:25.880 --> 0:01:30.080 of new bone growth evidence of healing. This and the 0:01:30.200 --> 0:01:32.840 meticulous intentional way in which the bones seemed to have 0:01:32.880 --> 0:01:35.880 been removed led archaeologists to conclude that this limb had 0:01:35.880 --> 0:01:40.200 been deliberately surgically amputated, making this the oldest evidence of 0:01:40.240 --> 0:01:44.880 ancient surgery ever discovered. Scholars have long assumed that prehistoric 0:01:44.920 --> 0:01:50.280 societies had very basic surgical skills. We've found evidence of dentistry, suturine, 0:01:50.320 --> 0:01:53.920 and cranial trepination, among other things, but evidence of a 0:01:54.040 --> 0:01:58.640 complete and successful amputation suggests something else. That these people 0:01:58.680 --> 0:02:02.920 had well developed knowledge of anatomy, vascular systems, and remedies 0:02:02.920 --> 0:02:06.040 for infection. They knew how to stave off further harm 0:02:06.080 --> 0:02:09.480 to the body, and continued care in the postoperative time. 0:02:09.960 --> 0:02:12.880 The long standing assumption has been that surgical knowledge and 0:02:12.919 --> 0:02:16.600 technology really only developed after humans began to shift from 0:02:16.639 --> 0:02:20.079 hunting and foraging to farming. A pivot that began around 0:02:20.080 --> 0:02:23.720 ten thousand years ago. The discovery of a successful amputation 0:02:23.800 --> 0:02:26.519 from over thirty thousand years ago, in which the patient 0:02:26.560 --> 0:02:28.480 not only didn't die, but went on to live for 0:02:28.560 --> 0:02:33.359 many years afterwards, completely changes how surgical knowledge and processes 0:02:33.560 --> 0:02:36.120 are thought to have developed and places them in a 0:02:36.200 --> 0:02:39.960 much earlier period. Have we ever originally thought? If you 0:02:40.000 --> 0:02:43.160 think about the past one hundred years, our medical technology 0:02:43.200 --> 0:02:46.040 has evolved at a staggering pace. We hope for the 0:02:46.080 --> 0:02:48.600 best at hospitals and can often trust that we might 0:02:48.680 --> 0:02:52.240 leave there better than when we arrived. We revere doctors 0:02:52.240 --> 0:02:55.880 in white coats and defer to their best judgment and dexterous, 0:02:55.919 --> 0:02:59.280 steady hands. Many of us only have the vaguest idea 0:02:59.320 --> 0:03:01.799 of what goes on inside of our bodies and how 0:03:01.800 --> 0:03:04.720 all of the puzzle pieces are put together. We hope 0:03:04.760 --> 0:03:06.760 that they have a better idea than we do, but 0:03:07.120 --> 0:03:10.720 they haven't always. In fact, surgical amputation only became a 0:03:10.800 --> 0:03:14.519 norm within the last century. At one time, amputation would 0:03:14.560 --> 0:03:17.800 be done as a last ditch effort to save someone's life. 0:03:17.840 --> 0:03:21.240 While it might and often did kill a patient, they 0:03:21.280 --> 0:03:24.080 most certainly would die if the offensive body part was 0:03:24.160 --> 0:03:27.400 left intact. The history of surgery is a long and 0:03:27.520 --> 0:03:31.560 fascinating one, chuck full of curiosity and ham fisted cleaverers. 0:03:31.840 --> 0:03:35.680 It's been misguided at times and totally astonishing in others, 0:03:36.040 --> 0:03:40.720 and with plenty of bloodshed along the way. I'm Aaron Manky, 0:03:41.280 --> 0:03:51.120 and welcome to bedside Manners. You've heard me say this before, 0:03:51.280 --> 0:03:55.080 but I'll say it once again. Archaeology isn't an exact science. 0:03:55.360 --> 0:03:58.520 It's a discipline of best guesses. A field filled with 0:03:58.560 --> 0:04:02.680 detectives covered in dirt figuratively a field, but also sometimes 0:04:02.720 --> 0:04:06.360 literally in a field. Before the twenty twenty two discovery 0:04:06.360 --> 0:04:09.840 in Indonesia, some of the oldest surgical discoveries were believed 0:04:09.840 --> 0:04:12.280 to have come from about ten thousand years ago. The 0:04:12.480 --> 0:04:15.360 Neolithic period, as it was known, was the time period 0:04:15.360 --> 0:04:18.080 in which humans began to take up farming. When people 0:04:18.120 --> 0:04:20.560 did this, they also started to store their dead and 0:04:20.640 --> 0:04:23.800 shared locations. Burying our dead is one of the oldest 0:04:23.839 --> 0:04:26.520 expressions of our humanity, and we've been at it for 0:04:26.560 --> 0:04:30.680 over one hundred thirty thousand years. As ancient people created communities, 0:04:30.800 --> 0:04:33.760 they created burial sites too, and it's in these burial 0:04:33.800 --> 0:04:37.400 sites across the globe that archaeologists have found over fifteen 0:04:37.480 --> 0:04:40.760 hundred skulls that bear evidence of trefination, the act of 0:04:40.839 --> 0:04:43.400 drilling a hole into the skull of a living person 0:04:43.680 --> 0:04:46.479 in the hopes of curing sickness. There is a chance 0:04:46.560 --> 0:04:49.159 that this practice existed far before these people lived, but 0:04:49.279 --> 0:04:52.520 we can imagine that the intentional placement and preservation of 0:04:52.560 --> 0:04:55.280 these bodies had something to do with our ability to 0:04:55.320 --> 0:04:58.760 make this discovery. The question, though, is why, and the 0:04:58.800 --> 0:05:02.680 truth is will probably never know, but one guess is that, 0:05:02.760 --> 0:05:05.039 like a lot of medicine up until the past few 0:05:05.120 --> 0:05:09.719 hundred years, healing and spirituality were deeply intertwined. Were these 0:05:09.760 --> 0:05:13.680 ancient neurosurgeons trying to relieve patients of physical symptoms such 0:05:13.680 --> 0:05:16.719 as headaches or seizures, or to provide an escape hatch 0:05:16.760 --> 0:05:19.480 for voices and demons that may have affected the person. 0:05:20.000 --> 0:05:21.960 What we do know is that these people went on 0:05:22.040 --> 0:05:26.080 to live hopefully healed, as evidenced by bone regrowth. And 0:05:26.200 --> 0:05:29.440 we know too that Neolithic surgeons were operating on head 0:05:29.480 --> 0:05:34.520 injuries and seemingly successfully at times. As civilizations developed thousands 0:05:34.560 --> 0:05:38.240 of years later, Babylon, Egypt, China, and Greece among them, 0:05:38.520 --> 0:05:41.159 the great thinkers across the ancient world tried their hands 0:05:41.160 --> 0:05:44.039 at understanding what it meant to be a healer and 0:05:44.120 --> 0:05:47.680 how that's squared with cutting into the body. Different social 0:05:47.760 --> 0:05:52.479 mores across cultures dictated what was allowable For thousands of years. 0:05:52.720 --> 0:05:56.160 Health and healing were directly tied to these supernatural in 0:05:56.240 --> 0:05:59.479 some ways, and in some places it still is. Before 0:05:59.520 --> 0:06:02.440 the advent of modern science and medicine, humans believe that 0:06:02.480 --> 0:06:05.680 sickness was caused by unseen forces, and they were kind 0:06:05.680 --> 0:06:08.320 of right. But it wasn't the invisible spirits they had 0:06:08.320 --> 0:06:12.359 to fear, but microscopic germs invisible to the naked eye. 0:06:12.760 --> 0:06:15.120 It was the ancient Egyptians who first peered into the 0:06:15.200 --> 0:06:17.640 human skull with the idea that it was the brain 0:06:17.720 --> 0:06:20.280 that was the command center of the body. They were 0:06:20.360 --> 0:06:23.680 right far before anyone else was. But not everyone was 0:06:23.720 --> 0:06:27.520 so gung ho as they were about internal investigations. In 0:06:27.600 --> 0:06:31.240 ancient China and Greece, religious and spiritual beliefs dictated that 0:06:31.279 --> 0:06:33.720 the body was sacred, and as you learned in our 0:06:33.720 --> 0:06:37.719 previous episodes, human dissection was outlawed for a very long time. 0:06:38.040 --> 0:06:40.960 In fact, the original Hippocratic oath, which is still taken 0:06:41.000 --> 0:06:45.279 by doctors today, specifically forbade them from cutting. It said, 0:06:45.480 --> 0:06:48.560 and I quote, I will not use a knife, not 0:06:48.680 --> 0:06:52.320 even on sufferers from stone, but will withdraw in favor 0:06:52.360 --> 0:06:55.839 of such men as are engaged in this work. The Oath, 0:06:55.880 --> 0:06:58.839 of course, also set out to create two distinct classes 0:06:58.839 --> 0:07:03.599 of healers, sally physicians and tradesman surgeons. Following the rise 0:07:03.600 --> 0:07:06.240 of the Roman Empire, Greek healers and their knowledge were 0:07:06.240 --> 0:07:11.360 absorbed into the social fabric. Hippocratic beliefs spread throughout the territory, 0:07:11.520 --> 0:07:16.080 and the demand for care often outpaced supply. Interestingly, it's 0:07:16.200 --> 0:07:18.760 here that we saw more and more enslaved people and 0:07:18.880 --> 0:07:23.720 servants take on more surgical responsibilities for their households and communities. 0:07:24.040 --> 0:07:27.000 The physician Galen, who wrote a great deal about anatomy 0:07:27.040 --> 0:07:30.880 and surgical procedures, likely never performed or even witnessed the 0:07:30.960 --> 0:07:33.920 dissection of a human because of the Roman outlaw of 0:07:33.960 --> 0:07:37.760 the practice. However, he had been a surgeon to gladiators, 0:07:37.760 --> 0:07:40.720 where spilled blood and guts were all in a day's work. 0:07:41.120 --> 0:07:43.840 Most of his surgical knowledge, though, was just based on 0:07:43.960 --> 0:07:47.200 animal dissection, which could only help so much when it 0:07:47.240 --> 0:07:50.080 came to understanding the human body, he became the leading 0:07:50.120 --> 0:07:53.040 authority on the matter. But what he didn't understand he 0:07:53.200 --> 0:07:56.200 made up, If you'll pardon the pun, he took a 0:07:56.280 --> 0:07:58.880 stab at it with best guesses as to how the 0:07:58.960 --> 0:08:01.920 human body worked. And yet his word was taken as 0:08:01.960 --> 0:08:05.880 fact for a very long time, until sensibility shifted into 0:08:05.960 --> 0:08:09.720 a place where intentional slicing was not only acceptable but 0:08:09.840 --> 0:08:20.640 absolutely necessary in moving knowledge forward. King Louis the fourteenth 0:08:20.720 --> 0:08:23.760 would meet a bad end, but November eighteenth of sixteen 0:08:23.760 --> 0:08:26.640 eighty six wasn't going to be that day. That said, 0:08:26.720 --> 0:08:28.880 he was certainly in for a bit of suffering due 0:08:28.920 --> 0:08:32.800 to his well his other bad end. By early morning 0:08:32.840 --> 0:08:36.040 of that day, our king was flanked by his closest advisers, 0:08:36.040 --> 0:08:39.920 faced down, prostrate and pantless in bed. His people held 0:08:39.960 --> 0:08:42.920 his legs apart and firmly to the bed. As Charles 0:08:42.920 --> 0:08:47.360 Francois Felix began, the king was suffering from an anal fistula. 0:08:47.679 --> 0:08:51.760 For months. He had tried lansings and laxatives, leeches and irons, 0:08:51.960 --> 0:08:55.160 but no physician could relieve the king's suffering, and by 0:08:55.160 --> 0:08:57.719 the spring of that year he was growing desperate. So 0:08:57.800 --> 0:09:01.920 he called for a surgeon. Louis summoned Charles Francois and 0:09:02.040 --> 0:09:05.080 pleaded for help. But knowing that one wrong step or 0:09:05.400 --> 0:09:08.679 slice could mean the end of Charles Francois's career and 0:09:08.800 --> 0:09:12.040 possibly the end of him, the surgeon implored the king 0:09:12.080 --> 0:09:13.800 to give him a few more months of time to 0:09:13.800 --> 0:09:16.760 study and figure out a way to help his condition. So, 0:09:16.800 --> 0:09:20.000 with a deep breath and probably a few prayers, Charles 0:09:20.000 --> 0:09:24.360 Francois took his special made metal protractor, his knife shaped 0:09:24.400 --> 0:09:27.040 like a scythe, and got to work in the candlelight, 0:09:27.600 --> 0:09:30.960 without any antiseptic and without any pain relief. The king 0:09:31.080 --> 0:09:34.680 soldiered on through the morning. By lunchtime, the operation was over, 0:09:35.040 --> 0:09:38.160 and you know what, it was a success. And with 0:09:38.240 --> 0:09:41.200 that the new year of sixteen eighty six was deemed 0:09:41.400 --> 0:09:44.640 the year of the Fistula by the crown. He filled 0:09:44.760 --> 0:09:47.960 fountains with wine and saying his own praises of bravery 0:09:48.040 --> 0:09:51.439 in the face of adversity. The king rewarded Charles Francois 0:09:51.480 --> 0:09:54.280 with a heavy sum of francs and a large estate, 0:09:54.559 --> 0:09:57.400 making him a celebrity in his own right. In a 0:09:57.640 --> 0:10:02.160 strange twist, the surgery became somew fashionable, with folks clamoring 0:10:02.200 --> 0:10:04.640 for a cure when there was no problem to begin with. 0:10:05.120 --> 0:10:07.760 This moment helped to change the public's view of surgeons. 0:10:08.000 --> 0:10:11.800 In the collective imaginations, they evolved from simple tradesmen to 0:10:11.960 --> 0:10:15.719 skillful healers. As you've heard by now, barber surgeons were 0:10:15.720 --> 0:10:20.240 long considered to be well barbarous, knife wielders and blood letters. 0:10:20.360 --> 0:10:24.199 They occupied a distinctly different social space than the refined 0:10:24.240 --> 0:10:27.920 minds of the academy. Their job meant getting down and dirty, 0:10:28.040 --> 0:10:31.360 while the physicians preferred to look but not touch. In 0:10:31.400 --> 0:10:34.520 the Middle Ages, there were various attempts to unify physicians 0:10:34.520 --> 0:10:37.840 and surgeons and have them work together rather than in opposition, 0:10:38.200 --> 0:10:41.320 but as you can imagine, this was sometimes a fraud endeavor. 0:10:41.880 --> 0:10:44.600 With the Renaissance came a turn in the story for surgeons, 0:10:44.800 --> 0:10:48.000 as they finally moved into positions of respectability within the 0:10:48.040 --> 0:10:51.240 healing business. They were starting to be viewed as innovators, 0:10:51.400 --> 0:10:54.880 not quacks or buffoons. They held sharp clinical skills and 0:10:54.960 --> 0:10:58.480 an understanding of the body's interior geography based on hands 0:10:58.520 --> 0:11:02.640 on experience and observation rather than just old theories. By 0:11:02.640 --> 0:11:06.000 the eighteen hundreds, London and Paris had become the epicenters 0:11:06.040 --> 0:11:10.400 of surgical development, serving both the needs of science and entertainments. 0:11:10.720 --> 0:11:12.760 I've been at this for a good number of years, 0:11:12.800 --> 0:11:16.079 and I've read my fair share about the Victorian culture. 0:11:16.320 --> 0:11:18.720 But one of the most striking discoveries that one makes 0:11:18.760 --> 0:11:22.199 when reading into their history is their love of the macabre. 0:11:22.679 --> 0:11:25.120 For example, this was the time when crime scenes, the 0:11:25.200 --> 0:11:29.520 ghastlier the better, became tourist attractions. True crime stories became 0:11:29.559 --> 0:11:32.240 all the rage. People wanted to look but not touch. 0:11:32.400 --> 0:11:34.640 They wanted to step close to danger and be able 0:11:34.679 --> 0:11:37.400 to walk away. It's not that different from the way 0:11:37.400 --> 0:11:40.880 that we still experience true horror podcasts and scary movies. 0:11:41.200 --> 0:11:45.720 It's voyeurism. It's safe, and to them, these surgical procedures, 0:11:45.720 --> 0:11:49.800 often bloody and grotesque, didn't look much different than crime scenes. 0:11:50.160 --> 0:11:53.440 Public operations and dissections became not just the means by 0:11:53.480 --> 0:11:56.280 which a budding surgeon could learn new skills, but they 0:11:56.320 --> 0:11:59.240 also doubled as entertainment for folks who headed out for 0:11:59.280 --> 0:12:03.000 a night on the public operating theaters where bodies were 0:12:03.040 --> 0:12:06.560 center stage were happy to take their money. Even into 0:12:06.600 --> 0:12:10.000 the mid nineteenth century, invasive surgeries were very rare and 0:12:10.320 --> 0:12:13.840 very risky. They were generally avoided except as an absolute 0:12:13.920 --> 0:12:17.200 last resort, So people came to catch a glimpse of 0:12:17.200 --> 0:12:19.760 these rare events when they could, sort of like when 0:12:19.800 --> 0:12:22.040 the circus might come to town, a once in a 0:12:22.040 --> 0:12:26.200 while event, a spectacle ripe for public consumption. But hey, 0:12:26.240 --> 0:12:28.640 if that isn't morbid enough, let me remind you that 0:12:28.720 --> 0:12:32.640 hospitals were known as houses of death. Think mushrooms and 0:12:32.720 --> 0:12:36.320 maggots in the bedsheets, wailing in the hallways, and rodents 0:12:36.440 --> 0:12:40.479 nibbling on discarded limbs. They were fetid and squalid places, 0:12:40.480 --> 0:12:43.560 filled with the lingering stench of blood, custs, and the 0:12:43.720 --> 0:12:47.640 undigested food and fecal matter that still slashed around inside 0:12:47.640 --> 0:12:51.199 the stomachs of dissected cadavers, and those corpses were often 0:12:51.280 --> 0:12:54.280 less strewn about, dripping blood onto the floors where it 0:12:54.360 --> 0:12:58.280 congealed and dried. Students and practitioners wore aprons that had 0:12:58.280 --> 0:13:01.000 been passed down to them by professor and former staff, 0:13:01.080 --> 0:13:03.959 which had never been washed. In fact, they were worn 0:13:04.040 --> 0:13:07.440 as badges of honor. And hey, if I've captivated you 0:13:07.480 --> 0:13:10.520 thus far, and maybe even ruined your breakfast, then there's 0:13:10.559 --> 0:13:13.080 one more surgeon you just have to meet, because he 0:13:13.200 --> 0:13:16.920 so very infamously cemented himself into the history books for 0:13:17.000 --> 0:13:28.920 reasons you might find hard to believe. Robert Liston walked 0:13:28.960 --> 0:13:32.440 into the operating room, flanked by his assistance. He was 0:13:32.480 --> 0:13:36.040 an imposing fellow, his apron starched with blood and tissue. 0:13:36.400 --> 0:13:39.560 He was a vision, part angel and part butcher, with 0:13:39.600 --> 0:13:42.800 the skills of both. Pulling up next to the operating table, 0:13:42.840 --> 0:13:45.720 he looked at his audience. Time me, gentlemen, he said, 0:13:46.040 --> 0:13:50.040 time me. Then he made a cut. Screams filled the theater, 0:13:50.120 --> 0:13:54.080 and everyone looked on in wrapped fascination. If history remembers 0:13:54.080 --> 0:13:56.800 the fastest gun in the West, it could certainly remember 0:13:56.920 --> 0:14:01.160 the fastest knife. With a custom made amputation fourteen inches 0:14:01.240 --> 0:14:04.719 long and one and a quarter inches wide, Robert's amputation 0:14:04.800 --> 0:14:08.160 knife was also one of the sharpest. While his emphasis 0:14:08.200 --> 0:14:10.960 on speed may strike you was a bit reckless, it 0:14:11.040 --> 0:14:14.280 was an appreciated skill. His work, which also happened to 0:14:14.280 --> 0:14:17.199 be highly accurate, gave patients peace of mind at a 0:14:17.240 --> 0:14:21.480 time when anesthesia didn't exist. The shorter, the suffering, the better. 0:14:22.080 --> 0:14:25.320 Standing At an imposing six foot two inches tall, Robert 0:14:25.400 --> 0:14:27.760 was a full eight inches taller than the average Brits 0:14:27.760 --> 0:14:31.960 of his day. He was brutish and abrasive, vain and bombastic, 0:14:32.320 --> 0:14:35.000 but he was always charitable to the poor and warm 0:14:35.040 --> 0:14:37.160 to his sick patients. He was one of the very 0:14:37.200 --> 0:14:40.000 best surgeons of his time, with only about one in 0:14:40.080 --> 0:14:43.840 ten patients dying on his table. Nearby hospitals weren't as lucky, 0:14:44.000 --> 0:14:46.920 with a mortality rate of about one in four cases. 0:14:47.320 --> 0:14:49.960 But although his patients came willingly, it doesn't mean that 0:14:50.000 --> 0:14:53.880 they stayed happily. The unlucky or lucky, depending on how 0:14:53.920 --> 0:14:56.880 you think about it, were often strapped to blood encrusted 0:14:56.920 --> 0:15:00.920 operating tables, held down by attendance, and over with agony. 0:15:01.160 --> 0:15:03.960 He could amputate limbs in just a few strokes in 0:15:04.040 --> 0:15:06.160 less than a minute. The hope was that the pain 0:15:06.240 --> 0:15:09.160 he caused his patients would only be a temporary state, 0:15:09.360 --> 0:15:11.680 and that they would go on to live functional lives. 0:15:12.160 --> 0:15:16.080 Until the eighteen forties, surgical practice remained a superficial art. 0:15:16.360 --> 0:15:19.480 Little could be done deep inside the body's cavities. As 0:15:19.560 --> 0:15:22.720 we've seen, surgery carried a lot of risks, even as 0:15:22.800 --> 0:15:27.200 it became a relatively more commonplace part of medicine. Robert Liston, though, 0:15:27.320 --> 0:15:30.120 would prove to be a cut above the rest. As 0:15:30.120 --> 0:15:32.040 a young man, he had come to London to study 0:15:32.040 --> 0:15:36.040 surgery and anatomy, before bouncing between the city and Edinburgh, Scotland. 0:15:36.240 --> 0:15:40.080 He was brilliant and provocative, prone to disagreements that severed 0:15:40.120 --> 0:15:43.600 professional relationships and made him rather insufferable to work with. 0:15:43.920 --> 0:15:46.720 Even so, he was ahead of his time. He found 0:15:46.760 --> 0:15:49.760 hospital conditions to be deplorable, and in a time before 0:15:49.840 --> 0:15:53.560 germ theory worked toward cleanliness, he was adamant about clean 0:15:53.680 --> 0:15:57.920 simple bandage, dressings and washing sponges and surgical tools. He 0:15:57.960 --> 0:16:00.560 had returned to London in eighteen thirty for as an 0:16:00.600 --> 0:16:03.560 instructor at one of the new teaching hospitals, playing a 0:16:03.600 --> 0:16:07.360 major role in the transformation of surgery into a modern specialty. 0:16:07.800 --> 0:16:10.800 His staff was small and money was thin, but here 0:16:11.120 --> 0:16:15.000 he saw the opportunity before him. Because medical specialties didn't 0:16:15.040 --> 0:16:18.440 exist yet, Robert did it all. He set fractures and 0:16:18.480 --> 0:16:23.680 did facial reconstructions, performed amputations and removed tumors. He could 0:16:23.760 --> 0:16:27.200 use his bare hands as a tourniquet. He invented tools 0:16:27.200 --> 0:16:30.000 that we still use today, and he carried his knife 0:16:30.080 --> 0:16:34.040 up his sleeve to always keep it warm. His trademark speed, though, 0:16:34.240 --> 0:16:37.240 sometimes came at a price. As the legend goes, there 0:16:37.320 --> 0:16:40.880 was one surgery that, for all of his successes, Robert's 0:16:40.880 --> 0:16:43.960 celebrity hasn't been able to live down. Whether it's true 0:16:44.040 --> 0:16:46.360 or not depends on the sources you consult and the 0:16:46.400 --> 0:16:50.080 people you ask as primary source. Documents couldn't be turned up, 0:16:50.240 --> 0:16:52.360 but it's a good story, so I'm going to tell 0:16:52.400 --> 0:16:55.080 it to you anyway. Like any other day in the office, 0:16:55.360 --> 0:16:58.760 Robert don his starched and sticky surgical garb and set 0:16:58.760 --> 0:17:02.600 out to conduct a leg amputation. Famously, he once amputated 0:17:02.600 --> 0:17:05.359 a young boy's leg with an easy six strokes, so 0:17:05.440 --> 0:17:09.280 this shouldn't have proven to be a difficult case. But somewhere, somehow, 0:17:09.760 --> 0:17:13.600 things went fatally wrong. In the midst of the surgical spectacle, 0:17:13.960 --> 0:17:17.520 someone moved carelessly with his blade. He sliced off the 0:17:17.560 --> 0:17:20.280 fingers of his surgical assistant and then went on to 0:17:20.320 --> 0:17:23.520 cut off a spectator's coattails. It said that neither the 0:17:23.560 --> 0:17:27.080 patient nor the assistant fared well, and both soon died 0:17:27.240 --> 0:17:31.800 from infection. And while coattails being cut isn't a fatal injury, 0:17:32.080 --> 0:17:34.479 the spectator is said to have died from shock from 0:17:34.520 --> 0:17:38.080 the whole incident, earning list in the ignoble achievement of 0:17:38.160 --> 0:17:41.840 performing a single surgical procedure with a three hundred percent 0:17:42.000 --> 0:17:45.520 mortality rate. Now, of course, why someone would make up 0:17:45.600 --> 0:17:48.439 this story, if it indeed isn't true, is something to 0:17:48.480 --> 0:17:53.400 wonder about. His professional peers simultaneously loathed and admired him, 0:17:53.640 --> 0:17:56.639 and his students adored him. But in many ways he 0:17:56.680 --> 0:17:59.760 seemed larger than life in both his stature and his 0:17:59.800 --> 0:18:03.160 contributions to his community. So I guess it would make 0:18:03.200 --> 0:18:05.560 sense that a bit of mythology was bound to take 0:18:05.640 --> 0:18:08.120 roots about him. One thing that I think we can 0:18:08.160 --> 0:18:10.720 all agree on, though, is that we're all pretty fortunate 0:18:10.840 --> 0:18:13.359 that we'll never have to meet him in the operating 0:18:13.440 --> 0:18:23.919 theater and find out if it's true for ourselves. Robert 0:18:23.960 --> 0:18:26.760 Liston brought speed to the surgical tables at a time 0:18:26.840 --> 0:18:29.760 when that skill was paramount, But soon there would be 0:18:29.800 --> 0:18:34.399 something else that would usurp its, rendering his trademark clip unnecessary. 0:18:34.760 --> 0:18:37.239 For thousands of years, up until this point, we had 0:18:37.280 --> 0:18:40.040 been working through gradual stages to arrive at a place 0:18:40.080 --> 0:18:43.679 where surgery could be both safe and painless. First we 0:18:43.720 --> 0:18:46.199 had to understand the body's anatomy. Then we had to 0:18:46.240 --> 0:18:49.439 learn to control bleeding. A third point arrived around eighteen 0:18:49.520 --> 0:18:53.320 forty six, when we learned to control consciousness. Anesthesia had 0:18:53.400 --> 0:18:57.040 arrived in Europe under Robert's watch. As history tells us, 0:18:57.240 --> 0:18:59.560 the winter of eighteen forty six brought with it a 0:18:59.640 --> 0:19:02.680 patient by the name of Frederick Churchill. After many years 0:19:02.680 --> 0:19:06.320 of bouncing from physician to physician looking for cure after cure, 0:19:06.600 --> 0:19:08.679 it became obvious to all that the only thing to 0:19:08.720 --> 0:19:11.800 do for his knee pain was to remove the limb entirely. 0:19:12.040 --> 0:19:15.560 He lay in Robert's candlelit operating room, surely aware of 0:19:15.600 --> 0:19:18.320 the spectacle that was about to befall the audience, then 0:19:18.400 --> 0:19:21.560 the starring role that he had at center stage. But 0:19:21.640 --> 0:19:24.840 when Robert walked in, he brandished only an empty looking 0:19:24.920 --> 0:19:27.520 jar and a whole lot of bravado. He held it 0:19:27.600 --> 0:19:29.520 up to the audience and announced that he was going 0:19:29.560 --> 0:19:33.399 to use ether to make his patient insensible. The idea 0:19:33.480 --> 0:19:36.440 came to him after hearing stories about dentists in America 0:19:36.520 --> 0:19:38.159 using it, and he was going to give it a 0:19:38.240 --> 0:19:41.040 try here. And with that, Robert had the patient Frederick 0:19:41.119 --> 0:19:43.679 stick a rubber tube attached to the jar into his 0:19:43.800 --> 0:19:47.359 mouth and inhale. It took all of twenty eight seconds 0:19:47.400 --> 0:19:50.359 for Robert to slice off his leg, full minutes before 0:19:50.400 --> 0:19:53.560 Frederick would stir again. Both the ether and the surgery 0:19:53.600 --> 0:19:57.560 had been successful with time to spare, so successful, in fact, 0:19:57.640 --> 0:20:00.520 that when Frederick woke up he asked when the surgery 0:20:00.640 --> 0:20:05.160 would begin. The audience, without a doubt, was astounded. They 0:20:05.160 --> 0:20:08.840 had witnessed something new that in time would become commonplace 0:20:09.280 --> 0:20:12.960 surgery as we had once known it had pivoted indefinitely, 0:20:13.480 --> 0:20:21.760 all under the watchful knife of Robert Liston. It's easy 0:20:21.800 --> 0:20:25.040 to believe, after listening to the grizzly history of surgery, 0:20:25.320 --> 0:20:30.200 that the procedures performed often ended or severely ruined lives. Certainly, 0:20:30.240 --> 0:20:33.560 the stories about speed surgeons like Robert Liston do a 0:20:33.640 --> 0:20:36.240 good job of making us wonder if those wielding the 0:20:36.359 --> 0:20:39.800 knife truly had their patient's best interest in mind. But 0:20:39.920 --> 0:20:42.960 some procedures have done more than saved lives. In fact, 0:20:42.960 --> 0:20:46.280 one saved a man's career and in the process set 0:20:46.359 --> 0:20:48.760 him on a course to change history. And if you 0:20:48.800 --> 0:20:52.120 stick around through this brief sponsor break my teammate Robin 0:20:52.160 --> 0:21:01.720 Miniter will tell you all about it. Alan Shephard thought 0:21:01.760 --> 0:21:04.760 his career was over. He was mad, he was grieving, 0:21:05.160 --> 0:21:06.720 and he was said by some to be the most 0:21:06.760 --> 0:21:10.800 disgruntled employee working at NASA. It hadn't always been this way, though, 0:21:11.240 --> 0:21:13.639 you see. Alan had been the first American in space. 0:21:14.040 --> 0:21:16.560 He had been a hero, a national icon, and he 0:21:16.680 --> 0:21:20.480 was now what a paper pusher. Sitting at his desk 0:21:20.520 --> 0:21:23.280 as the new chief of the Astronaut Office, Alan couldn't 0:21:23.280 --> 0:21:25.760 help but feel like he was now just riding the bench. 0:21:26.119 --> 0:21:28.439 He had been one of the original seven astronauts in 0:21:28.480 --> 0:21:31.520 Project Mercury before he fell out of ranks. Alan had 0:21:31.560 --> 0:21:34.280 been reassigned after was determined that he was no longer 0:21:34.320 --> 0:21:37.399 fit for flight. The problem, you see, was that Alan 0:21:37.520 --> 0:21:40.360 was found to be suffering from something called Meniere's disease, 0:21:40.600 --> 0:21:44.359 an inner ear problem that causes dysregulation and balance. It's 0:21:44.400 --> 0:21:47.960 known to trigger spontaneous bouts of vertigo into nitis attacks, 0:21:48.000 --> 0:21:51.320 which left Alan dizzy and vomiting. You can imagine how 0:21:51.359 --> 0:21:54.960 catastrophic this might be for somebody piloting a rocket. But 0:21:55.040 --> 0:21:56.879 he had heard of a new procedure that might be 0:21:56.920 --> 0:21:58.720 able to cure him, and he found a doctor. In 0:21:58.800 --> 0:22:01.960 early nineteen sixty he had decided to go to Los 0:22:01.960 --> 0:22:04.960 Angeles and Chances of Surgery in the hopes of salvaging 0:22:05.000 --> 0:22:08.560 everything that he had worked for. Scientific testing to determine 0:22:08.560 --> 0:22:10.639 if a procedure is going to be effective is a 0:22:10.680 --> 0:22:14.400 pretty murky business. There's conflict between the ethics of research 0:22:14.480 --> 0:22:18.280 and the ethics of clinical practice. The former balances benefit 0:22:18.359 --> 0:22:21.000 and harm an individual level and the hopes of serving 0:22:21.040 --> 0:22:25.200 the broader good. Medicine's hippocratic oath fundamentally does not condone 0:22:25.240 --> 0:22:28.920 causing harm, however minimal it may be. The problem, then, 0:22:29.080 --> 0:22:31.840 is that medical practitioners can't know if something is going 0:22:31.880 --> 0:22:35.400 to be effective until it's been subjected to scientific testing. 0:22:35.920 --> 0:22:39.040 And if a treatment becomes commonplace and people believe it 0:22:39.080 --> 0:22:42.240 to be effective, the medical professionals are sometimes worried that 0:22:42.320 --> 0:22:45.560 conducting tests to see whether or not something might indeed 0:22:45.680 --> 0:22:50.120 be effective will deny patient's potential help should it be shelved. 0:22:50.760 --> 0:22:53.240 The important thing to note here is a necessity of 0:22:53.280 --> 0:22:56.040 belief on the part of the patient that something might 0:22:56.160 --> 0:22:59.520 be effective. Time and time again, those in medicine have 0:22:59.640 --> 0:23:03.040 run to what's known as the placebo effect. For whatever reason, 0:23:03.080 --> 0:23:05.640 It's been found in double blind trials that even the 0:23:05.640 --> 0:23:09.360 theater of pills and procedures seemed to alleviate chronic ailments. 0:23:09.800 --> 0:23:12.280 There's a perceived effectiveness, either on the part of the 0:23:12.280 --> 0:23:16.400 patient or their doctor that is undeniable, though it's all subjective. 0:23:16.880 --> 0:23:19.480