BONUS Episode 54 PREVIEW: Anesthesia

gonna get a lot of e-mails from folks who don't understand the gag offering to redo the youtube thumbnail on this one i tell you what full episode on our patreon: https://www.patreon.com/posts/knockout-154358089

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:00November Kelly?

  In the West, for most of history, your options for like not feeling stuff hurt you amount to things which are compiled in, I would say, the greatest British film of all time, drunk lads hitting each other with chairs.

• 0:16Liam McAnderson?

  I was gonna say, where did you get this? This is a still image from Roz and I in college. We looked a lot better back in the day, Roz.

• 0:24November Kelly?

  Is what this is. This is a beautiful kind of romance. I haven't even included the screenshots of the guy fully knocked out, being held up by the arms by two other also shirtless lads.

• 0:39Speaker 02

  I think one of my friends has got like a painting or a line drawing of this that she got as a Christmas present off her husband because she loves videos so much, someone does an artwork of it, which is incredible.

• 0:46November Kelly?

  Renaissance stuff. But this comprises your two options, right, which are option one, drink a lot of alcohol, and option B, get hit really hard in the head.

• 0:59Liam McAnderson?

  Yes.

• 1:00November Kelly?

  And this was it for a long time. And for the most part, you know, the Ryan Gosling meme, I simply deal with the pain. That's surgery for a long time, is you just have a lot of people hold you down, and then the surgeon does whatever they're gonna do, and you are not enjoying it, and you are very much present for it.

• 1:24Speaker 02

  Yeah, and that's why they, you know, originally, the biggest thing that they valued in a surgery was speed, because the quicker the operation was over, the more pleasant it was, I guess. Samuel Pepys had a bladder stone removed famously. It was the size of a tennis ball. And he was gonna recount this in his diary, and it's basically, yeah, they reckon he maybe survived because he was the first one to get done that day, so all the instruments were probably clean. But by the time you let the 20th guy on the list, your goose is probably cooked.

• 1:50November Kelly?

  Yeah, yeah. I was, I was reading about this. I was struck by, in 1824, a surgeon wrote to The Lancet, the British Medical Journal, in a kind of reform-minded way, being like, we've got to do something about this. And what he describes, like, gallstone surgery that takes three surgeons 20 minutes of just kind of rooting around in there.

• 2:16November Kelly?

  In which the patient is screaming the entire time.

• 2:22Liam McAnderson?

  Would you shut up? I'm trying to focus here, shaky hands.

• 2:28Speaker 02

  At least when I have to watch them take four hours to do a gallbladder nowadays, the patients are not screaming the whole time. That's a lot less distracting than it would be.

• 2:35November Kelly?

  Yeah, yeah, there's a line.

• 2:36Speaker 03

  Can we go back to the industrial accidents that kill you instantly?

• 2:40November Kelly?

  Oh, don't worry.

• 2:40Speaker 03

  I prefer thinking about oblivion when it's when it's immediate.

• 2:44November Kelly?

  That's that's our bread and butter. But yeah, there's a line in this in this letter. It is woeful to the patient. It is disgraceful to the surgeon. And also, there's there's a letter by Fanny Bernie, funny name,

• 3:02November Kelly?

  describing her own mastectomy, like, no anaesthetic, right?

• 3:07Justin Roczniak?

  Oh, wow.

• 3:09November Kelly?

  Yeah, I looked into this a bit and there's a bit where she describes like having to hold up her own breast to be amputated. And because like she's got like a sort of like gauze between her and the like surgical site, right? But like, she can see the surgeon communicating in sign language to indicate what he's gonna do, which is a kind of like, actual consideration you have to make because the patient can hear you and can talk to you. Right? So if you don't want that to happen, your only other options are get hit really hard in the head, get drunk. She had like a wine cordial before this, which was.

• 3:48Speaker 02

  Just a little bit.

• 3:49November Kelly?

  You need straight fucking everclear. Nice aperitif. Yeah. It's like having having one drink before surgery because I don't want to go crazy, you know?

• 4:01Speaker 02

  They've got things to do tomorrow, they won't be hungover.

• 4:05November Kelly?

  Next slide, please. Yeah. So, speaking of, right? One of the other effective painkillers that we know about is is opium, right?

• 4:15Justin Roczniak?

  Very pretty.

• 4:16Liam McAnderson?

  I didn't review these slides beforehand.

• 4:18November Kelly?

  It's a scene here in its cameo role on the global war on terror, right?

• 4:23Justin Roczniak?

  Oh, I heard they're bringing it back. I heard they're doing a reboot.

• 4:27Speaker 03

  Dark gritty reboot of the global war on terror. No, they invented opium too.

• 4:34November Kelly?

  So opium. It's like the juice of like a poppy seed bulb, which you can't see on the plants on the left, but what you can see in the crest on the right.

• 4:46Speaker 02

  Which is the crest of the Royal College of Anesthetists and it's got poppies on it. And it's also got some coca leaves because cocaine was the first local anaesthetic that we ever used, which we'll come on to talk a little bit about later. So yeah, it's cool. Quite a cool way. Cool. We crest that's got, I think it's got the national flowers of all the constituent countries of the UK.

• 5:06November Kelly?

  It's got, it's got a sort of Scottish thistle. It's got an English Tudor rose and then it's got for Wales, I guess, opium, which I, I don't know that I want to sort of make that association.

• 5:19Justin Roczniak?

  That good Welsh shit, that good Welsh opium that you can't even pronounce.

• 5:24Speaker 02

  The two guys that are supporting the crest are, one of them's John Snow, who was also the famous epidemiologist who locked up the pump at the.

• 5:32November Kelly?

  Oh, yeah.

• 5:35Speaker 02

  And the other one, I think, mate, is it Joseph Clover holding a chloroform bag? I can't actually remember.

• 5:40November Kelly?

  Yeah, I'm going to talk about Joseph Clover in a bit, but yeah, good grade in podcasting. Next slide, please. So on the kind of just having guys hold you down while a guy soars your leg off. As, as we said, like, speed is the kind of determinant of how long you're in pain for, which is the only kind of real variable you can, you can change, which means I get to tell my favorite pre anesthesia surgery story. Because one of the more famous British surgeons of the 19th century was a guy called Robert Liston, who fastest knife in the West, right? There's a long quote here from his Wikipedia page. He was six foot

• 6:23November Kelly?

  two and operated on a bottle green coat with Wellington boots.

• 6:28November Kelly?

  He sprung across the bloodstained boards upon his swooning, sweating, strapped-down patient like a duelist, calling "Time me, gentlemen, time me", to students with craning with pocket watches from the iron railing galleries. Everyone swore that the first flash of his knife was followed so swiftly by the rasp of saw on bone that sight and sound seemed simultaneous. To free both hands, he would clasp the bloody knife between his teeth.

• 6:59Liam McAnderson?

  I, uh, so, I'm gonna hijack this episode for a second to talk about another engineering disaster. It's called profound vomiting, which is what I'm going to do. I, uh, I, I just love this image. I, I, if you're on audio, shut up.

• 7:15November Kelly?

  Yeah.

• 7:16Liam McAnderson?

  Of this guy.

• 7:17November Kelly?

  Stop making this upload, though.

• 7:18Liam McAnderson?

  Yeah, stop it. The, the hold me back guy as he's literally being held back and just everyone's just being timed.

• 7:25November Kelly?

  Getting your shit sorted off, like you're lucky you're on parole. Yeah. So, so, so Liston, Liston's record for, for, Liston's record for doing a leg was two and a half minutes, like, um, like soup to nuts, right?

• 7:40Liam McAnderson?

  That is bad.

• 7:41November Kelly?

  Yeah, it's like the worst two and a half minutes of your life, but then it's over, right? Well, then you die like two days later because they haven't administered sterilization.

• 7:49Liam McAnderson?

  Right. You have two minutes of your life so far.

• 7:53November Kelly?

  Yeah. Funny you should mention.

• 7:55Justin Roczniak?

  Why not use like a sort of guillotine type situation, you know? I, I'd imagine that'd be quicker.

• 8:00November Kelly?

  You have, you have trouble getting through bone is the limiting factor.

• 8:04Speaker 02

  We, we did a surgical skills course at the ambulance last year where we got a load of pig carcasses and to practice on. And right at the end of the day, we realized that the bins they'd given us to dispose of the meat weren't big enough. So me and another, me and another doctor spent half an hour sawing some pigs in half. It takes a long time, like, to do that. So, yeah. So, yeah.

• 8:24November Kelly?

  You can.

• 8:25Speaker 02

  So, yeah.

• 8:27November Kelly?

  If you work in medicine, you can just do anything. I would have taken that home, put it on the smoker.

• 8:34Liam McAnderson?

  Yeah, with the hair still on it. Yeah, you'd be getting ice prosciutto that way.

• 8:38Speaker 02

  The specialist kind of butchers and meat companies specialize in this stuff, like giving you bits of bits of animals designed specifically to practice procedures on.

• 8:46November Kelly?

  Friend of mine who's a biomedical scientist talks a lot about getting like limb bins down to like do pathology on and just sort of like essentially like a dumb way so that might have like trays of samples. And then just sometimes it's like a leg sized bin, you know, it's like.

• 9:04Speaker 02

  Yeah, it's very unceremonious when they kind of take a leg off, just drop it into this big yellow bin. Yeah, kind of guess a bit of a thud as it lands. Yeah.

• 9:11Speaker 03

  I just want to, I just want to throw out here really quick. I did like a stop the bleed course recently. Cause I was like, you know, it seems like a useful skill to have. And they gave us tourniquets and I was like, I should put one on myself and just, you know, know how to do it. That shit hurts like crazy.

• 9:27Speaker 02

  Oh, yes. Horrible.

• 9:27Speaker 03

  That shit hurts like crazy for like five seconds. Uh, everything about this is making me squirm out of my skin.

• 9:34November Kelly?

  I'm so sorry.

• 9:35Liam McAnderson?

  Oh, yeah. Victoria, Victoria, I'm dying out here.

• 9:39Speaker 03

  I'm literally this, I was beginning to sweat. When I was like.

• 9:43Liam McAnderson?

  This image has not suffered nearly as much as I have.

• 9:45Speaker 03

  Somebody in the audience will probably know what I'm talking about. When I was like seven years old, I read this series of books about a kid who could time travel by holding old baseball cards. I don't remember anything else about it. But at some point he goes back to like the civil war. And for some reason, the middle of this otherwise normal children's book, there is a very grisly section on amputation. And I was haunted by it for most of my like, from about aged nine to like probably 13, I just like haunting of like, oh yeah, civil war era amputation seems bad.

• 10:17November Kelly?

  I'm giving you sort of like sleep paralysis stuff, but it is going to get worse because I haven't even told the story yet, right?

• 10:25Liam McAnderson?

  But it is going to get worse.

• 10:26November Kelly?

  The story is. How old is the baseball card?

• 10:31Justin Roczniak?

  Did they have, I don't, when, when was baseball invented? I thought that was a post civil war.

• 10:36Speaker 03

  Okay, so I think the original series, I think the original series was the kid.

• 10:40November Kelly?

  Seizing control of this fact. So Liston has to amputate the guy's leg, right? He comes in, he's wearing his like bottle green coat and his wellies, right? Like he's going to Glastonbury and so he like, also, all of this is done for an audience of medical students, right? That's who you like, see also the public at this point. Like, that's who you see on the left is this gallery of people who are just like watching this happen, right? And so he's doing this amputation, takes the leg off. In the course of so doing, the saw like cuts off the fingers of one of his attendants, right? And then one of the members of the public or the students in the galleries is so shocked

• 11:25November Kelly?

  by this, faints, falls out of the gallery, dies. The guy who is being like operated on dies of infection. The guy who gets his fingers cut off dies of infection. 300% mortality rate for one case.

• 11:43Justin Roczniak?

  Kill zone. Okay, okay, but what's his batting average otherwise? Yeah, to bring it back to baseball.

• 11:51Speaker 02

  It's actually a very common misconception. Baseball cards were invented first and the sport came afterward.

• 11:56Justin Roczniak?

  Yeah, no, they needed, they needed the cards in order to, in order to describe the sport.

• 12:01November Kelly?

  Yeah, baseball. All right, next slide, please. So there is a very cool chemical out there called diethyl ether. This has been known about since forever, right? Like, the fact that it has like analgesic properties has been known about since like the eighth century, right? Like in this, in the Islamic Golden Age, they had doctors like trying this shit out on dogs, right? Etherizing a dog is, I guess, one of the funniest things you could possibly do because all throughout history, it turns out, people were just doing it and then not bothering to think about broader applications. It was like, yeah, this is a fun thing to do. I'm bored. I guess I'll etherize a dog.

• 12:44Liam McAnderson?

  Cause I'll dog out the dog, right?

• 12:46November Kelly?

  Yeah. And so ether, if you, if you inhale it, right? You, it's like very euphoric. It's, it's like, it's a, it's a good time, right? Likewise, nitrous oxide or laughing gas, as we see here on the right hand side. This is a playbill for an evening of laughing gas. You could just, you could just go out of an evening and be like, I'm gonna, I'm gonna get fucked up on nitrous.

• 13:18Justin Roczniak?

  Thirty gallons of gas will be prepared and administered to all in the audience who desire to inhale it.

• 13:25Liam McAnderson?

  Men will be invited from the audience to protect those under the influence of the gas from injuring themselves or others. This course is adopted that no apprehension of dangers may be entertained. I'm sorry. Probably no one will attempt to fight.

• 13:40November Kelly?

  The entertainment will be accompanied by experiments in electricity.

• 13:44Liam McAnderson?

  Yeah. Just probably no one will attempt to fight is also the tagline for our live shows.

• 13:49November Kelly?

  You can just hang out, right? And this is, this is entirely recreational and it's, it's a big deal to the extent that we have this misogynist cartoon from the 19th century. Surely on the left hand side, which is, is your bitch wife annoying you? Why don't you try giving her laughing gas? Because, you know, let's, let's see, you complain about not having the vote now.

• 14:12Justin Roczniak?

  This, this is, this is better living through chemistry.

• 14:16November Kelly?

  Try gassing your wife.

• 14:19Justin Roczniak?

  Yeah.

• 14:20Liam McAnderson?

  Don't, don't try doing that.

• 14:21November Kelly?

  And the thing is, right? Nobody really knows what to do with this. This is just a kind of like vulgar entertainment, right? This is kind of like bored, half middle class stuff. Next slide, please. We're gonna take a brief sort of diversion into biography here. And I'm going to talk about the strange, sad life of a man named Horace Wells, who's on the left here. So Horace Wells was a dentist. And in the 19th century, mid 19th century, being a dentist is mostly about pulling rotten teeth, right? There's no kind of dental hygiene. You just, you know, it's much like Britain now, right? You eat a lot of food that's bad for your teeth. You never take care of them. And then when they rot, you pay a guy to like, get you drunk, hit you over the back of the head with a cartoon

• 15:06November Kelly?

  hammer, and then pull one of your teeth. And this guy.

• 15:10Justin Roczniak?

  I can't believe they've been replaced by piano.

• 15:12November Kelly?

  Exactly, right? And this guy, Horace Wells, he's like a bleeding heart. He hates doing this because it's like, obviously harmful. It's like barbaric. He's kind of up there with like Ignace Semmelweis in terms of being like a kind of frustrated time traveler. Like, he's one of the sort of.

• 15:30Justin Roczniak?

  Because of those baseball cards.

• 15:32November Kelly?

  Exactly. He's got like a fistful of baseball cards, and he's trying to sell people on the idea of brushing their teeth ever.

• 15:40Speaker 03

  I just want to say, I think that for the, for the story in the Civil War, the kid touched a photograph. I don't think, I think it was like, they took him to the proto-baseball game. They had not invented the sport of baseball yet. But the kid was, was both there at Gettysburg and the invention of baseball.

• 15:56November Kelly?

  Incredible. But yeah, so he's, he's like a big advocate of like, tooth brushing, of like, leaving teeth in place, rather than just the, the standard of care at the time, which is just pull all of them the second one starts to rot, and then just do dentures.

• 16:11Speaker 02

  I'll just take them all out completely. Did you know about this? It was pretty common in Scotland for a long time for people to get all their teeth pulled out as a wedding present?

• 16:18November Kelly?

  Yeah, absolutely.

• 16:19Speaker 02

  So we, we've got, we've got, we've got a family friend who's like 96 now. And when she got married 70 plus years ago, and one of the things she was offered was everyone basically would, would, would club together. And as a wedding present, you'd get all your teeth taken out and get dentures made. Because they were only going to cause you bother. And before NHS dentistry, it was just going to cost you a fortune to get them fixed. So people would have a dental clearance and get dentures as a wedding present. And Ina refused because she said she quite liked her teeth. And she's still got almost all of them 70 years later, just kind of sitting there going, yeah, fuck you guys, you're all dead. And I've still got my teeth.

• 16:53November Kelly?

  No, no, no. Not related to the podcast. It's absolutely the kind of like dentistry this guy's practicing and he hated it, right? Um, and so bored of an evening, he and his wife go to one of these nitrous parties. Hell fucking yeah. Wow. And this guy, this like day laborer named Samuel Cooley is out of his gourd on, this is ether specifically rather than nitrous, right? Um, and he's like banging around in this, on, on this like wooden bench. Um, to the point that he's got like bruising on his leg. He's like cut his leg open. Um, and he can't feel any pain. Not only that, but when the ether wears off, he doesn't remember doing it, right?

• 17:37November Kelly?

  What if you use that for dental extractions? Ooh. Smart, right? And this works really well because a dental extraction is fast, right? Like you, you're pulling a tooth. It's a relatively quick process. You don't have to do a lot of like complicated stuff on the way in or out generally. And if you're getting your tooth pulled, you're probably not on death's door. So this is like relatively kind of safe. It's relatively common as a thing to do. Um, however, all of these guys are going to do this, right? There's a few different 19th century doctors, dentists, chemists I'm going to talk about. All of them loved one thing more than anything else, trying it on themselves. Yes. They loved that shit. They couldn't get enough of it, right?

• 18:20November Kelly?

  Um, and so he just gets his friend who is a chemist to make him up some ether in a paper bag. Takes a big half of this thing and then gets his other friend who's a dentist to pull one of his wisdom teeth. Just to see if it works. I don't like this. It's okay. We got three more tries after this one. He gets his tooth pulled and he says, presumably not very clearly, this is the greatest invention in human history. Which he's not necessarily a man given to modesty, but you can see why, right? You have this idea that-

• 18:56Justin Roczniak?

  No, they haven't invented sliced bread yet.

• 18:58November Kelly?

  Yeah, this is the greatest invention before sliced bread or baseball card. And so he's like, cool, we have abolished pain, right? Just fucking conquered it.

• 19:10November Kelly?

  Now, trying to get, he's like doing extractions on dental patients with this, but there's some kind of medical chauvinism at the time as well, because he's a dentist, right? He's the tooth guy. But he keeps trying to shop this around and eventually Harvard Medical School indulge him in a like one hour, let's hear this guy out talk, which they should really, they should really bring those back, I think. They should, they should make medical students be like, this is just one hour a year. Just here's a guy, you know?

• 19:42Speaker 02

  Yeah, just dragon's den.

• 19:43November Kelly?

  Yeah, he reckons he's got something. And so he gets another volunteer to again, get like a tooth pulled. Unfortunately, our patient is an overweight alcoholic who does not know how to- Well, you don't have-

• 20:01Justin Roczniak?

  Yeah, I, I, what year is this?

• 20:03November Kelly?

  Eighteen forty something.

• 20:05Justin Roczniak?

  Oh, that was, no, I mean, okay, if you were alcoholic in eighteen forty something, that was real bad, beyond the pale.

• 20:13November Kelly?

  Yeah, for sure. He's also, he doesn't know how to take a good half out of a paper bag, right? So he kind of underdoses himself. And so when Horace Wells goes to like pull his tooth, he like cries out in pain, right? And even though-

• 20:28Speaker 02

  And it'd be quite easy to do that with ether because it takes absolutely ages to work. Like the books all say, you need to breathe 20% ether for 20 minutes to get good surgical anesthesia. So, you know, you'd probably need to, you'd be at it a long time. You might get lucky if you took a big enough half, if it was just for a quick extraction or something. But yeah, it's going to take a long time to build up in some people. And if you're a fat alcoholic, it's gonna not work.

• 20:51November Kelly?

  And so-

• 20:52Speaker 02

  Even like, it was gonna work even-

• 20:53November Kelly?

  And so, and so this guy, when he's sort of like, you know, so when it wears off afterwards, he doesn't remember- But having been in any pain, but this is still enough that it ruins Wells' career. Right. He's never going to work in this town again. He's also really kind of given to depression, which same. And so he, he does, he goes back to his dental practice. It's kind of, his life kind of falls apart after this. He gets, uh, he gets addicted to chloroforming himself, which is one of those addictions that is really funny on paper. Right. To just be like, I'm going to take a big half out of this handkerchief. But it does ruin his fucking life. Thirty third birthday, he goes out and he, this is again weird science shit.

• 21:39November Kelly?

  Acid attacks two sex workers.

• 21:43November Kelly?

  Oh. Thankfully doesn't injure either of them. He like burns their clothes. But so he gets arrested. And because in the 19th century, nothing was real, least of all laws. He just in jail goes, hey, do you remember my shaving kit? And of course they just bring him a straight razor, which he uses to. Yeah. On, on, on himself to a fatal end. Right? However, soul consolation did not feel any pain from doing that because he had already chloroformed himself. So. Just. Surreal analytics, baby. Yeah. A life, life kind of like defined by anesthesia.