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You can essentially stick a spike into the brain, move it back and forth to cut the nerve fibers. I know it's awful, isn't it? It gets worse. Just wait till we get to poop transplants. I'm Richard Barnett. I'm a historian of medicine, and I'm here today to answer your questions from the internet. This is history of medicine support. BB Hawty asks, "So, like surgery before anesthesia, what did you do? Like just scream the entire time? Or just get knocked out with the cast iron skillet?"
Well, pretty much the former, in fact. In the 1820s, 1830s, 1840s, various dentists, surgeons started experimenting with things like laughing gas, nitrous oxide, and ether. Now, the first widely publicized demonstration of general anesthesia was done in 1846, and the procedure very, very quickly spreads after that. But for centuries before then, yeah, you pretty much had to grin and bear it. But in many cases, surgeons are actually quite keen to keep their patients awake. This isn't because they're horrible sadists, it's because the great fear of surgeons in early surgery isn't pain. Pain won't kill you.
What might kill you is if you start drifting off into unconsciousness and sort of, you know, gradually kind of falling into death. So, there's a sense that pain at least kind of helps to keep you conscious and helps to kind of survive this assault on the body, which is basically what early surgery was. There's a real emphasis on being as quick as possible. You can't really expect a patient to lie there for hours while you hack away at their leg. Now, one of the fastest surgeons we know about was a 19th century surgeon working in London, a man called Robert Liston, who worked at King's College Hospital.
Liston became famous because he could have somebody's leg off in a standing start in under a minute. But the price you pay for this sometimes is inaccuracy. There's a famous story about Liston, which may or may not be apocryphal, that he was once cutting off a patient's leg, he accidentally took off the patient's testicles while he was operating. One of the burly surgical assistants who was holding down the patient, Liston accidentally cut off his thumb. That man got an infection and died. There was a woman standing in the balcony watching the procedure, and she's supposed to have dropped down dead from fright. The old joke is that this is the only operation in history with a 300% mortality rate. So, this question is from Mcfapkins, who
wants to know what in the world is cupping and why is it so popular? Cupping makes use of little glass cups like this one. You would take a candle or perhaps a match, burn it inside to create a partial vacuum, and then you apply it to the flesh, perhaps the back. The vacuum inside would pull up the skin, cause something like a blister, which could then be left or it could be lacerated to draw out blood or pus. Now, the ideas behind this are very ancient indeed. The idea that four humors, blood, black bile, yellow bile, and phlegm govern health and disease. So, the idea behind cupping is that you can use the technique to draw out some
of these excess humors and restore balance to the body. Cupping has seen something of a renaissance in the last few decades with the rise of alternative medicine and especially the kind of the wellness boom. Like a lot of techniques in alternative medicine, you could perhaps argue that there's some sort of placebo effect behind it, but there's not a great deal of evidence that it has really any kind of clinical effect. Jeremy Jones says, "Louis Pasteur rolling in his grave right now." Pasteur might be rolling in his grave for several reasons. Pasteur was a French chemist working in the middle of the 19th century. He grows up in the French
countryside, so he's very interested in the kind of problems that affect French agriculture. So, in his early research, he's trying to answer the kind of questions that really upset French people like why does my wine go sour? So, he does a lot of early work on the chemistry of fermentation. He shows that when grape juice ferments and turns into wine or when milk ferments and turns into cheese, it's actually all caused by microorganisms. And when things go bad, it's a result of the wrong microorganisms getting involved. So, as part of this, Pasteur develops a technique of heating grape juice or wine or beer or milk to a certain temperature for a certain period to kill off the microorganisms and as we now say to
sterilize it. This is pasteurization and this not only becomes very widespread and does a great work to improve the health of many foods, it also makes Pasteur a great deal of money because he very sensibly patents it. But in later life, he becomes very well known for his work on vaccines. He begins his work trying to understand the kind of diseases that affect farm animals. Pasteur works out that if you identify the bacterium or the spore that's causing the disease, you can actually use it to make a vaccine. You can, as he says, attenuate it, and then you can use those weakened killed germs as a kind of vaccine. So, in 1881, Pasteur carries out a very large, very public, very well-publicized trial of his vaccines involving dozens of farm
animals. But his most famous work is done on a human disease, rabies. Rabies is a much-feared disease in the 19th century. Not only is there no effective treatment for it, but it's a really, really horrible way to die. Pasteur starts to again apply this technique of attenuation to making a vaccine for rabies. In 1885, a young French boy called Joseph Meister is savaged by a rabid dog. His parents bring him to Pasteur. Pasteur tries out this experimental vaccine, and it's a very difficult vaccine. It involves, I think, 13 injections into the abdominal cavity over about 11 days. So, poor Joseph Meister goes through quite a trial. But he remains healthy. As a result of this, Pasteur really does become a French
national hero. He gets his own medical institution, the Institut Pasteur, still works in France. He gets just about every honor that the French state can throw at him. So, example is here asks, "You ever heard of Radithor?" Radithor was an American patent medicine sold in about the decade after the end of the First World War, and it was immensely popular. It sold hundreds of thousands of bottles every year. You were drinking distilled water mixed with traces of radioactive isotopes, mostly radium. Now, why on earth were people doing this? Now, this goes back to a an episode that historians have called the radium craze. At the end of the 19th into the early 20th century, there's a great deal of
public fascination with new work that's being done in physics, especially around the idea of radiation. Now, Pierre and Marie Curie discover radium in 1898. Marie Curie gets the Nobel Prize in Chemistry in 1911 for her discovery. There's a lot of medical interest in radiation as well, not only through x-rays, but also through the idea that radioactive substances might be used to treat diseases, especially cancer. Probably the most famous victim of Radithor was an American golfer, a man called Eben Byers. He seems to have been absolutely addicted to the stuff. It's thought that he drank more than a thousand bottles of it during his lifetime. In the late 1920s, he
developed cancer of the mouth, which in its very late stages led to the loss entire lower jaw. And it's as a result, largely of the publicity around this case, that Radithor was eventually banned in 1932. R.N. Morris asks, "When you think about it, the expression blowing smoke up your ass is very strange. Where did it come from? How is the smoke blown? Through a tube? And what does the smokee get out of it?" If you think about 18th century Britain, a seafaring nation, there's a great deal of concern about how to revive sailors who've been washed overboard. One idea is to use tobacco smoke. Tobacco smoke is seen as a kind of irritant. If you think about breathing it in, it can make you cough.
So, some physicians start to experiment with specially designed bellows that have a sort of little tobacco pipe built into them. You can inflate the bellows, fill it with tobacco smoke, and essentially push it up the bottom of some poor drowned person, and blow it in. And the idea is, as I say, that if there's even a little bit of life left inside this person, this will bring them back to life. And I think it's probably fair to say that it would. A user on the Two Western Europe for You subreddit says, "Share your most controversial Nobel Prize winner. I'll start. Egas Moniz, inventor of the lobotomy." I think I'd agree with that.
António Egas Moniz was a Portuguese neurologist. In the 1930s, he develops this new procedure, lobotomy. Lobotomy literally means lobe cutting or brain cutting. So, it's a matter of opening up the skull and severing some of the connections that connect the frontal lobes with the rest of the brain. Now, Moniz in doing this was trying to come up with a new treatment for some of the most severe kinds of mental illness. He very quickly found that people who went through this procedure were indeed quieter and calmer, but the procedure caused tremendous problems for those who went through it. They very often suffered changes in character. Very often they suffered physical symptoms, physical disabilities as well. So, the
question really is why did lobotomy become so popular, so widely used if it had such terrible consequences for patients? Well, the answer really goes back to the 19th century. All sorts of new institutions, especially medical institutions, are established and one response to the what's seen as a growing problem of insanity is institution alizing the mad, putting them away in asylums. But by the early 20th century, it's becoming clear that asylums really don't work as a kind of therapy for mental illness. Unlike the great transformations in medicine and surgery, psychiatrists don't really have much to show by the end of the 19th century in terms of really effective techniques for
treating madness. So, historians have talked about a kind of age of heroic therapy in the early 20th century. All kinds of new therapies being tried using insulin to put patients into something like a diabetic coma for several days with again the idea that this might in some ways almost sort of reset their minds. This is also the period in which electroshock therapy starts to be used for certain kinds of conditions. But lobotomy has become the most notorious of these heroic therapies. Now, part of the reason it becomes so popular is the work of an American doctor, Walter Freeman. He simplifies the procedure, which is called the transorbital lobotomy. So, essentially, you take something like a like an ice pick, you
make an incision just above the eyelids, so in the orbital bone, and through that you can get directly into the brain. Now, for more than 30 years, Freeman traveled across the United States moving from asylum to asylum carrying out thousands of these procedures in waiting rooms or in doctors' offices. Now, Freeman eventually became notorious for his work and in 1967, he was banned from medical practice. But lobotomy became a symbol of a kind of oppressive, restrictive kind of psychiatry. If you've ever seen the film One Flew Over the Cuckoo's Nest, you'll know that the lobotomy in that film is really used as a kind of punishment. It's not really a kind of therapy at all.
12 asks, "Were maggots ever purposely cult 12 evidence of the use of maggots in this way in many traditional medical cultures around the world. And from about the Renaissance onwards, military surgeons working in Europe start to notice that even if a soldier's been lying on a battlefield for days, even if their wound has got infected with maggots, very often that wound will actually stay uninfected and will heal quite well. And this is a technique that's often been used in situations where no other kinds of treatment are available. Maggot therapy is still occasionally used today. Of course, the most important thing is that you have sterile disinfected maggots. So, Wow full asks, "Explain like I'm five, what is the iron lung and how does
it work?" So, picture in your head a metal tube, looks a little bit like a railway carriage, but imagine it's about the size of a coffin. Now, imagine you lie inside that tube, and it's got a seal around your neck so that you're sealed inside it. And there's a pump at the far end of the tube that's pumping air into the tube and out of the tube. Now, why on earth would you do this? Well, this is a kind of respirator. So, for patients who've lost the ability to breathe, this is a machine that can be used to inflate and deflate their lungs and keep them alive. It was developed in the US in the late 1920s, initially for
treating victims of coal gas poisoning. But, the iron lung really came into its own during the polio pandemic of the early mid-20th century. Polio is an infectious disease that largely affects the nervous system. It can leave patients physically paralyzed, but it can also leave them in a situation where they can't breathe for themselves. So, iron lungs became a way of keeping many polio patients alive through this epidemic at a great cost to their kind of mobility and quality of life. You do have cases of people being infected with polio at quite young age and living decades inside an iron lung. The use of the iron lung declined with the decline of polio. Effective vaccines come along
in the 1950s and 1960s. There's a very successful public drive for vaccination to try and eliminate this disease. So, iron lungs now are hardly ever used. Sleepy Mount Everest asks, "WTF is bloodletting?" This was a very widespread procedure, especially in medieval and classical medicine. Again, based on the idea that health is a matter of balance. So, if you have too much blood inside your system, blood is seen to be a very hot, fiery kind of overstimulating humor. It's the humor of spring. It's the humor of youth. So, it can kind of make you overexcited and feverish. So, there's a very long-standing idea that if you let a few
pints of blood out of your body, it'll calm you down. And it certainly does. There are some very famous cases of bloodletting carried to kind of extraordinary excesses. One of the most famous is in the last few days of the life of the first American president, George Washington. Washington's physicians kept bleeding him over and over again, eventually letting several pints of blood out. And there's an argument that actually his death in the end was the result of the action of his physicians, not of the disease he was suffering from. Stop That Girl 7 asks, "Hey Siri, who was Typhoid Mary?" Typhoid Mary was Mary Mallon. She came to the US to work as a cook. In the early 20th century, several outbreaks of typhoid were associated
with the households in which Mary had worked. Now, the New York Public Health Department investigated this case, and they discovered that Mary was what's called an asymptomatic carrier of the disease. In other words, she carried the bacterium responsible for typhoid, but she didn't suffer from the disease herself. Like many asymptomatic carriers in this period, she was forcibly quarantined for a while. She was released in 1910, but in 1915, a further series of outbreaks at a maternity hospital in New York were linked to her. And sadly enough, she spent the rest of her life incarcerated. She died in quarantine in 1938. Now, Typhoid Mary has become almost a figure of sort of gothic folklore. But in many ways, her
case raises issues that are very familiar to us in the last 10 years. The questions we all face during the COVID lockdown of how do we balance individual freedom with the question of sort of larger public health and social good. There's also a question about why Mary was treated so harshly. She was far from the only asymptomatic carrier of typhoid identified in this period, but she was the only one who was incarcerated for so long. And historians have suggested that this may be connected with fact that she was working class, the fact that she was Irish, and the fact that she was a woman who tried to stand up for herself. So, Quarry use asks, is trepanning still used today? Well, trepanning is very
ancient technique. It's the idea of cutting or drilling a hole in the skull. Now, this sounds like rather a radical intervention, but it's actually one of the oldest techniques that we have evidence for. Archaeologists working as far back as the Neolithic have found skulls to which this has been done. Holes have been cut or chipped, presumably with quite sort of simple flint tools. And the most extraordinary thing is that many of these skulls show some evidence of healing. Now, because texts don't really survive from these ancient societies, we don't really know why it was done. It might have been some sort of surgical intervention, perhaps to relieve the symptoms of mental illness or to treat some kind of head
injury, but it's perfectly possible that it was perhaps some kind of um initiation right. One thing it almost certainly wasn't was a kind of punishment, simply because there are easier ways of inflicting more suffering. The technique is still used. Modern surgeons will use it sometimes if a patient has suffered a serious head injury to try and relieve pressure on the brain or in some other kinds of diseases like brain cancer. 3K Carlo asks, "Yo, how did surgeons learn that stuff? Like, there had to be a psychopath who was cutting people's bodies open and exploring." If you're going to learn surgery, if you're going to learn about the human body, the best
way to do it is not learning through text, but rather through practice. Well into the 18th century, the way that you learn surgery was really through apprenticeship. You'd be apprenticed to a master surgeon, you'd follow them around, you'd watch them doing their procedures, so you'd learn very much in practice. One of the things this gives early surgeons is a really good sense of the kind of materiality of the body. So, a lot of what we've come to learn about, yeah, the fine detail of movement or circulation of the blood or things like that, really come from dissection, come from getting to grips with the kind of rather bloody, messy materiality of the body.
This is from the AskHistorians subreddit. What is the oldest example of a plastic surgery or plastic surgery-like procedure? What was the procedure like? So, we may think of plastic surgery as a very modern phenomenon, but in fact it's a very old idea indeed. Wherever we find ancient medical texts, we find interventions that are intended not only to restore the function of the damaged body part, but also its appearance. And probably the most famous of these early procedures is called rhinoplasty. The earliest records of this come from ancient Sanskrit medical texts of the Ayurvedic tradition. I imagine you've lost your nose, [snorts] it's been cut off of as a punishment or you've suffered some awful disfiguring disease.
One thing you can do or a surgeon can do to try and at least recreate the appearance of a nose is to cut a triangle of skin from your forehead, leaving a little strip so that the skin is still getting blood supply, still stays alive, and kind of fold it down and then attach it on either side to form something like a nose. And the idea is that the tissue will heal and you'll have not a kind of properly functioning nose, but at least something that looks like a nose. Alex8762 asks, "Why did it take so long for surgeons to recognize the need for sterilization of equipment and washing their hands?" It's a very simple question that opens up a very rich historical subject.
Now, in some ways there's a paradox here. Microscopes are developed in Europe in about sort of the middle of the 17th century. People start using them to look at all sorts of objects and substances. One thing they find very quickly is that the world is full of these previously unsuspected tiny little dots and squiggles and blobs that seem to be alive. But it's not until the 19th century that ideas like germ theory and with it the idea that cleanliness and disinfection are kind of central to effective surgery start to become very prevalent. So, why did it take two and a half centuries for these ideas to arise?
Well, the first thing to say, I suppose, is that it's not at all clear to the first observers that germs actually cause disease. These germs cover every surface that early micro- microscopists look at and they seem to be all over every bit of the body that they look at. So, many people say, "Well, if these germs are everywhere, how can they possibly cause disease? Why don't we just sort of all die immediately of this overwhelming infection?" There's also not really a sense that there are different kinds of germs. That really only kind of comes out of laboratory medicine in the 19th
century. There's also a question about the kind of the nature of what we'd now call scientific evidence itself. It can be very hard in practice actually to identify the cause of a disease. So, a walking surgeon might say, "Well, sometimes wounds get infected, sometimes they don't. Perhaps it's a consequence of the body trying to heal surgical wounds." So, there are lots of reasons that it's quite hard for early surgeons to draw this connection between cleanliness of surgical instruments and the rates of wound infection. J.D. Nelson asks, "Well, barber surgeons were a thing. Time for a comeback."
Well, it probably isn't time for a comeback, but barber surgeons certainly were a thing. It's rather strange to the modern mind to think that the kind of people who cut your hair might also have been the sort of people who cut your leg off. But the connection going back three or four hundred years is that both barbers and surgeons are working on the outside of your body with sharp implements. You can imagine a barber perhaps accidentally cutting you while he was shaving, kind of dressing the wound. It's maybe not an enormous step from that to think about barbers carrying out basic kinds of surgical procedures. So, although it's very counterintuitive today, historically there was a very close connection between barbers and surgeons. And this
is embodied most famously in the old blood and bandages, the red and white striped pole that you still see outside many modern barber shops. The Pixel Paint asks, was the discovery of penicillin really an accident? Well, pretty much yes. So, this was the work of a Scottish physician and bacteriologist Alexander Fleming. Fleming in the 1920s has already done some work on the body's natural defenses against bacteria. He's discovered an enzyme called lysozyme, which the body secretes in things like snot and mucus that attacks bacteria and viruses that
try to get into the body. So, Fleming is very interested in this idea of simple chemicals that might kill bacteria. But the discovery of penicillin itself really was a kind of lucky accident. In the summer of 1928, Fleming leaves his laboratory in St. Mary's Hospital, goes on holiday, comes back about a month later, and finds that some of the Petri dishes of bacterial cultures that he's been using have become contaminated with mold. Now, he's about to throw these away, but he takes a look at one of them and makes a fortuitous and fantastic discovery. He notices that the mold growing on this Petri dish is clearly secreting or releasing something, some chemical, that is killing the bacteria
that were growing on the Petri dish. Fleming cultures this mold separately. He tries to extract a drug, a kind of simple chemical from it, and he calls this drug penicillin. If you were trying to grow certain kinds of bacteria and your cultures kept getting infested with others, you could perhaps use penicillin to kind of clear out these cultures and make sure that only the bacteria you wanted were growing. But in the 1930s, two things happen. The first really successful antibacterial drug called prontosil is developed in Germany. Second, the outbreak of the Second World War. Military surgeons, Allied governments are very well aware that they're going to need effective treatments for battlefield injuries. So,
a research project is started in Oxford, which essentially kind of combs the literature looking for techniques that might lead to effective drugs. This project, led by Howard Florey and Ernst Chain, come across Fleming's paper. They start work on developing penicillin as a kind of mass-market pharmaceutical. It becomes the world's first successful antibiotic, and Florey, Chain, and Fleming share the 1945 Nobel Prize for their discovery. And this extract of the Penicillium mold, penicillin, turns out to be the world's first effective antibiotic. Runner Love Jewel asks, "How is Mad Hatter's disease a real thing? Like what do you mean? You had continuous exposure to mercury and only got a little silly?"
Well, Mad Hatter's disease certainly was a real thing. Alice in Wonderland, we all know the Mad Hatter behaving and talking in the strange way that he does. What Carroll is alluding to with this character is the characteristic trade disease of hatters in the 18th and the 19th centuries. Mercury was used in the preparation of the animal pelts that we used to make things like beaver hats. So, hatters in the course of their work were often exposed to mercury, and by the ends of their lives, they'd often suffered quite severe neurological damage, in some cases even forms of madness, from this long exposure to mercury.
So, Queen Hassada asks, "Why wasn't measles eradicated like smallpox?" As the question suggests, it would be perfectly possible for measles to be eradicated. We have very effective vaccines, and there are many global programs associated with the World Health Organization that are working towards this aim. But since 2017, the disease has seen a resurgence, and this was made much worse by the COVID pandemic. As you can imagine, medical attention, medical resources were diverted elsewhere. Vaccination programs in many parts of the world were paused. After the end of the pandemic, the incidence of the disease has started to rise again in many countries where it had been declining for decades. Now, it's rather useful here to compare
measles with another infectious disease like smallpox. Smallpox historically was widely feared. It was a very serious, disfiguring, often fatal disease. It became the subject of the world's first vaccination. The English doctor Edward Jenner in 1796 develops a fairly effective vaccination technique against smallpox. And in 20th century, even at the height of the Cold War, the disease was the subject of one of the first kind of global attempts to eradicate a disease, and this was finally successful. Now, compare smallpox to measles. Part of the problem with measles is that we still don't take it very seriously.
We tend to think of it as a kind of childhood disease, the sort of thing you get and then get over. But it's a very, very serious disease. It can cause serious disfigurement like blindness. It can also leave your immune system compromised and leave you susceptible to other diseases. And of course, a big problem in the West in the last 20 or 30 years has been the rise of vaccine skepticism. The English doctor Andrew Wakefield in 1998 published a paper which claimed to show an association between the MMR vaccine and the development of childhood autism. Now, this paper has been comprehensively discredited, and The Lancet, to its great credit where it was first published, has now withdrawn the paper.
But unfortunately, it has very much contributed to the rise of vaccine skepticism. Now, I don't want to get on my high horse here, but if you're lucky enough to live in a country that has vaccination programs against measles, for heaven's sake, get vaccinated. Tori 42 asks, "Why is it called an X-ray?" Well, if you think back to algebra that you learned in school, X is the term that we use in mathematics and science for the unknown quantity. So, X-rays are called X-rays because when they were first discovered in 1895 by Wilhelm Röntgen, who was a German physicist, they were unknown. Now, Röntgen is working in his laboratory using new scientific equipment, vacuum tubes, cathode ray tubes that seem to emit certain kinds of radioactivity. He
discovers very quickly that these rays have very strange qualities that they can pass through the human body, but they cast shadows of the bones which you can capture on a fluorescent screen or even on photographic paper. There's a famous story of Röntgen bringing his wife in to take an X-ray of her hand, and when he shows her the X-ray that she supposedly exclaimed, "I see my death." As if she'd seen her own skeleton, her own mortality for the first time. Good one for you asks, "Some surgeons still pull cataracts out of the eye with a fish hook, but when did that start?" Well, you might think that operations on the eye, such a delicate, sensitive part of the body, would be a very modern phenomenon. But actually
operations for cataracts are some of the oldest surgical procedures that we know about. Now, cataracts arise when the lens that sits in the front of the eye and is responsible for focusing light onto the retina and go cloudy and that can cause blindness. Now, the earliest procedure for dealing with cataracts was called couching. We find this described in many ancient medical texts from many different traditions. Essentially, you take a little tool, perhaps something like a fish hook, and you just insert it into the eye and you just push the cloudy lens out of the way. Now, this restores vision. It does leave you without a lens. So, you get something like very, very blurred vision, but it's better than blindness.
Now, it's in the middle of the 18th century that European physicians start removing the lens instead of just pushing it to one side. In 1884, an Austrian neurologist, a colleague of Sigmund Freud, called Carl Koller, starts to use cocaine as a local anesthetic to help keep the eye still during eye surgery and this makes cataract surgery a great deal easier and a great deal more precise. And the roots of modern cataract surgery, where instead of just removing a lens we try and insert an artificial lens, that goes back to 1949. An English surgeon called Harold Ridley had been working during the Second World War with fighter pilots. Many of them had been in bad crashes and the acrylic windscreens of
their planes had shattered and bits of acrylic had got into their eyes. Now, Ridley noticed that unlike most substances, a piece of acrylic in the eye isn't rejected by the body. So, Ridley starts experimenting with replacement lenses made out of acrylic and this is really the kind of the origin of modern cataract surgery. So, allwrong74 asks, "Did leeching actually do anything?" Leeches are little invertebrates that swim around in pools and they live by sucking blood from other creatures. So, leeches were, as it were, kind of nature's way of doing bloodletting and it really had all of the kind of negative sides that bloodletting had. If you were unlucky enough to get a leech that was infected with a disease, you could catch the
disease and as with bloodletting, it could be done to excess. You could find yourself kind of seriously weakened and compromised by losing too much blood to a leech. So, that's everything for today. I hope you enjoyed this and I hope you had fun. Thanks so much for watching History of Medicine Support.
