Medical Historian Answers History of Medicine Questions

You can essentially stick a spike into the brain,

move it back and forth to cut the nerve fibers.

I know it's awful, isn't it?

It gets worse.

[everyone laughs]

Just wait till we get to poop transplants.

I'm Richard Barnett.

I'm a historian of medicine

and I'm here today to answer your questions

from the internet.

This is History of Medicine Support.

[upbeat music]

Bbhawtie asks,

So like surgery before anesthesia, what did you do?

Like, just scream the entire time

or just get knocked out

with the cast-iron skillet?

Well, pretty much the former in fact.

In the 1820s, 1830s, 1840s,

various dentists, surgeons start experimenting

with things like laughing gas,

nitrous oxide, and ether.

Now, the first widely publicized

demonstration of general anesthesia is done in 1846,

and the procedure very, very quickly spreads after that.

But for centuries before then, yeah,

you pretty much had to grin and bear it.

But in many cases,

surgeons are actually quite keen

to keep their patients awake.

This isn't because they're horrible sadists.

It's because the great fear of surgeons

in early surgery isn't pain.

Pain won't kill you.

What might kill you is

if you start drifting off into unconsciousness

and sort of, you know,

gradually kind of falling into death.

So there's a sense that pain at least kind of helps

to keep you conscious

and helps to kind of survive this assault on the body,

which is basically what early surgery was.

There's a real emphasis on being as quick as possible.

You can't really expect a patient

to lie there for hours

while you hack away at their leg.

Now, one of the fastest surgeons we know

about was a 19th century surgeon working in London,

a man called Robert Liston

who worked at King's College Hospital.

Liston became famous

because he could have somebody's leg off

in a standing start in under a minute,

but the price you pay

for this sometimes is inaccuracy.

There's a famous story about Liston,

which may or may not be apocryphal,

that he was once cutting off a patient's leg.

He accidentally took off the patient's testicles

while he was operating.

One of the burly surgical assistants

who was holding down the patient,

Liston accidentally cut off his thumb.

That man got an infection and died.

There was a woman standing

in the balcony watching the procedure,

and she's supposed

to have dropped down dead from fright.

The old joke is that this is the only operation

in history with a 300% mortality rate.

So this question is from Mcfapkins, who wants to know,

what in the world is cupping

and why is it so popular?

Cupping makes use of little glass

cups like this one.

You would take a candle or perhaps a match,

burn it inside to create a partial vacuum,

and then you'd apply it to the flesh, perhaps the back.

The vacuum inside would pull up

the skin cause something like a blister,

which could then be left or it could be lacerated

to draw out blood or pus.

Now the ideas behind this are very ancient indeed,

the idea that four humors--

blood, black bile, yellow bile,

and phlegm govern health and disease.

So the idea behind cupping is

that you can use this technique

to draw out some of these excess humors

and restore balance to the body.

Cupping has seen something of a renaissance

in the last few decades

with the rise of alternative medicine

and especially the kind of the wellness boom.

Like a lot of techniques in alternative medicine,

you could perhaps argue that there's

some sort of placebo effect behind it,

but there's not a great deal of evidence

that it has really any kind of clinical effect.

Jeramy_Jones says,

Louis Pasteur rolling in his grave right now.

Pasteur might be rolling in his grave

for several reasons.

Pasteur was a French chemist working

in the middle of the 19th century.

He grows up in the French countryside.

So he's very interested

in the kind of problems that affect French agriculture.

So in his early research,

he's trying to answer the kind of questions

that really upset French people, like,

Why does my wine go sour?

So he does a lot of early work

on the chemistry of fermentation.

He shows that when grape juice ferments

and turns into wine,

or when milk ferments and turns into cheese,

it's actually all caused by microorganisms

and when things go bad,

it's a result of the wrong microorganisms getting involved.

So as part of this,

Pasteur develops a technique of heating,

grape juice or wine or beer or milk

to a certain temperature for a certain period

to kill off the microorganisms,

and as we now say to sterilize it.

This is pasteurization.

And this not only becomes very widespread

and does great work to improve the health of many foods,

it also makes Pasteur a great deal of money

because he very sensibly patents it.

But in later life,

he becomes very well known for his work on vaccines.

He begins his work trying to understand the kind of diseases

that affect farm animals.

Pasteur works out that if you identify

the bacterium or the spore that's causing the disease,

you can actually use it to make a vaccine.

You can, as he says, attenuate it,

and then you can use those weakened,

killed germs as a kind of vaccine.

So in 1881, Pasteur carries out a very large,

very public, very well-publicized trial of his vaccines

involving dozens of farm animals.

But his most famous work is done

on a human disease, rabies.

Rabies is a much feared disease in the 19th century.

Not only is there no effective treatment for it,

but it's a really, really horrible way to die.

Pasteur starts to, again,

apply this technique of attenuation

to making a vaccine for rabies.

In 1885, a young French boy called Joseph Meister

is savaged by a rabid dog.

His parents bring him to Pasteur.

Pasteur tries out this experimental vaccine

and it's a very difficult vaccine.

It involves, I think,

13 injections into the abdominal

cavity over about 11 days.

So poor Joseph Meister goes through quite a trial,

but he remains healthy.

As a result of this,

Pasteur really does become a French national hero.

He gets his own medical institution.

The Institut Pasteur still works in France.

He gets just about every honor

that the French state can throw at him.

So Exampleishere asks,

Y'all ever heard of Radithor?

Radithor was an American patent medicine

sold in about the decade after the end

of the First World War,

and it was immensely popular.

It sold hundreds of thousands of bottles every year.

You were drinking distilled water mixed

with traces of radioactive isotopes, mostly radium.

Now, why on earth were people doing this?

Now, this goes back to an episode

that historians have called the radium craze.

At the end of the 19th into the earliest 20th century,

it's a great deal of public fascination

with new work that's being done in physics,

especially around the idea of radiation.

Now, Pierre and Marie Curie discover radium in 1898.

Marie Curie gets the Nobel Prize

in chemistry in 1911 for her discovery.

There's a lot of medical interest in radiation as well,

not only through X-rays,

but also through the idea that radioactive substances

might be used to treat diseases, especially cancer.

Probably the most famous victim

of Radithor was an American golfer,

a man called Eben Byers.

He seems to have been absolutely addicted to the stuff.

It's thought that he drank more than a thousand bottles

of it during his lifetime.

In the late 1920s,

he developed cancer of the mouth,

which in its very late stages led

to the loss of his entire lower jaw.

And it's largely as a result

of the publicity around this case

that Radithor was eventually banned in 1932.

RNMorris asks, When you think about it,

the expression blowing smoke up your

ass is very strange.

Where does it come from?

How is the smoke blown?

Through a tube? And what does the smokee get out of it?

If you think about 18th century Britain,

a seafaring nation has a great deal of concern

about how to revive sailors who've been washed overboard.

One idea is to use tobacco smoke.

Tobacco smoke is seen as a kind of irritant.

If you think about breathing it in,

it can make you cough.

So some physicians start to experiment

with specially designed bellows

that have a sort of little tobacco pipe built into them.

You can inflate the bellows,

fill it with tobacco smoke,

and essentially push it up

the bottom of some poor drowned person and blow it in.

And the idea is, as I say,

that if there's even a little bit of life

left inside this person,

this will bring them back to life.

And I think it's probably fair to say that it would.

A user on the r/2WesternEurope4U subreddit says,

Share your most controversial Nobel Prize winner.

I'll start Egas Moniz, inventor of the lobotomy.

I think I'd agree with that.

Antonio Egas Moniz was a Portuguese neurologist.

In the 1930s, he develops this new procedure, lobotomy.

Lobotomy literally means lobe cutting or brain cutting.

So it's a matter of opening up the skull

and severing some of the connections

that connect the frontal lobes

with the rest of the brain.

Now, Moniz, in doing this was trying to come up

with a new treatment

for some of the most severe kinds of mental illness.

He very quickly found that people

who went through this procedure

were indeed quieter and calmer,

but the procedure caused tremendous problems

for those who went through it.

They very often suffered changes in character.

Very often they suffered physical symptoms,

physical disabilities as well.

So the question really is why did lobotomy become

so popular, so widely used

if it had such terrible consequences for patients?

Well, the answer really goes back to the 19th century.

All sorts of new institutions,

especially medical institutions,

are established and one response

to the what's seen as a growing problem of insanity

is institutionalizing the mad,

putting them away in asylums.

But by the early 20th century,

it's becoming clear that asylums

really don't work as a kind of therapy

for mental illness.

Unlike the great transformations in medicine and surgery,

psychiatrists don't really have much

to show by the end of the 19th century

in terms of really effective techniques

for treating madness.

So historians have talked

about a kind of age of heroic therapy

in the early 20th century,

all kinds of new therapies being tried

using insulin to put patients

into something like a diabetic coma

for several days with again,

the idea that this might

in some ways almost sort of reset their minds.

This is also the period

in which electroshock therapy starts

to be used for certain kinds of conditions,

but lobotomy has become the most

notorious of these heroic therapies.

Now, part of the reason it becomes

so popular is the work of an American Dr. Walter Freeman.

He simplifies the procedure,

which is called the transorbital lobotomy.

So essentially you take something like an ice pick,

you make an incision just above the eyelids,

so in the orbital bone,

and through that, you can get directly into the brain.

Now, for more than 30 years,

Freeman traveled across the United

States moving from asylum to asylum,

carrying out thousands of these procedures

in waiting rooms or in doctors' offices.

Now, Freeman eventually became notorious

for his work, and in 1967,

he was banned from medical practice,

but lobotomy became a symbol of a kind of oppressive,

restrictive kind of psychiatry.

If you've ever seen the film

One Flew Over the Cuckoo's Nest,

you'll know that the lobotomy

in that film is really used as a kind of punishment.

It's not really a kind of therapy at all.

12--12--12 asks,

Were maggots ever purposely cultivated

for field medicine?

Fascinating and rather gruesome fact:

maggots, which are the larvae of certain kinds of flies.

If they get into a wound,

they will eat dead tissue,

but they won't eat live tissue.

So many doctors have noticed that this

is a technique you can use

for what's called debridement,

getting rid of dead or infected tissue within a wound.

Now, this is a rather kind of counterintuitive idea.

You might think if a wound is infected

with maggots and flies,

this would be a very, very bad thing.

But we can actually find evidence

of the use of maggots in this way

in many traditional medical cultures around the world,

and from about the Renaissance onwards,

military surgeons working in Europe start

to notice that even if a soldier's been lying

on a battlefield for days,

even if their wound has got infected with maggots,

very often that wound will actually stay uninfected

and will heal quite well.

And this is a technique that's often been used

in situations where no other kinds

of treatments are available.

Maggot therapy is still occasionally used today.

Of course, the most important thing is

that you have sterile disinfected maggots.

So Wowerful asks,

Explain like I'm five,

what is the iron lung and how does it work?

So picture in your head a metal tube,

looks a little bit like a railway carriage,

but imagine it's about the size of a coffin.

Now imagine you lie inside that tube

and it's got a seal around your neck

so that you're sealed inside it,

and there's a pump at the far end of the tube

that's pumping air into the tube and out of the tube.

Now, why on earth would you do this?

Well, this is a kind of respirator.

So for patients who've lost the ability to breathe,

this is a machine that can be used

to inflate and deflate their lungs and keep 'em alive.

It was developed in the U.S. in the late 1920s

initially for treating victims of coal gas poisoning.

But the iron lung really came into its

own during the polio pandemic

of the early mid 20th century.

Polio is an infectious disease

that largely affects the nervous system.

It can leave patients physically paralyzed,

but it can also leave them in a situation

where they can't breathe for themselves.

So iron lungs became a way of keeping

many polio patients alive

through this epidemic at a great cost

to their kind of mobility and quality of life.

You do have cases of people being infected

with polio at quite a young age

and living decades inside an iron lung.

The use of the iron lung declined

with the decline of polio.

Effective vaccines come along in the 1950s and 1960s.

There's a very public drive for vaccination

to try and eliminate this disease.

So iron lungs now are hardly ever used.

sleepymteverest asks,

WTF is bloodletting?

This was a very widespread procedure,

especially in medieval and classical medicine.

Again, based on the idea that health

is a matter of balance.

So if you have too much blood inside your system,

blood is seen to be a very hot,

fiery kind of overstimulating humor.

It's the humor of spring.

It's the humor of youth,

so it can kind of make you overexcited and feverish.

So there's a very longstanding idea

that if you let a few pints of blood

out of your body, it'll calm you down.

And it certainly does.

There are some very famous cases

of bloodletting carried to kind of extraordinary excesses.

One of the most famous is in the last

few days of the life of the first American president,

George Washington.

Washington's physicians kept bleeding

him over and over again,

eventually letting several pints of blood out.

And there's an argument that actually his death

in the end was the result of the action of his physicians,

not of the disease he was suffering from.

Stopthatgirl7 asks, Hey Siri, who was Typhoid Mary?

Typhoid Mary was Mary Mallon.

She came to the U.S. to work as a cook.

In the early 20th century,

several outbreaks of typhoid were associated

with the households in which Mary had worked.

Now the New York Public Health

Department investigated this case

and they discovered that Mary

was what's called an asymptomatic carrier of the disease.

In other words, she carried the bacterium responsible

for typhoid, but she didn't suffer from the disease herself.

Like many asymptomatic carriers in this period,

she was forcibly quarantined for a while.

She was released in 1910,

but in 1915, a further series of outbreaks

at a maternity hospital in New York were linked to her.

And sadly enough,

she spent the rest of her life incarcerated.

She died in quarantine in 1938.

Now, Typhoid Mary has become almost

a figure of sort of gothic folklore,

but in many ways her case raises

issues that are very familiar to us in the last 10 years.

The questions we all faced during

the COVID lockdown of how do we balance individual freedom

with the question of sort of larger

public health and social good?

There's also a question

about why Mary was treated so harshly.

She was far from the only asymptomatic

carrier of typhoid identified in this period,

but she was the only one who was incarcerated for so long.

And historians have suggested

that this may be connected

with the fact that she was working class,

the fact that she was Irish

and the fact that she was a woman

who tried to stand up for herself.

So a Quora user asks,

Is trepanning still used today?

Well, trepanning is a very ancient technique.

It's the idea of cutting or drilling a hole in the skull.

Now this sounds like rather a radical intervention,

but it's actually one of the oldest

techniques that we have evidence for.

Archeologists working as far back

as the Neolithic have found skulls

to which this has been done.

Holes have been cut or chipped,

presumably with quite sort of simple flint tools,

and the most extraordinary thing

is that many of these skulls show

some evidence of healing.

Now, because texts don't really survive

from these ancient societies,

we don't really know why it was done.

It might have been some sort of surgical

intervention perhaps

to relieve the symptoms of mental illness

or to treat some kind of head injury.

But it's perfectly possible that it

was perhaps some kind of initiation rite.

One thing it almost certainly wasn't

was a kind of punishment simply

because there are easier ways

of inflicting more suffering.

The technique is still used.

Modern surgeons will use it sometimes

if a patient has suffered a serious head injury

to try and relieve pressure on the brain

or in some other kinds of diseases like brain cancer.

3KCarlo asks, Yo, how did surgeons learn that stuff?

Like, there had to be a psychopath

who was cutting people's bodies open and exploring.

If you're going to learn surgery,

if you're going to learn about the human body,

the best way to do it is not learning through texts,

but rather through practice.

Well, into the 18th century,

the way that you learn surgery

was really through apprenticeship.

You'd be apprentice to a master surgeon,

you'd follow them around,

you'd watch them doing their procedures,

so you'd learn very much in practice.

One of the things this gives early surgeons

is a really good sense

of the kind of materiality of the body.

So a lot of what we've come to learn about, yeah,

the fine detail of movement or circulation of the blood

or things like that really come from dissection,

come from getting to grips

with the kind of rather bloody,

messy materiality of the body.

This is from the AskHistorians subreddit.

What is the oldest example of a plastic surgery

or plastic surgery-like procedure?

What was the procedure like?

So we may think of plastic surgery

as a very modern phenomenon,

but in fact, it's a very old idea indeed.

Wherever we find ancient medical texts,

we find interventions that are intended not only

to restore the function of the damaged body part,

but also its appearance.

Now, probably the most famous of these

early procedures is called rhinoplasty.

The earliest records of this come

from ancient Sanskrit medical texts

of the Ayurvedic tradition.

I imagine you've lost your nose,

it's been cut off as a punishment,

or you've suffered some awful disfiguring disease.

One thing you can do or a surgeon can do

to try and at least recreate the appearance of a nose,

is to cut a triangle of skin from your forehead,

leaving a little strip

so that the skin is still getting blood supply,

still stays alive,

and kind of fold it down and then attach it

on either side to form something like a nose.

And the idea is that the tissue will heal

and you'll have not a kind of properly functioning nose,

but at least something that that looks like a nose.

Alex8762 asks,

Why did it take so long for surgeons to recognize the need

for sterilization of equipment and washing their hands?

It's a very simple question that opens

up a very rich historical subject.

Now, in some ways, there's a paradox here.

Microscopes are developed in Europe

in about sort of the middle of the 17th century,

people start using them

to look at all sorts of objects and substances.

One thing they find very quickly

is that the world is full of these

previously unsuspected tiny little dots

and squiggles and blobs that seem to be alive.

But it's not until the 19th century

that ideas like germ theory and with it

the idea that cleanliness

and disinfection are kind of central

to effective surgery start to become very prevalent.

So why did it take two and a half centuries

for these ideas to arise?

Well, the first thing to say,

I suppose, is that it's not at all clear

to the first observers that germs actually cause disease.

These germs cover every surface

that early microscopists look at,

and they seem to be all over every

bit of the body that they look at.

So many people say, well,

if these germs are everywhere,

how can they possibly cause disease?

Why don't we just sort of all die

immediately of this overwhelming infection?

There's also not really a sense

that there are different kinds of germs.

That really only kind of comes

out of laboratory medicine in the 19th century.

There's also a question about the kind of the nature

of what we'd now call scientific evidence itself.

It can be very hard in practice actually

to identify the cause of a disease.

So a working surgeon might say, well,

sometimes wounds get infected, sometimes they don't.

Perhaps, it's a consequence of the body trying

to heal surgical wounds.

So there are lots of reasons that it's quite hard

for early surgeons to draw this

connection between cleanliness of surgical instruments

and the rates of wound infection.

JDNelson asks, Well, barber-surgeons were a thing.

Time for a comeback?

Well, it probably isn't time for a comeback,

but barber surgeons certainly were a thing.

It's rather strange to the modern mind

to think that the kind of people

who cut your hair might also

have been the sort of people who cut your leg off.

But the connection going back three

or 400 years is that both barbers and surgeons

are working on the outside of your body

with sharp implements.

You can imagine a barber

perhaps accidentally cutting you while he was shaving,

kind of dressing the wound.

It's maybe not an enormous step

from that to think about barbers

carrying out basic kinds of surgical procedure.

So although it's very counterintuitive today,

historically, there was a very close connection

between barbers and surgeons.

And this is embodied most famously

in the old blood and bandages,

the red and white striped pole

that you still see outside many modern barbershops.

Thepixelpaint asks,

Was the discovery of penicillin really an accident?

Well, pretty much yes.

So this was the work of a Scottish physician

and bacteriologist Alexander Fleming.

Fleming, in the 1920s, has already done some work

on the body's natural defenses against bacteria.

He's discovered an enzyme called lysozyme,

which the body secretes in things like snot

and mucus that attacks bacteria

and viruses that try to get into the body.

So Fleming is very interested

in this idea of simple chemicals that might kill bacteria,

but the discovery of penicillin

itself really was a kind of lucky accident.

In the summer of 1928,

Fleming leaves his laboratory in St. Mary's Hospital,

goes on holiday, comes back about a month later

and finds that some of the Petri dishes

of bacterial cultures that he's been using

have become contaminated with mold.

Now he's about to throw these away,

but he takes a look at one of them

and makes a fortuitous and fantastic discovery.

He notices that the mold growing

on this Petri dish is clearly secreting

or releasing something,

some chemical that is killing

the bacteria that were growing on the Petri dish.

Fleming cultures this mold separately,

he tries to extract a drug,

a kind of simple chemical from it,

and he calls this drug penicillin.

If you were trying to grow certain

kinds of bacteria and your cultures

kept getting infested with others,

you could perhaps use penicillin

to kind of clear out these cultures

and make sure that only the bacteria

you wanted were growing.

But in the 1930s, two things happened.

The first really successful

antibacterial drug called Prontosil

is developed in Germany.

Second, the outbreak of the Second World War.

Military surgeons, Allied governments,

are very well aware that they're going

to need effective treatments for battlefield injuries.

So a research project is started in Oxford,

which essentially kind of combs the literature

looking for techniques that might lead to effective drugs.

This project led by Howard Florey

and Ernst Chain come across Fleming's paper.

They start work on developing penicillin

as a kind of mass market pharmaceutical.

It becomes the world's first successful antibiotic.

And Florey, Chain, and Fleming share the 1945 Nobel Prize

for their discovery.

And this extract of the penicillin mold,

penicillin turns out

to be the world's first effective antibiotic.

Runnerlovejul asks,

How is Mad Hatter's disease a real thing?

Like, what do you mean you had

continuous exposure to mercury

and only got a little silly?

Mad Hatter's disease certainly was a real thing.

Alice in Wonderland, we all know

the Mad Hatter behaving and talking

in the strange way that he does.

What Carroll is alluding to with this character

is the characteristic trade disease of hatters

in the 18th and the 19th centuries.

Mercury was used in the preparation

of the animal pelts that we used

to make things like beaver hats.

So hatters in the course of their work

were often exposed to mercury,

and by the end of their lives,

they'd often suffered quite severe neurological damage.

In some cases,

even forms of madness from this long exposure to mercury.

So queenhadassah asks,

Why wasn't measles eradicated like smallpox?

Now, as the question suggests,

it would be perfectly possible

for measles to be eradicated.

We have very effective vaccines,

and there are many global programs associated

with the World Health Organization

that are working towards this aim.

But since 2017,

the disease has seen a resurgence,

and this was made much worse by the COVID pandemic.

As you can imagine, medical attention,

medical resources were diverted elsewhere.

Vaccination programs in many parts

of the world were paused.

After the end of the pandemic,

the incidence of the disease has started

to rise again in many countries

where it had been declining for decades.

And it's rather useful here

to compare measles with another

infectious disease like smallpox.

Smallpox historically was widely feared.

It was a very serious disfiguring, often fatal disease.

It became the subject of the world's first vaccination.

The English doctor, Edward Jenner,

1796 develops a fairly effective

vaccination technique against smallpox.

And in the 20th century,

even at the height of the Cold War,

the disease was the subject of one

of the first kind of global attempts

to eradicate a disease, and this was finally successful.

Now, compare smallpox to measles.

Part of the problem with measles

is that we still don't take it very seriously.

We tend to think of it as a kind of childhood disease,

the sort of thing you get and then get over.

But it's a very, very serious disease.

It can cause serious disfigurement like blindness.

It can also leave your immune system

compromised and leave you susceptible to other diseases.

And of course, a big problem in the West

in the last 20 or 30 years

has been the rise of vaccine skepticism.

The English Dr. Andrew Wakefield

in 1998 published a paper which claimed

to show an association between the MMR vaccine

and the development of childhood autism.

Now, this paper has been comprehensively discredited

and The Lancet to its great credit

where it was first published has now withdrawn the paper,

but unfortunately, it has very much contributed

to the rise of vaccine skepticism.

Now, I don't wanna get on my high horse here,

but if you're lucky enough to live

in a country that has vaccination

programs against measles, for heaven's sake, get vaccinated.

Torleif42 asks,

Why is it called an X-ray?

Well, if you think back to algebra

that you learned in school,

X is the term that we use in mathematics

and science for the unknown quantity.

So X-rays are called X-rays

because when they were first discovered

in 1895 by Wilhelm Roentgen,

who was a German physicist, they were unknown.

Now, Roentgen is working

in his laboratory using new scientific equipment,

vacuum tubes, cathode ray tubes that seem

to emit certain kinds of radiation.

He discovers very quickly that these

rays have very strange qualities

that they can pass through the human body,

but they cast shadows of the bones,

which you can capture on a fluorescent screen

or even on photographic paper.

There's a famous story of Roentgen

bringing his wife in to take an X-ray of her hand.

And when he shows her the X-ray

that she's supposed to have exclaimed,

I see my death,

as if she'd seen her own skeleton,

her own mortality for the first time.

Goodoneforyou asks,

Some surgeons still pull cataracts

out of the eye with a fish hook, but when did that start?

Well, you might think that operations on the eye,

such a delicate, sensitive part of the body

would be a very modern phenomenon.

But actually operations for cataracts are some of the oldest

surgical procedures that we know about.

Now, cataracts arise when the lens that sits

in the front of the eye and is responsible

for focusing light onto the retina and goes cloudy,

and that can cause blindness.

Now, the earliest procedure for dealing

with cataracts was called couching.

We find this described in many ancient medical texts

from many different traditions.

Essentially, you take a little tool,

perhaps something like a fish hook,

and you just insert it into the eye

and you just push the cloudy lens out of the way.

Now, this restores vision,

it does leave you without a lens.

So you get something like

very, very blurred vision,

but it's better than blindness.

It's in the middle of the 18th century,

the European physicians start removing

the lens instead of just pushing it to one side.

In 1884, an Austrian neurologist,

a colleague of Sigmund Freud called Karl Koller,

starts to use cocaine as a local anesthetic

to help keep the eye still during eye surgery.

And this makes cataract surgery

a great deal easier and a great deal more precise,

and the roots of modern cataract surgery

where instead of just removing a lens,

we try and insert an artificial lens

that goes back to 1949.

An English surgeon called Harold Ridley

had been working during

the Second World War with fighter pilots.

Many of them had been in bad crashes,

and the acrylic windscreens of their planes had shattered

and bits of acrylic had got into their eyes.

Now, Ridley noticed that unlike most substances,

a piece of acrylic in the eye isn't rejected

by the body.

So Ridley starts experimenting

with replacement lenses made out of acrylic.

And this is really the kind of the origin

of modern cataract surgery.

So AllWrong74 asks,

Did leeching actually do anything?

Leeches are little invertebrates

that swim around in pools,

and they live by sucking blood from other creatures.

So leeches were, as it were,

kind of nature's way of doing bloodletting,

and it really had all of the kind of downsides

that bloodletting had.

If you were unlucky enough

to get a leech that was infected with a disease,

you could catch the disease.

And as with bloodletting, it could be done to excess.

You could find yourself kind of seriously weakened

and compromised by losing too much blood to a leech.

So that's everything for today.

I hope you enjoyed it, and I hope you had fun.

Thanks so much for watching History of Medicine Support.