- 12 hours ago
Category
📺
TVTranscript
00:01It's early morning in East London.
00:03A woman collapses on the street and is brought to hospital.
00:08She has an extreme case of gangrene in both her legs.
00:13She's rushed to theatre for an operation that few surgeons have ever attempted.
00:19One which she may not survive.
00:23The year...
00:29...is 1638.
00:33This is St Bartholomew's, Britain's oldest hospital.
00:39This hospital has cared for people through the reign of Henry VIII,
00:43through the plague, the Great Fire of London, the Covid pandemic and beyond.
00:49Over nine centuries of scientific discoveries are here at my fingertips.
00:55There's something extremely special in this box.
00:59Now, for the first time...
01:01Oh, wow, OK.
01:02...I'll reveal how the breakthroughs of the past...
01:05You've got to see this with your own eyes.
01:08...are helping to write the future of medicine.
01:11I am absolutely blown away by this.
01:14...I'll step inside the day-to-day of this state-of-the-art institution...
01:19That is incredible.
01:20...where they've been saving lives and making history...
01:24...oh, wow, for nearly a thousand years.
01:28And behind every door is a new secret, just waiting to be discovered.
01:44Every year, over a hundred thousand people from all over the country step through the doors of BARTs.
01:53Good morning.
01:55Across nine floors of wards, theatres and clinics, the staff here provide world-class care, 24-7.
02:04That's lovely.
02:32That's lovely. Thank you.
02:33No problem.
02:33But BARTs has been here much, much longer than that.
02:38Hundreds of years of history, thousands of patients being treated.
02:42So many stories.
02:46And incredibly, BARTs has kept a record of all of them.
02:54It has one of the oldest hospital collections in the country, stretching all the way back to the Middle Ages.
03:02From priceless texts to precious photographs, even a charter signed by none other than Henry VIII, as well as a
03:12museum packed with medical specimens and body parts.
03:17As a former doctor who's fascinated by history, it's amazing to have full access to everything here.
03:26Archivist Kate Jarman is showing me one of their most prized items.
03:34This is our oldest document, and this is from 1137.
03:39So that is almost as old as the hospital itself?
03:43That's right.
03:44That is amazing.
03:45I can't believe you've got something which goes back quite so early.
03:50Is that a St. Bartholomew?
03:52Yes, St. Bartholomew, so of St. Bartholomew's.
03:57This document is a grant in return for a payment to the hospital made by its founder, a man called
04:07Rahir.
04:07He was a courtier of King Henry I, son of William the Conqueror.
04:12And believe it or not, he claimed he had a vision of St. Bartholomew himself,
04:16who instructed him to build a priory, a religious house, with a hospital for the sick.
04:23So these are the two seals of the priory.
04:26The priory you can see here, the building, and it's got three towers.
04:29Yeah.
04:30And this is the seal of the hospital with St. Bartholomew.
04:33And they're the earliest examples of the hospital and priory seals that survive.
04:40Little did Rahir know what his vision would become.
04:47Over the years, this humble hospital would evolve and adapt, serving countless eras of British monarchs,
04:56from the Tudors to the Georgians and the Victorians,
05:02drawing on the brilliance of centuries of Barth's doctors who shaped medical knowledge.
05:07All this paved the way for a hospital now recognised worldwide for its groundbreaking specialist treatments.
05:17And when it comes to specialisms, it's hearts that Barth's has become known for.
05:23Today, it has one of the largest cardiac centres in Europe.
05:28In the King George V wing, up on the third floor, is Dr Mick Oskor, clinical director of cardiology.
05:37How are we doing?
05:38Just finished there.
05:39OK.
05:39The heart is, I guess, the number one organ.
05:42It's the quarterback of the team.
05:44It's the captain of the team.
05:47It's the organ that maintains everything else.
05:50And it's the one that we want to keep as healthy as possible.
05:54How are you feeling today? Better?
05:56Much better than I did yesterday. Yeah, much better.
05:58Thank God for everyone here at Barth's.
06:01These are people from all walks of life, and they've got all backgrounds,
06:04and they've come in with a major event in their lives.
06:08Oh, wow, that's my heart, isn't it?
06:11That one.
06:11Thank you for showing me that.
06:14But this department is also the hospital's port of call for emergencies.
06:19In the UK, someone is admitted to hospital with a heart attack every five minutes.
06:24And at Barth's, they help 6,000 of these patients a year.
06:31That phone there is the heart attack phone or the back phone.
06:36Any heart attack happening in the region is called into there to tell us they're on their way.
06:40Any cardiac emergency within the surrounding 200 square miles is directed straight to Barth's.
06:47The second they arrive, the team will spring into action.
06:51And before long, the call comes in.
06:59Patient is self-ventilating.
07:01Coming up, it's a race against time for a patient in the heart attack centre.
07:06Bear with us, Andrew.
07:08I find out how and where patients slept through the centuries.
07:12Bring in the next bed!
07:14And discover that finding a bed is no easy task today.
07:19There used to be a plan, because there's now six people coming in.
07:31Barts Hospital has stood in the centre of London for almost 1,000 years.
07:37Set up to help the poor in the Middle Ages,
07:40it's now a centre of excellence treating thousands of patients from all over the country every year.
07:47Keeping track of them all is this man, Jason Morley-Smith.
07:5216 beds, 19 beds.
07:56Jason is head of clinical site management,
07:59and for the past 17 years,
08:02he's been in charge of making sure the hospital runs like a well-oiled machine,
08:07including ensuring they have enough beds and medics
08:10for the ever-changing numbers of patients.
08:13Hello. Yeah, good, how are you?
08:16You feel like you're an octopus at times, that you need eight arms.
08:20Hello, sister. Hi.
08:23Staffing tonight.
08:25Yeah, fine.
08:26What's fine in numerical numbers?
08:29It's all about patient flow.
08:31Patients to come in, patients to go out.
08:33Matron.
08:34What do we forecast are going to be our problems?
08:37So far today, Jason has everything under control.
08:42I'm comfortable that we've covered everything with the ward managers, the matron,
08:46so there's no concerns at all at this moment in time.
08:50But before long...
08:58All that changes.
09:01What are they doing?
09:03That's somebody at the registrar who's forgot to tell people about.
09:07Of course, we'll find out when we go upstairs whether there's beds or not.
09:12Today, it's a given that each and every patient coming into Barts needs a proper bed.
09:20But wind back the clock, and the wards looked very different indeed.
09:26The hospital was founded in the Middle Ages, when England was ruled by the Norman king, Henry I.
09:34Back then, it's thought there would only have been one ward,
09:37and you may not have had the luxury of a bed at all,
09:41as I'm finding out from social historian Ruth Goodman.
09:4611.23.
09:48The whole of this floor would have been covered in a deep layer of straw and rushes.
09:55They're sleeping on the floor?
09:56They're sleeping on the floor.
09:57We don't have a record of the medieval ward at Barts,
10:01but it's likely patients slept on straw-filled mattresses,
10:05or even raised wooden platforms.
10:08And a carpet of herbs would discourage unwanted visitors.
10:13I don't know if you know this one. This is wormwood.
10:15This is an insect repellent.
10:17It means that things like lice or fleas are deterred.
10:22So when do we have the massive major leap forward that is the bed?
10:27I'm going to call forth now some elves.
10:30Bring in the next bed!
10:34This is your standard 16th century bed.
10:37Thank you very much.
10:38Thank you very much.
10:39Gone are the rushes, and we're sleeping up on beds.
10:43Particularly as people get chimneys.
10:45Once you have a chimney, you've got a draft at ground level.
10:47Cold down there.
10:48And the last tough thing you want to be doing is putting your sick patients on a drafty floor.
10:53See?
10:54Let's have a look.
10:54We've got a rope base to it there.
10:57Yeah.
10:57Yeah.
10:57Now, as you can see on that, that gives you a little bit of give,
11:00but this one's got a bit too much give.
11:02So this is where this comes in.
11:04So if I...
11:05Can you see that the ropes go round?
11:07If I slot that in...
11:08Yeah.
11:09..and give it a twist.
11:11So when people say that they want you to sleep tight, this is what they mean.
11:16Oh, so sleep tight is, you know, you've tightened up your rates,
11:19you'll have a much better night's sleep.
11:21You'll have a better night's sleep.
11:22That's quite comfortable.
11:24It's not perfect, but it's a huge improvement compared to sleeping on the ground.
11:29Fast forward another 300 years, and by the end of the 19th century,
11:34the beds at Barts were starting to look a bit more familiar.
11:38The Industrial Revolution of the Victorian era saw urban populations explode,
11:44fuelling devastating outbreaks of cholera.
11:47People began to realise the link between sanitation and the spread of disease,
11:52and that something had to be done about making beds more hygienic.
11:57So if that was about 1,600, this is about 1,900.
12:02So we've got an iron bedstead now?
12:04And this is all about hygiene.
12:08So if we move our mattress, you can see this is completely dismantled.
12:13It's like a dick saw.
12:14What's important about that is that there are no joints
12:18that you can't take apart and clean.
12:20Anything that is touched by an infected person's bodily fluids
12:25is going to pass on the infection.
12:28Ruth's assured me this bed has had a good wipe down,
12:31so I'm safe to give it a try.
12:33Oh, yeah.
12:34So much as I liked the rape bed, actually this one is comfier.
12:38It is.
12:39Today, the high-tech beds at BARTs are kept meticulously germ-free,
12:44and thankfully the hospital no longer has to worry about cholera.
12:50But they do still have one pressing issue.
12:54They need to find enough beds for their incoming cardiac emergencies.
13:00Has any of these got any beds anywhere else?
13:03Each ward keeps a list of their available beds.
13:07We've got one side room, one female, and then we will have one male.
13:14Side room, a female, a male.
13:17But just when Jason seems to have found a space, he gets another update.
13:23That's a different patient that they're now putting on.
13:25Another unexpected patient is en route to BARTs.
13:28So bed 19 has got the DAP in there.
13:31And the emergencies don't stop there.
13:34Patient is self-ventilating.
13:37BARTs hospital.
13:39AMI activation.
13:40That's another AMI.
13:43AMI stands for acute myocardial infarction, a heart attack.
13:47And this next patient is just ten minutes away.
13:50I think everybody has decided to have a heart attack this afternoon,
13:54so we're just going to try and find out where we're going to put everybody.
13:58There needs to be a plan, because there's now six people coming in.
14:03Heart attack patients are treated just on the other side of this wing.
14:08Here there are ten state-of-the-art labs,
14:10where each day around 80 doctors and nurses
14:13perform a range of minimally invasive heart procedures
14:17pioneered by their forebears.
14:20From fitting pacemakers to changing heart valves.
14:24There's a history of ischemic heart disease.
14:26Dr Mick Osco is in the lab.
14:29I'll assess him when he's here.
14:30Good. Let's get going.
14:32Today we've got about six patients planned,
14:35but at the same time we are on call for heart attacks for the whole region.
14:39While Mick moves on to his next planned procedure...
14:42So you ready?
14:44We're ready to go.
14:45News of an emergency has reached the team.
14:49Patient is self-ventilating.
14:51Dr Oliver Gutmann is straight on the case.
14:54We just heard it and then heart attack is coming in,
14:56so we just have to go and get ready now.
14:59Big rush and make sure we don't waste any time.
15:03Dr Fadi Al-Dubbi is in charge of assessing the patient's condition on arrival.
15:10We already received his pre-assessment done by the ambulance crew.
15:13We are going to do a very rapid assessment for him.
15:16Make sure that he is stable before taking him for an emergency procedure.
15:23So, Nigel, once you are on the table,
15:25we are going to go through some safety checks.
15:27Just to make sure all the team are on the same page, OK?
15:30The patient is 70-year-old marketing consultant Nigel Rodliffe,
15:35who first needs a live X-ray taken of his heart.
15:51It's critical that blood flow is restored to Nigel's heart,
15:54so they need to unblock the vessel.
15:57And to do that, they'll be using a very clever bit of kit called a stent.
16:02I've come to the cath labs myself,
16:04where medical director Andrew Ragg
16:07and cardiologist Rohini Ramassation are going to show me how it works.
16:12That's the stent there, and then underneath that is a balloon,
16:15which, as we inflate the balloon, will leave the stent behind.
16:20First used in the 1980s,
16:23a stent is introduced into the body via a catheter,
16:26a tiny tube inserted into a blood vessel in the wrist or groin
16:30and fed all the way up to the heart.
16:33The stent, made of wire mesh,
16:36is inflated using a tiny balloon.
16:38It then acts as a piece of scaffolding holding the blocked heart vessel open.
16:44This whole set-up is connected to this in-deflator.
16:47It's like a bicycle pump that blows up the little balloon.
16:52As you can see, that's now expanding.
16:56And then, if I now deflate the balloon...
17:02..you can see that that's the stent that stays inside the body.
17:06That is incredible.
17:08So that is like a little cylindrical cage
17:11that you've opened up inside the blood vessel.
17:14That's right.
17:15And that now keeps that blood vessel open.
17:17Yep.
17:18How long have you been using this technology?
17:21When was it invented?
17:24Balloon angioplasty was the very beginning.
17:26That was invented by a very creative chap
17:29who was actually a royal kind of disruptor
17:31by doing something that felt to be crazy.
17:33This disruptive chap was a German doctor called Andreas Grundzig.
17:38He was the first person to insert a balloon
17:41into the vessels of the heart in 1977,
17:44having developed the device on his kitchen table.
17:48Little did he know how many lives his invention would save.
17:53Stent technology became widely available essentially during the late 1990s.
17:57But, you know, we were both at medical school at the same time in the 90s.
18:00That's right, yeah.
18:00This was just about on the horizon then.
18:02It was just about on the horizon.
18:03I mean, that is incredible, life-saving treatment.
18:06Absolutely, yeah.
18:07Many people across the country have got stents inside their hearts
18:10and are doing really well as a result of this great technology.
18:14Today, around 90,000 people in Britain each year are fitted with stents.
18:20The team needs to work fast here to get one in place for Nigel
18:23before his heart is starved of oxygen.
18:26You OK?
18:27Are you decreasing?
18:29Yeah.
18:29Usually it gets a little bit worse before it gets better
18:32because now the blood is going to the place
18:34where you didn't have any blood before, right?
18:36It's a bit like when your muscle and your leg is falling asleep
18:39and then suddenly you get teeming.
18:41Luckily, the doctors here work with the focus
18:44of a Formula One pit stop team.
18:48We have a clock that takes, we call it, door-to-balloon time.
18:52So, door means that the time the patient arrives to the hospital.
18:56And our balloon time is when we open the artery with the balloon
19:01and restore the blood flow.
19:02The whole process should be less than 60 minutes.
19:07Bear with us, Nigel.
19:08OK, we're going to put the stents in now, OK?
19:12Nigel will soon be out of the woods.
19:14Back on the cardiology wards,
19:17clinical site manager Jason is making headway,
19:20finding beds for the patients to recover in.
19:24A hundred years ago,
19:25this job would have been done by hospital stewards,
19:28like this man, Mark Morris, who lived on site.
19:32And Jason is certainly no less busy today.
19:35As you will notice,
19:36I will spend a lot of time walking down these corridors,
19:40the cardiology corridors,
19:41going from one problem to the other,
19:42to sort and avert and come back again.
19:46I've lost him.
19:47Where has he gone?
19:49It's like he hides.
19:51We are discharging her, definitely,
19:54and we are discharging him, definitely.
19:57So these two will be...
19:58I'm moving her, as we were saying, to here,
20:01so we have...
20:02Is that lady able to go to 3D?
20:04Yes, she is.
20:06Perfect.
20:06So there's four beds in title.
20:08Four beds.
20:08We're cooking on gas now.
20:09All right?
20:10Yes, literally.
20:11In just 15 minutes,
20:14Jason's ferreted out the remaining beds
20:16for all the incoming emergencies,
20:18playing his crucial part
20:20in Bart's world-leading heart care.
20:23OK, bye.
20:24It's been a little bit harder
20:26than we would want it to be.
20:29We've facilitated all of those patients.
20:32I feel like I need a gin and tonic,
20:34but we've achieved what we wanted to achieve.
20:42Coming up,
20:43a mission to save the oldest part of the hospital.
20:47There was a real danger
20:48this building was going to fall into rapid decay.
20:51I uncover the grisly history of X-rays.
20:54What we've got here are actual fingers.
20:58And a famous face makes an appearance at Bart's.
21:01Dear old George, yes,
21:03I missed out there, didn't I?
21:13St. Bartholomew's Hospital in London
21:15is renowned for its world-class heart and cancer care.
21:20But although the medicine here is modern,
21:24Bart's has a very deep history.
21:27The buildings surrounding the elegant central courtyard
21:30were first designed back in the 1730s
21:33when King George II was on the throne.
21:39Will Palin is the chief executive of Bart's Heritage,
21:43safeguarding centuries of Bart's history for the future.
21:49Here is a view of St. Bartholomew's Hospital.
21:53It's got this incredible history.
21:56The east and west wings of the hospital
21:58have been successfully adapted for modern hospital use.
22:02The east wing, which originally had wards for 504 patients,
22:07is now used for outpatient assessments,
22:10while the west wing, once containing wards for female patients,
22:13is now home to the breast screening unit.
22:17But there's one wing that was never meant for patients at all.
22:22The north wing was a place for administration
22:25and to entertain wealthy donors.
22:29But over the years,
22:31this historic space slowly fell out of use.
22:35There was a real danger this building
22:37was going to fall into rapid decay.
22:42Then, 18 months ago,
22:44a £9.5 million project,
22:47supported by the National Lottery Heritage Fund,
22:49began to restore this incredible wing of the hospital
22:52to its former glory.
22:56Reviving the elegance of the Great Hall,
22:59preserving the spectacular art
23:01that wraps around the walls of the grand staircase,
23:04refitting the priceless stained-glass windows,
23:07and conserving much of the building's exterior.
23:13Contractor Steve Clarke has been overseeing the team
23:16mending the slate roof,
23:17which has been there since the north wing
23:19was built in the Georgian era.
23:22We've had to strip off this roof completely.
23:26So we've had to redo the lead work.
23:29We've redone the slates
23:31to make the roof watertight again
23:33for hopefully the next hundred years.
23:36Renovating a Grade 1 listed building
23:38means Steve and the team
23:40must use as many of the existing materials as possible,
23:43including piecing together the roof's original slate tiles,
23:48mined from quarries in Wales over 250 years ago.
23:53I need a 28, Kieran.
23:56By 12.
23:58It's like a giant puzzle, basically.
24:02They're very fragile in places.
24:05We are in the middle of a working hospital,
24:07so the hardest challenge for us
24:09is getting men and materials into a working hospital
24:13with the public passing through
24:15and all the medical staff as well.
24:17While Steve and his team continue
24:19to bring the 250-year-old roof back to life,
24:23six floors down,
24:25in the far corner of the historic courtyard,
24:27the staff at the Minor Injuries Unit
24:29are gearing up for another busy day.
24:33Receptionist Susan Albany
24:34is a Barts veteran.
24:36It's actually come up on my email
24:39wishing me a happy anniversary.
24:41I started here on the 8th of September, 1986,
24:45and, er, yeah, here we are.
24:50There's a lot of, er, George Clooney up there.
24:54What's going on with that?
24:55Yes, yes.
24:57Dear old George, yes, I, er,
24:59I missed out there, didn't I?
25:03Susan has been the first port of call
25:05for anyone coming through the doors
25:07for almost 40 years.
25:09Will you hobble over there?
25:11Have a seat and listen out for your name.
25:15In reception today is Andrew Sperry,
25:18who's limped his way here from the airport.
25:21I decided it was a good idea
25:23to climb up Mount Everest Base Camp,
25:27and I slipped on some ice,
25:30and, er, the ligament in my foot just went pop.
25:33Nurse practitioner Martin Keenan
25:35takes a closer look.
25:38You can sort of see there's a little crack in the bone,
25:41so you did a fracture.
25:42Wow.
25:43I'm quite impressed,
25:44you're still able to walk afterwards.
25:47Using an X-ray,
25:49Martin can assess Andrew's ankle
25:51in a matter of minutes.
25:53But for most of Bart's history,
25:55this was technology that doctors
25:57could only have dreamed of.
26:01X-rays were first discovered
26:03by accident in 1895
26:05by German physics professor
26:07Wilhelm Röntgen.
26:10He stumbled across these mysterious beams
26:13in his lab
26:14and noticed, using his own hand,
26:17that they could pass through flesh
26:18but not bones.
26:20He didn't know what these puzzling rays were,
26:23so he called them X-rays.
26:27I've come to Bart's Pathology Museum,
26:30tucked away in the west corner of the hospital,
26:33where they have a fantastic record
26:35of the early use of X-rays here at Bart's.
26:39I find it quite hard to imagine medicine without X-rays.
26:43We're so used to that idea
26:45that we can look inside the human body.
26:48But while X-rays would be a huge leap forward for doctors,
26:52what they didn't realise at first
26:54was quite how dangerous they could be.
26:57People were holding X-ray plates
27:00while the X-rays were being used.
27:02They were even testing the equipment in the morning
27:05by putting their hand in.
27:07In the early 1900s,
27:09X-rays took around 90 minutes to make,
27:12compared to just a fraction of a second nowadays,
27:15and they were delivering 15,000 times
27:19the radiation we use today.
27:21Repeated exposure to X-rays
27:23can damage the DNA of the cells of the body,
27:27and this had horrendous consequences
27:29for the staff here at Bart's.
27:31This person has been exposed to repeated X-rays,
27:36and you can see what's happened to their fingers.
27:39It starts with a rash,
27:41then you'll get ulceration,
27:43and actually there will be cancerous growth in here as well.
27:46And then what we've got here in these pots
27:49are actual fingers that were amputated
27:53from somebody who worked in the electrical department
27:55at Bart's Hospital.
27:57So Arthur Stowe, in 1907,
28:00he has his index finger amputated,
28:02and then his other three fingers here
28:05just became so painful
28:06that he asked to have those amputated as well.
28:11Gradually, people became aware of the dangers of X-rays,
28:14and in 1921, we get the first guidelines
28:18about protecting people working with X-rays.
28:22And we've got this great photograph here
28:24from the late 1920s,
28:26and you can see the radiographer is wearing a lead apron,
28:29as we might see in theatre today.
28:32A hundred years on, X-rays are still incredibly useful,
28:36and with modern digital imaging,
28:38it's a really quick way to look inside the body.
28:42It's in a good position.
28:43We're not too concerned.
28:44That should heal quite well.
28:46The solution for Andrew today
28:49is a basic walking boot
28:50to stabilise his fractured ankle while it heals.
28:54Thank you for your time.
28:55OK. Good luck with the next hike.
28:58But this isn't the only way
29:00that doctors use X-rays today.
29:04They're also a key tool
29:06for Bart's world-leading cancer team,
29:09including clinical oncologist Pandora Rudd,
29:13who's currently doing her rounds on the ground floor.
29:17Morning, sir.
29:18Would you like a cookie?
29:19Oh, always. Thank you very much.
29:21There we go.
29:22So, we're just handing out some cookies to the team
29:24to give us energy to get through the clinic today.
29:27Good morning.
29:28Would you like a cookie?
29:29Our nurses are so incredible here,
29:30and that is the very least I can do
29:32to help them through their day.
29:35Wow. Thank you.
29:37As well as being a keen baker,
29:39Pandora is a specialist in skin cancer.
29:42And today, her next patient is 89-year-old Terry Brown.
29:47First of all, it started here.
29:49I had this done first.
29:52Then this one here.
29:53There's a big hole in my head.
29:55Then this one here.
29:57Scar there.
29:58This would be fourth, fifth.
30:02So far, Terry's had four surgical operations on his face,
30:05but as an ex-soldier, he's made of strong stuff.
30:10I was in the Royal Fusiliers back in 1955.
30:14We went to Egypt, saw his campaign, and that was it.
30:20Come back to Dover and demobbed.
30:23Ta-da.
30:24Terry is seeing Pandora for a small tumour on his left eyelid
30:28called a basal cell carcinoma.
30:32Basal cell carcinoma doesn't usually spread around the body,
30:36but Terry's been referred to us here at Barts
30:38for us to zap it and essentially get rid of it
30:41without the need for surgery.
30:44Pandora will be treating Terry's tumour using radiotherapy.
30:48This is a process where the carcinoma is exposed
30:51to beams of very high-energy X-rays,
30:54which kill the cancer cells.
30:59Radiotherapy is like having a million chest X-rays
31:02at the same time,
31:03so we're going to be completely protecting his eyeball
31:06with something called the lead internal eye shield,
31:08allowing us to deliver high doses of radiotherapy
31:11to the tumour alone.
31:13Hello, Mr. Burr.
31:14Hello.
31:15Lovely to see you.
31:16Yeah, good.
31:17Will it come through?
31:18Yeah, why not?
31:21Today is just a test run of Terry's treatment
31:24for Pandora to measure up the equipment they'll need.
31:28We don't need to treat the entire surgical area.
31:30We just need to treat the recurrence,
31:32so there's a small nodule there.
31:33First, they make Terry's eye numb using anaesthetic eye drops.
31:38Can you just blink a few times if you need to?
31:40Oh, it does stink, don't you?
31:41Yeah, it does.
31:42Then they insert the lead eye shield.
31:45This shield is covered with a protective lacquer,
31:49so the metal is never directly touching Terry's eye,
31:52because although lead is brilliant at blocking radiation,
31:56it is highly toxic if it gets into the body.
32:00But just like x-rays in the past,
32:02people haven't always realised how dangerous lead can be.
32:07The ancient Egyptians used a lead mineral as eyeliner.
32:12The Romans used lead vessels to make a syrup to sweeten their wine.
32:18And Elizabethan women, including Queen Elizabeth I,
32:22used lead carbonate to whiten their faces.
32:26But since the early 1900s,
32:29medics have learned to use lead safely to block harmful radiation,
32:33and now it's an essential tool for doctors like Pandora.
32:37That's looking really good.
32:40Pandora is just one of 300 consultants working at Barthes,
32:45all helping patients like Terry every day.
32:49But they owe their expertise to centuries of Barthes doctors
32:53who went before them,
32:54and developed the medical knowledge that's still saving lives today.
32:59One of the most influential was a surgeon appointed to St Bartholomew's
33:04in 1616, John Woodall.
33:09Archivist Ginny Dorr Woodings has dug out his extraordinary handbook,
33:14one of the earliest English examples of a manual for surgery.
33:19John Woodall, a surgeon to His Majesty's Hospital, St Bartholomew's, 1653.
33:26How wonderful to have this book.
33:28That's amazing.
33:29He was noticing that the surgeons didn't have a lot of consistency because at the time there was no standardised
33:35education.
33:37Back in the 1600s, if you wanted to practise surgery,
33:40you might have done an apprenticeship with a guild called the Barber Surgeons.
33:45Renowned for their skills with blades,
33:47they offered haircuts but also a range of operations.
33:51They were known by their red and white striped barber poles,
33:55supposedly representing blood and bandages,
33:58which you might still spot today.
34:00Woodall himself left his apprenticeship to travel the world as a military surgeon.
34:08When he returned from his voyages and took up a post at Bartholomew's,
34:12he began writing The Surgeon's Mate, a handy guide for surgeons at sea.
34:17John Woodall decided to write this book to put down what he believed were proven techniques,
34:23how to do operations, the type of medicines you need, the instruments you need.
34:26Possibly the most dangerous procedure Woodall covered
34:30was one that he was performing right here at Barthes, amputation.
34:36He writes here about how he had from more than 100 persons cut off from some a leg,
34:43both the legs, a hand, a foot, a toe or toes, an arm, a finger, etc., of such rotten members.
34:48So he's practising and writing down what he's experienced from probably St Bartholomew's.
34:55In the 17th century, amputation was far more common than it is today.
35:01Without antibiotics or any real understanding of infection,
35:05surgeons like Woodall often had no other choice.
35:08But he did have some tips, which incredibly still apply today.
35:13What's his first rule?
35:14Amputation is never to be undertaken by any artist without the advice of other expert surgeons.
35:18Oh, right.
35:19You shouldn't operate without first getting a second opinion.
35:22By artist, does he mean surgeon?
35:23Yes, he refers to the practice of surgery as an art.
35:26The third one is, I advise that no artist attempt to undertake the work of taking away any member from
35:31any person,
35:31but with the full consent of the said person first had.
35:34Isn't that interesting?
35:35This is such a fundamental, in surgery and indeed medical practice very generally today, informed consent.
35:42So it says sickly, let the surgeon not forget to call upon God for a blessing on their endeavours as
35:49the work is never performed without the danger of death.
35:52So very much you're going into this knowing that you might not come out the other side of this operation.
35:58But even with these guidelines, operating back then, without any effective anaesthetic, was a risky business.
36:07And I'm about to find out just how terrifying an amputation would have been back in the 17th century.
36:15Everybody hold her steady.
36:24Bart's Hospital in London treats around 2,000 people every week.
36:30But over the past 900 years, there have been generations of patients who've turned up at these doors.
36:37I've been immersing myself in the Surgeon's Mate, one of the earliest manuals for surgery written by Bart's doctor, John
36:45Woodall, back in the 1600s.
36:48And in it, he tells the story of one particularly unfortunate patient.
36:54Ellen French was a poor woman with a bad case of gangrene.
36:59Now, she'd worked as a servant in a wealthy household, and apparently, they said later, had a reputation for being
37:07light-fingered.
37:08Her employers accused her of stealing from them.
37:11And she was so horrified by this accusation that she said,
37:15if it's true, let my fingers and toes rot away.
37:20And that's exactly what happened.
37:24Ellen's gangrene spread to most of her fingers and both her legs.
37:28So she was brought to Bart's for Woodall to perform a life-or-death amputation.
37:35I'm at the Old Operating Theatre in Southwark, where historian Alana Gilmore has some of the tools that would have
37:41been used,
37:42and they're not for the faint-hearted.
37:47So we have the curved knife in the 1600s.
37:51So the surgeon can get a good grip on the wooden handle, and then one sweeping motion around the limb
37:56to cut through the flesh, all of the muscles, nerves, veins.
38:00Once the bone has been exposed by the knife, the surgeon would go for the bone saw, which does exactly
38:07what the name suggests.
38:09John Woodall's manual provides a step-by-step guide, not only for the surgeon, but for the team of assistants
38:15he'd be relying on for such a dangerous, yet potentially life-saving operation.
38:21One, to sit behind the patient to hold him, or her.
38:25A second, to stand before him and bestride the limb to be amputated.
38:31And a third, to hold the lower end of the diseased member to be taken off.
38:36A fourth, to bring the sharp instruments.
38:39And a fifth, that'll be you, to attend to deliver the artist his needles and buttons with other adamants and
38:46services.
38:49And the artist, the surgeon, comes around to start the operation.
38:53Once the team is in place and the surgeon begins, it's a race against time.
38:59Severing a large artery could cause a fatal bleed-out in as little as two minutes.
39:06So this is all about speed, isn't it?
39:08I would need to saw as quickly as I could through that bone.
39:13This is going to be quite terrifying for poor Eleanor.
39:16Everybody holds her steady.
39:19It's incredible to think patients would have been conscious while this was happening.
39:24And the most Ellen may have been offered for her pain was probably a stiff drink.
39:29The assistant holding the leg can take it away.
39:32All that's left is to burn or tie off the blood vessels and loosely stitch the skin around the wound.
39:39You're ready to bandage the stump.
39:44The amputation is done.
39:48But Ellen wasn't safe yet.
39:51She may have survived the grisly operation, but the threat of infection still loomed.
39:57And the cause of infection was poorly understood at the time.
40:01People didn't even know about microbes.
40:03And doctors weren't routinely washing their hands.
40:07It's likely around half of amputation patients didn't survive the first few days.
40:12But was Ellen's operation a success?
40:16John Woodall certainly thought so.
40:18He says that he took off both legs and parts of her seven fingers in one morning.
40:25He claims without pain or loss of blood or spirits at all.
40:30He made her perfectly whole in a very short time, namely within three months.
40:35So merciful is God.
40:38We don't hear about Ellen French again.
40:40She's lost to history.
40:41But what we can say is that Woodall and his surgeon's handbook gave her a chance.
40:51Back in the 21st century, and on the ground floor of Bart's, things are quietening down for the afternoon.
40:59And the wards are about to get a lot more cheery, with a visit from the shop trolley, manned by
41:05volunteer Leslie Lawson.
41:09It's basically to see what we can do for the patients that can't get out of bed.
41:13It adds a bit of lightness to their day.
41:16Anything from a trolley shop today?
41:18So if they want a Mars bar or a packet of fruit pastels or cheese and onion crisps, they can
41:23at least get that.
41:25Leslie is part of a long tradition.
41:27The tea trolley was an essential in the NHS when it first started in 1948.
41:34Good morning.
41:35Good morning.
41:35Anything from a trolley shop today, gentlemen?
41:37Yeah, I might have something.
41:39Certainly.
41:40I've also got some...
41:41Do you want some money?
41:41What do you want, brother?
41:42Do you want a packet of crisps?
41:43You want some crisps?
41:44You're going to be a good son.
41:46It's nice that he's peeing for stuff.
41:48It helps being friendly with people.
41:50It tends to find if you smile at other people, they'll smile back.
41:58One of the people recovering on the wards is heart attack patient Nigel,
42:02whose rapid emergency stent procedure has been a success.
42:07I am quite amazed at the whole process.
42:11They were friendly with me and made me feel relaxed is perhaps too strong, but made me feel better than
42:18I would otherwise have been.
42:21It's been an eye-opener for him and his wife, Kathy.
42:25Hello.
42:25We both thought it would be indigestion.
42:28A consultant said to me, if I'd had money for every patient who's told me that,
42:35though it happened before, I thought it was indigestion, but, you know, it just goes to show,
42:40take it seriously when something is wrong, do something about it.
42:45OK.
42:47No beer.
42:49It's nearly the end of the day, and the final few outpatients at BART's are having their appointments.
42:56Down in radiotherapy, Terry Brown has come in for his treatment.
43:03You'll hear a bit of a buzzing noise, but you won't see or feel anything.
43:08Looks very good, yeah?
43:09OK, Mr Brown, well done.
43:11That's all finished.
43:12Thanks, sir.
43:14It's the last of five visits for Terry, who's being treated for a small tumour on his eyelid
43:20by consultant Pandora Rudd.
43:22Come and take a seat.
43:25Is it OK if I have a quick look?
43:27Yes.
43:28I know how you hate sticky tape.
43:29I hate the tape.
43:31Just look at me.
43:33Lovely.
43:34No pain, nothing?
43:35No, no.
43:37Good.
43:38I'll just pop that down.
43:40I think the treatment's gone really well.
43:42The little cancer cells there are responding early to the radiotherapy, so that's good.
43:48That's good.
43:48It's a good sign.
43:49And everything's gone well.
43:50Job done, isn't it?
43:51Job done, exactly.
43:52Every patient's a story.
43:54I listen to their story, and I find out the problem.
43:57We're a tiny pinpoint of their journey, and we just need to make them better and get them
44:02back to doing what they want to do.
44:09Next time, I learn how a state-of-the-art surgical robot is revolutionising cancer treatment.
44:16It's a harder operation where the robot earns its money.
44:20I get a lesson in bladder stone surgery, 1600s style.
44:24It's really difficult doing it blind.
44:26Knock, knock.
44:27And I find out what it takes to be a nurse at Bart's.
44:31If you ever need a hug, bless you.
44:35And that's brand-new, our hospital through time next Wednesday at 8.
44:39Michael Portillo's sheer enthusiasm makes us want to pack up and join him.
44:43His travels around Spain take him to Mercy, I knew, tomorrow at 8.
44:46Next, being a surgeon carries so much responsibility and pressure.
44:49How do they cope both at work and at home?
44:52A brand-new series with incredible insight after the break.
Comments