This programme contains some scenes which some viewers may find upsetting
200 years ago, thousands of wounded soldiers
lay dying on the battlefield of Waterloo.
Surgery had changed little since the Middle Ages.
Antibiotics had yet to be invented.
Infection control was haphazard at best...life-threatening at worst.
While advances in medicine were slow,
the science of killing was moving on at pace.
Soldiers were being maimed in ways never seen before.
Medicine simply couldn't keep up. But all that was about to change.
On the outskirts of Portsmouth, on the south coast of England,
a building steeped in history lies abandoned.
Secrets inside here tell the story of medicine spanning 250 years.
The labyrinth of corridors,
wards and operating theatres here all provide clues to a bloody past.
This is the Royal Hospital Haslar.
Once the largest hospital in Europe,
at the forefront of military medicine,
it was here that many casualties from Waterloo
were brought and treated.
You would be held from behind by a colleague or tied down,
and you could then push the blade through the soft tissues
above the bone.
You would swallow actual mercury?
It's seriously frightening, really, because as we know today,
it poisons you.
It is a very brutal experience.
As Nelson is brought down here, this environment, the cockpit,
has come to resemble shelves in a butcher's shop.
It's grim.
This is the story of how Haslar hospital helped kick-start
modern military medicine and pave the way
for hospitals as we know them today.
Portsmouth docks.
Home to the British Navy for the last 800 years.
GARBLED MILITARY COMMUNICATIONS
During the 18th century, our island's security
depended on the might of the British Army,
but also the brute force of the Royal Navy -
the most successful fighting machine in the world.
Technological leaps had turned the sea into a deadly battlefield.
Gunpowder and cannonballs had the power
to rip apart ships...and people.
The injuries - horrific.
Chances of survival - minimal.
Even worse, there was
no dedicated facility to treat injured men brought back to land.
The sick were lodged in public houses or privately owned hospitals.
So, in 1746, after years of debate, foundations were laid here
in Gosport for the first purpose-built naval hospital.
Five years later,
the largest brick building in Europe opened its now decaying doors.
Back then, they didn't do things by halves. This place is enormous.
The front of the hospital was a statement to the world.
Over 567ft long, it was the largest hospital in England,
with 114 wards and 2,500 beds.
From the outside, it was a grand, imposing design, full of promise.
But this place was just as much a prison as it was a hospital.
During the 18th and 19th centuries, many of the troops
serving in the Navy had been forced to sign up for a life at sea.
For injured sailors,
being sent to hospital offered an opportunity for escape.
Haslar was built on an isolated peninsula for good reason.
Most sailors couldn't swim, so would-be escapees faced the prospect
of drowning in the sea on one side, or in Haslar Creek on the other.
There really was nowhere to run.
And what went on inside was shocking.
MAN SCREAMS IN AGONY
The year is 1753,
almost 100 years before Florence Nightingale revolutionised
nursing into a worthy profession.
It was a world where the cause of disease was still a mystery.
MAN SCREAMS
Doctors wore dirty overcoats over their day coats
in the operating room, but only to protect their own clothes.
Surgical instruments caked in blood
weren't even cleaned after operations,
let alone disinfected,
and many still believed illness was a punishment from God.
Eric Birbeck used to work here
and has an encyclopaedic knowledge of its early days.
They commenced building in 1745.
By 1753, the navy of the day and the crews
had actually got to hear about what was being done
and they arrived in their droves wanting entry.
The Admiralty actually gave the order in October of 1753 -
"Open the hospital."
What must it have been like as a casualty
to have been brought here, faced with this?
I would have thought overpowering,
because if you'd have been a sailor, seven years at sea,
not in this country,
you're injured, you're dying of disease,
and you come through the gate
and you've got this Georgian hospital that's been built...
Just bearing down on you.
..and you come from, shall we say, an old cottage somewhere in the country,
you would have gone, "Wow."
ROB CHUCKLES
Impressive, isn't it?
It really is. It doesn't disappoint, from the outside.
No, but it holds so much history. If only these walls could talk.
Listen to the echo - that's just us in here.
Imagine the amount of people in here and the cries and shouts
and the carnage. Pain, screams.
The fact of being laid onto the stone floor
while they waited to see the surgeon,
having been removed from the handcarts.
If they were well injured,
they'd be bleeding their lifeblood into these very flagstones.
DISTANT CRIES OF PAIN
It may be dead quiet in here now...
..and quite eerie because of it,
but throughout history this hospital and, in fact, this ward,
would have been bustling with activity and full of people
and noise.
It must have been chaos at times.
I think the best way to actually sum it up is the word bedlam.
Hells, bells, smells.
And bodies could have been strewn around everywhere.
Yes, waiting to be seen,
because there was no triage as we know it today.
It was a case of the fact that you were seen
virtually in the order by which you'd arrived.
But that was accepted, was it? That was accepted.
You formed a queue.
250 years later
and modern military medicine had moved on.
So much so that this site was no longer deemed essential
to the British Navy.
The hospital closed in 2009.
Ha!
Whilst plans are being drawn up to redevelop the site,
its wards and operating theatres remain untouched.
But it was back in the 19th century that Haslar made its name.
In 1805, the hospital took centre stage
in one of history's most famous battles.
It was, of course, the Battle of Trafalgar.
Admiral Lord Nelson led the Royal Navy against the mighty Napoleon
and his French and Spanish fleets.
I've come to the Portsmouth Historic Dockyard
to discover the sort of injuries sustained during naval warfare.
This is HMS Victory, Nelson's flagship at the Battle of Trafalgar.
And wow, look at this!
You can certainly see why these things are called battleships.
HMS Victory is effectively a floating platform for guns.
She is beautifully designed and constructed,
but this ship's actually all about function.
She's a feat of engineering
and everything's built around a central premise
of providing as much firepower at sea as possible.
On HMS Victory, the gun is king.
Victory's curator, Andrew Baines,
knows all about this ship's killing power.
Cannonballs, solid shot, 24lb sphere of iron -
smashing, causes splinters.
Point-blank is about 400 yards.
Actually, the ships are a lot, lot closer.
You will easily see the people you are shooting at.
If you can hit some with a cannonball, all well and good,
but really, it's the huge splinters that are thrown out and around
from a cannonball smashing through 18 inches of oak.
If they hit you in the abdomen, that's really bad news,
cos you're probably going to have internal injuries from that
and it's going to be infected,
which is a problem for the surgeon later on down the line,
or it's going to break your arm, and, indeed, in some cases,
the splinters are large enough to actually take a limb off.
CANNONS BOOM
The Battle of Trafalgar started on 21st October, 1805.
Lord Nelson stood and watched from this point here on the deck.
The battle soon descended into a confused melee
of combat between individual ships,
each fighting in such close quarters
and HMS Victory became entangled with the French ship Redoutable.
Locked in their deadly ballet,
the two ships blasted each other a point-blank range.
And then, from his position in the upper rigging on the Redoutable,
a French sharpshooter took aim.
In his sights, the most prized target of all.
He fired and sent a musket ball
hurtling towards Lord Nelson's left shoulder.
The bullet ripped a path through Nelson's lower back,
and it was a wound which, famously, proved to be fatal.
Miles from the operating rooms at Haslar,
there was little that Nelson's surgeon, John Beatty,
could do for him onboard Victory.
It's a very brutal experience and in Beatty's own words,
as Nelson's brought down here,
this environment, the cockpit,
has come to resemble a butcher's shambles,
shelves in a butcher's shop. It's grim.
We've got the heaviest guns on board, 32-pounders,
going off just over our heads.
Every couple of seconds, there's one of those going off.
It's noisy and, of course,
the queue's forming, so Beatty, as a surgeon,
can be operating on someone here and taking an arm off
and you might be the fourth or fifth bloke in the queue
who's actually watching what's going to happen to you next,
and then the surgeon's going to come at you
with a knife and then with a saw.
Nelson's shoulder had been shattered.
He bled to death two hours after hearing the French had surrendered.
Victorious, but with hundreds injured,
the Trafalgar fleet headed home to the surgeons at Haslar.
On 1st December, 1805,
Colossus, Mars, Africa and the Fighting Temeraire
discharged their sick and injured
that remained from the Battle of Trafalgar
into this very arcade to be received.
And all pretty much in one chunk, in one go, all these injured soldiers.
That one day. In one day? Yes.
Because on 4th December, Victory arrived at St Helen's Roads,
which is the anchorage at Spithead, and discharged their sick and wounded
and all the escorting fleet as well, to Haslar.
SHIP'S HORN BLASTS
Only a few years later, Napoleon was back on the warpath.
Haslar once again braced itself for an influx of injuries
caused by sabres, musket balls and cannons.
The injuries inflicted by these cutting-edge weapons
caused wounds that surgeons had never seen before.
I've come to the Old Operating Theatre Museum in London
to find out how they coped.
Former surgeon Mick Crumplin is an expert on 18th century warfare.
Mick, around the time of the Napoleonic Wars,
how well trained would surgeons have been?
Often poorly trained,
because for surgery, you might have been an apprentice to an apothecary
or a physician and the type of civilian surgery that existed then
was really minimal compared to the battlefield challenges.
So what kinds of injuries are we looking at
and what kind of weapons were being used?
Well, we had hand-held weapons,
which didn't cause a vast number of injuries.
We have a pointed weapon like this, which will obviously pierce you
and if it doesn't hit anything vital, you'll probably survive.
The other type of hand-held weapon was the cavalry sabre,
or slashing sabre. That's vicious.
They did cause unpleasant injuries - a lot a slicing,
flesh flaps turned up, arms partially avulsed and so forth.
Actually, the French surgeons complained to the British surgeons
after one battle... Really? ..about the desperate type of injuries
caused by British light cavalry sabres.
SHOUTS AND HORSES' HOOVES CLATTER
So what would a battlefield have looked like
after fighting had finished?
I don't think any of us can possible imagine.
For every one man killed, there were four injured,
so there would be a high proportion of badly injured men -
many who'd been shot through the leg, who couldn't move,
they'd have to drink water out of puddles,
there would be screaming and groaning
and I think the horses, with one leg missing, or being disembowelled,
men with the same injuries,
the scene must have been awful.
The medics at Haslar were on a steep learning curve.
The Napoleonic battles were brutal.
On 20th January, 1809,
2,500 sick and injured men arrived here for treatment.
They'd been loaded on ships in northern Spain
following the Battle of Corunna.
The French were defeated, but at great cost.
The scenes here forced the hand of one surgeon
to record what he saw through a series of paintings.
They not only document the wounds he was seeing,
but capture the pain of the people he operated on.
The Scottish surgeon turned artist, Sir Charles Bell,
had responded to a call from the Admiralty to come and help treat
the huge number of injured soldiers arriving here at Haslar,
and his sympathies lay very much with the patients
he was so struggling to treat.
He gained a reputation for speaking out against practices in surgery
which were causing suffering amongst patients.
It was this criticism that saw him barred
from practising and teaching in Scotland.
But here at Haslar, his war against suffering continued,
and for good reason.
Of the 1,400 men brought here from the Battle of Corunna,
200 died and this was a notably higher average death rate
than other military hospitals at the time.
This man sustained a gunshot wound to the arm.
His bones were shattered,
and Bell wrote how this meant his chances of infection were so high
he'd almost certainly lose his arm.
MAN GROANS AND PANTS
You'd be held from behind by a colleague, or tied down,
for both leg and arm surgery.
You can't expect someone not to move, flinch, faint
or be extremely unhappy at what was going on.
It was a very, very difficult procedure.
What they did was to have a straight knife like this,
and you could then push the blade
through the soft tissues above the bone
and push it through below the bone.
And as you cut out, you created a D-shaped flap of skin and muscle.
When you'd sawn the bone across after pulling the soft tissues back,
you then had two flaps of skin to cover the bone properly.
Throughout all of this, would any painkiller have been used?
Not at all. You just had to grin and bear it? Yeah.
But they were used to that. You're looking at it through today's eyes.
Those men and women were used to losing their babies at birth,
they were used to disaster and pain.
They knew nothing better.
Despite the brutal nature of the surgery,
the chances of surviving an amputation were pretty good.
But without antibiotics,
post-operative infection was a killer,
and it was this that troubled Bell the most.
This is Bell's most famous painting.
It's his depiction of tetanus.
So easily treatable today, in the mid-19th century,
this bacterial infection presented a terrifying list of symptoms.
Swallowing became difficult,
the jaw would tighten or completely clamp shut,
you'd get spasms in the neck and the back,
followed by severe contractions down the back muscles,
as this man here is experiencing.
Treatment was utterly useless
and ranged from chucking cold buckets of water on the patient
to giving them a hot bath.
Occasionally, incisor teeth would be removed
to enable feeding through a tube when the jaw had clamped shut.
But as a surgeon, it was desperate, and Bell would have felt powerless.
It's impossible for me today to imagine the almost hellish suffering
that Bell witnessed and documented through his artwork here at Haslar,
and perhaps even in this very room.
But looking at each of the paintings,
you can tell he was a compassionate man.
There's an air of sympathy in each one of these pieces.
During the summer of 1815,
hundreds of wounded soldiers arrived at Haslar.
They'd been injured at one of the most defining battles in history -
the Battle of Waterloo.
Many of them had survived
emergency operations,
but had picked up infections and diseases such as tetanus
from the muddy battlefields.
Doctors turned to medicine for help.
Haslar Hospital would have had a pharmacy,
but often what was dispensed
had more in common with ancient witchcraft than modern antibiotics.
Karen Howell is an expert in 18th century medicine.
In the 18th century, the medicines are still constant
from the earlier periods, right the way through to the 1830s, really.
You've got different materials that are what we would consider herbal,
different plants, for instance - cloves, juniper berries.
That would be, most people would know the smell as gin.
It would sterilise, say, pieces of meat, as does thyme, for instance.
It actually sterilises and kills salmonella and things like that.
One of the biggest killers was an infection that had more to do
with the back streets of Portsmouth
than the bloody battlefields of Waterloo.
Syphilis was an embarrassment to the British Navy,
whose sailors were riddled with it.
Your bones, your skull, underneath here, for instance,
would be corrupted with lesions,
and these specimens show that people are in a lot of pain.
This doesn't look too good,
but if you imagine this goes down to the bone level,
it's actually a change in your structure.
What, then, were the treatments, or, at least, the medicine
that was being prescribed for syphilis at the time?
Snail water, and that snail water is six gallons of snails,
three gallons of earthworms,
and juniper berries.
OK, so this was the treatment being used for syphilis at the time?
Snail water? Yeah. And you were talking actual snails?
Yeah, you're dosing yourself, if you like, with a proteinous liquid.
You would put on weight, slightly, and you would start to feel better.
But when snails failed to cure you,
there was an even more frightening treatment.
If you go to the mercury, that is the other cure that you can have...
You'd swallow actual mercury?
They would give you a mix of mercury into solution.
And you'd take that?
You'd have that, that'd disperse the mercury into your body,
and a big dose would make you salivate.
How was that deemed as a treatment, or as a cure?
This is the one that works.
It's seriously frightening, really,
the fact that it works is frightening,
because you'd be, in the hospitals especially,
put in a little felt suit, or like a little cloth to seal you in,
and you just sit with a little tray.
The mercury does attack it, poisons it,
but as we know today, it poisons you.
Syphilis was the scourge of the Royal Navy,
but wasn't its biggest killer.
That accolade went to a disease that was wiping out entire crews at sea
and baffling doctors around the world.
James Lind worked as a doctor at Haslar.
He became captivated by this very specific ailment.
One journey in particular horrified him -
George Anson's circumnavigation of the globe.
It was a triumph for the British Navy,
but a disaster for the crew.
In 1740, Anson's fleet left Portsmouth with a crew of 2,000.
Three years later, he returned with fewer than 600.
Something had killed 1,400 men
and that something was scurvy.
Lind was sickened by the tragic loss of so many of Portsmouth's men.
He made it his mission to find out what had caused their deaths
and why the symptoms seemed confined to life at sea.
I've come to the National Archives in Kew.
..puffy swelling of the legs...
Historian Bruno Pappalardo has unearthed
a 260-year-old surgeon's logbook.
Uniquely, this journal contains some remarkable drawings...
Oh, boy. ..some vivid, accurate representations
of the outward signs of scurvy.
It really paints a picture, let alone having the picture here.
Exactly. More men were lost through scurvy annually
than throughout the whole of the six battles during the Napoleonic Wars.
The Royal Navy was always at the forefront of technological
and scientific advance, and for them,
ensuring that the men are healthy in sailing ships
would give them a considerable edge over the enemy.
With so many men dying of scurvy,
Haslar's very own James Lind set about finding a cure.
He conducted a trial that would prove once and for all
the most effective treatment for the disease.
Lind's documented the experiment in his paper here,
"A Treatise On The Scurvy",
published 1757, and it went a little bit like this.
He selected 12 men from a ship, each suffering from scurvy,
and divided them into six pairs.
Now, the first pair were ordered each a quart of cider a day.
Not bad, there you go.
Yeah.
The second pair were given 25 drops of an acidic solution
to gargle three times a day.
The next two had to have a daily dose of seawater.
The fourth pair were prescribed two spoonfuls of vinegar
three times a day.
Two more were given a rather colourful cocktail.
First up, some nutmeg.
Some garlic.
Some mustard seed.
Some balm of Peru, which is a tree resin.
Barley water.
Just a splash.
And finally, some cream of tartar.
If I just give this a good press and mix...
It certainly doesn't look very nice.
Don't know if I'd really want to have any of that.
But there was no such concoction for the final pair.
They were given a plentiful supply of oranges and lemons.
Those dosed up on Vitamin C from the oranges and lemons
experienced a remarkable recovery in just a matter of days.
While the benefits of citrus fruit had been known for centuries,
Lind had definitely proven the superiority of this cure
above all other remedies.
Although Lind's discovery was recognised at the time,
it wasn't until the 1790s that it became compulsory
for naval ships to carry citrus juice.
When that happened, scurvy all but disappeared from the Royal Navy.
During his time at Haslar,
Lind introduced a radical system of infection control.
He insisted that patients with different diseases
were separated where possible.
And there were designated wards
for patients to recover in after surgery.
Lind's reforms reduced the spread of infection
and life expectancy at Haslar slowly began to improve.
By the time of the Battle of Waterloo,
the hospital was looking in increasingly ship shape.
Those early days at Haslar wrote a new chapter
in the history of modern medicine,
and as battles continued, so progress did its best to keep up.
Later, both world wars delivered injured soldiers to Haslar's doors,
followed by conflicts in the Falklands and the Gulf.
The hospital earned itself a reputation for excellence
across the globe.
But Haslar's story doesn't end here.
The site has been sold to developers.
Its wards, outbuildings and gardens will soon be transformed
into a mixed community of businesses and homes.