0:00:03 > 0:00:07For three centuries, Scotland's doctors
0:00:07 > 0:00:12have been transforming the health and wellbeing of the entire world.
0:00:12 > 0:00:17It's been estimated that he might have saved over 200 million lives.
0:00:18 > 0:00:21They have pushed the boundaries of human knowledge forward.
0:00:21 > 0:00:23Operation by operation,
0:00:23 > 0:00:24discovery by discovery,
0:00:24 > 0:00:26decade by decade.
0:00:26 > 0:00:30It changes the course of history.
0:00:30 > 0:00:34It changes the way our culture views illness.
0:00:36 > 0:00:40Shaping life from the cradle to the grave.
0:00:40 > 0:00:41Hunter...
0:00:41 > 0:00:44Simpson...Fleming...
0:00:44 > 0:00:45and many more.
0:00:45 > 0:00:50This is the story of how doctors in Scotland made the modern world.
0:01:01 > 0:01:07In the 18th century, before the discovery of anaesthetics, surgery meant pain.
0:01:08 > 0:01:11PATIENT YELLS
0:01:14 > 0:01:15In the 18th century,
0:01:15 > 0:01:19operations were very different to surgical operations today.
0:01:19 > 0:01:21No concept of antisepsis or asepsis,
0:01:21 > 0:01:23no knowledge of germs as a cause of infection,
0:01:23 > 0:01:26no anaesthesia, so your patients would be conscious
0:01:26 > 0:01:29throughout the operation.
0:01:29 > 0:01:32Surgery was something to be avoided basically,
0:01:32 > 0:01:35at all costs, if at all possible.
0:01:35 > 0:01:38So surgery was always the last resort.
0:01:38 > 0:01:45There was a lovely phrase used by surgeons and people writing about surgery in the early 19th century.
0:01:45 > 0:01:48It's called "bottom". Patients demonstrated bottom -
0:01:48 > 0:01:55this reserve of strength and stoicism that I think would be quite remarkable by today's standards.
0:01:55 > 0:01:58Surgery was dangerous.
0:01:58 > 0:02:03Death by loss of blood, infection or trauma was common.
0:02:05 > 0:02:08One Scotsman was determined to change this.
0:02:11 > 0:02:15John Hunter was born the tenth son of a farmer in what is now East Kilbride in 1728.
0:02:15 > 0:02:23He would transform the way the world looked at medicine and at life itself.
0:02:23 > 0:02:26What John Hunter did was to encourage surgeons
0:02:26 > 0:02:28to think of the body not just as something
0:02:28 > 0:02:32they should operate on, but as something they should understand.
0:02:32 > 0:02:37He wanted his students to comprehend what he called the "animal economy".
0:02:37 > 0:02:42Sounds a very strange term today, but it's really what we mean now by "biology".
0:02:42 > 0:02:46And John Hunter said that only by understanding how bodies worked
0:02:46 > 0:02:51could a surgeon operate effectively to treat an injury or cure a disease.
0:02:52 > 0:02:57In the 18th century, surgeons seldom got involved in studying the human body.
0:02:57 > 0:03:02When they cut someone open, they didn't hang around to look inside.
0:03:02 > 0:03:06But Hunter was obsessed by how nature worked. He believed that
0:03:06 > 0:03:12if surgeons didn't understand the workings of the human body, surgery would remain primitive and painful.
0:03:15 > 0:03:19He wasn't afraid to get his hands dirty.
0:03:19 > 0:03:23He understood that if you really wanted to know what was happening in the body,
0:03:23 > 0:03:27there was no way other than to dissect and to observe for yourself.
0:03:34 > 0:03:37By dissecting and studying the human body,
0:03:37 > 0:03:42Hunter developed a deep knowledge of the intimate workings of life. And he didn't stop at humans.
0:03:42 > 0:03:46If it had a pulse, John Hunter knew he could learn from it.
0:03:51 > 0:03:54The Hunterian Museum today contains over 300 different species
0:03:54 > 0:03:58of plants and animals all studied by John Hunter.
0:03:58 > 0:04:04He kept a leopard, other large cats, and he also used the private menageries in London
0:04:04 > 0:04:07as a source for animals to study
0:04:07 > 0:04:12and dissect. The museum's been called
0:04:12 > 0:04:15"John Hunter's unwritten book"
0:04:15 > 0:04:18because it was designed to be read by his students as a source of
0:04:18 > 0:04:21information that would help them in their careers as surgeons.
0:04:23 > 0:04:29Armed with a peerless knowledge of anatomy, Hunter began to challenge the conventional wisdom of surgery.
0:04:31 > 0:04:36One of the remarkable things about John Hunter is he's been called the "reluctant surgeon".
0:04:36 > 0:04:39He would only operate if he absolutely had to.
0:04:39 > 0:04:44And one of the reasons why he was so reluctant was that through his museum
0:04:44 > 0:04:48he built up an understanding of what the body could do to heal itself.
0:04:48 > 0:04:54He saw the surgeon's job as aiding that natural process of recovery.
0:04:54 > 0:04:59And so Hunter wouldn't operate unless he was absolutely sure that he could do some good,
0:04:59 > 0:05:05in comparison with many of his contemporaries, who were quite gung ho
0:05:05 > 0:05:08when it came to laying into patients with the knife.
0:05:08 > 0:05:13Hunter's knowledge of how the body worked guided his approach to surgery.
0:05:13 > 0:05:17He would observe, study, think,
0:05:17 > 0:05:22and then devise a delicate operation based on his observations of how the body itself worked.
0:05:22 > 0:05:27Aneurisms for example, swellings in arteries,
0:05:27 > 0:05:30Hunter treated not by cutting in to the aneurysm itself,
0:05:30 > 0:05:33which would inevitably lead to the patient bleeding to death
0:05:33 > 0:05:35but by making an incision elsewhere,
0:05:35 > 0:05:38tying off the artery, cutting off the blood supply
0:05:38 > 0:05:41and relying on what's known as a collateral circulation,
0:05:41 > 0:05:45a kind of natural bypass, to maintain the blood supply to the affected limb.
0:05:45 > 0:05:47It was a very elegant operation.
0:05:49 > 0:05:55John Hunter was the first man to introduce a genuinely scientific approach to surgery
0:05:55 > 0:05:59and his techniques remain pillars of surgery to this day. He is credited with
0:05:59 > 0:06:06groundbreaking developments in the treatment of gunshot wounds, venereal disease and inflammations.
0:06:06 > 0:06:11As well as transforming our understanding of the digestive and lymphatic systems.
0:06:16 > 0:06:20John Hunter's work, I think, brought out the fundamental workings
0:06:20 > 0:06:23of the human body in a way that hadn't been achieved before.
0:06:25 > 0:06:29His legacy was a generation of British surgeons
0:06:29 > 0:06:33committed to pushing forward their knowledge of human life.
0:06:33 > 0:06:37What John Hunter did was to encourage students to dissect bodies themselves
0:06:37 > 0:06:41and get a kind of hands-on feel for what the body was like.
0:06:41 > 0:06:45John Hunter created a whole generation of surgeons
0:06:45 > 0:06:52who were familiar with the body, health and disease and could apply that knowledge in their practice
0:06:52 > 0:06:53when they were treating patients.
0:06:53 > 0:06:56I know surgeons today still revere him,
0:06:56 > 0:07:00and I meet surgeons who've gone into medicine because they were
0:07:00 > 0:07:03inspired by reading John Hunter's story,
0:07:03 > 0:07:07so he's still an important figure in surgery today.
0:07:09 > 0:07:13John Hunter's scientific approach to surgery and disease
0:07:13 > 0:07:17was typical of a new group of intellectuals from Scotland.
0:07:17 > 0:07:22John Hunter was definitely part of what's now called the Scots' enlightenment.
0:07:22 > 0:07:25The group of educated men
0:07:25 > 0:07:31who established themselves not just in medicine but in law and other professions in the 18th century.
0:07:31 > 0:07:35What John Hunter did was to make surgery
0:07:35 > 0:07:37a part of that Scottish enlightenment.
0:07:40 > 0:07:42By the time of Hunter's death,
0:07:42 > 0:07:47Scotland was the most important centre for medical learning in the world.
0:07:47 > 0:07:50Nine out of ten doctors in Britain were trained here.
0:07:50 > 0:07:53In the first half of the 18th century,
0:07:53 > 0:08:00Scottish universities produced 30 times as many medical graduates as Oxford and Cambridge combined.
0:08:00 > 0:08:05And the reason for Scotland's pre-eminence was the enlightenment.
0:08:05 > 0:08:08An extraordinary flowering of ideas that transformed the way
0:08:08 > 0:08:12Scotland looked at the world and the way the world looked at Scotland.
0:08:15 > 0:08:20The enlightenment was a Scottish manifestation of learning
0:08:20 > 0:08:22that was applying knowledge for improvement.
0:08:22 > 0:08:27People envisaged improvement through lifestyle, technology,
0:08:27 > 0:08:29through social organisations.
0:08:29 > 0:08:33In drawing rooms and in taverns, intellectuals from every field
0:08:33 > 0:08:36met and discussed new discoveries and theories.
0:08:36 > 0:08:39That's one of the essences of the Scottish enlightenment -
0:08:39 > 0:08:41conviviality.
0:08:41 > 0:08:44Pleasure in depth, especially through drink.
0:08:44 > 0:08:46Um...well into the night.
0:08:46 > 0:08:52The medics would be conversing with the historians, the political scientists,
0:08:52 > 0:08:56the legal philosophers, but the thing that focused each of them
0:08:56 > 0:09:01was their interest in society, in humanity.
0:09:01 > 0:09:08Enlightenment philosophy transformed the way medicine was taught in universities.
0:09:08 > 0:09:12The whole philosophy behind the universities was one of investigation,
0:09:12 > 0:09:16so the Scots doctors were actually nearly always philosophers
0:09:16 > 0:09:18and natural historians,
0:09:18 > 0:09:22they had a real desire to learn about the world and find out the causes of things.
0:09:22 > 0:09:26The result was an army of medical graduates eager to
0:09:26 > 0:09:32experiment, investigate, and solve the mysteries of life itself.
0:09:32 > 0:09:36What stamps the Scottish enlightenment to a large extent is the emphasis on,
0:09:36 > 0:09:37if you like, humanity.
0:09:37 > 0:09:39What makes human beings tick?
0:09:39 > 0:09:46John Hunter may have armed surgeons with a new understanding of what made human beings tick,
0:09:46 > 0:09:52but despite his work, surgical mortality rates remained high.
0:09:55 > 0:10:00For serious operations, there was barely a one-in-three chance of the patient surviving.
0:10:03 > 0:10:09You would be tied down or you would be held by strong people.
0:10:09 > 0:10:11You might be given laudanum,
0:10:11 > 0:10:15which is a mixture of opium and alcohol, if you were lucky.
0:10:15 > 0:10:18Or perhaps a swig of brandy or something.
0:10:18 > 0:10:23And then you would more or less be fully conscious as the knife went in.
0:10:25 > 0:10:28It had to be swift and brutal. The thing was to
0:10:28 > 0:10:30get through the skin as fast as possible.
0:10:30 > 0:10:34The surgeons were famously slick at doing this,
0:10:34 > 0:10:36large curved knives and so forth.
0:10:36 > 0:10:40Woe betide anyone who got their fingers in the road when this was being done.
0:10:40 > 0:10:47By the mid-19th century, the most famous surgeon in Britain was Robert Liston from Lilnlithgow.
0:10:47 > 0:10:52He had a fiery temper and a self-assurance that bordered on arrogance.
0:10:52 > 0:10:58He had fallen out with most of his peers in Edinburgh who disliked his showy technique.
0:10:58 > 0:11:02His operations were public events.
0:11:02 > 0:11:08Spectators would come and see if Liston could break his own record for a speedy amputation.
0:11:08 > 0:11:10Liston was a fast operator.
0:11:10 > 0:11:14It was said he could take off someone's leg in under a minute.
0:11:14 > 0:11:18And of course when your patient was conscious,
0:11:18 > 0:11:22operating quickly but safely was a very useful skill for a surgeon to have.
0:11:22 > 0:11:27Well, the surgical heroes in those days were the fastest.
0:11:27 > 0:11:28He was the fastest of the fast.
0:11:30 > 0:11:33Liston was more than just a showman.
0:11:33 > 0:11:39By operating quickly, he was able to minimise the pain of his fully conscious patient.
0:11:39 > 0:11:44But being fast did not always mean being successful.
0:11:44 > 0:11:46He was amputating a patient's leg.
0:11:46 > 0:11:51During the amputation, he managed to cut off the finger of his assistant
0:11:51 > 0:11:55who was holding down the patient. The assistant later succumbed to an infection and died.
0:11:55 > 0:11:59Someone in the audience was so shocked by this that
0:11:59 > 0:12:03they had a heart attack and died. The patient died.
0:12:03 > 0:12:06One operation with a 300% mortality rate.
0:12:08 > 0:12:11Liston knew that as long as the patient remained conscious,
0:12:11 > 0:12:16surgery would remain a dangerous experience for patient and doctor.
0:12:18 > 0:12:22In 1846, he heard that dentists in America
0:12:22 > 0:12:24were experimenting with the chemical, ether,
0:12:24 > 0:12:29which could anaesthetise patients during operations on their teeth.
0:12:29 > 0:12:31It wasn't very pleasant.
0:12:31 > 0:12:35Ether was very pungent. The patient did sort of groan and moan a bit,
0:12:35 > 0:12:38but it was successful enough to convince everyone there
0:12:38 > 0:12:41that this technique had something in it.
0:12:43 > 0:12:49Liston knew that if he could apply ether during major surgery, he would vastly increase the chances
0:12:49 > 0:12:53of the operation's success and remove the pain suffered by the patient.
0:12:53 > 0:12:59He was determined to be the first man in Europe to perform an operation using the chemical.
0:13:03 > 0:13:06In December 1846, he operated on Frederick Churchill,
0:13:06 > 0:13:09a butler with an infection in his leg.
0:13:09 > 0:13:12Liston used ether, amputated the leg.
0:13:12 > 0:13:18He did the operation quickly of course, because he wasn't sure how ether would work.
0:13:18 > 0:13:23But it was so effective that the patient came round afterwards and asked when the operation would begin.
0:13:27 > 0:13:32Robert Liston's use of ether marked the beginning of a new era in British medicine.
0:13:32 > 0:13:36It meant that pain could be removed from the art of surgery forever.
0:13:36 > 0:13:40The introduction of anaesthesia gave surgeons much more freedom
0:13:40 > 0:13:47to operate and to carry out a wider range of procedures than they'd been able to before.
0:13:47 > 0:13:51For another Scottish doctor, James Young Simpson,
0:13:51 > 0:13:55anaesthesia opened up a whole new world of possibilities in the fight against pain.
0:13:58 > 0:14:02Simpson's belief was that the physician had two purposes.
0:14:02 > 0:14:07One was obviously to preserve life but second was also to alleviate suffering wherever possible.
0:14:07 > 0:14:12But Simpson's view of pain was not shared by all his fellow doctors.
0:14:12 > 0:14:14Pain was really looked upon as being
0:14:14 > 0:14:17a stimulant at a time of great stress to the body.
0:14:17 > 0:14:21Pain would keep the body going during the operation.
0:14:21 > 0:14:26And in religious circles, pain was believed to have a divine purpose.
0:14:28 > 0:14:34Pain was suffering, which was really a physical expression of man's
0:14:34 > 0:14:39original sin in the garden of Eden and you sort of grew with it and tolerated it.
0:14:39 > 0:14:45But Simpson saw the potential of anaesthesia to soothe one of the most sacred painful events in life -
0:14:45 > 0:14:48childbirth.
0:14:48 > 0:14:54The religious argument about pain in childbirth had always tracked back to
0:14:54 > 0:14:58the original Hebrew saying, "Sorrow thou shalt bring forth children."
0:14:58 > 0:15:01This was known as the curse of Eve.
0:15:01 > 0:15:06Simpson, a religious man himself, was unconvinced.
0:15:06 > 0:15:12Simpson argued that the word, sorrow, had always been misinterpreted. That rather than pain,
0:15:12 > 0:15:19sorrow should be interpreted as the physical excursion, the labour of giving birth,
0:15:19 > 0:15:26and that if you give anaesthesia, that takes away the pain but doesn't actually halt the contractions.
0:15:26 > 0:15:29So therefore you're not interfering with the process.
0:15:29 > 0:15:34Simpson disregarded religious objections and concentrated
0:15:34 > 0:15:38on finding an anaesthetic suitable for childbirth.
0:15:38 > 0:15:45Simpson had taken up ether as soon as it had been announced and he found it to work satisfactorily
0:15:45 > 0:15:51but he knew that patients didn't like it because it was irritant, it was pungent, it was difficult to breathe
0:15:51 > 0:15:55so he set about looking for another volatile chemical
0:15:55 > 0:15:59that would have, as he said, ether's advantages without its disadvantages.
0:15:59 > 0:16:05Simpson's assistants scoured Britain's pharmacies to prepare a menu of exotic chemicals
0:16:05 > 0:16:10for Simpson and his friends to test on themselves at Edinburgh dinner parties.
0:16:11 > 0:16:18On the 4th November 1847 he tried a sweet colourless liquid called chloroform.
0:16:18 > 0:16:22It's faster acting than ether.
0:16:22 > 0:16:27It basically goes into the bloodstream via the lungs and then it goes up to the brain.
0:16:27 > 0:16:29And within minutes they're all unconscious
0:16:29 > 0:16:35and as Simpson came round he's reputed to have said, "This is much stronger and much better than ether."
0:16:35 > 0:16:40One week later, Simpson used chloroform on a patient for the first time.
0:16:40 > 0:16:47She gave birth to a healthy baby girl and named her Anaesthesia.
0:16:47 > 0:16:52Simpson went on to become the personal physician to Queen Victoria.
0:16:52 > 0:16:55His advocacy of chloroform was given official sanction
0:16:55 > 0:17:00when she gave birth to her eighth child, Prince Leopold, whilst under the influence of the drug.
0:17:04 > 0:17:09The work of Simpson, Liston and Hunter had immense medical and social implications.
0:17:09 > 0:17:16Together, these Scottish doctors had transformed understanding of the human body, pushed the boundaries
0:17:16 > 0:17:23of surgery and most fundamentally, challenged our understanding of pain itself.
0:17:23 > 0:17:27Pain went from being something that was a natural part of medicine,
0:17:27 > 0:17:33illness, that kind of process, to being something which can be managed, reduced, eliminated.
0:17:40 > 0:17:45In some respects seeing your living skeleton is horrifying.
0:17:45 > 0:17:47It reminds us of our own mortality.
0:17:47 > 0:17:50We are mortal. We are all walking skeletons.
0:17:50 > 0:17:52We don't like to be reminded of this.
0:17:52 > 0:17:55By the end of the nineteenth century,
0:17:55 > 0:17:57pain was in retreat.
0:17:57 > 0:18:02The next medical challenge was to diagnose ailments and disease without using a knife at all.
0:18:04 > 0:18:08One Scottish doctor, John Macintyre, would become the first
0:18:08 > 0:18:11to master the art of seeing inside the living body.
0:18:13 > 0:18:16John Macintyre was born in Glasgow. He grew up in Glasgow.
0:18:16 > 0:18:19Spent his working life in Glasgow. And he died in Glasgow.
0:18:19 > 0:18:23He was a Glaswegian through and through. And that defined the man.
0:18:23 > 0:18:26The phenomenon that was to make Macintyre's name
0:18:26 > 0:18:32was first spotted in November 1895 by German scientist, Wilhelm Rutgen.
0:18:32 > 0:18:36He was experimenting with cathode rays in a glass bulb in his laboratory.
0:18:36 > 0:18:42He saw that a fluorescent screen lit up at some distance away and he
0:18:42 > 0:18:45couldn't explain that, because the glass bulb was covered with card.
0:18:45 > 0:18:49Rutgen realised that something was penetrating the card
0:18:49 > 0:18:52and illuminating the screen on the other side of the room.
0:18:52 > 0:18:53This was something entirely new.
0:18:53 > 0:18:58It couldn't be explained by traditional 19th century physics and therefore he called it X.
0:18:58 > 0:19:02Rutgen had accidentally discovered the X-Ray.
0:19:02 > 0:19:07For advice, he turned to Europe's most pre-eminent physicist,
0:19:07 > 0:19:09Lord Kelvin of Glasgow University.
0:19:11 > 0:19:16It is difficult for us now to appreciate how astonishing this actually was.
0:19:16 > 0:19:21And then prior to that, the only way you saw inside the body was either on the graveyard, the battlefield,
0:19:21 > 0:19:23the mortuary or the operating theatre.
0:19:23 > 0:19:27Kelvin was intrigued and enlisted the help of John Macintyre,
0:19:27 > 0:19:30the chief electrical engineer at Glasgow's Royal Infirmary.
0:19:32 > 0:19:37Macintyre was already pioneering the use of electrical equipment in medicine.
0:19:37 > 0:19:42At this time the use of electrical apparatus in medicine was increasing very dramatically.
0:19:42 > 0:19:46He was very interested in looking inside the body and so he was using
0:19:46 > 0:19:49batteries and very small electric barbs to look inside the body.
0:19:51 > 0:19:58Straightaway, Macintyre realised that Rutgen's mysterious rays would transform medical technology.
0:19:58 > 0:20:03But elsewhere, X-Rays promised not advancement but amusement.
0:20:03 > 0:20:08In New York there was a law passed that said you weren't allowed to use X-Ray's and opera glasses.
0:20:08 > 0:20:13The idea was you'd go into a theatre with people dancing on the stage. You take your opera glasses with
0:20:13 > 0:20:16X-Rays in. You can actually see them without their clothes on.
0:20:16 > 0:20:21Whilst the world contemplated being able to see through women's clothes,
0:20:21 > 0:20:26in Glasgow, Macintyre had been busy building the world's first Diagnostic Radiology department.
0:20:26 > 0:20:30Only four months had passed since Rutgen's discovery.
0:20:30 > 0:20:35I think the astonishing thing is how advanced he was at really quite an early stage.
0:20:35 > 0:20:40He took radiographs of really quite deep statures of the body whist other people were still looking at
0:20:40 > 0:20:43peripheral parts of the body, such as hands and feet.
0:20:43 > 0:20:49Macintyre took the first X-Rays of kidney stones and made these first moving X-Ray shots of a frog's leg.
0:20:49 > 0:20:56The people of Glasgow became the first in the world to benefit from what he called the new light.
0:20:59 > 0:21:04Towards the end of the 19th century, they basically thought that everything had been worked out.
0:21:04 > 0:21:06Physics was understood. Chemistry was understood.
0:21:06 > 0:21:10Medicine had been worked out. What more discoveries could be made?
0:21:10 > 0:21:14And along came the X-Rays that completely changed the way we look at ourselves.
0:21:14 > 0:21:18To see inside the living body which is something entirely unexpected.
0:21:18 > 0:21:23X-Rays reached parts of the body that other medical technology couldn't reach.
0:21:25 > 0:21:29Macintyre had pioneered the next great leap in medical science.
0:21:35 > 0:21:40While patients in Scotland and the west were enjoying the benefits of new technology...
0:21:40 > 0:21:43in the rest of the world people were dying from the same
0:21:43 > 0:21:48ancient diseases which had been killing human beings for centuries.
0:21:48 > 0:21:51The infection begins when the mosquito bites
0:21:51 > 0:21:53and injects infective stages into your blood.
0:21:55 > 0:21:58After the gestation period in the liver
0:21:58 > 0:22:02the parasites burst out and then take up residence in your red blood cells
0:22:02 > 0:22:04which carry oxygen around the body.
0:22:04 > 0:22:07That causes a tremendous amount of blood loss and that's
0:22:07 > 0:22:09the first signs of the infection.
0:22:09 > 0:22:13The symptoms can include nausea, fever, vomiting,
0:22:13 > 0:22:15headaches, chills, muscle pain.
0:22:15 > 0:22:18Inevitably as the parasites destroy your red blood cells you become
0:22:18 > 0:22:23anaemic and some people can even die from pronounced anaemia.
0:22:23 > 0:22:28Just over 40% of the world's population live in areas where malaria is transmitted.
0:22:28 > 0:22:34Malaria is one of the most ancient and deadly diseases known to man.
0:22:34 > 0:22:38A disease that thrives in tropical climates in which would become an
0:22:38 > 0:22:43obsession of doctors from a much colder and wetter part of the world.
0:22:45 > 0:22:50The British Empire was expanding and almost an inevitable consequence of that
0:22:50 > 0:22:54was that you had Scottish doctors manning the clinics in the empire.
0:22:54 > 0:22:59Looking at the patients who are coming in with the tropical infectious diseases.
0:22:59 > 0:23:06Scots doctors were the first to identify the causes of those particular diseases.
0:23:06 > 0:23:12One of these doctors was Patrick Manson from Old Meldrum in Aberdeenshire.
0:23:12 > 0:23:18Patrick Manson's discovery that a multitude of diseases could be transmitted from one person
0:23:18 > 0:23:24to another or even from an animal to a person through the medium of what we call a vector.
0:23:24 > 0:23:26Insects, bugs, fleas and so on.
0:23:26 > 0:23:29It really opened our eyes to tropical medicine.
0:23:29 > 0:23:34Manson speculated that malaria could be transmitted by mosquitoes.
0:23:34 > 0:23:38When people thought that Manson was mad and people used to walk
0:23:38 > 0:23:41along around the streets of this area here, flapping their wings or their arms.
0:23:43 > 0:23:47But Manson's mosquito theory attracted the attention
0:23:47 > 0:23:53of Ronald Ross, a little known Scottish doctor working with the British Indian army.
0:23:53 > 0:23:56He was initially not terribly interested in medicine.
0:23:56 > 0:23:59He wanted to be an artist and he spent most of his early
0:23:59 > 0:24:06years in India writing novels, composing poems, writing music, playing golf, tennis, cycling.
0:24:06 > 0:24:10But after witnessing firsthand the devastating effects of malaria
0:24:10 > 0:24:14which was killing over one million people in India every year,
0:24:14 > 0:24:18Ross turned his considerable energy into fighting the disease.
0:24:18 > 0:24:22His partnership with Manson was to change the world.
0:24:22 > 0:24:26Manson by this stage was feeling too old to go back out
0:24:26 > 0:24:33to the tropics and in Ross he found a willing protege to go and carry out that work on his behalf.
0:24:33 > 0:24:37The critical thing was if you could really show that malaria
0:24:37 > 0:24:41was transmitted by the mosquito you have a means of dealing with malaria.
0:24:41 > 0:24:47You can control the mosquito and therefore prevent transmission of the disease.
0:24:47 > 0:24:53Ross returned to India and set about confirming Manson's theory.
0:24:53 > 0:24:59He would take malaria patients and there were no shortage of those in India at the time
0:24:59 > 0:25:06and he would collect mosquitoes and he would breed mosquitoes himself and he would feed those mosquitoes on
0:25:06 > 0:25:10his malarias patients. And then, with extraordinary patience
0:25:10 > 0:25:15spend the next several weeks methodically dissecting
0:25:15 > 0:25:22those mosquitoes in order to see whether they had picked up the parasites or not.
0:25:22 > 0:25:24It was physically incredibly demanding.
0:25:24 > 0:25:28In fact he frequently complained of great eye strain as he was literally
0:25:28 > 0:25:32looking down a microscope for hours on end, hoping to find
0:25:32 > 0:25:36- parasites in the mosquito. - But luck was against him.
0:25:36 > 0:25:38There are two kinds of mosquito.
0:25:38 > 0:25:41One that transmits malaria and one that doesn't.
0:25:41 > 0:25:46And he chose the most common one, which unfortunately did not transmit malaria.
0:25:46 > 0:25:51Seeing no proof of a link between mosquitoes and malaria, Ross became disheartened.
0:25:51 > 0:25:56Manson was constantly cajoling Ross through a phenomenal correspondence.
0:25:56 > 0:26:02They're writing to each other long letters, pretty much every week over the next two years.
0:26:02 > 0:26:08Ross usually complaining that he's looked at another 10,000 mosquitoes without seeing any malaria parasites
0:26:08 > 0:26:15and Manson explaining to him the rewards of making the connection are so great he must continue.
0:26:15 > 0:26:19Manson famously told Ross that his quest was the quest for
0:26:19 > 0:26:23the Holy Grail and Ross needed to consider himself to be Sir Galahad.
0:26:25 > 0:26:28The weather became very hot again in August.
0:26:28 > 0:26:31At first I toiled comfortably but then as failure followed failure
0:26:31 > 0:26:35I became exasperated and worked till I could hardly see
0:26:35 > 0:26:38my way home in the late afternoons.
0:26:38 > 0:26:45The screws of my microscope were rusted with sweat from my forehead and hands.
0:26:45 > 0:26:48Ross decided to switch his focus to a different breed of mosquito.
0:26:48 > 0:26:51On the 20th August 1897,
0:26:51 > 0:26:56he noticed something strange inside an anopheles mosquito.
0:26:56 > 0:27:02Ross would have seen these banana shaped structures and he would have known that they couldn't be produced
0:27:02 > 0:27:09by mosquitoes and they weren't part of the patients blood so they had to be parasites of some kind.
0:27:12 > 0:27:14He was absolutely elated.
0:27:14 > 0:27:17Having looking at literally tens of thousands of mosquitoes
0:27:17 > 0:27:24without showing the link, when eventually he showed it, he was absolutely ecstatic.
0:27:26 > 0:27:30Ross had proved Manson's hypothesis that mosquitoes transmit malaria.
0:27:30 > 0:27:33This was an immense discovery in itself.
0:27:33 > 0:27:37But Ross persisted and was able to reveal for the first time,
0:27:37 > 0:27:41the entire complex life cycle of the disease.
0:27:41 > 0:27:46He showed that not only do mosquitoes pick up the parasites from one individual.
0:27:46 > 0:27:50The same mosquito would then transmit those parasites
0:27:50 > 0:27:53to the next individual.
0:27:53 > 0:27:57Ross had unravelled the mystery of one of mankind's greatest enemies.
0:27:57 > 0:28:01It was a quantum leap as happens in many areas of science.
0:28:01 > 0:28:05It's been estimated that he might have saved over 200 million lives.
0:28:07 > 0:28:10Ross was awarded the Nobel Prize in 1902.
0:28:10 > 0:28:12The first Britain to win the award.
0:28:15 > 0:28:19Armed with knowledge of how the parasite transmits malaria,
0:28:19 > 0:28:23governments were able to devise methods to combat the disease.
0:28:23 > 0:28:29Within a few decades of Ross' discovery, malaria was in retreat all over the world.
0:28:29 > 0:28:32But it is a stubborn disease
0:28:32 > 0:28:38and in recent years has fought back against the drugs designed to contain it.
0:28:38 > 0:28:44One problem is the drugs that we developed to target parasites with
0:28:44 > 0:28:48very quickly become ineffective because the parasites evolve resistance to these drugs.
0:28:48 > 0:28:54Today in Edinburgh, Sarah Reece leads a team of doctors
0:28:54 > 0:28:58who are revisiting the first principles of Ross' work.
0:28:58 > 0:29:04If we can understand more about the biology of the parasites, and why they've evolved to do what they do,
0:29:04 > 0:29:07we can understand and make predictions about how they're likely to evolve
0:29:09 > 0:29:11to new drugs and new vaccines.
0:29:11 > 0:29:15I think all malaria research over the last 100 or so years
0:29:15 > 0:29:20is built on the work of Ross because it was such a foundation to be able to have the life cycle
0:29:20 > 0:29:22to go on.
0:29:26 > 0:29:30Thirty years after Ross' momentous work, another little known Scottish doctor
0:29:30 > 0:29:35stumbled upon a discovery that would save even more lives.
0:29:35 > 0:29:39It changes the course of history.
0:29:39 > 0:29:43It changes the way our culture views illness.
0:29:43 > 0:29:47In this tiny lab one of the most momentous discoveries in medical
0:29:47 > 0:29:52history was made by the son of a tenant farmer from Ayrshire.
0:29:52 > 0:29:57There's some people who know about engines and they know how that engine feels,
0:29:57 > 0:30:01sense when something's about to go wrong and when it's running smoothly.
0:30:01 > 0:30:05Well, Alexander Fleming knew about bacteria. He could make them grow.
0:30:05 > 0:30:06He could dry them.
0:30:06 > 0:30:08He could make patterns with them.
0:30:08 > 0:30:11He was a real genuine craftsman.
0:30:11 > 0:30:16In 1928, Alexander Fleming was preparing vaccines in his lab
0:30:16 > 0:30:18at St. Mary's Hospital in Paddington.
0:30:18 > 0:30:26Before leaving for a holiday in Sussex, Fleming left several plates of bacteria on his workbench.
0:30:26 > 0:30:29When he returned, something caught his eye.
0:30:29 > 0:30:33He observed that a mould
0:30:33 > 0:30:38on a dish was stopping bacteria growing possibly even killing them.
0:30:40 > 0:30:46And he has a sense that this is interesting, whereas other people may not have noticed it.
0:30:46 > 0:30:52Fleming was fascinated by the liquid oozing out of the mould, which appeared to be killing the bacteria.
0:30:52 > 0:30:58He called it 'moljuice' and later renamed it penicillin.
0:30:58 > 0:31:04Bacteria reproduce by splitting and building new cell walls.
0:31:04 > 0:31:09First of all there was one bacterium, suddenly there's two bacteria.
0:31:09 > 0:31:11And they do this every twenty minutes.
0:31:11 > 0:31:18The penicillin stops the bacteria forming the cell walls that would protect them.
0:31:18 > 0:31:23In 1928, these tiny bacteria were killers.
0:31:23 > 0:31:28If they infected even the smallest wound, then medical science was virtually powerless.
0:31:28 > 0:31:32If there was an infection, there was nothing much that could be done.
0:31:32 > 0:31:37Famously the son of the President of the United States had in the 1920s
0:31:37 > 0:31:41had got a sore on his foot from playing tennis.
0:31:41 > 0:31:43Five days later he died.
0:31:43 > 0:31:46And that was the son of the President of the United States.
0:31:47 > 0:31:52The only method available for infected wounds was antiseptics.
0:31:52 > 0:31:56Fleming had seen firsthand the drawbacks of these drugs.
0:31:56 > 0:32:02In the first world war, where he'd been a doctor, he'd seen the failure
0:32:02 > 0:32:05of using antiseptics on deep wounds.
0:32:05 > 0:32:10Basically they damaged the body as much as they damaged the bacteria.
0:32:10 > 0:32:18Fleming suspected that his mysterious new substance, penicillin could be useful in treating wounds.
0:32:18 > 0:32:23But he lacked the expertise to turn his discovery into a medicine.
0:32:23 > 0:32:29What he can't do at all is extract whatever it is that's
0:32:29 > 0:32:32oozing out of the mould
0:32:32 > 0:32:36into a medicine. The normal way you extract
0:32:36 > 0:32:41crystals from a liquid is by heating the liquid, driving off the water and you're left with the crystals.
0:32:41 > 0:32:46But the trouble is that penicillin is extremely fragile and the heating of it would destroy it.
0:32:46 > 0:32:53Fleming sent samples of penicillin to academic colleagues and went back to work in his lab.
0:32:53 > 0:32:58Penicillin remained an academic curiosity.
0:32:58 > 0:33:03There was no great sense in 1928 that this was going to revolutionize medicine at all.
0:33:06 > 0:33:12But in 1938, Dr. Ernst Chane, a Jewish scientist who had fled Nazi Germany,
0:33:12 > 0:33:14and who was an admirer of Fleming,
0:33:14 > 0:33:20decided to see if he could transform penicillin into a workable drug.
0:33:20 > 0:33:27Chane picks on this problem, not because it's useful, but because it's scientifically interesting.
0:33:27 > 0:33:29And it's a challenge to extract this.
0:33:29 > 0:33:35Working with Oxford scientist, Howard Florry, Chane was able to
0:33:35 > 0:33:37extract penicillin from Fleming's mould.
0:33:37 > 0:33:39He gave this extract to lab mice.
0:33:41 > 0:33:43It's administered to sick mice.
0:33:43 > 0:33:48The sick mice who get the penicillin survive.
0:33:48 > 0:33:50The sick mice who don't get it die.
0:33:50 > 0:33:53It's a very obvious clean experiment.
0:33:54 > 0:33:57Chane had confirmed what Fleming suspected.
0:33:57 > 0:34:01That penicillin could be used to fight bacteria and illness.
0:34:01 > 0:34:05SIRENS AND EXPLOSION
0:34:05 > 0:34:09Penicillin arrived just when Britain needed it most.
0:34:09 > 0:34:14Every night, casualties from German air raids died from wounds that penicillin could treat.
0:34:16 > 0:34:19But in a nation on the brink of defeat there simply wasn't enough
0:34:19 > 0:34:23capacity to produce penicillin on an industrial scale.
0:34:25 > 0:34:30In April 1941, Howard Florry, was smuggled into the USA.
0:34:30 > 0:34:33With him, he carried samples of penicillin.
0:34:45 > 0:34:48America is already preparing for war.
0:34:48 > 0:34:51America isn't in the war yet but it knows war is going to come.
0:34:51 > 0:34:55Out of the reach of German bombs, US drug companies
0:34:55 > 0:34:59were soon manufacturing penicillin on a massive scale.
0:35:03 > 0:35:06There's enormous excitement about penicillin.
0:35:06 > 0:35:12Penicillin could be used for wounds like gangrene and also for treating very badly injured soldiers.
0:35:12 > 0:35:16Soldiers who otherwise would not have survived.
0:35:16 > 0:35:20The idea that here there was a medicine that could cure those wounds
0:35:20 > 0:35:24made a huge impact, not just on the soldiers, but on politicians.
0:35:24 > 0:35:31Penicillin saved the lives of thousands of soldiers, as the war turned in the Allies favour.
0:35:32 > 0:35:38Towards the end of the war, if a wounded soldier managed to get back
0:35:38 > 0:35:43to his own lines and to medical care
0:35:43 > 0:35:47then he had more than a 95% chance of survival.
0:35:49 > 0:35:54The unassuming doctor from Ayrshire, who had originally discovered
0:35:54 > 0:35:57penicillin, soon became the most famous doctor in the world.
0:35:57 > 0:36:02It was expressed later that Britain was Greece to America's Rome.
0:36:02 > 0:36:07Britain did the original brainwork and then America would develop it.
0:36:07 > 0:36:11Well, that was exactly the role which was attributed to Fleming.
0:36:17 > 0:36:22Fleming's modest demeanour made him the perfect hero for a world exhausted by war.
0:36:22 > 0:36:28And his fame completely obscured that of Chane and Florry with whom he shared the Nobel Prize.
0:36:30 > 0:36:35Fleming has a bit of luck and luck is often important in science.
0:36:35 > 0:36:39There was no sense that he was systematically going out
0:36:39 > 0:36:47to look for new phenomena. Rather, he was enough of a craftsman to see one
0:36:47 > 0:36:49when it arrived.
0:36:49 > 0:36:57What Fleming can be seen as, is like a Scottish explorer who sees a distant land.
0:36:57 > 0:37:01He doesn't explore the land in detail but he's the first person to see it from a distance.
0:37:07 > 0:37:12Penicillin marked the birth of modern medicine, as we know it today.
0:37:12 > 0:37:15Lives would no longer be lost to simple infections.
0:37:17 > 0:37:21Its arrival coincided with the National Health Service.
0:37:21 > 0:37:25The most powerful drug in the world was now freely available to everyone.
0:37:28 > 0:37:34The National Health Service is clearly one of the most remarkable,
0:37:34 > 0:37:37historical developments in twentieth century Britain.
0:37:37 > 0:37:45Everybody in the country, gender, class, ethnic origin, religion,
0:37:45 > 0:37:48were going to be treated in exactly the same way.
0:37:48 > 0:37:51This was like a new Magna Carta
0:37:51 > 0:37:54for British and Scottish humanity.
0:37:56 > 0:38:01But in this brave new world of free health care and all powerful wonder drugs,
0:38:01 > 0:38:06there was one disease that even penicillin was unable to control.
0:38:06 > 0:38:12Tuberculosis was the scourge of Scotland. It was just part of life.
0:38:12 > 0:38:17People were noticed, and almost diagnosed
0:38:17 > 0:38:19by the community as consumptive
0:38:19 > 0:38:22and that was almost
0:38:22 > 0:38:24a sentence of death.
0:38:24 > 0:38:29It gripped Scotland's toxic cities, spreading freely in the polluted air.
0:38:29 > 0:38:35I remember the smogs of Glasgow of the 1950s, which were totally debilitating.
0:38:35 > 0:38:41It would stop you in the street and lead to tremendous problems that really affected your breathing.
0:38:43 > 0:38:50Tuberculosis is one of the oldest plagues known to man affecting millions of people across the world.
0:38:52 > 0:38:56It is spread by coughing, sneezing and simply breathing.
0:38:56 > 0:38:59It is highly infectious.
0:38:59 > 0:39:02In 1951 a young doctor took up the post
0:39:02 > 0:39:07of professor of respiratory diseases at Edinburgh University.
0:39:07 > 0:39:11The situation in Scotland was dire.
0:39:13 > 0:39:16Between the wars
0:39:16 > 0:39:20much more was done about slums in England than was done in Scotland.
0:39:20 > 0:39:27Still very gross overcrowding after the war, and worse of course after the bombing.
0:39:27 > 0:39:32In practically all other European countries,
0:39:32 > 0:39:34the incidence came down
0:39:34 > 0:39:40after the end of the war when nutrition and things were better.
0:39:40 > 0:39:43Doctors hoped that the introduction of powerful antibiotics
0:39:43 > 0:39:46might finally rid Scotland of the plague of TB.
0:39:46 > 0:39:49There was a...
0:39:49 > 0:39:52feeling then, because antibiotics, like penicillin,
0:39:52 > 0:39:57only had to be given for a week or two, then you might get rid of tuberculosis quickly
0:39:57 > 0:39:59with one medication.
0:39:59 > 0:40:01But the results were patchy.
0:40:01 > 0:40:08None of the three main antibiotics used to treat tuberculosis provided an effective cure.
0:40:08 > 0:40:12John Crofton and his team of doctors in Edinburgh decided to find out why.
0:40:12 > 0:40:15We spent our first two years
0:40:15 > 0:40:16of research...
0:40:18 > 0:40:23..besides doing all the clinical work of course, in looking at the causes of failure.
0:40:23 > 0:40:28That these drugs worked in some places and not in others.
0:40:28 > 0:40:33The answer lay in TB's ability to adapt to the drugs designed to kill it.
0:40:33 > 0:40:40Two of the patients proved to have been infected by cells already resistant
0:40:40 > 0:40:47to one of the two drugs. So we decided the safest thing was to start them on all three drugs.
0:40:47 > 0:40:51And then, to our astonishment, we found we were curing everybody.
0:40:51 > 0:40:54Crofton's idea was simple.
0:40:54 > 0:41:01The key for defeating TB was to attack it with a course of all three antibiotics rather than just one.
0:41:01 > 0:41:04He gambled that whilst the disease may have developed resistance
0:41:04 > 0:41:09to one of the drugs, it was unlikely to be resistant to all three.
0:41:09 > 0:41:16We ensured that everyone, whether they were waiting in hospital or out of hospital,
0:41:16 > 0:41:18had the new treatment,
0:41:18 > 0:41:23and the steadily rising annual increase
0:41:23 > 0:41:27went down by 59% in three years.
0:41:29 > 0:41:34The treatment became known all over the world as the Edinburgh method.
0:41:34 > 0:41:41By 1960, Crofton and his team had completely eradicated TB from the city.
0:41:41 > 0:41:47The Edinburgh method completely transformed the way Scotland treated TB sufferers,
0:41:47 > 0:41:52ending the need to confine people to sanatoriums, cut off from their jobs, homes and families.
0:41:52 > 0:41:56When we saw how well things had gone,
0:41:56 > 0:42:01I thought we might be able to treat them without changing their lives at all.
0:42:01 > 0:42:06And of course for breadwinners and mothers of families, this was very important.
0:42:08 > 0:42:11John Crofton's Edinburgh method was the first treatment
0:42:11 > 0:42:16that demonstrated humanity's oldest plague could be cured.
0:42:16 > 0:42:23But TB is a complex disease, and like malaria, drug resistance is an ongoing problem.
0:42:23 > 0:42:30Each generation of doctors has to confront a disease that has mutated and adapted.
0:42:30 > 0:42:36As he approaches his 100th birthday, Sir John Crofton is still involved in fighting TB.
0:42:36 > 0:42:39His Edinburgh method is credited with saving ten million lives.
0:42:45 > 0:42:50The 1950s were a time of great optimism in Scottish medicine.
0:42:50 > 0:42:55Old scourges were on the wane and the NHS provided a safety net
0:42:55 > 0:42:58from the grave all the way back to the cradle.
0:43:01 > 0:43:06In 1958, thanks to a Scottish doctor, life before the cradle
0:43:06 > 0:43:08became visible for the first time.
0:43:17 > 0:43:20Very few of the other junior doctors were interested.
0:43:20 > 0:43:26The pictures were very grainy at that time, but I just loved the imaging.
0:43:26 > 0:43:28I really loved that side of it.
0:43:28 > 0:43:34This is a pregnancy of about 18 to 20 weeks gestation
0:43:34 > 0:43:38in which the foetal head is well outlined in this sectional view.
0:43:38 > 0:43:43Ian Donald had this belief, and this is the strength of the man,
0:43:43 > 0:43:47he just knew this was the way forward.
0:43:50 > 0:43:52It is no exaggeration to forecast that in the near future,
0:43:52 > 0:44:00more sophisticated equipment will permit the pioneering of whole new areas of medical diagnosis.
0:44:05 > 0:44:08He was quite a frightening character.
0:44:08 > 0:44:13He was quick thinking, always firing questions at you,
0:44:13 > 0:44:16and he had a quick temper as well.
0:44:16 > 0:44:21Born in Paisley in 1910, Ian Donald was professor of midwifery
0:44:21 > 0:44:28at Glasgow University, leading a team of doctors which included a young Stuart Campbell.
0:44:28 > 0:44:33Although treatment of childbirth had improved immensely since James Simpson first applied chloroform,
0:44:33 > 0:44:38the nine months of pregnancy remained a mysterious and uncertain time.
0:44:39 > 0:44:43A patient would come to the antenatal clinic, you'd take her blood pressure and you'd test the urine
0:44:43 > 0:44:49and you'd feel her abdomen, and you really had no idea how old the foetus was, was it growing properly?
0:44:49 > 0:44:51There was a lot of guesswork in it.
0:44:51 > 0:44:55But Ian Donald's interests did not stop at medical science.
0:44:55 > 0:44:59He was fascinated by the latest engineering technology
0:44:59 > 0:45:05being used in the shipyards on the Clyde only a few miles from his office.
0:45:05 > 0:45:08When an ultrasonic beam, in its passage through metal,
0:45:08 > 0:45:12for example, encounters a flaw,
0:45:12 > 0:45:17a blip can be made to appear on a cathode ray tube.
0:45:17 > 0:45:25He went to Kelvin Hughes, an engineering company in Glasgow, and asked to use their flaw detector.
0:45:25 > 0:45:30He took a series of tumours and he saw the reflected wave from these tumours.
0:45:30 > 0:45:34That was A-scan, that was very simple ultrasound.
0:45:34 > 0:45:39This is the two-dimensional automatic scanning apparatus
0:45:39 > 0:45:44which can scan either in longitudinal or transverse section.
0:45:44 > 0:45:49Ian Donald believed that ultrasound could be adapted and applied to pregnancy.
0:45:51 > 0:45:54In the old days with Ian Donald,
0:45:54 > 0:45:58you had a probe you turned it and you moved it over the abdomen
0:45:58 > 0:46:02and you almost kind of painted an image on the screen.
0:46:02 > 0:46:05But not everyone was convinced.
0:46:05 > 0:46:08There was huge scepticism. I mean,
0:46:08 > 0:46:15people would look at these images, and the early images were very fuzzy,
0:46:15 > 0:46:20and if you were used to looking at them you knew what they were.
0:46:20 > 0:46:25But people were actually laughing at some of the images and said we can't make anything out of these.
0:46:27 > 0:46:30This diameter is recognised by the simultaneous recording
0:46:30 > 0:46:35of large echoes from the near and far walls of the foetal skull.
0:46:35 > 0:46:39The posterior uterine wall may show up as well.
0:46:39 > 0:46:42I can remember the coffee room chat that this would never work.
0:46:42 > 0:46:45And it takes a tough person to keep going
0:46:45 > 0:46:48when you hear that sort of thing.
0:46:48 > 0:46:54Ian Donald ignored the doubters and started using his scanner on expectant women in Glasgow.
0:46:54 > 0:46:58It transformed their experience of pregnancy.
0:46:58 > 0:47:05With ultrasound, the woman became part of the examination and that's another great strength of ultrasound.
0:47:05 > 0:47:08The woman is lying there looking at the image
0:47:08 > 0:47:13and you are pointing out this is your baby's nose. This is your baby's spine.
0:47:13 > 0:47:16This is your baby's fingers...
0:47:16 > 0:47:20You are involving her in her pregnancy.
0:47:20 > 0:47:24Glasgow's doctors and parents now had knowledge of pregnancy
0:47:24 > 0:47:27that no-one in the world had ever had before.
0:47:27 > 0:47:30One of the last mysteries of life was unravelling.
0:47:33 > 0:47:36With the advent of ultrasound, everything changed.
0:47:36 > 0:47:40We knew precisely how old the foetus was if you measured it early enough.
0:47:40 > 0:47:43You could tell its rate of growth.
0:47:43 > 0:47:47You could tell if there was any abnormality in the foetus.
0:47:47 > 0:47:53Abnormality of the brain, the spine, the heart, the kidneys, fingers, toes - you could tell these things.
0:47:53 > 0:47:58Ultrasound introduced the foetus to the world
0:47:58 > 0:48:04and the flickering image of the unborn baby became a powerful symbol of human life.
0:48:04 > 0:48:12The dilemma of Ian Donald came when ultrasound became so good that it was diagnosing foetal abnormalities.
0:48:12 > 0:48:16Foetuses with no kidneys or with major heart defects,
0:48:16 > 0:48:19huge spina bifida.
0:48:19 > 0:48:23Women wanted termination of pregnancy and most doctors were sympathetic to that.
0:48:23 > 0:48:28That caused a crisis for Ian Donald because he was anti-abortion.
0:48:28 > 0:48:31He just felt the sanctity of life meant
0:48:31 > 0:48:36that you should never terminate a human being.
0:48:36 > 0:48:43Ian Donald lost the argument, and in 1967 abortion was legalised.
0:48:43 > 0:48:48He had pioneered a technology that, by giving women more information about their pregnancies,
0:48:48 > 0:48:52often gave them more confidence to make the decision to terminate.
0:49:01 > 0:49:08But today, as ultrasound technology has improved, the reality of life in the womb has become clearer.
0:49:17 > 0:49:21The foetus will start to show facial expressions as early as 18 weeks,
0:49:21 > 0:49:26and you can see so many things like thumb sucking, the foetus grasping.
0:49:26 > 0:49:33Ian Donald would have loved this because it makes the foetus really human.
0:49:33 > 0:49:37And really now the continuum
0:49:37 > 0:49:42between prenatal and postnatal life
0:49:42 > 0:49:46is demonstrated beautifully by this technique.
0:49:56 > 0:50:01Today, the technology Ian Donald adapted from the rusty yards of Clydeside
0:50:01 > 0:50:04can be found across the world.
0:50:04 > 0:50:11It is used in the treatment of infertility, of cancer and of gynaecological disease,
0:50:11 > 0:50:14as well as managing pregnancies.
0:50:14 > 0:50:18It is the biggest advance in the history of obstetrics and gynaecology.
0:50:18 > 0:50:21In the history of the care of women and the care of pregnancy,
0:50:21 > 0:50:24it is the single biggest advance.
0:50:24 > 0:50:26No two ways about it.
0:50:28 > 0:50:34Since the 1967 Abortion Act, the ethical challenges faced by doctors have multiplied.
0:50:37 > 0:50:42And in 1997 a living, breathing ethical challenge trotted out of a pen
0:50:42 > 0:50:47in the Roslin Institute near Edinburgh and sniffed her nostrils at a disbelieving world.
0:50:49 > 0:50:53We knew that this was an extraordinary scientific achievement,
0:50:53 > 0:50:57probably the most important thing we would ever been involved in.
0:50:57 > 0:51:01Dolly was Scotland's most recognisable sheep
0:51:01 > 0:51:05and at the same time she was the least individual sheep
0:51:05 > 0:51:11in the country. She was a genetically engineered exact clone of another sheep
0:51:11 > 0:51:15created by a process known as nuclear transfer.
0:51:15 > 0:51:19To do a nuclear transfer, you have to have two cells.
0:51:19 > 0:51:23You have to have an egg taken from an animal at the time when normally she would be mated.
0:51:23 > 0:51:27And you remove the genetic information.
0:51:27 > 0:51:33The other cell that you need can come from another animal and that cell will provide the genetic information
0:51:33 > 0:51:36which you introduce into that egg,
0:51:36 > 0:51:41and that genetic information will determine all of the characteristics of the resulting offspring.
0:51:41 > 0:51:44Dolly marked the birth of a new era in medicine.
0:51:44 > 0:51:51The technology that created her could be used to treat and defeat genetic diseases.
0:51:51 > 0:51:58Let's say there is a human infection which doesn't produce antibodies in humans, like HIV, for example.
0:51:58 > 0:52:02Or let's say you're thinking about a cancer which doesn't produce an immune response.
0:52:02 > 0:52:07It may be possible to inject proteins from this virus or cancer into Dolly,
0:52:07 > 0:52:12produce an immune response, collect antibodies, either from milk
0:52:12 > 0:52:19or from the blood, and hopefully have a new way and a more effective way of attacking that particular disease.
0:52:19 > 0:52:23The benefits of this technology could touch the lives
0:52:23 > 0:52:26of every individual, every family, on the planet.
0:52:29 > 0:52:34We all know people, sadly, who are suffering from or have suffered from these degenerative diseases.
0:52:34 > 0:52:38I think one of the exciting things in human biomedical research
0:52:38 > 0:52:40is to think that, over a period of time,
0:52:40 > 0:52:44it's very likely that new treatments for these diseases will come along.
0:52:48 > 0:52:52But Dolly's birth provoked huge ethical concerns.
0:52:52 > 0:52:58I think the thing which made most people concerned was the idea of reproductive cloning of people.
0:52:58 > 0:53:03There were magazine covers with copies of Hitler and things like that.
0:53:03 > 0:53:06But it's the kind of thing in Boys From Brazil -
0:53:06 > 0:53:10they just make good stories. They're not realistic.
0:53:10 > 0:53:16I think we should ask what it would like to be a clone, a genetically identical twin of anybody else.
0:53:16 > 0:53:20It might be suggested, for example,
0:53:20 > 0:53:25that a couple who can't have children might have a clone.
0:53:25 > 0:53:28So you can put genetic information from the husband into an egg
0:53:28 > 0:53:32from the woman and produce a genetically identical twin to the father.
0:53:32 > 0:53:39I just don't think people would react to that child in a way you would react to a normal child.
0:53:39 > 0:53:46The Roslin team insisted Dolly was a force for good and not a harbinger of a terrible new world.
0:53:46 > 0:53:48Over the next 20, 50 years,
0:53:48 > 0:53:54I think we can expect to see treatments coming forward for all sorts of diseases.
0:53:54 > 0:53:58There are other neuro-degenerative diseases, psychiatric diseases,
0:53:58 > 0:54:04asthma, metabolic diseases. There are a huge range of diseases
0:54:04 > 0:54:06which people inherit which are not understood
0:54:06 > 0:54:09and for which there isn't an effective treatment at this time.
0:54:09 > 0:54:14I have no doubt that the benefits from this research
0:54:14 > 0:54:20far outweigh the disadvantages, and that is the balance that we and society should make.
0:54:22 > 0:54:26As Dolly aged, her own health problems multiplied.
0:54:26 > 0:54:34We became aware after a few years that she was limping, that she had some damage to a joint, to her knee.
0:54:34 > 0:54:38We have no real way of knowing whether it was because of cloning
0:54:38 > 0:54:44or she lived indoors and she was rather heavy so it's possible it was just unusual wear and tear.
0:54:44 > 0:54:48In 2003, Dolly developed lung cancer.
0:54:48 > 0:54:52It signalled the end for Scotland's world famous sheep.
0:54:53 > 0:54:56I think everybody there was shocked as to how bad the tumour was.
0:54:56 > 0:55:01We actually decided it was kinder not to let her recover so she was euthanased.
0:55:01 > 0:55:05In her short life Dolly changed medical science,
0:55:05 > 0:55:11laying the foundations for many of the advances we will see in the 21st century.
0:55:11 > 0:55:16Now medical science will increasingly focus on the building blocks of life itself
0:55:16 > 0:55:20as a means of treating disease and keeping us in good health.
0:55:20 > 0:55:28Today in Edinburgh, doctors are experimenting using embryonic human stem cells.
0:55:28 > 0:55:32This ground-breaking work could change the lives
0:55:32 > 0:55:36of millions of people in every corner of the world.
0:55:36 > 0:55:42There are some estimates that up to 150,000 women a year
0:55:42 > 0:55:45die of haemorrhage after giving birth,
0:55:45 > 0:55:50many of whom would be saveable if we had a more secure blood supply.
0:55:50 > 0:55:57Professor Turner and his team are attempting to culture disease-free blood from stem cells.
0:55:59 > 0:56:04Even in Scotland, we still run short of blood from time to time,
0:56:04 > 0:56:08but if you look worldwide there are more serious problems in many countries.
0:56:08 > 0:56:12Our ultimate vision is that we might be able to provide blood
0:56:12 > 0:56:16which is of a universal donor type - O Rhesus negative -
0:56:16 > 0:56:20that is shown to be free of infection
0:56:20 > 0:56:25and in quantities required particularly for those countries
0:56:25 > 0:56:28which are not able to support a blood service themselves.
0:56:30 > 0:56:37I think potentially in the very long term, the work could have a very great impact on many people.
0:56:37 > 0:56:43The work of Dr Turner and his team is the latest in a long line of innovation
0:56:43 > 0:56:47to have sprung from the Scottish tradition of medical excellence.
0:56:47 > 0:56:50It is a tradition which champions curiosity and humanity
0:56:50 > 0:56:56and which is unafraid of challenging accepted wisdoms.
0:56:57 > 0:57:04Usually, a new technology will bring forward potential benefits, but also potential risks.
0:57:04 > 0:57:09You can go back hundreds of years when somebody put a sharp stone onto a stick and they had an axe.
0:57:09 > 0:57:12They could kill people or they could chop firewood.
0:57:12 > 0:57:19It's just a fact of life, and what we have to do is try and see that we take the maximum possible benefit.
0:57:19 > 0:57:26And I think we should be excited by the new opportunities rather than being too afraid by them.
0:57:26 > 0:57:30Pioneers, by and large have it hard,
0:57:30 > 0:57:36because the medical profession and the public sometimes
0:57:36 > 0:57:40are fairly conservative in their approach to things.
0:57:40 > 0:57:44But again, a tough guy wins through in the end, if he's right.
0:57:46 > 0:57:52From the taverns of Enlightenment Edinburgh to the operating theatres of he world,
0:57:52 > 0:57:58Scotland has built a tradition of humane and ingenious medical innovation.
0:57:58 > 0:58:02Scottish medical tradition lives on.
0:58:02 > 0:58:06It's certainly one of the long-term effects of the Enlightenment -
0:58:06 > 0:58:11the view that nature
0:58:11 > 0:58:15can be changed rationally by human intervention for the better.
0:58:15 > 0:58:17Subtitles by Red Bee Media Ltd
0:58:17 > 0:58:19E-mail subtitling@bbc.co.uk