How to Stay Alive in Renaissance England

Summary

Podcast Summary: "How to Stay Alive in Renaissance England"

Not Just the Tudors | Hosted by Professor Suzannah Lipscomb | Guest: Dr. Alana Skuse
Date: October 20, 2025

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Episode Overview

This engaging episode explores the perilous and fascinating world of healthcare in Renaissance England. Professor Suzannah Lipscomb interviews Dr. Alana Skuse, Associate Professor at the University of Reading and author of How to Stay Alive in Renaissance England, to uncover the realities, misconceptions, and innovations that shaped the medical landscape during the 16th and 17th centuries. The conversation delves into medical practices, the roles of various healers, perceptions of disease, and the blurred boundaries between science, tradition, and faith.

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Key Discussion Points

The Landscape of Renaissance Medicine

• Constant Threats to Health
  Illness, from plague and pox to wounds and melancholy, was ever-present. Medical care was both a science and an act of imagination, faith, and community resilience.

  • “Medicine in this period was as much about imagination and faith as it was about science.” (03:13)

• The Spectrum of Practitioners
  Healers ranged from elite physicians and surgeons to apothecaries, midwives, bonesetters, and household women, with “quacks” filling the gaps.

  • Physicians: Expensive, highly trained, Galenic theory adherents (i.e., focused on humors).
  • Surgeons: Often maligned as “butchers,” but drove innovation through hands-on practice, especially in warfare.
  • Apothecaries: Ubiquitous, essential, sometimes viewed with suspicion due to the power of their remedies.
  • Domestic Healers (women): Central to daily and emergency care; knowledge passed via “receipt” books.

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The Logic and Practice of Renaissance Medicine

• Perceptions of Health & Disease: The Four Humors

  • Health was seen as a balance between blood, phlegm, yellow bile (choler), and black bile (melancholy), mapped onto hot/cold and wet/dry qualities.
  • “It’s almost like us thinking in terms of cells today… that’s what it’s like for most people when they're understanding the humors.” (09:24)

• Holistic Treatments

  • Treatment aimed to restore equilibrium, primarily through diet, purges, vomiting, bloodletting, and lifestyle adjustments.
  • “In a way, all treatment is holistic. They have a very holistic view of the body….” (11:06)

• Placebo and Common Sense

  • Many remedies worked through suggestion or common-sense measures—some, like willow for pain, have genuinely effective ingredients.
  • “There's a massive placebo effect… but there are also a lot of common sense things.” (13:11)

• Domestic Medicine & Women’s Expertise

  • Receipt books functioned as family medical encyclopedias, documenting remedies, experiments, and results.
  • “Any self-respecting… woman… will be keeping what we call a receipt book or a recipe book. And that contains… a lot of medical recipes.” (15:07)

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Medical Professions and Innovations

• Physicians

  • Relied on detailed patient interviews, urine analysis (even tasting it to diagnose diabetes), and narrative diagnosis, often at a distance.
  • Case: Mrs. Ladd’s cancer treatment—emotional letters trace hope and despair amid dangerous mercury or arsenic remedies.
    • “She cries a porridge bowl’s worth of tears.” (21:00)

• Surgeons

  • Developed practical skills out of necessity, especially on battlefields; innovations included careful use of prostheses and new approaches to wound care.
  • Ambroise Paré’s discoveries, such as abandoning boiling oil for gunshot wounds, advanced surgical practices.
  • “You need a particular temperament, I think, to be a surgeon… and some of the surgeon’s textbooks advise… train on dead bodies or even animal carcasses.” (26:14)
  • Patient endurance: The story of Mrs. Townsend, who survived mastectomy without anaesthetic and lived for years after. (27:25–27:46)

• Apothecaries

  • Vital for dispensing both prescribed and self-developed cures, sometimes stepping in when physicians or surgeons were unavailable.
  • In times of plague, apothecaries stayed in cities to care for the sick, earning respect and trust.
    • “Some of the accounts… are quite touching. There's one who says he sits by the bedside of his patients… holds their hand while they're dying because there's nobody else to do it.” (36:52)

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Gender and Medical Authority

• Midwives and Female Healers

  • Outnumbered physicians and surgeons by far, though experiences among midwives varied widely due to lack of regulation.
  • Childbirth was dangerous: ~1% maternal mortality; up to 10% infant mortality before age one.
  • Medical texts often betrayed deep misunderstandings of female anatomy, e.g., the “wandering womb” and the “one sex model.”
  • “There's a great deal of mysteriousness about the womb… The womb can kind of get a bit loose and start roaming around your body a little bit.” (40:51)

• Resistance to Professionalisation

  • While men sought to formalise and control medicine, women fiercely defended their roles and practices.
  • “Female practitioners don’t take that lying down… at the end of the 17th century, the midwives are still unregulated, they're still in charge of probably 99% of birth, despite the best efforts of the men.” (48:04)

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Quacks, Unlicensed Healers, and Medical Regulation

• Blurred Boundaries
  • The line between “real” doctors and “quacks” was often social and economic, not just about skill or knowledge.
  • Case of faith healer Valentine Great Rakes—drew support from the elite and the Royal Society, blurring lines between miracle and medicine.
  • Punishments for unlicensed practice existed but were not strong deterrents. Some preferred to pay fines as a business expense.
    • “Often people were making enough money that they just didn’t really care that much…” (53:08)

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Hospitals and Medical Institutions

• Emergence and Evolution
  • Early hospitals were more like hospices; the Civil War prompted increased investment and professionalization.
  • Hospital and medical staff began to integrate more closely, with prominent surgeons like John Woodall at St Bart’s.

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Misconceptions and Modern Reflections

• Enduring Myths

  • Many contemporary assumptions—such as diseases like cancer being “modern”—are false; cancer, diabetes, and epilepsy were well-recognized.
  • “Don’t think that they're just looking at people and saying, that person's possessed. Very few diseases get attributed to witchcraft or demonic influence.” (56:16)

• Surprising Discoveries

  • The emotional toll of researching patient narratives (e.g., the Henry Moore letters about Mrs. Ladd) was unexpectedly powerful for Dr. Skuse.

• Who would Dr. Skuse trust with her care?

  • Ambroise Paré, the innovative French surgeon: “He is just cracking… the progress he makes in a short space of time is astounding.” (59:09)

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Notable Quotes & Memorable Segments

• Dr. Alana Skuse on internal logic in historical medicine:

  • “There is an internal logic to this stuff and I know that people are looking for the best they can do in the same way that we are today.” (05:25)

• On women's contribution:

  • “Some women, particularly upper class women, are really good at this stuff… they will pass down those books… If they don’t have daughters, they’ll pass them to a niece…” (15:07)

• On apothecaries during the plague outbreak:

  • “My feeling is that it’s a substantial portion, maybe up to sort of 30, 40% of apothecaries who are operating in London have died from staying there and looking after plague victims.” (36:52)

• Reframing quackery and alternative medicine:

  • “The battle for what is real medicine and what’s going to be alternative medicine or quackery is taking place in front of our very eyes.” (53:01)

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Timestamps for Key Segments

• 01:52 – Episode Begins: Framing medicine in Renaissance England
• 05:19 – Dr. Alana Skuse joins; her motivations for researching Renaissance medicine
• 09:08 – Explanation of the four humors and their significance
• 11:06 – Holistic approaches to treatment; purges, diet, bloodletting
• 15:07 – Domestic medicine and women’s “receipt books”
• 18:04 – How physicians diagnosed illness
• 21:00 – The poignant case of Mrs. Ladd and her cancer treatment
• 22:14 – The evolving profession and reputation of surgeons
• 26:14 – The courage required for surgery and the story of Mrs. Townsend
• 36:52 – Role of apothecaries, especially during the plague
• 40:51 – Misunderstandings about the female body; the “wandering womb”
• 48:04 – The struggle for professionalisation versus female healers’ resistance
• 53:01 – Faith healers and the quack/doctor divide
• 56:16 – Debunking myths about historical medicine and disease
• 58:30 – Dr. Skuse’s most surprising research discovery
• 59:09 – Who Dr. Skuse would choose as her physician

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Concluding Insights

This episode offers a vivid, respectful look at how Renaissance England’s medical world was much more complex, dynamic, and experimental than conventional narratives suggest. From holistic home remedies and the often-overlooked expertise of women, to the grim realities and innovations of surgery, listeners gain a new appreciation for the courage and resourcefulness at every level of early modern healthcare.

For those seeking a deeper dive, Dr. Alana Skuse’s book, How to Stay Alive in Renaissance England, comes highly recommended.

Transcript

[Professor Susannah Lipscomb]

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[Professor Susannah Lipscomb]

Hello, I'm Professor Susannah Lipscomb, and welcome to Not Just the Tudors From History Hit the podcast in which we explore everything from Anne Boleyn to the Aztecs, from Holbein to the Huguenots, from Shakespeare to samurais relieved by regular doses of murder, espionage and witchcraft. Not, in other words, just the Tudors, but most definitely also the Tudors. In an age of dazzling art, revolutionary science and spiritual upheaval, there was one constant threat to life in Renaissance England. Illness. From plague and pox to childbirth complications, cancer, melancholy and wounds from war, disease and injury stalked the 16th and 17th centuries with a merciless persistence. When the body broke down, the question was not if you could be cured, but who Might save you. Physicians were highly trained, inexpensive, their advice often couched in the obscure language of humors and spirits. Apothecaries sold powders and potions, some healing, some deadly. Surgeons offered terrifying, painful procedures without anesthesia. Midwives and household healers, usually women, attended births and everyday sickness with herbal remedies and recipes passed down through generations. And beyond them were the so called quacks, tooth drawers, bonesetters and travelling charlatans who dazzled crowds with miraculous promises. Medicine in this period was as much about imagination and faith as it was about science. Before microscopes, anesthesia or antibiotics, practitioners relied on observation, experiment and inherited wisdom stretching back to Hippocrates and Galen. They believed that health lay in the balance of the four humours, blood, phlegm, yellow bile or choler and black bile or melanchola, and prescribed purges, bleeding or strict diets to restore equilibrium. At the same time, anatomy advanced through dissections and the work of pioneers like Vesalius, while chemical medicine, faith healing and even astrology shaped how people understood their bodies. Yet amid rivalry, experiment and uncertainty, one thing is clear. The ability to stay alive depended not just on doctors and remedies, but on courage, resilience and community. To be ill in Renaissance England was to face a world of choices, some costly, some dangerous, all uncertain. Joining me today to explore this world of physicians, surgeons, apothecaries, midwives and quacks and how ordinary people fought to survive is historian and literary scholar Dr. Alana Skus, Associate professor at the University of Reading. She's written two academic monographs on early modern healthcare and her brand new book for the general public, the Surgeon the Midwife of the how to Stay Alive in Renaissance England is out now. I'm Professor Susannah Lipscomb and this is not just the Tudors from history hit Dr. Skews. Welcome to the podcast.

[Dr. Alana Skuse]

Thank you for having me.

[Professor Susannah Lipscomb]

What was the main question you had in mind as you set out to write this book?

[Dr. Alana Skuse]

Well, when I'm talking about Renaissance medicine, I always notice two things. So people firstly asked me, did it work? And secondly, they asked me, well, why on earth would anybody do that? And I was getting a bit frustrated seeing Renaissance medicine continually represented as bit mad, a bit stupid, and the healers and their doctors is almost willfully ignorant. And I thought, actually, I know that there is an internal logic to this stuff and I know that people are looking for the best they can do in the same way that we are today. And there's also this preoccupation with the idea that on one side There are quacks and on the other side there are doctors. One side is bad, one side is good, and that's just not how it was. So we have this spectrum of people, people we might call quacks, but were often actually quite skilled, like the bonesetters, the tooth drawers, the traveling kind of peddlers of nostrums and things, and then, yes, the physicians. But they are actually a very small percentage of the people who offer medical care. You have more surgeons than you do physicians, you have more apothecaries than you do surgeons, and you have many, many more domestic healers, female healers and midwives than you do from either of those groups. So I wanted to tell their stories because I feel like they've not been heard before.

[Professor Susannah Lipscomb]

And is it fair to say that although the physicians were learned, they didn't necessarily have access to medical knowledge that a healer in a village might have.

[Dr. Alana Skuse]

They don't have the same amount of experience. I think that's the main thing. So they're going to their textbooks, and their textbooks are mainly Galenic, so they're from Galen of Pergam, who is in ancient Greek, and they are very wedded to Galen's ideas to the extent that when they go and do anatomies and the anatomies don't match what's in Galen's textbook, they think, oh, this must be some kind of freak of nature, because we know the textbook's right. By contrast, the people say midwives, who are going to the same sorts of cases day in, day out, or people like bonesetters, all they do is set fractures so they can do it more quickly and with more skill than somebody who does a whole range of practices, maybe only sees, you know, a few patients a week or a day because their fees are so much higher that they can afford to do that.

[Professor Susannah Lipscomb]

In some ways, what you're saying makes the physicians sound like general practitioners today, and the healers and the bonesetters like surgeons and specialists in, you know, consultants today.

[Dr. Alana Skuse]

Yeah, and I think there is very much that beginning of specialisation here. So back in the medieval period, you don't quite have this stratification of medical practitioners in the same way. And that's partly because the College of Physicians is founded in 1518. Thomas Lineacre goes to Henry VIII and says, we want to be official. And from that point onwards, they're continually trying to separate themselves from everybody else and to say, no, we are the legitimate medical practitioners. And all those others, they're just kind of mad quacks or butchers is a word they often use about surgeons. So that kind of divide between the different groups gets more and more distinct in the 16th and 17th century. And we can think of the physicians as GPs, but we might think of them as rather expensive private gps. They're really only accessible to, say, what we would now call the middling sort, but the cream of the middling sort and then the upper classes.

[Professor Susannah Lipscomb]

So talk me through how people in renaissance Europe, in 16th century England understood health and the human body and how one treated it medically.

[Dr. Alana Skuse]

So the predominant model at this time is the model of the four humors. And this is so prevalent that it's almost like us thinking in terms of cells today. You know, we might not understand that much about cells, but pretty much everybody knows that you have cells in your body and that's what it's like for most people when they're understanding the humors. But you can go as deep into the doctrine of the humours as you want, and you can get right into astrology and astronomy and all kinds of things. The basic tenet is that there are four humors in your body and they're arranged on this spectrum of hot, cold, wet, dry. So you have the hot and wet humour of the blood, which is called sanguine humor. You have the hot and dry humour of choler or yellow bile, the cold and dry humour of melancholy or black bile, and the cold and wet humour of phlegm. And depending on what humour predominates in your body, you will be vulnerable to certain illnesses. So if you've got a lot of melancholy, you'll be liable to what they call melancholy, but we might call depression. You'll be liable to cancers, migraines. If you've got lots of cholera, it's heating you up, so you're likely to get feverish sorts of illnesses. If you've got lots of phlegm, obviously things like pneumonia and blood doesn't cause too many problems. Blood is the best humour, and of course it's the one that predominates in men, whereas all the poor women are stuck with their melancholy humours. So those things are affected by your diet, your environment, all kinds of things which they call non naturals, but they're also affected by your gender, your life stage and where you're born.

[Professor Susannah Lipscomb]

And what did that mean when it came to treating illnesses they could diagnose through this humoral system? What does that mean in terms of treatment? I mean, everybody knows about bloodletting. What else does it mean?

[Dr. Alana Skuse]

So it means that in a way, all Treatment is holistic. They have a very holistic view of the body, where what you're always trying to do is just redress the balance. That means an awful lot of what they prescribe is diet. So let's say that you have a patient who has cancer. That cancer, they believe, has been caused by melancholy humours. And the worst cancers, the most aggressive ones, are caused when melancholy humours meet choleric humours. So the melancholy humours have been sort of cooked or stagnated under the influence of the choleric humours. So what you have to do is redress the body. So you get rid of the heating foods like the red meats, the onions, the garlic, the strong cheeses, the strong spices, and you bring in things like lettuce, fish, poultry, what they think of red meat as heating and things like poultry as they're okay to eat. And if that doesn't work, then you go to the medicinal substances that tend to do the same thing. So you might start using purges. You can cause somebody to vomit, you can give them laxatives, and both of those get everything out of your body. It's the same principle of bloodletting. So get everything out of your body and by default, the thing that you've got in excess, that's going to come out the most. So they do a lot of purges and actually quite a lot of people are doing purges just to keep themselves healthy. So you hear of people saying, oh, I have bloodlet every six weeks, whether I feel ill or not.

[Professor Susannah Lipscomb]

Like going for an enema, perhaps today. Or.

[Dr. Alana Skuse]

Yes, it's like the Renaissance version of colonic irrigation.

[Professor Susannah Lipscomb]

Okay. It's very easy from a modern perspective for somebody to look back and say, oh, these things didn't work, you know. But actually, some of what you've talked about in terms of a holistic approach may well have been genuinely useful. And the point is, also, the vast majority of people, presumably like us, just accepted what the people who knew about these things were saying, as we do today.

[Dr. Alana Skuse]

Yeah. So there's a massive placebo effect. A lot of the time people report feeling better when they've been given things which we know wouldn't have done anything for them. But there's that very powerful psychological effect. And also some of what they're doing is helpful. So melancholy is a really good case in point. We think of them treating depression or other kinds of what they would call madness as, oh, they just lock somebody up and beat them and starve them. Actually, the things that they prescribe for melancholy Are things like, can you make sure the person sees their friends, can you make sure they go outdoors and get some exercise, make sure that they don't drink too much alcohol, make sure that they're eating regular meals. So these are really common sense measures. It's easy to look at the kind of mad things that some Renaissance doctors do, and there are some really weird things. But there are also a lot of common sense things. Things like having rosemary water poured over a wound that might get infected, or gargling with sage, which is antibacterial if you've got a sore throat, using willow, which we now know has compounds similar to aspirin for pain relief. So they're not doing these things completely out of the blue. They are things that have been handed down and proven to work in many cases.

[Professor Susannah Lipscomb]

So I suppose we could argue that there's a kind of version of the scientific method being displayed here. They're experimenting with things, things turn out to work like willow or rosemary water, and then that is passed on from generation to generation. And you talk early in your book about how health begins at home. So is this something that is knowledge that is shared amongst, I don't know, the women of households, for example?

[Dr. Alana Skuse]

Very much so. So women in households, any self respecting kind of middle or upper class woman, anyone who can write basically will be keeping what we call a receipt book or a recipe book. And that contains recipes for cookery, recipes for getting stained out of clothes, but also a lot of medical recipes. And some women, particularly upper class women, are really good at this stuff. They're making really complicated recipes that have a lot of ingredients in and take a lot of time to prepare. And they will pass down those books. So they pass them to their daughters. If they don't have daughters, they'll pass them to a niece. They'll get recipes from other women, maybe their servants, maybe women who they're writing to. And we know that they are taking a critical eye on these because the ones that they like will have the words probatum est written next to them, it is proven. Whereas other ones, you'll see them furiously crossed out and they've written, you know, this was rubbish, didn't work at all. Some of them say, oh, this, this cured, so and so's maid. And that's very much what medicine does. John Ward, who's a vicar in this time, but he really wants to be a physician. He's always running around trailing after physicians. He keeps these fantastic diaries. And in one of his diaries he writes that when physicians say they do something tentatively. What they mean is experiment on human bodies. And that's what everybody's kind of doing all the time.

[Professor Susannah Lipscomb]

Was it common for clergy to get involved in medicine?

[Dr. Alana Skuse]

It was quite common. And in the later part of the 17th century, clergy particularly got involved with the treatment of the mentally ill because the clergy weren't getting the tithes that they used to get. And so they had to supplement their income in some way. A lot of them are in these quite big houses and so they start taking people in for hospice care, hospital care, and some of them then start to specialize in the care of the mentally ill. So the Reverend John Ashbourne, he takes in people to his own house. He says he's basically packed his wife and children into a few rooms so that he can turn over the rest of the rooms to take him in. People with mental illness, unfortunately, it ends really badly for him because one of the people he takes in, we think it's his brother in law. It's not totally clear, but the biography fits with it. Bringing his brother in law. But one day the brother in law obviously hasn't been recovering quite as well as John thought he was and he turns around and stabs him. But then his wife and his son continue to run the asylum after that.

[Professor Susannah Lipscomb]

So we've talked about clergy in mental health care and we've talked about women in the domestic sphere. Let's talk about some of the different kind of categories of medical practitioner otherwise. So physicians to start with then you said they're kind of like the private general practitioners, perhaps. How did they diagnose their patients?

[Dr. Alana Skuse]

Physicians are very proud of their diagnostic tools. It's the thing that most differentiates them from other kinds of medical practitioners. So they will go to a patient, they will take a history. There's a lot of narrative medicine involved here. A lot of. I think what makes patients feel better is that they're getting to talk to somebody about what's ailing them. But once they've done that, they will look at the patient's urine, they will smell, they might taste the urine, and this seems rather alarming, but it's to taste whether it's sweet. They're looking for what they call the pissing disease or diabetes. They will look at the patient's stools, then they'll take the patient's pulse and they're very proud of their ability to read the pulse. Although nobody ever seems to do very well on actually diagnosing anything from the pulse. They just always do it. And then they'll ask the Patient things about this, sleeping about what they've been eating, and they'll make a diagnosis that is a compound of all these things. So quite a lot of physicians, because they're so reliant on narrative medicine, can actually diagnose by letter. You'll get your servant to take a letter to your physician with a flask of your urine and he'll send you back some medicines and tell you what you should be doing.

[Professor Susannah Lipscomb]

So they don't necessarily have to see their patient.

[Dr. Alana Skuse]

No. Which is very handy because there are not many physicians around and the ones that there are, are concentrated in the big cities. They're in London and Norwich and brist. But if you've gone off to the country to, I don't know, escape the plague or something or just to have a little holiday, then you can write to your physician rather than going to the local, what they would disparagingly call a horse leech. So somebody who does a bit of medicine, but also does veterinary medicine and probably also has another job on the side, they don't want to be seeing those. They'd rather write to that sophisticated man in the city.

[Professor Susannah Lipscomb]

And I'm really interested in the way that we reinforce what we already believe, cognitive dissonance and go on and on about it. But I wonder, do you have any idea about what patients did or might do if the treatments that they had been prescribed didn't work? My suspicion here, my sort of working hypothesis were, as it were, is that they carried on going to the same physician. But do you have any evidence about that?

[Dr. Alana Skuse]

Yeah, there's a really sad story about. There's this guy called Henry Moore, who's a great philosopher, he's a great intellectual. And his niece, Mrs. Ladd, writes to Henry because she has cancer. And Henry pulls a few strings and he gets her a really top notch physician called Francois Van Helmont. Francois is the son of Jean Baptiste Van Helmont, who is a great big deal in European physic. So Henry says, okay, I've asked Francois to look into this case. He's now advising your local doctor. Doctor. They're corresponding about her and he's prescribing her something very strong. We don't know exactly what it was, but from the symptoms that Mrs. Ladd describes via her brother, we think it's either arsenic or mercury. These are both things that can be used to treat cancers. They're kind of early chemotherapies. They know they're bad for patients, but they kind of just hope it kills the cancer before it kills the patient. And poor Mrs. Ladd, she's writing back via her brother saying, you know, she's in a terrible state. She's got a massive sore, she feels really bad. She's waking up in the night sweating profusely, or crying. She says she. She cries a porridge bowl's worth of tears. And Henry's writing back, trying to reassure her of how good a physician Francois is. And they go, okay. She keeps going back and taking more of the medicine because she's so convinced by the credentials of this guy. Eventually Francois sees the way the wind is blowing and he decides he's not having any more to do with the case. And then poor Mrs. Ladd sort of disappears from the historical record for about a year. And a year later we hear from Henry more that he's going to see her because she's dying. So it's obviously not worked.

[Professor Susannah Lipscomb]

So let's think about another category of medical practitioner, which is the surgeon. These people needed to have real skill, didn't they?

[Dr. Alana Skuse]

Yes, I'm very fond of a surgeon. I have a particular soft spot for them. They've often been thought of as butchers. Saw bones, they were often called. Even their contemporaries often characterized them in that way. And it's understandable because their job is pretty horrific. Remember that all the surgery you're doing at this point is without anesthetic. That includes major surgeries. So people sometimes think that they didn't do any major surgeries and certainly none that were non emergency. Actually. You're not just cutting off arms and legs at sea, although there is a lot of that. People are doing mastectomy operations, they're doing large scale tumour removals, they're doing amputations on people who have to agree at some point, yeah, you come around my house on Thursday and you can cut off my leg while I'm awake. I mean, it's a really bloody, horrific trade. But the surgeons are also improving, probably more rapidly than any other kind of medical practitioner because there's so much war in this period. They are really getting to see a lot of cases and a lot of complicated cases. There's loads of war, there's increasing use of firearms, so there's a lot of shrapnel injuries, really complicated things like soft palate injuries, facial reconstruction. So the best surgeons become very, very quick at what they do and they become quite skilled. And there's a guy called Ambrose Pare who's operating in mostly France in the 16th century. He's my kind of historical favorite because he thinks up These amazing operations. But he also thinks about prostheses. So he convinces other surgeons to operate in such a way that you can fit a good prosthetic afterwards. He thinks about what his patients lives will be like when they go back to their villages. The other thing he does is he discovers that it's not good to use boiling oil to cauterize wounds. So he says he's going into his first battle. He's somehow managed to get himself a job as an army surgeon. He's sort of riding his luck here, doesn't really know what he's doing. And he says he turns up to his battle and he realises he's run out of turpentine oil for cauterizing the wounds. So he just does his best. He puts some ointment on them that he's made out of egg whites and some other stuff. And then the next morning he goes and he's astonished to find that the people with the ointment are doing much better. And so then he goes to the other surgeons and he says, guys, we've really got to stop using this boiling oil. It's not good. We should be ligating arteries and veins where we can and using ointment and styptic powders, which is powders to stop blood where we can't. So they're making actually pretty huge strides, even though it is at all times quite a traumatic experience.

[Professor Susannah Lipscomb]

Yes. I mean, it's interesting, isn't it, how warfare drives innovation and technology. People will say that a lot about the 20th century, but it's clear that it's happening in this century as well. But I'm really struck by the bravery of surgeons and those enduring the surgery, and also from the point of view of the surgeon, the calmness under pressure that you must need if what you're doing is inflicting enormous amounts of pain on someone who's awake and alive and that you have to believe that what you're doing is going to make them better. I mean, it's extraordinary. Sang froid, I suppose.

[Dr. Alana Skuse]

Yeah. You need a particular temperament, I think, to be a surgeon in particular. And some of the surgeons textbooks advise young surgeons to train on dead bodies or even animal carcasses, so that they can get really quick at doing these operations before they have the added complication of having to have a kind of wriggling live patient underneath them. And they talk about the terrible shrieks and cries of the patient, which would disturb the most seasoned operator. There's a story that John Ward, that vicar who really wanted to Be a doctor tells about one of his parishioners. She's called Mrs. Townsend, and she has a mastectomy. And she, as I said, invites these people to her house. She says, come around on this day, I will undergo this mastectomy without anesthetic. And the surgeons say afterward that they'd heard that women could endure more than men, but they didn't believe it until now. And they come back on several consecutive days to take away more of the cancer. So Mrs. Townsend is absolute heroine to allow this to keep happening.

[Professor Susannah Lipscomb]

I mean, how and was it successful? Do we know, in Mrs. Townsend's case and more generally, you know, was it worth undergoing such surgery to try and remove a cancer?

[Dr. Alana Skuse]

Well, Mrs. Townsend, John Ward eventually goes to her post mortem, but I think that is sometime later. Ward's diaries are very difficult to date. He never puts dates on them. And he uses the same notebooks. You know, he'll put them down for five years and pick them up again. But from what I can tell, he's going to her post mortem maybe two, three, four years after she has the operation. So she certainly recovers from the operation initially, whether it extends her life or not, it's difficult to say. But it is working at least enough of the time for other people to want to chance it. And you see newspaper reports saying, oh, lady, so and so has had a mastectomy operation and is recovering. If everybody was dying or if it wasn't helping anybody, they wouldn't keep going. They're not stupid. So it must have been working in some cases, obviously at a really terrible cost. And we don't know whether those were benign tumors that maybe they'd have just carried on not being a problem or they were malignant ones. But certainly these surgical interventions work in some cases.

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[Dr. Alana Skuse]

What.

[Professor Susannah Lipscomb]

Are the sort of issues we have with the source record? What kind of sources can we turn to and what does it tell us? I mean, who is left out? Who is overrepresented? Is it possible even to answer those questions?

[Dr. Alana Skuse]

Yeah, so the big issue with the sources is that you don't hear from patients. This is overwhelmingly the issue. You can get to some of those patient narratives, you get some diaries, you get some letters between patients. But most of what we have is written by the practitioners, and the overwhelming majority of that is written by physicians. And I think that's what's driven this idea that there are just physicians and then kind of everybody else that doesn't matter is because the physicians are getting to write everything down. They're getting to publish their work, which they do partly as a sort of public service. Here's some advice for other young physicians, but they do partly as advertising. So you've always got to read between the lines because these physicians are not saving everybody. But if you read their books, you'd think that they were just swooping in and curing everyone with a click of their fingers. You also have the receipt books. They're really, really valuable and they tend to be quite well preserved where we have them, because they're precious things. You know, people take care of them, but don't take care of them too much. That's something that we don't want in our sources. We actually want those sources where people have written in the margins, they've crossed things out, they've kind of written their shopping list in the back. I must say, John Ward's diary was a real treat because it's just bonkers. There's medical receipts in there, but there's also things like he just wrote a note to himself saying, turkeys have more blood than other birds and they have more bones and they're very fierce. Just things like that. Anything he hears just goes in the book. So it's a real sort of stream of consciousness.

[Professor Susannah Lipscomb]

That's fascinating. So we've also got apothecaries. Where do they fit in?

[Dr. Alana Skuse]

Apothecaries are very numerous compared to physicians or even surgeons. There are a lot of apothecaries in London in particular. You go to parts of central London, say round St Paul's there are streets where every other place is an apothecary. So the official job of the apothecaries is that your physician goes to see you, he gives you a prescription and you take that to the apothecary and the apothecary fills it out. So, like our pharmacists, essentially, that's what the physicians would like the apothecaries to do. In fact, the apothecaries do that, but they also do a bit of their own work. You know, they see a lot of sick people, so they're making up some of their own medicines, they are seeing some of their own patients. And people like Nicholas Culpepper are actually challenging the College of Physicians and they're saying, you know, this stuff you are prescribing is really expensive. It doesn't work. And I have ideas for better medicines which people can get for themselves just from the hedgerows and looking at plants which grow near them. And they're bound to be more suitable, Culpepper says, because they are in tune with people's bodies, because they're local to them. So the apothecaries are an interesting group and a very numerous group. Again, they're ones that aren't particularly represented in the sources.

[Professor Susannah Lipscomb]

I mean, one of the places an apothecary comes to attention is in the sort of fabulous, scandalous case of Thomas Overbury and his murder. Tell me about that and how it plays into fears at the time when it comes to apothecaries.

[Dr. Alana Skuse]

Yeah. So your listeners will probably know about the Overbury murder. In which Francis Carr goes to the apothecary, Franklin, and asks him for a poison, and he gives her a poison which he's apparently tested on a cat, and the cat has died in a very excruciating and painful way. When this all came out, when it came to light that Overbury had been poisoned, of course, Franklin is first for the chopping block or the hangman's noose. And it really put fuel on the fire for both the apothecary's agenda and the physician's agenda. So the physicians turned around and said, well, this proves that you can't trust apothecaries. Somebody needs to be regulating all these apothecaries, and that somebody should be us. The apothecary said, this shows that the physician's attempts at oversight have not been working. We need a stronger trade body of apothecaries that can effectively police itself. And both of them were playing into the fact that actually the medicines that you are able to access are getting stronger and stronger. You're quite unlikely to kill somebody by giving them too much rosemary, right? But you can very easily kill somebody with one of the new drugs from the New world, like colasins, or by giving them one of the strong chemical medicines like mercury or arsenic or even opium. So they very much bring to the fore the fact that these medicines are potent and they are becoming a problem because they can very easily be used as poisons.

[Professor Susannah Lipscomb]

And yet it is the apothecaries who, by the mid 17th century, when we get to the 1665 plague outbreak, I mean, obviously plague is recurring regularly, but in that particular case where things are so terrible, they manage to demonstrate their steadfastness, increase their popularity, don't they?

[Dr. Alana Skuse]

The apothecaries are really embedded in their communities in a way that the physicians and the surgeons aren't quite so much. So the physicians mostly flee the city. Not all of them. There are people like George Thompson who make a point of staying, but largely they follow their clientele to the countryside. But the apothecaries are still there. And in fact, they're deputising for the physicians in some of the hospitals. At Saint Barts, there's an apothecary taking over. And some of the accounts of what the apothecaries are doing are quite touching. There's one who says he sits by the bedside of his patients. He sits with them while they're dying and suffers them to breathe in his face and holds their hand while they're dying because there's nobody else to do it. And they should pay a massive price for this. It's very difficult to say how many apothecaries died because we don't have very good records of them, basically. But my feeling is that it's a substantial portion, maybe up to sort of 30, 40% of apothecaries who are operating in London have died from staying there and looking after plague victims. What it does do is after that, you don't hear too much about stamping down on the apothecaries anymore because they become very popular. Whereas the physicians get a lot of flak from people who say, well, actually we needed you and you abandoned us.

[Professor Susannah Lipscomb]

So would you say that it's in this period we see apothecaries kind of moving from basically being glorified shopkeepers to becoming accepted as essential, you know, key medical workers.

[Dr. Alana Skuse]

Yeah. If you look at somebody like Nicholas Culpepper, he starts off as an apothecary. He then publishes this amazing tome which we now call Culpable Terrible. It's still in print, it's had more editions than Grey's Anatomy. And he publishes a lot of books. He's a bit of a workaholic. Publishes, publishes right up until he dies age 38 from what appears to be probably TB and exhaustion. But he is one of the best selling medical authors of the entire century. So one of the primary voices that people are listening to is an apothecary.

[Professor Susannah Lipscomb]

We also, of course, have midwives. Back to women again. Can you give me an idea of how dangerous childbirth was in the 16th and 17th centuries?

[Dr. Alana Skuse]

The dangers of childbirth accrue not quite so much to the mother as we normally think of it as to the child. So we have a mortality rate for mothers of around 1% actually dying in childbirth, which is very bad. It's about 100 times worse than it is now, but probably less than most people think. Danger to infants is much higher. Around 1 in 10 infants will die before their first birthday. And a lot of those, it's in the very first few weeks of life. The things that kill mothers in childbirth, blood loss, baby getting stuck. So breech births, twin births are very dangerous. And tearing of the placenta, placenta not coming away, or somebody trying to remove it and botching it, and then infections directly after childbirth. They kill quite a lot of women.

[Professor Susannah Lipscomb]

Two of Henry VIII's wives. So can you make sense of this for me? Because as I understand it, medical knowledge of female anatomy, particularly, and particularly the internal female anatomy, was rudimentary at this time. I mean, they've, you know.

[Dr. Alana Skuse]

Yeah, John Ward says he thinks that the child in the womb breathes through the mother's privities.

[Professor Susannah Lipscomb]

Goodness me. Okay, so I know Thomas Vickery discovered the clitoris and discovered with heavy inverted commas at that point, but you know, ovaries aren't discovered till much later. And what do they, how do they understand the womb to function?

[Dr. Alana Skuse]

There's a great deal of mysteriousness about the womb. They seem to understand it as something like another sort of organism within the body. So they talk about the womb being pleased or displeased with things in fits of the mother. The womb can kind of get a bit loose and start roaming around your body a little bit. And if you need to put it back in place, then you hold foul smelling things to the woman's nose and sweet smelling things under her skirts to kind of lure it back as if it was some sort of errant pet. You need to get back in its cage. And so they're very cautious about the womb. They also have this other model which is called the one sex model. And there's been a lot of debate in the scholarship over to what extent they believe this, but certainly some of them think in these terms, which is that the female reproductive anatomy is just an inverted version of the males. So the vagina is an inverted version of the penis and the ovaries are basically a woman's testicles. But the male's genitals are all on the outside because they need to be kept cool because his humours are hotter and you don't want to cook the sperm, whereas the woman needs to keep them on the inside because of her cold humors and because obviously she needs to keep the baby warm to grow it.

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[Professor Susannah Lipscomb]

And I understand, correct me if I'm wrong, that that One sex model suggests that a woman is a deformed man, that there was not enough heat in the process of conception to force the genitalia outside her body. So she's basically an incomplete man, a man that hasn't been properly formed. Is that right?

[Dr. Alana Skuse]

Yeah, Aristotle came up with that one, and everybody was very happy to jump on that bandwagon. And it's reflected in how people talk about women's health. So if you read some of the medical text, it's a miracle that there are any women alive, because they're just so subject to a whole raft of illnesses. They're much more subject to cancers. So 9 out of 10 cancers that are ever diagnosed would be breast cancer, because that's where it's most visible. And probably the 10th one is cancer of the womb. Headaches. Hysteria. Well, what we would call hysteria, but they would call frenzy or melancholy. Basically any kind of illness you can think of. Women get it worse and they get it more frequently.

[Professor Susannah Lipscomb]

But it's interesting, you're suggesting that there's a tension between the one sex model and belief in the womb as being this kind of wandering animal. Those two things were kind of incompatible at the time, even though people might believe both.

[Dr. Alana Skuse]

Yeah. And this is something I find very interesting about Renaissance people in general, actually, is they have this ability to have two ideas in their mind that appear to be incompatible or even contradictory, and yet maintain those two ideas both at once. And that's the sort of habit of thought that I think we've lost now. But it's quite familiar to them. They use it in many different ways. They'll use it in how they think about cognition and morality and all sorts of things.

[Professor Susannah Lipscomb]

Yes. And actually, it is entirely possible to have two ideas in your head that are contradictory and ascribe to both of them. So given what you've said about maternal mortality rates and infant mortality rates as a result of childbirth, or despite that, perhaps, isn't it probably not the case that midwives were saving more people than they condemned? So, I mean, how do we make sense of the gap between theoretical knowledge and practical expertise here?

[Dr. Alana Skuse]

The quality of midwives is very variable. You have people like Jane Sharp, who's the first woman to publish a midwifery text. Jane Sharp knows a lot. She's got endless diagrams in her book of all the different weird ways in which babies can present and how you're going to try and manipulate the mother and the child to get them to both come through the experience safely. A lot of it is put the mother's leg above her head or get her to walk around or put her in a chair or put her in a bed. So she's doing a lot of quite gentle but probably quite effective things. Then you have midwives who are very inexperienced. Maybe they're out in the sticks. They don't do a lot of midwifery. It's not their job. And that's a function of the fact that midwives aren't regulated. So you don't need anybody else's permission to become a midwife. You've probably learned it from a relative or an older woman in the community. And maybe you're somebody like Jane Sharp. You're going to several births every day. It's your job. You're getting fairly well paid for it because you're attending middle and upper class women. Some of those midwives, maybe they've only been to the births of their family members. And as soon as something starts to go wrong, it goes wrong very, very quickly. And if you don't have a surgeon near you, then there's really nothing that you can do. The surgeon is brought in when the baby is really stuck and you think that the mother is about to die and his job is really quite grim. If a surgeon enters the birthing chamber, it means that you think that the baby has died in the mother and you are prepared for the surgeon to use his collection of tools to. To get the baby out, if necessary, in pieces. So it really is a last resort. But it's a myth that surgeons would do caesareans on living women in order to save the baby. Actually, the priority is always to save the mother because the mother can go on and have another child.

[Professor Susannah Lipscomb]

That's interesting. And I've understood that one way to characterize this period is that female healers and midwives had to kind of give way before the professionalization. And therefore the male takeover of medicine. Is that accurate, do you think?

[Dr. Alana Skuse]

The male practitioners would certainly like that to be accurate, and they're trying very hard to make that accurate. Female practitioners don't take that lying down. So the midwives are a good example. There are numerous attempts, many of them spearheaded by a family of man midwives, the Chamberlain family, to bring midwives into some kind of formal regulatory framework to have a corporation of London midwives. I mean, they're sensible enough to see that they're not going to manage to regulate all the country midwives, but they think the ones in London, we could get hold of all of those and we can make them do what we say and we can Put a man in charge of it. They try and try, but they keep getting stymied by the fact that the midwives point out that actually some of the man midwives, the chamberlains, aren't particularly good at what they do. Or if they are good at what they do, they're a bit money grabbing. There's all these stories about, oh, well, he said he wouldn't go to this woman until she'd agreed to pay this extortionate fee. So at the end of the 17th century, the midwives are still unregulated. They're still in charge of probably 99% of birth, despite the best efforts of the men. And it's the same story with the domestic medics, right, the noble women who are dishing out medicines. There are a lot of attempts to put them in their place or say that they're not any good. But these women are not pushovers. You know, there's people like Lady Ann Halkett, she's treating people with their skulls exposed by shrapnel wounds. She's not about to just roll over. And there's also a slightly strange position for the physicians because they are servants. You are paying them. So they can't be too rude about the noble women because they know which side their bread sputtered on. They have to talk in these kind of vague terms where they go, oh, well, a lot of. A lot of women, but not this woman, are not very good at their job, but not that woman, she's all right. We're talking about all the other ones. They never really get to the kind of position of domination that they would like.

[Professor Susannah Lipscomb]

You mentioned earlier that many of those who are unlicensed medical practitioners have been and were at the time written off as quacks. But what sort of other knowledge, other practitioners were present in society at this time? And do we see a distinction between, you know, the professions of medicine and the unlicensed healers particularly emerging at this point?

[Dr. Alana Skuse]

I'm very interested in this question and I think it might be my next book. So I don't have all the answers yet, but there is something going on about how you delineate quacks from regular practitioners. I think in the first half of the century, it's a lot to do with social status. So the good practitioners, the regular practitioners, are the ones who have that higher social status. They're sort of middling classes. And the quacks are basically all the poor people doing medicine. My feeling is that this shifts in the second half of the century to be more about the type of. Of medicine. There's a really interesting point in the 1660s where there's a guy coming over from Ireland called Valentine Great Rakes. His name is the Stroker.

[Professor Susannah Lipscomb]

It's a great name, full stop, though.

[Dr. Alana Skuse]

I mean, it is a good. It's good name. And he's called the Stroker because he's essentially a faith healer. And what he does say you have a headache, he starts stroking your head and then he'll kind of stroke down your arm until the headache comes out at your fingertips. And he's brought over by Lady Anne Conway, who has terrible migraines that nobody's been able to cure. And in fact, she'll die quite young, probably of something connected to these migraines. He doesn't manage to cure her, but a load of other people come to her house and he's having quite good success curing them. So he goes to Worcester, he's getting crowds by this point. Then he's summoned to London, he meets Charles ii. So he is being brought right into the establishment. He's got backing of people like Robert Boyle. So people in the Royal Society are trying to work out what's going on with this guy, but at the same time, some of what he's doing is very reminiscent of quackery. He goes into one of the parks in London and it's said that somebody is selling jars of his urine and a woman buys a jar of his urine and is pouring it into her ears to try and help her earache. So there's this really interesting moment, I think, where everything's up for grabs. The battle for what is real medicine and what's going to be alternative medicine or quackery is taking place in front of our very eyes.

[Professor Susannah Lipscomb]

And were the punishments if you operated without a license at the time, I mean, was it. Was it a dangerous thing to do?

[Dr. Alana Skuse]

There were punishments, but often, often people were making enough money that they just didn't really care that much. So if you are, say, doing the physician's work when you are a surgeon, which is something that the Chamberlain family are habitually getting in trouble for, you will get fined. You can get fined quite a lot. Peter Chamberlain at one point gets fined 40 shillings because he keeps doing physician work when he shouldn't be. Eventually he gets put in Newgate Prison for a little bit, but that's the worst thing that's going to happen to you. And I think a lot of them are making the calculation, okay, well, it's better to just do it and pay the fine when I have to, because this is a good business for me.

[Professor Susannah Lipscomb]

And this is a period in which there are some famous institutions. I mean, in terms of dealing with mental health, there's the infamous Bedlam Hospital. But also we've talked about some of the hospitals like Bart's and St. Thomas's and others. How do these professions of medicine that we've talked about and the emergence of institutions align in this period?

[Dr. Alana Skuse]

So at first, the hospitals and the doctors are almost bizarrely separate. You have, in the early 17th century, hospitals that are. They're more like nursing homes. People go there, they're very sick and you expect them probably to just die. In these hospitals, you're just providing a place for people to go. And it's not until really the civil wars that hospitals start to be taken very seriously because they become a political football, right? Each side is saying, oh, the other side, they don't even have any good hospitals. They're just sending them to kind of country places where nobody knows anything. They'll probably just hit them on the head if they don't think they're going to get better. And so they're putting in now some of the best physicians into the hospitals. They're putting in people like John Woodall, who's a quite famous surgeon, into Saint Barts Hospital. The hospitals also start to become better funded. This is very relative because they're starting from almost nothing. When Henry VIII got rid of the monasteries, he also got rid of a lot of the hospital provision. So we're starting from zero. But by the last decades of the 17th century, there's a real hospital building project on. It's almost fueled by Bedlam, because Bedlam gets a nice new site, nice big hospital with kind of pineapple carvings on the walls and things, and others follow suit. It becomes more and more formalised. It's partly because there's been such mismanagement at Bedlam that they've realized that they really need to pull their socks up. And that extends to everywhere else as well.

[Professor Susannah Lipscomb]

You started this podcast by talking about the misconceptions that exist around medical practice at this time. Is there another common misconception about the period or about this topic of healthcare, particularly that you would like to correct now that you have this chance to do so?

[Dr. Alana Skuse]

I think there's a misconception about some diseases. We imagine that some diseases are post industrial. So when we think about cancer, it very often is conceived of as a disease of the 20th century, the 20th, 21st century. It's not. Cancer goes as far back as we can trace, basically, and it's absolutely understood in the 16th, 17th century as a metastatic disease. They don't understand about cells, but they know that cancer spreads through the body. Other diseases, such as epilepsy, they can distinguish epilepsy from other kinds of fits, things like diabetes. They don't know how diabetes works, but they know that it is there. So actually don't think that they're just looking at people and saying, that person's possessed. A lot of people always say to me, oh, they must have just thought that was witchcraft. Very few diseases get attributed to witchcraft or demonic influence. Even people who are, you know, displaying really outlandish behavior, they're quite reluctant to attribute it to supernatural causes. They are looking for those natural causes, and a lot of the time they are finding them.

[Professor Susannah Lipscomb]

And the word cancer, as I understand it, is, I think, etymologically, isn't it? Yeah, it's to do with canker, isn't it? Is that right? What's the etymology of it?

[Dr. Alana Skuse]

Yeah, so cancer comes from the Latin for crab, and it shares a name with the crab. But they say, like the crab, once it grabs hold of a person, it doesn't let them go. Another name for cancer is wolf, and that's for the same reason. It's this idea of cancer is almost zoomorphic or anthropomorphic disease that purposely eats people up. Obviously, that's not how we conceive of it now, but I think a lot of our rhetoric that we now have around cancer actually goes all the way back to those early perceptions.

[Professor Susannah Lipscomb]

So two more questions for you before we finish. One is, what has most surprised you in doing research into this topic?

[Dr. Alana Skuse]

I think the thing that most surprised me was those Henry Moore letters. I wasn't expecting to find them. I was delighted when I found them. But I was also really sad. It's not often that doing my job, something emotionally affects you. I read a lot of stories about horrible things happening to people and people dying, but the way that you could see the hope and the gradual fading of hope in those letters was really affecting.

[Professor Susannah Lipscomb]

And lastly, who would you go to if you were in this period and you required medical attention?

[Dr. Alana Skuse]

I would go to Ambaraz Kare. I think he is just cracking. He has a few blips on his record, but the progress he makes in a short space of time is astounding, and it really sets the pattern for almost every other surgeon in this period.

[Professor Susannah Lipscomb]

Brilliant. Pere for the win. Okay, thank you so much. This has been really wonderful, informative and entertaining. I'VE really enjoyed our conversation. Thank you.

[Dr. Alana Skuse]

It's great to chat about this stuff.

[Professor Susannah Lipscomb]

Thank you for listening to this episode of Not Just the Tudors From History Hit. Thank you also to my researcher Max Wintle, my producer Rob Weinberg, and to Amy Haddow who edited this episode. We are always eager to hear from you, including receiving your brilliant ideas for subjects we can cover. So do drop us a line and Not Just the [e-mail] and I look forward to joining you again for another episode. Next time on Not Just the Tudors From History Hit.

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