[speaker001:] . Thank you very much.... [students' voices in background] Let's have a look at this finger.... [shouting] Gentlemen can we have a bit of quiet please? Assif, Neil, Colin. [] .
[Tony:] What did you do to that finger, Lisa?
[speaker001:] [LAUGHTER] I slammed it in the car door. []
[Tony:] Slammed it in the car door. Sorry about that. I'm doing a Mr.
[speaker001:] [LAUGHTER]. []
[Tony:] Right. Don't worry.... Where did you slam it?
[speaker001:] Here. Across there.... [students' voices in background]
[Tony:] [shouting] Gentlemen. []... This may hurt a little bit.... Right.... Ladies and gentlemen.
[speaker001:] [sigh]...
[Tony:] Er just... quietly while I'm checking... Lisa's finger. What's happened Lisa Look, if I press those two fingers, can you see they go white?
[speaker001:] Yes.
[Tony:] That one goes red and that one stays white much longer.... The circulation to that finger is poor... and I think there's something interfering with the circulation. Also... I know you had it bandaged up but the skin there has gone white... and I honestly think that ought to be X-rayed.
[speaker001:] . [sigh]
[Tony:] To be perfectly blunt with you... I would suggest that... erm... that wants doing fairly urgently. It wants checking over. Can I just feel If you lift your hand, would you please?
[speaker001:] It er it's not that bad. It doesn't hurt.
[Tony:] ... Yeah it's not that I'm worried about.... Would you have a feel Kelly?
[speaker001:] Mm.
[Tony:] Can you tell whether you think that finger's colder than the rest?...
[speaker001:] Yeah..
[Tony:] ... Yes I think so. Your circulation to that is poor and that wants looking at quite urgently.... Seriously. Erm is anybody at home?
[speaker001:] No.
[Tony:] I think you ought to get that X-rayed.... [shouting] Right.... Ladies and gentlemen. []...
[speaker001:] Sir, why have you got that on your er?
[Tony:] Right er let me explain briefly what's going on.... Mr 's daughter, I think it's his daughter, er is working for the British National Corpus and they are looking at... the how words are used in ordinary everyday situations. And what they've done is they've asked various volunteers, mugs, call them what you will, to be er recorded... while they are carrying their out their normal duties. So
[speaker001:] [LAUGHTER]. [LAUGHTER].
[Tony:] I might have known
[speaker001:] .
[Tony:] it would you be you Ashley.
[speaker001:] Is it on?.
[Tony:] It is on, yes.
[speaker001:] . When do you switch if off? Whe wh wh when you get a bit angry?
[Tony:] Let me just very briefly read you one or two of the things it says. [reading] We are asking a large cross-section of people and organizations around the country to help by allowing us to record their conversations, []
[speaker001:] !
[Tony:] [reading] meetings, broadcasts and so on both in private homes and on company premises. These recordings will then be transcribed onto computer and built into a database which will contain several million words. []
[speaker001:] Why? [LAUGHTER] Sir, how long's the tape? .
[Tony:] Forty five minutes. And the aim is that the conversations are going to be anonymous and they are trying to compile a dictionary of words that people actually use, rather than a dictionary for people who do crosswords.
[speaker001:] Oh. Sir will you erm wh if you change the tape will you tell us?
[Tony:] Well I've er turned the tape over after side one, which was my first lesson and I'm now doing side two, which is this lesson... and... the idea is to look at the s way in which language is used.
[speaker001:] [puking noise] [LAUGHTER]..
[Tony:] It is very interesting the way two different groups react to the same situation.
[speaker001:] .
[Tony:] Now the other group... realizing that of course this is serious research project were of course
[speaker001:] Wh wh wh!
[Tony:] [LAUGHTER] quite sensible [].
[speaker001:] [LAUGHTER].
[Tony:] On the other hand there are people like Neil and Assif who are obviously trying to make names for themselves.
[speaker001:] [LAUGHTER]....
[Tony:] Right. Er ladies and gentlemen...
[speaker001:] Sir, er can you pick up from away with that?
[Tony:] Yes.
[speaker001:] [LAUGHTER].... .
[Tony:] Thank you.... My teaching point starting off today...
[speaker001:] .
[Tony:] Thank you. Is starting off from Lisa's fingers.
[speaker001:] [LAUGHTER]. Eh? Eh? Why what what did she do? . She trapped them in a car door. [LAUGHTER] There you go Sir....
[Tony:] Now... there's a serious point from starting from there because...
[speaker001:] .
[Tony:] There are three main components of your blood.... White cells,
[speaker001:] .
[Tony:] Yep.... Next one?
[speaker001:] Red blood cells. Red cells.
[Tony:] Red cells.
[speaker001:] .
[Tony:] No they don't absorb carbon dioxide.
[speaker001:] Alright then
[Tony:] It's the plasma that does this, which is your last one. Alright. So your three components. Your major part of your blood is the plasma which carries the carbon dioxide away, the red cells carry the oxygen and the white cells fight disease. And the red cells are far more numerous than the white cells. What... Erm bit of revision for the biologists, what is special... about the er red cells? Why are they different from all other cells?
[speaker001:] No nucleus.
[Tony:] No nucleus, right.... The red cells contain which... element?
[speaker001:] Haemoglobin.
[Tony:] Well haemoglobin... is
[speaker001:] .
[Tony:] ... Haemoglobin is the red colouring compound that carries the oxygen and gives the red cells their colour.... What element has to be present in haemoglobin?
[speaker001:] Iron.
[Tony:] Iron.... Right. That is why somebody who is sort of iron is anaemic. Shortage of iron makes people breathless, get tired very easily, the reason being that there is not enough oxygen being carried round the blood. That's why somebody who's anaemic and somebody who's got blood loss suffer very similar symptoms. In both cases, although for quite different reasons, there's not enough oxygen being carried round body.... Now iron... is the crucial element there, and it gives it this red coloration.... When you suffer bruising... you what you're doing is... rupturing the capillaries in the er skin. So the capillaries... are the very fine tubes that carry the blood around... the body. And for the biologists again if er... if you look at the capillaries in the body, there is no cell in the body requiring a blood supply that is more than one fortieth of a millimetre away from a capillary. So your capillaries are all over the place. Now if you damage... yourself by whatever way, and the classic one that we see at school is if you get banged in the eye in rugby, somebody elbows you in the scrum or something similar,... you then get a swelling caused by what? What's happening?
[speaker001:] Fluid.
[Tony:] Fluid, yes. The blood is actually leaking out of the capillaries... into the surrounding tissues and you get several effects.... So let us say... er well let's take an example, you've just been er hit in the eye by a hockey ball hit by our friend Jonathan.
[speaker001:] [LAUGHTER].
[Tony:] A sort of typical everyday school accident. Or you've been er clouted on the elbow by Jonathan with a hockey stick or something similar.
[speaker001:] Or whacked in the face by Natalie.
[Tony:] Mm.... Well apparently rumour has it that the doctor at the hospital who dealt with these last cases was saying words to the effect that er Jonathan just put Jonathan in a situation and he'd keep the hospital in business for evermore. So... let us say you've been hit in the eye... accidentally by a hockey ball.... Very soon afterwards because of that blood leaking into the tissues, what is that wound that injury going to do?
[speaker001:] Swell Sir.
[Tony:] Swell.... It's going to swell. Because of the blood coming out oozing out under pressure into the surrounding area.... What colour is it going to be?
[speaker001:] Red.
[Tony:] Pardon?
[speaker001:] Blue.
[Tony:] Red.... Right. So a black eye starts off red, and it starts off red because of the blood leaked into the skin. If you feel it what is it going to feel?
[speaker001:] Sir.... Sore.
[Tony:] Well apart from feeling sore. It's going to hurt, right, cos of nerve damage. If you actually feel its temperature?
[speaker001:] Warm.
[Tony:] It's going to be warm. The reason it's warm is because of all that warm blood that's leaked into it. So when you first get a bruise injury those are the sorts of things that happen.... The chemistry comes in... as to what happens later on. Now the red blood cells and so on have leaked out into the surrounding tissues.... They are then the fluid eventually absorbed and the swelling starts to decrease. What colours does it then start to turn?
[speaker001:] Yellow. Er green.
[Tony:] Right. Blue,... black,... purple,... green,...
[speaker001:] Violet, orange.
[Tony:] yellow,
[speaker001:] .
[Tony:] ... And you get a real spectrum of colour changes.... And the reason for those... is the iron in the... blood is being oxidized... by various substances in the body, it's being broken down into a form in which the body can reabsorb that iron,... and during the process you go through all these colour changes because of the different forms of iron oxide being produced. So when you get a bruise that's a nice yellow colour, yellowy-green, you know it's a very old bruise. When we're doing first aid incidents erm... the standard thing we're doing for adults... when they're doing a first aid exam is we'll give present them with a casualty with perhaps a cut hand or something like that and they'll actually have a black eye.... And quite a lot of the adults will try and treat a black eye. Now when I say a black eye I mean one that actually looks blue-black and is quite swollen....
[speaker001:] .
[Tony:] What's the point about that black eye?
[speaker001:] It's old.
[Tony:] It's an old injury, yes. If it's gone black it's a least a couple of days old.... So... chemistry in action. When you start turning funny colours...
[speaker001:] [LAUGHTER]
[Tony:] tha... that's because the iron is er being broken down in the body.... Now.... taking the chemistry a little bit further,... there are two sorts...
[speaker001:] [LAUGHTER]
[Tony:] ... Thank you very much.... There are two sorts of conditions in the body....
[speaker001:] [LAUGHTER].
[Tony:] Right. What does what is Jane Fonda into in in a big way?
[speaker001:] .
[Tony:] [LAUGHTER] And don't answer that one [], I want the honest legal answer.
[speaker001:] Fit erm fitness things.
[Tony:] Fitness things. Called what?
[speaker001:] Several ways to. .
[Tony:] Come on....
[speaker001:] Aerobics.
[Tony:] Aerobics, right.
[speaker001:] .
[Tony:] Right.
[speaker001:] .
[Tony:] This is actually... tying this up with an exam question, I was looking through some past papers to try and spot things we may not have covered in detail....
[speaker001:] [LAUGHTER].
[Tony:] Aerobics. The whole point about aerobics is that your exercise is done with plenty of?
[speaker001:] .
[Tony:] Oxygen, right. So the key thing with aerobics is lots and lots of oxygen. That means that... the food in the body is burnt up totally and effectively. What... fuel does our body actually use at the muscle level?... What fuel does our body actually use at the muscle level? Produced by our livers from the food that we eat.
[speaker001:] .
[Tony:] Right, you're on the right lines.... It's... it's sugar. Er you mentioned glucose in fact the one that is actually... produced
[speaker001:] Dextrose.
[Tony:] Dextrose.... If you are very ill,... to save your liver having to do any conversion work to convert sucrose, glucose into dextrose, you're actually given dextrose and saline solution because your muscles can use the dextrose... erm straightaway without any further conversion. So when you're very ill you get dextrose and saline. The salt is to make up for any salt that you lose. So aerobics look at burning that oxygen with the sugar effectively and completely.... A sprinter... will actually work in different way altogether.
[speaker001:] Anaerobic.
[Tony:] Anaerobic. Good. Now...
[speaker001:] Anaerobic sludge. [LAUGHTER]....
[Tony:] Yep, we'll come along to anaerobic sludge later. Anaerobic... er... is without enough oxygen. Now a sprinter beforehand will actually be on the blocks and will take in a lot of oxygen to try and saturate as much oxygen into their blood as possible,... so that when that gun goes off they will aim to have all of their red cells where possible carrying oxygen.... During that ten second or less dash for the line... they will actually be using up oxygen faster than their bodies can take it in. That's why sprinters when they cross the line very often collapse... many of them, because they've used up their oxygen so much so that there's not got enough and their brain switches off momentarily and they collapse. Till they They faint effectively.
[speaker001:] .
[Tony:] And they use anaerobic conditions. They don't have enough oxygen because you just can't breathe fast enough to use up that oxygen in that tremendous burst of power. That's why sprinters can't keep it up....
[speaker001:] [LAUGHTER].
[Tony:] Ana Anaero.
[speaker001:] [LAUGHTER]....
[Tony:] [LAUGHTER] I'm going to wish I hadn't said that. [] Anaerobic conditions... m er mean that the sugar the dextrose is burnt with the oxygen and actually forms... lactic acid. Now lactic acid. Now lactic acid...
[speaker001:] .
[Tony:] ... Yeah lactic acid...
[speaker001:] Is poisonous.
[Tony:] is poisonous in one sense.
[speaker001:] Gives you stitch.
[Tony:] What Yes. Neil, say it again.
[speaker001:] Gives you stitch and cramps.
[Tony:] Yes, gives you stitch and cramps. Yes.
[speaker001:] Cramp?
[Tony:] That's why when you've been running hard... you've got the stitch or whatever, that's caused a buildup of lactic acid in the... er... muscles,... what you then do [sigh] is your muscles say, Enough. You end up er collapsed, taking deep breaths, and what that is trying to do is that the deep breaths are circulating oxygen into the body, the oxygen is then able to break down the lactic acid into other substances which are less harmful.
[speaker001:] Sir, on that after you've had food does... more fre more often than when you've had nothing to eat?
[Tony:] Right.... Good question. If you take food... Food is absorbed in a form which your body cannot directly use. So you don't get bacon and eggs er floating round your bloodstream. So for that to happen... for that food to be converted into a form that your body can use it's got to be broken down. Broken down in your liver, and your liver has to do work. Yes? The liver to do that work has to have a very very good supply of oxygen.... If it's breaking down lots of food, a really heavy meal, then it's actually maybe making such a big demand on the oxygen level in your bloodstream that your oxygen level in your bloodstream drops and there's not enough to go round the muscles to make to break up any lactic acid that's being formed. Because your heart isn't being given the triggers that says, Hey, I'm exercising, I need to pump more blood round the body because I'm doing exercise. The liver's just quietly working away churning this food into blood sugars, using up quite a high level of oxygen, and the rest of the body is suffering. That's why overeating's considered bad for you. Taking it a stage further... we've got a situation... where we have two types of bacteria.... Two types of microbe. We have... aerobic bacteria, which need plenty of oxygen, and anaerobic bacteria which do not like oxygen. And somebody mentioned earlier, I suspect it was Colin over at the back, or one of those...
[speaker001:] .
[Tony:] about anaerobic sludge.
[speaker001:] .
[Tony:] And at the sewage treatment works... And this again is on the syllabus folks, so you need to bear it in mind, The sewage works, they make use of both sorts of bacteria. In the early stages of the sewage works when they're dealing with the liquid they use aerobic bacteria. So they warm up the water sometimes, they either blow warm air through or at Stoke Bardolph they whip up the erm... sewage with fans which beat air into the water, and the aerobic bacteria digest some of the harmful substances in the sewage. The sludge is then separated off, and that is heated in tanks... away from oxygen where anaerobic bacteria break the sludge down into an odourless substance and produce methane gas. The methane gas is then used as a fuel round the rest of the power s er in the power station to provide electricity for the rest of the sewage works.
[speaker001:] .
[Tony:] So you have two sides to this. Aerobics, anaerobic bacteria. Now anaerobic bacteria include things like erm... tetanus, and another one, which is lovely, is gas gangrene.... Let's have a look at tetanus first of all.... Where do you find tetanus bacteria living?...
[speaker001:] Hopefully not in you.
[Tony:] Hopefully not in you. Yes, I'd agree with that....
[speaker001:] In the dirt. In the ground.
[Tony:] Yeah. That's right.... Soil. Particularly in soil in areas where there've been cows and things in the past. And if you think of the country as a whole,... er you'll find tetanus in most... areas of the country. For example, here is an old farm.
[speaker001:] [LAUGHTER] It's an old what? [] [LAUGHTER]. [LAUGHTER].
[Tony:] Well if you look at it, this was called Top Valley Farm because it was the... highest valley coming out of the city.... The farm that was here we've got the name Old Farm Road because of the farm. When this school first opened the estate over there hadn't been built yet, and the farm buildings where still there when the school first opened.
[speaker001:] The what estate?
[Tony:] . The estate.
[speaker001:] The what estate? .
[Tony:] . The estate where you've got and er and all those names....
[speaker001:] .
[Tony:] Just down there Assif. [shouting] Right, gentlemen. []... Now then. If you scratch yourself... and you get soil into it. For example, there was a dear old lady who was pruning her roses, scratched herself on a rose, and er a little bit later died quite horribly of tetanus.... The only thing she'd done is make a small scratch with a rose thorn and was unfortunate enough to get a piece of contaminated soil
[speaker001:] Sir, when did it... stopped being compulsory for you to have a tetanus... jab?
[Tony:] It's not actually compulsory now. Er you
[speaker001:] But they like... sort of push you to have one don't they.
[Tony:] They do indeed. And the reasons I'll come onto in a moment. Cos I'll er... thought I'd explain to you what happens with tetanus.... The reasons they push it on you is that... young people particularly do activities that are liable to get infection. Like for example, you get flaps of skin ripped off by er people's football boots and you get soil underneath the flap of skin and obviously you've got ripe conditions for tetanus infection to get in.... As an adult,... adults... such as myself haven't been through the procedure as a young person where your immune system's been challenged by the vaccine... so that you've developed tetanus antibodies.... You will have been protected hopefully from birth, or shortly after birth, by the tetanus vaccine, which will have caused you to produce antibodies against it. And because of that, I believe they recommend when you're stop your school vaccinations, you have a top-up every ten years. Now in my case,... I... have got buried away in the depths of here somewhere... my tetanus vaccine card. If I can fi Here it is.... The doctor who last saw this said, It's somewhat of a museum piece. As you can see, it's just er mm Even with its sort of
[speaker001:] .
[Tony:] ... plastic cover to try and keep it nice it's looking a little bit er worse for wear. The reason is that in fact I acquired this... on the thirteenth of August nineteen seventy two.
[speaker001:] [LAUGHTER] I wasn't even born then. []
[Tony:] That's right. So that is twenty one years old.... Not only that, it says [reading] The accident department in Nottingham General Hospital [].
[speaker001:] .
[Tony:] Exactly. Erm so that shows what a long time ago it was.... And it says [reading] You have been given one injection of tetanus vaccine absorbed and another of tetanus antitoxin. These will protect you for a short time against tetanus. [] Now you lot have all have the tetanus... vaccine.... You haven't had the tetanus antitoxin. And you're about to say, hopefully, what is the difference? The difference is that your body takes a long time to react to the tetanus antitoxin... Sorry, to the tetanus vaccine, to make antibodies against it. During the time that your body is trying to make... the antibodies against the infection... that infection may well spread so rapidly through your body that you become seriously ill, indeed, your life may be threatened.... To protect people who haven't have your course of vaccinations, what they do is they inject the tetanus vaccine into a horse.... The horse makes antibodies. They then draw off some of the horse's blood, remove the serum containing the antibodies, return the blood to the horse,... and these horses are used for producing the tetanus erm antibodies. So what you get is an injection of the vaccine like you have and a legful of the horse serum.... And the horse serum er allows the tetanus antibodies from the horse to fight any infection you have got.
[speaker001:] How come they use the horse Sir? Why a horse?
[Tony:] Because a horse has got plenty of blood and doesn't miss a bit of blood drained off and then returned.... [whispering] Right. [] Also a big animal like a horse produces lots and lots of antibodies. Now the problem is this, human beings are not horses. And when you've had your tetanus
[speaker001:] .
[Tony:] When you've had your tetanus antibodies from the horse serum you then normally develop an allergy to the horse serum. If you then get it a second time... you will then possibly have an allergic reaction to the horse serum. Now you don't get tetanus cards to carry because you've not had the horse serum. I have to carry my tetanus card so that if I was er injured and unconscious and not being able to say that I've had the horse serum, the doctor thinking, Oh look look he's got lots of soil in that cut, er give him a quick injection of the horse serum, that could actually be fatal....
[speaker001:] .
[Tony:] Now lockjaw, tetanus.
[speaker001:] .
[Tony:] Tetanus is a anaerobic...
[speaker001:] .
[Tony:] Thank you very mu
[speaker001:] [LAUGHTER]. .
[Tony:] Thank you very much for telling me.
[speaker001:] [LAUGHTER].
[Tony:] Right.... As I was saying the er...
[speaker001:] [LAUGHTER].
[Tony:] Tetanus the old name is lockjaw.... And it's an anaerobic condition that gets into the nervous system and causes nerve paralysis in such a way that you get acute muscular contractions. What happens is this, that your You know you've got two sets of muscles? Your muscles normally works in pairs. There's one muscle that pulls your arm that way and another that pulls it back again. I think the proper word is, and biologists will correct me if I'm wrong, antagonistic muscles.
[speaker001:] . Yeah, that's right.
[Tony:] One works one way, one works t'other. Now... in lockjaw
[speaker001:] .
[Tony:] what happens is both muscles contract together fully.... So you've got one muscle trying to pull your arm that way, another muscle trying to pull your arm that way, and your muscles become rigid and locked.... There h have been cases where the person's back muscles have pulled up so tight that their... they've formed an arch. Their head has been in t touch with the bed, their heels, but the whole body's been arched like a bow with the contraction of these muscles.
[speaker001:] . Does this happen in your... jaw, or?
[Tony:] No, it's all over your body. But it's called lockjaw because er one of the stages is that your jaw actually locks solid.
[speaker001:] Is there any like a cure or have you got to?
[Tony:] Yes there is.
[speaker001:] death. [LAUGHTER].
[Tony:] Mm. Well that's what I was going to come to. There are now only two places in the country that actually deal with tetanus poisoning.... One is Oxford and the other is in Leeds. Er
[speaker001:] Sir, what do they do in Scotland then?
[Tony:] You're flown down in helicopter to Leeds.
[speaker001:] Is that how common it is, Sir? Yeah but if you're in your arch how?
[Tony:] How common is it?
[speaker001:] [LAUGHTER].
[Tony:] Yeah but it doesn't come on quickly Assif.
[speaker001:] Oh.
[Tony:] It's quite a slow disease. And that that lies in the problem, because it's so rare now doctors have a great difficulty in diagnosing it. Right Neil, the reason is, at one stage there was er centres all over the country that could treat it. It has become so rare thanks to vaccination... that there's only two n places needed i to cover the whole country, Scotland included.... How do you treat it?... And the answer is... [whispering] Thank you. [] When you have an operation these days that's lasting anything more than just er a couple of minutes or so, they will insert down your windpipe an endotracheal airway, which is a tube that goes down into your windpipe to seal into the windpipe, so if you vomit, for example, no vomit can down round that tube. It comes out of your mouth and instead of a mask over your face, your this tube connects directly to the... ventilator and the anaesthetic machine. In order that you don't fight this ventilator, and also that you don't start twitching when they start carving you up, they inject you with a chemical er a muscle depolarizer that stops your muscles working. Now the only muscle that doesn't stop working
[speaker001:] Heart.
[Tony:] is your heart, because that's a special sort of muscle. So you are completely and totally paralysed. You cannot, literally, move a muscle. The only muscle in your body that's still working is your heart....
[speaker001:] . [LAUGHTER].
[Tony:] And you are left in this condition during the operation, then at the end of the operation they give you a second injection that reverses the first one that paralysed you.
[speaker001:] Any side effects?
[Tony:] No, but I'll come onto some effects that it did have in a moment. Now. If you've got tetanus, to stop you breaking your back with these muscle contractions, so that they can nurse you adequately, they inject you with this stuff and you are paralysed until the tetanus has been fought off. They will give you the antitoxin, they will give you the vaccination, and they will keep you breathing. Cos what normally happens is with tetanus, that the reason it kills you is that you stop breathing because your muscles... that work your lungs, the diaphragm, the intercostal muscles between the ribs, those seize up and you just stop breathing. So if they can keep you breathing... and get your body to produce the necessary antibodies, then they can cure you. But it may take three months, so you are three months possibly on a ventilator. What will happen is, at regular intervals they'll take you off the ventilator... inject you with the er... antidote to the depolarizer and see if your muscles lock up. If they do, another injection, tube back down and back on the life-support machine. Now bear in mind that you may be up anything up to three months in a condition where you're completely and totally unable to move a muscle... for yourself. That's
[speaker001:] Ugh
[Tony:] ... [tut] That's why it's specialized nursing, because the nurses have to do everything for you.
[speaker001:] . [LAUGHTER].
[Tony:] The physiotherapists... will come round and they come round regularly and exercise your muscles
[speaker001:] [LAUGHTER].
[Tony:] to try and stop them wasting away.
[speaker001:] . Which ones do they?
[Tony:] Legs and arms, particularly.
[speaker001:] Oh. But there's another one. [LAUGHTER].
[Tony:] Now just imagine you are imagine being paralysed by this drug and yet being fully awake. You can't do move your eyes,... er so your eyes are actually taped closed to stop anything going in them. Just imagine lying
[speaker001:] Can you see?
[Tony:] there... continuously. Well the answer is you'd go stark staring raving mad. So what they normally do is they also give you by continuous intravenous drip They f have to feed you by this tube,
[speaker001:] .
[Tony:] and they also give you erm a suitable... relaxant erm so you go into what's called t twilight sleep. So you're not really conscious but you're not really unconscious
[speaker001:] .
[Tony:] and you don't care what's happening to you.
[speaker001:] .
[Tony:] And you'll spend three months of your life like that.... Now then, Assif was asking were there any side effects. Let's have a look. There is a certain Asian anaesthetist who used to work at the... City Hospital Maternity Unit.... I say used to because he's been struck off the medical register.... What's he done to get that? The answer's simple.... When you have a general anaesthetic for a caesarean section or a general anaesthetic in general, you are... first of all given a pre-med. Now the pre-medication is a drug based on atropine which has erm... I'm not really Anti-something- or-other and er I can't pronounce the words concerned. But it h er has certain effects which basically cause muscle relaxation, small amount of muscle relaxation, dries up the saliva in your throat. Cos obviously if you having an operation they've got this tube down your throat and your mouth starts filling up with saliva, they've got to suck it out. So this drug makes you very dry, also makes you drowsy, the idea being that you're basically not going to worry about what's happening to you....
[speaker001:] Pain.
[Tony:] Okay.... You're then taken down into the operating theatre and the first injection you are given is usually something on the lines of erm... er special K, ketomine or the most common one is
[speaker001:] thyropentone sodium because it's the cheapest. This is an injection of general anaesthetic into the vein, back of the hand, or the... ar arm, which puts you to sleep very quickly. Once you are asleep they then inject the muscle relaxant, put an endro-t tracheal airway into your throat, connect you up to the anaesthetic machine and get the life-support machine breathing for you. The ventilator.... So you are therefore paralysed... and, hopefully, because of the anaesthetic you've been given in the form of gas, things like er halothane, er enfluorane [shouting] Come in. []... Mr.... .
[Tony:] Right.
[speaker001:] Possible R O A, cross curricular, we'd like to keep that as it is but we can change that.... [students' voices in background]
[Tony:] Looks reasonable.... [students' voices in background] Right. Oh, by the way Mr.... [students' voices in background]
[speaker001:] Ah.... I've done that.
[Tony:] You've done yours. Right.
[speaker001:] . Sir, to do summat to do like... she was paralysed but she could still feel the pain?
[Tony:] That's the one.... Yeah. And so this poor woman who was supposed to be asleep, And the problem is... that er it's very difficult to decide whether somebody's actually unconscious or not if they can't move. Now normally if you're not unconscious and they start cutting up open you're going to scream.
[speaker001:] Yeah. But if you're paralysed you... [LAUGHTER].
[Tony:] Exactly. Now this poor woman... the anaesth Ah.
[speaker001:] .
[Tony:] Sister.
[speaker001:] Poor woman.
[Tony:] Yes.
[speaker001:] Erm I've got a girl sitting down in the foyer. She is she she was just running and she's done something to something there. She's not in pain sitting in the foyer so what I've said is you'll look at her at break time. Can you? Cos I'm I would say she's pulled something but more than that
[Tony:] Right.
[speaker001:] I'm trying to sort out the e year eight sex education with Bernie at the moment.
[Tony:] Oh well er
[speaker001:] [LAUGHTER].
[Tony:] Yes. We're actually talking about erm er muscle er depolarizers
[speaker001:] Oh right.
[Tony:] used in general anae er anaesthesia,
[speaker001:] Right.
[Tony:] and I was telling them about that Indian or Asian doctor at the City Hospital in the Maternity unit.
[speaker001:] Which one's that?
[Tony:] Oh the one er who didn't give them enough anaesthetic so they woke up.
[speaker001:] Oh right! Yes they woke up and they're carving them and cutting away, but couldn't say anything.
[Tony:] That's right.
[speaker001:] Yes. Brilliant, yes. She got quite a lot of money.
[Tony:] Mm. Five hundred thousand wasn't it?
[speaker001:] Yes. Was it a caesarean section?
[Tony:] It was.
[speaker001:] Yes that's right. I can't imagine. Anyway, she's she's sitting there
[Tony:] .
[speaker001:] but she's okay while she's sitting still.
[Tony:] Right. I'll have a look at her.
[speaker001:] Okay.
[Tony:] Thanks, right.... [students' voices in background] [whispering] Right. [] [shouting] As I was saying. [] So this poor woman... is er anaesthetized, intubated, which is when they put the tube down the throat and connect you up to the life-support machine, and then she's supposed to be being maintained in her unconscious state with inhalation anaesthesia, in other words they give her er gas and air to breathe to keep her unconscious. Unfortunately this anaesthetist wasn't very good and he didn't give her enough. So she woke up.... Now bear in mind, she... er normally for an operation they normally tape your eyes closed, put a pad over your eyes as well, just in case they drop something on your face by mistake during the operation.
[speaker001:] [LAUGHTER].
[Tony:] So she's completely and totally paralysed... but she's paralysed and can feel pain. So she suddenly feels what's like something like a red-hot knife being put into her stomach. It wasn't a red-hot knife, it's just simply that the surgeon had taken this knife, started to carve her abdomen open, and the heat part of the heat was the actual blood that was coming out of this wound.
[speaker001:] Ugh.
[Tony:] And then of course they've got this soldering iron type thing called the diathermy cautery device that seals up the blood vessels and this is being stabbed into her. And all the time this is going on she is completely and totally aware of everything that's going on.... Now when they reverse... the erm... paralysis and take the tube out, the first thing she does, quite unsurprising, is screams,... and then proceeds to tell the doctors exactly what's happened to her. Now the doctors don't believe her. Until she starts to tell them word for word what they said during the operation.... And the next thing she does on recovery is file a criminal n erm... a sorry civil negligence suit against the anaesthetist.
[speaker001:] .
[Tony:] Now... two things. Number one... is... erm if Er this is unlikely to happen today. For example, a member of staff in the school, who teaches not a million miles from here, had a hernia operation. And it was done at the convent hospital, where the anaesthetist there, not only gave this gentlemen a general anaesthetic... but also a spinal anaesthetic as well.... That's when you inject a chemical in the spine to paralyse the nerves below that site. So we're working on the principal that even if the person does wake up in the operation they're s not going to sue you cos they can't feel anything in the area you're operating in.
[speaker001:] Sir?
[Tony:] No.... The other side of that is that I was listening to Medicine Now on Radio Four, and they've got a device where they you actually have er an earpiece put into your ear... and it clicks continuously.
[speaker001:] .
[Tony:] Now... the idea is that er they put a couple of monitors and monitor your brainwaves. They put you to sleep and this clicking continues...
[speaker001:] As soon as you start.
[Tony:] and as soon as you er go to sleep your brain level drops.... So your r er reaction to these clicks drops. As you start to recover your brain's activity rises. So this device couple of... electrodes on the head, this device in the ear clicking away madly,... and they monitor The anaesthetist... s connects it all up, presses a button saying Awake, injects the person with the
[speaker001:] thyropentone sodium, where they can assess the effect because they haven't paralysed the person yet, when the person stops responding and is asleep they press the button for Anaesthetized, and then the machine logs... the differences between the brain activity between the two. Then if the patient starts to wake up, this device sounds an alarm saying that the brain activity is increasing, and that is commensurate with the person waking up, so the anaesthetist knows that he's got to put a bit more anaesthetic into the person.... So hopefully that's going to stop this sort of thing happening in the future.... But er one of the major problems is that surgeons are trying to use less and less anaesthetic all the time. Can anybody suggest why?... Less side effects Sir.
[Tony:] Yeah. Fewer side effects, that's right. Er
[speaker001:] What's your chances of waking up then in an operation?
[Tony:] Very small, thankfully. It's quite rare, which is why it made so much publicity. But the erm... chances of dying in an operation are one in one thousand eight hundred....
[speaker001:] Eh?
[Tony:] Chances of dying in an operation are one in one thousand eight hundred.
[speaker001:] Can you die of your pain?
[Tony:] Er would be possible. Now before Neil starts panicking and worrying about that, bear in mind that that is spread over the whole spectrum of operations, including things like heart transplants and the like, and also, for example, an elderly person who's just been smashed up by er Astra G T E...
[speaker001:] [LAUGHTER].
[Tony:] and who's going in for emergency surgery and whose chances of coming out are virtually nil anyway....
[speaker001:] [LAUGHTER].
[Tony:] So if you are a n relatively fit normal person your chances of survival are excellent.
[speaker001:] are these the chances of surviving er a hernia operation or?
[Tony:] For the average hernia operation which is done remember as cold surgery, not as an emergency, the chances of dying under the anaesthetic are vanishingly small....
[speaker001:] How small?
[Tony:] Put it this way, you're probably at more risk of dying crossing the road. And er one of the reasons they've reduced the levels of anaesthetic is because the more they reduce the levels of anaesthetic, the lower your chances of dying during the anaesthesia.... Right.... Any questions... about that?
[speaker001:] Yeah, what... what you got under your? You've got. [LAUGHTER].
[Tony:] I don't know. [tape change]