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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 that it kills a third of its patients.
00:18The life of one of Britain's most famous writers
00:22hangs in the balance.
00:25His 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.
01:04...I'll reveal how the breakthroughs of the past...
01:07You've got to see this with your own eyes.
01:10...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
01:43St 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 Bartholomew's Hospital...
01:56...is that its doors have been open for an extraordinary nine centuries.
02:01And its history of life-saving progress is right at my fingertips.
02:10This is Bartholomew's Pathology Museum and it's an incredible collection.
02:15There's lots of specimens here, lots of history.
02:18We 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 are from centuries of patients...
02:32...cared for at Bartholomew's, including hundreds of body parts...
02:36...removed during surgery.
02:39Today, 50 dedicated Bartholomew's surgeons work across...
02:44...10 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.
02:55Bartholomew's Parts today offers many different sorts of operations...
02:58...but if you go back 400 years ago, two of the most common...
03:01...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...
03:17...and this, of course, was a time before anaesthesia.
03:20And 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 Bartholomew's cutting ward was built...
03:41...in which surgeons operated on stricken Londoners.
03:47Fascinatingly, many stones extracted via lithotomy have been carefully preserved.
03:53To find out more about this agonising condition and its treatment...
03:58...I'm meeting urologist Jonathan Goddard.
04:01These are some actual bladder stones.
04:04These are real bladder stones removed from...
04:06Look at that one.
04:06I know, it looks huge, isn't it?
04:07Absolutely huge.
04:09Poor people that had that.
04:10And look at this one.
04:11It's covered in spikes.
04:13Actually, bladder stones are quite common, weren't they?
04:16Yeah.
04:16Do we know why?
04:17We think it's to do with diet.
04:18So, stones form in urine.
04:20They grow in a concentrated solution.
04:23So, if you don't drink enough water, I'm afraid you get bladder stones.
04:27Beautiful things, but a horrible condition.
04:30These hard stones form when minerals in the urine turn into crystals.
04:36Today, tiny telescopic cameras make bladder stones quite simple to treat under anaesthetic.
04:42Nowadays, you would pass a small telescope through the pipe into the bladder...
04:47...and then you could see the stone, and usually you can smash it with a laser and wash the dust
04:51out.
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.
05:13Then 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.
05:18If 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.
05:22Yes.
05:23The majority of bladder stone sufferers were, and still are, male.
05:28The operation was so dangerous and painful, the patient had to be restrained...
05:33..to prevent him from kicking out in agony.
05:37With the patient's legs splayed above him, the surgeon would then be able to access the perineum...
05:43..and begin the procedure 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.
05:54Right.
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...
06:11..former painter and father of two, Chris Lynch.
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, not too bad.
06:46..is Henrietta Wilson.
06:48I'm a consultant thoracic surgeon.
06:51And that means that I operate on everything from here to here that's not your heart.
06:56The anatomy within the chest is beautiful.
07:00I 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.
07:08They'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?
07:17Good morning.
07:18So, all set for today?
07:20OK, Miss Wilson, yes.
07:21Yeah. The team will keep you updated.
07:23But 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.
08:00Now, 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.
08:10Yes.
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.
08:20OK.
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, if I just click my fingers
08:32together, and 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, yeah.
09:09And then, once your head is in, just click your fingers together.
09:12Oh, God.
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.
09:24With 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,
09:41with pinpoint accuracy, which means Chris should suffer less bleeding and pain, and will heal better afterwards.
09:49So, 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.
10:03There 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.
10:33We'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, 1600s style.
10:46You've got the scrutum 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 wardroans.
11:07Hello, darling.
11:21Today, there are over a thousand nurses working at Barts.
11:26They're the front line of care for every patient that passes through these doors.
11:33Just arrived at work is 25 year old nurse Sabila Shaheed.
11:39Since completing her training here two years ago, Sabila has been working on the oncology ward.
11:46Round about when I was about 16 to 20 years old.
11:49I think my mum sort of just suggested to me, oh, why don't you think about nursing?
11:54And I was a student here.
11:55I was so inspired.
11:56I was just like, yes, this is where I want to work.
12:00Nurses at Barts work 11 and a half hour shifts and every day that she's here, Sabila is responsible for
12:06the care of up to five seriously ill cancer patients.
12:10Clinical duties that a nurse would do includes taking your blood pressure, your temperature, administrating all of the medications.
12:18When they take blood normally, do they struggle? Is it difficult normally?
12:22No, it's not normally.
12:23No? Okay.
12:24One of Sabila's most important and frequent jobs is something we've probably all experienced, having our blood taken.
12:31We do routine bloods for every single patient on the ward every morning.
12:34It's very important because bloods determine whether they are fit or not for treatment.
12:38It's just generally how well or unwell the patients are.
12:42Around 2.6 million diagnostic blood tests are carried out every year here at Barts.
12:49But the vital connection between our blood and our health wasn't always so well understood.
12:58Scientists have been analysing blood at a cellular level since 1658, when red blood cells were first observed by Dutch
13:08naturalist Jan Swamadam.
13:10But it wasn't until the early 20th century that blood tests became available to diagnose diseases, and one of the
13:18earliest was syphilis in 1906.
13:22Syphilis was so rife at the time that the so-called Wasserman test was rolled out in many countries as
13:28a requirement for getting a marriage licence.
13:33Now, just one tiny blood test can uncover countless diseases within a couple of hours if necessary.
13:40Knock, knock. Hiya.
13:42Hello.
13:42How are you today?
13:44I'm good, I'm good.
13:45But perhaps the most important part of Sybilla's job is making her charges feel well cared for.
13:52I'd just like to eyeball all my patients if there's anything pressing, and go and say hi to everyone one
13:57by one.
13:58Did you sleep alright last night?
13:59On and off. I've got a little bit of sleep.
14:0161-year-old Kevin O'Hara has terminal renal cancer, and two days ago was admitted to Sybilla's ward with
14:09a fever.
14:10Sybilla comes in every now and again, even when she's not working, she pops in just to say hello.
14:14And that's what's really good about the NHS in part. Nothing's too much for them.
14:19I'll just chase with the doctors about this whole viral sort of progression.
14:23You didn't sound this congested yesterday, but you said you feel alright otherwise?
14:26I do, I feel great.
14:27Yeah, okay.
14:28It's just that I'm not.
14:30Kevin is a lovely man.
14:32You can see he's a very lively chap, can talk to anyone and everyone.
14:36I like how positive he is, and I do admire that.
14:39Thanks very much for what you've done for my daughter yesterday.
14:41That's alright.
14:42When you're finished doing my lunch, you put your arms around her, you gave Emma a lovely cuddle.
14:45Oh, bless.
14:46Thank you very much.
14:47Do you ever need a hug from here?
14:48Oh, bless you.
14:49You can have one now if you want.
14:50Thank you very, thank you very much for that.
14:52They don't, they don't come as a cost.
14:53They don't come as a cost.
14:53That doesn't come as a job description, but that's what you did.
14:57Bless you.
14:58That was lovely.
14:58That was really lovely, that was.
15:01Ah.
15:06Providing care for those who need it most has always been the Bart's way.
15:11But 900 years ago, nursing wasn't a job for trained medical professionals.
15:18When the hospital was founded in 1123, it's thought that it was actually housed in a single building, and the
15:25sick were looked after by eight religious brothers and four sisters.
15:29It's a term we still use for senior nurses today.
15:35But in the 16th century, what had been a religious institution was re-founded.
15:41In 1547, Henry VIII handed the running of the hospital to the city of London, and new secular jobs were
15:49created.
15:51These are laid out in the order of the hospital issued by the new governors in 1552, and that document
15:58has been dug out for me by archivist Kate Jarman.
16:02They have to faithfully and charitably serve, help the poor in all their griefs and diseases, as well by keeping
16:08them sweet and clean, as in giving them their meats and drinks.
16:11OK.
16:12So, it's not that dissimilar to now.
16:14It's ensuring that the patients are well fed, they are clean and comfortable.
16:19Yeah, absolutely.
16:21And what about the matron then, because this is an entirely new role in the hospital?
16:24Yes, she has to make sure that they do their duties.
16:28And in the few hours when they might have had some free time, they were still expected to be kept
16:32busy, so they would be spinning yarn and weaving linen for the wards.
16:38And there were also rules about behaviour outside the hospital.
16:46Above all things, they have to avoid, abhor and detest scolding and drunkenness as the most pestilent and filthy vices.
16:53And they've also got to avoid and shun the conversation and company of all men.
16:58That seems a bit extreme.
17:00The rules were strict and the penalties for breaking them severe, as the impressive hospital governor's minutes describe.
17:08You do get regular entries about the dismissal of nurses and of sisters.
17:14This one is in 1775.
17:17And you can see here, Hester really wasn't sticking to the idea of avoiding drunkenness.
17:22Oh.
17:23So Hester Hill, sister in Hope Ward, discharged from her office for selling gin, et cetera, to the patients, giving
17:29away the hospital's provisions contrary to the rules and orders.
17:32That's the book we've just looked at.
17:33Yeah.
17:33And otherwise misbehaving.
17:35Oh, she's having a lovey time.
17:36So she was discharged straight away.
17:38Yeah.
17:39Yeah.
17:39Well, I can see why they got rid of her.
17:44Though selling gin to patients is unsurprisingly still forbidden, boosting morale is a top priority.
17:52And there's a new physician on the wards.
17:55His name is Dr. Archie.
18:04Archie and I are here today at Bart's where we volunteer with Bart's volunteer services and pets' therapy.
18:12It's very attentive and sweet.
18:14And very calming.
18:16Right, buddy?
18:16We'll go this way.
18:18All right.
18:18Take care.
18:19Bye-bye.
18:21He has come as Dr. Archie to give cheer and cuddles to patients and staff alike.
18:29Archie, sit.
18:30There you go.
18:31Suzanne Louie has been bringing Archie to Bart's for four years.
18:35The medicine he provides works every time.
18:40Hello.
18:41What's your name?
18:42Ellen.
18:42Hi, Ellen.
18:43I'm Suzanne.
18:44This is Archie.
18:45How are you?
18:46Loads of patients will respond to him.
18:49What are these four years?
18:51I know.
18:52So are you.
18:53Yes.
18:54Do you want to give him a treat?
18:55No.
18:56Ellen's going to get to you.
18:57Don't be greedy.
18:58Don't be greedy.
18:59You have a treat.
19:00Good boy.
19:01Today, there are over 4,000 registered therapy dogs visiting patients in healthcare settings around the UK.
19:09But pet therapy is nothing new.
19:13In ancient Greece, horses were apparently used to lift the spirits of the sick.
19:19Florence Nightingale had a pet tortoise on her hospital wards.
19:24Before psychologist Boris Levinson coined the term pet therapy in the 1950s, writing papers on his co-therapist Jingles.
19:36Today, a swift recovery is the goal for every member of the BART staff.
19:43But alongside the life-saving work carried out here on patients, the hospital itself has been undergoing a major operation.
19:55For more than a year and a half, a team of experts has been restoring its Georgian north wing in
20:01a ÂŁ9.5 million project.
20:05The 300-year-old entrance boasts a grand staircase with two enormous paintings by renowned artist William Hogarth.
20:15They were once illuminated by an ornate chandelier.
20:19Hi, guys. How's it going?
20:21Really well.
20:22Good, good, good.
20:23For four months, the chandelier has been painstakingly restored and is now ready to be rehung.
20:31Conservator Stephen Payne is here to oversee the delicate operation.
20:36We have this wonderful chandelier.
20:39We believe it's by a very famous furniture maker, George II, Benjamin Goodison,
20:46who really was the absolute top of the tree in the period.
20:50And there is a sister chandelier, we believe, in Hampton Court.
20:54And I'd say that makes it a very special piece.
20:57A very valuable one, too, given equivalent Georgian chandeliers sell for six figures.
21:04Now the day has come for it to be rehung in its original position.
21:10It's a very fragile thing.
21:12The ten swan necks are incredibly sort of vulnerable.
21:16So it really requires a normal sort of care.
21:18If you can lift the tube up, that's it.
21:22Right, that's on.
21:23OK, so ready to start winding when you are.
21:27Go up, maybe six turns in spot.
21:31It's vital the chandelier is winched slowly and steadily into position,
21:36four metres above the floor.
21:41Any lateral movement could start it swinging like a pendulum,
21:44making it impossible to control.
21:48So, carry on going up with the winch.
21:55Nice and slow, go slower, slower.
21:58It's a nerve-wracking moment for Stephen.
22:03He goes, he goes.
22:08OK, stop, stop.
22:10There she blows.
22:13And the team can relax.
22:16The chandelier is at last back in its rightful place.
22:27The hospital's Grand North Wing was never intended for patient care.
22:32But on the first floor of the King George V building,
22:35a potentially life-saving operation is about to take place.
22:41Knife when you're ready.
22:44Retired painter Chris has been prepared for surgery.
22:48Starting.
22:48And brought into theatre four.
22:50Over the next three hours,
22:53he'll have his lung tumour removed by Henrietta Wilson,
22:56one of Europe's foremost experts in robotic lung surgery.
23:01Bringing the camera into the chest.
23:04The camera allows Henrietta to see inside the chest as the team introduces metal tubes called ports.
23:13These will allow the robot's delicate instruments to go in and cancerous tissue to come out without damaging the rest
23:20of the lung.
23:22I'm going to start at the bottom of the lower lobe.
23:24And I'm just going to start with a little bit of dissection so that we can take away some lymph
23:29nodes.
23:30So you can see this little black thing here.
23:33That's a lymph node.
23:34I'm going to want to gently tease that out.
23:39Cancer can spread through lymph vessels which drain tissue fluid to lymph nodes.
23:47Henrietta needs to check these nodes are clear of cancer.
23:53So that's a lymph node now that I've taken out.
23:57And we're going to remove that through the port.
24:01It's going to want to be out.
24:03With multiple lymph nodes collected, Henrietta now moves on to locate and remove the cancerous lobe of the lung.
24:11Just a lot in the way, that's the trouble.
24:14She must first find the branch of the pulmonary artery which supplies blood to this lobe.
24:20Sometimes we have to work in these little spaces because the anatomy of the human lung is not the same
24:27for every person.
24:28But it's hard to reach.
24:32There's a lot of lung tissue between where we are and where we want to be.
24:38Like mining for gold.
24:42Oh, there we go.
24:46There she blows.
24:49After nearly two and a half hours in surgery, Henrietta can finally take out the tumour.
24:55So we're putting her bag into the chest and this is how we're going to extract the lingula.
25:01I'm just going to put it into the bag and then we can remove.
25:05The tumour has been cut out, surrounded by a layer of healthy tissue to ensure no cancer cells are left
25:11behind.
25:14OK, so we'll have a look at the specimen to make sure we've got the tumour that we need.
25:18Because before the case we've marked the tumour with a coil, so we should be able to feel it within
25:25the specimen.
25:27Yeah, it's there. Perfect.
25:30Finally, both the robot and Henrietta can stand down.
25:35It was technically a challenging operation, but that's when the robot earns its money.
25:41If they were all really straightforward, it wouldn't be too difficult.
25:45So it's really in the harder operations where the robot makes it possible, really.
25:49Coming up, I'll find out how antiseptic changed surgery forever.
25:55It would be sprayed out of this nozzle straight over the patient.
25:58I discover how cleaning a hospital has changed through the centuries.
26:03So it's done a really good job of soaking that blood up.
26:07This is lovely, spotlessly down here. It's all good.
26:11And learn that rules for nurses remain surprisingly strict until just a few years ago.
26:17You were not allowed to be married. You weren't allowed to be married? No.
26:21No.
26:36I've witnessed some incredibly high-tech equipment here at Barts.
26:40And at the forefront of modern surgery is its million-pound robot.
26:44It enables surgeons to carry out extremely complex operations and patients recover quickly.
26:51How are you getting on?
26:53Chris, who had an operation to remove lung cancer only yesterday, is now almost fit to leave the hospital.
27:02Hopefully get you home tomorrow morning, then. All being well.
27:05We'll get everything set up. Okay.
27:06Thank you so much.
27:07You take care now.
27:08Thank you very much.
27:08Okay.
27:09Chris has only four small scars as evidence of a three-hour surgical procedure, but operations haven't always been so
27:17neat and tidy.
27:20Today, we have futuristic million-pound robots following advances in medical imaging and the advent of anaesthetic.
27:31But 400 years ago, operations were much more brutal, like the lithotomies or bladder stone removals I investigated earlier.
27:42One celebrated writer who underwent a lithotomy was 17th-century civil servant Samuel Pepys, who documented it in his famous
27:52diary.
27:53Pepys recorded daily life in great detail and was famous for burying his precious stash of cheese to protect it
28:01during the Great Fire of London.
28:03At just 25, he chose renowned Bart's surgeon Thomas Hollier to remove his excruciating bladder stone.
28:11Though, as Pepys was well off, his surgeon came to him. The hospital was reserved for the poor.
28:18With no cameras or visual guide of any sort, I'm going to attempt this dangerous 17th-century surgery on our
28:26very own Samuel Pepys,
28:28under the expert guidance of urologist Jonathan Goddard.
28:32If we go over to Samuel here, first you have to find the stone.
28:37So you have to feel for the stone. And actually, you have to listen for the stone.
28:41So you use something called a sound.
28:44OK.
28:45What you do, if you pass that into the bladder, you might hear it go, dink.
28:50You sound and listen for the stone.
28:52You listen for it, tapping against the stone.
28:54And you'll feel it as well as you pass that in.
28:56You should be able to feel it as well.
28:57It's a combination.
28:57Yeah. And you have to pass it into the urethra, and it wants to end up like that.
29:03Yeah.
29:03The sound is pushed through the urethra until it enters the bladder.
29:09And then as you start to go down, turn it round.
29:12Ooh.
29:12There you go.
29:13OK. Right. I think I'm here.
29:14So you're round that curve, and you're in the bladder.
29:16Yeah.
29:16We know from contemporary reports, that's really painful.
29:19Yeah.
29:20It's not nice.
29:21But you have to carry on. You can't stop.
29:23The surgeon must now feel and listen out for the metal tool hitting the stone above the screams of the
29:30patient before making the incision.
29:33You might be able to feel that.
29:35Yes, I can. Yes.
29:36I can feel the sound.
29:37So you know that's where you need to go.
29:39So you've got the scrotum here.
29:40Yeah.
29:41The anus just there.
29:42And that's the perineum.
29:43I can feel that sound there.
29:45Yeah.
29:45So if I cut straight down there, I should come down onto the urethra.
29:48Aim for the sound.
29:50Brilliant.
29:50How big a hole?
29:51Well, they said between two and four inches.
29:53So that's probably big enough.
29:54But remember, you've got to get the stone out.
29:55Oh, OK.
29:56So you need to slide that into the bladder.
29:58Basically, again, along the sound?
30:00Again, along the sound.
30:02There's the sound.
30:02You can hear it into the bladder.
30:06It's really difficult doing it blind.
30:08And he's not screaming at you, and he's not bleeding.
30:11OK, hopefully.
30:12Hopefully that's in the bladder.
30:14And then out this comes.
30:16And then I'm going to give you the stone forceps.
30:19See if you can feel the stone.
30:21OK.
30:23So I'm pushing in here.
30:27Am I in the right place?
30:29This is the problem.
30:30I'm listening.
30:31And all the while, I've got peeps screaming.
30:33Screaming.
30:34Begging you to stop.
30:36Can you feel the stone?
30:37I've got something.
30:38Paul.
30:40Oh, my goodness.
30:41Here it comes.
30:42Oh, it's huge.
30:43Here it comes.
30:43It's gone.
30:44He can't leave it in his perineum.
30:46Pull it out.
30:48Quickly.
30:48Come on, come on, come on.
30:50Oh, my goodness.
30:51That's it.
30:52The stone's out.
30:53It's out, it's out.
30:54The worst is over.
30:55Or is it?
30:56So now...
30:57He now has to survive.
30:58Yeah.
30:58So he survived that.
31:00He hasn't bled to death on the operating table.
31:02Well, he'll be bleeding now.
31:03He'll be bleeding heavily.
31:04So do I stitch things up?
31:06We...
31:06You mustn't stitch the wound.
31:08Because if you stitch the wound and you get an infection inside, it becomes an abscess.
31:11That will...
31:11That will definitely kill him.
31:12So you have to leave and see what happens.
31:14I've done my work.
31:15You've done your work.
31:16That was hard.
31:17Yeah.
31:18That's a bit hard.
31:21Unlike many, peeps lived to tell the tale.
31:24And he celebrated his survival every year with an anniversary party, writing in 1664,
31:31This day it is two years since it pleased God that I was cut of the stone and did resolve
31:37while I live to keep it a festival.
31:45In Samuel Peep's time, hospitals were dirty and downright dangerous places, with patients
31:52regularly dying of post-operative infections.
31:56Nowadays, Bart's has a vast team of cleaners, making sure the hospital is spotless.
32:05But up until the 1800s, keeping the hospital clean was a whole different ballgame.
32:12OK.
32:13I've got some fake blood here.
32:15And we're going to imagine quite a gruesome operation.
32:19The blood is pouring out of this hemorrhaging patient, and the operation is becoming more
32:27and more dangerous itself, because the surgeon is going to be slipping around.
32:32But the floor of the operating theatre in the 1800s was covered with something that was
32:41very good at soaking up blood, sawdust.
32:45A common by-product of 19th century building work, sawdust was both cheap and readily available.
32:53But was it effective?
32:55Well, certainly covering it.
32:57The surgeon would have been able to walk around on that sawdust.
33:01It's going to solve the problem of the slippy floor.
33:04Our patient's continuing to bleed, though.
33:08And so we'll pour some blood on top.
33:11And you can see that's soaking in quite nicely.
33:15Immediately.
33:19And then, once the patient is out and off to recovery, I suppose you have to tidy up, don't you?
33:26So let's see how well this sweeps up, then.
33:32It's pretty good, actually.
33:34Look at that.
33:35So it's done a really good job of soaking that blood up.
33:41Though the sawdust did a better job than I expected, something revolutionary was thankfully on the horizon.
33:49In the early 19th century, up to 80% of all surgical patients died, usually due to infection.
33:56But in the 1860s, an extraordinary discovery had life-saving consequences.
34:04Down in the archives, archivist Ginny Dorr-Widdings has got an intriguing invention to show me.
34:11So this is an example of Lister's carbolic acid spray.
34:18In 1865, Scottish surgeon Joseph Lister started using carbolic acid, a chemical already being used to treat sewage at the
34:27time.
34:31Inspired by Louis Pasteur's groundbreaking theory that disease could be caused by bacteria,
34:39Lister proposed that such germs could be carried on dressings, hands and surgical instruments.
34:49He started out by doing washing hands, washing instruments and preparing wounds with carbolic acid,
34:55and found this to be effective.
34:57And then he thought that maybe there might be additional germs in the air.
35:00So he decided to create a spray which could create vaporised and aerosol carbolic acid to spray over the patient
35:06and the surgical team during the surgery.
35:08This one is from about the 1880s and was used in St Bartholomew's on the wards and in the surgeries.
35:12Yeah, actually used in this hospital.
35:14Yeah. How does it work?
35:15So, what you have up here is a water tank and underneath here is a paraffin lamp which would have
35:20heated this to create a steam.
35:21In this little jar here you had your carbolic acid and there would be a rubber tube connecting this valve
35:26down to here.
35:28The steam would vaporise the carbolic acid, creating a pungent yellow mist.
35:34And it would, yeah, be sprayed straight over the patient.
35:37And what was it like to be operating in a room with that being sprayed around?
35:42Reports aren't good. It created a very slick oil sheen over the patient and surgical team,
35:47but also people reported having skin irritation, eye irritation and respiratory problems on the back of it.
35:52Yeah.
35:52And Lister himself seems to have fallen out of love with it by 1880s. He's stopped using it.
35:57Though chemicals were still used to clean surfaces, at the end of the 1800s Lister and his contemporaries realised that
36:05cleaning clothing and equipment with hot water and steam was just as effective at killing germs.
36:11So they began to focus on creating an entirely sterile or aseptic environment in which to operate.
36:22So do we know if this actually worked alongside the other measures that he was putting in place?
36:27It definitely would have been effective.
36:31In fact, these innovations were so effective that mortality rates following surgery dropped from around 40% to less than
36:403% by 1910.
36:43And maintaining a clean environment continues to be of the utmost importance to BART's hospital staff.
36:51Up on the surgical ward, Medical Director Andrew Ragg is performing his regular infection prevention ward round.
36:59So here we're up on a surgical ward. This is patients who are recovering from major cardiac surgery.
37:06Doing an infection prevention walk around, it's really important that we make sure that the environment is as clean as
37:11possible.
37:12Because obviously, although it doesn't seem as glamorous as major heart surgery, actually infection control prevention is as important as
37:18any of the work that we do in the hospital.
37:20We're really focused on kind of looking for those places on a ward where maybe a bit of dirt can
37:26be missed, a bit of dusting can be overlooked.
37:29I mean, it's just such an endless task.
37:33Yeah, it's all good. Nice, clean space.
37:36There are 290 patient beds in BART's, and as the director ultimately responsible for infection control, it's Andrew's job to
37:45make sure the entire hospital meets the highest standards.
37:49Hello, hi, Jason. Hi.
37:51My name's Andrew. We're just doing a little inspection of your room, so we're going to have a little look
37:55around, if that's OK?
37:55Yeah, absolutely, go ahead.
37:56Yeah, good. So some of the things is to look for the spaces where we know that kind of dust
38:00can hide and collect.
38:02And this is the common one we do, looking on the high surface high dust and nothing there, but let's
38:07just try the back.
38:08OK, yeah, so maybe not unexpected, we've got a tiny little bit of dust there, which we kind of nearly
38:13always find in some of the spaces in the wards,
38:16because the dust collects so quickly. It comes from the linen, paper towels, clothes.
38:21So it's not the kind of the heavy build-up of the bad dust and dirt that you can get
38:26if you don't clean.
38:28But Andrew's not finished yet. Even a small amount of dust can harbour dangerous microbes.
38:34Here we are. So this helps, saves my knees, a mirror on a stick.
38:39But what it does allow is to check under the bed rail to make sure it's really clean.
38:44This is lovely, spotlessly down here.
38:45Thanks so much for letting us have a look around. Thanks so much for your time.
38:49It takes all sorts of professionals to keep Barts running smoothly.
38:54Maintaining a germ-free environment is of course essential, but so is making the patients feel well cared for.
39:02And I'm about to learn of a tradition that embodies the huge heart of Barts.
39:08All sisters would bring in patients that they knew were lonely to fill in the beds at Christmas and give
39:14them a really good Christmas.
39:26The dedicated staff of St Bartholomew's have always been its beating heart.
39:32From offering help in the minor injuries department.
39:35Now this is the bit that's going to be uncomfortable.
39:38To administering cutting-edge treatments.
39:42We'll start with the first 30 mils.
39:44There are many key roles to play, including all those carried out by its tireless nurses.
39:50And since the NHS began in 1948, they've seen a lot of changes.
39:56Hello.
39:57Hello.
39:58Lovely to meet you.
40:01Carol Bavin and Alison Knapp trained as nurses and worked here at Barts between 1955 and 2010.
40:10We all started at a preliminary training school, PTS, and I'm second row back.
40:17I see you there.
40:18The first one.
40:19This is me at PTS actually.
40:21Yeah.
40:21This is you.
40:23Yes.
40:24Trainees of the past had to put up with quite a number of rules.
40:28We were not allowed to live out in our nursing training, which was three years long.
40:32We lived in nurses' homes.
40:34Yeah.
40:34That were controlled by the hospital.
40:36What were they like?
40:37Well, you were not allowed to be married and you were not allowed...
40:40You weren't allowed to be married?
40:41No.
40:42Good to say.
40:44Aside from two late night parties a month, the young women were given a strict 10pm curfew.
40:52If you came in late, then you'd be on Matron's doorstep the next morning.
40:57But there were other subtle ways of getting in.
41:00When an ambulance came to A&E, and then if you were smart, then as the doors opened to let
41:08the ambulance in, you slipped in as well.
41:12Alison and Carol may have lived under somewhat draconian conditions, but their pride is evident, especially in their Barts badges
41:20that they still wear today.
41:23You could be anywhere in the world and someone will look up at a medic in particular or another nurse,
41:29look up and say, oh, you're Barts.
41:31Really?
41:32Very much so, yes.
41:33Tell me about this photograph then.
41:35Well, it's Christmas carols round the wards. Nurses would go round the wards with their capes inside out and singing
41:41carols for the patients.
41:42That's lovely.
41:43But the wards were decorated and nurses themselves had tinsel on their hats and everything.
41:49So it was very festive. I remember a lot of very festive Christmases.
41:53Yeah.
41:54Some of the experienced ward sisters would bring in patients that they knew were lonely, that had nothing the matter
42:01with them.
42:01Really?
42:02To fill in the beds at Christmas and give them a really good Christmas.
42:04Oh, my goodness, that's amazing.
42:06It was a lovely idea, because they used to send up a huge turkey to each ward.
42:10Probably the surgeons were better at carving it than the physicians.
42:17Though traditions and practices have changed over the decades and centuries of Barts history, one thing that's remained a constant
42:25is the dedication of its team.
42:29Hello.
42:31Hi.
42:31For nurse Sabila, the job is hugely satisfying.
42:36Thank you very much.
42:37To have someone so sick come in and really need your help, and then to be able to give that
42:41help, it's the best feeling ever.
42:44It's the most rewarding thing, because it really does make a difference.
42:48So that's delivering.
42:50Thank you, Sabila.
42:54Knock, knock.
42:55Hiya.
42:56Hello.
42:56How are you today?
42:58I'm good, I'm good.
42:58But it can also have an emotional cost.
43:03Three weeks ago, Sabila started caring for patient Kevin O'Hara, who came to Barts with terminal renal cancer.
43:11Out of all the places in all the world, this is the place I'd rather be.
43:14I know they all know what they're doing.
43:17Every nurse that's come in here has a chat and has a talk.
43:20No problem.
43:21That is really good.
43:22It lifts your spirits.
43:24And I love them.
43:25I love them all.
43:25If you give people good memories, that's what it's all about.
43:29We're only here once.
43:30Enjoy it.
43:33And I will be enjoying the next, however long I've got, we will enjoy it.
43:39Now news has come that Kevin has sadly died from his cancer.
43:44Kevin was an amazing person.
43:46He was someone that I can say that I'm very glad to have met.
43:52No matter how many times you see a patient die, it doesn't make it easier.
43:58And you just continue to feel the better space, not forgetting them, but just in memory of them.
44:22Next time, I uncover one of the most important medical discoveries of all time.
44:27There's something extremely special in this box.
44:31Which helped make life-saving heart operations at Barts possible.
44:36Okay, moving the distal clamp.
44:38Okay.
44:39And I get up close and personal with the famous bloodsuckers of Barts.
44:44Here's a nice piece of liver for your little leeches.
44:48And that's brand new, our hospital through time next Wednesday at 8.
44:52And if you or someone you know has been affected by anything into tonight's programme,
44:56head to channel5.com slash helplines for information and support.
45:01Next, from preparing women in the consultation room to operating in theatre and then home as mum,
45:07we follow Sasha to see just how she juggles life as the surgeon.
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