Secret forceps & pig bladders: medical objects through time

Summary

History Extra Podcast Summary: "Secret Forceps & Pig Bladders: Medical Objects Through Time"

Release Date: January 10, 2025
Host: Lauren Good
Guest: Dr. Carol Cooper
Produced by: Daniel Kramer Arden

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Introduction to the Episode

In this enlightening episode of the History Extra Podcast, host Lauren Good engages in a captivating conversation with Dr. Carol Cooper, author of the newly released book, The History of Medicine in 12 Objects. Dr. Cooper delves into the transformative medical tools and machines that have revolutionized healthcare throughout history. This summary encapsulates their discussion, highlighting key objects, their historical significance, and notable insights shared during the episode.

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1. The Trephine: Pioneering Neurology

Timestamp: [02:46]

Dr. Cooper begins by exploring the trephine, one of the earliest surgical instruments used to create openings in the skull.

"It was one of the first surgical instruments ever... It really led the way to the study of neurology."
— Dr. Carol Cooper [02:46]

The trephine not only symbolizes early surgical endeavors but also marked the inception of neurology by revealing the intricate connections within the brain and nerves.

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2. The Bone Saw: A Barbaric Yet Crucial Tool

Timestamp: [03:59]

Next, the bone saw is discussed, highlighting its grim use without anesthetic yet its role in advancing surgical techniques.

"It did lead to improvements in surgical techniques because... the quicker you were, the more likely your patient was to survive."
— Dr. Carol Cooper [04:12]

Despite the horrific nature of amputations performed without pain relief, the bone saw necessitated rapid surgery, inadvertently fostering better survival rates and surgical efficiency.

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3. The Surgical Mask: From Protecting the Patient to the Practitioner

Timestamp: [05:33]

Dr. Cooper traces the history of the surgical mask, emphasizing its dual role in safeguarding both patients and medical professionals.

"Masks can do two things, and they're not necessarily the same... a mask isn't always enough."
— Dr. Carol Cooper [05:51]

Initially designed to protect others from the patient's germs, masks evolved to also shield healthcare workers, especially with the advent of germ theory.

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4. The Microscope: Unveiling the Invisible

Timestamp: [07:00]

The microscope's pivotal role in medical advancements is explored, particularly its contribution to germ theory.

"Van Leeuwenhoek... found little things moving, and he called them animalcules... Louis Pasteur... we owe the germ theory to him."
— Dr. Carol Cooper [07:00]

By enabling the visualization of microorganisms, the microscope transformed understanding of diseases, leading to breakthroughs in diagnosis and treatment.

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5. The Stethoscope: Listening to the Heart's Secrets

Timestamp: [09:10]

Dr. Cooper discusses the invention of the stethoscope by René Laennec and its impact on patient-centered care.

"It led to greater classification of disease apart from the scientific part of it as well... Rene Laennec was very, very patient centered."
— Dr. Carol Cooper [09:29]

The stethoscope not only facilitated auscultation but also fostered a deeper scientific approach to assessing patient symptoms.

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6. The Ether Inhaler: Pioneering Anesthesia

Timestamp: [11:15]

The introduction of ether as an anesthetic revolutionized surgery by making procedures more bearable and safer.

"Ether... opened the way to safer surgery and very importantly, more bearable surgery."
— Dr. Carol Cooper [11:35]

Despite initial resistance and misuse, ether's adoption marked a significant leap towards modern surgical practices.

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7. Obstetric Forceps: The Secretive Innovation

Timestamp: [16:29]

Obstetric forceps, developed secretly by the Chamberlain family, exemplify early innovations in childbirth management.

"They managed to keep the forceps secret for about 100 years... It's such a dramatic story."
— Dr. Carol Cooper [17:48]

The forceps' clandestine use and eventual discovery highlight the challenges and breakthroughs in improving maternal and neonatal outcomes.

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8. The Hypodermic Needle and Syringe: Revolutionizing Injections

Timestamp: [18:14]

The evolution of the hypodermic needle and syringe transformed medical treatments by enabling precise delivery of substances.

"Once the syringe and hypodermic needle came along... healthcare without a needle and syringe is unimaginable today."
— Dr. Carol Cooper [18:38]

From rudimentary devices to the sophisticated tools used today, the syringe's development was pivotal in advancing medical therapies.

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9. The X-Ray Machine: Illuminating the Hidden

Timestamp: [20:16]

X-rays, discovered by Wilhelm Röntgen, swiftly integrated into clinical practice, despite early fears and misconceptions.

"Within a few months, doctors were using X rays to find foreign objects in people's hands, to diagnose broken bones."
— Dr. Carol Cooper [20:30]

The rapid adoption of X-ray technology underscored its immense diagnostic value, even as societal concerns about privacy emerged.

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10. The Prosthetic Hip: Enhancing Mobility

Timestamp: [24:10]

Prosthetic hips, particularly the Austin Moore's prosthesis, revolutionized orthopedic surgery and patient mobility.

"Hip replacement can really change lives for the better... it was the first off the peg, as it were, hip replacement."
— Dr. Carol Cooper [25:34]

The development of durable and functional hip prosthetics significantly improved quality of life for individuals with severe hip ailments.

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11. The Electroconvulsive Therapy (ECT) Machine: Addressing Mental Health

Timestamp: [28:33]

ECT machines, despite their controversial history, represent a critical, albeit imperfect, advancement in psychiatric treatment.

"ECT is still sometimes used and the treatments have been modified so that you don't get most of these horrendous side effects."
— Dr. Carol Cooper [32:38]

Dr. Cooper acknowledges the complex legacy of ECT, balancing its therapeutic benefits against historical abuses and side effects.

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12. The Heart-Lung Machine: Enabling Cardiac Surgery

Timestamp: [32:53]

The heart-lung machine, pioneered by John Gibbon, transformed cardiac surgery by maintaining circulation and oxygenation during operations.

"It led to all the possibilities that we have today to repair congenital heart defects, to help people with coronary artery disease, even to replace hearts."
— Dr. Carol Cooper [32:53]

This machine's invention marked a monumental leap in enabling life-saving heart surgeries that were previously deemed impossible.

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Conclusion: The Computer as a Potential 13th Object

Timestamp: [35:36]

Dr. Cooper muses on what could represent the next pivotal medical object, suggesting the computer for its indispensable role in modern healthcare.

"Data gathering is one of the most vital procedures in medicine."
— Dr. Carol Cooper [35:36]

While not exclusively a medical tool, computers have undeniably transformed medical research, diagnostics, and treatment planning.

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Final Thoughts

Dr. Carol Cooper's exploration of these twelve medical objects underscores the intricate interplay between innovation, societal acceptance, and the relentless pursuit of improving human health. From primitive tools to sophisticated machines, each object tells a story of ingenuity, challenge, and the ever-evolving landscape of medicine.

Access More Insights:
To delve deeper into these fascinating medical histories and more, consider accessing the full content at HistoryExtra.com with a 6-month subscription for just 99p.

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This summary captures the essence of the "Secret forceps & pig bladders: medical objects through time" episode, providing a comprehensive overview for those who seek to understand the transformative tools in medical history without listening to the full podcast.

Transcript

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[Lauren Good]

Welcome to the History Extra Podcast. Fascinating historical conversations from the makers of BBC History Magazine. What was it like to undergo an operation in a world where with no anesthetic, how was the stethoscope invented? And when did we first operate on a human heart? In her new book, Dr. Carol Cooper condenses the history of medicine down to the stories of 12 pivotal objects, from the bone saw to the heart lung machine. Lauren Good spoke to Carol to find out more. And please be aware the following podcast does contain descriptions of medical and mental health issues.

[Carol Cooper]

Carol, thank you for joining me to explore your new book, the History of medicine in 12 objects. Let's start with a question I know I was asking when I started reading this book. How on earth did you begin narrowing down this expansive history to the 12 objects we'll be talking about today?

Hi Lauren. Well, it was not an easy task and I really wanted to make it about 20 objects. But then I realized I wouldn't be able to devote as many words, as much space if I did that. So I really had to narrow it down to 12. But I think each of the objects I go through the antecedents to that object or what came before, and also how the object was used, how it was received by fellow professionals and patients, and what it led to afterwards. So, for example, the X ray machine leads on to other improvements in imaging and actually new ways of doing surgery.

I'm going to attempt to touch on all the objects, as you do so brilliantly in the book. First, the trephine, which many will see as a somewhat barbaric tool used to make a hole in the head. Why has it made the list?

It was one of the first surgical instruments ever. And of course, what's really awesome is how did the idea come about and how did people stay still long enough for somebody else to make a hole in. In the skin and through the skull? And I suppose the answer is that they were very ill, that there was nothing else that could be done. And in some cultures, there was a belief that this would help them. It made the list because it was the forerunner of much else that was to come. And it really led the way to the study of neurology. And I think there was a light bulb moment when they realized that making a hole in the head actually affected the other side of the body. And there was a realization that there were pathways in the nerves and brain. So it led to more questions and more and more questions, and I think that's actually true for many of the objects.

Another tool that some people might see, also leaning on this more barbaric site. Is the bone sore. It's almost unimaginable, isn't it, people going through this surgery with no anesthetic?

Yes, it is. That in itself was a great problem, obviously, for the patient, for the family, and for the surgeon and the assistants. You know, anybody and everybody was hauled in to hold someone down as their leg was being sawn off. But it did also lead to improvements in surgical techniques because, you know, you had to be very quick. You had to be very quick and get it over with. And the quicker you were, the more likely your patient was to survive.

I know it will have changed as the decades and centuries went on, but how likely was somebody to survive having their leg cut off with no anesthetic?

It very much depends on why the leg was being cut off and how well it was done and the conditions in which it was done. So, for example, in the middle of a battlefield, your chances were probably not very good. You might have other injuries at the same time. There was a risk of infection, and, you know, nobody much is going to look after you afterwards. But in a more serene setting, your chances would probably be a lot better than 50. 50. But, you know, those first operations, the bolder they were, of course, the less chance the person had to survive.

As I said earlier, it's almost unimaginable. Now we're changing the subject slightly Here for the third object that you mention, which is the mask. You know, we're much more familiar with the mask now, with the recent pandemic. When does the history actually begin?

Oh, it begins a really long time ago in classical times, when there was this idea that you could protect yourself from dust and particles. While you were basically doing diy, so little stone carving and so on, you could protect yourself from inhaling the dust by wearing a mask. But it was a really long time before surgeons wore masks, and the concept there was to protect other people, not to protect yourself. But of course, it does work both ways. But a mask can do two things, and they're not necessarily the same. And a mask isn't always enough. If you're going to protect the operator, they may well need a visor and so on.

And later, of course, we would discover that the reason masks could be successful was the presence of germs. It's pretty difficult to imagine a world where the concept of germs doesn't exist, isn't it? You discuss this discovery with your fourth chosen object, the microscope. How did we actually begin to find out about the presence of germs?

The microscope was really important because it helped us see small objects that we didn't know existed. And there were two people in particular, an Italian called Malpighi who looked in detail at various parts of the body. But the idea of seeing germs or things moving, really, a lot of it goes down to a Dutchman called van Leeuwenhoek. And he was not a scientist. He was a draper, and he had his draper's shop. And he wanted to see in detail the quality of the threads and cloths he was using. And so he devised this compound microscope. And he wouldn't tell anybody else how he'd done it. He was obviously quite a craftsman, and he started looking at all sorts of things, and he became interested in looking at living things under the microscope, and he found little things moving, and he called them animalcules, for little animals, but he had no idea what they did. And then we have the British scientist Robert Hooke, who invented the word cells. When he looked under the microscope, he did a lot of many other interesting things. He was an architect, a geographer, an astronomer, and we think he also invented the sash window, but that's by the by. He did C cells and he gave them that name, but nobody really knew what they did until Louis Pasteur came along. And we owe the germ theory to him. He was the one who realized that these small things, yeasts fungi, bacteria could cause disease and they could spoil a good bottle of wine as well.

It's interesting. You've got the microscope being invented by a draper and then the mask being invented for people doing diy. They're not the origins you expect, are they?

I think it's interesting that so many non doctors invented and developed so many different medical objects. I think it's also a lesson to the doctors of today. You don't have to follow a straight career path to make your mark or even to get a Nobel Prize.

Now the fifth object you talk about, Carol, is the stethoscope. And I found this a really interesting part of the book. You discuss how we tried to find out what was going on inside a patient's chest before this invention. Could you talk about these pretty strange methods?

Before the stethoscope, the doctor might just put his ear on the patient's chest or he might put his ear and shake the patient at the same time to find out if there was a splashing noise. So nobody had the idea of using a tube of any sort. And along came Rene Laennec, who was a French physician. He had a really interesting history. He was very musical, he was multi talented actually. He was good at languages, sport, but especially music. And he went to see a patient back in, oh, 1816 and he was a young doctor in Paris. It was a female patient and she was young. Anyway, he felt embarrassed putting his ear directly onto her chest. So he grabbed a piece of paper that was nearby, rolled it up and made a tube and listened with that. And to his surprise, he heard really well through it. And the stethoscope actually developed from that. But you know, we think of the stethoscope as the archetypal medical instrument. Oh, how boring. Of course she's going to include the stethoscope. But it led to much more. It led to really scientific study of patient symptoms and the chest conditions especially. And it led to greater classification of disease apart from the scientific part of it as well. Rene Laennec was very, very patient centered. He didn't just listen to patients with a stethoscope, he listened to them speak. So I think this was the beginning of modern medicine as we know it, or as it should be today. A really good amalgam of science and art.

The six object you talk about, Carol, is a little different because it's not really an object, it's a substance. We've talked about holes being bored into the head and people having limbs chopped off with no anesthetic. But then we have the ether inhaler. What did this do for patients?

Of course, ether was one of the first anesthetics and it opened the way to safer surgery and very importantly, more bearable surgery. So it enabled surgeons to save more lives. But of course, in the early days, as with most things, nobody quite knew how to use it and there were overdoses. And the same is true of chloroform, which was also used early on. So it's been a bumpy road. And there were also people who didn't think that anesthetics were a good idea, unbelievably so. There was a general, I think he was in the US Army. He didn't think any of his men should have an anesthetic if they had their limbs chopped off. A young man should be able to withstand it all, you know, it was a badge of courage. It was quite shocking. I think when you look at the time before or around these innovations and look at how they were received, they weren't always immediately popular.

That resistance to change is really interesting, isn't it, throughout the book?

It really is. And somewhere in the book I've quoted the economist John Maynard Keynes, who says somewhere that the difficulty lies not so much in developing new ideas as in escaping from the old ones.

And ether isn't just linked to surgery, there's also a link to childbirth. Could you please talk about what that link is?

It was a great boon for women to be able to have anaesthetic for labour and also especially for instrumental labor. But again, there was resistance. There was resistance to the idea of using anaesthetic for labor because, you know, it says in the Bible that you should bring forth in sorrow. So religious people and many doctors were against it. I think, as Queen Victoria did a lot to popularize anesthetic and labor because she had chloroform for two of her children's births. And she really started a trend and everybody then started talking about chloroform a la reine. So if the Queen had it, then surely it was fine. And it was a celebrity endorsement, of course, for John Snow, the doctor who'd administered it.

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[Carol Cooper]

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[Carol Cooper]

You talk as well about Twilight sleep during labour what was this?

This was a mix of drugs and funnily enough, my first encounter was Twilight sleep. I'm actually too young to have had it myself, but my mother had Twilight sleep when I was born and believe me, she talked about it for years as to how unpleasant it was. It was supposed to kill pain, but it didn't. It caused amnesia and sedation, although not always. It also caused a lot of agitation. Some women became really violent, they would thrash out and then inevitably someone would have to restrain them so they were tied up and after the event they would somehow have produced a baby who may or may not be healthy, because a lot of the drugs affected the baby as well. And it was initially popular in Germany, then came to the UK and a lot of women thought it was a really good idea because I suppose they thought it would make for a less painful birth, but it didn't actually remove the pain, it removed the memory and a lot of the other sensations rather than the pain.

Now I'm going to just mix up the order a little bit, because you do also talk about obstetric forceps in the book, which we still use today. When did we actually start using forceps in delivery?

Forceps go back to about the 16th century and they had a very mysterious beginning. We owe the forceps to the Chamberlain family, who were originally Huguenots, and they fled France, came to England and one of them invented the forceps. But the family kept it all very secret and they would go around delivering babies with forceps, but they didn't want anybody to see the forceps. So they had this amazingly ornate trunk which was carried around and they would only open the trunk after they got to the birthing chamber and after everybody else had left and the woman wasn't allowed to look. And they managed to keep the faucet secret for about 100 years. Nobody knew what their secret was, but basically they delivered babies in difficult cases. And in many cases, both mother and baby survived. So it was seen as something of a miracle. And that didn't hurt their celebrity one little bit. It was a huge commercial secret and they tried to make money out of it and didn't entirely succeed.

How did the secret actually come out?

Well, the secret came out years later when somebody had moved into their old ancestral home, went up to the attic and lifted some boards in the attic and found the forceps.

It's such a dramatic story, isn't it, with this idea of the chest being brought to the delivery room and then discovered in an attic.

Absolutely. There was so much subterfuge. I mean, it's, you know, it's really worthy of a play.

Now, Carol, another object you talk about in the book that our listeners will be familiar with is the hypodermic needle and syringe, which has a surprisingly long history. Like many of the objects you discuss in the book. Before needles, you say that we had syringe like devices. What sort of things did we use before we had the syringes we have today?

Well, before the syringe was developed, doctors would use all sorts of things to try to get substances into the patient's body or indeed out of it. So they would have fancy arrangements with pig bladders and quills and so on. And as you can imagine, none of these were particularly clean and none of the treatments were particularly evidence based either. So it was all very hit and miss. But, you know, once the syringe and hypodermic needle came along and methods of cleaning them, it revolutionized medicine. We really could not imagine healthcare without a needle and syringe these days.

And how was the needle that we're most familiar with today actually discovered?

It was made out of a rolled sheet of metal and it was rolled tightly and then lengthened and then cut with a bevel, which I think showed a lot of foresight. And then you had to attach it to a syringe. And the first syringes were not see through, so you couldn't tell exactly what you're injecting. You could have been injecting a lot of air for all you knew, with all the dangers that that brings. And there was a lot of debate as to who really invented the needle and syringe. So the person you think invented it, a Scotsman called Alexander Wood, may not have invented it after all. So I cover the whole controversy in the book.

Now as we come to the end of the book, you focus more on machinery rather than tools. Perhaps you include x ray machines in your list. Firstly, how was X ray actually discovered?

Well, X ray was discovered by a German called Roentgen, and he was investigating the cathode ray tube and he found that it emitted radiation even when he covered it with cardboard. And then he found that whatever he did, this amazing radiation, which he called X, went through so many different things. It wouldn't go through lead sheeting, but it went through many, many other things. And he spent weeks, apparently in his lab without going home. And finally his wife decided to find out what on earth was going on. So she turned up at the lab and she was rewarded with an X ray picture of her hand. So it shows up all the bones and the rings she was wearing. And this was probably the first X ray. So that's how X rays were discovered. And it's amazing. This was about 1895 and they went into clinical almost immediately. Within a few months, doctors were using X rays to find foreign objects in people's hands, to diagnose broken bones. It was amazing how quickly it was taken up. But of course there were fears and the popular press went wild. So if X rays could see past barriers, they could see through clothes. So you could get all sorts of perverts looking at people and essentially undressing them. And an enterprising factory started making X ray proof underwear for ladies who wish to preserve their modesty.

You can understand this resistance a little bit though, can't you, because this was such a massive discovery.

Yes, yes, it really was. And I'm amazed at how quickly it went into clinical use. But of course, the early X ray machines took a really long time to build up a picture. So it might take hours to image a person's hand. So it's not exactly practical until further refinements came in.

And when did we come to discover the issues with radiation exposure?

Well, you know, all the early researchers on X rays and on radioactive substances ended up with problems. So Henri Becquerel, the Frenchman who was credited with discovering radioactivity, although, spoiler, I don't think he did. He used to carry vials of radioactive stuff in his pockets. Pierre and Marie Curie did as well. And these researchers also would offer research on themselves. So problems did show up quite early, but they weren't always acted on. And, you know, until quite recently, we had these X ray machines in children's shoe shops to delineate the bones of a child's foot and just to aid in finding the right size. And I find that absolutely extraordinary that this went on until about the 1950s or so, we knew the dangers and yet somehow this went on.

Yeah, it's strange, isn't it, again, to imagine a world where we didn't know what the issues were.

That's right. I think there's bound to be side effects from almost anything. So we need to think before rushing in to adopt something new.

Yeah, it's strange to think, isn't it? Say somebody was recording this podcast in a few hundred years time. What do they know with hindsight that we don't know at the moment in healthcare?

That's right. But we are far more evidence based than generations in the past and I think we're much better at gathering data, so we're much more alert to potential problems. So I like to think we're a bit more savvy. But you know, as you say, who knows?

Before we talk about two other machines you mention in the book, I'd like to touch on another invention you include, which is the prosthetic hip. Why did you choose the hip instead of other prosthetic limbs?

Well, because the hip takes most of the weight of the body and it is the load bearing joint par excellence. When you run or walk several times, your body weight goes through your hip. And hip arthritis is so very, very common nowadays. So I chose the hip because hip replacement can really change lives for the better. So I definitely wanted to include that. And it was also the forerunner of other joint replacements.

When did we first fit a prosthetic hip?

It was a long process and doctors had to overcome the concept of cutting things off whenever they went wrong. Medics had to become attuned to limb preservation instead of amputation. And to us it's self evident, but it wasn't at the time when the prevailing ethos was, you know, it's been injured, let's remove it or it doesn't work, let's remove it. And most of the hip replacements started thanks to TB of the hip and TB was a really, really common infection. One of the first attempts to replace a hip was by a surgeon in London called Anthony White. And it wasn't exactly a hip replacement, but it was a forerunner. There was a 9 year old boy with TB of the hip and he got the idea of removing the head of the femur, the ball of the socket joint, if you will, and he removed it. And his colleagues thought he was mad, they were going to report him, they were going to censure him, he was never going to operate again, etc. Well, the operation was a success and so White sent the little Boy round post op, that is. Obviously, when his mobility had been restored, he sent the little boy around to visit all his detractors and tell them how successful his surgery had been.

This must have been a huge point of progress in surgery. I mean, of course, it must take, you know, much more skill to do this kind of surgery than just amputating a limb.

Yeah, absolutely. It took a lot of ingenuity to figure out what was going to work best as a replacement hip. And it took a lot of bravery to try out these different things. So we had French surgeons who used fatty tissue and soft tissue as fake joints. Some used wooden blocks, others used ivory. Some used muscle and celluloid and silver plates. And our friend, the pig bladder was also pressed into service as a F hip. And none of them really worked that well. The idea was to help create a fake joint, but none of these things worked that satisfactorily. And in the end, metal won the day. And one of the first was a US surgeon called Austin Moore. He was from South Carolina. He did a heroic operation on someone who was very overweight with a totally destroyed hip. And he created the Austin Moore's prosthesis, which is still sometimes used today. It was so successful, it was the first off the peg, as it were, hip replacement. And so many people implanted it. And Austin Moore actually had that prosthesis eventually on the bonnet of his 1951 Chrysler Imperial. He was that proud of it.

Now there are two more objects, or machines as we might call them. Another that you mention in this list is the ECT machine. We've spoken a lot, Carol, about physical health so far, but this part of the book, very importantly explores the topic of mental health. Why did electroconvulsive therapy start being used?

Well, that's a really good question. And it started because, with all the realizations that neurological diseases had a physical origin, people also thought that mental illness had to reside somewhere physical. And if we could only figure out how to get to it, we would help. All those people who were locked up in asylums with no other treatments, and they were very distressed. Some of them were there for decades and decades with no help. So something had to be done. And the 1930s in particular were very busy decade for the treatment of mental illness. Why did ECT become popular? Well, I think you have to look at what came just before it as well. We had lobotomy. It was a very popular way of treating mental illness. It started with work on chimps at Yale, and John Farquhar Fulton, the professor there realized that removing the frontal lobes of chimps made them act as if they didn't have a care in the world. Instead of being agitated and upset when they couldn't complete a task, they became as happy as Larry. And there was a Portuguese doctor who attended a conference where Fulton presented his results and he thought, well, this is a good idea. He was an interesting person. His full name, which is rather lyrical, was Antonio Caetano de Abreu Freire Egas Muniz. And his portfolio was just as long as that. He was a neurologist, he was a diplomat, he was an author of books on sexology, and he thought lobotomy or lobectomy would be a really good idea. And he won a Nobel Prize for it. There was Walter Freeman, a US psychiatrist at St Elizabeth's Hospital in Washington, DC, who pioneered leucotomy. He called it lobotomy, in fact, but he used a kind of ice pick and a mallet arrangement, and he'd go through the patient's eyeball or just above the eyeball and into the frontal lobe to cut the connections. And that was hugely popular at the time. The mortality was about 15%. But he went round the country doing this surgery until he was stopped, because people did die or get infections, but people always trying to find a link between physical problems and mental ill health. And it was noticed that schizophrenics who happened to have epilepsy would feel better after a convulsion. So when Italian ugocerletti decided to create a machine that gave people convulsions again, you have to look at what came before. There was a drug that could give convulsions and do this, but huge side effects emerged. It gave people fractures during their convulsion and it also gave them such a feeling of dread that they would not turn up for their next session. So new methods had to be found. And Hugo Ciarletti's machine, ECT machine, went into use pretty much straight away. I have to say that ECT is still sometimes used and the treatments have been modified so that you don't get most of these horrendous side effects. But, you know, for most people with mental ill health, we really struggle to treat them.

It's a hugely difficult topic. The final object you cover in this book is the heart lung machine, which still seems absolutely extraordinary, doesn't it? How did we come to a point where this could actually be used?

Oh, well, it's a wonderful thing and I couldn't resist putting it in the book because I've worked at Harefield Hospital, where the heart lung machine was in daily use and taken for granted. But of course, there was a time before the heart lung machine, and there was a time when you weren't supposed to operate on the heart. It was a big no, no. Eminent doctors would come out and say that anyone who tried to operate on the heart was a fool. And of course, all the early operations on the heart, because obviously you tell a doctor they can't do something and they're going to go and do it. The early operations on the heart took place without a heart lung machine. So you had to be quick. If you don't have blood flow to the brain after four minutes, you're dead. So there was a need for the heart lung machine. And it's came to a doctor called John Gibbon in the States, and he was a young doctor and he had a very sick patient. And the boss told him he just had to look after this patient overnight because nothing could be done for her. She had a large clot on the lung a couple of weeks after surgery and nothing could be done. And so he watched her sat by her bed all night and just observed her as she deteriorated. And one of the things he thought of in the middle of the night was, if only there was a machine that could take out the blood that didn't have enough oxygen in it, put in the oxygen, take out the carbon dioxide and return it to the body, my patient would live. Of course, that wasn't possible at the time, and the patient did duly die. But it spurred Gibbon and his wife, who was a scientist, to work on a machine that would do exactly, exactly that. And people thought he was crazy, but he did fashion a heart lung machine, and that led to all the possibilities that we have today to repair congenital heart defects, to help people with coronary artery disease, even to replace hearts.

Now, Carol, we have talked about so much in this podcast, from the trephine to the heart lung machine, you know, this massively expansive history. I've got to ask you for my final question. We've got a list here of 12amazing, you know, hugely fascinating objects in medical history. What would object 13 be?

Well, if I were allowed to choose a 13th object, I think it would have to be the computer. It goes against the rules that I made for the book in that it's not exclusively designed for medicine, but I think it has made possible better data gathering, better research, so that we can get the most out of what happens in medicine, get the most out of the treatments. And I think data gathering is one of the most vital procedures in medicine.

[Lauren Good]

That was Carol Cooper. Her new book, the History of medicine in 12 objects, is out now, published by Quarto Publishing. Thanks for listening. This podcast was produced by Daniel Kramer Arden.