1 00:01:04,042 --> 00:01:07,228 Crowded, the world today, isn't it? And getting more so. 2 00:01:07,312 --> 00:01:10,922 Amazing really, all these people. Thanks to science: 3 00:01:11,064 --> 00:01:14,107 fed, clothed, housed, and reproducing themselves by the million. 4 00:01:14,462 --> 00:01:16,104 And not an epidemic in sight. 5 00:01:16,331 --> 00:01:20,238 I don't mean flu and measles and that kind of kids’ stuff, I mean the real killers, 6 00:01:20,592 --> 00:01:23,225 typhoid, Black Death, tuberculosis. 7 00:01:23,409 --> 00:01:27,529 And that’s what’s amazing, if you think about the sheer numbers involved, 8 00:01:27,530 --> 00:01:32,242 and the way we are all jammed together in a kind of giant ideal germ culture, 9 00:01:32,356 --> 00:01:35,866 that's when the full power of modern medicine comes home to you. 10 00:01:57,285 --> 00:02:01,263 Every day, thanks to modern medicine and its life saving techniques, 11 00:02:01,264 --> 00:02:05,808 the population grows and gets older, as doctors treat us from the cradle on. 12 00:02:06,119 --> 00:02:08,979 And it doesn't seem to matter that we don't understand medicine, 13 00:02:09,192 --> 00:02:11,966 we take it all, trustingly, for granted. 14 00:02:12,150 --> 00:02:15,491 The drugs, and the technology, and the research, 15 00:02:17,091 --> 00:02:20,786 and the miracle of keeping these little babies alive, for instance. 16 00:02:21,164 --> 00:02:23,723 And as for the diseases they can't cure today, 17 00:02:26,022 --> 00:02:27,925 well they will tomorrow. Won’t they? 18 00:02:32,013 --> 00:02:33,949 I mean, nobody understand what they are doing, 19 00:02:33,961 --> 00:02:36,418 but then you don't exactly argue with the doctor, do you? 20 00:02:36,599 --> 00:02:40,325 He is not interested in your opinion, it's the bug you have got he is after. 21 00:02:40,687 --> 00:02:44,899 He says, “lie down, shut up, take your clothes off”, you do. 22 00:02:46,077 --> 00:02:49,056 Ironic, that unquestioning obedience, 23 00:02:49,237 --> 00:02:51,185 because it came into existence 24 00:02:51,321 --> 00:02:55,386 thanks to the help and inspiration of the fellow who founded this hospital for the poor, 25 00:02:55,839 --> 00:02:57,153 here in Philadelphia. 26 00:03:01,830 --> 00:03:05,624 His name was Benjamin Franklin and the last thing he was, was obedient. 27 00:03:05,749 --> 00:03:08,013 He and his friends thumbed their noses at us. 28 00:03:08,285 --> 00:03:11,739 They ran the American Revolution here in Independence Hall. 29 00:03:12,679 --> 00:03:17,877 We solemnly declare our resolve to preserve our Liberty 30 00:03:18,602 --> 00:03:23,415 and die as free men rather than live as slaves. 31 00:03:26,178 --> 00:03:31,591 When it was all over in 1776, congress here sent Franklin off to France to buy guns, 32 00:03:31,625 --> 00:03:34,966 sign treaties, and export revolution. 33 00:03:35,124 --> 00:03:39,643 Among other things he took with him, an entirely new American way of looking at public health. 34 00:03:40,028 --> 00:03:43,595 Oh, and a copy of this too, of course. 35 00:03:43,915 --> 00:03:46,780 If there was ever a statement of disobedient individualism, 36 00:03:46,916 --> 00:03:49,883 it was the anti-British declaration of American independence 37 00:03:50,189 --> 00:03:51,684 that Franklin helped to write. 38 00:04:17,657 --> 00:04:21,411 When Franklin left America for France in October 1776, 39 00:04:21,412 --> 00:04:25,511 he was the second most popular man in the country in the country after George Washington himself. 40 00:04:25,652 --> 00:04:28,249 He had almost single-handedly made Philadelphia 41 00:04:28,327 --> 00:04:31,222 the most progressive city in the 13 states. 42 00:04:34,976 --> 00:04:38,715 Franklin's Philadelphia hospital, above all, was better than anything in Europe, 43 00:04:38,872 --> 00:04:41,359 as was the health of the citizens. 44 00:04:46,835 --> 00:04:49,839 For the would-be revolutionaries waiting across the Atlantic, 45 00:04:49,918 --> 00:04:53,454 Franklin was living proof of the 18th century unthinkable. 46 00:04:53,594 --> 00:04:56,238 That you could declare war on your own king, 47 00:04:56,270 --> 00:04:59,478 handle anything his professionally trained army then threw at you, 48 00:04:59,556 --> 00:05:03,593 invent an entirely new kind of government, take a vote on the whole affair, 49 00:05:03,765 --> 00:05:05,236 and get away with it. 50 00:05:07,786 --> 00:05:12,808 So, Franklin's credit rating with his French hosts was going to be slightly unlimited. 51 00:05:12,933 --> 00:05:15,077 In spite of one minor awkwardness, 52 00:05:15,155 --> 00:05:18,378 revolution-wise they have actually done the dirty deed, yet. 53 00:05:18,441 --> 00:05:20,647 There was still a king in residence. 54 00:05:20,725 --> 00:05:26,921 If residence isn't too humdrum a word for Louis XVI’s cut-glass lifestyle. 55 00:05:50,156 --> 00:05:53,879 Franklin turned up here in his moth-eaten fur hat and bifocals, 56 00:05:53,880 --> 00:05:55,788 and stole the show. 57 00:06:04,001 --> 00:06:06,692 Well, with the revolution in France just round the corner, 58 00:06:07,068 --> 00:06:10,150 and Franklin the superstar of the one they just had in the US, 59 00:06:10,338 --> 00:06:13,060 small wonder he was an ideological sensation. 60 00:06:13,326 --> 00:06:16,142 Added to which, he was a man of charm and wit. 61 00:06:16,314 --> 00:06:18,676 And ladies fell, heavily. 62 00:06:18,942 --> 00:06:23,088 Which is why we are in a salon. See, in 18th century terms, 63 00:06:23,089 --> 00:06:25,701 this is where the elite, meet. 64 00:06:25,952 --> 00:06:29,800 And at the time, the salon for all the name-droppers 65 00:06:29,909 --> 00:06:34,994 was run by the lovely widow of a late leading liberal called Helvetius. 66 00:06:35,306 --> 00:06:42,284 Madame Helvetius was crazy for freemasons, scientists, philosophers, reformers, and Americans. 67 00:06:42,598 --> 00:06:46,650 Well Franklin was all of them, so they became… friends. 68 00:06:46,807 --> 00:06:52,846 And the future of France turned, as it so often has done, on a discreet mixture 69 00:06:52,971 --> 00:06:55,803 of politics and pillow talk. 70 00:07:00,888 --> 00:07:05,363 Politics because, come the Revolution, this was all to be replaced by one house of government 71 00:07:05,394 --> 00:07:08,867 and Franklin had actually written a constitution with only one house: 72 00:07:08,868 --> 00:07:11,527 the constitution of the State of Pennsylvania. 73 00:07:14,688 --> 00:07:16,721 Pillow talk? Well, 74 00:07:16,800 --> 00:07:19,663 Madame Helvetius also had a young friend, err, 75 00:07:19,772 --> 00:07:26,499 living in at the time, a doctor called Cabanis, whose bedside manner was really something quite new. 76 00:07:26,812 --> 00:07:29,127 Because that's what he wanted to do to French medicine. 77 00:07:29,268 --> 00:07:34,978 And Franklin's long talks about American hospitals and public health programmes back home, 78 00:07:35,087 --> 00:07:39,875 convinced Cabanis, that revolutionary democracy was good for your health. 79 00:07:40,611 --> 00:07:43,536 Which, at the time, European medicine wasn't. 80 00:07:43,630 --> 00:07:46,540 I mean, if you were sick and rich, this is what happened. 81 00:07:46,838 --> 00:07:52,283 If you were poor, nothing happened. So, the doctor came and you would tell him what to do. 82 00:07:52,486 --> 00:07:56,022 The patient, if you will forgive the phrase, called the shots. 83 00:07:56,476 --> 00:08:00,012 Doctors thought disease caused different symptoms in different people. 84 00:08:00,199 --> 00:08:02,280 So you really diagnosed yourself. 85 00:08:02,640 --> 00:08:05,894 And every symptom was in the doctor’s pocket book of symptoms, 86 00:08:06,098 --> 00:08:07,600 2400 of them. 87 00:08:07,913 --> 00:08:14,437 Diseases like nostalgia, described as “a vehement desire to go home”. 88 00:08:17,754 --> 00:08:22,682 You can see why revolutionary young Cabanis went for Franklin's ideas on medical reform. 89 00:08:22,839 --> 00:08:27,298 The question was, with incompetence like this around, “How?” 90 00:08:27,877 --> 00:08:29,630 Came the revolution… 91 00:08:56,323 --> 00:08:59,154 By 1793, the new republic was at war, 92 00:08:59,232 --> 00:09:03,019 and with a million men in the field, there were just too many wounded for 93 00:09:03,020 --> 00:09:06,648 the properly qualified, officially recognised doctors to handle. 94 00:09:06,926 --> 00:09:11,088 So they brought in surgeons who, believe it not, weren’t regarded as real doctors. 95 00:09:11,463 --> 00:09:14,624 Well, this kind of mess was just what surgeons were good at: 96 00:09:14,625 --> 00:09:18,128 instant treatment and never mind what the patient thinks. 97 00:09:20,491 --> 00:09:23,558 In most cases, the surgeons had to work without supplies, 98 00:09:23,636 --> 00:09:28,064 and discovered things like the best cure for wounds was water, not ointment; 99 00:09:28,314 --> 00:09:30,911 that shock killed you as quick as anything else, 100 00:09:31,021 --> 00:09:34,870 so they invented the idea of the ambulance to get soldiers treated fast; 101 00:09:35,339 --> 00:09:40,393 that if you didn't amputate within 24 hours, the patient would lose a lot more than his leg; 102 00:09:40,565 --> 00:09:46,995 and once you cut whatever it was off, the best bandage to use was the patient’s own skin. 103 00:09:49,967 --> 00:09:55,412 With do-it-yourself instruments and shirts for bandages, grass poultices and no drugs, 104 00:09:55,413 --> 00:09:58,885 the surgeons saved far more lives than the physicians. 105 00:09:58,933 --> 00:10:02,938 And with so much raw material, if you will forgive the phrase, to practise on, 106 00:10:03,032 --> 00:10:07,053 they learned more about treatment from the battlefield than from any textbook. 107 00:10:07,975 --> 00:10:13,811 By 1794, after two years of this, the surgeons were finally awarded the status of ‘doctor’. 108 00:10:14,061 --> 00:10:18,973 In most cases, given the horrific casualty rate, it was a posthumous award. 109 00:10:36,418 --> 00:10:40,172 So many doctors had been killed by the time it was all over, 110 00:10:40,251 --> 00:10:43,818 they had to open new medical schools all over the country to replace them. 111 00:10:44,288 --> 00:10:48,762 Not just because of the tens of thousands of returning wounded that had to be patched up, 112 00:10:49,106 --> 00:10:52,047 but also because of the ambitious revolutionary plans 113 00:10:52,188 --> 00:10:55,959 to provide free medical care for any citizen in the new republic. 114 00:10:56,100 --> 00:11:00,340 So, the first thing they had to do was to find somewhere to put all the bodies. 115 00:11:00,606 --> 00:11:04,595 Places like this one, the old Valle de Gras monastery in Paris, 116 00:11:04,596 --> 00:11:10,446 were commandeered and turned into state hospitals, where they sometimes had to pack them in six to a bed. 117 00:11:10,775 --> 00:11:16,689 Still, at least the doctors were a new breed, the surgeons ran the place now and there were new rules. 118 00:11:16,752 --> 00:11:22,728 Mugging up lists of phoney symptoms was out, on-the-job training was in. 119 00:11:22,994 --> 00:11:27,109 If you wanted to get ahead, hospital doctoring was the way to go. 120 00:11:32,272 --> 00:11:35,854 Hospitals started to look like they do now when the ex-officer doctors 121 00:11:35,855 --> 00:11:40,924 dropped the old bedside manner for good, after Cabanis took over in 1798. 122 00:11:41,377 --> 00:11:45,774 And the patients? Well, they were obedient ex-soldiers used to taking commands, 123 00:11:45,836 --> 00:11:49,122 or they were the poor off the streets, too scared to argue. 124 00:11:54,158 --> 00:11:59,947 With new rules and regulations about everything, getting cured took on the regimented feel it has today. 125 00:12:02,419 --> 00:12:04,906 The patient did what the doctor ordered. 126 00:12:06,049 --> 00:12:09,819 And with Cabanis's book on how scientifically-accurate medicine ought to be, 127 00:12:09,851 --> 00:12:14,669 things looked set to become more efficient and less mumbo-jumbo than ever before. 128 00:12:14,810 --> 00:12:18,143 Except for one, relatively serious, impediment: 129 00:12:18,393 --> 00:12:21,866 They might well have got it right on the battlefield about how to handle fractures and 130 00:12:21,976 --> 00:12:24,025 wounds and hygiene and such, 131 00:12:24,339 --> 00:12:29,815 but when it came to what disease, itself, was, well they were still really going round in circles. 132 00:12:32,647 --> 00:12:35,713 The answer to their problem was to come from a German university 133 00:12:35,714 --> 00:12:38,733 and the mathematics of a certain Godfrey Leibniz, 134 00:12:38,734 --> 00:12:41,956 who had discovered a way to measure the infinitesimally small changes 135 00:12:41,957 --> 00:12:44,662 that happened in the speed of planets in orbit. 136 00:12:45,038 --> 00:12:48,668 Leibniz had reckoned that being able to measure infinitely small things 137 00:12:48,777 --> 00:12:52,845 meant you also get to grips with the fundamental structure of all existence. 138 00:12:52,971 --> 00:12:56,772 Now, as you can tell by the expression of rapt attention here, 139 00:12:56,945 --> 00:12:59,463 the maths involved wasn't exactly two and two. 140 00:12:59,683 --> 00:13:04,752 But according to Leibniz, if you understood his equations, you have the key to the universe. 141 00:13:07,162 --> 00:13:10,353 Well the philosophers have that off him faster than you could say “calculus”. 142 00:13:10,557 --> 00:13:15,047 And by the 1790s, European thought was in the grip of people like a fellow who worked here 143 00:13:15,266 --> 00:13:20,179 at Wurtzburg, name of Schelling. Called himself a ‘nature philosopher’ becomes he said, 144 00:13:20,367 --> 00:13:24,654 if you could break down any organism into its infinitesimally small bits, 145 00:13:24,685 --> 00:13:30,239 you could see how everything connected with everything else, and that would give you, wait for it, 146 00:13:30,348 --> 00:13:32,147 The Secret of Life. 147 00:13:32,148 --> 00:13:36,309 Well, the doctors had that off him faster than you could say “Nature Philosophie”. 148 00:13:38,077 --> 00:13:42,942 In particular, a doctor called Xavier Bichat. 149 00:13:43,021 --> 00:13:46,416 Know who he was? One of those surgeons back in Paris. 150 00:13:47,589 --> 00:13:53,033 Now, what can I tell you about Bichat except that he must have had absolutely no sense of smell, 151 00:13:53,283 --> 00:13:58,462 because what he did was go hunting for infinitesimal small bits in the human body. 152 00:13:58,666 --> 00:14:05,534 In graves, coffins, accidents, mortuaries, if it was dead, he borrowed it. 153 00:14:05,800 --> 00:14:10,619 And when he had finished weighing it, boiling it, pickling it, drying it, cooling it, 154 00:14:10,712 --> 00:14:16,783 frying it, shredding it, and doing what, in general, I believe cooks call “reducing the stock”, 155 00:14:16,955 --> 00:14:20,084 in 1800, he announced that bodies were made of tissue. 156 00:14:20,319 --> 00:14:24,026 Muscle tissue, lung tissue, skin tissue, twenty-one types of tissue. 157 00:14:24,277 --> 00:14:28,110 And that diseases didn't hit whole bodies, they hit tissues. 158 00:14:28,111 --> 00:14:31,897 And if you could look at the tissue of a corpse that died from a particular symptom, 159 00:14:31,944 --> 00:14:34,447 you could connect symptom with disease. 160 00:14:34,776 --> 00:14:39,954 We call that “pathological anatomy”, these days. Invented by Xavier Bichat. 161 00:14:40,455 --> 00:14:45,696 His only problem, could you be sure of your conclusions if your supply of corpses was limited? 162 00:14:45,884 --> 00:14:48,434 Which, unfortunately, it tended to be. 163 00:15:00,698 --> 00:15:04,766 Back in Paris, the numbers game really caught on, because in 1820, 164 00:15:04,861 --> 00:15:09,695 there were over 50,000 patient beds there in new, purpose-built hospitals, 165 00:15:09,805 --> 00:15:13,372 split, as they have been ever since, into separate wards for men, 166 00:15:13,373 --> 00:15:15,452 women and types of disease. 167 00:15:15,953 --> 00:15:20,177 And in those wards, with hundreds of thousands of patients to examine every year, 168 00:15:20,240 --> 00:15:22,962 medicine became mathematics. 169 00:15:23,776 --> 00:15:27,766 The numbers were big enough for statistical analysis of how diseases progressed 170 00:15:27,903 --> 00:15:32,299 and how well treatment worked. And with teaching going on during the new ‘ward rounds’; 171 00:15:32,424 --> 00:15:35,053 and the teaching staff active doctors themselves; 172 00:15:35,100 --> 00:15:38,416 and a new use of charts and regular records for a patient, 173 00:15:38,636 --> 00:15:42,187 the medical profession became what it is today, a profession. 174 00:15:42,390 --> 00:15:45,363 With journals and societies and in-house rules. 175 00:15:45,566 --> 00:15:49,212 And all the time, the patient became less involved in his own treatment 176 00:15:49,213 --> 00:15:53,388 as new instruments made it possible for a doctor to find out what was wrong with you, 177 00:15:53,482 --> 00:15:55,110 without having to ask you. 178 00:15:57,534 --> 00:16:00,554 By 1830, Paris was the hospital centre of the world. 179 00:16:00,601 --> 00:16:05,826 And foreign students were flocking in to find out how this “clinical medicine” worked. 180 00:16:12,913 --> 00:16:17,716 One of these foreign students of the new medicine-by-numbers was a young fellow called William Farr, 181 00:16:17,717 --> 00:16:24,178 who in 1831, after two years in Paris, sailed back here to London just in time to wish he hadn’t. 182 00:16:24,694 --> 00:16:30,937 You see, in the previous 14 years, a killer epidemic had been working its way inexorably outwards 183 00:16:30,938 --> 00:16:39,276 through India and, in 1831, it was in Hamburg, just across the North Sea with 50 million dead behind it. 184 00:16:39,510 --> 00:16:44,469 Well, there was total panic here. Britain was the perfect target for any epidemic. 185 00:16:44,546 --> 00:16:48,818 Why? Because she was right in the middle of the Industrial Revolution. 186 00:16:49,318 --> 00:16:52,650 In ten years, the number of towns had doubled to a thousand, 187 00:16:52,995 --> 00:16:58,533 the population had gone up from 9 to 14 million and all the extra were jammed into the cities, 188 00:16:58,534 --> 00:17:03,008 where they lived in stink and filth, 40 to a house, ankle-deep in sewage, 189 00:17:03,009 --> 00:17:08,705 working 16 hours days in unspeakable conditions and dropping like flies from malnutrition anyway. 190 00:17:09,299 --> 00:17:11,599 And, nobody knew what to do with them. 191 00:17:11,600 --> 00:17:14,510 There had never been that many people living that close together before. 192 00:17:14,823 --> 00:17:18,374 An epidemic might tip the scales to “anarchy”. 193 00:17:25,744 --> 00:17:30,422 Desperate attempts were made to quarantine the country. They closed all the ports, 194 00:17:30,469 --> 00:17:33,364 crossed their fingers, and failed. 195 00:17:34,459 --> 00:17:39,512 On Sunday, October the 23rd 1831, in the northern port of Sunderland, 196 00:17:39,606 --> 00:17:44,222 a sailor called Bill Sproat collapsed with violent pains, 197 00:17:44,472 --> 00:17:49,666 diarrhoea, vomiting, high fever, massive loss of body fluids. 198 00:17:49,979 --> 00:17:54,595 Three days later he was dead. The first British cholera victim. 199 00:17:54,752 --> 00:17:56,379 The nightmare had come. 200 00:17:56,817 --> 00:18:00,587 They put a ring of troops around Sunderland, the cholera went through it like that. 201 00:18:00,712 --> 00:18:03,435 Within one month, it was here in London. 202 00:18:03,717 --> 00:18:07,503 4,000 people were dead, the cholera was spreading like fire 203 00:18:07,519 --> 00:18:11,039 and nobody had the faintest idea how to stop it. 204 00:18:30,361 --> 00:18:34,163 In the swarming city slums, doctors tried everything they knew, 205 00:18:34,242 --> 00:18:38,544 everything from splashing vinegar or nitric acid around, to burning tobacco. 206 00:18:38,846 --> 00:18:44,368 Was cholera caused by bad smell? Or by people touching each other? Or flies? 207 00:18:49,438 --> 00:18:51,925 As the cholera went through cities like a ripsaw, 208 00:18:52,004 --> 00:18:54,914 attempts at prevention became more and more crazy: 209 00:18:55,227 --> 00:19:00,453 pepper, caster oil, hot bricks, whitewashing the houses, ringing church bells, 210 00:19:00,531 --> 00:19:06,914 evicting families into isolation. Everything failed, including the favourite, burning pitch. 211 00:19:09,261 --> 00:19:13,892 As the death toll climbed towards 32,000 by the end of the first year of cholera, 212 00:19:14,002 --> 00:19:19,071 something happened that was to bring William Farr and his French medical maths into the story. 213 00:19:20,713 --> 00:19:23,514 See, most of the workers belonged to friendly societies: 214 00:19:23,592 --> 00:19:27,096 they paid weekly dues to them in preparation for times like this, 215 00:19:27,128 --> 00:19:29,646 when they would need sick pay or funeral expenses. 216 00:19:29,709 --> 00:19:32,463 And the friendly societies charged subscriptions, 217 00:19:32,464 --> 00:19:35,936 based on the average age people got sick and died at. 218 00:19:36,811 --> 00:19:42,178 Trouble was, the figures were way out of date, A) because they had been compiled 100 years earlier 219 00:19:42,366 --> 00:19:46,042 and B) not only were conditions radically different now, 220 00:19:46,230 --> 00:19:50,783 but back then, the rate at which people died had been going down. 221 00:19:51,361 --> 00:19:54,772 Now it was going, very definitely, up. 222 00:19:55,100 --> 00:19:58,980 So, more people were dying than the clubs expected, so they were paying out more 223 00:19:59,090 --> 00:20:03,815 and going broke all over the country and making their million-odd poverty-stricken customers 224 00:20:03,909 --> 00:20:05,662 desperate enough, without cholera. 225 00:20:09,980 --> 00:20:14,345 So, for various reasons, getting the numbers right seemed like the thing to do all round. 226 00:20:14,533 --> 00:20:18,585 And it was the actuary for this place, Legal and General Assurance that did the trick. 227 00:20:18,945 --> 00:20:21,933 He pulled together all the up-to-date figures he could find, 228 00:20:22,184 --> 00:20:27,096 processed them and found that all death rates went through three consistent stages. 229 00:20:27,315 --> 00:20:31,758 Before the age of fertility they fell, during the fertile years 230 00:20:31,836 --> 00:20:36,107 they remained more-or-less steady, and after the fertile years, they rose again. 231 00:20:36,530 --> 00:20:40,754 And they did that at each stage at the same rate for everybody. 232 00:20:41,505 --> 00:20:43,821 When William Farr saw that, he jumped at it. 233 00:20:43,899 --> 00:20:46,762 This was evidence that human life obeyed mathematical laws. 234 00:20:46,903 --> 00:20:50,423 That you could treat people like numbers, and they would respond like numbers. 235 00:20:50,688 --> 00:20:55,209 So, when the General Registrar’s office opened in 1836, to centralise all the data collecting, 236 00:20:55,366 --> 00:20:57,618 and stuff like this started coming in, 237 00:20:57,650 --> 00:21:01,452 millions of fact sheets on death with all details, including cause of death, 238 00:21:01,905 --> 00:21:04,987 William Farr went at it like a sweet tooth in a chocolate factory. 239 00:21:06,145 --> 00:21:11,027 In the 1840s, he did all the statistics for a major report on conditions in the cities. 240 00:21:11,246 --> 00:21:13,186 The report scared the hell out of everybody. 241 00:21:13,499 --> 00:21:18,271 In a nutshell it said, pave the streets, bring in clean water, knock down the slums, 242 00:21:18,381 --> 00:21:22,668 get the dung and the disease and the cesspits out of peoples’ homes or what you will have, 243 00:21:22,809 --> 00:21:23,732 is a revolution. 244 00:21:24,249 --> 00:21:28,489 Before the authorities could even harrumph, cholera exploded again. 245 00:21:28,599 --> 00:21:33,449 70,000 people dead this time and enough numbers for Farr to do something about it. 246 00:21:34,289 --> 00:21:38,920 Did poverty give you cholera? Bethnal Green, poorest place in London, number of deaths, 247 00:21:39,170 --> 00:21:43,019 less than places twice as rich. So it wasn't money. 248 00:21:43,206 --> 00:21:47,321 Was it where you lived? Maybe. Here’s the nationwide death rate. 249 00:21:47,525 --> 00:21:52,218 At these places much higher, all of them, towns on water. 250 00:21:52,235 --> 00:21:56,256 Farr double-checked. He looked at the death rates from an inland county 251 00:21:56,365 --> 00:22:01,904 and compared it with London, a port on a river and yes, a higher death rate. 252 00:22:02,295 --> 00:22:06,504 Liverpool? Same kind of location and even higher. 253 00:22:06,723 --> 00:22:10,009 Both of them on water, both high death rates. See? 254 00:22:10,635 --> 00:22:15,094 Now, Farr, believed in the ‘bad smell’ theory of disease and the Thames stank, 255 00:22:15,265 --> 00:22:18,661 so, in 1852, he checked that connection he had found with water. 256 00:22:18,895 --> 00:22:22,915 There is the Thames. Farr divided London into contour lines to see 257 00:22:22,962 --> 00:22:26,999 if how high above the water you lived had any effect. And there it was, 258 00:22:27,061 --> 00:22:30,097 the cholera deaths followed the contour lines exactly. 259 00:22:30,223 --> 00:22:33,289 Worst down at water level along the river where the stink was strongest, 260 00:22:33,415 --> 00:22:37,561 better higher up and best of all in the sweet smelling hills of Hampstead. 261 00:22:37,670 --> 00:22:43,662 Oh, and by way that explained Bethnal Green. It was there, poor, but 60 feet above the river. 262 00:22:44,038 --> 00:22:49,279 The big question was: what was lethal in the smell coming off the Thames? 263 00:22:57,993 --> 00:23:02,562 And then Farr got a break. The following year, during the next cholera attack, 264 00:23:02,609 --> 00:23:05,472 a local water-pump started killing people. 265 00:23:07,756 --> 00:23:11,918 Six hundred in ten days, and for no apparent reason. 266 00:23:11,919 --> 00:23:15,751 It pumped water up from a deep well that had never given trouble before. 267 00:23:16,283 --> 00:23:20,164 Then, somebody took a closer look down below and discovered that the local cess-pit 268 00:23:20,165 --> 00:23:23,575 was leaking into the well. And when you mapped out the deaths, 269 00:23:23,934 --> 00:23:28,611 there they were, in the streets all round the pump. Further out: none. 270 00:23:28,940 --> 00:23:31,834 It began to look like it wasn't the Thames after all. 271 00:23:32,773 --> 00:23:36,809 This water wasn't coming from the river. 272 00:23:37,076 --> 00:23:40,502 So was it something coming from the cess-pit? Sewage? 273 00:23:40,736 --> 00:23:46,681 And if cholera was caused by something in the water, what did that do to the bad smell theory? 274 00:23:48,324 --> 00:23:52,502 Well, in 1855, Farr finally came up with the answer. 275 00:23:52,845 --> 00:23:57,992 During this last lot of cholera, of all the companies that piped water to places that didn't have wells, 276 00:23:57,993 --> 00:24:00,683 only one had obeyed a new law 277 00:24:00,887 --> 00:24:04,970 to stop getting its water from the river downtown where all the sewage got dumped, 278 00:24:05,048 --> 00:24:09,460 and instead, get it from further upstream well above this polluted area here. 279 00:24:09,757 --> 00:24:14,200 That single, law abiding water supplier was called the Lambeth Water Company. 280 00:24:14,811 --> 00:24:19,895 Thing is, it supplied an area of South London, over there on the other side, 281 00:24:19,896 --> 00:24:23,266 street for street with a competitor who was still getting his water 282 00:24:23,453 --> 00:24:26,191 out of the unspeakable muck that flowed by here. 283 00:24:26,536 --> 00:24:28,304 And that turned out to be it. 284 00:24:29,008 --> 00:24:33,076 Of the people getting Lambert Company supplies, only 400 died. 285 00:24:33,123 --> 00:24:37,801 The dirtier stuff killed 10 times that. So it was what they were drinking. 286 00:24:40,743 --> 00:24:44,388 Meanwhile, in England, the theory that cholera was a divine punishment 287 00:24:44,483 --> 00:24:47,753 found expression in an attitude that also still exists today, 288 00:24:47,754 --> 00:24:54,167 the idea of the sound mind in the healthy body, and the mania for sport, born of Victorian paranoia. 289 00:24:57,124 --> 00:25:01,551 At the new public schools, the boys were driven by the belief that God hated the milksop 290 00:25:01,708 --> 00:25:04,071 and loved the manly athlete. 291 00:25:04,212 --> 00:25:07,185 As the playing fields echoed to the sound of compulsory games, 292 00:25:07,435 --> 00:25:11,237 the school chapels thundered with the Anglican answer to cholera. 293 00:25:11,518 --> 00:25:13,349 Muscular Christianity. 294 00:25:51,100 --> 00:25:56,106 And it was now, in the 1850s, from the sports we played out of sheer hypochondria 295 00:25:56,200 --> 00:25:58,891 that we get our modern habit for apologising for being sick 296 00:25:59,001 --> 00:26:01,301 and the myth about our national character. 297 00:26:01,317 --> 00:26:06,120 You know, being such jolly good losers. Well played. 298 00:26:09,046 --> 00:26:14,756 We have built a magnificent palace of legislature, on the banks of a magnificent river. 299 00:26:15,397 --> 00:26:19,856 Here in London, things were definitely not improving for one vital bunch of people, 300 00:26:20,075 --> 00:26:23,439 because little would be done until the stench and the filth got out of the slums 301 00:26:23,627 --> 00:26:25,223 and into the houses of Parliament. 302 00:26:25,630 --> 00:26:29,745 Well, in the long hot summer of 1858, the stench did just that. 303 00:26:29,870 --> 00:26:33,594 After half-hearted measures like paving streets and outlawing cess-pits, 304 00:26:33,641 --> 00:26:37,411 the problem was now flowing by, outside the medicated window blinds. 305 00:26:37,458 --> 00:26:39,773 The Thames was now a public lavatory. 306 00:26:39,992 --> 00:26:41,572 Oh the smell is absolutely disgusting 307 00:26:41,573 --> 00:26:45,702 Asphyxiating MPs were now, finally, to bring the solution to the cholera problem, 308 00:26:45,718 --> 00:26:50,850 and in doing so, turn the citizen into the number he is today. 309 00:26:53,149 --> 00:26:59,141 The Thames outside is a scandal to us before all Europe, something must be done 310 00:27:02,130 --> 00:27:06,104 To visit the metropolis while the river is in the present state, 311 00:27:06,105 --> 00:27:09,202 the mortality would be something dreadful 312 00:27:09,608 --> 00:27:13,535 Their decision was to mount one of the most ambitious civil engineering projects ever 313 00:27:13,536 --> 00:27:16,117 undertaken by a major city anywhere: 314 00:27:16,648 --> 00:27:18,354 to clean up the Thames. 315 00:27:20,591 --> 00:27:24,487 The man they gave the job to was a fellow called Bazalgette, an engineer. 316 00:27:24,768 --> 00:27:28,414 And you could say that he flushed out the problem. Come down and have a look. 317 00:27:30,933 --> 00:27:35,392 You see, at the time, sewers were built to handle only dry human waste, 318 00:27:35,393 --> 00:27:38,224 they would break in every so often and cart it all away. 319 00:27:38,349 --> 00:27:42,715 But now with the increased use, at the time, of the new WCs 320 00:27:42,825 --> 00:27:47,018 and that road surfacing you recall the reformers wanted, well, now, 321 00:27:47,019 --> 00:27:50,648 there was loo water and rain water runoff coming down here 322 00:27:50,649 --> 00:27:53,746 and washing tons of sewage off into the Thames. 323 00:28:00,270 --> 00:28:05,355 And, of course, at high tide, it would, err, back up again, out into the streets. 324 00:28:05,683 --> 00:28:10,158 Bazalgette’s plan was to build a network of intercepting sewers, 325 00:28:10,377 --> 00:28:14,585 to stop it getting to the river at all. This is one of those intercepting sewers. 326 00:28:15,055 --> 00:28:19,014 Coming in there, behind me, and then going away down there. 327 00:28:19,420 --> 00:28:20,891 Look at how it works. 328 00:28:22,846 --> 00:28:27,102 We are here. The old sewers ran this way, to the river 329 00:28:27,336 --> 00:28:32,124 and now hit Bazalgette’s new network of intercepting sewers running parallel to the Thames, 330 00:28:32,264 --> 00:28:37,396 three to the north and three to be south, joining up there and there, 331 00:28:37,599 --> 00:28:39,977 and diverting this sewage from the river. 332 00:28:50,225 --> 00:28:55,404 Where the North and South sewers ended, the latest in Victorian pumping technology, 333 00:28:55,592 --> 00:28:59,722 capable of handling 10,000 ft.³ of sewage a minute 334 00:29:00,019 --> 00:29:03,101 and double that during rainstorms. 335 00:29:11,002 --> 00:29:15,070 The south London stuff ended up here, at Crossness pumping station, 336 00:29:15,133 --> 00:29:19,952 on the Thames Estuary, 12 miles down from London, where four giant beam engines like this one 337 00:29:20,124 --> 00:29:24,552 lifted the sewage 30 feet up into a reservoir to wait for the tide to turn, 338 00:29:24,662 --> 00:29:30,576 when it was dumped, taken out to sea by the ebbing waters, never to be seen again. 339 00:29:32,202 --> 00:29:38,789 The scale of Bazalgette’s grandiose scheme shows, typically, in the statistics they published at the time: 340 00:29:39,183 --> 00:29:43,079 318 million bricks, 1300 miles of sewers, 341 00:29:43,251 --> 00:29:46,083 480 million gallons a day. 342 00:29:46,897 --> 00:29:48,555 Well, it all did the trick. 343 00:29:48,884 --> 00:29:51,575 They flushed the cholera away with the sewage, 344 00:29:54,860 --> 00:29:59,288 and it never came back. All thanks to Farr’s magic numbers. 345 00:29:59,708 --> 00:30:03,037 There was just one minor fly in the ointment, 346 00:30:03,325 --> 00:30:05,928 if that is right kind of image for this kind of story. 347 00:30:06,028 --> 00:30:10,935 They still didn't have the faintest idea what the mysterious cholera actually was. 348 00:30:28,308 --> 00:30:30,611 Meanwhile, unknown to everybody in Europe, 349 00:30:30,761 --> 00:30:35,568 events were to be spurred along by a gentlemanly GP in Georgia, USA. 350 00:30:35,706 --> 00:30:41,050 Back in 1842, here he was on his way to some rather dubious medical fun and games. 351 00:30:41,276 --> 00:30:45,819 Everybody around knew about the kind of parties you could have with Crawford Williamson Long. 352 00:30:46,183 --> 00:30:50,263 Parties where the wildest things happened because of what he could get people to do, 353 00:30:50,601 --> 00:30:55,094 once they had taken a sniff of what was in his mysterious bottle. 354 00:30:55,307 --> 00:30:57,811 Even girls would misbehave. 355 00:31:01,091 --> 00:31:06,172 The mystery ingredient in Long's bottle that got everybody all excited was called ‘ether’, 356 00:31:06,173 --> 00:31:10,553 and this get-together behind closed doors was called an ‘ether frolic’. 357 00:31:10,727 --> 00:31:14,432 Because what sniffing ether did to the nicest Southern Ladies and Gentlemen, 358 00:31:14,582 --> 00:31:17,148 was to make them frolic. 359 00:31:17,861 --> 00:31:20,678 I mean, you might find yourself kissing somebody 360 00:31:20,778 --> 00:31:23,306 when you hadn't been properly introduced to them. 361 00:31:26,498 --> 00:31:30,015 Doctor Long and half the young people in Jefferson City, Georgia, 362 00:31:30,166 --> 00:31:31,893 were having themselves a whole lot of laughs 363 00:31:31,918 --> 00:31:35,710 two or three times a week, turning on to the uproarious effects of ether. 364 00:31:36,261 --> 00:31:41,793 Apart from all that misbehaviour, ether turned the dullest fellow into the life and soul of the party. 365 00:31:47,600 --> 00:31:51,392 The ether seemed to release every last trace of inhibition 366 00:31:51,693 --> 00:31:54,384 from even the most reluctant of people. 367 00:31:58,464 --> 00:32:01,343 Before long, they would be happily burbling away at each other. 368 00:32:01,394 --> 00:32:03,534 Total gibberish, but who cared? 369 00:32:03,909 --> 00:32:07,952 Now and again, of course, some guy was bound to overdo it and take one too many sniffs, 370 00:32:08,428 --> 00:32:10,568 with inevitable results. 371 00:32:16,752 --> 00:32:20,181 It was at one of these incoherent little interludes that Long realised 372 00:32:20,406 --> 00:32:22,684 the full potential of his magic potion. 373 00:32:22,772 --> 00:32:25,526 Not only did it make you behave like a falling down drunk, 374 00:32:25,751 --> 00:32:30,232 but, just like the totally plastered, it left you feeling no pain. 375 00:32:34,224 --> 00:32:36,802 After these, hmm, ‘clinical trials’, 376 00:32:37,691 --> 00:32:40,858 Long was to try the stuff on a patient during a minor operation 377 00:32:40,870 --> 00:32:44,475 with extraordinary results. Because what he had discovered 378 00:32:44,476 --> 00:32:46,165 was anaesthesia. 379 00:32:50,933 --> 00:32:53,862 Now, I know what it sounds like, it sounds great. 380 00:32:54,100 --> 00:32:58,293 But any sane patient in the mid 19th century here in the sleepy South, 381 00:32:58,405 --> 00:33:02,073 or anywhere else, needed anaesthetic like a hole in the head. 382 00:33:02,874 --> 00:33:06,303 Because, while it did take your consciousness away, 383 00:33:06,580 --> 00:33:08,820 there was a good chance it wouldn’t come back. 384 00:33:09,020 --> 00:33:09,796 Why? 385 00:33:09,971 --> 00:33:14,778 Because anaesthetics encouraged doctors to operate more. That's why. 386 00:33:15,929 --> 00:33:18,896 Look at the new tools they had to play with by 1860. 387 00:33:18,921 --> 00:33:22,776 Things like viewing tubes’ for poking into every orifice. 388 00:33:23,013 --> 00:33:23,977 They hurt. 389 00:33:24,603 --> 00:33:25,979 But not with anaesthetic. 390 00:33:26,217 --> 00:33:29,809 So the doctors could look down their little tubes and see things worth taking out. 391 00:33:29,810 --> 00:33:31,799 and that was a problem. 392 00:33:32,476 --> 00:33:36,594 Because with walls dripping with fungus, 60 to a ward, 393 00:33:36,906 --> 00:33:40,736 blood and sawdust on the floor, drunken nurses, 394 00:33:40,949 --> 00:33:44,165 filthy bandages and bed sheets, (this is a hospital I am describing), 395 00:33:44,441 --> 00:33:47,545 the very last thing you wanted was a cut of any kind. 396 00:33:47,608 --> 00:33:50,462 Or, to put it technically, you were a dead duck. 397 00:33:50,775 --> 00:33:54,830 I mean, they tried to stop people going septic with bread poultices and tea. 398 00:33:55,143 --> 00:33:59,674 So most of the time it was, “the operation was a success, but the patient died”. 399 00:33:59,889 --> 00:34:02,480 That is, until 1864. 400 00:34:04,632 --> 00:34:08,725 That was the year some cows got sick in Carlisle, back on the Scottish border. 401 00:34:08,938 --> 00:34:14,170 And the locals threw carbolic acid into the sewage and all over the cows and they got better. 402 00:34:14,645 --> 00:34:17,887 So the Glasgow professor of surgery, a fellow called Lister, 403 00:34:18,075 --> 00:34:22,581 kind of threw carbolic acid all over eleven infected compound fracture patients, 404 00:34:22,793 --> 00:34:26,898 who were pegging out, and nine of them promptly didn’t. Peg out. 405 00:34:27,249 --> 00:34:30,628 So, Lister being a thorough kind of fellow who took things to extremes, 406 00:34:30,766 --> 00:34:34,370 decided that if the germs were in the air, which is where he thought they were, 407 00:34:34,621 --> 00:34:37,012 that’s where the carbolic acid should be. 408 00:34:37,387 --> 00:34:38,326 With these. 409 00:34:38,327 --> 00:34:42,920 Well, he converted scent sprays. As his fellow surgeons used to say before one of his ops, 410 00:34:42,995 --> 00:34:45,073 “let us spray”. 411 00:34:46,136 --> 00:34:48,477 Bad joke, great idea. 412 00:34:51,944 --> 00:34:56,713 In January 1878, Lister made all this modern life saving work possible 413 00:34:56,763 --> 00:35:01,419 with one of the most daring bits of ‘put your money where your mouth is’ in medical history. 414 00:35:01,682 --> 00:35:05,474 He anaesthetised one of his patients who had a compound fracture, 415 00:35:05,775 --> 00:35:10,368 and then, deliberately, made an incision. And the patient survived. 416 00:35:17,227 --> 00:35:20,619 Today, even open heart surgery is a commonplace thing, 417 00:35:20,620 --> 00:35:23,435 thanks to Lister’s antiseptic and Long’s anaesthesia. 418 00:35:23,635 --> 00:35:26,364 And another shift in the attitude towards the patient. 419 00:35:26,627 --> 00:35:28,793 No longer even conscious to be consulted, 420 00:35:28,981 --> 00:35:32,360 his survival now a matter of killing germs to prevent infection. 421 00:35:32,773 --> 00:35:38,042 But, whatever the germs were, and whether they were in the air, as Lister thought, or not, 422 00:35:38,218 --> 00:35:41,434 and how they caused disease, and about a zillion other questions, 423 00:35:41,610 --> 00:35:46,266 were still in the doctors’ minds as they carried out one successful operation after another. 424 00:35:46,466 --> 00:35:49,682 Knowing only that they were surrounded by invisible bugs, 425 00:35:49,732 --> 00:35:54,751 like septicaemia or gangrene. Invisible, but thanks to Lister, dead. 426 00:35:55,214 --> 00:35:58,844 However, they weren’t to remain invisible for long. 427 00:36:06,592 --> 00:36:09,208 In another part of the medical forest, so to speak, 428 00:36:09,333 --> 00:36:13,401 people had been beavering away with something, would you believe, Lister's father had developed. 429 00:36:13,751 --> 00:36:17,806 A fancy microscope, down which for the first time you could see clearly, 430 00:36:17,844 --> 00:36:20,773 what it was you are peering at. 431 00:36:23,776 --> 00:36:27,957 When they looked into a drop of water, remember water was still the mystery cholera carrier, 432 00:36:28,081 --> 00:36:31,999 what they saw, made them think alright: it was all very confusing. 433 00:36:32,336 --> 00:36:38,369 They could focus in on the things in the water, OK, things like cells and microorganisms. 434 00:36:38,719 --> 00:36:43,488 Trouble was, some of them were dead. So, obviously something even smaller killed them. 435 00:36:43,788 --> 00:36:48,770 Now, dead cells were calls by a disease. But where was the disease? 436 00:36:53,814 --> 00:36:57,756 Stare as they might, the only strain they could come up with was eyestrain! 437 00:36:58,007 --> 00:37:02,675 The big unanswered question: “if disease was caused by something you couldn’t see, 438 00:37:03,502 --> 00:37:04,966 how could you find it?” 439 00:37:13,978 --> 00:37:16,502 The fellow who found the answer here, in Africa, 440 00:37:16,752 --> 00:37:19,556 was an arrogant, fanatically metholocal, 441 00:37:19,786 --> 00:37:22,519 hypochondric German called Robert Koch, 442 00:37:22,719 --> 00:37:27,335 who started out life as a country doctor in a boring bit of Prussia, 443 00:37:27,456 --> 00:37:31,511 where the only excitement was guessing how many sheep would keel-over that week from anthrax. 444 00:37:32,501 --> 00:37:36,376 Koch shut himself away there for three years with a microscope 445 00:37:36,607 --> 00:37:39,861 and some unfortunate animals, solved the anthrax mystery 446 00:37:40,162 --> 00:37:42,165 and kind of invented modern bacteriology. 447 00:37:42,585 --> 00:37:45,739 He looked at drops of anthrax-infected blood, 448 00:37:49,124 --> 00:37:53,510 and, in among the blood cells, saw lots of little filament things everywhere. 449 00:37:56,584 --> 00:38:00,999 You put these into healthy mice, and you get instantly unhealthy mice. 450 00:38:01,529 --> 00:38:05,024 Koch made the little bugs comfortable with warmth, food and air, 451 00:38:05,025 --> 00:38:07,548 and they turned in to these. 452 00:38:08,820 --> 00:38:12,865 Spores, which resisted everything you threw at them, just sat there for years. 453 00:38:14,657 --> 00:38:18,292 But the instant they were back in an animal, they turned into the little filaments again 454 00:38:18,402 --> 00:38:20,655 and the animal got taken seriously dead. 455 00:38:22,688 --> 00:38:23,899 So, that was it, 456 00:38:23,989 --> 00:38:26,222 the highly resistant spores could live in the ground 457 00:38:26,223 --> 00:38:28,726 for ages and then get picked up by any passing sheep. 458 00:38:29,105 --> 00:38:33,531 Big thing, Kock had proved that one bug causes one disease. 459 00:38:33,981 --> 00:38:37,205 Which left about a zillion others, so on he went. 460 00:38:39,829 --> 00:38:42,803 First thing was to find a way to get the bugs to sit still, 461 00:38:42,883 --> 00:38:44,895 because in the droplets, they whizzed about. 462 00:38:45,306 --> 00:38:49,502 Koch hit on this stuff, agar, you make jelly with it. 463 00:38:49,953 --> 00:38:54,729 Agar plus 1% of meat extract is a bug’s idea of gourmet heaven. 464 00:38:55,090 --> 00:39:01,218 And it is solid, so they sit still and grow in little groups, separate from other bugs. 465 00:39:01,948 --> 00:39:04,822 Koch cultured any of these minute villains he could find 466 00:39:05,112 --> 00:39:07,896 and took the first ever micro-mug-shots. 467 00:39:08,045 --> 00:39:13,142 Septicaemia or gangrene, abscess, if it festered, he fed it and took its picture, 468 00:39:13,242 --> 00:39:17,708 and identified six more diseases caused by specific bugs. 469 00:39:18,648 --> 00:39:24,766 And then this maddeningly slow, obsessive methodical approach was galvanised by colour. 470 00:39:25,653 --> 00:39:30,659 See, in 1877, Germany was becoming the world's industrial dye centre. 471 00:39:30,920 --> 00:39:35,386 And when one of Koch’s chemist friends showed him some, sure enough, Koch put it on a slide. 472 00:39:35,866 --> 00:39:37,458 And saw that it did nothing…. 473 00:39:38,099 --> 00:39:41,503 to the general junk in blood: fats, crystals, cells. 474 00:39:41,944 --> 00:39:44,778 But what it did do, was to colour his little bugs. 475 00:39:45,218 --> 00:39:50,575 Which is why, in 1882, it only took him six months’ work to identify that. 476 00:39:52,538 --> 00:39:53,619 See the blue bits? 477 00:39:53,759 --> 00:39:57,925 That’s what you gives you tuberculosis, the tubercle bacillus. 478 00:40:00,759 --> 00:40:04,003 One year later, since you probably guessed I'd finally get the point, 479 00:40:04,074 --> 00:40:07,828 cholera came back to North Africa. Koch was on the next boat. 480 00:40:08,039 --> 00:40:11,684 Using his meticulous techniques, he found the cholera bug, 481 00:40:11,825 --> 00:40:15,369 cultured it, photographed it and stained it in three weeks. 482 00:40:19,054 --> 00:40:20,446 It looked like a comma. 483 00:40:20,716 --> 00:40:23,189 Which is why he called it the comma bacillus. 484 00:40:25,783 --> 00:40:30,039 And yes, it was transmitted when you drank water that had been polluted by sewage 485 00:40:30,079 --> 00:40:34,195 or soiled laundry. The mystery killer was a mystery no more. 486 00:40:34,494 --> 00:40:39,881 Koch was a hero and just as arrogant as ever, but his laws for investigation: 487 00:40:40,262 --> 00:40:43,506 ‘make sure one particular bug is always there when the disease is present; 488 00:40:43,747 --> 00:40:47,462 culture that bug; use the culture to give the disease to a healthy animal 489 00:40:47,532 --> 00:40:49,905 and get the same bug back out of that animal’, 490 00:40:50,056 --> 00:40:55,303 made bacteriology a science and put the patient on the slide for good. 491 00:41:10,282 --> 00:41:14,848 That transition by medicine from bedside to hospital to chemistry, is complete. 492 00:41:15,030 --> 00:41:18,204 And with it, the disappearance of the patient from our story. 493 00:41:18,374 --> 00:41:22,529 His complaint, once voiced personally and authoritatively, 494 00:41:22,670 --> 00:41:25,523 and is now reduced to a string of numbers on a computer terminal. 495 00:41:36,879 --> 00:41:41,310 “Of all the sciences,” as that philosopher back in Wurzburg, Schelling, you remember, said, 496 00:41:41,599 --> 00:41:44,652 “of all the sciences, medicine is king”. 497 00:41:44,740 --> 00:41:47,844 Because it deals, exclusively, with us and our well-being 498 00:41:48,019 --> 00:41:50,873 and there is nothing that any of us likes more than ourselves. 499 00:41:50,874 --> 00:41:55,392 So, as medical science has become more capable of enhancing that well-being, 500 00:41:55,504 --> 00:42:01,111 we have happily invited it to become more and more involved in wider and wider areas of life until, 501 00:42:01,387 --> 00:42:05,630 today, a doctor does much more than just heal the sick. 502 00:42:07,470 --> 00:42:12,076 Medical judgements rule, they go unquestioned in such areas, for instance, 503 00:42:12,151 --> 00:42:18,008 as diet, exercise, working conditions, abortion, job application, military service, 504 00:42:18,009 --> 00:42:23,239 parenthood, insurance, social security, and even, in some places, political acceptability 505 00:42:23,240 --> 00:42:25,079 and ideological dissidence. 506 00:42:25,254 --> 00:42:28,146 Doctors don’t just cure us any more, they pronounce us 507 00:42:28,233 --> 00:42:30,386 fit members of the community, in any sense. 508 00:42:30,774 --> 00:42:33,891 And, in that, they have more power, almost, than anyone else. 509 00:42:34,134 --> 00:42:37,200 That’s what Koch and all the others achieved. 510 00:42:37,654 --> 00:42:42,692 In 1892, the first public hygiene laboratory doing bacteriological testing 511 00:42:42,708 --> 00:42:46,118 was set up here in the hospital of the University of Pennsylvania, 512 00:42:46,322 --> 00:42:51,391 and our unquestioned obedience to the power of medical statistics began to spread 513 00:42:51,392 --> 00:42:53,472 to the non-medical parts of life. 514 00:42:53,551 --> 00:42:57,791 Because the man who ran the lab was a fellow called John Shaw Billings, 515 00:42:57,979 --> 00:43:02,218 and he had the idea of putting medical statistics onto punch cards. 516 00:43:02,344 --> 00:43:05,270 The punch cards that gave birth to the computer, 517 00:43:05,348 --> 00:43:11,340 whose existence makes all of us sick or healthy statistics, numbers. 518 00:43:22,574 --> 00:43:24,701 Like the sick patient, 519 00:43:24,811 --> 00:43:28,065 the population at large can now be diagnosed and treated, 520 00:43:28,205 --> 00:43:31,788 medically or not, without even knowing it. 521 00:43:31,866 --> 00:43:35,606 The irony is, that it should have all begun here in Philadelphia, 522 00:43:35,636 --> 00:43:40,189 the home, some might say, of the inalienable right of the individual to lead a life 523 00:43:40,408 --> 00:43:43,788 freely, and without interference.