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01:05Crowded the world today, isn't it? And getting more so. Amazing, really.
01:09All these people, thanks to science, fed, clothed and housed and reproducing themselves by the million,
01:15are not an epidemic in sight.
01:17I don't mean flu and measles and that kind of kid stuff. I mean the real killers.
01:21Typhoid, black death, tuberculosis. And that's what's amazing.
01:25If you think about the sheer numbers involved and the way we're all jammed together in a kind of giant
01:31ideal germ culture,
01:33that's when the full power of modern medicine comes home to you.
01:58Every day, thanks to modern medicine and its lifesaving techniques, the population grows and gets older,
02:04as doctors treat us from the cradle on. And it doesn't seem to matter that we don't understand medicine.
02:10We take it all trustingly for granted. The drugs and the technology and the research.
02:17And the miracle of keeping these little babies alive, for instance. And as for the diseases they can't cure today...
02:26Well, they will tomorrow, won't they?
02:32I mean, nobody understands what they're doing, but then you don't exactly argue with the doctor, do you?
02:37He's not interested in your opinion. It's the bug you've got he's after.
02:41He says, lie down, shut up, take your clothes off. You do.
02:47Ironic, that unquestioning obedience, because it came into existence
02:51thanks to the help and inspiration of the fellow who founded this hospital for the poor, here in Philadelphia.
03:02His name was Benjamin Franklin, and the last thing he was was obedient.
03:06He and his friends thumbed their noses at us. They ran the American Revolution here, in Independence Hall.
03:12We solemnly declare our resolve to preserve our liberties and die free men, rather than to live as slaves.
03:27When it was all over in 1776, Congress here sent Franklin off to France to buy guns, sign treaties and
03:34export revolution.
03:35Among other things, he took with him an entirely new American way of looking at public health.
03:40Oh, and a copy of this too, of course.
03:44If there was ever a statement of disobedient individualism,
03:47it was the anti-British Declaration of American Independence that Franklin helped to write.
04:19The New York Times
04:20The New York Times
04:21TARED
04:22he was the second most popular man in the country
04:24after George Washington himself.
04:26He had almost single-handedly made Philadelphia
04:29the most progressive city in the 13 states.
04:32Remember, click.
04:34Step this way, please.
04:36Franklin's Philadelphia hospital, above all,
04:38was better than anything in Europe,
04:39as was the health of the citizens.
04:47For the would-be revolutionaries waiting across the Atlantic,
04:51Franklin was living proof of the 18th century unthinkable,
04:54that you could declare war on your own king,
04:57handle anything his professionally trained army then threw at you,
05:00invent an entirely new kind of government,
05:03take a vote on the whole affair, and get away with it.
05:08So Franklin's credit rating with his French hosts
05:11was going to be slightly unlimited,
05:14in spite of one minor awkwardness.
05:16Revolution-wise, they hadn't actually done the dirty deed yet.
05:18There was still a king in residence,
05:21if residence isn't too humdrum a word
05:24for Louis XVI's cut-glass lifestyle.
05:51Franklin turned up here in his moth-eaten fur hat and bifocals
05:54and stole the show.
06:03Well, with the revolution in France just round the corner,
06:06and Franklin the superstar of the one they'd just had in the US,
06:10small wonder he was an ideological sensation,
06:12added to which he was a man of charm and wit,
06:15and ladies fell heavily,
06:17which is why we were in a salon.
06:20You see, in 18th-century terms,
06:22this is where the elite meet.
06:25And at the time,
06:27the salon for all the name-droppers
06:29was run by the lovely widow
06:31of a late leading liberal called Helvetius.
06:34Madame Helvetius was crazy for Freemasons,
06:38scientists, philosophers, reformers and Americans.
06:41Well, Franklin was all of them.
06:43So they became friends.
06:45And the future of France
06:47turned, as it so often has done,
06:50on a discreet mixture of politics and pillow talk.
07:00Politics, because, come the revolution,
07:02this was all to be replaced by one house of government,
07:04and Franklin had actually written a constitution
07:07with only one house,
07:08the constitution of the state of Pennsylvania.
07:14Pillow talk?
07:15Well, Madame Helvetius also had a young friend
07:19living in at the time,
07:20a doctor called Cabany,
07:22whose bedside manner was really something quite new,
07:26because that's what he wanted to do to French medicine.
07:28And Franklin's long talks about American hospitals
07:32and public health programmes back home
07:34convinced Cabany
07:35that revolutionary democracy was good for your health,
07:40which, at the time, European medicine wasn't.
07:43I mean, you were sick and rich.
07:45This is what happened.
07:46If you were poor, nothing happened.
07:48So, the doctor came,
07:49and you'd tell him what to do.
07:51The patient, if you'll forgive the phrase,
07:54called the shots.
07:56Doctors thought disease caused different symptoms
07:58in different people,
07:59so you really diagnose yourself.
08:01And every symptom was in the doctor's pocketbook of symptoms,
08:052,400 of them.
08:07Diseases like nostalgia,
08:10described as a vehement desire to go home.
08:17You can see why revolutionary young Cabany
08:19went for Franklin's ideas on medical reform.
08:22The question was,
08:23with incompetence like this around,
08:25how came the revolution?
08:28and the French adult population.
08:29o'clock, o'clock, o'clock,
08:44o'clock, o'clock Jutte, o'clock.
08:50o'clock, o'clock, o'clock, o'clock, o'clock.
08:56By 1793, the new republic was at war, and with a million men in the field,
09:00there were just too many wounded for the properly qualified, officially recognised doctors to handle.
09:06So they brought in surgeons who, believe it or not, weren't regarded as real doctors.
09:11Well, this kind of mess was just what surgeons were good at.
09:14Instant treatment and never mind what the patient thinks.
09:19In most cases, the surgeons had to work without supplies,
09:23and discovered things like the best cure for wounds was water, not ointment.
09:27That shock killed you as quick as anything else,
09:30so they invented the idea of the ambulance to get soldiers treated fast.
09:34That if you didn't amputate within 24 hours, the patient would lose a lot more than his leg.
09:40And once you cut whatever it was off, the best bandage to use was the patient's own skin.
09:49With do-it-yourself instruments and shirts for bandages, grass poultices and no drugs,
09:55the surgeons saved far more lives than the physicians.
09:58And with so much raw material, if you'll forgive the phrase, to practice on,
10:02they learned more about treatment from the battlefield than from any textbook.
10:07By 1794, after two years of this, the surgeons were finally awarded the status of doctor.
10:13In most cases, given the horrific casualty rate, it was a posthumous award.
10:35So many doctors had been killed by the time it was all over.
10:39They had to open new medical schools all over the country to replace them.
10:43Not just because of the tens of thousands of returning wounded that had to be patched up,
10:48but also because of the ambitious revolutionary plans to provide free medical care for every citizen in the new republic.
10:55So the first thing they had to do was to find somewhere to put all the bodies.
11:00Places like this one, the old Val-de-Grace Monastery in Paris,
11:04were commandeered and turned into state hospitals where they sometimes had to pack them in six to a bed.
11:10Still, at least the doctors were a new breed.
11:12The surgeons ran the place now, and there were new rules.
11:16Mugging up lists of phony symptoms was out.
11:19On-the-job training was in.
11:22If you wanted to get ahead, hospital doctoring was the way to go.
11:31Hospitals started to look like they do now when the ex-officer doctors dropped the old bedside manor for good
11:37after Cabernet took over in 1798.
11:40And the patients?
11:42Well, they were obedient ex-soldiers used to taking commands,
11:45or they were the poor off the streets, too scared to argue.
11:53With new rules and regulations about everything,
11:56getting cured took on the regimented feel it has today.
12:01The patient did what the doctor ordered.
12:05And with Cabernet's book on how scientifically accurate medicine ought to be,
12:09things looked set to become more efficient and less mumbo-jumbo than ever before.
12:13Except for one relatively serious impediment.
12:17They might well have got it right on the battlefield
12:19about how to handle fractures and wounds and hygiene and such.
12:23But when it came to what disease itself was,
12:27well, they were still really going round in circles.
12:32The answer to their problem was to come from a German university
12:35and the mathematics of a certain Gottfried Leibniz,
12:38who'd discovered a way to measure the infinitesimally small changes
12:41that happened in the speed of planets in orbit.
12:44Leibniz had reckoned that being able to measure infinitely small things
12:48meant you could also get to grips with the fundamental structure of all existence.
12:52Now, as you can tell by the expression of rapt attention here,
12:56the maths involved wasn't exactly two and two.
12:59But according to Leibniz, you understood his equations,
13:01you had the key to the universe.
13:06Well, the philosophers had that off him fast and you could say calculus.
13:10And by the 1790s, European thought was in the grip of people
13:13like a fellow who worked here at Würzburg.
13:16Name is Schelling.
13:17He called himself a nature philosopher because he said if you could break down any organism
13:21into its infinitesimally small bits, you'd see how everything connected with everything else.
13:27And that would give you, wait for it, the secret of life.
13:31Well, the doctors had that off him faster than you could say natu or philosophie.
13:37In particular, a doctor called Xavier Bichard.
13:42Know who he was?
13:43One of those surgeons back in Paris.
13:46Now, what can I tell you about Bichard,
13:48except that he must have had absolutely no sense of smell?
13:51Because what he did was go hunting for infinitesimally small bits in the human body,
13:57in graves, coffins, accidents, mortuaries.
14:01If it was dead, he burrowed it.
14:04And when he'd finished weighing it, boiling it, pickling it, drying it, cooling it,
14:09frying it, shredding it, and doing what in general I believe cooks call reducing the stock,
14:15in 1800 he announced that bodies were made of tissue.
14:18Muscle tissue, lung tissue, skin tissue, 21 types of tissue.
14:22And that diseases didn't hit whole bodies, they hit tissues.
14:26And if you could look at the tissue of a corpse that died from a particular symptom,
14:30you could connect symptom with disease.
14:33We call that pathological anatomy these days, invented by Xavier Bichard.
14:39His only problem, could you be sure of your conclusions if your supply of corpses was limited,
14:44which, unfortunately, it tended to be?
14:47Well, mathematically speaking, that possibility was on the cards.
15:09Mugs game this, really, you know.
15:11I mean, take the roulette wheel.
15:1336 numbers and a zero.
15:15You know what my chances are of breaking the bank at Monte Carlo,
15:18just because my number comes up only six times in a row?
15:23133,488,702 to one against.
15:31Now, those kinds of numbers attract two kinds of people,
15:34suckers and mathematicians.
15:37And back in Bichard's time, there was a gambling epidemic.
15:40Which is why a numbers freak and the head of Napoleon's science think tank,
15:45called Laplace,
15:47used the tables as research material
15:49and came up with the mathematics of probability.
15:52Now, in very simple terms, that's the three-card trick.
15:55Look, you bet on what I've got.
15:58Three red cards, three black cards, or a mix.
16:01And odds are you'll get it right.
16:02I'll shorten the odds for you.
16:04There.
16:05Now you know it wasn't three red cards.
16:08Now, with these new mathematics,
16:09what Laplace could do was work backwards from this card
16:11to work out the odds and the possible combinations of the cards I started with.
16:15Three blacks, or two blacks and a red,
16:17or one black and two reds.
16:21And going backwards like that was just what Napoleon wanted.
16:25Part of his reason was outside.
16:30Monaco, along with Nice, Holland and northern Italy,
16:34annexed in the recent war.
16:35And the first thing they had to do to administer this new, bigger France
16:38was to count the population.
16:41And they couldn't afford to count everybody.
16:43But with Laplace mathematics, they didn't have to.
16:45They took 30 small areas, added up the people, and divided by the birth rate.
16:50Got one baby per 28.353845 people.
16:55OK.
16:55For the whole country, the annual birth rate was known from parish registers.
16:59One and a half million babies.
17:01Multiply that by 28.353845,
17:03and you get 42,529,267.
17:12Laplace used his maths to tell him what the chances were
17:15that those accurate small-scale samples he'd taken
17:18had given him a national figure that would be valid.
17:23Laplace gave that an inverse probability of being right
17:25to within half a million.
17:27Close enough for Napoleon.
17:28And just the idea for Bichat's pathologists.
17:32For the first time in history,
17:33the patient was about literally to become a number.
17:39Oh, the hand, three blacks.
17:55Back in Paris, the numbers game really caught on,
17:58because by 1820, there were over 50,000 patient beds there
18:02in new, purpose-built hospitals split, as they have been ever since,
18:06into separate wards for men, women and types of disease.
18:10And in those wards, with hundreds of thousands of patients
18:13to examine every year, medicine became mathematics.
18:18The numbers were big enough for statistical analysis
18:21of how diseases progressed and how well treatment worked.
18:24And with teaching going on during the new ward rounds,
18:27and the teaching staff, active doctors themselves,
18:29and a new use of charts and regular records for a patient,
18:33the medical profession became what it is today,
18:35a profession, with journals and societies
18:38and in-house rules.
18:40And all the time, the patient became less involved
18:43in his own treatment, as new instruments
18:45made it possible for a doctor to find out
18:47what was wrong with you without having to ask you.
18:52By 1830, Paris was the hospital centre of the world,
18:55and foreign students were flocking in
18:57to find out how this clinical medicine worked.
19:07One of the foreign students of the new medicine by numbers
19:10was a young fellow called William Farr,
19:12who in 1831, after two years of Paris,
19:15sailed back here to London, just in time to wish he hadn't.
19:19You see, for the previous 14 years,
19:22a killer epidemic had been working its way inexorably outwards from India.
19:26And in 1831, it was in Hamburg, just across the North Sea,
19:31with 50 million dead behind it.
19:34Well, there was total panic here.
19:36Britain was the perfect target for any epidemic.
19:39Why?
19:40Because she was right in the middle of the Industrial Revolution.
19:44In ten years, the number of towns had doubled to a thousand.
19:47The population had gone up from 9 to 14 million,
19:50and all the extra were jammed into the cities,
19:53where they lived in stink and filth,
19:5540-to-a-house, ankle-deep in sewage,
19:57working 16-hour days in unspeakable conditions,
20:00and dropping like flies from malnutrition anyway.
20:04And nobody knew what to do with them.
20:06There'd never been that many people living that close together before.
20:09An epidemic might tip the scales to anarchy.
20:20Desperate attempts were made to quarantine the country.
20:23They closed all the ports, crossed their fingers, and failed.
20:29On Sunday, October 23rd, 1831,
20:32in the northern port of Sunderland,
20:34a sailor called Bill Sprote collapsed
20:36with violent pains, diarrhoea, vomiting,
20:41high fever, massive loss of body fluids.
20:44Three days later, he was dead,
20:46the first British cholera victim.
20:49The nightmare had come.
20:51They put a ring of troops around Sunderland.
20:53The cholera went through it like that.
20:55Within one month, it was here in London.
20:584,000 people were dead,
21:00the cholera was spreading like fire,
21:02and nobody had the faintest idea how to stop it.
21:24In the swarming city slums,
21:26doctors tried everything they knew,
21:29everything from splashing vinegar or nitric acid around
21:31to burning tobacco.
21:33Was cholera caused by bad smell
21:35or by people touching each other or flies.
21:43As the cholera went through cities like a ripsaw,
21:47attempts at prevention became more and more crazy.
21:50Pepper, castor oil, hot bricks,
21:52whitewashing the houses,
21:54ringing church bells,
21:55evicting families into isolation.
21:57Everything failed,
21:59including the favourite burning pitch.
22:03As the death toll climbed towards 32,000
22:06by the end of the first year of cholera,
22:09something happened that was to bring William Farr
22:11and his French medical maths into the story.
22:15See, most of the workers belonged to friendly societies.
22:18They paid weekly dues to them in preparation for times like this,
22:22when they'd need sick pay or funeral expenses.
22:24And the friendly societies charged subscriptions
22:26based on the average age people got sick and died at.
22:31Trouble was, their figures were way out of date.
22:34A, because they'd been compiled 100 years earlier,
22:36and B, not only were conditions radically different now,
22:40but back then,
22:42the rate at which people died had been going down.
22:46Now, it was going very definitely up.
22:49So more people were dying than the clubs expected,
22:52so they were paying out more
22:53and going broke all over the country
22:55and making their million-odd poverty-stricken customers
22:58desperate enough without cholera.
23:04So, for various reasons,
23:06getting the numbers right
23:07seemed like the thing to do all round.
23:09And it was the actuary for this place,
23:11Legal and General Assurance, who did the trick.
23:13He put together all the up-to-date figures he could find,
23:17processed them,
23:18and found that all death rates
23:20went through three consistent stages.
23:22Before the age of fertility, they fell.
23:25During the fertile years,
23:26they remained more or less steady.
23:28And after the fertile years,
23:29they rose again.
23:31And they did that at each stage
23:33at the same rate for everybody.
23:36When William Farr saw that, he jumped at it.
23:38This was evidence that human life
23:40obeyed mathematical laws,
23:41that you could treat people like numbers
23:43and they'd respond like numbers.
23:45So, when the General Registrar's office
23:47opened in 1836
23:48to centralise all the data collecting,
23:50and stuff like this started coming in,
23:52millions of fact sheets on deaths
23:54with all details including cause of death,
23:56William Farr went at it
23:58like a sweet tooth and a chocolate factory.
24:00In the 1840s,
24:02he did all the statistics
24:03for a major report on conditions in the cities.
24:05The report scared the hell out of everybody.
24:08In a nutshell, it said,
24:09pay the streets,
24:10bring in clean water,
24:12knock down the slums,
24:13get the dung and the disease
24:14and the cesspits out of people's homes,
24:16or what you will have is a revolution.
24:19Before the authorities could even harumph,
24:21cholera exploded again.
24:2370,000 people dead this time
24:25and enough numbers
24:26for Farr to do something about it.
24:28Did poverty give you cholera?
24:31Bethnal Green,
24:31poorest place in London,
24:33number of deaths.
24:34Less than places,
24:35twice as rich.
24:36So it wasn't money.
24:38Was it where you lived?
24:39Maybe.
24:40Here's the nationwide death rate.
24:42At these places,
24:43much higher.
24:44All of them,
24:45towns on water.
24:47Farr double-checked.
24:48He looked at the death rates
24:49from an inland county
24:50and compared it with London,
24:52a port on a river,
24:54and, yes,
24:55a higher death rate.
24:57Liverpool,
24:57same kind of location,
24:59and even higher.
25:01Both of them on water,
25:03both high death rates.
25:04See?
25:05Now,
25:06Farr believed in the bad smell theory of disease,
25:08and the Thames stank.
25:09So in 1852,
25:10he checked that connection
25:12he'd found with water.
25:13There's the Thames.
25:15Farr divided London into contour lines
25:17to see if how high above the water you lived
25:19had any effect.
25:20And there it was.
25:21The cholera deaths
25:22followed the contour lines exactly.
25:25Worst,
25:25down at water level along the river
25:26where the stink was strongest,
25:28better higher up,
25:29and best of all,
25:30in the sweet-smelling hills of Hampstead.
25:32Oh, and by the way,
25:33that explained Bethnal Green.
25:34It was there,
25:35poor,
25:36but 60 feet above the river.
25:38The big question was,
25:40what was lethal
25:41in the smell coming off the Thames?
25:51And then Farr got a break.
25:53The following year,
25:54during the next cholera attack,
25:56a local water pump
25:57started killing people.
26:01Six hundred in ten days,
26:03and for no apparent reason.
26:05It pumped water up from a deep well
26:07that had never given trouble before.
26:09Then somebody took a closer look down below
26:12and discovered that the local cesspit
26:13was leaking into the well.
26:19It began to look as if it wasn't the Thames after all.
26:32It began to look as if it wasn't the Thames after all.
26:41Well, in 1855,
26:44Farr finally came up with the answer.
26:46During this last lot of cholera,
26:48of all the companies that piped water
26:50to places that didn't have wells,
26:51only one had obeyed a new law
26:54to stop getting its water
26:56from the river downtown
26:57where all the sewage got dumped,
26:58and instead get it from further upstream,
27:01well above this polluted area here.
27:02That single law-abiding water supplier
27:05was called the Lambeth Water Company.
27:08Thing was,
27:09it supplied an area of South London,
27:11over there on the other side,
27:13street for street,
27:14with a competitor
27:15who was still getting his water
27:16out of the unspeakable muck
27:18that flowed by here.
27:20And that turned out to be it.
27:22Of the people getting Lambeth Company supplies,
27:25only 400 died.
27:26The dirtier stuff killed ten times that.
27:29So it was what they were drinking.
27:33Well, those who could afford to leave all this
27:35took the resultant fixation with clean water
27:37to positively Germanic lengths.
27:41Now, I was going to list the weird things
27:43the Cold Water Treatment Brigade
27:45got up to in upper-class Germany
27:47and then throughout Europe,
27:48starting the fashion that still survives today,
27:51that clean water equals good health.
27:53But the lunacy speaks for itself.
28:13The middle water bites
28:15as they Moreover binnhukes
28:32is way to comprehend
28:34CHOLER PLAYS
28:52Ready?
28:55Meanwhile, in England, the theory that cholera was a divine punishment
28:59found expression in an attitude that also still exists today,
29:02the idea of the sound mind in the healthy body
29:05and the mania for sport, born of Victorian paranoia.
29:08Go on, Ashby!
29:11At the new public schools, the boys were driven by the belief
29:14that God hated the milksop and loved the manly athlete.
29:18As the playing fields echoed to the sound of compulsory games,
29:22the school chapels thundered with the Anglican answer to cholera.
29:25Go on, McFlyney!
29:26Muscular Christianity.
29:41Muscular Christianity.
30:02Oh, well, hell!
30:05And it was now, in the 1850s, from the sports we played out of sheer hypochondria,
30:10that we got our modern habit of apologising for being sick,
30:13and the myth about our national character, you know, being such jolly good losers.
30:19Well played.
30:23All the clichés about the English started with cricket.
30:27Team spirit, fair play, stiff upper lip, a straight bat, all Victorian inventions,
30:31designed to keep the boys in the healthy open air, to teach them command and discipline,
30:36and prepare them to handle the anarchy that might come in the cities, if things didn't improve.
30:48Oh, a bolt!
30:50We have built a magnificent palace of legislature on the banks of a magnificent river.
30:56Here in London, things were definitely not improving for one vital bunch of people,
31:01because little would be done until the stench and the filth got out of the slums and into the Houses
31:06of Parliament.
31:07Well, in the long, hot summer of 1858, the stench did just that.
31:11After half-hearted measures like paving streets and outlawing cesspits,
31:15the problem was now flowing by outside the medicated window blinds.
31:19The Thames was now a public lavatory.
31:21Oh, the smell's absolutely...
31:23Asphyxiating MPs were now finally to bring the solution to the cholera problem,
31:27and in doing so, turned the citizen into the number he is today.
31:33The Thames outside is a scandal to us before all Europe.
31:39Something must be done.
31:42If the cholera were to visit the metropolis,
31:45while the river is in the present state,
31:47the mortality would be something to present.
31:51Their decision was to mount one of the most ambitious civil engineering projects
31:55ever undertaken by a major city anywhere,
31:58to clean up the Thames.
32:02The man they gave the job to was a fellow called Basil Jet, an engineer.
32:06And you could say he flushed out the problem.
32:08Come down and have a look.
32:12You see, at the time, sewers were built to handle only dry human waste.
32:17They'd break in every so often and cart it all away.
32:19But now, with the increased use at the time of the new WCs,
32:24and that road surfacing, you recall the reformers wanted?
32:27Well, now, there was loo water and rainwater runoff
32:31coming down here and washing tons of sewage off into the Thames.
32:41And, of course, at high tide, it would back up again out into the streets.
32:47Basil Jet's plan was to build a network of intercepting sewers
32:51to stop it getting to the river at all.
32:53This is one of those intercepting sewers coming in there behind me
32:58and then going away down there.
33:00Look at how it worked.
33:04We're here.
33:05The old sewers ran this way to the river
33:08and now hit Basil Jet's new network of intercepting sewers
33:12running parallel to the Thames,
33:14three to the north and three to the south,
33:16joining up there and there
33:18and diverting the sewage from the river.
33:31Where the north and south sewers ended,
33:34the latest in Victorian pumping technology,
33:37capable of handling 10,000 cubic feet of sewage a minute
33:41and double that during rainstorms.
33:52The south London stuff ended up here
33:55at Crossnest Pumping Station
33:56on the Thames estuary 12 miles down from London,
33:59where four giant beam engines like this one
34:01lifted the sewage 30 feet up into a reservoir
34:04to wait for the tide to turn
34:05when it was dumped,
34:07taken out to sea by the ebbing waters,
34:09never to be seen again.
34:13The scale of Basil Jet's grandiose scheme
34:16shows, typically,
34:18in the statistics they published at the time.
34:21318 million bricks,
34:231,300 miles of sewers,
34:25480 million gallons a day.
34:28Well, it all did the trick.
34:30They flushed the cholera away with the sewage
34:35and it never came back,
34:38all thanks to Farr's magic numbers.
34:41There was just one minor fly in the ointment,
34:44if that's the right kind of image for this kind of story.
34:47They still didn't have the faintest idea
34:49what the mysterious cholera actually was.
35:09Meanwhile, unknown to everybody in Europe,
35:12events were to be spurred along
35:14by a gentlemanly GP in Georgia, USA.
35:17Back in 1842,
35:19here he was on his way to some rather dubious medical fun and games.
35:23Everybody around knew about the kind of parties you could have
35:25with Crawford, Williamson, Long.
35:28Parties where the wildest things happened
35:29because of what he could get people to do.
35:32Once they'd taken a sniff
35:33of what was in his mysterious bottle.
35:36Even girls would misbehave.
35:42The mystery ingredient in Long's bottle
35:45that got everybody all excited
35:46was called ether
35:47and this get-together behind closed doors
35:50was called an ether frolic
35:52because what sniffing ether did
35:53to the nicest southern ladies and gentlemen
35:55was to make them, well, frolic.
35:59I mean, you might find yourself kissing somebody
36:02when you hadn't even been properly introduced to them.
36:07Dr Long and half the young people
36:10in Jefferson City, Georgia
36:11were having themselves a whole lot of laughs
36:13two or three times a week
36:14turning on to the uproarious effects of ether.
36:17Apart from all that misbehaviour,
36:20ether turned the dullest fellow
36:21into the life and soul of the party.
36:29The ether seemed to release
36:30every last trace of inhibition
36:32from even the most reluctant of people.
36:40Before long, they'd be happily burbling away at each other,
36:43total gibberish, but who cared?
36:45Now and again, of course,
36:46some guy was bound to overdo it
36:48and take one too many sniffs
36:49with inevitable results.
36:58It was at one of these incoherent little interludes
37:01that Long realised the full potential
37:02of his magic potion.
37:04Not only did it make you behave
37:05like a falling-down drunk,
37:07but just like the totally plastered,
37:09it left you feeling no pain.
37:12No.
37:13I'm fine.
37:15After these clinical trials,
37:19Long was to try the stuff on a patient
37:21during a minor operation
37:22with extraordinary results
37:24because what he'd discovered
37:25was anaesthesia.
37:32Now, I know what it sounds like.
37:34It sounds great.
37:35But any sane patient
37:37in the mid-19th century,
37:38here in the sleepy South
37:39or anywhere else,
37:41needed anaesthetic
37:42like a hole in the head.
37:44because while it did take
37:46your consciousness away,
37:48there was a good chance
37:49it wouldn't come back.
37:50Why?
37:51Because anaesthetics
37:52encouraged doctors
37:54to operate more.
37:55That's why.
37:57Look at the new tools
37:58they had to play with by 1860.
38:00Things like viewing tubes
38:02for poking into every orifice.
38:04They hurt.
38:06But not with anaesthetic.
38:07So the doctors
38:08could look down
38:09their little tubes
38:09and see things worth taking out.
38:11And that was the problem.
38:14Because with walls
38:15dripping with fungus,
38:1662 a ward,
38:18blood and sawdust
38:19on the floor,
38:21drunken nurses,
38:22filthy bandages
38:23and bedsheets,
38:24this is the hospital
38:25I'm describing,
38:26the very last thing
38:27you wanted
38:27was a cut of any kind.
38:29Or to put it technically,
38:31you were a dead duck.
38:32I mean,
38:32they tried to stop people
38:33going septic
38:34with bread poultices
38:35and tea.
38:36So most of the time
38:37it was the operation
38:39was a success,
38:39but the patient died.
38:41That is,
38:42until 1864.
38:46That was the year
38:47some cows got sick
38:48in Carlisle,
38:49back on the Scottish border.
38:50And the locals
38:51threw carbolic acid
38:53into the sewage
38:54and all over the cows
38:54and they got better.
38:56So the Glasgow
38:57professor of surgery,
38:58a fellow called Lister,
38:59kind of threw carbolic acid
39:01all over 11
39:02infected compound
39:03fracture patients
39:04who were pegging out
39:05and nine of them
39:06probably didn't
39:07peg out.
39:09So Lister,
39:09being a thorough
39:10kind of fellow
39:10who took things
39:11to extremes,
39:12decided that
39:13if the germs
39:13were in the air,
39:14which is where
39:15he thought they were,
39:16that's where
39:17the carbolic acid
39:17should be.
39:18With these.
39:20Well,
39:20he converted scent sprays.
39:21As his fellow surgeons
39:23used to say
39:23before one of his ops,
39:24let us spray.
39:27Bad joke.
39:28Great idea.
39:33In January 1878,
39:35Lister made all this
39:36modern,
39:37life-saving work
39:37possible with one
39:38of the most daring
39:39bits of put your money
39:40where your mouth is
39:41in medical history.
39:43He anaesthetised
39:44one of his patients
39:45who had a compound
39:46fracture and then
39:48deliberately made
39:49an incision
39:50and the patient survived.
39:52in the silence.
39:58Today,
39:59even open-heart surgery
40:01is a commonplace thing
40:02thanks to Lister's
40:03antiseptic
40:03and Long's anaesthesia
40:05and another shift
40:06in the attitude
40:06towards the patient.
40:08No longer even
40:09conscious to be consulted,
40:10his survival now
40:11a matter of killing germs
40:12to prevent infection.
40:14But,
40:15whatever the germs were
40:16and whether they were
40:17in the air
40:18as Lister thought
40:18or not
40:19and how they caused disease
40:21and about a zillion
40:22other questions
40:23were still in the doctor's minds
40:24as they carried out
40:25one successful operation
40:27after another,
40:28knowing only that
40:29they were surrounded
40:29by invisible bugs
40:31like septicemia
40:32or gangrene.
40:33Invisible,
40:34but thanks to Lister,
40:36dead.
40:37However,
40:37they weren't to remain
40:38invisible for long.
40:48in another part
40:49of the medical forest,
40:50so to speak,
40:51people had been
40:51beavering away
40:52with something
40:53would you believe
40:53Lister's father
40:54had developed,
40:55a fancy microscope
40:56down which,
40:57for the first time,
40:58you could see clearly
40:59what it was
41:00you were peering at.
41:05When they looked
41:06into a drop of water,
41:07remember water
41:07was still the mystery
41:08cholera carrier.
41:10What they saw
41:10made them think all right.
41:12It was all very confusing.
41:14They could focus in
41:15on the things
41:15in the water okay,
41:17things like cells
41:18and microorganisms.
41:20Trouble was,
41:21some of them were dead,
41:22so obviously
41:23something even smaller
41:24killed them.
41:25Now,
41:26dead cells were caused
41:27by disease,
41:28but where was the disease?
41:35Stare as they might,
41:36the only strain
41:37they could come up with
41:38was eye strain.
41:39The big unanswered question,
41:41if disease was caused
41:42by something you couldn't see,
41:44how could you find it?
41:53The fellow
41:54who found the answer
41:55here in Africa
41:56was an arrogant,
41:58fanatically methodical,
42:00hypochondriac German
42:01called Robert Koch,
42:02who started out life
42:04as a country doctor
42:06in a boring bit of Prussia
42:07where the only excitement
42:08was guessing how many sheep
42:09would keel over that week
42:10from anthrax.
42:12Koch shut himself away there
42:14for three years
42:15with a microscope
42:16and some unfortunate animals,
42:18solved the anthrax mystery
42:20and kind of invented
42:21modern bacteriology.
42:22He looked at drops
42:23of anthrax-infected blood
42:29and in among the blood cells
42:31saw lots of little
42:32filament things everywhere.
42:36You put these into healthy mice
42:38and you get instantly
42:40unhealthy mice.
42:42Koch made the little bugs
42:43comfortable with warmth,
42:44food and air
42:45and they turned into these
42:49spores,
42:49which resisted everything
42:51he threw at them,
42:51just sat there for years.
42:54But the instant
42:55they were back in an animal,
42:56they turned into
42:57the little filaments again
42:58and the animal
42:59got taken seriously dead.
43:03So, that was it.
43:04The highly resistant spores
43:05could live in the ground
43:06for ages
43:07and then get picked up
43:07by any passing sheep.
43:09Big thing,
43:10Koch had proved
43:11one bug
43:12causes one disease,
43:14which left about
43:15a zillion others.
43:16So on he went.
43:20First thing was to find a way
43:21to get the bugs to sit still
43:23because in the droplets
43:24they whizzed about.
43:25Koch hit on this stuff,
43:28agar.
43:28You make jelly with it.
43:30Agar plus 1% of meat extract
43:32is a bug's idea
43:33of gourmet heaven.
43:35And it's solid.
43:37So they sit still
43:38and grow in little groups
43:39separate from other bugs.
43:42Koch cultured any of these
43:43minute villains he could find
43:45and took the first ever
43:46micro mug shots.
43:48Septicemia, gangrene,
43:50abscesses.
43:51If it festered,
43:52he fed it and took its picture
43:53and identified six more diseases
43:55caused by specific bugs.
43:58And then this maddeningly slow,
44:01obsessive, methodical approach
44:03was galvanised
44:03by colour.
44:05See, in 1877,
44:08Germany was becoming
44:09the world's industrial dye centre.
44:10And when one of Koch's
44:12chemist friends
44:13showed him some,
44:14sure enough,
44:14Koch put it on a slide
44:15and saw that it did nothing
44:18to the general junk in blood,
44:20fats, crystals, cells.
44:21But what he did do
44:23was to colour his little bugs,
44:25which is why in 1882
44:26it only took him
44:27six months' work
44:28to identify that.
44:32See the blue bits?
44:34That's what gives you tuberculosis,
44:36the tubercle bacillus.
44:40One year later,
44:42when, since you probably guessed
44:43I'd finally get to the point,
44:44cholera came back
44:45to North Africa,
44:46Koch was on the next boat.
44:48Using his meticulous techniques,
44:50he found the cholera bug,
44:52cultured it, photographed it
44:53and stained it in three weeks.
44:59It looked like a comma,
45:00which is why he called it
45:02the comma bacillus.
45:05And yes,
45:06it was transmitted
45:07when you drank water
45:08that had been polluted
45:09by sewage
45:10or soiled laundry.
45:11The mystery killer
45:13was a mystery no more.
45:15Koch was a hero
45:15and just as arrogant as ever.
45:17But his laws for investigation
45:20make sure one particular bug
45:22is always there
45:22when the disease is present,
45:24culture that bug,
45:25use the culture
45:26to give the disease
45:26to a healthy animal
45:27and get the same bug
45:29back out of that animal,
45:30made bacteriology a science
45:32and put the patient
45:33on a slide for good.
46:02music plays
46:06The transition by medicine from bedside to hospital to chemistry is complete, and with
46:12it the disappearance of the patient from our story.
46:15His complaint, once voiced personally and authoritatively, is now reduced to a string
46:20of numbers on a computer terminal.
46:33Of all the sciences, as that philosopher back in Wurzburg, Schelling, you remember said,
46:38of all the sciences, medicine is king, because it deals exclusively with us and our well-being,
46:44and there's nothing any of us likes more than ourselves.
46:46So, as medical science has become more capable of enhancing that well-being, we have happily
46:53invited it to become more and more involved in wider and wider areas of life.
46:57Until today, the doctor does much more than just heal the sick.
47:04Medical judgements rule.
47:05They go unquestioned in such areas, for instance, as diet, exercise, working conditions, abortion,
47:13job application, military service, parenthood insurance, social security, and even in some
47:18places political acceptability and ideological dissidence.
47:21Doctors don't just cure us anymore.
47:23They pronounce us fit members of the community in every sense.
47:26And in that, they have more power almost than anyone else.
47:30That's what Koch and all the others achieved.
47:34In 1892, the first public hygiene laboratory doing bacteriological testing was set up here,
47:40at the hospital of the University of Pennsylvania.
47:42And our unquestioned obedience to the power of medical statistics began to spread to the non-medical
47:49parts of life, because the man who ran the lab was a fellow called John Shaw Billings, and
47:54he had the idea of putting medical statistics onto punch cards, the punch cards that gave birth
48:00to the computer, whose existence makes all of us sick or healthy statistics, numbers.
48:19Like the sick patient, the population at large can now be diagnosed and treated, medically or not,
48:26without even knowing it's happening.
48:28The irony is that it should have all begun here, in Philadelphia, the home, some might say,
48:33of the inalienable right of the individual to lead a life freely and without interference.
49:03O."
49:08VIOLIN PLAYS
49:38VIOLIN PLAYS
49:52VIOLIN PLAYS
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