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00:00It's late summer. The country is in lockdown, as a deadly illness spreads like wildfire.
00:09No 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 pharmacist in charge.
00:21But to save patients' lives, they'll have to risk their own.
00:27The year is 1665.
00:33This is St. Bartholomew's, Britain's oldest hospital.
00:39This hospital has cared for people through the reign of Henry VIII, through the plague, the Great Fire of London,
00:46the Covid pandemic and beyond.
00:49Over nine centuries of scientific discoveries are here at my fingertips.
00:54There's something extremely special in this box.
00:59Now, for the first time, I'll reveal how the breakthroughs of the past,
01:05you've got to see this with your own eyes, are helping to write the future of medicine.
01:10I am absolutely blown away by this.
01:14I'll step inside the day-to-day of this state-of-the-art institution.
01:18That is incredible.
01:20Where they've been saving lives and making history.
01:24Oh, wow!
01:25For nearly a thousand years.
01:28And behind every door is a new secret just waiting to be discovered.
01:42Hi!
01:42Clinic five.
01:44Clinic five.
01:45These lifts here.
01:46Second floor.
01:48Hospitals are there for us from our birth to our deaths.
01:51And some of us will end up in a place like this through a life-changing experience.
01:58Staff at BART's have been looking after patients through medical emergencies, life and death surgeries and routine illnesses for centuries.
02:05For them, it's not just a job.
02:08Thanks very much.
02:08Thank you, Walter.
02:09It's a vocation.
02:12I've just called the Encore SHO.
02:14Yeah.
02:15His car seems 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.
02:27Carol, how are you?
02:285A is a cancer ward.
02:30How are you?
02:31As a world-renowned centre of excellence for cancer care, BART takes patients from all over the country who need
02:38urgent 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. Obviously, we know it's been really low today, but you've had the
02:50fluids.
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.
03:01I did a CT scan on my stomach to find out that there was a tumourous 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, meaning it had spread from a
03:17primary source somewhere else.
03:19Two specific cancer marker blood tests and a physical exam eventually 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.
03:35Nothing big.
03:37Went your own water?
03:38Yep.
03:39Consultant oncologist Kenrick Ong is looking after Harrison.
03:43This is Harrison's initial CT scan.
03:47And the 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, occupying most of the left side of
04:07his 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. Do 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, but I'm being upbeat in terms of the
04:39situation 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, the chances of it returning or relapsing are quite high.
05:04His mum, Julie, an NHS clinical systems manager, has put her job on hold so she can be by her
05:12son's side throughout his treatment.
05:14Harrison, he's my only one and we will be with him every step of this journey.
05:20That key thing is, day by day, just embrace every moment that you have, and which we're doing.
05:35Over the next two months, Harrison will have two more cycles of chemo, each lasting up to three weeks, to
05:42try to reduce the cancer.
05:44To help him deal with the side effects, he's been put on a regime of steroids, anti-nausea pills and
05:51pain relief medication.
05:52These are delivered to his room three times a day, straight from the hospital's pharmacy.
06:00It looks very different from just a hundred years ago, when Bart's pharmacists, men only back then, would still mix
06:08the medicines by hand.
06:10And we find standardised recipes for common medicines going back as early as 1618.
06:17A new space was created at the hospital to 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, and I'm trying to work out where that would have been.
06:35We've got this plan of Bart's from the 1600s here, so we can imagine what it would have been like.
06:43Now, this big block in front of me would not have been here, because that was built in the 1700s.
06:48But the church would have been, Bartholomew is the less, and then there would have been cloisters reaching out in
06:55front of me.
06:56There's a big building here, it 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.
07:08The job of Apothecary is an ancient one.
07:11For many centuries, they were more like grocers, selling all kinds of herbs, spices and wines.
07:19In the early 1600s, King James I formally recognised Apothecary's as specialists in mixing and dispensing medicines.
07:30When the Apothecary's shop was built here, it was quickly stocked up.
07:36We've got evidence of what was being bought for 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, which holds centuries worth of medical artefacts.
08:15OK, well this is a question of hunt, the pestle and mortar.
08:20What's that? That's not a pestle, that's a chamber pot.
08:25Drug pots.
08:28Poisons.
08:31And now that is a pestle.
08:34But 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 into powders, poultices, ointments.
08:53Gives you an idea of the volume of medicines that 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, was called Francis Barnard.
09:14When Francis started the role in 1661, he had no idea that just four years later, he would face the
09:22biggest challenge of his life.
09:25Coming up, I discover the horror when the plague came to Bartz.
09:31This swelling is a bubo.
09:33I'm going to cut into that and it should relieve a bit of the pain.
09:39Harrison's treatment continues.
09:41For any parent to see your child go through that is absolutely horrific.
09:47And Bartz faces a battle of a different kind.
09:50We suddenly heard the guns gearing, then the bombs began to fall.
10:03Bartz has served patients through some of the most challenging times in history.
10:07From the Covid pandemic to both world wars.
10:11But one of its darkest chapters arrived 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.
10:39Some 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 because this swelling is a bubo, an infected lymph node.
10:59I 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 would help the patient by releasing the badness.
11:18And anyone with signs of infection was likely to be locked up inside their house, along with their family, to
11:26either recover or die.
11:28At night, bodies were brought out and disposed of, along with the rest of the city's dead, in mass plague
11:35pits.
11:35Now, today, we understand bubonic plague very well.
11:41We know it's caused by a bacterium called Yersinia pestis.
11:45We can treat it with antibiotics.
11:49We know that it can jump from animals into humans.
11:53Once it's in human populations, it can spread quite rapidly, as it did in the 1600s.
12:00The infection likely spread from rodents to humans via fleas, and then from human to human via body lice.
12:09Now, they didn't know any of that in the 1600s, but they did realise that it was dangerous to be
12:17close to somebody who was suffering from the plague.
12:21With plague victims confined to their homes, Bartz continued to admit patients with other ailments, until finally there was a
12:30breach.
12:33Archivist Kate Jarman has the Bartz governor's minutes for September 1665.
12:39The plague's been raging all summer, and on the 2nd of September, this is the first time where plague actually
12:44gets into the hospital.
12:46With the plague now inside Bartz 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.
13:01They aren't in London anymore. The wealthier staff just left town.
13:05So, who's left?
13:06So, you've got a record of the governors appointing another surgeon, Thomas 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, he's been appointed to prescribe for the patients in the doctor's
13:28stead.
13:28So, he's stepping up into the role of physician, basically.
13:32As well as Francis, other workers in the hospital also stayed.
13:36Then you've got Margaret Blake, the matron, and 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 must have worked during this horrific moment in history.
13:52I want to find out how Francis could have helped the plague victims at Barts.
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, particularly if they had poppy in.
14:13That would certainly have enabled them to sleep and get a bit of rest.
14:18As well as making up prescriptions for the patients, Francis would have also tried to purify the hospital itself.
14:25On the windowsills, there would have been herbs and spices, because 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, Francis would have combined some pungent
14:44ingredients.
14:46If you smell, that reminds you of your childhood Christmas, cloves and oranges.
14:49That smells really Christmas.
14:50I know, it does. It immediately snatches you back to being little.
14:54So, the idea is that you're breathing in air, but it's coming through.
14:56And 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. It just happened to be wrong.
15:04Before antibiotics and vaccinations, social distancing and luck were your best bets for surviving the plague.
15:12By the time it was over, the outbreak had claimed the lives of more than 100,000 people in London
15:19alone.
15:20His efforts may have been futile, but Francis had stayed with his patients.
15:26He survived and continued working at the hospital for many years.
15:39Over the centuries, tens of thousands of dedicated staff here have cared for patients.
15:46But Bart's also has a community of volunteers.
15:53Like Rita Buttigieg, who works in the Bart's Guild Shop on the ground floor of the King George V building.
16:00How are you, Miss Rita?
16:02Good.
16:02I had cancer, I was treated in Bart's, and I felt I wanted to give back a thank you.
16:09See you soon.
16:10Right.
16:11And I've worked in the shop for 14 years.
16:17Rita does a shift here every Thursday, helping to keep the shop running.
16:21See you.
16:21Have a lovely day.
16:22We sell sweatshirts, pens, hand 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 a hundred years, and its contribution to the hospital has been
16:40vital.
16:40Founded by the wives of five Bart's consultants back in 1911, Guild members hand-sewed clothing and bed linen, made
16:50splints and crutches, and raised money.
16:53After the creation of the NHS in 1948, the Guild shifted to running the hospital shop, and by the 70s
17:00they even had a florist.
17:03We've got some very good knitters, and our knitted teddies are very popular.
17:09I think it's more than a shop.
17:12It gives comfort to a lot of people, and there's always in here someone to listen to their story.
17:19Thank you very much.
17:20Thank you. Bye-bye.
17:22Rita is just one of thousands of patients who've been treated for their cancer at Bart's.
17:28Up on Ward 5A, 24-year-old Harrison Berkey was admitted a month ago with advanced testicular cancer that had
17:37spread 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, Harrison is preparing for his second round of high-dose chemotherapy under consultant
17:54oncologist Kenrick Ng.
17:55So chemotherapy is quite gruelling.
17:58It does come with its host of side effects.
18:01Loss of hair, loss of appetite, soreness in the mouth, ulcers which can cause difficulty with eating and drinking.
18:09These side effects mean Harrison has been losing weight, so he's now been fitted with a feeding tube to ensure
18:15he gets the nutrition he needs.
18:17This feeding tube going in is one of those things I was a bit scared about, but now I've done
18:21it and it's out of the way, it's like okay, 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, which attack cancer cells, stopping them growing and
18:39multiplying.
18:40Like many medical breakthroughs, it was discovered by accident and from very unlikely origins.
18:47Doctors studying the effect of the chemical agent mustard gas in World War One discovered that soldiers' white blood cells
18:55had been destroyed.
18:56They soon realised components from the powerful chemical agent could be used to target cancer cells.
19:03The first human trial took place in 1942 and within a decade, chemotherapy was transforming cancer survival rates.
19:14How are you feeling?
19:16I'm feeling okay, 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, he'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 and help with this healing process.
19:58400 years ago, apothecary Francis Barnard was making remedies for his patients on site.
20:05And today, Harrison's chemotherapy drugs are still made right here in Bart's state-of-the-art chemo lab.
20:13They produce over 20,000 customised chemotherapy doses each year,
20:18in addition to the 120,000 ready-made drugs dispensed by the hospital's pharmacy.
20:24So this is your lair down here.
20:26It is.
20:27Lead pharmacist, Sotiris Antonio, is showing me how it all works.
20:33And it's not what I expected.
20:35Where are the medicines?
20:36Wow, things have changed over the years.
20:38All of our medicines are effectively behind that white wall there.
20:41Okay.
20:41Everything'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 for 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.
21:10Yeah.
21:10Exactly.
21:11Exactly.
21:11And it's continuously working 24-7.
21:14When medicines are delivered to the hospital, the pharmacy teams scan them into the system and let the robot work
21:21out the best place to store them until they're needed.
21:24Right.
21:24So can I do this one?
21:25You can.
21:26So scan it.
21:26Scan this little bar cage.
21:28And then place it.
21:30That's it.
21:31All the way.
21:31Let go.
21:33Give it a couple of seconds.
21:35It will pick it up.
21:37Oh my goodness.
21:37Yes.
21:38Place it.
21:39And optimize its space.
21:41It's quite strange when you hear that noise.
21:44When a drug is required by a patient, a member of the 120 strong pharmacy team orders them up and
21:51the 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.
22:04Coming 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 a hundred years ago.
22:18It was an incredible trust that they're placing in him.
22:21Transforms 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, Barts story is interwoven with the history of London itself.
22:43And it often found itself right in the heart of the action.
22:48In the First World War, Germany launched over 50 aerial attacks, some from the giant inflatable airships known as Zeppelins.
22:59Many were focused on the capital, the centre of the country's economic power and military command.
23:08On the 8th of September 1915, a Zeppelin dropped a bomb really close to Barts and it did cause considerable
23:16damage.
23:18The hospital governors wrote about the aftermath of the bomb.
23:221,197 panes of glass were broken by the force of the explosion.
23:29But in the close outside the hospital, a hole big enough for a motor boss was made.
23:37To this day, the hospital still bears the scars from 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 are hitting the wall.
23:56Look at that massive crater.
24:02But for Barts, the worst air raid of the First World War came on the morning of the 13th of
24:08June, 1917.
24:1130 German bombers had entered the skies above East London and 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, who was there to witness the horror firsthand.
24:29We had no warning.
24:31We suddenly heard the guns going, then the bombs began to fall and everyone springs into action.
24:38Look, the students cleared the hospital square of the beds and patients in just over five minutes.
24:45I've never seen anything like the way they worked.
24:49The bombing rocks the city.
24:52Casualties began to pour into Barts.
24:56We filled every bed in the hospital that was empty, including the military block.
25:01The surgery felt like a battlefield.
25:04Amid the chaos, a very unexpected visitor dropped in to check on the wounded.
25:10King George V, grandfather of Queen Elizabeth II.
25:14The King came into the surgery, no work was stopped for him and he visited all the patients in the
25:23wards and at the end made a speech in the square, congratulated everyone on the way they'd worked.
25:29By the end of that day, 162 Londoners had been killed and over 400 injured.
25:37As well as treating civilian casualties, the East Wing of Barts was turned over to accommodate wounded soldiers shipped back
25:45from the battlefields.
25:47Ginny Dorr Woodings has the hospital journal from May 1915, which includes an account of their shocking injuries.
25:55They're encountering a sort of warfare and 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 of industrial warfare.
26:13Machine guns, tanks, mortar bombs and close range trench fighting led to unimaginable casualty numbers and traumatic injuries.
26:22It fell to army medics, some of them from Barts, to offer first line treatment.
26:28You get a sense of people feeding back techniques and knowledge that they're learning at the front and having it
26:32published so they can learn from what's happening out there.
26:35But figuring out how to treat such disfiguring facial injuries was a new challenge.
26:42Enter surgeon Harold Gillies.
26:46Born in New Zealand in 1882, Gillies moved to England to study medicine, training at Cambridge and then at Barts.
26:54In 1915, he joined the Royal Army Medical Corps, serving in France, where he experienced the horrors of trench warfare
27:04up close.
27:07Gillies soon began experimenting with procedures that could reconstruct the faces of injured servicemen.
27:15I've come to the Royal College of Surgeons to learn more from plastic surgeon Nick Bennett.
27:23Harold Gillies was involved in many thousands of nasal reconstructions.
27:28And because of the volume that he was treating, he pushed on the specialty quite dramatically.
27:32So he's become known as the pioneer of modern plastic surgery.
27:36There's evidence of nasal reconstructions being carried out as early as 600 BCE in India, often on criminals who'd had
27:45their noses cut off.
27:46Then in 1596, the Italian surgeon Taglia Cozzi developed a method of borrowing skin from a patient's arm to recreate
27:57the 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, who was struck by a missile, and it essentially took his nose
28:15off his face.
28:16Now, these are shrapnel injuries, and shrapnel is irregular shape.
28:21Yeah, so it's ripping through tissue.
28:23So imagine this searing injury.
28:25Private Hickey suffered the hit during the Battle of the Somme in 1916.
28:30The severity of his injuries soon landed him in the care of Gillies, who by 1917 had set up a
28:37dedicated hospital in Sidcup in South East London.
28:41I mean, there's the trauma of having been involved in that kind of warfare.
28:44Yes.
28:45And then the additional trauma for these patients of that facial disfigurement.
28:49Exactly.
28:49So I think Harold Gillies was very interested in helping them with the process of looking in the mirror again.
28:55And the holistic approach to these injuries.
28:57Gillies' pioneering technique was to borrow a flap of skin from the soldier's head or neck to help rebuild their
29:04missing facial features.
29:06The key was to keep this donor skin connected to its blood supply via an artery, meaning it stayed healthy
29:14while the graft healed in place.
29:16But it wasn't a pretty or quick process, as Hickey was to find out.
29:22So this is quite shocking.
29:24Yes, he's got a nose now, and the form of that is much better, but he's got a big area
29:30of damage on his forehead, and this is just extraordinary.
29:34Yes. What's that?
29:34This skin is keeping his nasal skin alive.
29:39Nick has made a plasticine model, so 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 of this man's nose.
29:58OK.
29:58So if we keep this artery intact, we can take a bit of skin around that and know that that
30:04artery will keep all that skin alive.
30:05The next thing we do is we create a template for the bit of skin that we want to move.
30:12Like this.
30:13So this is exactly what you would do?
30:14This is exactly what I would do to a human patient, exactly.
30:19Gillies would have then cut the skin to create a flap, still attached via a pedicle containing the all-important
30:26blood supply, but moveable enough to reposition it and 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 for this to get a blood supply from the nasal area.
30:44Yeah.
30:45And that just happens naturally?
30:46Yeah.
30:47Yeah.
30:47Exactly.
30:48Once the skin flap had settled, Gillies would insert a piece of cartilage from elsewhere in the body to create
30:54the 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 and things will get better.
31:03Yes.
31:04After 18 long months and eight operations, Gillies' patient, Hickey, was ready to be discharged.
31:10So this is, I think, a remarkable result when you compare that to the original injury.
31:17I mean, that's the image, isn't it? That he's starting here with no nose to speak of. No external nose.
31:24And here he is.
31:25Isn't that remarkable? I think as a young man, you'd be pretty happy that you'd come from there to there.
31:31Over 10,000 reconstructions later, Gillies returned to Barts in 1930 as its first ever plastic surgeon, having revolutionised the
31:42practice.
31:42And the techniques Gillies developed are still being used at Barts today by surgeons like Laura Johnson.
31:52Just starting with Janina, we've not heard anything back from the Dieppe subway.
31:55Laura specialises in the treatment of breast cancer, the most common cancer here in the UK.
32:02Seeing the impact of the disease up close is 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 really made me want to be able to deliver that
32:17and use that experience that I had to hopefully make things better for other people.
32:22Laura works in the relatively new field of oncoplastics.
32:27That's plastic surgery specifically directed at cancer treatment and reconstruction.
32:32And it's really important for me to be able to deliver surgical treatment that gives patients
32:38not only the best long-term outcome when it comes to survival, but 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 is lifelong Eastender
32:54and grandmother of six, Julia Cole.
32:59Julia has two cancerous lumps in her right breast.
33:03Laura will remove the lumps and then use plastic surgery techniques
33:08to reshape not only this breast, but her left one as well.
33:13So, what we're going to do is because we're going to remove probably about that much tissue.
33:17It could be under a full general anaesthetic.
33:19Great.
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 from around 2500 BCE.
33:36Breast cancer is also specifically mentioned in ancient Greek writings, including those attributed
33:42to the physician Hippocrates from around 400 BCE.
33:49Surgeons were operating on breast cancer as early as the 16th century, with the first radical mastectomies being performed in
33:571882.
33:59It was a procedure which left patients with significant scarring.
34:04Nowadays, surgeons like Laura are focused not just on cancer removal, but also reconstruction.
34:10I've got a great team in theatre today in terms of the medical workforce. A strong all-female team today.
34:1742, please.
34:19Can I have a force set, please?
34:20The cancer cells are located deep in Julia's breast tissue. Laura will need to cut the breast open fully to
34:28find them.
34:30She'll try to preserve Julia's nipple, which means she needs to maintain its blood supply.
34:36She's marked out the key artery feeding that area of skin and is carefully keeping it intact as she cuts
34:43around the nipple.
34:45It's essentially the same pedicle flap method that Gilly's used for his facial reconstructions.
34:54Many breast surgeons have done subspecialty training with plastic surgeons and learn plastics techniques.
35:01And 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 into the area of breast tissue containing the tumour.
35:19During surgery, she can use a magnetic wand to locate the seeds identifying the cancerous tissue, which is invisible to
35:27the naked eye.
35:28It responds to detection with a sophisticated metal detector, basically.
35:35So the seeds are guiding me to the abnormal area.
35:41Once the cancerous tissue is cut out, it's x-rayed right here in the operating theatre to check that Laura's
35:48metal detecting has worked.
35:50So here we can see that seed is in one of her cancers, that seed is in the other, and
35:56I'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, she's left with quite a big dent.
36:12I can fill the gap and then close the skin around it, and all of a sudden, the area where
36:17she would have had a gap, she no longer does.
36:21After reattaching the nipple and closing up, Laura's work is done.
36:27Great. I'm very pleased with how everything looks.
36:30I hope Julia will be too. I'm confident that we've got the cancer out.
36:34Well, this 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, they look almost green.
36:51And Harrison discovers if his chemo has worked.
36:55How are you?
36:56I'm a little bit nervous.
37:08Barts looks after over 77,000 inpatients a year who come from all over the UK to this world-renowned
37:15centre of excellence.
37:17But for some, this is their local hospital, like 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 has 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.
37:43Great.
37:43Julia's now able to go home.
37:45It's just nice to see patients the next day with 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.
38:01You 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, but in the past it relied on income from its property and
38:18the generosity of wealthy benefactors.
38:20In the 1730s, to inspire them to part with their cash, the hospital governors commissioned two enormous murals on the
38:29staircase of the North Wing.
38:31This is all looking lovely in here now, isn't it?
38:34They depict two Bible scenes, the 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. That 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 may perhaps have been modelled on real patients from Bart's.
39:07Jean Paolo Martinelli is a consultant anaesthetist, but he also has a keen interest in art.
39:13Hogarth was very much interested in Bart's because he was born not far from here.
39:20So for him, Bart's was something that was really part of his upbringing.
39:25And I think he showed certain sympathy towards people who were suffering.
39:29Yeah, a bit of humanity.
39:31Jean Paolo is putting my powers of observation to the test, asking me what I think about these patients of
39:38his.
39:38There's a lot of different colours, like the flesh is a different colour in a lot of these individuals.
39:44Yeah.
39:44Over here, there's a woman with a white cap on her head.
39:48Yeah.
39:49She's got quite a ruddy complexion, especially when you compare her to the person that she's standing next to,
39:54who is so pallid they look almost green.
39:57Different colours that reflect something that people believed at that time, which was the theory of the humorism.
40:05Humorism was a leading theory in medicine in Europe and beyond for over 2,000 years.
40:12Developed by ancient physicians including the Greek Hippocrates and the Roman Galen,
40:17it suggested that the body contained four vital liquids or humours.
40:23Blood, phlegm, black bile and yellow bile.
40:27If your humours were out of balance, it 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 and was treated with bloodletting.
40:42Too much yellow bile gave you pallid skin and yellow eyes.
40:47You might have been given wine to help heat the body and would have been advised to avoid exercise after
40:52eating.
40:52The most dangerous one was actually the black colour, which 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, but people whose skin had darkened through 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, they ask to eat something white.
41:17There is no evidence, but I think it's something that is coming from the past.
41:27Over the centuries, darts has been a steady presence for 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, Harrison Berkey has finished his final round of chemotherapy
41:50after three long months of intensive treatment for cancer.
41:54He's been looked after by consultant oncologist Kenrick Ng,
41:58who's just received the results of Harrison's final scan.
42:01We're trying to assess in the CT how well his cancer has responded to the chemotherapy.
42:08When Harrison first arrived at Bart's, his 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, and the liver is just so much cleaner now.
42:26You can't see those grey spots there anymore.
42:29And what's most striking is this huge 20-centimetre tumour.
42:35And that big mass in the abdomen, a lot smaller now.
42:41It probably measures maximum diameter of 10 centimetres, but 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, stopping the spread and shrinking the tumours as much as possible is the vital first step.
43:00He came with very aggressive cancer. I'm delighted with the response.
43:05The remaining cancer is now small enough to remove surgically.
43:09Kenrick has come to let Harrison and his family know.
43:13How are you?
43:14I feel 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.
43:35Time for you to go home.
43:39Well done, darling.
43:46Extremely proud of my bloody brilliant son.
43:49Just amazing.
43:51We did win the lottery coming here.
43:53The life lottery.
43:56I'm really hopeful for the future and being able to live the rest of my life normally.
44:03After his positive response to the chemotherapy, Harrison can now focus on rebuilding his strength, ready for the next step
44:11in his treatment.
44:12Surgery.
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.
44:25Knife, 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 eight.
44:44And if you or someone you know has been affected by any of the issues raised in tonight's programme,
44:50please get to channel5.com slash helplines for information and support.
44:55Can DCI Ellis solve a murder no one else can?
44:58She's back on the crime scene as the case continues.
45:02New next.
45:04New next.
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