Bedside Manners 5: Slice ‘n Dice

markers on the ground of the cave's largest chamber. They had an idea about what this might be, and slowly, methodically, and meticulously began to upturn the earth. At almost five feet down, they found it an ancient grave. The skeleton appeared to be a young person around twenty years old. It was almost fully intact. Almost finding bones in the ground isn't, in principle uncommon, but there were many things that made this find spectacular. Archaeologist determined that this person

died over thirty thousand years ago. The age of the skeleton and its intentional burial felt astonishing to them. It was one of the oldest examples of this ever found. The skeleton was missing its foot, but they found no evidence of infection nor blunt force trauma on its own. This might not seem very spectacular, but the team discovered something that made this not just a grape vine but a revolutionary one. You see, there was a considerable amount

of new bone growth evidence of healing. This and the meticulous intentional way in which the bones seemed to have been removed led archaeologists to conclude that this limb had been deliberately surgically amputated, making this the oldest evidence of ancient surgery ever discovered. Scholars have long assumed that prehistoric societies had very basic surgical skills. We've found evidence of dentistry, suturine, and cranial trepination, among other things, but evidence of a

complete and successful amputation suggests something else. That these people had well developed knowledge of anatomy, vascular systems, and remedies for infection. They knew how to stave off further harm to the body, and continued care in the postoperative time. The long standing assumption has been that surgical knowledge and technology really only developed after humans began to shift from hunting and foraging to farming. A pivot that began around

ten thousand years ago. The discovery of a successful amputation from over thirty thousand years ago, in which the patient not only didn't die, but went on to live for many years afterwards, completely changes how surgical knowledge and processes are thought to have developed and places them in a much earlier period. Have we ever originally thought? If you think about the past one hundred years, our medical technology

has evolved at a staggering pace. We hope for the best at hospitals and can often trust that we might leave there better than when we arrived. We revere doctors in white coats and defer to their best judgment and dexterous, steady hands. Many of us only have the vaguest idea of what goes on inside of our bodies and how all of the puzzle pieces are put together. We hope that they have a better idea than we do, but they haven't always. In fact, surgical amputation only became a

norm within the last century. At one time, amputation would be done as a last ditch effort to save someone's life. While it might and often did kill a patient, they most certainly would die if the offensive body part was left intact. The history of surgery is a long and fascinating one, chuck full of curiosity and ham fisted cleaverers. It's been misguided at times and totally astonishing in others, and with plenty of bloodshed along the way. I'm Aaron Manky,

and welcome to bedside Manners. You've heard me say this before, but I'll say it once again. Archaeology isn't an exact science. It's a discipline of best guesses. A field filled with detectives covered in dirt figuratively a field, but also sometimes literally in a field. Before the twenty twenty two discovery in Indonesia, some of the oldest surgical discoveries were believed to have come from about ten thousand years ago. The Neolithic period, as it was known, was the time period

in which humans began to take up farming. When people did this, they also started to store their dead and shared locations. Burying our dead is one of the oldest expressions of our humanity, and we've been at it for

over one hundred thirty thousand years. As ancient people created communities, they created burial sites too, and it's in these burial sites across the globe that archaeologists have found over fifteen hundred skulls that bear evidence of trefination, the act of drilling a hole into the skull of a living person

in the hopes of curing sickness. There is a chance that this practice existed far before these people lived, but we can imagine that the intentional placement and preservation of these bodies had something to do with our ability to make this discovery. The question, though, is why, and the truth is will probably never know, but one guess is that, like a lot of medicine up until the past few

hundred years, healing and spirituality were deeply intertwined. Were these ancient neurosurgeons trying to relieve patients of physical symptoms such as headaches or seizures, or to provide an escape hatch for voices and demons that may have affected the person. What we do know is that these people went on to live hopefully healed, as evidenced by bone regrowth. And we know too that Neolithic surgeons were operating on head

injuries and seemingly successfully at times. As civilizations developed thousands of years later, Babylon, Egypt, China, and Greece among them, the great thinkers across the ancient world tried their hands at understanding what it meant to be a healer and how that's squared with cutting into the body. Different social mores across cultures dictated what was allowable For thousands of years. Health and healing were directly tied to these supernatural in

some ways, and in some places it still is. Before the advent of modern science and medicine, humans believe that sickness was caused by unseen forces, and they were kind of right. But it wasn't the invisible spirits they had to fear, but microscopic germs invisible to the naked eye. It was the ancient Egyptians who first peered into the human skull with the idea that it was the brain that was the command center of the body. They were right far before anyone else was. But not everyone was

so gung ho as they were about internal investigations. In ancient China and Greece, religious and spiritual beliefs dictated that the body was sacred, and as you learned in our previous episodes, human dissection was outlawed for a very long time. In fact, the original Hippocratic oath, which is still taken by doctors today, specifically forbade them from cutting. It said, and I quote, I will not use a knife, not even on sufferers from stone, but will withdraw in favor

of such men as are engaged in this work. The Oath, of course, also set out to create two distinct classes of healers, sally physicians and tradesman surgeons. Following the rise of the Roman Empire, Greek healers and their knowledge were absorbed into the social fabric. Hippocratic beliefs spread throughout the territory,

and the demand for care often outpaced supply. Interestingly, it's here that we saw more and more enslaved people and servants take on more surgical responsibilities for their households and communities. The physician Galen, who wrote a great deal about anatomy and surgical procedures, likely never performed or even witnessed the dissection of a human because of the Roman outlaw of the practice. However, he had been a surgeon to gladiators, where spilled blood and guts were all in a day's work.

Most of his surgical knowledge, though, was just based on animal dissection, which could only help so much when it came to understanding the human body, he became the leading authority on the matter. But what he didn't understand he made up, If you'll pardon the pun, he took a stab at it with best guesses as to how the human body worked. And yet his word was taken as fact for a very long time, until sensibility shifted into a place where intentional slicing was not only acceptable but

absolutely necessary in moving knowledge forward. King Louis the fourteenth would meet a bad end, but November eighteenth of sixteen eighty six wasn't going to be that day. That said, he was certainly in for a bit of suffering due to his well his other bad end. By early morning of that day, our king was flanked by his closest advisers, faced down, prostrate and pantless in bed. His people held

his legs apart and firmly to the bed. As Charles Francois Felix began, the king was suffering from an anal fistula. For months. He had tried lansings and laxatives, leeches and irons, but no physician could relieve the king's suffering, and by the spring of that year he was growing desperate. So he called for a surgeon. Louis summoned Charles Francois and

pleaded for help. But knowing that one wrong step or slice could mean the end of Charles Francois's career and possibly the end of him, the surgeon implored the king to give him a few more months of time to study and figure out a way to help his condition. So, with a deep breath and probably a few prayers, Charles Francois took his special made metal protractor, his knife shaped like a scythe, and got to work in the candlelight, without any antiseptic and without any pain relief. The king

soldiered on through the morning. By lunchtime, the operation was over, and you know what, it was a success. And with that the new year of sixteen eighty six was deemed the year of the Fistula by the crown. He filled fountains with wine and saying his own praises of bravery in the face of adversity. The king rewarded Charles Francois with a heavy sum of francs and a large estate,

making him a celebrity in his own right. In a strange twist, the surgery became somew fashionable, with folks clamoring for a cure when there was no problem to begin with. This moment helped to change the public's view of surgeons. In the collective imaginations, they evolved from simple tradesmen to skillful healers. As you've heard by now, barber surgeons were long considered to be well barbarous, knife wielders and blood letters.

They occupied a distinctly different social space than the refined minds of the academy. Their job meant getting down and dirty, while the physicians preferred to look but not touch. In the Middle Ages, there were various attempts to unify physicians and surgeons and have them work together rather than in opposition, but as you can imagine, this was sometimes a fraud endeavor.

With the Renaissance came a turn in the story for surgeons, as they finally moved into positions of respectability within the healing business. They were starting to be viewed as innovators, not quacks or buffoons. They held sharp clinical skills and an understanding of the body's interior geography based on hands

on experience and observation rather than just old theories. By the eighteen hundreds, London and Paris had become the epicenters of surgical development, serving both the needs of science and entertainments. I've been at this for a good number of years, and I've read my fair share about the Victorian culture. But one of the most striking discoveries that one makes when reading into their history is their love of the macabre. For example, this was the time when crime scenes, the

ghastlier the better, became tourist attractions. True crime stories became all the rage. People wanted to look but not touch. They wanted to step close to danger and be able to walk away. It's not that different from the way that we still experience true horror podcasts and scary movies. It's voyeurism. It's safe, and to them, these surgical procedures, often bloody and grotesque, didn't look much different than crime scenes.

Public operations and dissections became not just the means by which a budding surgeon could learn new skills, but they also doubled as entertainment for folks who headed out for a night on the public operating theaters where bodies were center stage were happy to take their money. Even into the mid nineteenth century, invasive surgeries were very rare and

very risky. They were generally avoided except as an absolute last resort, So people came to catch a glimpse of these rare events when they could, sort of like when the circus might come to town, a once in a while event, a spectacle ripe for public consumption. But hey, if that isn't morbid enough, let me remind you that hospitals were known as houses of death. Think mushrooms and maggots in the bedsheets, wailing in the hallways, and rodents

nibbling on discarded limbs. They were fetid and squalid places, filled with the lingering stench of blood, custs, and the undigested food and fecal matter that still slashed around inside the stomachs of dissected cadavers, and those corpses were often less strewn about, dripping blood onto the floors where it congealed and dried. Students and practitioners wore aprons that had been passed down to them by professor and former staff, which had never been washed. In fact, they were worn

as badges of honor. And hey, if I've captivated you thus far, and maybe even ruined your breakfast, then there's one more surgeon you just have to meet, because he so very infamously cemented himself into the history books for reasons you might find hard to believe. Robert Liston walked into the operating room, flanked by his assistance. He was an imposing fellow, his apron starched with blood and tissue. He was a vision, part angel and part butcher, with

the skills of both. Pulling up next to the operating table, he looked at his audience. Time me, gentlemen, he said, time me. Then he made a cut. Screams filled the theater, and everyone looked on in wrapped fascination. If history remembers the fastest gun in the West, it could certainly remember the fastest knife. With a custom made amputation fourteen inches long and one and a quarter inches wide, Robert's amputation

knife was also one of the sharpest. While his emphasis on speed may strike you was a bit reckless, it was an appreciated skill. His work, which also happened to be highly accurate, gave patients peace of mind at a time when anesthesia didn't exist. The shorter, the suffering, the better. Standing At an imposing six foot two inches tall, Robert was a full eight inches taller than the average Brits

of his day. He was brutish and abrasive, vain and bombastic, but he was always charitable to the poor and warm to his sick patients. He was one of the very best surgeons of his time, with only about one in ten patients dying on his table. Nearby hospitals weren't as lucky, with a mortality rate of about one in four cases. But although his patients came willingly, it doesn't mean that

they stayed happily. The unlucky or lucky, depending on how you think about it, were often strapped to blood encrusted operating tables, held down by attendance, and over with agony. He could amputate limbs in just a few strokes in less than a minute. The hope was that the pain he caused his patients would only be a temporary state, and that they would go on to live functional lives. Until the eighteen forties, surgical practice remained a superficial art.

Little could be done deep inside the body's cavities. As we've seen, surgery carried a lot of risks, even as it became a relatively more commonplace part of medicine. Robert Liston, though, would prove to be a cut above the rest. As a young man, he had come to London to study surgery and anatomy, before bouncing between the city and Edinburgh, Scotland. He was brilliant and provocative, prone to disagreements that severed professional relationships and made him rather insufferable to work with.

Even so, he was ahead of his time. He found hospital conditions to be deplorable, and in a time before germ theory worked toward cleanliness, he was adamant about clean simple bandage, dressings and washing sponges and surgical tools. He had returned to London in eighteen thirty for as an instructor at one of the new teaching hospitals, playing a major role in the transformation of surgery into a modern specialty. His staff was small and money was thin, but here

he saw the opportunity before him. Because medical specialties didn't exist yet, Robert did it all. He set fractures and did facial reconstructions, performed amputations and removed tumors. He could use his bare hands as a tourniquet. He invented tools that we still use today, and he carried his knife up his sleeve to always keep it warm. His trademark speed, though, sometimes came at a price. As the legend goes, there was one surgery that, for all of his successes, Robert's

celebrity hasn't been able to live down. Whether it's true or not depends on the sources you consult and the people you ask as primary source. Documents couldn't be turned up, but it's a good story, so I'm going to tell it to you anyway. Like any other day in the office, Robert don his starched and sticky surgical garb and set out to conduct a leg amputation. Famously, he once amputated a young boy's leg with an easy six strokes, so

this shouldn't have proven to be a difficult case. But somewhere, somehow, things went fatally wrong. In the midst of the surgical spectacle, someone moved carelessly with his blade. He sliced off the fingers of his surgical assistant and then went on to cut off a spectator's coattails. It said that neither the patient nor the assistant fared well, and both soon died

from infection. And while coattails being cut isn't a fatal injury, the spectator is said to have died from shock from the whole incident, earning list in the ignoble achievement of performing a single surgical procedure with a three hundred percent mortality rate. Now, of course, why someone would make up this story, if it indeed isn't true, is something to wonder about. His professional peers simultaneously loathed and admired him,

and his students adored him. But in many ways he seemed larger than life in both his stature and his contributions to his community. So I guess it would make sense that a bit of mythology was bound to take roots about him. One thing that I think we can all agree on, though, is that we're all pretty fortunate that we'll never have to meet him in the operating

theater and find out if it's true for ourselves. Robert Liston brought speed to the surgical tables at a time when that skill was paramount, But soon there would be something else that would usurp its, rendering his trademark clip unnecessary. For thousands of years, up until this point, we had been working through gradual stages to arrive at a place where surgery could be both safe and painless. First we had to understand the body's anatomy. Then we had to

learn to control bleeding. A third point arrived around eighteen forty six, when we learned to control consciousness. Anesthesia had arrived in Europe under Robert's watch. As history tells us, the winter of eighteen forty six brought with it a patient by the name of Frederick Churchill. After many years of bouncing from physician to physician looking for cure after cure, it became obvious to all that the only thing to do for his knee pain was to remove the limb entirely.

He lay in Robert's candlelit operating room, surely aware of the spectacle that was about to befall the audience, then the starring role that he had at center stage. But when Robert walked in, he brandished only an empty looking jar and a whole lot of bravado. He held it up to the audience and announced that he was going to use ether to make his patient insensible. The idea came to him after hearing stories about dentists in America using it, and he was going to give it a

try here. And with that, Robert had the patient Frederick stick a rubber tube attached to the jar into his mouth and inhale. It took all of twenty eight seconds for Robert to slice off his leg, full minutes before Frederick would stir again. Both the ether and the surgery had been successful with time to spare, so successful, in fact, that when Frederick woke up he asked when the surgery

would begin. The audience, without a doubt, was astounded. They had witnessed something new that in time would become commonplace surgery as we had once known it had pivoted indefinitely, all under the watchful knife of Robert Liston. It's easy to believe, after listening to the grizzly history of surgery, that the procedures performed often ended or severely ruined lives. Certainly, the stories about speed surgeons like Robert Liston do a good job of making us wonder if those wielding the

knife truly had their patient's best interest in mind. But some procedures have done more than saved lives. In fact, one saved a man's career and in the process set him on a course to change history. And if you stick around through this brief sponsor break my teammate Robin Miniter will tell you all about it. Alan Shephard thought his career was over. He was mad, he was grieving, and he was said by some to be the most disgruntled employee working at NASA. It hadn't always been this way, though,

you see. Alan had been the first American in space. He had been a hero, a national icon, and he was now what a paper pusher. Sitting at his desk as the new chief of the Astronaut Office, Alan couldn't help but feel like he was now just riding the bench. He had been one of the original seven astronauts in Project Mercury before he fell out of ranks. Alan had been reassigned after was determined that he was no longer

fit for flight. The problem, you see, was that Alan was found to be suffering from something called Meniere's disease, an inner ear problem that causes dysregulation and balance. It's known to trigger spontaneous bouts of vertigo into nitis attacks, which left Alan dizzy and vomiting. You can imagine how catastrophic this might be for somebody piloting a rocket. But he had heard of a new procedure that might be

able to cure him, and he found a doctor. In early nineteen sixty he had decided to go to Los Angeles and Chances of Surgery in the hopes of salvaging everything that he had worked for. Scientific testing to determine if a procedure is going to be effective is a pretty murky business. There's conflict between the ethics of research and the ethics of clinical practice. The former balances benefit and harm an individual level and the hopes of serving

the broader good. Medicine's hippocratic oath fundamentally does not condone causing harm, however minimal it may be. The problem, then, is that medical practitioners can't know if something is going to be effective until it's been subjected to scientific testing.

And if a treatment becomes commonplace and people believe it to be effective, the medical professionals are sometimes worried that conducting tests to see whether or not something might indeed be effective will deny patient's potential help should it be shelved. The important thing to note here is a necessity of belief on the part of the patient that something might be effective. Time and time again, those in medicine have

run to what's known as the placebo effect. For whatever reason, It's been found in double blind trials that even the theater of pills and procedures seemed to alleviate chronic ailments. There's a perceived effectiveness, either on the part of the patient or their doctor that is undeniable, though it's all subjective. Alan arrived in Los Angeles ready to be operated on. His surgeon placed a tiny silicone tube with his ear, allowing excess fluids to drain if need be. The surgeon's

handiwork appeared to have been just the ticket. Following the procedure, Alan reported a full recovery and a total cure from the mysterious Maniaire's disease that had taken him out of commission. So he was put back on the flight team and as the commander of the Apollo fourteen mission, he got his flight to the Moon, but his story doesn't end there. Years later, this procedure went to testing. It was found not to have any kind of therapeutic benefit, but it

was still found to cure Manierre's disease. Patience. In what is called a double blind, random placebo controlled test, a group of patients were all operated on externally. You couldn't discern them from one another. But over the course of three years it was found that over two thirds of the patients had made a complete recovery, both of those who have the real procedure and a placebo one healed,

suggesting that the procedure is essentially meaningless. It's possible that Alan's chair was in the belief that he would be cured. But this is indeed a slippery slope of logic, as one can quickly come to blame someone for being sick. But the mind is a powerful tool, and we can

all wonder if believing is the key to healing. Perhaps just as much as the salves and the knives, as we've seen in prior episodes, think that we know to be somewhat harmful, such as bloodletting, were believed to be therapeutic by practitioners and their patients, and in the century since leeching bellad of fashion, we've seen placebo remedies come

and go. One scholar made a great suggestion that with every operation, the surgeon should ponder whether the patient has been healed because of the surgery or in spite of it. Grim and Mild Presents Bedside Manners was executive produced by Aaron Manky and narrated by Aaron Manky and Robin Minater. Writing for this season was provided by Robin Minater, with research by Sam Alberty, Taylor Haggerdorn, and Robin Minater. Production assistance was provided by Josh Thayne, Jesse Funk, Alex Williams,

and Matt Frederick. You can learn more about this show, the Grim and Mild team, and all the other podcasts that we make over at Grimm and miild dot com and, as always, thanks for listening