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00:01It's a spring day.
00:03A 25-year-old man is in excruciating agony.
00:09A top surgeon is called to perform an operation
00:12so dangerous it kills a third of its patients.
00:18The life of one of Britain's most famous writers
00:22hangs in the balance.
00:24His name is Samuel Pepys.
00:27And the year is 1658.
00:34This is St Bartholomew's, Britain's oldest hospital.
00:41This hospital has cared for people
00:43through the reign of Henry VIII,
00:45through the plague, the Great Fire of London,
00:48the Covid pandemic and beyond.
00:51Over nine centuries of scientific discoveries
00:54are here at my fingertips.
00:57There's something extremely special in this box.
01:01Now for the first time...
01:03Oh wow, okay.
01:04I'll reveal how the breakthroughs of the past...
01:07You've got to see this with your own eyes.
01:09...are helping to write the future of medicine.
01:12I am absolutely blown away by this.
01:16I'll step inside the day-to-day of this state-of-the-art institution...
01:20That is incredible.
01:22...where they've been saving lives and making history...
01:25Oh wow!
01:27...for nearly a thousand years.
01:29And behind every door is a new secret...
01:32...just waiting to be discovered.
01:41St Bartholomew's Hospital occupies seven acres...
01:45...right in the heart of London.
01:48Patients come here because of its world-class medical care.
01:54But what's different about Barthes is that its doors have been open...
01:58...for an extraordinary nine centuries.
02:02And its history of life-saving progress is right at my fingertips.
02:10This is Barthes Pathology Museum and it's an incredible collection.
02:15There's lots of specimens here, lots of history.
02:19We can see the range of diseases that people suffered from in the past...
02:23...and the treatments that were available.
02:26Many of the 5,000 specimens housed here...
02:30...are from centuries of patients cared for at Barthes.
02:34Including hundreds of body parts removed during surgery.
02:39Today, 50 dedicated Barthes surgeons...
02:43...work across ten state-of-the-art operating theatres.
02:46But the range of treatment was once far more limited...
02:50...not to mention rather more crudely delivered.
02:54Arts today offers many different sorts of operations.
02:58But if you go back 400 years ago...
03:00...two of the most common were amputation, cutting off limbs...
03:04...and lithotomy, which literally means stone cutting.
03:08And this was cutting stones out of bladders.
03:12Surgeons would be doing that on patients who were desperate, who were in pain.
03:17And this, of course, was a time before anaesthesia.
03:19And it was done in a place that was rather insensitively called...
03:23...the cutting ward.
03:28Bladder stones still affect thousands of patients a year in Britain.
03:33But in the 1600s, it was a much more common problem.
03:36And in 1691, the Barthes cutting ward was built...
03:41...in which surgeons operated on stricken Londoners.
03:47Fascinatingly, many stones extracted via lithotomy...
03:51...have been carefully preserved.
03:54To find out more about this agonising condition and its treatment...
03:58...I'm meeting urologist Jonathan Goddard.
04:02These are more than actual bladder stones.
04:03These are real bladder stones.
04:05I mean, some of them... Look at that one.
04:06I mean, it looks huge, isn't it? Absolutely huge.
04:09Poor people that had that.
04:10And look at this one. It's covered in spikes.
04:13Actually, bladder stones are quite common, weren't they?
04:16Yeah. Do we know why?
04:17We think it's to do with diet. So, stones form in the urine.
04:20They grow in a concentrated solution.
04:23So, if you don't drink enough water, I'm afraid you get bladder stones.
04:26Beautiful things, but a horrible condition.
04:29These hard stones form when minerals in the urine turn into crystals.
04:36Today, tiny telescopic cameras make bladder stones...
04:39...quite simple to treat under anaesthetic.
04:42Nowadays, you would pass a small telescope through the pipe...
04:46...into the bladder and then you could see the stone...
04:48...and usually you can smash it with a laser and wash the dust out.
04:51Wow.
04:52But in the 1600s, over 250 years before endoscopic cameras were invented...
04:58...the surgeons on the cutting ward were working completely blind.
05:04It was too dangerous to go in the top because you're too near the bowels.
05:07So, you have to go underneath.
05:09But you're going through the root of the penis here.
05:13Yes. Then you're having to go through this muscle.
05:14Yeah.
05:15Then you've got to go through the prostate.
05:16Yes.
05:17Before you get to the bladder.
05:18Before you get to the bladder.
05:18And if you've got something like this, you've then got to pull that out.
05:20You've then got to pull it out.
05:22Yes.
05:23The majority of bladder stone sufferers were, and still are, male.
05:27The operation was so dangerous and painful, the patient had to be restrained to prevent him from kicking out in
05:35agony.
05:36With the patient's legs splayed above him, the surgeon would then be able to access the perineum and begin the
05:44procedure without anaesthetic.
05:47Up to a third of patients would die.
05:49A third?
05:50Even if you didn't bleed to death, you could die of sepsis quite easily.
05:54You could die of just the traumatic amount of pain that you're having on the table.
05:58The operation may sound brutal, but at the time this was a highly skilled procedure.
06:05Fortunately today, complex surgery looks very different for patients like 62-year-old, former painter and father of two, Chris
06:14Lynch.
06:16I'm in today for an operation on my left lung for cancer.
06:20I smoked since I was nine years of age. I gave up about 12 years ago.
06:25In 2022, a surgeon here at Bart's removed a cancerous tumour from Chris's right lung.
06:32And six weeks ago, they found another, this time on his left lung, and it's about to be removed.
06:40Performing this potentially life-saving surgery once again...
06:43How are things?
06:44Very well, thank you. How are you?
06:45Yeah, up to your bed.
06:46..is Henrietta Wilson.
06:48I'm a consultant thoracic surgeon, and that means that I operate on everything from here to here that's not your
06:55heart.
06:56The anatomy within the chest is beautiful. I fell in love with it straight away.
07:03Henrietta has been a surgeon here at Bart's for eight years.
07:07I love working at Bart's. They've given me the opportunity as a very young surgeon.
07:13Good morning.
07:14Good morning.
07:15Good morning. How are you?
07:16I'm very well, thank you. How are you?
07:17Not too bad.
07:18So, all set for today?
07:20Okay, Miss Wilson, yes.
07:21Yeah. The team will keep you updated, but otherwise I will see you again after the operation.
07:26All right, take care now.
07:28Thank you. Bye-bye.
07:30And in a far cry from the crude methods of the cutting ward, Henrietta will operate using some of the
07:37most advanced surgical technology in the world.
07:42This million-pound robot, funded by Bart's charity, may look like something out of a sci-fi movie, but it's
07:50the latest addition to Bart's cutting-edge surgical facilities.
07:54Please, come on in.
07:55So, this is state-of-the-art surgery, isn't it?
07:58It is, yes.
07:59Now, I'm no stranger to a scalpel, but in a career first, I'm going to have a lesson in robotic
08:07surgery.
08:08Henrietta, introduce us to the patient, then.
08:11Yeah, yeah.
08:11Who is this patient?
08:12So, what we've done is we've got half a pepper, and the pepper has seeds in it.
08:17You're going to be picking the seeds out of the pepper.
08:20Okay.
08:20And then popping them into the pot next to it.
08:23Oh, right.
08:23So, we'll come over to this surgeon console.
08:27You've got your hand controls here, but once my head is in the console, I just click my fingers together,
08:32and then I can move my instruments around.
08:35The robot boasts four fully controllable arms, offering extreme accuracy, so the surgeon can do more than they can with
08:44just two hands.
08:46And your fingers opening and closing are opening and closing your instruments, and then you're moving them in space.
08:54This is incredible.
08:55Because here you are, moving that, and over there, the arms are moving above the pepper.
09:02Let's do it.
09:03Time for me to have a go.
09:05I want to put my finger and thumb in here.
09:08That's it.
09:08Yeah.
09:09And then, once your head is in, just click your fingers together.
09:12Oh!
09:14God.
09:15So, if I push in, I think I should be able to touch the pepper.
09:20Where is it?
09:21Oh, there it is.
09:22I'm just touching it.
09:25With enhanced 3D magnified vision.
09:28Look at that, they twist.
09:31And a much greater range of motion than the human hand, surgeons like Henrietta can perform ever more complex, minimally
09:39invasive surgery with pinpoint accuracy.
09:42Which means Chris should suffer less bleeding and pain, and will heal better afterwards.
09:48So, why don't you see whether you can pick up one of those seeds.
09:54That's it.
09:55Yeah, there we go.
09:56Pull it off.
09:57You can start to come across and deposit our seed.
10:03Lovely.
10:03I did it.
10:04There we go.
10:05This is amazing.
10:07I mean, honestly.
10:08Good work.
10:09I am absolutely blown away by this.
10:13It's incredible.
10:14I didn't think I would be able to pick it up quite so easily.
10:19Now, obviously, I'd need a lot more training before I was able to do surgery with this.
10:23But it's really intuitive.
10:26And we're getting better patient outcomes.
10:29We're not talking about replacing surgeons with robots.
10:32We're extending the surgeon's abilities.
10:37And that's better for everybody.
10:39Coming up.
10:41There's your scalpel.
10:42I attempt a dangerous bladder stone extraction, 1600 style.
10:46We've got the scrotum here.
10:48Yeah.
10:48The anus just there.
10:49How big a hole?
10:51We'll explore the role of nurses here in the time of Henry VIII.
10:55Above all things, they have to avoid, abhor and detest scolding and drunkenness as the most pestilent and filthy vices.
11:03And we'll accompany therapy dog Archie on his wall drones.
11:07Hello, darling.
11:18Today, there are over a thousand nurses working at Barts.
11:23They're the front line of care for every patient that passes through these doors.
11:30Just arrived at work is 25-year-old nurse Sabila Shaheed.
11:36Since completing her training here two years ago, Sabila has been working on the oncology ward.
11:43Round about when I was about 16 to 20 years old, I think my mum sort of just suggested to
11:48me,
11:49Oh, why don't you think about nursing?
11:51And I was a student here.
11:52I was so inspired.
11:54I was just like, yes, this is where I want to work.
11:57Nurses at Barts work 11 and a half hour shifts.
12:00And every day that she's here, Sabila is responsible for the care of up to five seriously ill cancer patients.
12:07Clinical duties that a nurse will do includes taking your blood pressure, your temperature,
12:13administrating all of the medications.
12:15When they take blood normally, do they struggle?
12:17Is it difficult normally?
12:19It's not normally.
12:20No? Okay.
12:21One of Sabila's most important and frequent jobs is something we've probably all experienced, having our blood taken.
12:28We do routine bloods for every single patient on the ward every morning.
12:32It's very important because bloods determine whether they are fit or not for treatment.
12:35It's just generally how well or unwell the patients are.
12:39Around 2.6 million diagnostic blood tests are carried out every year here at Barts.
12:47But the vital connection between our blood and our health wasn't always so well understood.
12:56Scientists have been analysing blood at a cellular level since 1658,
13:01when red blood cells were first observed by Dutch naturalist Jan Swammerdam.
13:07But it wasn't until the early 20th century that blood tests became available to diagnose diseases,
13:14and one of the earliest was syphilis in 1906.
13:19Syphilis was so rife at the time that the so-called Wasserman test was rolled out in many countries as
13:26a requirement for getting a marriage licence.
13:30Now, just one tiny blood test can uncover countless diseases within a couple of hours if necessary.
13:37Knock, knock.
13:39Hiya.
13:39Hello.
13:40How are you today?
13:41I'm good, I'm good.
13:42But perhaps the most important part of Sybilla's job is making her charges feel well cared for.
13:49I just like to eyeball all my patients if there's anything pressing and go inside to everyone one by one.
13:55Did you sleep alright last night?
13:56I don't know. I've got a little bit of sleep.
13:5861-year-old Kevin O'Hara has terminal renal cancer and two days ago was admitted to Sybilla's ward with
14:06a fever.
14:07Sybilla comes in every now and again, even when she's not working, she pops in just to say hello.
14:11And that's what's really good about the NHS in part. Nothing's too much for them.
14:16I'll just chase with the doctors about this whole viral sort of progression.
14:20You didn't sound this congested yesterday.
14:21But you said you feel alright otherwise?
14:23I do, I feel great.
14:24Yeah, okay.
14:25It's just that I'm not.
14:27Kevin is a lovely man.
14:29You can see he's a very lively chap, can talk to anyone and everyone.
14:33I like how positive he is and I do admire that.
14:36Thanks very much for what you've done for my daughter yesterday.
14:38That's alright.
14:39When you finished doing my blood, you put your arms around her.
14:41You gave Emma a lovely cuddle.
14:43Oh, bless.
14:43Thank you very much.
14:44Do you ever need a hug from here?
14:45Oh, bless you.
14:46You can have one now if you want.
14:48Thank you very much for that.
14:49They don't come as a cost.
14:50They don't come as a cost.
14:51That doesn't come as a cost.
14:51That doesn't come as a job description.
14:52But that's what you did.
14:54Bless you.
14:55That was lovely.
14:55That was really lovely, that was.
14:58Ah.
15:03Providing care for those who need it most has always been the Bart's way.
15:08But 900 years ago, nursing wasn't a job for trained medical professionals.
15:15When the hospital was founded in 1123, it's thought that it was actually housed in a single building.
15:22And the sick were looked after by eight religious brothers and four sisters.
15:26It's a term we still use for senior nurses today.
15:32But in the 16th century, what had been a religious institution was re-founded.
15:38In 1547, Henry VIII handed the running of the hospital to the City of London and new secular jobs were
15:46created.
15:48These are laid out in the order of the hospital issued by the new governors in 1552.
15:54And that document has been dug out for me by archivist Kate Jarman.
15:59They have to faithfully and charitably serve, help the poor in all their griefs and diseases,
16:04as well by keeping them sweet and clean, as in giving them their meats and drinks.
16:08OK.
16:08So it's not that dissimilar to now. It's ensuring that the patients are well fed, they are clean and comfortable.
16:16Yeah, absolutely.
16:18And what about the matron then? Because this is an entirely new role in the hospital.
16:22Yes, she has to make sure that they do their duties.
16:25And in the few hours when they might have had some free time, they were still expected to be kept
16:29busy,
16:30so they'd be spinning yarn and weaving linen for the wards.
16:35And there were also rules about behaviour outside the hospital.
16:43Above all things, they have to avoid, abhor and detest scolding and drunkenness as the most pestilent and filthy vices.
16:51And they've also got to avoid and shun the conversation in company of all men.
16:55That seems a bit extreme.
16:57The rules were strict and the penalties for breaking them severe,
17:01as the impressive hospital governor's minutes describe.
17:05You do get regular entries about the dismissal of nurses and of sisters.
17:11This one is in 1775.
17:14And you can see here, Hester really wasn't sticking to the idea of avoiding drunkenness.
17:20Oh.
17:20So Hester Hill, sister in Hope Ward, discharged from her office for selling gin, et cetera, to the patients,
17:26giving away the hospital's provisions contrary to the rules and orders,
17:29that's the book we've just looked at, and otherwise misbehaving.
17:32Oh, she's having a lovely time.
17:33So she was discharged straight away.
17:35Yeah.
17:36Well, I can see why they got rid of her.
17:41Though selling gin to patients is unsurprisingly still forbidden, boosting morale is a top priority.
17:49And there's a new physician on the wards.
17:52His name is Dr. Archie.
18:01Archie and I are here today at Barts, where we volunteer with Barts Volunteer Services and Pets' Therapy.
18:09It's very attentive and sweet.
18:11And very calming.
18:13Right, buddy?
18:13We'll go this way.
18:15All right.
18:15Take care.
18:16Bye-bye.
18:17Hi.
18:18He has come as Dr. Archie to give cheer and cuddles to patients and staff alike.
18:26Archie, sit.
18:27There you go.
18:28Suzanne Louis has been bringing Archie to Barts for four years.
18:33The medicine he provides works every time.
18:37Hello.
18:38What's your name?
18:39Ellen.
18:39Hi, Ellen.
18:40I'm Suzanne.
18:41This is Archie.
18:42How are you?
18:43Loads of patients will respond to him.
18:46Look, he's four years old.
18:48I am.
18:49So are you.
18:50Yes.
18:51You want to give him a treat?
18:52All right.
18:53Ellen's going to get it to you.
18:54Don't be greedy.
18:55Don't be greedy.
18:56You have a treat.
18:57Good boy.
18:58Today, there are over 4,000 registered therapy dogs visiting patients in healthcare settings
19:04around the UK.
19:06But pet therapy is nothing new.
19:11In ancient Greece, horses were apparently used to lift the spirits of the sick.
19:15Florence Nightingale had a pet tortoise on her hospital wards.
19:21Before psychologist Boris Levinson coined the term pet therapy in the 1950s, writing papers
19:28on his co-therapist, Jingles.
19:33Today, a swift recovery is the goal for every member of the BART staff.
19:40But alongside the life-saving work carried out here on patients, the hospital itself has
19:47been undergoing a major operation.
19:51For more than a year and a half, a team of experts has been restoring its Georgian North
19:57Wing in a £9.5 million project.
20:02The 300-year-old entrance boasts a grand staircase with two enormous paintings by renowned artist
20:10William Hogarth.
20:12They were once illuminated by an ornate chandelier.
20:17Hi guys, how's it going?
20:18Really well.
20:19Good, good, good.
20:20For four months, the chandelier has been painstakingly restored and is now ready to be re-hung.
20:28Conservator Steven Payne is here to oversee the delicate operation.
20:33We have this wonderful chandelier.
20:36We believe it's by a very famous furniture maker to George II, Benjamin Goodison, who really
20:44was the absolute top of the tree in the period.
20:47And there is a sister chandelier, we believe, in Hampton Court.
20:52And I'd say that makes it a very special piece.
20:54A very valuable one too, given equivalent Georgian chandeliers sell for six figures.
21:02Now the day has come for it to be re-hung in its original position.
21:07It's a very fragile thing.
21:09The ten swan-necks are incredibly sort of vulnerable.
21:13So it really requires a normal sort of care.
21:16If you can lift the tube up.
21:19Right, that's on.
21:21OK, so ready to start winding where you are.
21:24Go up, maybe six turns into the spot.
21:26Have a great spin.
21:28It's vital the chandelier is winched slowly and steadily into position, four metres above
21:34the floor.
21:35Just give you a little bit of tension, I think it comes up.
21:38Any lateral movement could start it swinging like a pendulum, making it impossible to control.
21:45So, carry on going up with the winch.
21:52Nice and slow, go slower, slower.
21:55It's a nerve-wracking moment for Stephen.
22:00Keep going, keep going.
22:05OK, stop, stop.
22:07Oh, she blows.
22:11And the team can relax.
22:13The chandelier is at last back in its rightful place.
22:24The hospital's Grand North Wing was never intended for patient care.
22:29But on the first floor of the King George V building, a potentially life-saving operation
22:35is about to take place.
22:38Knife when you're ready.
22:41Retired painter Chris has been prepared for surgery.
22:45Starting.
22:45And brought into theatre four.
22:48Over the next three hours, he'll have his lung tumour removed by Henrietta Wilson,
22:53one of Europe's foremost experts in robotic lung surgery.
22:58Just bringing the camera into the chest.
23:01The camera allows Henrietta to see inside the chest,
23:05as the team introduces metal tubes called ports.
23:10These will allow the robot's delicate instruments to go in,
23:13and cancerous tissue to come out, without damaging the rest of the lung.
23:19I'm going to start at the bottom of the lower lobe,
23:21and I'm just going to start with a little bit of dissection
23:25so that we can take away some lymph nodes.
23:27So you can see this little black thing here.
23:30That's a lymph node.
23:31I'm going to want to gently tease that out.
23:37Cancer can spread through lymph vessels,
23:39which drain tissue fluid to lymph nodes.
23:45Henrietta needs to check these nodes are clear of cancer.
23:50So that's a lymph node now that I've taken out.
23:54And we're going to remove that through the port.
23:58OK, once we have.
24:00With multiple lymph nodes collected,
24:03Henrietta now moves on to locate and remove the cancerous lobe of the lung.
24:08Just a lot in the way, that's the trouble.
24:10She must first find the branch of the pulmonary artery,
24:14which supplies blood to this lobe.
24:17Sometimes we have to work in these little spaces
24:19because the anatomy of the human lung is not the same for every person.
24:25But it's hard to reach.
24:29There's a lot of lung tissue between where we are and where we want to be.
24:35Like mining for gold.
24:39Oh, there we go.
24:43There she blows.
24:46After nearly two and a half hours in surgery, Henrietta can finally take out the tumour.
24:52So we're putting her bag into the chest and this is how we're going to extract the lingula.
24:57I'm just going to put it into the bag and then we can remove.
25:02The tumour has been cut out, surrounded by a layer of healthy tissue
25:07to ensure no cancer cells are left behind.
25:11OK, so we'll have a look at the specimen,
25:13make sure we've got the tumour that we need.
25:16Because before the case we've marked the tumour with a coil,
25:20so we should be able to feel it within the specimen.
25:24Yeah, it's there. Perfect.
25:27Finally, both the robot and Henrietta can stand down.
25:33It was technically a challenging operation,
25:35but that's when the robot earns its money.
25:38If they were all really straightforward, it wouldn't be too difficult.
25:42So it's really in the harder operations where the robot makes it possible, really.
25:47Coming up, I'll find out how antiseptic changed surgery forever.
25:52It would be sprayed out of this nozzle straight over the patient.
25:55I discover how cleaning a hospital has changed through the centuries.
26:00So it's done a really good job of soaking that blood up.
26:04This is lovely, spotlessly down here. It's all good.
26:09And learn that rules for nurses remained surprisingly strict until just a few years ago.
26:15You were not allowed to be married.
26:16You weren't allowed to be married?
26:17No.
26:30I've witnessed some incredibly high-tech equipment here at Barts.
26:34And at the forefront of modern surgery is its million-pound robot.
26:38It enables surgeons to carry out extremely complex operations and patients recover quickly.
26:46How are you getting on?
26:48Chris, who had an operation to remove lung cancer only yesterday, is now almost fit to leave the hospital.
26:56Hopefully get you home tomorrow morning then, all being well.
26:59We'll get everything set up.
27:00OK.
27:01Thank you so much.
27:01You take care now.
27:02Thank you very much.
27:03Chris has only four small scars as evidence of a three-hour surgical procedure.
27:09But operations haven't always been so neat and tidy.
27:14Today, we have futuristic million-pound robots following advances in medical imaging and the advent of anaesthetic.
27:25But 400 years ago, operations were much more brutal, like the lithotomies or bladder stone removals I investigated earlier.
27:36One celebrated writer who underwent a lithotomy was 17th-century civil servant Samuel Pepys, who documented it in his famous
27:46diary.
27:47Pepys recorded daily life in great detail and was famous for burying his precious stash of cheese to protect it
27:55during the Great Fire of London.
27:57At just 25, he chose renowned Bart's surgeon Thomas Hollier to remove his excruciating bladder stone.
28:05Though, as Pepys was well off, his surgeon came to him.
28:10The hospital was reserved for the poor.
28:12With no cameras or visual guide of any sort, I'm going to attempt this dangerous 17th-century surgery on our
28:20very own Samuel Pepys,
28:22under the expert guidance of urologist Jonathan Goddard.
28:26If we go over to Samuel here, first you have to find the stone.
28:31So you have to feel for the stone, and actually, you have to listen for the stone.
28:36So you use something called a sound.
28:38OK.
28:38OK?
28:39What you do...
28:40Yeah.
28:40..if you pass that into the bladder, you might hear it go...
28:43..dink!
28:44You sound and listen for the stone.
28:46Ah, OK.
28:47You listen for it, tapping against the stone.
28:48And you'll feel it as well as you pass that in.
28:50You should be able to feel it as well.
28:51It's a combination.
28:52Yeah.
28:52And you have to pass it into the urethra, and it wants to end up like that.
28:57Yeah.
28:58The sound is pushed through the urethra until it enters the bladder.
29:03And then as you start to go down, turn it round.
29:06Ooh, OK.
29:07There you go.
29:07Right, I think I'm in.
29:08So you're around that curve, and you're in the bladder.
29:10Yeah.
29:11We know from contemporary reports, that's really painful.
29:14Yeah.
29:14It's not nice.
29:15But you have to carry on.
29:16You can't stop.
29:18The surgeon must now feel and listen out for the metal tool hitting the stone,
29:23above the screams of the patient, before making the incision.
29:27You might be able to feel that.
29:29Yes, I can.
29:30Yes.
29:31I can feel the sound.
29:31So you know that's where you need to go.
29:33So you've got the scrotum here.
29:35Yeah.
29:35The anus just there.
29:36And that's the perineum.
29:37I can feel that sound there.
29:39Yeah.
29:39So if I cut straight down there, I should come down onto the urethra.
29:43Aim for the sound.
29:44Brilliant.
29:44How big a hole?
29:45Well, they said between two and four inches.
29:47So that's probably big enough.
29:48But remember, you've got to get the stone out.
29:49Oh, OK.
29:50So you need to slide that into the bladder.
29:52Basically, again, along the sound?
29:54Again, along the sound.
29:56There's the sound.
29:57You can hear it into the bladder.
30:00It's really difficult doing it blind.
30:02And he's not screaming at you, and he's not bleeding.
30:05OK, hopefully.
30:06Hopefully that's in the bladder.
30:08And then out this comes.
30:10And then I'm going to give you the stone forceps.
30:13See if you can feel the stone.
30:15OK.
30:17I'm pushing in here.
30:21Am I in the right place?
30:23This is the problem.
30:24I'm listening.
30:25And all the while I've got peeps screaming.
30:27Screaming.
30:28Begging you to stop.
30:30Can you feel the stone?
30:31I've got something.
30:32Paul.
30:34Oh, my goodness.
30:36Here it comes.
30:36Oh, it's huge.
30:37Here it comes.
30:37It's gone.
30:38You can't leave it in his perineum.
30:40Pull it out.
30:42Quickly.
30:43Come on, come on, come on.
30:44Oh, my goodness.
30:46That's it.
30:46The stone's out.
30:47It's out.
30:48The worst is over.
30:49Or is it?
30:50He now has to survive.
30:52Yeah.
30:52So he survived that.
30:54He hasn't bled to death on the operating table.
30:56Well, he'll be bleeding now.
30:57He'll be bleeding heavily.
30:58So do I stitch things up?
31:00No.
31:00You mustn't stitch the wound.
31:02Because if you stitch the wound and you get an infection inside, it becomes an abscess.
31:05That will definitely kill him.
31:07So you have to leave and see what happens.
31:08I've done my work.
31:09You've done your work.
31:10That was hard.
31:11Yeah.
31:12That's a bit hard.
31:15Unlike many, peeps lived to tell the tale.
31:18And he celebrated his survival every year with an anniversary party.
31:23Writing in 1664,
31:25This day it is two years since it pleased God that I was cut of the stone
31:30and did resolve while I live to keep it a festival.
31:39In Samuel Peep's time, hospitals were dirty and downright dangerous places.
31:45With patients regularly dying of post-operative infections.
31:50Nowadays, Bart's has a vast team of cleaners making sure the hospital is spotless.
31:58But up until the 1800s, keeping the hospital clean was a whole different ballgame.
32:07Okay.
32:08I've got some fake blood here.
32:09And we're going to imagine quite a gruesome operation.
32:13The blood is pouring out of this hemorrhaging patient.
32:18And the operation is becoming more and more dangerous itself
32:22because the surgeon is going to be slipping around.
32:26But the floor of the operating theatre in the 1800s
32:31was covered with something that was very good at soaking up blood.
32:38Sawdust.
32:40A common by-product of 19th century building work, sawdust was both cheap and readily available.
32:47But was it effective?
32:49Well, certainly covering it.
32:51The surgeon would have been able to walk around on that sawdust.
32:56It's going to solve the problem of the slippy floor.
32:59Our patient's continuing to bleed, though.
33:02And so we'll pour some blood on top.
33:06And you can see that's soaking in quite nicely.
33:09Immediately.
33:13And then, once the patient is out and off to recovery, I suppose you have to tidy up, don't you?
33:20So let's see how well this sweeps up, then.
33:26It's pretty good, actually. Look at that.
33:29So it's done a really good job of soaking that blood up.
33:35Though the sawdust did a better job than I expected,
33:39something revolutionary was thankfully on the horizon.
33:43In the early 19th century, up to 80% of all surgical patients died,
33:49usually due to infection.
33:50But in the 1860s, an extraordinary discovery had life-saving consequences.
33:58Down in the archives, archivist Ginny Daw Woodings has got an intriguing invention to show me.
34:05So this is an example of Lister's carbolic acid spray.
34:12In 1865, Scottish surgeon Joseph Lister started using carbolic acid,
34:18a chemical already being used to treat sewage at the time.
34:26Inspired by Louis Pasteur's groundbreaking theory that disease could be caused by bacteria,
34:33Lister proposed that such germs could be carried on dressings, hands and surgical instruments.
34:43He started out by doing washing hands, washing instruments
34:47and preparing wounds with carbolic acid and found this to be effective.
34:52And then he thought that maybe there might be additional germs in the air.
34:54So he decided to create a spray which could create vaporised and aerosol carbolic acid
34:59to spray over the patient and the surgical team during the surgery.
35:02This one is from about the 1880s and was used in St Bartholomew's on the wards and in the surgeries.
35:06Yeah, actually used in this hospital.
35:08How does it work?
35:09So what you have up here is a water tank and underneath here is a paraffin lamp which would have
35:14heated this to create a steam.
35:15In this little jar here you had your carbolic acid and there would be a rubber tube connecting this valve
35:20down to here.
35:22The steam would vaporise the carbolic acid creating a pungent yellow mist.
35:29And it would be sprayed straight over the patient.
35:32And what was it like to be operating in a room with that being sprayed around?
35:36Reports aren't good.
35:37It created a very slick oil sheen over the patient and surgical team.
35:41But also people reported having skin irritation, eye irritation and respiratory problems on the back of it.
35:46And Lister himself seems to have fallen out of love with it by 1880s. He's stopped using it.
35:52Though chemicals were still used to clean surfaces, at the end of the 1800s Lister and his contemporaries realised that
36:00cleaning clothing and equipment with hot water and steam was just as effective at killing germs.
36:06So they began to focus on creating an entirely sterile or aseptic environment in which to operate.
36:16So do we know if this actually worked alongside the other measures that he was putting in place?
36:22It definitely would have been effective.
36:25In fact these innovations were so effective that mortality rates following surgery dropped from around 40% to less than
36:353% by 1910.
36:38And maintaining a clean environment continues to be of the utmost importance to Bart's hospital staff.
36:44Up on the surgical ward, medical director Andrew Ragg is performing his regular infection prevention ward round.
36:53So here we're up on a surgical ward. This is patients who are recovering from major cardiac surgery.
37:00Doing an infection prevention walk around. It's really important that we make sure that the environment is as clean as
37:05possible because obviously although it doesn't seem as glamorous as major heart surgery, actually infection control prevention is as important
37:12as any of the work that we do in the hospital.
37:15We're really focused on kind of looking for those places on a ward where maybe a bit of dirt can
37:20be missed, a bit of dusting can be overlooked.
37:23I mean it's just such an endless task.
37:27It's all good. Nice clean space.
37:30There are 290 patient beds in Bart's and as the director ultimately responsible for infection control, it's Andrew's job to
37:39make sure the entire hospital meets the highest standards.
37:43Hello, hi Jason. Hi.
37:45My name's Andrew. We're just doing a little inspection of your room so we're going to have a little look
37:49around you, that's okay?
37:50Yeah, absolutely, go ahead.
37:50Yeah, good.
37:51So some of the things is to look for the spaces where we know that kind of dust can hide
37:55and collect.
37:56And this is the common one we do, looking on the high surface high dust and nothing there, but let's
38:01just dry the back.
38:02Okay, yeah, so maybe not unexpected, we've got a tiny little bit of dust there, which we kind of nearly
38:07always find in some of the spaces in the wards because the dust collects so quickly.
38:12It comes from the linen, paper towels, clothes, so it's not the kind of the heavy build-up of the
38:19bad dust and dirt that you can get if you don't clean.
38:22But Andrew's not finished yet, even a small amount of dust can harbour dangerous microbes.
38:28Here we are, so this helps, saves my knees, a mirror on a stick, but what it does allow is
38:35to check under the bed rail to make sure it's really clean.
38:38This is lovely, spotlessly down here.
38:39Thanks so much for letting us have a look around, thanks so much for your time.
38:43It takes all sorts of professionals to keep barts running smoothly.
38:48Maintaining a germ-free environment is of course essential, but so is making the patients feel well cared for.
38:56And I'm about to learn of a tradition that embodies the huge heart of barts.
39:02Ward's sisters would bring in patients that they knew were lonely to fill in the beds at Christmas and give
39:08them a really good Christmas.
39:17The dedicated staff of St Bartholomew's have always been its beating heart.
39:23From offering help in the minor injuries department.
39:26Now this is the bit that's going to be uncomfortable.
39:30To administering cutting-edge treatments.
39:33We'll start with the first 30 mils.
39:35There are many key roles to play, including all those carried out by its tireless nurses.
39:41And since the NHS began in 1948, they've seen a lot of changes.
39:48Hello. Hello.
39:50It's lovely to meet you.
39:52Carol Bavin and Alison Knapp trained as nurses and worked here at Barts between 1955 and 2010.
40:02We all started at a preliminary training school, PTS.
40:06And I'm second row back, the first one.
40:10This is me at PTS actually.
40:12Yeah. This is you.
40:14Yes.
40:15Trainees of the past had to put up with quite a number of rules.
40:19We were not allowed to live out in our nursing training, which was three years long.
40:23We lived in nurses' homes.
40:25Yeah.
40:25That were controlled by the hospital.
40:27What were they like?
40:28Well, you were not allowed to be married and you were not allowed...
40:31You weren't allowed to be married?
40:33No.
40:34Goodness me.
40:36Aside from two late night parties a month, the young women were given a strict 10pm curfew.
40:43If you came in late, then you'd be on Matron's doorstep the next morning.
40:48But there were other subtle ways of getting in.
40:51When an ambulance came to A&E and then if you were smart, then as the doors opened to let
40:59the ambulance in, you slipped in as well.
41:03Alison and Carol may have lived under somewhat draconian conditions, but their pride is evident, especially in their Barts badges
41:11that they still wear today.
41:14You could be anywhere in the world and someone will look up at a medic in particular or another nurse,
41:20look up and say, oh, you're Barts.
41:23Really?
41:23Very much so, yes.
41:25Tell me about this photograph then.
41:26Well, it's Christmas carols round the wards.
41:28Nurses would go round the wards with their capes inside out and singing carols for the patients.
41:34That's lovely.
41:35But the wards were decorated and nurses themselves had tinsel on their hats and everything.
41:40So it was very festive. I remember a lot of very festive Christmases.
41:44Yeah.
41:46Some of the experienced ward sisters would bring in patients that they knew were lonely that had nothing the matter
41:52with them.
41:53Really?
41:53To fill in the beds at Christmas and give them a really good Christmas.
41:56Oh, my goodness, that's amazing.
41:57It was a lovely idea because they used to send up a huge turkey to each ward.
42:01Probably the surgeons are better at carving it than the physicians.
42:08Though traditions and practices have changed over the decades and centuries of Barts history,
42:14one thing that's remained a constant is the dedication of its team.
42:21Hello.
42:22Hi.
42:23For nurse Sabila, the job is hugely satisfying.
42:27Thank you very much.
42:28To have someone so sick come in and really need your help and then to be able to give that
42:33help,
42:34it's the best feeling ever.
42:36It's the most rewarding thing because it really does make a difference.
42:40So that's delivering.
42:41Thank you, Sabila.
42:45Knock, knock.
42:46Hiya.
42:47Hello.
42:48How are you today?
42:49I'm good, I'm good.
42:50But it can also have an emotional cost.
42:54Three weeks ago, Sabila started caring for patient Kevin O'Hara, who came to Barts with terminal renal cancer.
43:02Out of all the places in all the world, this is the place I'd rather be.
43:06I know they all know what they're doing.
43:08Every nurse that's come in here has a chat and has a talk.
43:11No problem.
43:12That is really good.
43:13It lifts your spirits.
43:15And I love them.
43:16I love them all.
43:17If you give people good memories, that's what it's all about.
43:20We're only here once.
43:22Enjoy it.
43:24And I will be enjoying the next, however long I've got, we will enjoy it.
43:30Now news has come that Kevin has sadly died from his cancer.
43:35Kevin was an amazing person.
43:37He was someone that I can say that I'm very glad to have met.
43:43No matter how many times you see a patient's eye, it doesn't make it easier.
43:49And you just continue to feel the better space, not forgetting them, but just in memory of them.
44:13Next time, I uncover one of the most important medical discoveries of all time.
44:19There's something extremely special in this box.
44:22Which helped make life-saving heart operations at Barts possible.
44:28Okay, moving at this top line.
44:30Okay.
44:31And I get up close and personal with the famous bloodsuckers of Barts.
44:35Here's a nice piece of liver for you little leeches.
45:04Here's aеюсь.
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