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00:00It's late summer. The country is in lockdown as a deadly illness spreads
00:08like wildfire. No one knows how the disease is transmitted or how to cure it.
00:14In a London hospital all the doctors flee leaving just a matron and the
00:19pharmacist in charge. But to save patients lives they'll have to risk
00:25their own. The year is 1665. This is St. Bartholomew's, Britain's oldest hospital.
00:39This hospital has cared for people through the reign of Henry VIII, through
00:43the plague, the Great Fire of London, the Covid pandemic and beyond. Over nine
00:50centuries of scientific discoveries are here at my fingertips. There's something
00:56extremely special in this box. Now for the first time, oh wow okay, I'll reveal how
01:03the breakthroughs of the past, you've got to see this with your own eyes, are helping
01:08to write the future of medicine. I am absolutely blown away by this. I'll step
01:15inside the day-to-day of this state-of-the-art institution. That is incredible. Where
01:21they've been saving lives and making history. Oh wow. For nearly a thousand years. And behind
01:43these three, five. Clinic five, these lifts here, second floor. Hospitals are there for
01:49us from our births to our deaths. And some of us will end up in a place like
01:54this through a life changing experience. Staff at Barts have been looking after
01:59patients through medical emergencies, life and death surgeries and routine
02:04illnesses for centuries. For them it's not just a job.
02:07Thanks very much. Thank you. It's a vocation.
02:12I've just called the Encore SHO. Yeah. His calcium's 1.7.
02:17Up on Ward 5A, nurse Sabila Shaheed is just beginning her evening shift.
02:22She's worked at Bart's for two years since completing her training here.
02:26Hello. Carol, how are you? 5A is a cancer ward. How are you?
02:31As a world-renowned centre of excellence for cancer care,
02:34Bart takes patients from all over the country who need urgent and radical treatment.
02:40The most recent arrival from Colchester is 24-year-old data engineer Harrison Berkey.
02:46So, we'll just do your blood pressure quickly.
02:48Obviously, we know it's been really low today, but you've had the fluids.
02:51Harrison had been to the GP feeling unwell.
02:54I had been suffering with lots of stomach pains.
02:57As his symptoms worsened, he finally went to A&E.
03:00They did a CT scan on my stomach to find out that there was a tumorous growth in my stomach
03:05that had spread to my liver and my lungs.
03:08The cancer in Harrison's stomach, liver and lungs was diagnosed as a secondary cancer,
03:15meaning it had spread from a primary source somewhere else.
03:19Two specific cancer marker blood tests and a physical exam
03:23eventually pinpointed the origin in his testis.
03:27So, they rapidly got me here to get my chemotherapy treatment as soon as possible.
03:33They're really tiny anyways.
03:35Thank you, right?
03:36Nothing big.
03:37Went your own water?
03:38Yep.
03:40Consultant oncologist Kenrick Ong is looking after Harrison.
03:44This is Harrison's initial CT scan.
03:47The organ on the right here is the liver.
03:50This is normal liver tissue in white.
03:52But you also see these dark spots over here, which are cancer deposits.
03:57The most striking feature is a huge mass measuring up to 19 centimetres,
04:03occupying most of the left side of his abdomen.
04:07And that's why we had to go ahead with chemotherapy straight away.
04:12Harrison has already had one round of treatment with high-dose chemotherapy drugs.
04:18Kenrick hopes the chemo will stop the spread of the cancer and shrink his existing tumours.
04:24The original primary cancer in his testis can then be surgically removed.
04:29Call me if you need it.
04:30Do you want me to check when you're next due?
04:31Yes, please.
04:33My treatment is going to be a long road ahead, I know,
04:35but I'm being upbeat in terms of the situation that I'm in.
04:41So the next couple of weeks are probably going to be one of the toughest periods for him.
04:47Harrison needs a high dose of chemotherapy because of the extent of spread of his cancer.
04:53It is quite aggressive.
04:54And if we gave him standard chemotherapy,
04:57the chances of it returning or relapsing are quite high.
05:01So you've got this. You can do this.
05:05His mum, Julie, an NHS clinical systems manager,
05:09has put her job on hold so she can be by her son's side throughout his treatment.
05:14Harrison, he's my only one,
05:16and we will be with him every step of this journey.
05:21That key thing is, day by day,
05:24just embrace every moment that you have
05:30and which we're doing.
05:35Over the next two months,
05:37Harrison will have two more cycles of chemo,
05:39each lasting up to three weeks,
05:41to try to reduce the cancer.
05:44To help him deal with the side effects,
05:46he's been put on a regime of steroids,
05:49anti-nausea pills and pain relief medication.
05:53These are delivered to his room three times a day,
05:56straight from the hospital's pharmacy.
06:00It looks very different from just a hundred years ago,
06:03when Bart's pharmacists, men only back then,
06:07would still mix the medicines by hand.
06:10And we find standardised recipes for common medicines
06:14going back as early as 1618.
06:17A new space was created at the hospital
06:19to make up medications on site in 1614.
06:23The man who prepared the drugs there was the apothecary.
06:27His domain was known as the apothecary's shop,
06:30and I'm trying to work out where that would have been.
06:35I've got this plan of Bart's from the 1600s here,
06:39so we can imagine what it would have been like.
06:43Now, this big block in front of me would not have been here,
06:46cos that was built in the 1700s,
06:48but the church would have been,
06:50Bartholomew is the less,
06:51and then there would have been cloisters
06:54reaching out in front of me.
06:56There's a big building here.
06:57It says Great Cloister just there,
07:00and this apothecary's shop we know was in the cloisters.
07:04So it could have been right here.
07:07The job of apothecary is an ancient one.
07:11For many centuries, they were more like grocers,
07:14selling all kinds of herbs, spices and wines.
07:19In the early 1600s, King James I
07:22formally recognised apothecaries as specialists
07:25in mixing and dispensing medicines.
07:30When the apothecary's shop was built here,
07:33it was quickly stocked up.
07:36We've got evidence of what was being bought
07:40for the apothecary's shop.
07:41So we've got the hospital ledger here.
07:43We've got payments for drugs and herbs,
07:47and then this artefact for preparing some of these medicines.
07:53A great brass mortar and pestle and a block to set it upon.
08:01Miraculously, a pestle and mortar from the original shop still survives.
08:06I know it's somewhere in the Barts Museum,
08:09which holds centuries' worth of medical artefacts.
08:15OK, well, this is a question of hunt, the pestle and mortar.
08:21What's that? That's not a pestle, that's a chamber pot.
08:25Drug pots.
08:28Poisons.
08:31And now that is a pestle.
08:35But not a brass one.
08:38Ah, this has got to be it.
08:40That's enormous.
08:42There we go, large brass pestle and mortar.
08:45This is for grinding up ingredients to be made
08:49into powders, poultices, ointments.
08:53Gives you an idea of the volume of medicines
08:56that were being made in that apothecary's shop.
08:59That would have taken some elbow grease, wouldn't it?
09:01Grinding up your herbs.
09:05This particular kit dates to 1660.
09:09And the apothecary, who would have been using it,
09:12was called Francis Barnard.
09:14When Francis started the role in 1661,
09:18he had no idea that just four years later,
09:21he would face the biggest challenge of his life.
09:25Coming up, I discover the horror when the plague came to Barts.
09:31This swelling is a bubo.
09:33I'm going to cut into that,
09:36and it should relieve a bit of the pain.
09:39Harrison's treatment continues.
09:41For any parent to see your child go through that
09:44is absolutely horrific.
09:47And Barts faces a battle of a different kind.
09:50We suddenly heard the guns going,
09:53then the bombs began to fall.
10:03Barts has served patients
10:05through some of the most challenging times in history,
10:08from the COVID pandemic to both world wars.
10:11But one of its darkest chapters
10:13arrived in the summer of 1665.
10:19An epidemic swept through London and across the country.
10:23People died in their thousands.
10:27An epidemic that would become known as the Great Plague.
10:34Some of the symptoms were general.
10:37Headaches, vomiting and fever.
10:40Some victims developed gangrene in their fingers and toes.
10:44But there was one sign of the plague that was practically unique.
10:48She's got this large swelling.
10:51This is what gives the plague its name.
10:53We call it the bubonic plague
10:55because this swelling is a bubo, an infected lymph node.
11:00I expect that's quite painful, Ellie.
11:02So I'm going to cut into that.
11:05And it should actually relieve a bit of the pain, Ellie.
11:10Medics of the time believed lancing the buboes
11:13would help the patient by releasing the badness.
11:18And anyone with signs of infection
11:21was likely to be locked up inside their house
11:24along with their family to either recover or die.
11:28At night, bodies were brought out and disposed of
11:32along with the rest of the city's dead in mass plague pits.
11:36Now, today, we understand bubonic plague very well.
11:41We know it's caused by a bacterium called Yersinia pestis.
11:46We can treat it with antibiotics.
11:49We know that it can jump from animals into humans.
11:53Once it's in human populations,
11:55it can spread quite rapidly, as it did in the 1600s.
12:00The infection likely spread from rodents to humans via fleas
12:04and then from human to human via body lice.
12:09Now, they didn't know any of that in the 1600s,
12:12but they did realise that it was dangerous to be close to somebody
12:18who was suffering from the plague.
12:21With plague victims confined to their homes,
12:25Bartes continued to admit patients with other ailments
12:28until finally there was a breach.
12:33Archivist Kate Jarman has the Bartes governor's minutes for September 1665.
12:39The plague's been raging all summer, and on the 2nd of September,
12:42this is the first time where plague actually gets into the hospital.
12:46With the plague now inside Bartes for the first time, the gates were locked.
12:52Those within were left to wait and see who would be the next victim.
12:56It was a risk some weren't willing to take.
12:59A few days later, the two physicians are gone.
13:02They aren't in London anymore.
13:03The wealthier staff just left town.
13:05So who's left?
13:06So you've got a record of the governor's appointing another surgeon,
13:11Thomas Gray, for the business only of the pestilence,
13:14but otherwise there are no trained medical staff on the site.
13:17The doctors may have fled, but at least one member of staff remained.
13:21Francis Barnard, who is the apothecary at the hospital,
13:24he's been appointed to prescribe for the patients in the doctor's stead.
13:28So he's stepping up into the role of physician, basically.
13:31As well as Francis, other workers in the hospital also stayed.
13:36Then you've got Margaret Blague, the matron,
13:38and the 15 ward sisters that she's responsible for.
13:42That's pretty much it.
13:44It's hard to imagine how tirelessly this dedicated team
13:48must have worked during this horrific moment in history.
13:52I want to find out how Francis could have helped the plague victims at Bartes.
13:57So I've come to meet medical historian Leslie Smith in her apothecary shop.
14:03Leslie, what kinds of things would Barnard have been preparing?
14:07He certainly would have produced cordials to make them comfortable,
14:11particularly if they had poppy in.
14:12That would certainly have enabled them to sleep and get a bit of rest.
14:18As well as making up prescriptions for the patients,
14:21Francis would have also tried to purify the hospital itself.
14:25On the windowsills, there would have been herbs and spices
14:29because we thought that sickness like this came from miasma.
14:34We thought it was carried in the air.
14:36To combat the toxic air or miasma that was believed to cause the plague,
14:42Francis would have combined some pungent ingredients.
14:46If you smell that,
14:46it reminds you of your childhood Christmas, cloves and oranges.
14:49That smells really Christmas.
14:50I know, it does.
14:51It immediately snatches you back to being little.
14:54So the idea is that you're breathing in air,
14:55but it's coming through those herbs.
14:57And it's being filtered by these sweet herbs.
14:59Yeah.
14:59So therefore, it's dealing with the miasma.
15:01It's a nice idea.
15:02It just happened to be wrong.
15:05Before antibiotics and vaccinations,
15:07social distancing and luck were your best bets for surviving the plague.
15:12By the time it was over,
15:14the outbreak had claimed the lives of more than 100,000 people in London alone.
15:20His efforts may have been futile,
15:23but Francis had stayed with his patients.
15:26He survived and continued working at the hospital for many years.
15:39Over the centuries,
15:41tens of thousands of dedicated staff here have cared for patients.
15:46But Bart's also has a community of volunteers.
15:51Hello.
15:51Hello.
15:52How are you?
15:53I'm good.
15:53Like Rita Buttigieg,
15:55who works in the Bart's Guild Shop
15:57on the ground floor of the King George V building.
16:00How are you, Miss Rita?
16:01Oh, fine, thank you.
16:02Good.
16:03I had cancer.
16:04I was treated in Bart's,
16:06and I felt I wanted to give back a thank you.
16:09See you soon.
16:10Bye then.
16:12And I've worked in the shop for 14 years.
16:16Rita does a shift here every Thursday,
16:19helping to keep the shop running.
16:21See you.
16:21Have a lovely day.
16:22We sell sweatshirts, pens,
16:25hand-knitted cardigans with a whole list of things,
16:28and all of the donations go straight to the Guild.
16:33The Bart's Guild has been in operation for over 100 years,
16:37and its contribution to the hospital has been vital.
16:40Founded by the wives of five Bart's consultants back in 1911,
16:46Guild members hand-sewed clothing and bed linen,
16:50made splints and crutches, and raised money.
16:53After the creation of the NHS in 1948,
16:56the Guild shifted to running the hospital shop,
16:59and by the 70s, they even had a florist.
17:03We've got some very good knitters,
17:05and our knitted teddies are very popular.
17:09I think it's more than a shop.
17:12It gives comfort to a lot of people,
17:14and there's always in here someone to listen to their story.
17:19Thank you very much.
17:20Thank you. Bye-bye.
17:23Rita is just one of thousands of patients
17:25who've been treated for their cancer at Bart's.
17:29Up on Ward 5A, 24-year-old Harrison Berkey
17:33was admitted a month ago with advanced testicular cancer
17:37that had spread to his liver, stomach and lungs.
17:40I've just recently shaved my head because it needed doing.
17:46With his mum Julie by his side,
17:48Harrison is preparing for his second round of high-dose chemotherapy
17:52under consultant oncologist Kenrick Ng.
17:56So chemotherapy is quite grueling.
17:58It does come with its host of side effects.
18:01Loss of hair, loss of appetite, soreness in the mouth,
18:05ulcers which can cause difficulty with eating and drinking.
18:09These side effects mean Harrison has been losing weight,
18:12so he's now been fitted with a feeding tube
18:14to ensure he gets the nutrition he needs.
18:17This feeding tube going in is one of those things I was a bit scared about,
18:20but now I've done it and it's out of the way,
18:23it's like, OK, that's the next thing.
18:26Chemotherapy is one of the most commonly used treatments for cancer.
18:30It involves injecting a mix of powerful, toxic drugs into the bloodstream
18:35which attack cancer cells, stopping them growing and multiplying.
18:40Like many medical breakthroughs,
18:42it was discovered by accident and from very unlikely origins.
18:47Doctors studying the effect of the chemical agent mustard gas in World War I
18:52discovered that soldiers' white blood cells had been destroyed.
18:56They soon realised components from the powerful chemical agent
19:00could be used to target cancer cells.
19:03The first human trial took place in 1942
19:06and within a decade,
19:08chemotherapy was transforming cancer survival rates.
19:13How are you feeling?
19:15I feel OK, I'm just getting used to the tube.
19:18I know, people take a little bit of getting used to that one.
19:23For him and for his family, it's a dramatic change.
19:27I try to reassure him that he's young,
19:30he's physically robust and he's got great mental strength.
19:34I think he'll get through this.
19:37Harrison's mum, Julie, is by his side.
19:40For any parent to see your child go through that is absolutely horrific.
19:47However, it's not me in that bed, it's my son, Harrison.
19:51So you have to put your own feelings aside
19:54and help with this healing process.
19:58400 years ago, apothecary Francis Barnard
20:02was making remedies for his patients on site
20:04and today, Harrison's chemotherapy drugs
20:08are still made right here
20:10in Bart's state-of-the-art chemo lab.
20:12They produce over 20,000 customised chemotherapy doses each year
20:18in addition to the 120,000 ready-made drugs
20:22dispensed by the hospital's pharmacy.
20:24So this is your lair down here.
20:26It is.
20:27Lead pharmacist Satiris Antonio is showing me how it all works.
20:33And it's not what I expected.
20:35Where are the medicines?
20:36Well, things have changed over the years.
20:38All of our medicines are effectively behind that white wall there
20:41because everything's now done and dispensed by a robot
20:44and it supplies all our medicines for the whole of the hospital.
20:47All automated.
20:49And if you come round here, I can show you the robot specifically.
20:52The robot...
20:53The Bart's pharmacy robot helps manage storage and dispensing
20:57for all the medicines needed across the hospital,
21:01all operating within a neat nine-metre-square space.
21:06So it can stack right up far higher than you could reach out here.
21:10Well, exactly.
21:11Yeah.
21:11Exactly.
21:11And it's continuously working 24-7.
21:14When medicines are delivered to the hospital,
21:17the pharmacy teams scan them into the system
21:19and let the robot work out the best place to store them
21:22until they're needed.
21:24Right, so can I do this one?
21:25You can.
21:26So scan it.
21:26Scan this little barcode?
21:27Yep.
21:28And then place it.
21:30That's it.
21:31All the way.
21:31Let go.
21:32Ooh.
21:33Give it a couple of seconds.
21:35It will pick it up.
21:37Oh, my goodness.
21:38Place it and optimise its space.
21:41It's quite strange when you hear that noise.
21:44When a drug is required by a patient,
21:46a member of the 120-strong pharmacy team orders them up
21:50and the robot dispenses them in no time at all.
21:53That's brilliant, isn't it?
21:5620 seconds.
21:57That took less then.
21:58Now we can take those up and put it with the bags that go up to the wards.
22:02Yeah.
22:02In the portering.
22:03Coming up, the hospital finds itself on the front line.
22:08We filled every bed in the hospital.
22:10The surgery felt like a battlefield.
22:13And a technique pioneered by a wartime surgeon 100 years ago...
22:18..of this incredible trust that they're placing in him
22:20transforms a Barts patient today.
22:23So my plan now is to try and get into this area where her disease is.
22:36As the oldest hospital in Britain,
22:39Barts' story is interwoven with the history of London itself,
22:43and it often found itself right in the heart of the action.
22:49In the First World War, Germany launched over 50 aerial attacks,
22:54some from the giant inflatable airships
22:57known as Zeppelins.
22:59Many were focused on the capital,
23:01the centre of the country's economic power and military command.
23:08On the 8th of September 1915,
23:11a Zeppelin dropped a bomb really close to Barts,
23:14and it did cause considerable damage.
23:18The hospital governors wrote about the aftermath of the bomb.
23:221,197 panes of glass were broken
23:26by the force of the explosion.
23:29But in the close, outside the hospital,
23:32a hole big enough for a motorboss was made.
23:38To this day, the hospital still bears the scars
23:41from air raids over the city.
23:43So this is definitely damage from bombs being dropped.
23:50You can imagine the force with which these pieces of shrapnel
23:54are hitting the wall.
23:56Look at that massive crater.
24:02But for Barts, the worst air raid of the First World War
24:06came on the morning of the 13th of June, 1917.
24:1130 German bombers had entered the skies above East London,
24:15and they dropped 72 bombs in just under 15 minutes,
24:19turning the streets into a war zone.
24:23I have a letter from Barts' nurse, Madge Vile,
24:27who was there to witness the horror firsthand.
24:29We had no warning.
24:31We suddenly heard the guns going,
24:34then the bombs began to fall,
24:36and everyone springs into action.
24:38Look, the students cleared the hospital square
24:41of the beds and patients in just over five minutes.
24:45I've never seen anything like the way they worked.
24:48The bombing rocked the city.
24:52Casualties began to pour into Barts.
24:55We filled every bed in the hospital that was empty,
24:59including the military block.
25:01The surgery felt like a battlefield.
25:04Amid the chaos, a very unexpected visitor
25:08dropped in to check on the wounded.
25:11King George V, grandfather of Queen Elizabeth II.
25:14The king came into the surgery.
25:18No work was stopped for him,
25:20and he visited all the patients in the wards,
25:23and at the end made a speech in the square,
25:26congratulated everyone on the way they'd worked.
25:30By the end of that day,
25:32162 Londoners had been killed,
25:35and over 400 injured.
25:37As well as treating civilian casualties,
25:40the East Wing of Barts was turned over
25:42to accommodate wounded soldiers
25:44shipped back from the battlefields.
25:47Ginny Dorr Woodings has the hospital journal
25:50from May 1915,
25:51which includes an account of their shocking injuries.
25:55They're encountering a sort of warfare
25:57and type of wound that they've never experienced before.
26:00Look at this, extraction of bullets or shrapnel, 111.
26:04Lots of injuries to the head and neck.
26:07The First World War ushered in a terrible new age
26:11of industrial warfare.
26:13Machine guns, tanks, mortar bombs
26:16and close-range trench fighting
26:17led to unimaginable casualty numbers
26:20and traumatic injuries.
26:22It fell to army medics,
26:24some of them from Barts,
26:26to offer first-line treatment.
26:28You get a sense of people feeding back techniques
26:30and knowledge that they're learning at the front
26:31and having it published
26:32so they can learn from what's happening out there.
26:35But figuring out how to treat
26:37such disfiguring facial injuries
26:40was a new challenge.
26:42Enter surgeon Harold Gillies.
26:46Born in New Zealand in 1882,
26:49Gillies moved to England to study medicine,
26:52training at Cambridge and then at Barts.
26:55In 1915, he joined the Royal Army Medical Corps,
26:59serving in France,
27:01where he experienced the horrors
27:03of trench warfare up close.
27:06Gillies soon began experimenting
27:08with procedures that could reconstruct
27:11the faces of injured servicemen.
27:15I've come to the Royal College of Surgeons
27:18to learn more from plastic surgeon Nick Bennett.
27:23Harold Gillies was involved in
27:25many thousands of nasal reconstructions
27:28and because of the volume that he was treating,
27:30he pushed on the specialty quite dramatically.
27:32So he's become known as the pioneer
27:34of modern plastic surgery.
27:36There's evidence of nasal reconstructions
27:39being carried out as early as 600 BCE in India,
27:44often on criminals who'd had their noses cut off.
27:47Then in 1596,
27:50the Italian surgeon Taglia Cozzi
27:52developed a method of borrowing skin
27:54from a patient's arm to recreate the nose.
27:58But such operations were few and far between.
28:02Gillies would help to change that.
28:04And he kept incredibly detailed records of his progress.
28:08So these are the documents of Private Hickey,
28:11who was struck by a missile
28:13and it essentially took his nose off his face.
28:16Now, these are shrapnel injuries
28:18and shrapnel is irregular shape.
28:20Yeah, so it's wricking through tissue.
28:23So imagine this searing injury.
28:25Private Hickey suffered the hit
28:27during the Battle of the Somme in 1916.
28:30The severity of his injuries
28:32soon landed him in the care of Gillies,
28:35who by 1917 had set up a dedicated hospital
28:38in Sidcup in south-east London.
28:41I mean, there's the trauma of having been involved
28:43in that kind of warfare
28:44and then the additional trauma for these patients
28:47of that facial disfigurement.
28:48Exactly. So I think Harold Gillies was very interested
28:52in helping them with the process
28:53of looking in the mirror again
28:54and the holistic approach to these injuries.
28:57Gillies' pioneering technique
28:59was to borrow a flap of skin
29:01from the soldier's head or neck
29:03to help rebuild their missing facial features.
29:06The key was to keep this donor skin
29:09connected to its blood supply via an artery,
29:12meaning it stayed healthy
29:14while the graft healed in place.
29:16But it wasn't a pretty or quick process,
29:20as Hickey was to find out.
29:22So this is quite shocking.
29:24Yes, he's got a nose now,
29:26and the form of that is much better,
29:28but he's got a big area of damage on his forehead,
29:32and this is just extraordinary.
29:34What's that?
29:34This skin is keeping his nasal skin alive.
29:38Nick has made a plasticine model
29:42so he can demonstrate Gillies' methods to me.
29:46So there is a skull in here?
29:47There's a skull inside.
29:48Right.
29:49The model has been created to show a nasal injury.
29:53So, Alice, we've got to reconstruct three quarters
29:56of this man's nose.
29:58Okay.
29:58So if we keep this artery intact,
30:00we can take a bit of skin around that
30:03and know that that artery will keep all that skin alive.
30:05The next thing we do is we create a template
30:08for the bit of skin that we want to move.
30:12So this is exactly what you would do...
30:14This is exactly what I would do to a human patient.
30:17Exactly.
30:19Gillies would have then cut the skin
30:20to create a flap,
30:22still attached via a pedicle,
30:24containing the all-important blood supply,
30:27but movable enough to reposition it
30:30and sew it in place.
30:32And here we're going to rotate it.
30:34So we would bring this round very gently.
30:39Now, we're going to wait three weeks
30:41for this to get a blood supply from the nasal area.
30:45And that just happens naturally?
30:46Yeah.
30:47Yeah.
30:47Exactly.
30:48Once the skin flap had settled,
30:50Gillies would insert a piece of cartilage
30:52from elsewhere in the body
30:54to create the structure of the nose.
30:57It was an incredible trust that they're placing in him.
30:59Yes.
31:00That they're going to go through this stage
31:01and things will get better.
31:03Yes.
31:04After 18 long months and eight operations,
31:08Gillies' patient, Hickey, was ready to be discharged.
31:11So this is, I think, a remarkable result
31:14when you compare that to the original injury.
31:17I mean, that's the image, isn't it,
31:19that he's starting here with no nose to speak of,
31:22no external nose, and here he is.
31:25Isn't that remarkable?
31:27I think as a young man,
31:28you'd be pretty happy that you'd come from there to there.
31:32Over 10,000 reconstructions later,
31:35Gillies returned to Bart's in 1930
31:38as its first-ever plastic surgeon,
31:40having revolutionised the practice.
31:43And the techniques Gillies developed
31:45are still being used at Bart's today
31:48by surgeons like Laura Johnson.
31:52Just starting with Janina,
31:53we've not heard anything back from the Dieppe subway.
31:55Laura specialises in the treatment of breast cancer,
31:59the most common cancer here in the UK.
32:02Seeing the impact of the disease up close
32:05is what drew her to the job.
32:06My mum, unfortunately, had breast cancer.
32:09I was an only child with just my mum.
32:12Dealing with the worry, the fear,
32:14really made me want to be able to deliver that
32:17and use that experience that I had
32:19to hopefully make things better for other people.
32:22Laura works in the relatively new field of oncoplastics.
32:27That's plastic surgery specifically directed
32:30at cancer treatment and reconstruction.
32:32And it's really important for me
32:34to be able to deliver surgical treatment
32:37that gives patients not only the best long-term outcome
32:40when it comes to survival,
32:42but also the best long-term cosmetic outcome.
32:46Hi, Julia.
32:47Good morning.
32:48How are you doing?
32:49I'm fine, thank you.
32:50One of her current breast cancer patients
32:52is lifelong Eastender and grandmother of six,
32:56Julia Cole.
32:59Julia has two cancerous lumps in her right breast.
33:03Laura will remove the lumps
33:05and then use plastic surgery techniques
33:08to reshape not only this breast,
33:10but her left one as well.
33:13So, what we're going to do is,
33:14because we're going to remove probably about that much tissue,
33:17you'll be under a full general anaesthetic.
33:19If everything's good, we'll get you home tomorrow.
33:21Oh, fantastic.
33:23Breast cancer is one of the oldest diseases to be described.
33:27The first surviving record comes from an Egyptian medical text
33:32from around 2,500 BCE.
33:36Breast cancer is also specifically mentioned
33:39in ancient Greek writings,
33:40including those attributed to the physician Hippocrates
33:43from around 400 BCE.
33:49Surgeons were operating on breast cancer as early as the 16th century,
33:53with the first radical mastectomies being performed in 1882.
33:59It was a procedure which left patients with significant scarring.
34:04Nowadays, surgeons like Laura are focused not just on cancer removal,
34:08but also reconstruction.
34:10I've got a great team in theatre today
34:12in terms of the medical workforce.
34:14A strong all-female team today.
34:1742, please.
34:19Can I have a force set, please?
34:21The cancer cells are located deep in Julia's breast tissue.
34:25Laura will need to cut the breast open fully to find them.
34:30She'll try to preserve Julia's nipple,
34:32which means she needs to maintain its blood supply.
34:36She's marked out the key artery feeding that area of skin
34:40and is carefully keeping it intact as she cuts around the nipple.
34:45It's essentially the same pedicle flap method
34:48that Gilly's used for his facial reconstructions.
34:54Many breast surgeons have done subspeciality training
34:58with plastic surgeons and learn plastics techniques,
35:02and that allows us to utilise these techniques to treat cancer.
35:07So my plan now is to try and get into this area where her disease is.
35:13Laura has previously inserted tiny metal seeds
35:16into the area of breast tissue containing the tumour.
35:20During surgery, she can use a magnetic wand
35:22to locate the seeds identifying the cancerous tissue,
35:26which is invisible to the naked eye.
35:28It responds to detection
35:31with a sophisticated metal detector, basically.
35:35So the seeds are guiding me to the abnormal area.
35:41Once the cancerous tissue is cut out,
35:44it's x-rayed right here in the operating theatre
35:46to check that Laura's metal detecting has worked.
35:50So here we can see that seed is in one of her cancers,
35:54that seed is in the other,
35:56and I've taken them with a rim of healthy breast tissue around it.
35:59An hour in, all of Julia's cancer has been removed,
36:03but Laura and her team are still only halfway through.
36:07Where I've just removed that area of cancer,
36:09she's left with quite a big dent.
36:12I can fill the gap and then close the skin around it,
36:16and all of a sudden, the area where she would have had a gap,
36:18she no longer does.
36:21After reattaching the nipple and closing up,
36:24Laura's work is done.
36:27Great.
36:28I'm very pleased with how everything looks,
36:30and I hope Julia will be too.
36:32I'm confident that we've got the cancer out.
36:35This has been a very successful operation.
36:39Coming up...
36:40So I'm going to go back to being a medical student.
36:42Yes.
36:43I try to diagnose a few of Bart's historical patients.
36:46Over here, there's a woman who is so pallid,
36:49they look almost green.
36:51And Harrison discovers if his chemo has worked.
36:55How are you?
36:56I'm a little bit nervous.
37:08BART's looks after over 77,000 inpatients a year
37:12who come from all over the UK
37:14to this world-renowned centre of excellence.
37:17But for some, this is their local hospital,
37:20like Julia Cole, who had her breast surgery here yesterday.
37:24Morning, Julia, it's Laura.
37:26Hi there.
37:27Hi, how are you doing?
37:28Yeah, good.
37:29Can I come in?
37:30And consultant oncoplastic surgeon Laura Johnson
37:33has come to check on her.
37:35Everything was fine with your surgery.
37:36I just wanted to reassure you that everything went really well.
37:38We got those two little areas out.
37:40We got a couple of little lymph nodes from your armpit.
37:43Julia's now able to go home.
37:45It's just nice to see patients the next day
37:47with the relief of having...
37:50The relief in her is...
37:51You can hear it, you can see it in her.
37:53I'm just so relieved that it's out.
37:56She's happy.
37:57And that's really, for me, what makes this job so worthwhile.
38:01All right, Julia.
38:01Do you have a lovely weekend?
38:02Yeah, you too. Take care.
38:07BART's has always provided free care to its patients.
38:11Today, the hospital is funded by the NHS,
38:14but in the past it relied on income from its property
38:18and the generosity of wealthy benefactors.
38:21In the 1730s, to inspire them to part with their cash,
38:25the hospital governors commissioned two enormous murals
38:29on the staircase of the North Wing.
38:31Well, this is all looking lovely in here now, isn't it?
38:34They depict two Bible scenes,
38:37the Good Samaritan and the Pool of Bethesda.
38:41Both feature a number of sick and wounded figures seeking healing.
38:46I can see a lot of different ailments.
38:48That certainly shouts out at me right from the beginning.
38:55The murals were painted by British artist William Hogarth.
39:00And it's believed that the people in them
39:02may perhaps have been modelled on real patients from Barts.
39:07Jean-Paolo Martinelli is a consultant anaesthetist,
39:10but he also has a keen interest in art.
39:13Hogarth was very much interested in Barts
39:18because he was born not far from here.
39:20So for him, Barts was something that was really part of his upbringing.
39:25And I think he showed certain sympathy
39:27towards people who were suffering.
39:29Yeah, a bit of humanity.
39:31Jean-Paolo is putting my powers of observation to the test,
39:35asking me what I think about these patients of his.
39:38There's a lot of different colours,
39:40like the flesh is a different colour
39:42in a lot of these individuals.
39:44Yeah.
39:44Over here, there's a woman with a white cap on her head.
39:48Yeah.
39:48She's got quite a ruddy complexion,
39:50especially when you compare her
39:52to the person that she's standing next to,
39:54who is so pallid, they look almost green.
39:57Different colours that reflect something
40:01that people believed at that time,
40:02which was the theory of the humorism.
40:05Humorism was a leading theory in medicine
40:08in Europe and beyond for over 2,000 years,
40:12developed by ancient physicians,
40:14including the Greek Hippocrates and the Roman Galen.
40:17It suggested that the body contained
40:20four vital liquids or humors.
40:23Blood, phlegm, black bile and yellow bile.
40:27If your humors were out of balance,
40:29it could affect your health and even your personality.
40:32And there were telltale signs.
40:35A ruddy complexion and headache was caused by too much blood
40:39and was treated with bloodletting.
40:42Too much yellow bile gave you pallid skin and yellow eyes.
40:46You might have been given wine to help heat the body
40:49and would have been advised to avoid exercise after eating.
40:53The most dangerous one was actually the black colour,
40:56which was the melancholic one.
40:58Is that this individual over here on the right?
41:00It's that individual which is the sickest of the lot.
41:02So not people with a naturally dark skin,
41:04but people whose skin had darkened
41:06through some kind of ailments.
41:07And the counteract was giving something white to eat.
41:11And in Italy, even now, if somebody is very sick,
41:14they ask to eat something white.
41:17There is no evidence,
41:18but I think it's something that is coming from the past.
41:27Over the centuries,
41:29BART's has been a steady presence
41:31for the thousands who've come through its doors
41:34to learn, to be treated, to work.
41:41Hi, you're back. Can I restart your fluids?
41:44Up on Ward 5A,
41:46Harrison Berkey has finished his final round of chemotherapy
41:49after three long months of intensive treatment for cancer.
41:53He's been looked after by consultant oncologist Kenrick Ong,
41:58who's just received the results of Harrison's final scan.
42:01We're trying to assess in the CT
42:04how well his cancer has responded to the chemotherapy.
42:08When Harrison first arrived at BART's,
42:11his testicular cancer had spread to his liver and stomach.
42:14What we've got over here is several grey spots.
42:17Those are cancer deposits from when he first arrived.
42:21This is his end-of-treatment scan.
42:23And the liver is just so much cleaner now.
42:26You can't see those grey spots there anymore.
42:29And what's most striking
42:31is this huge 20-centimetre tumour.
42:35And that big mass in the abdomen,
42:39a lot smaller now.
42:41It probably measures a maximum diameter of 10 centimetres,
42:46but just so much smaller than what it was before.
42:48It was occupying most of the left side of the abdomen.
42:52With cancer this extensive,
42:54stopping the spread and shrinking the tumours
42:56as much as possible is the vital first step.
43:00He came with very aggressive cancer.
43:02I'm delighted with the response.
43:04The remaining cancer is now small enough to remove surgically.
43:09Hello.
43:09Kenrick has come to let Harrison and his family know.
43:13How are you?
43:14I'm a little bit nervous.
43:19So you've been in for three months?
43:20Yeah.
43:23I think the chemo has done the job.
43:26I'm very happy with the scan results.
43:28Almost all the tumour has shrunk considerably.
43:32And congratulations.
43:35It's time for you to go home.
43:39Well done, darling.
43:46Extremely proud of my bloody brilliant son.
43:49It's just amazing.
43:51We did win the lottery coming here.
43:53The life lottery.
43:56Yeah, I'm really hopeful for the future
43:58and being able to live the rest of my life normally.
44:03After his positive response to the chemotherapy,
44:06Harrison can now focus on rebuilding his strength,
44:10ready for the next step in his treatment, surgery.
44:15Next time, I discover the gruesome truth behind how Bart's medics learned their anatomy.
44:21So executed criminals' bodies were given to doctors.
44:24Knife, please.
44:26We follow a literally heart-stopping procedure.
44:29On bypass, please.
44:31And discover the origins of anaesthetics that came at a deadly cost.
44:36What's important about this is to understand how lethal it was.
44:42Catch all that brand new next Wednesday at 8.
44:44And if you or someone you know has been affected by any of the issues raised in tonight's programme,
44:50please go to channel5.com slash helplines for information and support.
44:54Can DCI Ellis solve a murder no-one else can?
44:58She's back on the crime scene as the case continues.
45:02New next.
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