Blood The Scots Who Made the Modern World

For three centuries, Scotland's doctors

have been transforming the health and wellbeing of the entire world.

It's been estimated that he might have saved over 200 million lives.

They have pushed the boundaries of human knowledge forward.

Operation by operation,

discovery by discovery,

decade by decade.

It changes the course of history.

It changes the way our culture views illness.

Shaping life from the cradle to the grave.

Hunter...

Simpson...Fleming...

and many more.

This is the story of how doctors in Scotland made the modern world.

In the 18th century, before the discovery of anaesthetics, surgery meant pain.

PATIENT YELLS

In the 18th century,

operations were very different to surgical operations today.

No concept of antisepsis or asepsis,

no knowledge of germs as a cause of infection,

no anaesthesia, so your patients would be conscious

throughout the operation.

Surgery was something to be avoided basically,

at all costs, if at all possible.

So surgery was always the last resort.

There was a lovely phrase used by surgeons and people writing about surgery in the early 19th century.

It's called "bottom". Patients demonstrated bottom -

this reserve of strength and stoicism that I think would be quite remarkable by today's standards.

Surgery was dangerous.

Death by loss of blood, infection or trauma was common.

One Scotsman was determined to change this.

John Hunter was born the tenth son of a farmer in what is now East Kilbride in 1728.

He would transform the way the world looked at medicine and at life itself.

What John Hunter did was to encourage surgeons

to think of the body not just as something

they should operate on, but as something they should understand.

He wanted his students to comprehend what he called the "animal economy".

Sounds a very strange term today, but it's really what we mean now by "biology".

And John Hunter said that only by understanding how bodies worked

could a surgeon operate effectively to treat an injury or cure a disease.

In the 18th century, surgeons seldom got involved in studying the human body.

When they cut someone open, they didn't hang around to look inside.

But Hunter was obsessed by how nature worked. He believed that

if surgeons didn't understand the workings of the human body, surgery would remain primitive and painful.

He wasn't afraid to get his hands dirty.

He understood that if you really wanted to know what was happening in the body,

there was no way other than to dissect and to observe for yourself.

By dissecting and studying the human body,

Hunter developed a deep knowledge of the intimate workings of life. And he didn't stop at humans.

If it had a pulse, John Hunter knew he could learn from it.

The Hunterian Museum today contains over 300 different species

of plants and animals all studied by John Hunter.

He kept a leopard, other large cats, and he also used the private menageries in London

as a source for animals to study

and dissect. The museum's been called

"John Hunter's unwritten book"

because it was designed to be read by his students as a source of

information that would help them in their careers as surgeons.

Armed with a peerless knowledge of anatomy, Hunter began to challenge the conventional wisdom of surgery.

One of the remarkable things about John Hunter is he's been called the "reluctant surgeon".

He would only operate if he absolutely had to.

And one of the reasons why he was so reluctant was that through his museum

he built up an understanding of what the body could do to heal itself.

He saw the surgeon's job as aiding that natural process of recovery.

And so Hunter wouldn't operate unless he was absolutely sure that he could do some good,

in comparison with many of his contemporaries, who were quite gung ho

when it came to laying into patients with the knife.

Hunter's knowledge of how the body worked guided his approach to surgery.

He would observe, study, think,

and then devise a delicate operation based on his observations of how the body itself worked.

Aneurisms for example, swellings in arteries,

Hunter treated not by cutting in to the aneurysm itself,

which would inevitably lead to the patient bleeding to death

but by making an incision elsewhere,

tying off the artery, cutting off the blood supply

and relying on what's known as a collateral circulation,

a kind of natural bypass, to maintain the blood supply to the affected limb.

It was a very elegant operation.

John Hunter was the first man to introduce a genuinely scientific approach to surgery

and his techniques remain pillars of surgery to this day. He is credited with

groundbreaking developments in the treatment of gunshot wounds, venereal disease and inflammations.

As well as transforming our understanding of the digestive and lymphatic systems.

John Hunter's work, I think, brought out the fundamental workings

of the human body in a way that hadn't been achieved before.

His legacy was a generation of British surgeons

committed to pushing forward their knowledge of human life.

What John Hunter did was to encourage students to dissect bodies themselves

and get a kind of hands-on feel for what the body was like.

John Hunter created a whole generation of surgeons

who were familiar with the body, health and disease and could apply that knowledge in their practice

when they were treating patients.

I know surgeons today still revere him,

and I meet surgeons who've gone into medicine because they were

inspired by reading John Hunter's story,

so he's still an important figure in surgery today.

John Hunter's scientific approach to surgery and disease

was typical of a new group of intellectuals from Scotland.

John Hunter was definitely part of what's now called the Scots' enlightenment.

The group of educated men

who established themselves not just in medicine but in law and other professions in the 18th century.

What John Hunter did was to make surgery

a part of that Scottish enlightenment.

By the time of Hunter's death,

Scotland was the most important centre for medical learning in the world.

Nine out of ten doctors in Britain were trained here.

In the first half of the 18th century,

Scottish universities produced 30 times as many medical graduates as Oxford and Cambridge combined.

And the reason for Scotland's pre-eminence was the enlightenment.

An extraordinary flowering of ideas that transformed the way

Scotland looked at the world and the way the world looked at Scotland.

The enlightenment was a Scottish manifestation of learning

that was applying knowledge for improvement.

People envisaged improvement through lifestyle, technology,

through social organisations.

In drawing rooms and in taverns, intellectuals from every field

met and discussed new discoveries and theories.

That's one of the essences of the Scottish enlightenment -

conviviality.

Pleasure in depth, especially through drink.

Um...well into the night.

The medics would be conversing with the historians, the political scientists,

the legal philosophers, but the thing that focused each of them

was their interest in society, in humanity.

Enlightenment philosophy transformed the way medicine was taught in universities.

The whole philosophy behind the universities was one of investigation,

so the Scots doctors were actually nearly always philosophers

and natural historians,

they had a real desire to learn about the world and find out the causes of things.

The result was an army of medical graduates eager to

experiment, investigate, and solve the mysteries of life itself.

What stamps the Scottish enlightenment to a large extent is the emphasis on,

if you like, humanity.

What makes human beings tick?

John Hunter may have armed surgeons with a new understanding of what made human beings tick,

but despite his work, surgical mortality rates remained high.

For serious operations, there was barely a one-in-three chance of the patient surviving.

You would be tied down or you would be held by strong people.

You might be given laudanum,

which is a mixture of opium and alcohol, if you were lucky.

Or perhaps a swig of brandy or something.

And then you would more or less be fully conscious as the knife went in.

It had to be swift and brutal. The thing was to

get through the skin as fast as possible.

The surgeons were famously slick at doing this,

large curved knives and so forth.

Woe betide anyone who got their fingers in the road when this was being done.

By the mid-19th century, the most famous surgeon in Britain was Robert Liston from Lilnlithgow.

He had a fiery temper and a self-assurance that bordered on arrogance.

He had fallen out with most of his peers in Edinburgh who disliked his showy technique.

His operations were public events.

Spectators would come and see if Liston could break his own record for a speedy amputation.

Liston was a fast operator.

It was said he could take off someone's leg in under a minute.

And of course when your patient was conscious,

operating quickly but safely was a very useful skill for a surgeon to have.

Well, the surgical heroes in those days were the fastest.

He was the fastest of the fast.

Liston was more than just a showman.

By operating quickly, he was able to minimise the pain of his fully conscious patient.

But being fast did not always mean being successful.

He was amputating a patient's leg.

During the amputation, he managed to cut off the finger of his assistant

who was holding down the patient. The assistant later succumbed to an infection and died.

Someone in the audience was so shocked by this that

they had a heart attack and died. The patient died.

One operation with a 300% mortality rate.

Liston knew that as long as the patient remained conscious,

surgery would remain a dangerous experience for patient and doctor.

In 1846, he heard that dentists in America

were experimenting with the chemical, ether,

which could anaesthetise patients during operations on their teeth.

It wasn't very pleasant.

Ether was very pungent. The patient did sort of groan and moan a bit,

but it was successful enough to convince everyone there

that this technique had something in it.

Liston knew that if he could apply ether during major surgery, he would vastly increase the chances

of the operation's success and remove the pain suffered by the patient.

He was determined to be the first man in Europe to perform an operation using the chemical.

In December 1846, he operated on Frederick Churchill,

a butler with an infection in his leg.

Liston used ether, amputated the leg.

He did the operation quickly of course, because he wasn't sure how ether would work.

But it was so effective that the patient came round afterwards and asked when the operation would begin.

Robert Liston's use of ether marked the beginning of a new era in British medicine.

It meant that pain could be removed from the art of surgery forever.

The introduction of anaesthesia gave surgeons much more freedom

to operate and to carry out a wider range of procedures than they'd been able to before.

For another Scottish doctor, James Young Simpson,

anaesthesia opened up a whole new world of possibilities in the fight against pain.

Simpson's belief was that the physician had two purposes.

One was obviously to preserve life but second was also to alleviate suffering wherever possible.

But Simpson's view of pain was not shared by all his fellow doctors.

Pain was really looked upon as being

a stimulant at a time of great stress to the body.

Pain would keep the body going during the operation.

And in religious circles, pain was believed to have a divine purpose.

Pain was suffering, which was really a physical expression of man's

original sin in the garden of Eden and you sort of grew with it and tolerated it.

But Simpson saw the potential of anaesthesia to soothe one of the most sacred painful events in life -

childbirth.

The religious argument about pain in childbirth had always tracked back to

the original Hebrew saying, "Sorrow thou shalt bring forth children."

This was known as the curse of Eve.

Simpson, a religious man himself, was unconvinced.

Simpson argued that the word, sorrow, had always been misinterpreted. That rather than pain,

sorrow should be interpreted as the physical excursion, the labour of giving birth,

and that if you give anaesthesia, that takes away the pain but doesn't actually halt the contractions.

So therefore you're not interfering with the process.

Simpson disregarded religious objections and concentrated

on finding an anaesthetic suitable for childbirth.

Simpson had taken up ether as soon as it had been announced and he found it to work satisfactorily

but he knew that patients didn't like it because it was irritant, it was pungent, it was difficult to breathe

so he set about looking for another volatile chemical

that would have, as he said, ether's advantages without its disadvantages.

Simpson's assistants scoured Britain's pharmacies to prepare a menu of exotic chemicals

for Simpson and his friends to test on themselves at Edinburgh dinner parties.

On the 4th November 1847 he tried a sweet colourless liquid called chloroform.

It's faster acting than ether.

It basically goes into the bloodstream via the lungs and then it goes up to the brain.

And within minutes they're all unconscious

and as Simpson came round he's reputed to have said, "This is much stronger and much better than ether."

One week later, Simpson used chloroform on a patient for the first time.

She gave birth to a healthy baby girl and named her Anaesthesia.

Simpson went on to become the personal physician to Queen Victoria.

His advocacy of chloroform was given official sanction

when she gave birth to her eighth child, Prince Leopold, whilst under the influence of the drug.

The work of Simpson, Liston and Hunter had immense medical and social implications.

Together, these Scottish doctors had transformed understanding of the human body, pushed the boundaries

of surgery and most fundamentally, challenged our understanding of pain itself.

Pain went from being something that was a natural part of medicine,

illness, that kind of process, to being something which can be managed, reduced, eliminated.

In some respects seeing your living skeleton is horrifying.

It reminds us of our own mortality.

We are mortal. We are all walking skeletons.

We don't like to be reminded of this.

By the end of the nineteenth century,

pain was in retreat.

The next medical challenge was to diagnose ailments and disease without using a knife at all.

One Scottish doctor, John Macintyre, would become the first

to master the art of seeing inside the living body.

John Macintyre was born in Glasgow. He grew up in Glasgow.

Spent his working life in Glasgow. And he died in Glasgow.

He was a Glaswegian through and through. And that defined the man.

The phenomenon that was to make Macintyre's name

was first spotted in November 1895 by German scientist, Wilhelm Rutgen.

He was experimenting with cathode rays in a glass bulb in his laboratory.

He saw that a fluorescent screen lit up at some distance away and he

couldn't explain that, because the glass bulb was covered with card.

Rutgen realised that something was penetrating the card

and illuminating the screen on the other side of the room.

This was something entirely new.

It couldn't be explained by traditional 19th century physics and therefore he called it X.

Rutgen had accidentally discovered the X-Ray.

For advice, he turned to Europe's most pre-eminent physicist,

Lord Kelvin of Glasgow University.

It is difficult for us now to appreciate how astonishing this actually was.

And then prior to that, the only way you saw inside the body was either on the graveyard, the battlefield,

the mortuary or the operating theatre.

Kelvin was intrigued and enlisted the help of John Macintyre,

the chief electrical engineer at Glasgow's Royal Infirmary.

Macintyre was already pioneering the use of electrical equipment in medicine.

At this time the use of electrical apparatus in medicine was increasing very dramatically.

He was very interested in looking inside the body and so he was using

batteries and very small electric barbs to look inside the body.

Straightaway, Macintyre realised that Rutgen's mysterious rays would transform medical technology.

But elsewhere, X-Rays promised not advancement but amusement.

In New York there was a law passed that said you weren't allowed to use X-Ray's and opera glasses.

The idea was you'd go into a theatre with people dancing on the stage. You take your opera glasses with

X-Rays in. You can actually see them without their clothes on.

Whilst the world contemplated being able to see through women's clothes,

in Glasgow, Macintyre had been busy building the world's first Diagnostic Radiology department.

Only four months had passed since Rutgen's discovery.

I think the astonishing thing is how advanced he was at really quite an early stage.

He took radiographs of really quite deep statures of the body whist other people were still looking at

peripheral parts of the body, such as hands and feet.

Macintyre took the first X-Rays of kidney stones and made these first moving X-Ray shots of a frog's leg.

The people of Glasgow became the first in the world to benefit from what he called the new light.

Towards the end of the 19th century, they basically thought that everything had been worked out.

Physics was understood. Chemistry was understood.

Medicine had been worked out. What more discoveries could be made?

And along came the X-Rays that completely changed the way we look at ourselves.

To see inside the living body which is something entirely unexpected.

X-Rays reached parts of the body that other medical technology couldn't reach.

Macintyre had pioneered the next great leap in medical science.

While patients in Scotland and the west were enjoying the benefits of new technology...

in the rest of the world people were dying from the same

ancient diseases which had been killing human beings for centuries.

The infection begins when the mosquito bites

and injects infective stages into your blood.

After the gestation period in the liver

the parasites burst out and then take up residence in your red blood cells

which carry oxygen around the body.

That causes a tremendous amount of blood loss and that's

the first signs of the infection.

The symptoms can include nausea, fever, vomiting,

headaches, chills, muscle pain.

Inevitably as the parasites destroy your red blood cells you become

anaemic and some people can even die from pronounced anaemia.

Just over 40% of the world's population live in areas where malaria is transmitted.

Malaria is one of the most ancient and deadly diseases known to man.

A disease that thrives in tropical climates in which would become an

obsession of doctors from a much colder and wetter part of the world.

The British Empire was expanding and almost an inevitable consequence of that

was that you had Scottish doctors manning the clinics in the empire.

Looking at the patients who are coming in with the tropical infectious diseases.

Scots doctors were the first to identify the causes of those particular diseases.

One of these doctors was Patrick Manson from Old Meldrum in Aberdeenshire.

Patrick Manson's discovery that a multitude of diseases could be transmitted from one person

to another or even from an animal to a person through the medium of what we call a vector.

Insects, bugs, fleas and so on.

It really opened our eyes to tropical medicine.

Manson speculated that malaria could be transmitted by mosquitoes.

When people thought that Manson was mad and people used to walk

along around the streets of this area here, flapping their wings or their arms.

But Manson's mosquito theory attracted the attention

of Ronald Ross, a little known Scottish doctor working with the British Indian army.

He was initially not terribly interested in medicine.

He wanted to be an artist and he spent most of his early

years in India writing novels, composing poems, writing music, playing golf, tennis, cycling.

But after witnessing firsthand the devastating effects of malaria

which was killing over one million people in India every year,

Ross turned his considerable energy into fighting the disease.

His partnership with Manson was to change the world.

Manson by this stage was feeling too old to go back out

to the tropics and in Ross he found a willing protege to go and carry out that work on his behalf.

The critical thing was if you could really show that malaria

was transmitted by the mosquito you have a means of dealing with malaria.

You can control the mosquito and therefore prevent transmission of the disease.

Ross returned to India and set about confirming Manson's theory.

He would take malaria patients and there were no shortage of those in India at the time

and he would collect mosquitoes and he would breed mosquitoes himself and he would feed those mosquitoes on

his malarias patients. And then, with extraordinary patience

spend the next several weeks methodically dissecting

those mosquitoes in order to see whether they had picked up the parasites or not.

It was physically incredibly demanding.

In fact he frequently complained of great eye strain as he was literally

looking down a microscope for hours on end, hoping to find

-parasites in the mosquito.

-But luck was against him.

There are two kinds of mosquito.

One that transmits malaria and one that doesn't.

And he chose the most common one, which unfortunately did not transmit malaria.

Seeing no proof of a link between mosquitoes and malaria, Ross became disheartened.

Manson was constantly cajoling Ross through a phenomenal correspondence.

They're writing to each other long letters, pretty much every week over the next two years.

Ross usually complaining that he's looked at another 10,000 mosquitoes without seeing any malaria parasites

and Manson explaining to him the rewards of making the connection are so great he must continue.

Manson famously told Ross that his quest was the quest for

the Holy Grail and Ross needed to consider himself to be Sir Galahad.

The weather became very hot again in August.

At first I toiled comfortably but then as failure followed failure

I became exasperated and worked till I could hardly see

my way home in the late afternoons.

The screws of my microscope were rusted with sweat from my forehead and hands.

Ross decided to switch his focus to a different breed of mosquito.

On the 20th August 1897,

he noticed something strange inside an anopheles mosquito.

Ross would have seen these banana shaped structures and he would have known that they couldn't be produced

by mosquitoes and they weren't part of the patients blood so they had to be parasites of some kind.

He was absolutely elated.

Having looking at literally tens of thousands of mosquitoes

without showing the link, when eventually he showed it, he was absolutely ecstatic.

Ross had proved Manson's hypothesis that mosquitoes transmit malaria.

This was an immense discovery in itself.

But Ross persisted and was able to reveal for the first time,

the entire complex life cycle of the disease.

He showed that not only do mosquitoes pick up the parasites from one individual.

The same mosquito would then transmit those parasites

to the next individual.

Ross had unravelled the mystery of one of mankind's greatest enemies.

It was a quantum leap as happens in many areas of science.

It's been estimated that he might have saved over 200 million lives.

Ross was awarded the Nobel Prize in 1902.

The first Britain to win the award.

Armed with knowledge of how the parasite transmits malaria,

governments were able to devise methods to combat the disease.

Within a few decades of Ross' discovery, malaria was in retreat all over the world.

But it is a stubborn disease

and in recent years has fought back against the drugs designed to contain it.

One problem is the drugs that we developed to target parasites with

very quickly become ineffective because the parasites evolve resistance to these drugs.

Today in Edinburgh, Sarah Reece leads a team of doctors

who are revisiting the first principles of Ross' work.

If we can understand more about the biology of the parasites, and why they've evolved to do what they do,

we can understand and make predictions about how they're likely to evolve

to new drugs and new vaccines.

I think all malaria research over the last 100 or so years

is built on the work of Ross because it was such a foundation to be able to have the life cycle

to go on.

Thirty years after Ross' momentous work, another little known Scottish doctor

stumbled upon a discovery that would save even more lives.

It changes the course of history.

It changes the way our culture views illness.

In this tiny lab one of the most momentous discoveries in medical

history was made by the son of a tenant farmer from Ayrshire.

There's some people who know about engines and they know how that engine feels,

sense when something's about to go wrong and when it's running smoothly.

Well, Alexander Fleming knew about bacteria. He could make them grow.

He could dry them.

He could make patterns with them.

He was a real genuine craftsman.

In 1928, Alexander Fleming was preparing vaccines in his lab

at St. Mary's Hospital in Paddington.

Before leaving for a holiday in Sussex, Fleming left several plates of bacteria on his workbench.

When he returned, something caught his eye.

He observed that a mould

on a dish was stopping bacteria growing possibly even killing them.

And he has a sense that this is interesting, whereas other people may not have noticed it.

Fleming was fascinated by the liquid oozing out of the mould, which appeared to be killing the bacteria.

He called it 'moljuice' and later renamed it penicillin.

Bacteria reproduce by splitting and building new cell walls.

First of all there was one bacterium, suddenly there's two bacteria.

And they do this every twenty minutes.

The penicillin stops the bacteria forming the cell walls that would protect them.

In 1928, these tiny bacteria were killers.

If they infected even the smallest wound, then medical science was virtually powerless.

If there was an infection, there was nothing much that could be done.

Famously the son of the President of the United States had in the 1920s

had got a sore on his foot from playing tennis.

Five days later he died.

And that was the son of the President of the United States.

The only method available for infected wounds was antiseptics.

Fleming had seen firsthand the drawbacks of these drugs.

In the first world war, where he'd been a doctor, he'd seen the failure

of using antiseptics on deep wounds.

Basically they damaged the body as much as they damaged the bacteria.

Fleming suspected that his mysterious new substance, penicillin could be useful in treating wounds.

But he lacked the expertise to turn his discovery into a medicine.

What he can't do at all is extract whatever it is that's

oozing out of the mould

into a medicine. The normal way you extract

crystals from a liquid is by heating the liquid, driving off the water and you're left with the crystals.

But the trouble is that penicillin is extremely fragile and the heating of it would destroy it.

Fleming sent samples of penicillin to academic colleagues and went back to work in his lab.

Penicillin remained an academic curiosity.

There was no great sense in 1928 that this was going to revolutionize medicine at all.

But in 1938, Dr. Ernst Chane, a Jewish scientist who had fled Nazi Germany,

and who was an admirer of Fleming,

decided to see if he could transform penicillin into a workable drug.

Chane picks on this problem, not because it's useful, but because it's scientifically interesting.

And it's a challenge to extract this.

Working with Oxford scientist, Howard Florry, Chane was able to

extract penicillin from Fleming's mould.

He gave this extract to lab mice.

It's administered to sick mice.

The sick mice who get the penicillin survive.

The sick mice who don't get it die.

It's a very obvious clean experiment.

Chane had confirmed what Fleming suspected.

That penicillin could be used to fight bacteria and illness.

SIRENS AND EXPLOSION

Penicillin arrived just when Britain needed it most.

Every night, casualties from German air raids died from wounds that penicillin could treat.

But in a nation on the brink of defeat there simply wasn't enough

capacity to produce penicillin on an industrial scale.

In April 1941, Howard Florry, was smuggled into the USA.

With him, he carried samples of penicillin.

America is already preparing for war.

America isn't in the war yet but it knows war is going to come.

Out of the reach of German bombs, US drug companies

were soon manufacturing penicillin on a massive scale.

There's enormous excitement about penicillin.

Penicillin could be used for wounds like gangrene and also for treating very badly injured soldiers.

Soldiers who otherwise would not have survived.

The idea that here there was a medicine that could cure those wounds

made a huge impact, not just on the soldiers, but on politicians.

Penicillin saved the lives of thousands of soldiers, as the war turned in the Allies favour.

Towards the end of the war, if a wounded soldier managed to get back

to his own lines and to medical care

then he had more than a 95% chance of survival.

The unassuming doctor from Ayrshire, who had originally discovered

penicillin, soon became the most famous doctor in the world.

It was expressed later that Britain was Greece to America's Rome.

Britain did the original brainwork and then America would develop it.

Well, that was exactly the role which was attributed to Fleming.

Fleming's modest demeanour made him the perfect hero for a world exhausted by war.

And his fame completely obscured that of Chane and Florry with whom he shared the Nobel Prize.

Fleming has a bit of luck and luck is often important in science.

There was no sense that he was systematically going out

to look for new phenomena. Rather, he was enough of a craftsman to see one

when it arrived.

What Fleming can be seen as, is like a Scottish explorer who sees a distant land.

He doesn't explore the land in detail but he's the first person to see it from a distance.

Penicillin marked the birth of modern medicine, as we know it today.

Lives would no longer be lost to simple infections.

Its arrival coincided with the National Health Service.

The most powerful drug in the world was now freely available to everyone.

The National Health Service is clearly one of the most remarkable,

historical developments in twentieth century Britain.

Everybody in the country, gender, class, ethnic origin, religion,

were going to be treated in exactly the same way.

This was like a new Magna Carta

for British and Scottish humanity.

But in this brave new world of free health care and all powerful wonder drugs,

there was one disease that even penicillin was unable to control.

Tuberculosis was the scourge of Scotland. It was just part of life.

People were noticed, and almost diagnosed

by the community as consumptive

and that was almost

a sentence of death.

It gripped Scotland's toxic cities, spreading freely in the polluted air.

I remember the smogs of Glasgow of the 1950s, which were totally debilitating.

It would stop you in the street and lead to tremendous problems that really affected your breathing.

Tuberculosis is one of the oldest plagues known to man affecting millions of people across the world.

It is spread by coughing, sneezing and simply breathing.

It is highly infectious.

In 1951 a young doctor took up the post

of professor of respiratory diseases at Edinburgh University.

The situation in Scotland was dire.

Between the wars

much more was done about slums in England than was done in Scotland.

Still very gross overcrowding after the war, and worse of course after the bombing.

In practically all other European countries,

the incidence came down

after the end of the war when nutrition and things were better.

Doctors hoped that the introduction of powerful antibiotics

might finally rid Scotland of the plague of TB.

There was a...

feeling then, because antibiotics, like penicillin,

only had to be given for a week or two, then you might get rid of tuberculosis quickly

with one medication.

But the results were patchy.

None of the three main antibiotics used to treat tuberculosis provided an effective cure.

John Crofton and his team of doctors in Edinburgh decided to find out why.

We spent our first two years

of research...

..besides doing all the clinical work of course, in looking at the causes of failure.

That these drugs worked in some places and not in others.

The answer lay in TB's ability to adapt to the drugs designed to kill it.

Two of the patients proved to have been infected by cells already resistant

to one of the two drugs. So we decided the safest thing was to start them on all three drugs.

And then, to our astonishment, we found we were curing everybody.

Crofton's idea was simple.

The key for defeating TB was to attack it with a course of all three antibiotics rather than just one.

He gambled that whilst the disease may have developed resistance

to one of the drugs, it was unlikely to be resistant to all three.

We ensured that everyone, whether they were waiting in hospital or out of hospital,

had the new treatment,

and the steadily rising annual increase

went down by 59% in three years.

The treatment became known all over the world as the Edinburgh method.

By 1960, Crofton and his team had completely eradicated TB from the city.

The Edinburgh method completely transformed the way Scotland treated TB sufferers,

ending the need to confine people to sanatoriums, cut off from their jobs, homes and families.

When we saw how well things had gone,

I thought we might be able to treat them without changing their lives at all.

And of course for breadwinners and mothers of families, this was very important.

John Crofton's Edinburgh method was the first treatment

that demonstrated humanity's oldest plague could be cured.

But TB is a complex disease, and like malaria, drug resistance is an ongoing problem.

Each generation of doctors has to confront a disease that has mutated and adapted.

As he approaches his 100th birthday, Sir John Crofton is still involved in fighting TB.

His Edinburgh method is credited with saving ten million lives.

The 1950s were a time of great optimism in Scottish medicine.

Old scourges were on the wane and the NHS provided a safety net

from the grave all the way back to the cradle.

In 1958, thanks to a Scottish doctor, life before the cradle

became visible for the first time.

Very few of the other junior doctors were interested.

The pictures were very grainy at that time, but I just loved the imaging.

I really loved that side of it.

This is a pregnancy of about 18 to 20 weeks gestation

in which the foetal head is well outlined in this sectional view.

Ian Donald had this belief, and this is the strength of the man,

he just knew this was the way forward.

It is no exaggeration to forecast that in the near future,

more sophisticated equipment will permit the pioneering of whole new areas of medical diagnosis.

He was quite a frightening character.

He was quick thinking, always firing questions at you,

and he had a quick temper as well.

Born in Paisley in 1910, Ian Donald was professor of midwifery

at Glasgow University, leading a team of doctors which included a young Stuart Campbell.

Although treatment of childbirth had improved immensely since James Simpson first applied chloroform,

the nine months of pregnancy remained a mysterious and uncertain time.

A patient would come to the antenatal clinic, you'd take her blood pressure and you'd test the urine

and you'd feel her abdomen, and you really had no idea how old the foetus was, was it growing properly?

There was a lot of guesswork in it.

But Ian Donald's interests did not stop at medical science.

He was fascinated by the latest engineering technology

being used in the shipyards on the Clyde only a few miles from his office.

When an ultrasonic beam, in its passage through metal,

for example, encounters a flaw,

a blip can be made to appear on a cathode ray tube.

He went to Kelvin Hughes, an engineering company in Glasgow, and asked to use their flaw detector.

He took a series of tumours and he saw the reflected wave from these tumours.

That was A-scan, that was very simple ultrasound.

This is the two-dimensional automatic scanning apparatus

which can scan either in longitudinal or transverse section.

Ian Donald believed that ultrasound could be adapted and applied to pregnancy.

In the old days with Ian Donald,

you had a probe you turned it and you moved it over the abdomen

and you almost kind of painted an image on the screen.

But not everyone was convinced.

There was huge scepticism. I mean,

people would look at these images, and the early images were very fuzzy,

and if you were used to looking at them you knew what they were.

But people were actually laughing at some of the images and said we can't make anything out of these.

This diameter is recognised by the simultaneous recording

of large echoes from the near and far walls of the foetal skull.

The posterior uterine wall may show up as well.

I can remember the coffee room chat that this would never work.

And it takes a tough person to keep going

when you hear that sort of thing.

Ian Donald ignored the doubters and started using his scanner on expectant women in Glasgow.

It transformed their experience of pregnancy.

With ultrasound, the woman became part of the examination and that's another great strength of ultrasound.

The woman is lying there looking at the image

and you are pointing out this is your baby's nose. This is your baby's spine.

This is your baby's fingers...

You are involving her in her pregnancy.

Glasgow's doctors and parents now had knowledge of pregnancy

that no-one in the world had ever had before.

One of the last mysteries of life was unravelling.

With the advent of ultrasound, everything changed.

We knew precisely how old the foetus was if you measured it early enough.

You could tell its rate of growth.

You could tell if there was any abnormality in the foetus.

Abnormality of the brain, the spine, the heart, the kidneys, fingers, toes - you could tell these things.

Ultrasound introduced the foetus to the world

and the flickering image of the unborn baby became a powerful symbol of human life.

The dilemma of Ian Donald came when ultrasound became so good that it was diagnosing foetal abnormalities.

Foetuses with no kidneys or with major heart defects,

huge spina bifida.

Women wanted termination of pregnancy and most doctors were sympathetic to that.

That caused a crisis for Ian Donald because he was anti-abortion.

He just felt the sanctity of life meant

that you should never terminate a human being.

Ian Donald lost the argument, and in 1967 abortion was legalised.

He had pioneered a technology that, by giving women more information about their pregnancies,

often gave them more confidence to make the decision to terminate.

But today, as ultrasound technology has improved, the reality of life in the womb has become clearer.

The foetus will start to show facial expressions as early as 18 weeks,

and you can see so many things like thumb sucking, the foetus grasping.

Ian Donald would have loved this because it makes the foetus really human.

And really now the continuum

between prenatal and postnatal life

is demonstrated beautifully by this technique.

Today, the technology Ian Donald adapted from the rusty yards of Clydeside

can be found across the world.

It is used in the treatment of infertility, of cancer and of gynaecological disease,

as well as managing pregnancies.

It is the biggest advance in the history of obstetrics and gynaecology.

In the history of the care of women and the care of pregnancy,

it is the single biggest advance.

No two ways about it.

Since the 1967 Abortion Act, the ethical challenges faced by doctors have multiplied.

And in 1997 a living, breathing ethical challenge trotted out of a pen

in the Roslin Institute near Edinburgh and sniffed her nostrils at a disbelieving world.

We knew that this was an extraordinary scientific achievement,

probably the most important thing we would ever been involved in.

Dolly was Scotland's most recognisable sheep

and at the same time she was the least individual sheep

in the country. She was a genetically engineered exact clone of another sheep

created by a process known as nuclear transfer.

To do a nuclear transfer, you have to have two cells.

You have to have an egg taken from an animal at the time when normally she would be mated.

And you remove the genetic information.

The other cell that you need can come from another animal and that cell will provide the genetic information

which you introduce into that egg,

and that genetic information will determine all of the characteristics of the resulting offspring.

Dolly marked the birth of a new era in medicine.

The technology that created her could be used to treat and defeat genetic diseases.

Let's say there is a human infection which doesn't produce antibodies in humans, like HIV, for example.

Or let's say you're thinking about a cancer which doesn't produce an immune response.

It may be possible to inject proteins from this virus or cancer into Dolly,

produce an immune response, collect antibodies, either from milk

or from the blood, and hopefully have a new way and a more effective way of attacking that particular disease.

The benefits of this technology could touch the lives

of every individual, every family, on the planet.

We all know people, sadly, who are suffering from or have suffered from these degenerative diseases.

I think one of the exciting things in human biomedical research

is to think that, over a period of time,

it's very likely that new treatments for these diseases will come along.

But Dolly's birth provoked huge ethical concerns.

I think the thing which made most people concerned was the idea of reproductive cloning of people.

There were magazine covers with copies of Hitler and things like that.

But it's the kind of thing in Boys From Brazil -

they just make good stories. They're not realistic.

I think we should ask what it would like to be a clone, a genetically identical twin of anybody else.

It might be suggested, for example,

that a couple who can't have children might have a clone.

So you can put genetic information from the husband into an egg

from the woman and produce a genetically identical twin to the father.

I just don't think people would react to that child in a way you would react to a normal child.

The Roslin team insisted Dolly was a force for good and not a harbinger of a terrible new world.

Over the next 20, 50 years,

I think we can expect to see treatments coming forward for all sorts of diseases.

There are other neuro-degenerative diseases, psychiatric diseases,

asthma, metabolic diseases. There are a huge range of diseases

which people inherit which are not understood

and for which there isn't an effective treatment at this time.

I have no doubt that the benefits from this research

far outweigh the disadvantages, and that is the balance that we and society should make.

As Dolly aged, her own health problems multiplied.

We became aware after a few years that she was limping, that she had some damage to a joint, to her knee.

We have no real way of knowing whether it was because of cloning

or she lived indoors and she was rather heavy so it's possible it was just unusual wear and tear.

In 2003, Dolly developed lung cancer.

It signalled the end for Scotland's world famous sheep.

I think everybody there was shocked as to how bad the tumour was.

We actually decided it was kinder not to let her recover so she was euthanased.

In her short life Dolly changed medical science,

laying the foundations for many of the advances we will see in the 21st century.

Now medical science will increasingly focus on the building blocks of life itself

as a means of treating disease and keeping us in good health.

Today in Edinburgh, doctors are experimenting using embryonic human stem cells.

This ground-breaking work could change the lives

of millions of people in every corner of the world.

There are some estimates that up to 150,000 women a year

die of haemorrhage after giving birth,

many of whom would be saveable if we had a more secure blood supply.

Professor Turner and his team are attempting to culture disease-free blood from stem cells.

Even in Scotland, we still run short of blood from time to time,

but if you look worldwide there are more serious problems in many countries.

Our ultimate vision is that we might be able to provide blood

which is of a universal donor type - O Rhesus negative -

that is shown to be free of infection

and in quantities required particularly for those countries

which are not able to support a blood service themselves.

I think potentially in the very long term, the work could have a very great impact on many people.

The work of Dr Turner and his team is the latest in a long line of innovation

to have sprung from the Scottish tradition of medical excellence.

It is a tradition which champions curiosity and humanity

and which is unafraid of challenging accepted wisdoms.

Usually, a new technology will bring forward potential benefits, but also potential risks.

You can go back hundreds of years when somebody put a sharp stone onto a stick and they had an axe.

They could kill people or they could chop firewood.

It's just a fact of life, and what we have to do is try and see that we take the maximum possible benefit.

And I think we should be excited by the new opportunities rather than being too afraid by them.

Pioneers, by and large have it hard,

because the medical profession and the public sometimes

are fairly conservative in their approach to things.

But again, a tough guy wins through in the end, if he's right.

From the taverns of Enlightenment Edinburgh to the operating theatres of he world,

Scotland has built a tradition of humane and ingenious medical innovation.

Scottish medical tradition lives on.

It's certainly one of the long-term effects of the Enlightenment -

the view that nature

can be changed rationally by human intervention for the better.

Subtitles by Red Bee Media Ltd

E-mail [email protected]