Last Night's TV: Blood and Guts: A History of Surgery BBC4
Head masters with esprit de gore
Thursday 21 August 2008
Surgery remains the most gloriously B-movie of medical specialities, a field in which the phrase "cutting-edge science" repudiates the usually bloodless nature of the cliché. Other fields of medicine get more abstract and intangible, more distanced from their crude origins, but, for all the machinery and all the advances, this one still has to get its hands sticky, dabbling around in the gore. In the first part of Blood and Guts: a History of Surgery, Michael Mosley suggested that he would describe the historical transition of surgery from "butchery to brilliance". In fact, he engrossingly demonstrated that separating the two isn't easy when it comes to surgical advance. No feast without cruelty, and no brilliance without butchery, either, you might be inclined to argue.
Take Kathryn, for example, a 28-year-old florist who'd been having problems with epilepsy and now found herself pinned to an operating table while a team of brain surgeons prised the dome of her skull off like the top of a hard-boiled egg. Inside sat something that looked like an unusually gelatinous summer pudding: the outer coating of Kathryn's brain. And while she chattered to the nurse, her surgeon zapped her grey matter to make sure that he didn't remove anything functional when he came to remove the growth that was causing the trouble. There was a time when this procedure would probably have proved fatal. "Just getting in usually exsanguinated the patient," explained a medical historian, a polite way of saying that the incision would power-spray the surgeon with blood. But then an American called Harvey Cushing decided he'd have a crack at improving the mortality rates and worked out a way to peel people's heads without losing all the juice.
By all accounts, Cushing wasn't really a fun guy at a party, unless you wanted to talk about his collection of brain samples, but then a streak of ghoulish hobbyist enthusiasm connected several of the surgical pioneers encountered here. The most unnerving of them was Dr Walter Freeman, the American doctor who developed the frontal lobotomy, and then peddled it as a mental cure-all. Seeking to speed up the operation, he refined the technique of the transorbital lobotomy, which essentially consisted of hammering an ice-pick in through the eye socket and waggling it around in a hopeful way. This terrifying procedure was even performed on Howard, a 12-year-old boy who'd been acting up with his new stepmother, each stage of the operation recorded in photographs that should have successfully swabbed up that small percentage of the audience that hadn't yet fainted or brought up its supper.
Amazingly, the patient still survived, and, in a genuinely intriguing moment, Mosley took him off to an MRI scanner to see what damage had been done, the first time one of Freeman's many lobotomy patients had ever been investigated in this way. The scan revealed two gaping black holes in Howard's frontal lobes, the last place you'd want to damage if you were hoping to improve someone's self-control. Howard inspected his vandalised brain with an understandably pensive air, the thoughts in his mind somehow successfully skirting the craters left behind by medical hubris.
As if to counterbalance this grisly tale, Mosley kept returning to Kathryn on the operating table, living evidence that surgery could be benign as well as malignant in its effects. Or, rather, that dubious experimentation may lead to indubitable benefits. Jose Delgado, the neuroscientist who'd wired up a fighting bull so that he could switch its aggression on and off at will struck me as being worryingly flamboyant for a scientist, but without his work you probably wouldn't have the achievement the programme concluded with: a Parkinson's patient whose symptoms had been alleviated with a built-in battery pack and deep-brain electrodes. Mosley makes an engaging presenter, and gamely scrambled his own brain signals with a powerful magnet at one point to show how no amount of concentration can overcome electrical interference with the jelly computer we call our brain. But if you're at all squeamish, make sure you've got somewhere soft to land before you switch on.
In Trawlermen, back for a third series of pitching wildly from side to side, John D Buchan, wedged securely into a corner of the Ocean Venture's wheelhouse, explained that he hoped one day to match his father's prowess as a fisherman. The only problem right now was what he called "this Mother Nature carry-oan", a somewhat understated description of a storm that would have had most of us whimpering below decks somewhere, praying for a speedy end. Meanwhile, on the Arcane, Charlie McBride was having an even worse day at work. He's got six months to pay a £400,000 fine for selling fish outside his quota, but within 48 hours he was down another £30,000 after losing a fishing net and having his hydraulic system collapse. If you've been grumbling about the weather recently or worrying about the credit crunch, this series should restore a little perspective.
To mark Tolstoy's 186th birthdaybooks
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