SciShow Tangents - Surgery

Episode Date: July 27, 2021

This week, the Science Couch is more like the Science Operating Table. Get ready to have 33 minutes of pure, surgery-inspired science implanted directly into your brain, stat!A note about this week’s episode: Ceri is moving, and the room she normally records in is completely empty. That’s why she sounds like she’s lost in space. Sorry about that!Head to the link below to find out how you can help support SciShow Tangents, and see all the cool perks you’ll get in return, like bonus episodes and a monthly newsletter! https://www.patreon.com/SciShowTangentsA big thank you to Patreon subscriber Eclectic Bunny for helping to make the show possible!Follow us on Twitter @SciShowTangents, where we’ll tweet out topics for upcoming episodes and you can ask the science couch questions! While you're at it, check out the Tangents crew on Twitter: Ceri: @ceriley Sam: @slamschultz Hank: @hankgreenSources:[Fact Off]Burn healing surgerieshttps://www.who.int/news-room/fact-sheets/detail/burnshttps://www.jstor.org/stable/3408118https://www.americanjournalofsurgery.com/article/S0002-9610(35)90119-2/fulltexthttps://www.nature.com/articles/125058a0.pdfhttps://journals.sagepub.com/doi/pdf/10.1177/003591574003400104https://parjournal.net/article/view/1881/1348https://nzhistory.govt.nz/people/sir-archibald-mcindoeVideo Game Surgeons https://www.medtechdive.com/news/robotic-surgeries-surge-to-15-of-all-procedures-despite-limited-evidence/570370/https://www.eurekalert.org/pub_releases/2021-04/uoo-hfa040121.php[Ask the Science Couch]Organ transplant DNAhttps://www.sciencefocus.com/the-human-body/does-the-dna-of-a-transplanted-organ-change-to-that-of-the-recipient/https://www.genome.gov/27544325/using-dna-sequencing-to-detect-early-organ-transplant-rejectionhttps://pubchem.ncbi.nlm.nih.gov/compound/Cyclosporin-Ahttps://pubmed.ncbi.nlm.nih.gov/18290564/https://www.nih.gov/news-events/nih-research-matters/organ-transplants-without-life-long-drugs[Butt One More Thing]Louis XIV’s anal fistula https://tidsskriftet.no/2016/08/sun-kings-anal-fistulahttps://www.sciencedirect.com/science/article/abs/pii/S1043148914000566 

Hello and welcome to SciShow Tangents, the lightly competitive knowledge showcase. I'm your host, Hank Green, and join me as always this week as science expert, Sari Reilly. Sari, what is space? Hello. I'm in space right now, if you can't tell from my sound effects, which are definitely intentional and not because I'm sitting in an empty room in a corner like a sad boy. Space is, I mean, this is the problem what is space flight space flight apparently is if you just go high enough in the atmosphere that a commercial plane can't fly if you go a little bit farther than that where it's like a little bit thinner and harder to breathe if you were outside of the

vehicle then you're in space basically right but also i am in space right now because everything is space and i'm made of space. Space is all, space is everywhere. This is like this outer space, but like everything is space and the Earth is a giant spaceship. And we shouldn't be trying so hard just to get there because we're already there. We should only be going there to do stuff, not just to go there. I hope he hears this, Hank. We're talking about this because as we are recording, Jeff Bezos has recently landed

on Earth after being in space for 12 minutes. We're also joined, as always, by our resident everyman, Sam Schultz, who just likes Jeff Bezos in that he is not a scientist. He is just a everyday normal guy. I'm also like him in that I have a cowboy hat that's way too big on right now. I appreciate you wearing your way too big Jeff Bezos cowboy hat that's way too big on right now. I appreciate you wearing your way too big Jeff Bezos cowboy hat for this. Every week here on Tangents, we get together to try to one-up a maze and delight each other with science facts

while also trying to stay on topic. Our panelists are playing for glory and also for Hank Bucks, which I will award to them as we play. And at the end of the episode, one of them will be crowned the winner. And now as always, we're going to introduce this week's topic with the traditional science poem this week from Sam. Scrubby up my hands nice and clean.

We got to take out this guy's spleen. Put on my gloves so I don't touch his belly full of squinchy guts. It's time to do medicinal battle. Nurse, hand me that shiny scalpel. I assess the patient with a studied gaze. Should I make this incision length or sideways? Eh, either way, I'm going in. A slice, a spurt,

I need suction. I'm in wrist deep and feeling round till that pesky organ is found. Give me a dab. My brow's all sweaty. These guts, they feel just like spaghetti. He's flatlining. Hurry. Those shocky things, stat. Damn it, man, we've just got to bring you back.

Give me 50 cc's of some medicine stuff. Whew, his heart's restarted. All right, pal, hang tough. Aha, that's it, the forceps now. To heal this man's my solemn vow. Pull out the spleen, stitch up his slice. Procedure's done, nice and precise. At least that's what it looks like on TV.

If I left something out, please educate me. Sounds right to me. That sounds like surgery, which is the topic for today's episode. Sari, what is surgery? You know, I also had the same question because I feel like I could watch a TV episode and be like, oh, they're going into surgery. But I wasn't sure how to describe that. Science-y. So according to the American College of Surgeons statement, and I'm paraphrasing because it's a long paragraph.

But surgery is changing the human body by either cutting into or cutting away tissues for medical purposes. When you cut your fingernails, is that surgery? I don't know if it's for medicine. It's like making your life more convenient, which maybe is medicine. If you pop a pimple, is that surgery? I think if you include all those, then everyone is a surgeon. So I was watching a TikTok recently of a person removing an ingrown hair. And she said, I'm in Idaho and I'm an esthetician.

So in Idaho, you can't poke it or cut it. You have to just use tweezers. And so I can't cut or poke the skin. And I'm like, this is where it gets a little iffy, huh? Because now, it's now like, like you're just pushing, but if you got out a needle,

then you'd be a surgeon. Like legally, she can't poke the skin. Yeah. Interesting. Yeah. Anyway, there were two hairs in there

and she did a great job of getting them. Yeah. I do not like that kind of video. I do not watch any type of surgery video, big or small.

Yeah. I feel like there's a, there's a, there has got to be a clean line somewhere, but I don't know where it is. Yeah. It might be the tools. Like, I feel like tools is maybe where you narrow it down a little bit. So in this statement, they say, they list some examples like lasers, ultrasound, ionizing radiation, scalpels,els probes and needles the tissues can be

cut burned vaporized frozen sutured probed or manipulated by closed reductions or otherwise altered by mechanical thermal light-based electromagnetic or chemical means which is like quite a bit that that like feels like it encompasses putting ointment on your skin but i think it's like like in your poem Sam, you get to the gushy bits. Uh-huh. Or you go like- You got to get through the skin. Yeah.

And you have to be doing it for good. Yeah. That is a very good point as well. You have to be a certified or licensed physician or a certified nice guy. Yeah, exactly. Because there was a time before the certifications and those people were still surgeons now you maybe have to have a a certification but back then they were just helpful fellows not always helpful sometimes they were just weird men who were like let me implant some other animal's testicle into your testicle and let's see what

happens sarah do you know where the word surgery comes from is it from like uh is it like cut it's cut in there that is not any other guesses surge the alternative to mountain dew could be that this word was invented in 1997 an early surgery they sterilized it with surge it's such a unique word i can't think of any other words that are even like related to it except for surge except for surge the alternative to mountain dew or just the italian man sergio oh yeah was it sergio was it him he invented it no and in fact it's related to lots of different words once you go back to greek so the greek word is kairogeia, which comes from kyr, which is hand, and ergon, which is work. So it's handiwork, basically.

You are doing something by hand, and that is surgery. And I think then it evolved separately from other types of craftsmanship. The hand root also informs words like chiropractic or anything to do with a chiral molecule for handedness. The ergon word for work is in George. I didn't look at this. I just have a list of words that are related to it, but apparently George comes from work. Good old workers. Yeah, good old Georges. They work hard, those Geor George comes from work. Good old workers. Yeah, good old Georges. They work hard, those Georges.

Also, I imagine ergonomics. Yeah. Yeah, ergonomics, organism. Did people just start saying the word you said wronger and wronger until it became surgery? That's basically how it works. Yeah. It's not really wronger, it's just differenter.

Differenter, yeah. Greek, chirurgia. Old French, Serge air. And then, so like the French kind of made it. The French were like, that doesn't set us.

That's way too harsh of a noise. Yeah. We need to be sexy. Too many. Cause, and then they were like surgery. And then everyone was like, oh yeah,

surgery. Sure. I feel like this has been well-defined and that means that it is time to move on to the quiz portion of our show. This week, we're playing a new game, a brand new game. It's called the scientific definition

and the rules are simple. The points will be complicated. In fact, the rules might also be a little bit complicated. I'm going to give you a word and you're going to attempt to define that word. And whoever gets closer in my estimation

will win that round. I have three things. And for this inaugural, the scientific definition game, we're going to take a vocabulary tour of the history of surgery. I'm going to give you the name of a surgical tool

and each one of you will give me what you think the definition probably is. And then you will give me what you think the definition probably is. And then I will pompously correct you because I know all of the answers because I was given them beforehand. Your first word you must define for me is the scarificator. Sam, do you want to go first? It does seem maybe related to scarring, But what are you scarring if you're surgerying something? You're already going to make a scar. It's going to be there no matter what.

Yeah, but it could be like a cutting implement or like a meat tenderizer. You know, before you surgery someone, you meat tenderize them, make them nice and soft. See, I'm thinking it could be to like add texture to something that needs texture in the old guts. Okay, so you put texture on some part of your heart gets scarificated and that's helpful. That sounds horrible. That's my guess. Yeah, you put some extra new scar tissue on the heart. Everyone knows that's good.

It's needed. It's necessary for some reason. I think before we had, what's the thing called? Where you like, if you cut off a limb, you need to seal it off so that it stops bleeding.

I think it's... Cauterizing? Cauterizing, yeah. I think it's like an early cauterizer. You like did something to seal it up. Like put a cheese grater on it or something yeah it's clogged up in the cheese grater and then nothing bad happens so we have two definitions here one is a device that will cause scarring to the heart and one

is a device that stops bleeding i'm gonna give it to Sam because it is specifically a device that causes bleeding. So, Sari could not have been more wrong. Oh, no. A scarificator was a device for bloodletting from the 19th century. It's a brass box that had blades

on it. It's a cheese grater. Also, it was kind of a cheese grater. But I had to make the decision somehow. And also, you said cheese grater. I added the cheese grater well also it was kind of a cheese grater so like but i had to make the decision somehow and also you said cheese i added the cheese grater part in so i should get extra points for double right you're you're getting you're getting more than you deserve already so when leeches were unavailable it was just a bunch of blades that the doctor could push onto you and make you bleed a bunch i'd make him go look for more leeches if I was in that situation. Please, please, do not put that brass box that you have already put on other people onto me.

I forgot about that part. So the doctor would use a lever that retracts the blades and put it on the patient's arm and then press a button and the blades would pop into the patient's skin. No. And they were supposed to be quick. That would make it less painful. And the device could be heated to create a vacuum that would draw out the blood. So they made a little robot leech.

They were like, oh, what do leeches do? They bite and they suck. And so let's make a little robot that bites and sucks. All right. Well, congratulations, Sam, on getting your first point. Second, the word that you have to define for me is dental key. Oh, well, it has to do with mouth rocks, unless dental at some point meant something else. Like other parts of your skeleton that could be. No, I wouldn't think so. I'm sure we've defined dental before and it's the dents well my brother had braces

and he had to have a key to crank his mouth open wider but our braces surgery i don't think so i guess braces are not surgery sarah you go first with what a dental key is okay i'm gonna i think it's like a like a keystone in that it's like an essential part of the dental system and so if they had to remove a tooth or remove a chunk of the jaw a dental key is like a replacement stump that they put in there before they had other technologies to do it and so like you just stick a key into the hole. Maybe it's like some kind of drill. It's a drill for drilling out the jawbone hole where the tooth was. Similar to Sari's but opposite.

So we've got Sari with an object that you place into the jaw when there is a piece of the jaw slash teeth missing to take up that space. We've got Sam with a drill that is specific for drilling out jawbone. Yeah. And again, I think that I have to give it to Sam. It is ultimately just a device that removes teeth. It is the key that opens the tooth door for there to not be a tooth there anymore. Oh, no. So it was invented in the early 1700s,

and it was a hook that would wrap around a tooth and a rod that could be turned like a key to remove the tooth. So basically it had like a handle on it. So you could like, just like really get a good grip and pull it on out. And I hate it a lot. And, uh, local anesthetics were not available for tooth removal. So dental keys were a way to do it really quickly. But they could still be a pretty rough thing to go through.

In an 1849 work called On the Extraction of Teeth, Henry Gilbert wrote, the gums are not infrequently crushed and the tooth is not rarely broken. Oh. They're so bad looking. I'm going to post pictures of all of these things. So yeah, you can go see a picture. They're so bad looking.

All right, Sam. Well done. Two out of two so far. But now I've got another word for you and I'm going to attempt to pronounce it the écrasur. Another French guy. I assume that massive amounts

of blood are involved in whatever this is. It just sounds like something that would exsanguinate you instantly to me. Well, we already had one that was like blood. Well, it's all blood, Sarah. It's a surgery. I will say that all three of these will not not result in blood loss. Okay. This is probably the totally wrong direction, but the only word that i can think

of that sounds vaguely like this is croissant oh yeah so so my guess is it's like like if you had a assist or something and if you needed to poke it to like de-juice it. There's a word for that. Or cut it off. Then you'd use an egg presser and you'd like. Just nice. Some Dr. Pimple Popper shit. I think that it's just some kind of like spigot. You would hook up to somebody and you just turn it on and the blood would come out.

I don't know what part of your body it goes on, but it's draining blood out of you from a nozzle of some sort. Well, Sam, you were never going to get it because Sari was remarkably close to right. Wow. It actually, that word means to crush. Oh. Oh, boy.

But it was specifically used to remove growths. Wow. So it was like a wire or chain loop that would be wrapped around a projecting mass and then slowly tightened

until, quote, the mass is disconnected from the body. And an écrasour would be used for tumors, but also for castration of animals is what it is often used for. It looks like it would be good at that. Yeah.

And it just like tightens up the chain more and more. And it was designed for situations where a blade was difficult to use. In his case, the doctor who designed its case, he used it in 1854 to amputate a tongue. According to an 1892 edition of the Transactions of the American Surgical Association, it was still used for tongue amputations in the 1890s,

but was also contentious. One man they quoted said, the instrument is barbarous and obsolete and not in conformity with the principles of surgery. It represents the most slovenly and least efficient method of removing a part. You don't want that when you're getting your tongue cut off. No, I mean, like, I guess I'm not like intimately familiar with 1850s maladies, but how often do you have to cut off a tongue?

I don't know enough to make a whole thing that just does that for you. So, so the situation at hand is that Sam has two points and Siri has one point. And I found that game quite enjoyable to play. Thank you for playing it with me. Next up, we're going to take a short break and then it will be time for the Fact Off. Welcome back, everybody.

It's time for the Fact Off. Our panelists have all brought science facts to present to me in an attempt to blow my mind. And after they have presented their facts, I will judge them and award Hank Bucks any way I see fit. But to decide who goes first, I have a trivia question for you. One of the earliest surgeries we have evidence of is trepanning or boring a hole into the skull to treat cranial diseases or release pressure from an injury. And at times throughout history, trepanning was pretty popular. In northeastern France, there is a burial site that dates back to 65,000 BCE

where several skulls with trepanning holes were found. What fraction of the skulls uncovered had undergone trepanning surgery? I feel like that would be something they'd just do at the drop of a hat because they could do it. So 32. 32%. That feels like way too many for me. But maybe I have.

I mean, we just learned about three medical tools that sound like very bad. I'm going to say 5%. Well, let's say 33%. Oh, my gosh. Exactly one third of them. Oh, geez.

So, Sam, you couldn't have been much closer, and you get to decide who goes first. Ah. And that's not of like three skulls. It was 40 of 120 skulls. Well, I guess when all you got's a hammer, every problem looks like a nail. So, you're drilling some holes in some heads. Every head looks like a nail. Yeah.

I'd like Sari to go first, I believe. So our skin, besides being our biggest organ, provides incredible protection for our squishy insides, which is why injuries that damage the skin can be so dangerous. Burns, for example, can leave a hole in our skin shield, so harmful microorganisms can wreak havoc and cause serious sickness or even death. In late 1800s and early 1900s, surgeons treated serious burns by spraying or soaking them with a solution of tannic acid. And tannic acid can be extracted from oak trees in various forms and is most recognizably used for tanning non-human animal hides to make leather. And that's basically what happened in hospitals. Tannic acid is antimicrobial and would sterilize the treated area, but it would

also coagulate all the skin and blood and whatever goop into a hard, dark surface that couldn't be infected easily. Then, after a while, the dead skin would peel away at the edges, at which point the surgeon would help lightly cut it away to leave a scarred but healed area. So it kind of worked in that and increased survival rates compared to leaving the burns alone, but tannic acid treatments were extremely painful and often left intensely scarred skin behind, which affected the quality of life because there have always been people biased against people with any sort of disfigurements. And this is where a surgeon named Archibald McIndoe and likely his colleagues come in. He was trained in plastic

surgery, and as the story goes, during World War II, he noticed that burn patients who were pilots that fell into the ocean had better healing than any other burn patients. So instead of the gold standard of drying out burned skin with tannic acid, McIndoe went the opposite direction and tried to keep the skin moist with a saline solution, aka salt water. These saline treatments were less painful, still antimicrobial, and improved survival rates even more. And he was able to do surgery earlier in the patient's stay, grafting other skin onto the moist burn tissue and reducing the intensity of the scarring as they healed. And as a side note, he seems to have cared a lot about the social aspect of disease, which I felt was worth mentioning. After he treated burn patients,

he actively encouraged and accompanied them as they reentered the community and went to events and stuff, which seems very nice of him. But anyway, nowadays, still the top priority for skin wounds is disinfecting them to protect from bacteria or other pathogens. But keeping burns and other skin wounds moist has become the gold standard for treatment, especially before any kind of reconstructive surgery. And tannic acid is largely a thing of the past, thanks to this surgeon. So when they were deciding to try out tannic acid, was it really because they were like, well, it works for leather? I think it was partially that, but partially it's very antimicrobial. So they were like, we've got to keep the burns as clean as possible.

And then also it happens to work and create this leathery husk of dead skin. It's like making a band-aid out of your own body or something. Well, Sam, can you beat it? I don't know, but I'll try. So enough of this old stuff. Let's talk about robots. But first, a quick definition. So laparoscopic surgery is a type of surgery where the patient isn't cut like all the way open.

And instead, a tiny cut is made and a little camera with a flashlight is fed into the patient's like inflated abdomen. And then little thin tools are also fed in and they look through the camera and use these little tools to do stuff like remove appendixes, perform colon surgery, lots of procedures that you just don't have to open up the whole body for. It's great because cutting a person open isn't great for the person, no matter the circumstances, even if you're trying to help them. And laparoscopic surgery just requires, like I said, a teeny tiny little hole in you. But there are a few downsides, like doctors using a little like clamper on the end of a stick that's in like an inflated body are not as precise as they would be if they were just manipulating

something with their fingers or like a tool that was just directly in their hands. And looking through a camera really messes up depth perception. So more and more often, laparoscopies, I hope I'm saying that kind of right, are performed with robot assistants. So the tools are held by a collection of robotic arms

and the surgeon sits in another room or like across the world even and controls those arms with joysticks and buttons and stuff. So this solves for a few problems, like a surgeon can be more precise with the little tools on the end of the robot arm. And some systems even have like haptic feedback. So if you like bumped into a gut with your little grabber clot would like

vibrate. So you'd know, oh, I can't keep going that way. Plus it solves for some other common operating room problems. Like the surgeon can sit in a chair or something and not have to stand up for hours and hours at a time. But one thing that it still doesn't solve well for is depth perception. So you're using a little joystick and moving like an avatar, basically, around a 3D space on a little 2D screen. And that disconnect, the 3D to 2D disconnect, can be really hard for some surgeons. But it's not hard for surgeons who are also elite gamers. So a recent study from the University of Ottawa looked at surveys and stats of surgeons

who performed lots of robot-assisted laparoscopies. And one of the bits of information that they self-reported was if they were a gamer or not and how much of a gamer they were. So what they found was that surgeons who played video games were faster, more accurate, and just overall way better at robot-assisted laparoscopies. looked at played were the first person shooter half-life the car soccer game rocket league and super monkey ball all of which are extremely precision oriented games that require thinking in 3d while looking at something 2d especially super monkey ball i feel like if you're good at that you'd be the best surgeon in the whole wide world that's a tough one and of course there are vr rigs and specialized programs to train surgeons to do robot surgery,

but they're really expensive and there kind of aren't that many of them. But everybody and their grandma has a Wii that can play Super Monkey Ball. So training using video games, the researchers think, could be a way to make training more accessible and help doctors who are having that 3D to 2D problem get better at the surgery and just help all surgeons get more precise and better at this kind of thing. So if you're despairing over your kids playing Fortnite or Minecraft 24-7,

they possibly aren't just wasting their entire lives. They could be training to be the best surgeons in the history of the world in the future. Well, I mean, sometimes I see somebody do a no scope and I'm like, I wouldn't mind having that person take up my appendix i've never thought about before but yes it's like a cross like a cross map snipe with just the blink of of lifting the sniper rifle to your virtual eye yeah and if they have a robot arm on a laser that's responsible for zapping the thing off your eyeball. You want that person doing it. Can you just plug me into Fortnite

and turn like my appendix into the opponent? And then like, they don't even know they're doing surgery. Oh, it's like Ender's Game, except that they're all doing surgery. That's a really good idea. There's this bunch of teenagers and you don't have to pay them very much because they're teenagers.

Yeah. And you're just like, kids, if you get this ball in this hole, you're going to be really good at this game, and everyone's going to respect you. Yeah, and if they screw up and I die, they don't have to have that guilt. They don't know. They just think they lost a game. Wow, this is a really great, grim, and dark futuristic idea.

I like it. Well, I think, you know what? Because this never happens. And because I thought that it was a good, weird story that has resulted in good outcomes. And also, I like that there was a touch of the connection to the patient and the care for the patient. I'm going to give Sari not just the win here. I'm going to give her the win for the whole episode Suck it Sam

Suck it like that mechanical leech tool Suck it like you are a box full of knives That could be heated to become a vacuum somehow Oh okay if I have to But that does mean that it's time for Ask the Science Couch Where we've got a listener question for our couch of finely honed

scientific minds. It's from at PDX import who asks if you get an organ transplant from someone do you have two different sets

of DNA? And I'm pretty sure the answer is yes. Like if it's a tissue no. But if it's an organ yeah. But that's all

I got I'm pretty sure. But that's all I got. I'm pretty sure. The rest is for Sari. I'll bump up that pretty sure to a yes, because there is DNA in all cells and your cells will have your set of DNA and the donor cells will have different DNA. And this is like a big conundrum

in the field of organ transplants. Like this is why they're so difficult and they have been so difficult and they continue to be so difficult. It's because anything that is foreign material, so whether it's a bacterial genome or a virus or another human genome in our bodies, aside from being pregnant, which is its own weird alien thing, your body sees it as foreign and your immune system mounts a response to it. And so with organ transplants or any sort of transplant, even like a skin graft, if it's from someone else, there is going to be a chance of rejection, which basically means your immune system is attacking the new tissue and saying like, this is not good. This is not mine. This is not us. And I want to destroy it. And that's why if you get an organ transplant, not only do you have two different sets of DNA, but you take immunosuppressant medication. Those are those anti-rejection meds to dampen that immune response and try to make your body okay with the fact that

it has two different types of DNA inside it. But that it's not like the, uh, it's not like your body comes in and like eventually replaces all the cells with its own cells. That's not how it works. Unfortunately not. Uh, cause the donated organ or the donated tissue will have, I think we'll have some stem cell component to it. So if like you get a donated kidney, that kidney will still, as the cells die and turn over, it will still be produced from those stem cells and still have the donor DNA in it. There are situations where the connective tissue cells, so where the organ gets sutured to your connective tissue, your cells can grow in a little bit more,

but that doesn't stop the risk of rejection because the main big chunk of it is still donor DNA. Well, thank you, Sari, for that excellent answer. If you want to ask your science questions to our science couch, you can follow us on Twitter at SciShow Tangents, where we'll tweet out topics for upcoming episodes every week.

Thank you to at HansRat42, at MooneyRiot, and everybody else who tweeted us your questions for this episode. If you like this show and you want to help us out, it's super easy to do that. You can become a patron at patreon.com slash SciShow Tangents, where you can get access to things like our newsletter and

our new podcast, Boopy Peepypedia, which we did today record an episode of, and much to Sam's chagrin, it was awesome. It was really good. Damn it. Second, if you want to leave us a review wherever you listen, that's super helpful and helps us

know what you think about the show. And finally, if you want to show your love for SciShow Tangents, just tell people about us. Thank you for joining us. I've been Hank Green. I've been Sari Reilly. And I've been Sam Schult love for SciShow Tangents, just tell people about us. Thank you for joining us. I've been Hank Green. I've been Sari Reilly. And I've been Sam Schultz. SciShow Tangents is created by all of us and produced by Caitlin Hoffmeister and Sam Schultz,

who also edits a lot of these episodes. Our social media organizer is Paola Garcia Prieto. Our editorial assistant is Tupoki Chakravarti. Our sound design is by Joseph Tuna-Medish. And we couldn't make any of this without our patrons on Patreon. Thank you. And remember, the mind is not a vessel to be filled, but a fire to be lighted. But one more thing.

King Louis XIV had an anal fistula, an infected tunnel between the skin and the anus that developed following treatments of a pus-filled mass near the area. His chief surgeon effectively cut and drained it in 1686, starting a wave of surgeons being treated with higher esteem. Also, anal fistula surgery became fashionable because everyone wanted to be like the king and surgeons had to turn people away who didn't need the treatment. But more importantly for the medical community, surgical training improved and under Louis XV, the Royal Academy of Surgery in France was established in 1731. So this is the fistula that rocked the medical world. So it was so cool that his booty hurt that everybody was like, oh, my booty hurts too. It was so cool that his booty hurt and got treated by a surgeon who he then like praised

with esteem and wealth that everyone was like, oh man, I want, I want the butt guy to come do my butt. I mean, what a thing to be like, well, first of all, what a thing to be the king and say, God damn it. My ass hurts so bad.

I am the king of a country and I can't stop my ass from hurting. And then it's like, it turns out that you can look, you're the most powerful person ever. And now we can all get a person to help us with our butt pain. As long as you have a lot of money. We really gave it to the French this episode.