Blood and Guts (2 page)

David's example made me question my initial scepticism about
the benefits of this kind of surgery. I'm still not convinced that in his
circumstances I would opt for a transplant, but I can certainly
see why he did.

While making the series, I thought it would be interesting to
immerse myself in the subject by repeating experiments from
the early years of surgery. Things started innocuously enough
with a spot of leeching. I had been puzzled as to why doctors
and surgeons had gone on using bloodletting and leeches as a
significant part of their practice well into the nineteenth century,
so I met up with leech enthusiast Rory McCreadie, who promptly
put a young, hungry leech on my arm.

After a few moments getting orientated, the leech bit and
started to suck. Initially it was slightly painful, but then the bite went
numb as the leech injected some form of local anaesthetic into the
site. Rory and I now had to sit around for about an hour until the
leech had gorged itself to the point where it was happy to let go. If
you try to remove a leech before it is finished, it will leave its teeth
behind inside you. Rory told me that in the eighteenth century
leeches could be found all over England; a particularly good spot
for them was Glastonbury in Somerset. Sadly, industrial pollution
has wiped them out, and this particular one had been specially bred
in sterile conditions on a leech farm.

Eventually the leech, now four times its original size, fell off. My
blood then began to flow or, more accurately, slowly drip on to a
plate. This is main point of the exercise. The leech injects an anticoagulant
to stop your blood drying up when it is feeding. After it
stops feeding you continue to bleed; the aim is to lose about a
cupful of blood. In my case, I went on bleeding for nearly twenty-four
hours.

I actually found the whole experience surprisingly restful.
Having experienced it, I can see that if the surgeon and his patient
both believed in its benefits, then being leeched could have a
powerful placebo effect. Unfortunately, it was a treatment with
potentially serious side effects; some surgeons managed to bleed
their patients to death. Examples include George Washington, who
in December 1799 got a cold while out horse-riding. He died after
his doctor repeatedly bled him, extracting in total around five pints
of blood. I decided to stick to just the one leech, and took it home
as a family pet.

My next experiment concerned pain. I wondered if any of the
pain-relief treatments available to surgeons prior to the discovery of
ether as an anaesthetic in 1846 would have been effective. So I went
to a pub to find out.

First, I had myself hypnotized, then I tried sticking a needle
through the web of my hand. It really hurt. Next I drank five
double vodkas on an empty stomach and tried piercing my hand
again. I felt supremely confident, right up to the moment when the
needle went in. It was still really painful. Finally, I decided to try
something a little bit more scientific: nitrous oxide. Also known as
laughing gas, nitrous oxide had been widely used, mainly as a stimulant,
since 1800.

A friendly anaesthetist arranged for me to try some nitrous
oxide in the safe environment of an operating theatre. I took a few
deep breaths and almost immediately began to feel the effects. I was
intoxicated and euphoric. I was extremely pleased with myself and
babbling with enthusiasm. But how good was nitrous oxide going to
be at preventing pain?

My friendly anaesthetist had kindly brought along a device that
violently stimulates the muscles of the forearm. When I had shaken
off the effects of the first whiff of gas, I tried it. The result was
painful and distinctly unpleasant. Next he gave me the highest dose
of nitrous oxide he considered safe. Once again I went from being
entirely sober to wildly intoxicated in a matter of seconds. When I
was passed the pain-dealing device I seized it with enthusiasm. Once
more my muscles twitched madly, but this time it wasn't painful at
all; it was just funny. I could have gone on happily pressing the
button for quite a while, but then the nitrous oxide wore off and
suddenly my arm started to hurt and it wasn't funny any longer.

What I learnt from this bout of self-experimenting is that with-out
the discovery of ether and then chloroform's anaesthetic
qualities, it is unlikely that surgery could have progressed. None of
the other options were powerful, consistent, long-lasting or safe
enough to have allowed complex surgery to take place.

Few of the other things I tried out were quite as unpleasant as
trying to force a needle through my hand, though immersion in
near-freezing water came close. This was a re-enactment of an experiment
first done by Bill Bigelow, whom we meet in Chapter 2, a
pioneering researcher into hypothermia. Bill was convinced that if
you cool down an animal, you can slow its metabolic rate and
oxygen consumption. Do this with a cardiac patient, he reasoned,
and you buy the surgeon more operating time. Rather than testing
this idea on a dog, as Bill had done, the production team decided
to test it on me.

So on a bitingly cold winter's morning I went for a dip in
Hampstead Heath's men-only swimming pond. The temperature of
the water was just above freezing as I arrived wearing trunks and
some high-tech equipment. I had waterproof monitors to measure
my heart rate and blood pressure. I also wore a mask that would
measure my rate of oxygen consumption.

When I first went into the water it was extraordinarily painful,
and I did quite a bit of whimpering. My pulse rate and blood pressure
both doubled, while my consumption of oxygen also shot up.
This was my body's instinctive response to the initial shock. After
about five minutes my pulse rate and blood pressure had both fallen
below my pre-immersion rates, but my oxygen consumption was still
well above normal.

I had discovered what Bigelow also found in his dog: that cold
induces violent, involuntary shivering, which increases oxygen
demands. This was extremely bad news, as it meant that hypothermia
would make operating on the heart more, not less, difficult. Bill
persisted with his experiments, however, and soon found ways to
abolish the shivering. When he did that, the animal's oxygen needs
did indeed fall. Bill Bigelow's experiments led to the successful use
of hypothermia in operating theatres, something I had witnessed at
the John Radcliffe Hospital.

The application of cold, pain and leeches were all suitably
historical, but I was also interested in trying rather more high-tech
experiments. For the neurosurgery film, I thought it would be interesting
to find out what it would feel like to have parts of my brain
switched off.

For many years neuroscientists have known that different parts
of the brain do different things, and that creating an accurate
map of the brain is important for safe surgery (see Chapter 5).
In the early days doctors would find a patient who had had a brain
injury, study what they could or could not do, wait till he or she died
and then dissect their brain.

These days they have more sophisticated tools, which include
transmagnetic stimulation (TMS). This involves using a powerful
magnetic field to scramble brain cells temporarily in targeted parts
of the brain. Having switched off that section of the brain, the scientists
can deduce what it does by seeing what the volunteer is no
longer able to do.

I wanted to see the effects of interfering with my motor cortex,
the bit of the brain that governs fine movements, so I went to visit
Dr Joe Devlin of University College London. It was a strange experience.
When he turned on the TMS machine I completely lost
control of the fine movement of my fingers. However hard I tried, I
could no longer write, pour a glass of water or touch the tip of my
nose with my finger. As soon as the machine was turned off, everything
returned to normal.

This particular experiment made me reflect on how reliant we
are on exquisite coordination between different parts of the brain
and the body; how we only really appreciate what our body does when
it no longer performs in the ways we expect. It is, of course, when
things go wrong that we call first on the doctor, then on the surgeon.

We are extremely fortunate to live in an age when we have anaesthetics,
antibiotics and machines for looking inside the body and the
brain. We benefit enormously from the experiments and experiences
of all those who went before. When I look back at what has
been achieved in a comparatively short period of time by pioneers on
both sides of the knife, I feel awe and immense gratitude.

In the course of researching and making the television series on
which this book is based I met a lot of surgeons and their teams. I'm
deeply impressed by what a varied, skilful, interesting and dedicated
bunch of people they are, and I am very grateful for having had the
opportunity to see them in action.

I'd especially like to thank Jonathan Hyde, Robert Marston, Ian
Hutchinson, Alice Roberts and Peter Butler for their time and
patience. Also Paulo Santoni Rugio, eighty years old and still doing
facial reconstructive surgery in Cambodia.

I'd like to thank the production team at the BBC for their
patience, insights and sheer hard work: Claudia Lewis, Kate Shiers
and Kim Shillinglaw for driving the series editorially; Emma Jay,
Giles Harrison, Hannah Liptrot, John Holdsworth and Sadie
Holland for directing and producing the programmes; Giselle
Corbett, Max Goldzweig, Sophie Guttner, Ruth Lacey, Fiona Marsh,
Andrew Mayer, Laura Mulholland, Caroline Sellon and Sophie
Wallace-Hadrill for providing the support work that made sure it all
actually happened.

My mother always wanted me to be a surgeon. As a child, I spent
more time hanging around hospitals than was probably normal.
Mum was a nurse, so my sister and I became somewhat expert at
navigating our way around the corridors of the Norfolk & Norwich
Hospital. And, like most kids, I was often to be found in the
Accident & Emergency department when I had gashed my leg,
knocked my head in the playground, or swallowed a fish bone. I had
my first operation when I was ten.

It was an operation on my right eye to correct a squint, and my
family had absolute trust in the surgeon that it would be a success.
Almost every moment, from being admitted to the hospital right up
until the operation itself, stands out in my mind. I was in the children's
ward in the old part of the hospital. It was reached through a
long, chilly, stone-floored corridor. A few shabby partitions had
done little to transform the ward from its Victorian origins. The
ceilings were lofty, the radiators cast iron and the windows grimy.

I was given an injection before being taken to the operating
theatre and remember examining the exciting cracks in the ceiling
above my bed as the sedative took hold. I was wheeled along the
corridor, up a ramp (which the porter had to make a run at) and
to the operating theatre in the new part of the hospital. Outside the
door of the theatre I was asked to count down from ten. I have no
idea how far I got.

When I woke up my eye was covered with a bandage. The vision
in the other eye was a blur. Someone brought me some ice cream.
Three days later I was out of hospital and eventually went back to
school. The operation was not a complete success. My right eye is
still scarred (the scar is apparent when I get tired) and I had to have
another series of operations a few years later, with a different
surgeon, to correct the problem completely.

It is only when I look back at my first surgical experience that I
wonder whether our trust in the surgeon was misplaced. Could he
have done a better job? Was he having an off day? Was he desperate
to get away for a round of golf? Surgery is risky, but we have somehow
come to take it for granted that surgeons know what they are doing
and that operations will be successful. However, even today, the decision
to go 'under the knife' should not be taken casually. Imagine
what it was like fifty years ago or even one hundred and fifty years ago.

In writing this book I've tried to re-create the surgical experiences
of the past. It is a book about surgeons and the patients they
operated on. Everything I have described really did take place and
is based on accounts, reports, photographs, films and paintings
from the relevant period. I have not had to exaggerate or sensationalize.
In fact, in some cases I have had to tone down the stories to
make them readable. I can assure you that the operating table at
University College Hospital was stained with blood and that the
operating theatre was next to the mortuary. Surgeons did inject
paraffin wax under the skin, bombard patients with massive doses of
radiation, and stick ice picks through their eye sockets – all in the
interests of medical progress. There are some truly horrific episodes
in the history of surgery that I have done my best to recount as accurately
as possible.

There is, however, one important disclaimer. I came across the
same problem encountered by the producers of the excellent BBC
series that this book accompanies. There are so many stories that it
proved impossible to include them all. As a result, this book is
a
history of surgery rather than
the
history of surgery. I have tried to
include most of the more significant events, but also some of the
most shocking, dramatic and entertaining. I have missed out whole
areas of surgery, including orthopaedics and gynaecology, and
some grisly early operations, such as those to remove bladder
stones (you don't want to know). The chapters are arranged
thematically rather than chronologically, which I hope makes the
subject more accessible. I have also included a further reading
section at the end to help you find out more. The only bits of the
TV programmes that you won't find in the book are the presenter
Michael Mosley's own contributions.

As you will have realized, I never did become a surgeon, journalism
proving a much easier (albeit less lucrative) career path.
However, I have for many years been fascinated by the history of
medicine and surgery. One of my favourite TV programmes as a
child was
Your Life in Their Hands
, when surgeons were shown
performing real operations. One of my favourite museums is the
Old Operating Theatre in London (see page 301).

Despite being immersed in the subject, there were certain
events that even I found difficult to write about. Some of the
accounts and pictures of injured soldiers and airmen, for instance,
are deeply disturbing. I hope I have done justice to these remarkably
brave men. I also hope I have given a fair account of some of
the more controversial surgical treatments developed over the
years, such as cross-circulation, lobotomy and brain implants. I am
sure when you read this book you will find the stories equally
compelling.

I owe an immense debt of gratitude to my wife, Susan, for
putting up with me and for all her insightful editing and constructive
criticism. I must also thank my mum, Penelope, who lent me a
pile of books from her years in nursing and helped out with Chapter
1. As far as family goes, I also need to mention my son, Matthew, who
was very patient with me at the Old Operating Theatre ('Is this it,
Dad?' 'Yes, but isn't it fascinating?' Long pause. 'Can we go for a
pizza now?'), and my father, Peter, who was the most recent
Hollingham to go under the knife.

None of this would have been possible without the efforts of the
programme production team, all of whom have been immensely
helpful (their names are listed in the Foreword). They conducted
much of the original research and, of course, have made some
excellent TV programmes.

Thank you to the following people who helped me make sure
I got my facts straight: Vivian Nutton from University College
London (UCL); Alison Cook and Jonathan Hyde from the Royal
College of Surgeons of England, and the various other surgeons
Alison coerced into reading the drafts; Simon Chaplin, also from
the Royal College of Surgeons, who put me right about Hunter;
Peter Elliott from the Royal Air Force Museum, who helped me
out on Spitfires and Wellingtons; Steven Wright from UCL, who
provided a plan of Liston's hospital; and Stuart Carter, whose
story is featured in Chapter 5. Finally, I would like to thank
Martin Redfern and Christopher Tinker at BBC Books for their
encouragement and support.