Series 1. Ep. 10 An introduction to ligaments and incredible anatomical history from 335 BC

Dr David does an introduction to ligaments. Did you know we had 900 of them !

We dig deep into anatomical history, specifically Herophilus (335–280 BC) who put into place the building blocks of what became modern day medicine.

The two Scots brothers John (1728–1793) and William Hunter (1718–1783)Scottish brothers who revolutionized 18th-century medicine, anatomy, and obstetrics in London.

Dr David has the facts and figures in his head as he talks through his subject. Anatomy. Fascinating, compelling and true. 

Dr David Robson is a practicing Anatomist who lives and works in Edinburgh. 

Click here to contact Dr David Robson directly

Transcript

Alison 0:05

Hello and welcome along to the Real Anatomist Podcast with myself Alison Craig in conversation with Dr.

Dr David 0:12

David Wobson, MDMA.

Alison 0:15

And thank you very much for listening to the podcast. We've been looking at the latest stats and quite an excessive number of countries and cities. It's always interesting, isn't it?

Dr David 0:30

So it's going well, so people must be enjoying it.

Alison 0:33

Yeah, organically we're just letting it slide out.

Dr David 0:36

Yeah, which I think sometimes is the best thing to do.

Alison 0:38

Yeah. So thank you indeed for your support. And uh yeah, well, on we go. So on this particular podcast, we're going to be uh talking about ligaments.

Dr David 0:49

A general introduction to ligaments because I'll cover the ligaments in more details when I cover each region of the body. Okay. But as I said in the previous podcast, there's 900 ligaments in the body.

Alison 1:02

That's a lot of ligaments.

Dr David 1:03

It is. Well, you've got 360 joints, so you need the appropriate number of ligaments for these joints.

Alison 1:08

So what is the definition of a ligament?

Dr David 1:10

A ligament is a tough fibrous structure, mainly composed of protein collagen. And it normally contains type 1 collagen fibres for strength and type 3 collagen fibres for flexibility.

Alison 1:25

Okay.

Dr David 1:26

And ligaments are normally associated with joints. But there are different types of ligaments, unfortunately. Unfortunately, if you have to try and remember them all. Unfortunately, because you've got to try and remember the order of them all though. Primarily the ligaments are articular ligaments forming the capsule of a joint for strength. And with those, you get extra capsular ligaments. These are ligaments outside of the capsule. Prime example of that would be the major collateral ligament of the knee and the lateral collateral ligament of the knee. And then you have interarticular ligaments. These are ligaments that are found inside of a joint. And again, if you take the knee, for example, you have the cruciate ligaments. Interesting fact about the cruciate ligaments, they were first described and mentioned by Galen in the year 170 BC. In his writings. And he called them the ligamentum genu cruciata. In other words, meaning ligaments that cross a joint.

Alison 2:29

Right. Because of all the 900 ligaments in the body, that is the probably the only one I've heard of, actually, because a lot of people have issues with that.

Dr David 2:36

They have issues with the cruciate ligaments.

Alison 2:38

Yeah.

Dr David 2:38

They do, that's right. The knee is the one that's normally associated with joints and for ligaments if you're going to describe them. And then apart from those ones, you see, you then have functional ligaments. Functional ligaments are associated with particular joints like the knee, the elbow, the shoulder, the wrist, the ankle, and the spine.

Alison 3:01

So ligaments are just everywhere.

Dr David 3:04

They're everywhere. But those are the ligaments associated with joints. We now take those away, and one little set of ligaments are called the periodontal ligaments. Periodontal ligaments connect the cementum of the teeth to the areola bone.

Alison 3:21

Right.

Dr David 3:22

In the mandible and in the maxilla. You have to have a ligament to keep them in place.

SPEAKER_00 3:26

Okay.

Dr David 3:27

Okay. And then you have another set of ligaments, which are called fetal remnant ligaments. Now these are ligaments that actually developed during development of the embryo. When we were in the womb. When we were in the womb. And they're mainly comprised of circulatory vessels, either arteries or veins or both. And an example of those ones would be the ligamentum arteriosum, which is the remnant of the ductus arteriosum, which was the connection between the aorta and the pulmonary artery. Which meant the blue vent stress with the pulmonary artery to the aorta bypassing the lungs. Or you had another one called ligamentum venosum, which is a remnant of the obliterated umbilical vein. Going to the liver, to the IVC. Then you have the median circle, median umbilical arch ligaments, and the medial umbilical ligaments. And they're the main four types of remnant ligaments. And then you have another group of ligaments.

Alison 4:37

Could I have a genotonic, please? This is my brain is throbbing, yeah.

Dr David 4:41

And these ligaments are called the peritoneal ligaments.

SPEAKER_00 4:44

Right.

Dr David 4:45

Now these are two folds of peritoneum that actually connect organs to one another in the abdominal carry or to the abdominal wall. And again, they're comprised of circular vessels. So they're primarily the different types of ligaments that you find.

Alison 5:04

Gosh, well, somebody said they pulled a ligament. I mean, you've really got quite a mysterious uh job ahead to try and find out which one.

Dr David 5:12

Again, just the study of the ligaments themselves can be a big subject.

Alison 5:16

I mean, all the names that these ligaments have got that you've just you mentioned, a few, obviously, of the hundreds, where do they originate from? Who names these things?

Dr David 5:28

In history, in some places, there's no one person that's been accredited to actually describing all of the ligaments in the body. One of the best examples of that was Vesalius in his classic book of 1543, he described all of them. But the first ones that I mentioned before, the Cruciate ligaments, well that was Galen.

Alison 5:47

Right. And that was 170.

Dr David 5:49

That was in AD 170 in his writings.

Alison 5:52

170.

Dr David 5:54

Now, if you want to think of some historical facts for ligaments, an interesting one is the ligamentum teres of the hip. And the ligamentum teres of the hip is actually found within, arising from the floor of the acetabulum, and gets attached to the forvia capitus and the head of the femur. And it's a stabilizing ligament of the hip joint. Now that one has got an interesting history because one of the first people to actually describe that was an Egyptian physician between the years 100 and 130 BC. He was a member of the Alexandrian school, man Herophilus, who was the father of anatomy was teaching. But if you look at the historical context of that particular ligament, it's actually described and mentioned in the book of Genesis. And the reason it's mentioned in the book of Genesis, it's in relationship to Jacob. Now Jacob suffered a hip injury. So the history of the ligamentum teres goes way back in time. It used to be called ligamentum capitus femoris. Now we could just call it the ligamentum teres. And teres in anatomy means round.

Alison 7:23

The diagram.

Dr David 7:24

There's a lot of pain pathways within that particular ligament, but it's an important stabilizing ligament for the hip.

Alison 7:29

Pain pathways within that.

Dr David 7:31

Yeah.

Alison 7:33

What does that mean?

Dr David 7:34

Well, it means that if there's a problem with the hip, if there's any damage to the hip, if you've got degenerative changes, if you get what's called an impingement between the head of the femur and the acet edge of the acetabulum, that can cause tremendous pain.

Alison 7:47

Right.

Dr David 7:48

So the ligament is very sensitive for pain.

Alison 7:51

And how would you alleviate that pain? Would the ligament could the ligament be trapped or is it just it can be caused through an impingement?

Dr David 7:59

Right. Yeah, so you can do a surgical operation called a debidement where you go in an orthroscopy into the actual hip joint itself.

Alison 8:08

I mean there's a very good diagram of what you're discussing on the blackboard behind you, which I know you did in preparation for our chat today. So I'm going to take a photograph of that and put it up. So if you go to the website that comes with the podcast, the Real Anatomist, then you'll see a picture of the diagram that David has has drawn here, which will give you more detail and more terminology, which is all written clearly in on the blackboard.

Dr David 8:42

And the diagram next to it shows the strongest ligament in the human body, which is called the iliofemoral ligament.

Alison 8:49

Where's that?

Dr David 8:50

It's in the hip.

unknown 8:52

Okay.

Dr David 8:53

That one arises from the anterior inferior alliac spine. It's an inverted Y. So if you think of the Y in the alphabet, it's an inverted Y.

unknown 9:02

Okay.

Dr David 9:02

And it arises from the anterior inferior iliac spine and inserts into the superior and inferior cervical tubercles on the neck of the femur. And then between those two tubicles is an area called the interrochenteric line. And the allofemoral ligament is the strongest ligament in the body.

Alison 9:23

Well, that photograph and diagram will be on the uh its other name as the ligament of Bigelow. Bigelow?

Dr David 9:31

Bigelow, yeah, Jacob Henry Bigelow. He was an American surgeon. And he gave the first accurate description of this ligament in his book. And his book was published in 1869. And it was called The Mechanisms of Dislocation of the Hip. And Henry Jacob Bigelow was 1818 to 1890. But again, an interesting fact about that ligament. It was originally described in a book published in 1626. Was Vidus Vidius. It was an Italian anatomist, 1500 to 1567. And then if you want to take a back a historical looking at this particular, go to Hegatar. Hegathar was a physician of the Alexandrian school.

Alison 10:42

Which is where Herophilus was.

Dr David 10:46

So he's mentioned it as well.

Alison 10:47

It's extraordinary that all those thousands of years ago they were doing work that is now as relevant. Still as relevant today. Still as relevant. Yeah, it's extraordinary, yeah. And what is also extraordinary is that David's sitting here with no notes or any, you know, no manuals, or he doesn't have his iPhone, he's not flicking through anything. It's all in your rather extraordinary head, isn't it?

Dr David 11:14

It's there somewhere. It's just bringing it out. That's why sometimes I have to apologize sometimes when you're asking me something, sometimes it overrides you. And the only reason that happens is it's because I'm on a thread. And if I suddenly lose it, then it can be difficult for me to actually get back to that. And yet sometimes I can go on a slight detour, but manage to go back to it.

Alison 11:34

Yeah.

Dr David 11:35

But yeah, so ligaments are quite interesting.

Alison 11:37

Well, they certainly are, yeah.

Dr David 11:38

You know. And you get ligaments all over the body, and some of them do have classical names where they actually are named after people.

Alison 11:46

Okay.

Dr David 11:47

You know? You have a tiny little ligament in relationship to the head of the humus between the greater and lesser tuberosities of the humus. And that's called the transverse human ligament. And that ligament's important because that helps to keep the long-headed biceps in place.

SPEAKER_00 12:03

Oh.

Dr David 12:04

Otherwise known as the ligament of Brody. Charles Gordon Brody.

Alison 12:08

Well, he sounds like he came from round the corner.

Dr David 12:11

Ah, he is. You have ligaments associated with the breast. And the suspensory ligaments of the breast, the ligaments of Ashley Cooper, 1768 to 1841. We've discussed Astley Cooper before.

Alison 12:26

We have, and it's a fascinating story. We have because he's a fascinating one.

Dr David 12:29

That was a fascinating one that we did on that one.

Alison 12:33

Yeah, Asley Cooper, that was a fascinating story, which is uh in a previous episode, so you have a look back, you can dig deep into that. Joseph Town. Love that story.

Dr David 12:44

And the most famous surgeon of his of his day. Yeah. Was it Aslie Cooper?

Alison 12:50

One thing about ligaments, when you were talking about there at the beginning, you talked about them having collagen.

Dr David 12:56

Um they're made up of collagen.

Alison 12:58

So as we get older, certainly women, um, I don't know if this is the case of men as well.

Dr David 13:03

It's more so on skin.

Alison 13:05

Yeah, I see. So the collagen, it's a different kind of collagen.

Dr David 13:08

Yeah, that's it's a type 1 and type 3 in the ligaments. Right. For strength and flexibility.

Alison 13:15

So that's that doesn't diminish then as you get older.

Dr David 13:18

Not really, no. When it diminishes your keep damage in the muscle, keep damage in the ligaments. Right. But the interesting thing again, there's other ligaments that are named after people. You have the transverse ligament of the atlas. Otherwise known as the transverse part of the cruise-shaped ligament that helps to keep the odontide process in place, which acts as the body for the atlas. That's the transverse ligament of Louth. The atlas is your head, isn't it? Yeah. Yeah, it's what your skull sits on.

Alison 13:46

I am learning, you see.

Dr David 13:47

You see?

Alison 13:48

There you go, you see. They said it wasn't possible, but you didn't.

Dr David 13:51

Well, I don't believe that. And that's known as the transverse ligament of Louth, A U T. He was a German anatomist. Oh. In the 1800s. Described that one.

SPEAKER_00 14:02

Gosh.

Dr David 14:03

So lots of ligaments are named after people.

SPEAKER_00 14:06

Yeah.

Dr David 14:06

Not as many as what you would have thought. The important ligament that Part mentioned before is the one at the back of this, back of the neck, which is the ligamentum nuclei. And the ligamentum nuclei arises from the external triple occipital protrudent at the back of the skull of the occipital bone. And it's a triangular and extends down from there to the spine of C7. And is attached to all of the spines of the cervical vertebrae.

Alison 14:35

It's a long one.

Dr David 14:37

It is. It's an important one. The best place to see it is if you're in an abattoir, when the beast is sliced in half. And you look at its neck, you see this beautiful white glistening band. That's the power from the ligamentum nuclei.

Alison 14:52

Gosh, I had no idea there was a ligament there. And that's that's that's comparative anatomy. It's in our us as well.

Dr David 14:58

Yeah, it's there. It's attached from the external, except for the protuberance, which is there, that little bony point there. Yeah. Extends down to the spine of C7. Gosh, and C7's C7 is the last cervical vertebra in the neck. Okay. And it's it's different to the other ones because it's known as the cervical prominence, because it has the longest spine of all the cervical vertebrae.

Alison 15:19

Right. Gosh.

Dr David 15:20

And then from C7 going down, it changes its name. And it becomes a superspinous ligament in between each of the vertebrae. And the occipital crest. It's also attached to the occipital crest. Right. And attached to that are your muscles at the back of the neck, like your trapezius.

SPEAKER_00 15:42

Yeah.

Dr David 15:42

Alright, so they don't overlap. They attach the ligamentum nuclei. So in some respects, it is representing a raphe, a tendon between the muscles from one side of the neck to the other. But it's a very important ligament. But you can damage that ligament and hyper extension of the neck.

Alison 15:59

Oh.

Dr David 16:00

And if you read through the neck or in an accident, you can damage it.

Alison 16:04

Right. Because you know, the more I learn about the anatomy, having these conversations, it's just amazing that we can walk about. You know, there's so many thousands and thousands, hundreds of thousands of bits and pieces within our skin, within our body.

Dr David 16:21

If you think of it, it's the whole of anatomy itself.

Alison 16:25

Yeah.

Dr David 16:26

And you went through every single word in anatomy alone. That's 14,800 words. So it's a language all on its own. Yeah.

Alison 16:35

And it's one, I know we touch on this a lot, but I still feel quite passionately about it, as I know you do, that you know, 14,000 term words of terminology within the subject can't be taught in a term or can't be taught in a year. I mean it's uh taught in a week.

Dr David 16:53

Well, I mean it's a lifetime of work, it's a lifetime of work, it really is. But that's where if you want to learn the subjective anatomy, yeah, you have to have the self-discipline in order to do it. Yeah.

Alison 17:04

And you have to have someone to teach you.

Dr David 17:06

Well, yes. But you see, some students will try and learn will learn it on their own. Yeah. And in order to do it on your own, you need the discipline to say, I'm spending this amount of time to do it. And the sad thing about is it's one of the hardest subjects ever to learn. It's the easiest subject to forget.

Alison 17:25

Yeah, yeah.

Dr David 17:26

Unless you're constantly going over it.

Alison 17:28

Yeah. But as the history has shown so many times, the the people that are the experts, the people that have been describing all these pieces parts of the body and nerves and ligaments, have learnt by dissection, haven't they? They've seen in reality what they're talking about. They're not learning it in a on a diagram, they're not learning it in theory, they're learning it in practice, practical.

Dr David 17:55

The only way to learn it is to dissect the body. Yeah. And as I've mentioned before on previous podcasts, if you want to know anything about it, we'll go to a book on an encyclopedia. The body is in fact your book.

Alison 18:09

Yeah. I love that about the Hunter brothers, I think it was.

Dr David 18:13

John Hunter had a student that came over from America when he was in a near court, and the lad's name was Philip Van Sink. And his father brought him over from the States to learn anatomy. Studied in England, but to learn from John Hunter. And his father asked John Hunter, what books do you recommend? And John Hunter took him into his little into his dissecting room. And in the dissect room was a body over there, and he pointed to Philip Vansing's father and said, That's the book.

Alison 18:47

Yeah.

Dr David 18:48

And when you think about it, it is the only way to learn it because if you're dissecting it, doesn't matter if you're dissecting the neck or the hand, whatever part, you then understand and see the relationships of one structure to another. You'll also see if something unusual crops up, like an extra muscle, or an artery going in a different direction. Or an artery that actually passes through a nerve, which can happen.

Alison 19:13

And in order to know about the anomaly, you have to know. You have to know the normal. The normal, yeah.

Dr David 19:19

So it's that's just what makes it such a vast subject, but it is such an interesting subject. It really is.

Alison 19:26

I mean, never a day goes by where you don't pick up the phone to put may yet be another problem that you've never had to solve before, but you know, it's it's endless and vast and it's it's such a vast subject, it's like I said to the young student that I have questioned.

Dr David 19:42

You just never know.

Alison 19:43

Yeah.

Dr David 19:44

And you never know what's different. Uh huh.

Alison 19:51

I mean it's all rolled into all rolled into one. Yeah.

Dr David 19:55

It really is. That's what makes it such an interesting subject.

Alison 19:59

And I know you never mentioned this, but I am going to mention it because I think it's important, and seeing the diagram that you've written done today, you have got, you have written extensively and illustrated extensively, um, Robson's approach to anatomy, which is you know, they're huge amount of work and research, and you know, your drawings accompany you know the the book, so therefore it all makes sense within the context, and you have these books are available on Amazon. And I think you know, for people that are fascinated as I am with you know the conversations that we have, it's nice for them to know that they can actually reach out and get something that again will illustrate as you're sitting in your kitchen or you know, wherever, you can see what we're talking about as well as hear it.

Dr David 20:57

It was Pat's idea for me to put it into seven small books. Yeah. And that came to my mind when we were travelling on a train, you see people looking at the magazines.

SPEAKER_00 21:06

Yeah.

Dr David 21:07

And Pat said, Why don't you make it into smaller volumes that people can actually just pick up as opposed to one big book? Yeah. Because if you put the whole book together, it works out at 1600 pages.

Alison 21:20

I mean that's telephone directories, Will.

Dr David 21:22

And that's the curtailed version.

Alison 21:24

Yeah.

Dr David 21:25

I could have made it a lot bigger. But the problem is anatomy is not taught like that anymore.

Alison 21:32

And that's why we're doing it.

Dr David 21:34

So I curtail it. But it has all the relevant facts in. Yeah. So it means if you if like part one, book one is the skeleton. So the whole of the skeleton is in it.

SPEAKER_00 21:44

Yeah.

Dr David 21:45

So when you finish that, you have a thorough understanding of the human skeleton. Yeah. Part two is the back.

SPEAKER_00 21:52

Right.

Dr David 21:53

And the reason I decided to do it with the back next is because without the back you haven't got a body. Basically.

SPEAKER_00 22:01

Yeah.

Dr David 22:02

And then we go, then we go we go to the head and neck after that, which is three. Four is the upper limb. Five is the thorax. Six is the abdomen and pelvis, and seven is the lower limb. But they're all small little books. So people just want to look at one book for a particular reason. Like if you had a beauty therapist that's only concentrating on learning head and neck, then they just get volume three, which is head and neck. Yeah. Which is the biggest of the seven seven parts of the book.

Alison 22:35

I mean you say they're small books, but they're actually printed in in a big size, so that you know it's not like because I mean they print magazines now in about you know an A5 size and it's really annoying. Yeah, which is great.

Dr David 22:48

I mean that all the all the illustrations are mine.

Alison 22:51

Yeah.

Dr David 22:55

That's got the photographs in of the section that I did of the entire nervous system.

Alison 23:00

Fascinating stuff. But again, it's it's laid out for people to see and really understand.

Dr David 23:07

Well it is because it's one book finishes, the next one starts.

Alison 23:09

Yeah. And that's that's the other thing about, you know, perhaps a a degree of inverted snobbery within the medical profession that um it's it initially was looked upon as a very I mean you had you know the hierarchy of the the doctors and the surgeons. The physicians. Yeah, the physicians.

Dr David 23:33

Yeah. Yeah, the physicians because they were universally educated.

Alison 23:37

Yeah.

Dr David 23:38

And you had the surgeons that were that learned on the job by being apprenticed to an apothecary surgeon for seven years, and during that time you had to dissect at these two bodies.

Alison 23:47

And so it's a practical thing rather than just an I'm gonna say the word intellectual, that's probably not the right word, but um theoretical. But it was the practical work because it was the two brothers, wasn't it? One brother was a bit of a wild man and they didn't quite know a lot of. John and William. Yes.

Dr David 24:04

William was the elder one by ten years, with ten years exactly between them. William might have to study theology first. Wasn't really enjoying it, so it was suggested that he should study medicine, suggested that he should go to Edinburgh University and learn anatomy from Alexander Monroe, Primus. So he did. And he got attached to uh a GP called Hamilton. Hamilton introduced him to a guy called Monroe. Not Monroe, Cullen. Cullen. And Cullen helped William Hunter encouraged him to do this. And encouraged him by by giving letters of introduction to go to London. And he did. And then he met up with the surgeons down there. One in particular was a one called Douglas, James Douglas, who was the leading anatomist and a cushion of his day. So he worked with him and lived with him. And William Hunter taught Douglas' son and went off to France to learn different techniques, came back. And William set up his own anatomy school. And by 1776 was the most famous anatomy school in Europe.

Alison 25:16

Extraordinary.

Dr David 25:17

John was ambidextrous.

Alison 25:19

This is his brother.

Dr David 25:20

This is his brother. John, I know it was meant to be doing ligaments, but you did ask about No, no, it's a great John didn't like school at all. John didn't like books.

Alison 25:30

I love John's story because it's a big book.

Dr David 25:31

John liked to get out into the woods and go back and ask questions as to why is that tree changing colour? Trees do change colour every year.

unknown 25:40

Yeah.

Dr David 25:41

There's winter coming on, the leaves are changing, they become urban, they fall off the tree. You wanted to know why. Why does that particular egg in the nest have so many freckles on it and that one doesn't? What's the difference between a toad and a frog? He asked all these sort of questions. John's mum looked after John because he was the youngest of ten children. John eventually went up to Glasgow to work with his brother-in-law as a carpenter, and as I just said, he was ambitextuous, so he could use both hands. John wasn't really happy with that. And then John realised and saw what his brother William was doing in London. So thought maybe I should go to London and see if William could give him a job and help him. So in 1748, John left with a chap called Hamilton, was his pal. And they left from Leith on horseback. And it took them three weeks to get to London. And when they arrived in London, John went to Covent Garden as to where William had his anatomy school. And the thing was William felt for John. And John asked, you know, could he help him get a job or something like that? Now you've got to remember William was classes of dandy, he was well educated, he was dressed, everything. He was the male cushier, which is the French word for gynecologist obstetrician. So William decided to give John a chance to work in his anatomy school. So he asked John, would he dissect? Have a go dissecting a right arm. Just to show the muscles, nothing else. So John decided just to dissect the muscles of the arm, and he did a perfect job of it. William asked him, could he dissect another arm? But this time displayed the nerves in the blood vessels. And again, John displayed the nerves in the blood vessels. No problem whatever. John took to it like a duck takes to water. William eventually gave him a job as a demonstrator. And then he used to give he used to do some of the lectures for William. But John wasn't confident in teaching. He was a poor lecturer. But to cut the story short, where John was a student, John surpassed his master, which was his brother. And John became the leading surgeon in Europe.

Alison 28:28

See, I think that's such a powerful message now, you know, recently in the press, they're talking about what happens if you don't go to university, what do you do? Well, that was that's a great example of you know, if your brain doesn't necessarily work within that confine of books and learning like that, to be able to do that. Practical, yeah, and it's so important.

Dr David 28:49

And so that's what John did. Yeah. And John John wrote a classic paper on a descent of the testus. Um on for that, he was elected a fellow of the Royal Society, which didn't go down too well with William. It was a bit because he was made a fellow of the Royal Society six months before William became a fellow.

Alison 29:10

So a bit of sibling rivalry kicking out.

Dr David 29:13

Oh yeah, it was there, and then John also won the Copley Medal, which is the highest medal that you can beat. John did. John did. Right. Again from the Royal Society. I could see William getting all but they had a fallout. But because he was dissecting all the time and cramped conditions and the smell that affected John's health. Right. So John had to pack it up and he went off and joined the army. Gosh. Became an army surgeon. But to be fair to William, William did happen because he got he got John into St. George's as a surgeon pupil. Right. And got him to study with Chiseledon. Now, Chiseledon was the country's leading surgeon of his day. And he could do a lithotomy operation, which is removal of a stone from the bladder in less than a minute. And the other great surgeon of his day was Percival Pot. Potts tumors of the spine, TB, Potts puffy tumour fracture of the ankle where he went through and got a puffy tumour known as pot's fracture of the ankle joint. Well, it's a tumour. Tumour can be a soft tissue tumour.

SPEAKER_00 30:22

Right.

Dr David 30:23

One of the common ones is the lipoma. People have them on that move. It's just a fatty tumour. Right. They call lipoma tumor. Everyone goes, but it's not always a bad thing. No, it's not always cancer. So it's just a big thing. It's like mural fibro fibromatosis. Or benign tumors on nerve ends.

Alison 30:40

Right.

Dr David 30:41

Otherwise known as von Recklenhausen's disease. Which is what the elephant man had.

Alison 30:48

I think it's just one of these words that feel like fear into people's hearts.

Dr David 30:53

Of course it does. Yeah. But you see, you can start talking about ligaments. Yeah. And going a roundabout way.

SPEAKER_00 30:58

Yeah.

Dr David 30:59

Just to make the story that a little bit more interesting. Yeah. Because you're bringing in historical anecdotes and that. But yeah, no, John Hunter's story was fascinating.

Alison 31:08

Absolutely.

Dr David 31:08

He was the first surgeon, if you like. When he came back from the way he set up on his own. And he was in Leicester Square for a while.

Alison 31:18

Gosh.

Dr David 31:19

Earl's Court, he had a beautiful big house there, and that's where he had his dissecting woman. He had a menoragery of animals.

Alison 31:25

Oh, did he?

Dr David 31:26

Oh yeah, yeah.

Alison 31:27

But to look after or die. Oh, he looked after it. He looked after them. Of course you said when he was a wee boy he liked.

Dr David 31:33

He looked after them. And he knew the keepers in the of the zoo for the Tower of London. Oh. Because Tower of London used to have a zoo. Didn't it? So any of the animals that would die there, the curator would get in touch with John Hunt and I said, such and such has died, and John would go and collect it and dissect it. John didn't look at the anatomy of the human body, John studied comparative anatomy.

Alison 31:55

Right. But he did originally look at the when he was dissecting the human body.

Dr David 31:59

Oh yeah, yeah. But he wanted to learn more. It was fascinating. What was the difference between an animal's anatomy and a human's anatomy? And he dissected everything. He dissected whales, you name it, he dissected it. He dissected 4,000 bees just to understand the workings of the anatomy of a bee. He must have had very good eyesight. Yeah, and he used he used to go to but he used to get up between four and five o'clock every morning and go and work in his laboratory dissecting.

Alison 32:31

It was a complete passion obsession almost.

Dr David 32:35

That was a passion form.

Alison 32:36

Yeah. Did he describe a lot of the human body, John Hunter?

Dr David 32:43

It didn't make a lot of observation as as anomalies. He described bone growth for the first time. Right. He carried out the first transplant of a tooth. Because dentist was just rough and tumble in them days. And John wanted to understand about the blood supply to the tooth. So what he did was he he got a tooth and he planted it in the pectin of a cockle's head. What the the No, if you look at the cockle's head, it has a flappy bit like that.

Alison 33:16

Yeah, yeah.

Dr David 33:17

And it's shaped like that.

Alison 33:18

Yeah.

Dr David 33:19

Cool. All right. It's called the pectin.

Alison 33:21

Yes, it I never knew that.

Dr David 33:23

No, you have the pectin and the cockle's head, you also have the pectin and the anal canal of the human body. Really? Yeah. Because of the the the shape of it, the shape of the mucous membrane. And he took a tooth and he planted it in to the pectin of the cockle's cockle's head. And waited to see if it would grow, if it would get a blood supply.

Alison 33:43

And? It did.

Dr David 33:45

That would have been a bit. That was the first type of transplantation that he did. It was a pioneer that way for transplantation. Primitive plant plantations. He did that.

Alison 33:57

Goodness me. Just you know, it's a hard I'm I'm I'm just visualizing, you know, a cockerel with a tooth growing out of its top of its He kept it just to watch to see if the tooth would receive a blood supply from the pectin. Amazing.

Dr David 34:12

And it did.

Alison 34:15

So when he was getting his hands on, obviously they were naturally, you know, had died, these extraordinary animals from all over the world. He was doing this comparative anatomy.

Dr David 34:26

Whales and everything.

unknown 34:28

Could say.

Dr David 34:28

Dissected everything. The whales have turned up in the Thames and he went down and got it, took it back to his court, dissected it.

Alison 34:37

What an extra did he have a wife?

Dr David 34:41

His wife was called Anne.

Alison 34:43

Right.

Dr David 34:44

Anne was into music. Okay. Love music. One of her close friends was Max Haydn. That was Haydn, the composer. Yeah. Yeah. And she used to write portrait and stuff like that. And they always said it wouldn't last. But it did.

Alison 35:00

Goodness me, right? She outlived him. She outlived him.

Dr David 35:03

Because he died. He was born in 1728. On the 14th of February, 1728. And he died on the 16th of October, 1793, after a board meeting at St. George's Hospital. He lost his temper, went out. And he was dead before he hit the flood.

SPEAKER_00 35:20

Oh gosh.

Dr David 35:21

And when he died in that, his museum knows a total of 14,800 specimens.

unknown 35:28

Shh.

Dr David 35:29

And that's of And that formed the nucleus for the museum for the College of Surgeons in London. And that's still known as the Hunter Museum.

Alison 35:37

Because I think everybody knows or has heard of the Hunterian Museum.

Dr David 35:40

But Glasgow.

Alison 35:41

Right.

Dr David 35:42

There's two. Williams is in Glasgow. John's is in London. Williams has anatomy sections. A tremendous artwork. He had one of the finest private art collections in Europe, William. And coins and books.

Alison 36:00

And that's all in Glasgow.

Dr David 36:01

Uh-huh. Now when when William died in 1783, because he'd fallen out with John, he left nothing to John. Nothing. And when he tap when William had a stroke, it was John that looked after him. But the fallout had been so bad, he didn't leave anything to him. And what he did was he left his museum and everything to his nephew for 30 years. When the thirty years was up, it had to be handed to Glasgow because that's where he got his MDs from. John died. They didn't know what to do with the museum. So a petition was raised to go to Parliament. And Parliament bought it for£15,000.

Alison 36:51

Which must have been a king's ransom in those days.

Dr David 36:54

And was then they didn't know who would take it. So it was offered to the College of Surgeons, which was just the College of Surgeons, didn't have its royal charter then. And they took it.

Alison 37:05

And that's where it is to this day.

Dr David 37:08

Yeah, that's where it is to this day. Except a lot of specimens have been lost because during the Second World War it received a direct hit. So it lost a lot of specimens. So the original specimens of John Hunters that are still existing have a little red tag on, so that you know they're John Hunters.

Alison 37:28

That's a film waiting to be made, isn't it? The Hunter, the Hunter brothers.

Dr David 37:33

And without John and William and William Cullen, there wouldn't be the medical profession that we've got today because John raised it from a barbaric science to a scientific science. And John used to say to the students in that don't carry out an operation if you wouldn't have it done on yourself.

Alison 37:57

That's a very good rule of thumb.

Dr David 38:06

Exactly. So that's what that's what makes it all so interesting. William Cullen was a Glasgow professor of chemistry and that ended up being professor at Edinburgh.

Alison 38:17

Amazing. Yeah, there's never a podcast goes by when I'm actually struck down.

Dr David 38:24

So if we just go back to ligaments, yeah. And we think of the ligaments of the joints in particular. Some ligaments and and some ligaments and joints have an extra layer, an actual outer layer. And it's called an epiligament. Not all ligaments, just big ligaments, particularly the knee and that and the shoulder now. And line in this ep this layer of epiligament and tissue is where you find the blood vessels and the nerves. And they play an important role in helping to heal, repair the damaged ligaments. And it's a term that you will rarely ever, rarely ever hear of an epiligament. These little blue vessels and nerves are there in this ligament. So you say we've gone in a roundabout way, but we've ended up going back to ligaments.

Alison 39:20

Yeah.

Dr David 39:21

And it's called the epiligament.

Alison 39:23

The extraordinary way that the human body works all at the same time without us thinking about it. It's all going on in there. Yeah.

Dr David 39:34

Like if you think about it, there's nobody telling it what to do every day. No. It just quite marriedly works on. That's what I always say to people. Listen to your body. The body will give you warnings. If there's something wrong, but it'll only give you so many. If there's a pain, where's the pain coming from? They can have the pain in the knee, but it may not even be coming from your knee at all. It can be coming from your hip. Pain in the hip can be referred pain from the knee. It's this referred pain mechanism between joints.

Alison 40:10

And how is that transmitted?

Dr David 40:13

Because of the nerves, the nerves to the joints. So if you think of the obturator nerve, for example, the anterior division of the obturator nerve will supply the hip. The posterior division will supply the knee. Hence this referred pain mechanism between hip and knee.

Alison 40:30

Okay. I do remember that the other.

Dr David 40:38

Can be an indication that there's something wrong with the liver. Or there's an abscess under the diaphragm. Or there's a problem with the gallbladder. You get referred pain to the tip of the right shoulder. So you have to be able to distinguish between is it is the tip of the shoulder, the actual shoulder itself, is it being referred from somewhere else? That's that's classic referred pain. It's like if you have a heart problem, you get referred pain from the heart going down the left arm.

SPEAKER_00 41:08

Right.

Alison 41:09

And you can have a migraine pain, as they say that children can have a pain in their tummy.

Dr David 41:15

Yeah, from the solar plexus.

Alison 41:16

And that's uh can be referred to as as a migraine.

Dr David 41:20

As a migraine because of the entire nervous system.

Alison 41:23

It's yeah.

Dr David 41:24

It's like some people can get a migraine on the head and you can say, well, we don't know where it's coming from at all. And it can be actually coming from the back.

Alison 41:34

Oh, really? Yeah. Gosh.

Dr David 41:38

It's unusual, but it can happen. Yeah. I'd explain that to a l to a patient I had in last week. New allogist said, Well, I don't know what it is, and just tell me all about a back. And I I'd gone through a back because I knew a history. And explain what it was. It's it's the central pathways of nerves.

Alison 41:56

So you if you deal with the back, that should alleviate the can help with the migraine and just on the top.

Dr David 42:02

And I said, Oh, that's just a migraine. No, just that the nerves of the scalp are vast. So it's a blue fashion.

Alison 42:09

That's fascinating as well. Because sometimes if you're, you know, you've had a busy day or whatever and you rub your head, it's like sensitive. So that's nerves up there.

Dr David 42:18

That's all nerves. That's a tremendous the the sk the skull has a tremendous collection of nerves. Right. Like blood vessels, that's why if you really cut into the scalp, it'll bleed profusely. Yeah.

Alison 42:29

I remember that actually when my son was a kid and he's supposed to have a tremendous blood supply. Yeah.

Dr David 42:34

It really does. Well, you have this rich blood nerve supply. You've got nerves coming from the front, you have nerves at the side, you have nerves at the back, and all made up.

Alison 42:44

Gosh.

Dr David 42:47

Because if if you think about it, the interesting thing about it is, you know, if you if you nip your finger, you go, ooh. You know, you just know you think, ooh.

SPEAKER_00 42:53

Yeah.

Dr David 42:55

You do it to the brain, the brain can't feel it. The brain has no pen receptors.

SPEAKER_00 43:00

Oh, ooh.

Dr David 43:01

No, there's the spinal cord.

SPEAKER_00 43:03

Neither does the spinal cord. Spinal cord.

Dr David 43:05

No, that's why if you're watching hospital programs where they're doing neurosurgery, they put probes into the brain, but you won't feel it. It's got no pen receptors. I did see, I mean I That's why that's why now when they're doing neurosurgery, the patient's normally awake.

Alison 43:21

Yeah.

Dr David 43:21

And they have the neurophysiologists and they're and they're talking to them while the surgeons operating on the brain.

Alison 43:27

So they can see the way the brain.

Dr David 43:29

So that if you go anywhere near, it let you know if you're getting too close to a nerve.

Alison 43:33

Right.

Dr David 43:34

Because if you're doing a trigeminal range. If you're doing the nerve for trigaminal rhizo, the operation for that, for the fifth nerve, you've got to go to get to that, you've got to go near the seventh nerve. So you've got to be very careful that you don't damage it. So if you go too close on the scan for the neurophysiologist, it'll go beep beep beep beep beep. And she'll say you're losing you're losing sensation for that particular nerve of its function. You're too close.

Alison 44:00

So people a week when they do that procedure.

Dr David 44:03

It's a week. They're awake now. There was the one last week, the week before, she had brain surgery and she was playing the violin.

Alison 44:10

What?

Dr David 44:11

Yeah, she was playing the violin.

Alison 44:14

While she was having the surgery.

Dr David 44:15

While she was having the surgery. So they could see So they could watch, watch the moment of the hand and everything like that and talk to her. This is what makes neurosurgery so interesting. And it's all because the brain has no is not susceptible to pain. So when you think if you have a headache, you think, oh, it's a bit it's my brain, it's not it's not. That's the jury.

unknown 44:37

Okay.

Dr David 44:37

And the blood vessels become constricted and the nerves become affected, that affects the jury, hence you get a headache.

Alison 44:44

So if you get a headache as a an anatomist and a doctor, wh how do you alleviate it?

Dr David 44:51

Very rarely. I'll take a power cell.

Alison 44:53

Really?

Dr David 44:54

Otherwise just it'll go it'll go away itself. Yeah.

Alison 44:58

Absolutely fascinating. I know I use that word far too many times during this podcast, but it really there's a few words that would uh you know we'd be able to exchange for it because it's it is.

Dr David 45:11

That's a fascinating subject. Yeah. But that's why I said at the beginning, I'll go through all the ligaments in more detail when when I do each sure.

Alison 45:19

I said to a vast subject, but I love it, I love it, I love it. Never ever ever run out of anything to talk about.

Dr David 45:24

You can't on that fortunately you can't because you can you can talk about the anatomy, but then you can bring in medicine.

Alison 45:29

Yeah.

Dr David 45:30

And some clinical bits and bobs like that, just to make that a little bit more interesting.

Alison 45:36

So I think we've done a a lot today. We've talked about ligaments, we've done a little bit of um a recap on the Hunter Brothers, because I do find that whole fascinating. That whole story. Really, and also the um, you know, your book, which you know, I know you never ever said promote yourself. I think it's I've seen you know copies of the book here, and I used to love, I know you'll probably think, and I I mean this as a compliment, but when I was a wee girl, I used to love Richard Scarry books. Do you know Richard Scarry? He's a Canadian um children's author, but he would do brilliant drawings and of huge subjects like you know the inside of a cruise ship, or all using cartoons, and I loved all that for hours. And actually, when I saw your books, I found those drawings drew me in because they are of a scale where you can look at it and you think, oh my goodness, and it's so brilliantly drawn, and I just love that.

Dr David 46:34

The plain it's just black and white drawn, there's no colour, no nothing.

Alison 46:39

But it's it's because it's real and it's you and I, it's everybody, it's the way you do it. It lays out in in a way that I could understand, and I'm clearly not, you know, medically playing.

Dr David 46:50

The books uh didn't and the feedback that I got was that all right, there might be long words in it. Yeah. Which you can't do anything about. Yes. But it was so easy to read. Yeah. It just flowed. It wasn't complicated and it made it easy. And that's why you're trying to.

Alison 47:07

And that goes back again to uh to John Hunter, doesn't it? Because he was a practical man rather than an intellectual man.

Dr David 47:15

He wrote books, he wrote he wrote classic books on surgery and stuff like that.

Alison 47:20

But it I think encourages people maybe to delve into the subject who perhaps wouldn't think that that was something they could do, because you know, if you're faced with a textbook which is just words or you know, but to see it laid out like that I think is extraordinarily helpful and engaging, and as a layman, which you know that's a bit of an understatement actually, when it comes to this subject, I found it's not really absolutely fascinating.

Dr David 47:49

So it's like with anything, it's it's once you've found your niche and you're interested in it, yeah, you'll learn it.

SPEAKER_00 47:56

Yeah.

Dr David 47:57

And it's not a you think, oh I'll never ever learn that. But you do because you're interested in it. And it's just having that discipline.

SPEAKER_00 48:04

Yeah.

Dr David 48:05

If you don't have the discipline, you'll you'll never do it. Even the same at university, if you don't have the discipline, you'll never do it.

SPEAKER_00 48:11

Yeah, yeah, yeah. Yeah.

Dr David 48:13

Especially where anatomy is concerned. And the thing is, you're learning anatomy. And even talking to JPs nowadays, oh no, anatomy's not that important.

Alison 48:23

Gosh, it's just so wrong, isn't it?

Dr David 48:26

So it's it's not taught like that at all.

Alison 48:27

It's the basis of everything. It's the absolute education. The human body. Uh huh. And how can you have any of it without the education of the literally the bare bones. Well, thank you again, David, for a completely fascinating conversation. Um I'll do Dr.

Dr David 48:47

Barlow the next time. I know. Because we forgot again. I know.

Alison 48:51

Dr. Barlow, who is David's mentor, will do. We'll just go off on a tangent.

Dr David 48:56

But yeah, but we'll always go back to whoever started.

Alison 48:58

Yeah. And we'll do that next month. So we'll talk about Dr. Barlow and what else will we cover next time?

Dr David 49:04

Oh, I'll start. I think I'll give you an idea of the lig of the muscles. The muscles of the and then I'll then the one after that I'll actually start going into the body. Okay. And for that one, we'll start with the back.

Alison 49:15

There we are. That's a lot of food for us.

Dr David 49:18

That's a big one, even on its own, just the back at all.

unknown 49:20

Yeah.

Alison 49:21

Well, thanks, David, and uh have a nice uh have a good month, as it were, and I'll we'll speak in. We'll speak soon.

Dr David 49:30

Thank you. And thank you for understanding. If I do cut you up when you're talking to me, is I said it's just that I'm on that thread and I don't want to lose it.

Alison 49:37

Well, equally, I don't mean to interrupt you, but sometimes my mind's like, What? I can't believe what I'm hearing. I mean, I do. But it's good if you do. Yeah.

Dr David 49:44

It's just you and I just having a chat.

Alison 49:46

Yeah. And a very nice cup of tea, if you don't mind me saying.

Dr David 49:49

Oh, well, you've got to have the tea later. If you don't have the tea, forget it. We memor anything. We'll translate the Georgies. But let's have mentioned one book this time. Yeah. For bigger lows for the ligament and that's and uh some historical facts.

Alison 50:04

But I'll I'll take a a photograph, a video, in fact, of the diagram that we've got up on the board here, and you know, that will accompany the conversation we had earlier in the podcast. So thanks for listening. And uh from myself, it's uh goodbye.

Dr David 50:20

Thank you very much for listening. Hope you enjoy it.

Alison 50:23

Until next time.

Dr David 50:24

Bye bye.