The Making Of Modern Medicine

A major narrative history series exploring over 2,000 years of western medicine, written and presented by medical historian Andrew Cunningham.
The readers are David Rintoul, Scott Handy, Jason Watkins, Peter Capaldi, Tamsin Greig, Annette Badland

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Episodes

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01Hot, Cold, Wet And Dry20070205

We can trace origins of religious and western-learned medicine back to Hippocrates and Galen, whose writings and pithy pieces of advice for the aspiring physician in ancient Greece remained the basis for medical practice well into the 18th century.
Galen's basic understanding of anatomy proved remarkably accurate, yet his ideas of what was going on inside the body were not based on the anatomical facts at all. So why did medical knowledge remain unchallenged for so long?

02God's House, The Hospital.20070206

Aside from the universities to educate physicians, the hospital is one of the main innovations made in Christian Medieval times that persist into modern medicine. But where did it come from and why was it thought a good idea to segregate the sick in institutions away from the well?
Our starting point is Christ's description of the Last Judgement whose 'works of mercy' could be fulfilled by an institution that would welcome the poor, care for them body and soul - and all for free.

03The First Sexual Epidemic20070207

By 1490, the population of Europe had recovered to the level it had been at when the Great Plague had killed up to one in three people across the continent.

But a mysterious new disease broke out among the French army in 1492, terrifying everyone and sparing no one.

New mores of sexual behaviour that emerged during the late medieval period would mean that this epidemic of the pox would not be the last.

How did the medical medieval practitioners enact cures and preventions - and what were the beliefs behind so-called miracle treatments?

04Paracelsus And The People's Medicine20070208

The 16th Century witnessed the birth of a new kind of natural philosophy and medicine. Its chief advocate, Swiss medical reformer Paracelsus, rejected the traditional medicine of the Greeks because of its heathen roots in favour of both a spiritual and alchemical approach.
This captivating figure and scourge of the medical establishment clashed with the authorities wherever he went yet, as we hear, became hailed for his innovative use of chemical drugs.

05The Anatomical Renaissance20070209

Noses, ears and lips were often lost during swordfights in defence of honour.

Yet thanks to a renaissance in anatomy during the 16th century, the art of surgery had been perfected in Bologna, to the extent that artificial but living noses, ears and lips could be supplied in their place.

The rediscovery of Galen's ancient book The Method of Healing, and a new generation of emerging anatomists in the mid 1500s, such as the young physician Andreas Vesalius, meant that the approach to human anatomy and good surgery, would be completely reinvented.

06The Early Transfusion Experiments20070212

For almost 2,000 years in the West, medical men had been taking blood out of their patients to cure them. It wasn't until 1660 that anyone thought of putting blood in!

Andrew Cunningham explores how William Harvey's important and controversial discoveries of the circulation of the blood and the pumping force of the heart led to ideas of 'extending the circulation of the blood beyond the boundaries prescribed for it by Nature' and to pass blood from one person to another.

07Fever20070213

In the 17th Century, fevers were the main concern of physicians, who believed that nature had a natural way of responding to any disease by eliminating the offensive matter in the body.

But it was through the pioneering work of 'The English Hippocrates', physician Thomas Sydenham, who rejected all current theory, that gave us some of the first accounts of the symptoms and the fevered course of each epidemic disease.

Trial and error would lead to some impressive cures.

08Learning From The Illiterate20070214

By the early 18th Century, smallpox was taking between 10-15% of all lives in Europe and physicians were constantly arguing about how best to cure it. But a new method of treatment was gradually coming to attention - something which peasants and slaves had known for centuries.
This episode explores the work of the inoculators which would force medics to contradict all that they had learned. But would their work guarantee safe long-term protection from smallpox infection?

09The Coming Of The Gp20070215

Samuel Foote's riotous hit comedy The Devil Upon Two Sticks offers intriguing insight into a dramatic siege that took place in 1767 outside the Royal College of Physicians in London between old guard physicians and a new breed of general practitioners from Scotland.

The individual practices of physicians, surgeons and apothecaries were now under threat. It was to mark a major change in the skills and qualifications of medical men with the coming of the general practitioner, and as we discover, a violent outbreak of class war within medicine.

10Anatomy And The Invisible Hand20070216

Anatomy teaching was big business in the 1700s. Anatomists such as the ambitious William Hunter hoped to profit by supplying anatomical teaching - but in doing so created a huge and unsavoury demand for fresh bodies for use by medical students.
Amid rivalry and huge public debates, every anatomist wanted to make some new discovery and build a reputation. So how did this period come to be known as 'the perfection of anatomy' and secure one of the few medical disciplines that would survive the political upheaval that was about to engulf Europe?
The readers are David Rintoul, Peter Capaldi, Jason Watkins and Scott Handy

11Little Reading, Much Seeing And Much Doing20070219

The French Revolution ushered in new ambition and a new scientific clinical approach that is still taught to all medical students. Andrew explores this hugely significant moment in transforming medical thinking, training and practise in the early 1800s into an approach we recognise today.
Chemist Antoine Forcroy's demand for 'Little reading, much seeing and much doing' would have far reaching effects, as a new hands-on method to try to work out what was going on inside a patient's body began to get taken up.

12Making Signs20070220

Systematic post mortems revolutionised the study of disease. It enabled physicians armed with new instruments such as the stethoscope to translate the signs they were reading on the outside of the body into what was going on inside.
Andrew explores how doctors in the Paris hospitals could now link the symptoms of many different patients with particular diseases. But what did this mean for the patient who up until the 1800s had always expected to be seen as special and unique?

13A Long And Ghastly Kitchen20070221

Napoleonic France witnessed the second big event that made medicine scientific - Dr Magendie's experiments on live animals, which were conducted to find out how the animal and human body works.

English observers found this new field of experimental physiology mere self-indulgent cruelty in the pursuit of knowledge, despite Magendie laying out his position at length.

But what did this first generation of researchers discover which was considered to have an important impact on medicine?

14Changing Disease Identity20070222

We assume all diseases are eternal. But a side-effect of progress in medical thinking is that diseases often had their identities changed over time. New measuring tools meant that it was impossible to say whether a disease, before and after scientific medicine developed, was in fact the same disease.
Andrew examines the many changing identities of consumption - soon to become known as tuberculosis - a widespread disease throughout 19th century Europe, affecting people of all ages and from all walks of life.

15Sisters Of Charity20070223

According to the Nursing Record, a typical nurse in the 1830s was like Sarah Gamp in Charles Dickens' Martin Chuzzlewit - a domestic servant who was incompetent and rough with patients.

By the 1880s, a nurse was young, neat and uniformed and had been formally trained.

How did this change come about? As Andrew reveals, an enterprising Florence Nightingale gave us a new kind of nurse - offering a vocation that girls 'of good character' increasingly were called to undertake.

16Science Has No Sex20070226

The only way a woman could become a doctor in the early 19th century was by pretending to be a man. By the mid 1800s the situation began to change - in 1881, 25 women doctors were practising in England and Wales with numbers rising rapidly. Andrew Cunningham traces the influence and legacy of the pioneer women doctors.

17The Dark Side Of Obstetrics20070227

By the mid-19th Century, maternity hospitals had become scenes of carnage across Europe. Scientific measures intended to improve care in the birth room had all gone wrong. Doctors and medical students were unwittingly spreading child-bed fever in the hospitals.

As Andrew reveals, it was the work of Ignaz Semmelweis in Vienna who would pinpoint the cause; but would Semmelweis succeed in persuading his colleagues to adopt essential cleanliness to stop the spread of disease?

18A Yankee Dodge20070228

In 1846, the acclaimed surgeon Robert Liston's operation to amputate a patient's leg, using ether that had been recently trialled in the USA, marked the beginning of anaesthesia in Europe.

But to what extent would this transform surgery in the long term?

Andrew looks back to the origins of pain relief and how chloroform, with its rapid action and few side effects, would come to be favoured among surgeons - transforming the operating theatre from a place of panic and screaming to a one of calm and silence.

19The Disease Is Its Own Preventative20070301

July 1885: and the life of Joseph Meister, nine, bitten by a rabid dog, was about to be saved by Louis Pasteur's new anti-rabies vaccine.

This episode tells the story of how, with the rise of laboratory medicine, Pasteur was able to give the newly-developed germ theory further impetus. He identified the disease-causing germs of many infectious diseases. Soon invisible microbes could be manipulated in the lab that would succeed in preventing the disease they caused.

20Stopping The Rot20070302

During the late 1800s, the surgeon Joseph Lister had built upon Louis Pasteur's germ theory and introduced anti-sepsis into surgery. We now think of Lister's success with carbolic acid as having made internal surgery safe. But was this really the case?
Andrew examines the less than enthusiastic welcome for Lister's anti-sepsis, as surgeons - who were more concerned with general cleanliness of their operating environment - were experiencing greater success with their patients than ever before.

21Culturing The Germ Theory20070305

In 1875, Louis Pasteur's great European rival, Robert Koch - a country doctor from Prussia, succeeded in doing what has eluded all bacteriologists by tracing the entire life cycle of an anthrax bacteria cell.
Andrew reveals how this revolutionary insight would lead to proof that particular micro organisms cause a particular disease. But why would there continue to be resistance to this germ theory among some medical professionals?

22Transforming Plague20070306

When bubonic plague broke out in Hong Kong in 1894, European rivalry between France and Germany continued to be played out between two students of Louis Pasteur and Robert Koch, who headed straight to East Asia in a race to discover the micro organism responsible for plague.

No longer would plague be defined by its symptoms and course, but by its cause - thanks to a new series of rigorous laboratory tests. But how easy would it be for the micro biologists to get everyone to agree to this new approach?

23The Ministry Of Healing20070307

The new idea that doctors now needed to consult laboratory workers about the identity of a disease before they could make a final diagnosis was seen by many physicians as a threat to their authority over a patient.

But the Canadian physician William Osler did more than anyone to successfully unite the two worlds of the bedside and the laboratory. Andrew examines how Osler ensured that 'the lab would become indispensable in the everyday work of the practitioner'.

24Flinging The Tropics Open To Civilisation20070308

In the 1870s, the so-called 'scramble for Africa' saw many countries competing for a slice of the continent.

What role did European medicine play in spreading European culture across the Empire? Andrew traces the work of Patrick Manson - a colonial doctor who's credited with 'flinging the tropics open to civilisation' and creating the new discipline of 'tropical medicine'.

The readers are David Rintoul, Jason Watkins and Scott Handy

25Near Pavilions20070309

By 1900, hospitals were clean environments and open as much of the time as possible to fresh air. No longer were they 'more fatal than the battlefield' as Florence Nightingale had described them 50 years earlier.
Andrew traces the influence of Nightingale and the sanitarians in creating isolated pavilion style buildings designed on the basis of a current theory of disease. Not only would they become the place to care for the poor, but somewhere the middle classes would go to receive the services of a physician or surgeon.

26You Are What You Eat20070312

Doctors had long recognised that one of the crucial elements of health was a correct diet. In 1911, Frederick Gowland Hopkins conducted early animal experiments to show that aside from fat, carbohydrate and protein, another ingredient was essential in nutrition. It was the disease of beri-beri in the Dutch East Indies that would inspire medics that the absence of a vitamin rather than the presence of a microbe could be the cause of some disease.

27It Looks Like A Miracle20070313

By the 1940s the arrival of the first antibiotic, penicillin, appeared to be a miracle medicine. Its discoverer Alexander Fleming was regarded as a great hero, but how could he have failed to realise the medical significance of what he had discovered, leaving Howard Florey and Ernst Chain to develop its potential in the fight against staphylococcal infections?

28Free At The Point Of Need20070314

Aneurin Bevan called it the biggest single experiment in social service that the world has ever seen.

The National Health Service was set up in July 1948 to provide free health care for everyone.

Andrew Cunningham examines the system which the NHS replaced and explains how the ministry of health had to coax or force the hospitals and medics into the service.

29The Crippler20070315

Andrew traces the impact of the great polio epidemics and the ethical dilemmas they posed after World War II before a safe and effective vaccine was introduced in 1955.

30 LASTTransplant20070316

Organ transplantation has been described as the greatest therapeutic advance of the 20th century. In 1967, Christiaan Barnard performed the first heart transplant operation. Competition between pioneering teams of transplant surgeons pushed the limits in scientific medicine, assisted by rapid advances in technology. In conclusion, Andrew reflects on what scientific medicine has given us and what we have lost.