Blood and Guts: A History of Surgery (2008) s01e05 Episode Script

Bloody Beginnings

Contains scenes which some viewers may find upsetting.
I'm Michael Mosley, and in this series I have been tracing the history of surgery and the magnificent cast of characters who have taken it from the dark ages and turned it into a skilful, life-saving discipline.
I've covered magnificent breakthroughs.
You have a tube hanging like a trunk.
Ideas that were inspired and those that were deranged.
What you do is you bump it, bump it through the skull.
But none of this was possible without discoveries that would change the face of surgery forever.
Hold him down.
Mapping human anatomy, managing blood loss, developing pain relief Oh, God! Horrible.
And stopping infection.
I'm going back to surgery's crude beginnings, when it was little more than optimistic butchery.
I'll show you how surgery was utterly transformed into a discipline that for the first time could cure more people than it killed.
I'm rather excited because I'm about to do something I've been dying to do for years now.
In the early days, surgeons were not exalted gods, but a rather lower form of pond life.
Trained as barbers they could purge, bleed or cut off a limb.
Their most sophisticated tool - the bloodsucking leech.
These are our friends the leeches? European leeches and we know that because they've got green tummies.
Be careful! I've got one made ready for you, so if you put your arm on the table, I've put one in a wine glass.
Will this hurt? It's a bit like dentistry, the injection hurts then afterwards it doesn't.
Here we go.
Ooh, yes, ooh, yes, I can feel it, ooh, jeez.
Ooh, yes! I can feel it's little teeth going in.
It feels like about 300 very small drills drilling in.
You little bugger! What did they use leeches for? Everything - if you were to loose your left leg, or you had a headache.
So, by giving you a quick bleed the idea was to make you feel better.
Doctors might prescribe it, but blood letting itself was left largely to the unsophisticated barber surgeons.
The European obsession with blood letting goes back to the Greeks and their belief that an imbalance in any of the four humours, phlegm, yellow bile, black bile or blood, could cause sickness.
If you believed that, then blood letting was a logical treatment.
I think this leech has acquired a taste for Mosley blood.
It's actually quite pleasant, almost relaxing.
That's probably just the placebo effect kicking in.
If I lost enough blood, my blood pressure and core temperature would both fall, leaving me pleasantly sleepy but anaemic.
You could be over bled, physicians would bleed you again, and again over a course of weeks.
With a whole new bunch of leeches Each time, yes.
You could end up being bled to death.
It's come off now, and I'm beginning to bleed.
There he is absolutely gorged with blood.
How much blood could I loose? I would reckon you'll bleed for about four to five hours, and you could be looking at a good wine glass full of blood.
And this idea persisted despite the fact it's clearly nonsense, it persisted for thousands of years? Thousands of years.
Taken too far, blood letting could and did kill.
But it was still preferable to other treatments surgeons had to offer.
That was butchery.
Cutting out and chopping off.
A MAN SOBS Surgery is limited, it's defective and more often than not, it's fatal.
It's the beginnings of fatality, and the surgeon is the harbinger of death.
SCREAMING It's good to be back in the 21st Century.
I've got a pressure bandage on because I'm going to go on bleeding for a couple more hours.
And I've got my leech who I'm going to take home as a family pet.
I'm now on the trail of the men who made the leech redundant, who would drag surgery kicking and screaming out of the Dark Ages.
Today, whether it's a car crash, cancer or a a heart attack, around 75% of us will at some point come under the surgeon's knife.
32-year-old Jason Harvey has fallen over and smashed his knee cap.
This man's suffered a fracture right at the apex of his knee cap.
This fracture before the days in which we could safely do surgery would have significant repercussions on the patient's ability to walk, and would be a major disability.
If Jason's operation IS successful, then it will be largely thanks to four great breakthroughs, spanning 500 years of surgical advance and set-back.
The first breakthrough was fundamental - understanding human anatomy.
The first person to create accurate drawings of the human body was the Renaissance genius Leonardo da Vinci.
But they weren't published, so well into the 16th century, doctors relied for understanding of anatomy on crude drawings done 1,300 years before.
It would take a Flemish dwarf - Andreas Vesalius - to change that.
Picture the scene - it's 1536, a criminal has been hung and left to rot.
One evening, along comes Vesalius, he's a 22-year-old medical student, he looks at the corpse with longing.
Body snatching is illegal, but that doesn't deter him.
He jumps up, grabs the legs and pulls.
With a terrible ripping sound, they come off in his hands, he rungs away into the night, clutching them in his arms.
What Vesalius was doing was extraordinarily dangerous, not only was he risking jail and personal ruin, he was challenging long-established ideas.
At Vesalius' medical school, there was just one set of anatomical text books, written by Claudius Galen.
Not only had they been written 1,300 years before, but they were also largely based on animals, like pigs and apes.
At human dissections, Galen's words would be read out, while unquestioning students looked on from a distance.
Aged just 22, Vesalius decided to do something that would have outraged and disgusted his contemporaries - dissecting and examining the human body himself.
Undeterred by the rotting human flesh on his kitchen table, Vesalius began to strip the corpse down to its bare bones.
He treated it like making beef stock.
First he got a pan of water and set it to boil.
Then he removed as much flesh and skin as he could from the corpse and drops them into the pan.
He boils away for hours until the whole thing falls apart.
You wonder what the neighbours thought.
Vesalius' own choice to be like this, represents a quite extraordinary excitement in the pleasure of the dead and he's drawn to it and he insists on living with it, and surrounding himself with it in a way that is actually, I think, quite spooky.
Now, Vesalius had set himself one hell of a task.
There are 206 bones in the human body and when I was a medical student I could name each one.
These days I think I'd struggle.
Bone by bone, he painstakingly tried to identify every single part of the human skeleton and put the jigsaw back together again.
This is clearly a femur, but what this is I couldn't begin to tell you.
For Vesalius, it was just the start.
He now wanted to map every organ, muscle and ligament in the human body.
He was determined to understand how the whole thing fitted together.
To do this he needed more bodies, so naturally he stole them.
He stole them from the same place all these bodies came from - the cemeteries of Paris.
I'm here in Oxford to see what Vesalius risked so much to get his hands on - a dead body.
People are still understandably sensitive about human dissections.
We were fortunate to get special permission to film.
Dr Alice Roberts teaches anatomy to surgeons - she's dissected many bodies.
Hello, Alice, you about to start? Yes, just about to open up the abdomen.
Oh, no, perhaps not.
This woman donated her body - she wanted to help students learn anatomy.
To prevent decay she's been preserved in embalming fluid, a luxury Vesalius did not have.
I should prepare myself.
So you did dissection yourself? I haven't seen a human body in this state since I was at medical school.
It is bizarre.
It's a bit of a shock.
You can see the tissue's stiff.
We're now doing what Vesalius DID and others did not do - examine a body for ourselves.
It's strange to think of him obsessively chopping away in a dark basement.
Just starting to see some guts in there now.
The ascending colon there and eventually it's going to go down into the pelvis and turn into the rectum.
What was it Vesalius was challenging? The work of Claudius Galen.
I've got here, a modern copy of the blood that dominated Western medicine for so long.
What Galen says about the kidney, is it is proper to understand the usefulness of how the kidneys are placed.
Why the right one is higher up and attached to the liver and the left one is lower than the right.
No! No! There is the lower pole of the bottom of the left kidney and there is the lower pole of the right one.
So he gets it completely wrong.
Is this body wrong or is he wrong? And the answer is? The answer is, this can't be wrong because this is real, this is actual anatomy.
The location of the kidneys is just one of Galen's many glaring errors, but what I'm surprised by isn't that he got it wrong, but that he went unchallenged for so long.
Until Vesalius.
When Vesalius announced that much of what the great god, Galen, had written was incorrect, and that 1300 years of medical teaching were seriously flawed, he became extremely unpopular.
Some dismissed him as a madman, others, who actually chose to look, wondered if perhaps the human body had changed since Galen's time.
In all, Andreas Vesalius corrected over 200 of Galen's mistakes.
In 1543 he published his masterpiece - De Humani Corporis Fabrica.
On The Fabric Of The Human Body.
Vesalius correctly identified the locations of all the major organs, nerves and muscles in the body.
Finally, after 1,300 years of stagnation - anatomy, and therefore surgery, had taken a giant leap forward.
Andreas Vesalius began the proper study of human anatomy.
Others, like William Harvey, would later build on that.
Anatomy remains at the heart of medicine.
It's very important to know your anatomy.
Anatomy is the basis of medicine.
If you don't know your anatomy, makes diagnosis very difficult.
All medicine is based on anatomy.
three other formidable obstacles remained before surgery could move into the modern age.
Cutting up dead bodies is one thing.
Go, go, go! but operating on living, breathing patients creates a whole host of other problems.
Whether it's 500 years ago or today.
The very first thing surgeons need to know is how to stop us bleeding to death.
This is actually an exercise run by the Ministry of Defence.
But many of these people here will shortly be in Iraq, doing it for real.
The wounds may be fake, but the techniques the doctors are practising are genuine.
Even today, if you lose more than 3 litres of blood and it's not replacedyou're dead.
The secrets of managing blood loss were discovered on another battlefield, just a few years after Vesalius dissected his first bodies.
In the 16th century, Europe was at war.
And it was being waged with deadly new weapons.
Suddenly, surgeons were dealing with blood loss on an unimaginable scale.
I've come to meet historical weapons expert Kevin Hicks.
He's demonstrating the weapon responsible for this bloodshed - the musket.
The sheer blast, the heat that comes from the guns And when you add the heavy guns They do reckon that when the heavy guns opened fire, there was a mist above the soldiers.
That was actually blood.
I want to see the sort of damage a musket can do.
Instead of a man, I'm going to shoot 20lb of dead pig.
Right, great, moment of truth.
I've never done this before.
Fire at will.
Can I have another go? It would be bleeding like the proverbial pig.
If this was a stomach, imagine the trauma - the entire intestines, imagine the punch.
You know what it's like when someone punches your stomach.
That's an express train hitting you.
Let's see what's happening the other side.
Some holes here.
Bleeding heavily, the soldiers would be dragged off the battlefield to have the bullet extracted.
They put their finger in to find out where it was, but we can feel that one.
Look at that.
Fantastic - you've got one going right through there.
It's blown that vertebrae straight out.
Right, that kidney didn't enjoy it, did it? And with these terrible wounds came terrible blood loss.
MAN SOBS For centuries, surgeons had used hot irons to cauterise wounds.
But with gunshots, it was felt something more sophisticated was needed, so they came up with this - boiling oil.
It is almost unimaginable.
You've just been shot in the leg, the thigh, the upper arm.
And then a battle surgeon pours burning oil into your wound.
No wonder so many of them died.
Change, when it came, did via a Parisian barber shop.
In the 16th century, you'd use the same tools to cut off a beard or cut off a limb, and you'd often go to the same person for both.
To a barber surgeon like Ambroise Pare.
Pare spent his days shaving customers, lopping off the odd wart, and doing the occasional blood-letting.
Then in 1537, his life changed.
He was sent as a battlefield surgeon to the Siege of Turin.
Even the journey into the battlefield was traumatic.
Pare had to ride over the bodies of dying men, hearing their cries under his horse's hooves.
He encountered gun wounds on a horrific scale.
And day after day, week after week, he amputated limbs.
Amputation was enormously risky.
It meant pain and even more blood loss.
Pare's patients frequently bled to death before he could boil up the cauterising oil.
To be honest, it doesn't sound like Pare was a natural surgeon.
He was horrified by everything he saw.
But his lack of enthusiasm for pain and bloodshed may well have been the thing that drove him to find another way.
For a long time, even Pare had to stick to conventional techniques.
This is a saw used to cut off people's limbs, and then to stop the bleeding, he'd use this, a cauterising iron.
He was desperately looking for something better.
The important thing about Pare is Pare thinks for himself.
He never assumes he already knows how to do something.
He's always prepared to consider there might be a better way.
And that's a whole new way of thinking.
Pare was a compassionate man and he worked on a range of wonderful inventions.
Many were attempts to compensate for the limbs he had had to cut off.
My favourite is this, a mechanical arm with flexible fingers.
But in the end, the solution to the real problem - blood loss - was something incredibly simple.
A piece of thread.
This is a crow's beak - one of his inventions.
What he would do is he would clamp off the artery, and then take some silk thread and tie off the artery.
And that is his great discovery, that is his unique contribution to surgery - the ligature.
The ligature had been known to Arabs 500 years before, but it wasn't used in Europe until Pare put his new invention into action on the battlefield.
I want to show you just want Pare had to contend with and we're going to do it in here.
It's gruesome.
Hi, there, Ben Not yet, not yet! We've got an actor here and I think a very, very realistic injury there.
He wouldn't have had gown but I'm expecting quite a bit of splatter.
You ready to perform? This is the modern day equivalent of Pare's crow's beak.
This is a ligature.
Right, OK, so we've just chopped the leg off and we're ready to go Go! So I have to locate the artery which is somewhere down here If Ben's injury was real, a litre of blood would be pumping out every 60 seconds.
He'd be dead in five minutes.
Hold him down, you're doing well.
Right, it's left over right and under, right over left and under Well done.
What would happen now is that he would leave it long and in a while it would just die off and the thread would come off with it, and you might or might not survive, Ben! Thank you.
I've done it a few times! So Pare had invented the ligature, you'd imagine it'd have taken off but 100 years later, surgeons were still using boiling oil and cauterising wounds.
It was not the first time that surgeons have been slow to adopt something so obviously beneficial to their patientsnor would it be the last.
I really admire innovators like Pare and Vesalius.
They questioned conventional thinking, were ridiculed, but struggled on and found a better way.
And it is remarkable how after centuries of no progress, in a decade two men overcome two great barriers to modern surgery.
However, just as surgery looked like it was getting goingit stopped.
Fundamentally, surgery didn't change for an incredible 300 years.
Over the next three centuries, Newton discovered gravity.
Michael Faraday invented the electric motor and Beethoven transformed classical music.
But surgeons? They just went on killing people.
In fact there was no real progress at all until the 19th century, when industrialisation began to change the world.
Mechanised work meant new injuries.
Limbs ripped off, and horrible fractures.
This boom in demand for surgery collided with the Victorian age of invention, and it produced two enormous innovations which between them would transform the butchery that was surgery into something we would recognise today.
In 1840 if you were unlucky enough to need an operation, you were almost certainly conscious for it.
The discovery of pain relief, or anaesthesia, would be the third great barrier to be overcome.
It seems obvious to us that pain is a bad thing.
and you would think that every surgeon would see the need for it.
To be a surgeon is to not feel your patients' pain.
The moment you do, you're lost.
What I find really bizarre is Victorian surgeons had access to a range of pain-relieving techniques which they obviously chose not to use - was it that they didn't work very well? I'm going to try out these techniques on myself.
I'm going to start with something which I'm very interested in - but I'm also deeply sceptical about - hypnotism.
We'll explore how we can help to numb your hand during hypnosis.
First thing I'd like to do is find a baseline to measure it from, so we'll attach this peripheral nerve stimulator, and we'll put this onto your left And the person who's going to put me under is hypnotherapist Tom Mackay.
OK, I'm ready! No, no, it's fine, it's like sticking your finger in a socket An electric socket.
Let's try it a little bit higher.
I'll put it up to 30 Oh, Jesus, yes, that hurt! OK, all right.
It's not about being gullible, it's about being intelligent - what we find a lot of the time is the more intelligent you are You're appealing to my vanity! .
.
the deeper you can go.
Well, I'll be very very interested to see what you do.
Let your eyes relax completely.
Every breath you take can help you relax deeper and deeper Have you ever had the experience? How cold your hand is In my head, I'm snuggled up in bed.
Now I'm going to press the button.
Very good.
Arm is completely numb.
Now Press that button again, very good.
That was four times stronger than I coped with unhypnotised.
Would it be all right to increase that level one more time? It's bordering on unpleasant.
Two and one, open your eyes and come right the way back to the room, excellent.
It was impressive.
Before, I jumped.
I really jumped, it really hurt.
I noticed it, it didn't really hurt.
I'm just still curious as to whether if it really hurt, if you were drilling into my teeth could I get to a deep-enough level? So Tom once more put me under and this time suggested sticking a needle through my hand.
Imagine it's made of butter.
Numb, with every breath you taketotally numb, so that hand's made of butter.
Not working OK.
Really, no, it hurts.
OK.
'Part of the problem was that to stick the needle in I had to first come out of my hypnotic state.
'Tom believes that with more practice I'd manage it.
' .
.
You'd hold on to that numbness.
It hasn't bled, anyway.
It hasn't bled! You can close your eyes 'To get into a deep enough hypnotic state 'to be able to ignore serious pain normally requires 'a lot of preparatory work, so it's not a quick-fix solution.
' .
.
Your right hand palm-up.
'I'm after something faster and more effective.
' Lifting it, lighter and lighter, higher, higher and higher.
Now, alcohol is of course the traditional way of numbing the existential pain of life.
How well does it work when you try to numb the pain of pain? Here's one shot, I'm going to have a go until Ahh, that is so unpleasant Can I have another, please? I can begin to feel the alcohol hit my system now.
'I'm not a drinker, and on an empty stomach 'it takes embarrassingly little to get me drunk.
' Two vodkas and about this time I feel like flirting.
Hello HE LAUGHS Sadly, the barmaid doesn't want to flirt, so I think what I'll probably do is induce some pain in myself for lack of anything else to do.
How does that work? Here we go Ooh, nowrong button.
Right MACHINE WHINES Oh, God, that was still, that was still unpleasant! OK, I think I need another vodka.
Or another one You're looking more beautiful than ever.
Down the hatch.
HE INHALES Ah Oh, God, that's horrible, it still tastes as horrible as it did the first time round.
Where was I? I'm really quite intoxicated now, though I'm still able to say the word "intoxicated" which is impressive.
Um, so where was I - pain.
I think I've lost the train of thought.
What? But it was very interesting For a brief moment there it was extremely interesting, so, pain yeah, alcohol.
Am I being coherent? Am I being coherent, Jemma? Am I saying sense? Perfectly.
Perfectly.
Great, yeah.
'What I was trying to say, was we all have receptors in our skin 'which respond to damage and send the "ouch" message 'along peripheral nerves up the spinal cord and into our brains.
'Alcohol depresses the brain, so it doesn't respond so readily to the pain.
'Well, that's the theory.
' It's probably a good time to give myself some more pain, it's this arm here Oh, that is still very unpleasant.
I'll just go up a bit That is really, really quite uncomfortable.
When I was hypnotised, that didn't happen.
All I can say right at the moment is hypnotism - 1, alcohol - 0.
With both hypnotism and alcohol proving far from fail-safe, there was clearly a need for someone to come up with a better solution.
Scottish medical student James Younger Simpson was brash, precocious and deeply ambitious.
In 1827, aged only 16, he attended his first operation - surgery to remove a breast.
With no painkillers, the only thing her surgeon could offer the woman was speed.
Simpson found the whole experience so horrific, that for a while he gave up medicine.
But it also made him think about the importance of pain relief.
Then in 1846, he receives momentous news.
A dentist in Boston called William Morton has performed the first painless surgery using a substance called ether.
Simpson tried out ether on patients and soon discovered it was effective but it had problems.
This is a bottle of ether.
And it's quite unpleasant, it's quite pungent and I'd better not sniff too much of it or I'll pass out on the ground.
It was originally made by mixing alcohol with sulphuric acid, and people used to, unbelievably enough, drink it at parties.
Now it was an extremely effective anaesthetic, but it had one big drawback which, I think, Andrew, you're going to show us.
Yes, indeed.
Nice spray of this stuff HE LAUGHS Wow.
I can see why that's a drawback, if you're in the operating theatre and they were gas-lit at that time, if you knock over a bottle of ether, suddenly everyone loses their shirts.
As well as being explosive and pungent, ether irritated patients' throats and made them thrash about.
Not what you want in delicate surgery.
So the opportunity was still there to find a better anaesthetic.
In 1847, while sniffing chemicals at home, Simpson stumbled on chloroform.
Simpson himself didn't actually discover chloroform - that had been done 15 years earlier by a Dr Samuel Guthrie.
He, for reasons best known to himself, mixed together two gallons of whisky with a couple of pounds of chlorinated lime, put them together and then fed this substance to his daughter.
She took a sip, declared it quite delicious and then passed out.
He decided to market it as a stimulant and never realised that in fact, it was an anaesthetic.
So there you are, there's chloroform.
Thank you, I think I'll give it a little sniff.
It's actually much nicer, much, much nicer than ether.
It's got a sort of fruity nose to it, I can see why Simpson and his friends enjoyed to it so much.
Actually I can begin to feel, I'm not sure if it's suggestion but I'm beginning to feel some sort of effect.
HE INHALES Ah Thank you, I think I might hand this one back Actually a bit of an after-kick to this, isn't there? Simpson successfully used chloroform on a few patients.
And then, with a zeal for self-promotion worthy of a 21st-century marketing man, announced his stupendous findings to the medical world.
Simpson gave a talk to a group of interested doctors.
He extolled the virtues of chloroform and at the end got out a handkerchief and a bottle and asked them if they wanted to give it a try.
Soon great hilarity ensued as men fell unconscious to the ground, while others wandered around in a state of great intoxication.
Fortunately for the men who were unconscious, they all woke up.
Others, however, who were to try chloroform would not be so lucky.
Fanned by Simpson's enthusiasm, chloroform became widely used, and as that happened, patients began to die - first a handful, then a dozen, then in their hundreds.
Simpson refused to believe there was anything seriously wrong or investigate what was causing the deaths.
But until someone did that, the bodies would keep piling up.
Dr John Snow, today best known for proving that cholera is waterborne, soon became intrigued by the chloroform deaths.
He looked into the autopsy reports and noticed the victims had certain things in common.
The people who died were on the whole young, fit or fearful.
What on earth was going on? This is now an ad agency, but 150 years ago this was Snow's home, and the place where he did many of his chloroform experiments.
Snow was cool, analytical.
He carefully studied, measured and calculated.
He looks at case after case after case after case, looking for the pattern.
He tabulates, he records, he turns things into statistics.
Snow studies subjects to death.
In his own time, and at his own expense, Snow measured the exact quantity of chloroform in the dead bodies.
And he experimented, using chloroform on animals.
Snow soon discovered that chloroform can badly damage the heart.
That's because chloroform reduces the rate at which every cell in the body works.
It acts particularly fast on brain cells, so it knocks you out.
But chloroform can also slow heart cells, and too much will make them stop.
Chloroform is actually an extremely dangerous drug.
Just a third of a teaspoon is enough to knock you out, half a teaspoon enough to kill you.
So that explained part of the mystery why the young and fit died.
They needed a higher dose to knock them out and it pushed them closer to the fatal dose.
But why did it matter if you were fearful? Snow realised that they were the ones who were struggling, holding their breath for as long as possible.
Eventually they'd take an enormous gasp and inhale enough chloroform to stop their hearts.
Splashing spoonfuls onto a handkerchief and putting that on the patient's face was clearly not a great technique.
To reduce the risk of overdose, Snow invented one of these things - a chloroform inhaler.
What you do is pour the chloroform in here and warm it up with the hands so it creates a vapour.
The vapour comes up through a tube into a mask.
Much, much safer than splashing some of it onto a handkerchief.
Snow administered chloroform to over 4,000 people, including Queen Victoria, without a single death.
Thanks to John Snow, chloroform became a much safer drug and went on being used well into the 20th century.
Snow is a particular form of genius.
He creates a strong sense of medicine as a research project, and in that respect he is the founder of a new idea of what medicine is.
Back in Scotland, Simpson and his career were unaffected by Snow's devastating criticism.
Simpson refused to accept that chloroform was inherently dangerous.
When he died in 1870, he was a national hero and had a huge state funeral - the largest in Scottish history.
Flags flew at half-mast, and 30,000 mourners lined the streets.
The bombastic Simpson brought chloroform to the attention of the world.
But it was Snow who made it safe.
Simpson has statues and memorials, hospitals named after him.
All Snow has is a small grave a plaque and a pub.
But his legacy lives on.
Without the modern anaesthesia, this type of operation would be impossible.
Surgeons haven't got a wriggling, screaming patient to operate on - they're not chasing them round the room, if you like, so they now can take their time to be more delicate, more precise.
With the discovery of anaesthetics, surgery had taken another huge leap forward.
But despite this, and the earlier breakthroughs, half of the patients who went into operating theatresdied.
Finding out why became the obsession of a most unfortunate Hungarian doctor - Ignacz Semmelweis.
In 1847, 29-year-old Semmelweis began working in the maternity unit of the Vienna General Hospital.
All around him, a mystery was playing out.
WOMAN PANTS It's Vienna's leading hospital, but hundreds of women every year who go there to give birth develop a fatal condition called childbed fever.
Swollen abdomen, multiple abscesses, fever, then death.
Nobody knows what causes it and nobody knows how to stop it.
In the hospital there are two units.
One run by midwives, the other by doctors.
If you're unlucky enough to be in the one run by the doctors, where Semmelweis works, then you are nine times more likely to die of childbed fever than if you are in the hands of the midwives.
Why? BABY CRIES Semmelweis was greatly puzzled by this discrepancy.
He became obsessed with solving the mystery, trying everything from changing the way the women were lying to changing what they ate.
But nothing worked.
"Everything was unexplained, everything was dubious, "only the great number of victims was an indisputable reality.
" Semmelweis, and his fellow doctors, dissected the dead mothers, but they found nothing.
Nonetheless, day after day, he visited the mortuary before returning to the wards.
He works harder and harder but women just keep on dying.
He is depressed, he is confused, he is perplexed.
Then there is a vital breakthrough.
A friend, Jakob Kolletschka, a professor of forensic medicine, cut his finger doing an autopsyand was dead days later.
Distraught and desperate to know what killed him, Semmelweis dug out the post mortem report on Kolletschka's death.
The report revealed that when he died, his friend had a swollen abdomen, multiple abscesses, and fever.
The same things that had killed so many of the mothers.
"My mind in this excited state registered with irresistible clarity "the identity of the disease Kolletschka had died of, AND the disease "I had seen cause the death of so many hundreds of women in childbed.
" For Semmelweis, this must have been an astonishing and utterly appalling moment - could it be he had finally solved the mystery, that he had actually discovered that the killer was him, that he and his fellow doctors had somehow been carrying onto the wards death on their hands? It was a shocking, heretical thought.
But it would explain why being delivered by a midwife was so much safer than being delivered by a doctor.
Midwives didn't do autopsies.
They didn't carry deadly matter on their hands.
Without consulting his superiors, Semmelweis posted a notice on the door of the clinic, ordering all the doctors to wash their hands in chloride of lime.
It was not a popular move.
The doctors found this faddish handwashing tedious, pointless, time-consuming, Semmelweis had to hang around the wards day and night to force them to do it properly.
But he was determined.
Semmelweis's handwashing regime now began to produce spectacular results.
Death rates from childbed fever plunged down from more than 10% to less than 3%.
Dozens of women who otherwise would have died now lived.
This must have been the happiest period of Semmelweis' life.
But he was living on borrowed time, because he had not convinced the doctors.
He had no rational or scientific explanation of how dirty hands could cause death.
The women were dying from what we now call septicaemia, blood poisoning.
Semmelweis had no idea of its cause.
He just knew he was onto something.
However, with some simple equipment that Semmelweis didn't have, I can show you what he was up against.
Now, I have over here some agar jelly.
And what this is going to be useful for is I'm going to dip my hands in it, roll them around and three days ago I did exactly what I just described and this was the result.
Can you see that? Isn't that lovely? There are lots of little colonies on there, in fact tens of millions of bacteria.
One lot is apparently a relative of the bacteria that causes MRSA.
If that got into an open wound, it would do you no good at all.
Now what I'm going to do is add some bleach.
This is the equivalent of chloride of lime.
HE INHALES Ah, right, give them a good scrub.
Lovely, now what I need to do is I get another one of these and I dip my fingers again and roll them around, and you can see, much improved.
There are colonies there, there are far fewer of them.
Semmelweis knew dirty hands caused disease.
But he couldn't explain why.
And without a proper explanation, his colleagues just laughed at him.
The idea that a bit of dirt around your fingernail was enough to kill you was ridiculous.
They live in a world in which they've never thought of germs.
They know that if you look at a wound through a microscope, you will see lots of tiny things crawling around in it.
They believed that they are spontaneously generated and they regard them as harmless, as irrelevant.
They pay no attention to them.
Semmelweis's boss and his fellow doctors were sick and tired of his ideas.
So when his contract came to an end, it was not renewed and he went home, in disgrace, to Budapest.
He ended up at here, the St Rochus hospital, as director of the maternity ward.
When Semmelweis first came to this hospital, the maternity unit was in a terrible state - one in three women who came here to give birth died of childbed fever.
Semmelweis was about to change that.
He started a rigorous campaign of cleanliness - hands, linen, instruments, all had to be cleaned between patients.
This hospital has been modernised, but 150 years ago Semmelweis prowled these corridors trying to catch people who were disobeying his orders.
He did not make friends, but he did make progress.
It took him six years, but he managed cut death rates from over 30% to less than 1%.
Meanwhile in Vienna, where they had abandoned his methods, hundreds of women now died every year from hospital-caught infections.
But the Hungarians were as cynical as the Viennese.
And this disbelief, combined with Semmelweis's rather bullying style meant once again he managed to alienate the hospital staff.
And the knowledge that no-one was listening to him was starting to drive him mad.
Semmelweis, who has made the most extraordinary and brilliant discovery, can't explain that discovery to doctors in a way that makes sense to them.
He knows how to prevent deaths by the thousands, by the hundreds of thousands, and no-one will listen to him.
It's the most dreadful position to be in and he cannot stand it.
Semmelweis was desperate.
He regularly came here to the chapel attached to the hospital to pray to God for forgiveness.
He began writing to doctors, accusing them of being murderers, and would break down in lectures with bouts of uncontrollable weeping.
He would also go out onto the streets, stop any couples he met and implore them to make sure, should they ever have children, their doctors washed their hands before delivering.
His young wife found it increasingly hard to cope with his behaviour.
Driven to despair, Semmelweis now decided to do what he'd been avoiding for years - write a book.
In 1860, sitting at this desk, Semmelweis finally finished writing up his life's work.
Unfortunately, it was rather rambling and repetitious, but it does contain the essence of his ideas.
"The carrier is the examining finger, "the operating hand, instruments, bed linen, atmospheric air, sponges" It was an insight that could have saved thousands of lives.
For doctors who approach this book with an open mind, it's all here.
But Semmelweis spoils it somewhat by spending the last half of the book launching a long and vitriolic attack on all his many critics.
And with the book, he sent out venomous, ranting letters.
"And you, Herr Professor, have been partner in this massacre ".
.
the murderous deeds which were committed by the midwives and physicians in Wurtzburg ".
.
childbed fever, I declare before God and the world that you are a murderer!" The book was badly received and fed his already evident paranoia.
He took to heavy drinking and to prostitutes.
With his behaviour becoming increasingly erratic, his wife reluctantly agreed to a plot concocted by Semmelweis's doctors.
She proposed a family holiday to Austria.
When they got to Vienna his wife took him to visit a friend's hospital.
When they arrived, he was seized and dragged off to a padded cell.
The hospital was in fact a lunatic asylum.
What happened next is confused.
There are different stories - he was either beaten up or he cut his finger.
But whatever the reason, days after arriving in the asylum, he became very ill.
He developed multiple abscesses, a swollen abdomen and a rising fever.
He died two weeks later of septicaemia, blood poisoning.
The same condition that killed his friend and all those women.
He's buried here in the family home, quite literally in the family home - behind this wall.
He was just 47 when he died.
And there's a final tragic twist - by the time Semmelweis died, someone else had already found the missing piece of the puzzle that could explain why dirty hands cause disease.
In France, Louis Pasteur had proven that microbes cause decay.
Sadly, Semmelweis seems to have died never knowing of Pasteur's work.
But in the year of his death, a young Scotsman finally put together all the pieces of the puzzle and finished what Semmelweis himself had tried so very hard to do.
Joseph Lister was a keen young Scottish surgeon who, unlike Semmelweis, had read Pasteur's paper on bacteria.
Lister realised that if Pasteur was right, then they were actually being killed by invisible microbes.
But what could he do about it? One day a friend of his came onto the ward and cried, "My God, this place smells of sewage!" This was a Eureka moment.
"Sewage, of course! Sewage!" Why not try to curb infections with the same chemicals they used to deodorise sewage? Carbolic acid.
Lister soaked his instruments with it before his next operation - surgery on a young boy.
The boy survived, so he did it again.
Soon death rates had fallen by an astonishing two-thirds.
I'd like to tell you that British surgeons embraced this new idea with enormous enthusiasm, but in fact, it wasn't until he moved to London 12 years later and started doing pioneering knee surgery that they really sat up and took notice.
Slowly, surgeons accepted the need to wash hands and instruments in carbolic acid.
Before Lister, most patients did not survive major operations.
But the introduction of antiseptic techniques changed all that.
It finally turned surgery from butchery into a science.
The 20th-century operating theatre would bring together the joint legacy of these men - their commitment to anatomy, the science of anaesthetics, stopping blood loss, and above all, battling infection.
Jason Harvey's knee operation is over, and his recovery is surprisingly swift.
Well, when you think just just 24 hours ago, my kneecap was in two pieces, and here I am, walking down the corridor, and what can I say, but thank the surgeon and the surgery itself, it's fantastic.
It certainly is, but let's not forget it's come at great human cost.
Surgeons these days are much more constrained by what they can do, and rightly so.
But there can be no success without failure, and no development without risk.
I still hope there will be an opportunity in the future to do some of those brave bold experiments that characterised the past.