How to Survive in Renaissance England

Quacks, wise women, barber surgeons and private madhouses - just some of the options available if you were to find yourself in ill health in the 16th and 17th centuries. Dan is joined by historian Dr Alanna Skuse to look at healthcare in Renaissance England, from healing the humours and blood letting to cross animal blood transfusions, skin grafts that involved attaching the face to the upper arm and the notorious treatments of patients at Bedlam, Britain's most famous psychiatric hospital. But not all treatments were bizarre or gruesome; in fact, early practitioners had some pretty progressive ideas around holistic health, the benefits of nature, sleep and friendship. Alanna shares astonishing stories of treatments, patients and practitioners from her new book 'The Surgeon, the Midwife and the Quack: How to Stay Alive in Renaissance England' Produced by Mariana Des Forges and edited by Dougal Patmore We'd love to hear your feedback - you can take part in our podcast survey here: https://insights.historyhit.com/history-hit-podcast-always-on. You can also email the podcast directly at [email protected] mailto:[email protected]. Hosted on Acast. See acast.com/privacy https://acast.com/privacy for more information.

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:00Dan Snow?

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• 0:32Speaker 01

  Hey, we're Nick and Jack, hosts of the best one yet. Behind every episode, there's research, emails, spreadsheets and our shared Google Doc, the headline hammer. With Google Workspace with Gemini, Google's AI is built right into the premium versions of tools we already use, like Gmail, Docs and Sheets. No new tools or extra logins, just personalised AI for the way we work. That means less time on the work around the work and more time finding the stories worth talking about. Get AI tools for work. Upgrade to Google Workspace with Gemini at goo.gle/workspacewithGemini. That's goo.gle/workspacewithGemini.

• 1:08Dan Snow?

  Hi folks, welcome to Dan Snow's History Hit. Now, if you were to take a train to History Hit HQ, well, you have to go to the nearest station. We don't have an actual station inside the building yet. You'd have to get off probably at Liverpool Street Station in the middle of East London. That's not far from the River Thames. Those of you who know this part of the city know it's a bustling hub of city workers in skyscrapers, plus us media types tapping away in cafes, talking nonsense, offices in repurposed old warehouses. But what you might not know is that Liverpool Street Station sits on top of the site of the Old Bethlem Royal Hospital, which later became known as Bedlam, famed for its reputation as a mental asylum.

• 1:51Dan Snow?

  That kept patients all too often in appalling, torturous conditions from the 14th century through to 19th, when thankfully underwent all sorts of reforms. It's one of the world's oldest psychiatric institutions, and it did mark a turning point in medicine in England, a transition from the wealth of holistic and folk spiritual healing of perhaps faith healers, we call them, to more institutionalised healthcare. But frankly, the stories that came out of Bedlam tell us that this wasn't necessarily a better route. So, as a person with ailing health in the Renaissance era, if you were suffering from a kidney problem, say, or from plague, or you were caught in the throes of depression, what were your options to get help?

• 2:34Dan Snow?

  Would you go to a local wise woman, or the apothecary with its jars and drawers of remedies? Or would you enter the doors of an institution like Bedlam? Well, in this episode, I'm going to go through all your options with the help of Dr. Alana Skews. She has studied the history of healthcare in Renaissance England and found some pretty extraordinary stories about patients and healers, and the beginnings of the scientific revolution that was going to take place in England throughout the 16th and into the 17th century, well, and beyond. But how that revolution in healthcare didn't always deliver better results for the patients. It's a remarkable, thought-provoking story, folks. Enjoy.

• 3:34Dan Snow?

  Alana, before we get started, the past has got a very bad reputation in terms of trying to be alive and pain-free. Let's take the Tudor period as it was in England. Would you time travel back there, or was it just unrelentingly grim for most people most of the time, in terms of your respect for what's going on around you, but your own health?

• 3:52Speaker 02

  Yeah, you would not catch me time travelling back to 16th century. All kinds of horrible diseases, sweating sickness, which we still don't really know what it was. Infectious diseases all over the place, not to mention if you managed to have an accident, which a lot of people did because obviously they're doing accident prone type things, doing lots of manual labour, working with livestock, working with horses all the time. So, yes, it's pretty grim. What I would say is that there's an impression that it's almost purposely grim, that the doctors and the surgeons and things are these sort of heartless sore bones who take delight in giving people disgusting medicines and chopping them up while they're still alive.

• 4:31Speaker 02

  Actually, most people, most of the time, are doing the best they can with the knowledge they have available to them.

• 4:40Dan Snow?

  And they were sure they were doing the best they can, but often you read that medical intervention, it would do more harm than good. I mean, were you often better off not going to a doctor?

• 4:50Speaker 02

  Yes, you're often better off not going to a doctor. From what I've read, it seems that probably your best bet is to go to a woman healer. So a lot of noble women providing care for their servants and their family and their neighbours, and also kind of middle class women doing the same on a smaller scale. They often are better because they're not using quite such potent ingredients. So they sometimes are using those ingredients like arsenic and mercury and so on, but not with such relish and sort of gay abandon as the physicians seem to be using them.

• 5:23Dan Snow?

  Right, so it's the inherited sort of oral traditions, the ancestral, because as we know, there's so much that heals us in the natural world. They're using those more traditional remedies.

• 5:33Speaker 02

  Yeah, they're using things like willow bark, which is salicylic acid, it's a precursor to aspirin, but also things like rosemary and sage, a lot of the sort of cough and cold medicines have you gargling with some mixture of those, and they are actually antibacterial, so they would have made you feel a little bit better. And some of the medicines that they take for pain, things like hellebore, hembane, they're not good for you, but they would have had a kind of stupefying effect, which is why they were often given to people during acute ill. illnesses or in preparation for surgery. They can also give you opium, which they know is a good pain medicine. They also know that it's addictive and they know that it can do you harm. So that's why they don't tend to use it for surgery, but they are quite free with using opium for end of life care.

• 6:18Speaker 02

  So there are some things that they're doing which are actually more effective than you would think.

• 6:23Dan Snow?

  But the lads in London and Edinburgh are playing with new technologies and not knowing what the hell's going on and often making things worse for their patients. Right, interesting.

• 6:32Speaker 02

  Yes, and there are a few particular examples of this. So in the 1660s, the Royal Society gets going. And a couple of the members of the Royal Society decide that they will start experimenting with blood transfusions. And that sounds great, but the kind of transfusions they want to do are not transfusions of human blood in people who've lost blood. That's very, very briefly suggested and seems to be immediately tossed out of the window. What they want to do is transfer blood between different species. So they start with dogs and they go, well, if you put the blood of like a fierce dog into a timid dog, does it make the timid dog fierce?

• 7:15Speaker 02

  They do a number of experiments like this and then they think we've got a mad person here. Let's put the blood of a sheep into him because a sheep is a nice tame animal and hopefully it will calm him down. They managed to do this a couple of times. Unfortunately, in France, some physicians are doing the same thing. They're putting the blood of a calf into a man. And after a few rounds of this, unsurprisingly, he dies. And then it gets banned and we don't have blood transfusion then for another 200 years. So if you happen to get on the wrong end of a physician's experiments, then watch out.

• 7:54Dan Snow?

  So frustrating because in a way those experiments are necessary for the birth of modern science and medicine. But there's a lot of collateral damage in the way. But okay, so if you want decent healing, go to a woman to deliver that. So true in so many fields, but I'm getting ahead of myself. Let's talk about what people.

• 8:12Dan Snow?

  Thought, understood, whether they're healers or doctors or anyone really, what they understood about, I mean, the humoural thing you hear about so often, aren't you, with the various humours, what's going with that?

• 8:21Speaker 02

  It comes from mostly Galen of Pergamon, who is an ancient Greek, and it persists for an extraordinarily long time, mostly because it is actually quite intuitive. So you have your four humours, the four humours travel around your body as fluids. It's a bit confusing because one of the humours is called blood, the sanguine humour, but they also all travel around in the blood. There's a difference between blood humour and nutritive blood, which is the blood that you see when you cut yourself. And the four humours are on the spectrum of hot, cold, wet, dry. So you have black bile, which is melancholy, and that's cold and dry, got yellow bile or choleric humour, and that's

• 9:04Speaker 02

  hot and dry, phlegm, which is cold and wet, and blood, which is hot and wet. And those humours will affect how you look, how you act, the kind of foods that are good for you, and the kind of illnesses you get. So they really are fundamental to everything about your existence.

• 9:22Dan Snow?

  Do you think that this was a kind of quite widely a unifying thesis for really anyone involved in trying to work out why we were feeling good and bad?

• 9:30Speaker 02

  I think their understanding of the humours is a bit like our understanding now of cells. So you and I and Joe Blogs on the street, we all know that we're made of cells. We know that in a kind of abstract sense, but it doesn't actually affect my everyday life that much. It's just like kind of intellectual weather. The people over in the biology department of my university, they know a lot about cells and they're really interested in them, and they are writing about that all the time.

• 10:01Dan Snow?

  So yeah, they're looking at those cells every day, they're into them.

• 10:04Speaker 02

  Yeah, they love them. And the thing about the humours is you can make that system as complicated as you like. There's a lot of astrology and astronomy in the study of the humours, and you can go kind of down endless rabbit holes over, you know, which planet is influencing which humour at any given time, and too complicated for me to understand, and I've been studying it for a long time.

• 10:26Dan Snow?

  Okay, so is there any usefulness in that that might have made anyone better ever?

• 10:34Speaker 02

  The usefulness to my way of thinking is the holistic nature of it, which I think is now coming back around to a certain extent. So in the system of the humors, you emphasise the impact of the environment on the person's health. So almost all cures are what we would call social prescribing or lifestyle cures. Things like diet, things like seeing your friends, how your relationship is with your husband. Those are really, really important on a medical level. And it also means that there's no distinction really between mental health and physical health. Because the melancholy humors can cause you melancholia, like depression.

• 11:16Speaker 02

  The melancholy humors can also cause you cancer or migraines. And those two things aren't quantitatively different from each other.

• 11:24Dan Snow?

  Okay, so in that respect, as an organising principle of looking at the human body, there is some utility there.

• 11:30Speaker 02

  There is, and there's also specific things which we've actually picked up and used again. So we use leeches now, again, in hospitals, because they are quite a good way of getting infected blood out from the sites of wounds. There's a really mad operation that they use in the 16th century for replacing people's noses that have been lost from syphilis. It's called the Tagliacoccian operation. Somebody called Gaspar Tagliacoccia in Italy is doing this. And then it disperses all through the continent. And basically what you have to do, if your nose has fallen off because of syphilis, you get the person's arm, and if you imagine your upper arm, you cut three lines.

• 12:13Speaker 02

  So you cut three sides of a rectangle and then you fold that piece of skin back and you bandage it so it heals up. You leave that for a bit. And then you bandage the person's arm to their face. And you have to leave their arm attached to their face for at least a month. They can't move, they're not really supposed to talk, they definitely can't sneeze. And the idea is that it grafts onto their face. And then you cut off the fourth edge and you can kind of shape it into the nose. And this looks like one of the most bonkers things that you can do in Renaissance medicine. Even the other surgeons think that this is insane. But actually, it was used again in World War One. So some of these methods are more forward-thinking than you might imagine.

• 12:56Dan Snow?

  Speaking of treatments, the idea you have to keep these humors in balance, right? So what are the ways, you've mentioned using leeches. How do they bring these humors back into some kind of equilibrium?

• 13:07Speaker 02

  Probably eighty, ninety percent of all medicine at this time is really diet.

• 13:12Dan Snow?

  Okay.

• 13:12Speaker 02

  They think that your diet is incredibly important and you're just redressing the imbalance of humors. So let's say you've got loads of choleric humors. They are hot and dry and they'll make you have hot diseases like fevers and things, what they call agus. There's a lot of what we would now identify as malaria. So if they've got too much cholera in your body, you want to be eating things that are cold and wet. So lay off the hot, dry things, which would be red meat, salted foods, cheese, red wine. Basically, all the stuff people like to eat. And you eat things instead, like poultry, freshwater fish, lettuce and salads. And if you must have wine, then you have white wine instead.

• 13:56Dan Snow?

  Well, I mean, some of that sounds like quite a good idea.

• 13:59Speaker 02

  Yeah, it's quite close to a sort of heart-healthy diet now.

• 14:03Dan Snow?

  Okay, so you've gone to the Household Healer. They have given you actually some quite useful things because there's various, as you say, sage, rosemary, meadow sweet. There are things that do have an effect. So if we're a monarch and our lives are quite important, we're escalating, presumably. We're also getting self-appointed experts in. How else might we be treated?

• 14:24Speaker 02

  So if you're a monarch, you're probably going straight to the physicians. You will be surrounded by physicians of various stripes. You will also have your personal surgeon. And depending on what's wrong with you, the physician or the surgeon might take the lead. Traditionally, physicians deal with everything that goes on inside the body. And a surgeon is brought in for anything that is to do with the outside of the body. So any kind of tumors, rashes, bleeding you, anything like that. And the physician or the surgeon will write you a prescription for a medicine. The surgeons aren't really meant to write prescriptions for medicine, but they all do it. And then that will be taken to your local apothecary.

• 15:07Speaker 02

  And the apothecary will make up the prescription, rather like a modern pharmacist. In some ways, the monarchs are actually worse off, because as I say, the physicians, you really don't want to let the king die, so they will go straight in with the strongest things that they can think of. And of course, we all know that kings like their red meat, their wine, and all those other nice foods that the physicians thought they ought not to eat. It's rather difficult to tell them to lay off those when they can have your head chopped off.

• 15:37Dan Snow?

  Right, exactly. And they've got fancy offices in London, whereas they're not going to the simple healing woman out in the villages and the countryside who's probably doing more good.

• 15:45Speaker 02

  Yeah, the physicians are tremendously expensive, which is why there aren't that many of them. So between fifteen seventy and fifteen ninety, I think there are seventy three medical practitioners that we know of in Norwich, and only five of those are physicians. So they really are treating the lucky or unlucky few. They are like orders of magnitude more expensive even than a surgeon, and certainly much, much more expensive than an apothecary or an itinerant healer, what we would now call a quag.

• 16:17Dan Snow?

  Just talk to me quickly, why do people talk about barber surgeons? What is that illusion there?

• 16:23Speaker 02

  So the barber surgeons are formed as a company in the early sixteenth century. Traditionally, barbers have been doing surgery because monks are not supposed to do surgery. Monks are doing the rest of the medical treatment, but they're not supposed to spill blood. And of course, a barber is pretty handy with a razor, so it makes sense. But over time, you have some barbers who are really just now doing surgery and not cutting anyone's hair, and some barbers who are still doing haircuts. So they decide they're going to form this company of barber surgeons so that they can keep tabs on everybody. And the surgeons agree, they're going to stop trying to cut people's hair, they're just going to do medicine. And the barbers agree, okay, they're not going to do the medicine

• 17:06Speaker 02

  anymore. It's not until the seventeen forties that that divide gets broken down even more, and you have a college of surgeons, which is why now we call surgeons mister rather than doctor. It's because initially, the college of surgeons were very precious about their title of doctor, and they didn't want anyone else using it.

• 17:25Dan Snow?

  So quickly, before I come into mental health, I was going to ask, because you mentioned it, bloodletting, we've touched on it briefly, that seems to be a big feature. Why were they so obsessed with getting blood out of the body?

• 17:35Speaker 02

  They really were obsessed with it. And it's not that physicians really want to do it that much. It's a basic part of the physician's repertoire, but it's driven actually by patient demand. A lot of patients are saying, I will be led blood twice a year, whether I need it or not. It's a bit like going to the dentist. And the theory is that if you've got too much black bile in your nutritive blood, the blood that's going all around your body, then obviously if you let some of the blood out, then a greater proportion of the black bile is going to come out than it is of the other humors. So it does kind of make sense. Now, whether this ever helped anybody is a matter for debate. On the basic

• 18:19Speaker 02

  level, it probably mostly did harm. It certainly would have made people a bit dopey. So maybe it will have enabled them to sleep sometimes. But for some conditions that stem from high blood pressure, it might actually have provided some temporary relief. And there are a few modern scientific papers looking into that.

• 18:39Dan Snow?

  So through the 16th century, do things start to improve? Like, what's the point at which you would be confident to go to one of these physicians or doctors or medics? My thinking is around about 1985. But what would you say? I mean, we talked about the barber surgeons organising themselves. Are there things that start going on through the 16th century that point towards the present?

• 19:01Speaker 02

  There's increasing attempts to formalise and organise all kinds of medical practitioners, for better and worse. So as soon as you have the College of Physicians, who were established in 1518, other bodies start to realise that they need to organise themselves, otherwise the physicians are going to take over. So it's first the surgeons and then the apothecaries. And then in the 17th century, the physicians and the surgeons are relentlessly trying to organise the London midwives. Never actually works, because the midwives don't want to be organised, and especially don't want to be organised by the surgeons who are endlessly seeking to boss them around.

• 19:44Dan Snow?

  You're listening to Dan Snow's History. Don't go anywhere, there's more to come.

• 19:54Dan Snow?

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• 20:36Dan Snow?

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• 21:19Dan Snow?

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• 21:48Speaker 03

  Hey, we're Nick and Jack, hosts of the best one yet. Behind every episode, there's research, emails, spreadsheets, and our shared Google Doc, the headline hammer.

• 21:56Speaker 01

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• 22:07Speaker 03

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• 22:11Speaker 01

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• 22:18Speaker 03

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• 22:20Speaker 04

  After civil war, regicide and Cromwell's Republic, the monarchy returned. But Britain would never be the same. I'm Professor Suzanne Ellipsum, and this month on Not Just the Tudors, we're transported back to the age of Restoration royalty, from Charles II to Queen Anne and the birth of the Empire. Join me on Not Just the Tudors from History Hit, wherever you get your podcasts.

• 23:02Dan Snow?

  So things become more professionalised, but does that mean a higher standard of care or moving towards more sophisticated methods of treating people?

• 23:09Speaker 02

  The one thing that can happen, once you have formal bodies, is that you can bring people to account. So the College of Physicians will quite frequently bring people in for discipline if they think that they have committed malpractice. And you can bring a suit against a physician if you think that they've done the wrong thing. So there's a Dutch physician called Johannes Groeneweld, and he's brought to court in the 17th century because they say that he's given an unhealthy amount of something called Spanish fly, which is a kind of toxic caustic beetle, to this woman who was pregnant, and then she finds that she can't walk anymore, which is obviously pretty serious. So there is some recourse.

• 23:51Speaker 02

  It keeps a lid on the excesses of physicians because they're aware that they can be brought to book for their actions.

• 23:59Dan Snow?

  And so does that lead to an improvement, or at least I suppose it leads to your ability to identify and get rid of the worst offenders, the terrible malpractice, which probably does lift the overall standard?

• 24:09Speaker 02

  Yeah, it's difficult because occasionally the worst offenders are actually the people who run the College of Physicians. So there's a guy operating in St Bart's, and the apothecaries say that he has been prescribing ridiculous doses of this toxic medicine. But of course, because he is the head of the governing body, you can't really do anything about it. I wouldn't say it makes a load of difference to standards overall. Really, the driving factor, if standards go up, is not the trade bodies, it's the customers. These are service providers. And if you get a reputation for not delivering,

• 24:48Speaker 02

  or for delivering but in a way that's really horrible, or always prescribing things that are really unpleasant, people just won't go to you.

• 24:58Dan Snow?

  Well, that's a rugged capitalist approach, I suppose that works. Okay, so now what about hospitals? Because we start to see some big hospitals that still survive in Britain to this day. You can trace their lineage back to this sort of early modern period. And are those hospitals already differentiating sort of mental health to physical health? Or is it, are they still just a catchall?

• 25:16Speaker 02

  Pretty much the only hospital for the mentally ill in this period is what was originally called the Priory of St Mary of Bethlehem, which we would now know as Bethlehem or Bedlam. The other hospitals are pretty much exclusively for physical illness. Now, how often a degree of mental illness is going along with the physical illness is up for debate, especially as the hospitals really expand during the civil war. So obviously you've got people in there who've got physical injuries, but also experienced a large amount of trauma, both mental and physical.

• 25:50Dan Snow?

  Okay, so I imagine just simply living in this period with the amount of infant mortality that you'd have been through as a parent, the amount of physical pain you've been, I imagine your mental health would not be in terrific state most of the time.

• 26:02Speaker 02

  No, it's difficult to say. There was, for a long time among historians, a sort of feeling that because people lost children so often, so one in ten children die before their first birthday, one in four dies before they reach adulthood, that because it was so common, parents were kind of deadened to it. They didn't expect their children to live. Actually, if you read the accounts, parents react as you would think that they might react, as a modern parent would react. They experience that grief every time. So it's an incredibly difficult time to be a woman in particular, I think.

• 26:42Dan Snow?

  Yeah, I agree. I find those sources so interesting when you get a glimpse into the horror, the pain that they went through, which feels like our own would be. And then you think, God, they, all of them were going through that a lot and through their lives. So let's keep talking about the mental health and Bethlehem Hospital in particular. Was it so treated in the same way, humors, so humoristic treatment, or did they start to develop different approaches? When it seemed to be just the, perhaps just the head that was wounded, rather than obviously the body.

• 27:12Speaker 02

  Mental health has an interesting division between hospital and everywhere else. So in Bethlehem, the main treatment seems to have been bleeding people. It was very much humors based treatment. You bleed them, you purge them and you give them things to make them vomit. And that's pretty much all that they could do for people. Out in the community, you have treatments that look a lot more like what we would understand as holistic treatments. So in Robert Burton's Anatomy of Melancholy, was published in sixteen twenty one. He suggests, can you get the person to go outdoors? Can you make them take some exercise in the fresh air? Can you make sure they see their friends? Make sure they're not drinking too much and they have a good diet.

• 27:56Speaker 02

  So those are more holistic, more humane treatments, but the ones in Bethlehem are pretty bad.

• 28:03Dan Snow?

  Okay. But again, interestingly, it sounds like those are, well, I don't want to say common sense, but it sounds like those are not super advanced methods of treating mental health. They are just doing the basics.

• 28:14Speaker 02

  Yeah. But I think the basics quite often work because when we see the private madhouses in the seventeenth century, partly because Bethlehem is so awful, you start to get private asylums, which will take in the mentally ill. And they report quite good success rates. You have to take that with a pinch of salt. But a lot of them are advertising themselves, saying, okay, so and so's wife was completely distracted, but we cured her in three weeks and she went home. And I wonder in those cases, if actually what's happening is they're taking the mentally ill person out of the environment that has made them ill, maybe out of kind of an abusive domestic situation or something. And so what they're really offering is a kind of hospice, which is

• 28:59Speaker 02

  probably the thing that people need most.

• 29:02Dan Snow?

  Where it's clean and their trauma can be sort of engaged with and it's just a safe nature surrounded environment, I suppose.

• 29:09Speaker 02

  In theory, yes. I mean, the private madhouses vary a lot in their quality, but they advertise themselves as being warm. They specify that they have good fires in every room, having good meals three times a day and yet having a lot of access to nature. In some of them, there are patients who are there for a long time and those are obviously the people who are more seriously mentally ill or possibly people with learning disabilities who are being misdiagnosed.

• 29:38Dan Snow?

  Was there a stigma around mental health? Somehow people treated differently to people with more obviously physical ailments.

• 29:45Speaker 02

  They are equal opportunities horrible to everyone, I would say. So you do get incidents of people mocking and being cruel to people with mental illness. And you certainly get those visitors to Bedlam, right? It's quite a popular destination for apprentices to take their dates. And they go and they kind of poke at the people in Bedlam through the bars and try and make them lose their temper and tease them in various ways.

• 30:13Dan Snow?

  We can name some of these characters. I mean, the leadership was woeful, if we can call it that. I mean, it seemed to be just an opportunity to, well, for corruption. Tell me about, is it Helke a crook? There's a bit of a nominative determinism here.

• 30:25Speaker 02

  Yeah, crook by name and crook by nature. Crook is the exception to what I said earlier about most people are trying their best most of the time. Crook takes over in sixteen eighteen. He's had his eye on Bedlam for a while and he basically runs a smear campaign against the previous keeper of Bedlam. He takes over, whether he has good intentions when he takes over or not, I don't know, but pretty soon, he's barely there. There's no obligation for the physician that attends Bedlam to be there a set number of days a week. So you can choose your own and what he chooses is none. Instead, he leaves it to his son-in-law to do all of the day-to-day work. He's also

• 31:08Speaker 02

  siphoning off money. So by sixteen thirty-three, there's an investigation taking place and it reveals that for each patient admitted, this is a charity, so it's meant to be free, but Crook has been charging between fifteen and twenty shillings and just pocketing that money. He's also been selling off land that belongs to the hospital. And at one point, he's even sold some of the beds. So he's embezzling around a hundred pounds a year, which is not an insubstantial amount of money, straight into his own pocket. Eventually, it's the embezzlement that gets him kicked off the job rather than the cruelty to patients. Even though there's been inspections where they've seen that the patients are effectively

• 31:52Speaker 02

  starving, it's freezing cold, there's open sewers running basically through the hospital, so it's absolutely filthy, and the patients routinely have nothing to eat.

• 32:04Dan Snow?

  You're listening to Dan Snow's History at There's More Coming Up.

• 32:15Speaker 01

  Hey, we're Nick and Jack, hosts of The Best One Yet. Behind every episode, there's research, emails, spreadsheets, and our shared Google Doc, the headline hammer. With Google Workspace with Gemini, Google's AI is built right into the premium versions of tools we already use, like Gmail, Docs, and Sheets. No new tools or extra logins, just personalized AI for the way we work.

• 32:34Speaker 03

  That means less time on the work around the work and more time finding the stories worth talking about.

• 32:38Speaker 01

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• 32:45Speaker 03

  That's go.o.gle/workspacewithgemini.

• 32:47Speaker 04

  After civil war, regicide and Cromwell's Republic, the monarchy returned. But Britain would never be the same. I'm Professor Suzanne Ellipsum, and this month on Not Just the Tudors, we're transported back to the age of Restoration royalty, from Charles II to Queen Anne and the birth of the Empire. Join me on Not Just the Tudors from History Hit, wherever you get your podcasts.

• 33:28Dan Snow?

  I made a programme once on what people called shell-shocked during the First World War, and I was very struck with how PTSD presents differently in different generations because they have different cultural and social contexts. Do we know whether, if you went to Bedlam Hospital, how did people present with mental health problems back then? I mean, are there descriptions of those symptoms, of what that building was like?

• 33:51Speaker 02

  So when Bedlam moves to a slightly newer site in the 1670s, there are two statues at the front of it. One of them represents melancholy, and the other one represents frenzy. And those are basically the two ways in which madness is understood. Either you're kind of depressive, you don't have any engagement with the world, or you're frenzied, you're violent, you're hyperactive. And whether it relates to PTSD is quite an interesting idea. There's a lot of what we call religious melancholy, and I wonder if that is to do with the presence of death. Death is very close at hand, especially during wartime, and people become very, very occupied

• 34:34Speaker 02

  with the idea that maybe they are going to hell, maybe they're not capable of being saved. That can manifest in these depressive symptoms. It can also manifest in delusions. So something that a lot of writers at the time talk about is people who believe they're made of glass, people who believe they are birds or swans or something like that. And sometimes they try and trick Them out of it. So there's a story in, I think, Robert Burton's book about a man who is afraid to urinate because he thinks that his bladder somehow holds gargantuan amounts and he will drown everybody else. And so to fix this, they stage a small fire.

• 35:17Speaker 02

  And they tell him that the town is on fire and he needs to urinate on the fire to save the town. And apparently this works.

• 35:23Dan Snow?

  Amazing. Well, that's extraordinary. So this through the seventeenth, eighteenth century, lots of use of restraint. There's people can pay to go and laugh at them. I mean, it sounds horrific. The Enlightenment principles don't seem to be touching the mentally ill in London yet.

• 35:40Speaker 02

  No. So after Crook's tenure, a few years later, somebody called Thomas Allen takes over Bedlam. And he doesn't really have any better options for treatment. But we think that he has at least better control over the staff, which has always been a problem. It's endless writing among the governor's board of Bedlam about, well, we need to tell them to stop hitting the patients and stop stealing things from them. In Allen's tenure, we know that the patients are getting stuff brought to them by their friends and family, and they are managing to keep hold of that. So that's something. But James Monroe is elected as the keeper of Bedlam in seventeen twenty eight.

• 36:21Speaker 02

  And it then stays in the Monroe family for about one hundred and twenty five years. There's four generations. And the Monroes not only stick with the old treatments, but stick with them when there are known to be better alternatives. They just have no interest in keeping up with developments in mental health care. Bedlam only really starts to get better in eighteen fifty two, when William Hood comes in. And he institutes something called the moral cure, which is not moralizing to patients, but rather putting a great deal of emphasis on routine and occupation. So you have things like they'll have a ball every couple of weeks in the nineteenth century.

• 37:04Speaker 02

  They have gardens where they can work. The women are doing sewing and things like that. So that's really the turning point, even though it's far from perfect.

• 37:13Dan Snow?

  In the early 19th century, when these things are starting to happen across British society, there's an interesting parliamentary inquiry into Bethlehem hospitals undertaken, and they discover all sorts of horrific things. Is that what drives a move to a new facility, to trying to create better spaces?

• 37:29Speaker 02

  Yeah, so there's always been this belief, which is now borne out by clinical evidence, that being outdoors, being in nature, is one of the best things you can do for people's mental health. And so Bethlehem has continually moved further and further out from London, and it's basically been in pursuit of that green space. So in the site where it is now, it's still got actually quite a bit of green space, but that was initially right out in the rural surrounds of London, and has now been built up around, and I guess at some point it will move again. The site where it is now is also, they built it specifically so that none of the buildings are more than one storey high,

• 38:08Speaker 02

  and that's to make it less like an institution, to use the kind of negative phrase, and more like a sort of home from home.

• 38:19Dan Snow?

  There's so many therapeutic interventions you can make that do not involve, well, drugs, equipment, all that kind of thing.

• 38:25Speaker 02

  Yeah, that's true. And some of what we do, as I'm a literary scholar and a historian, is do work with people with mental health difficulties that involves creative practice. So last year I ran a project where we did a theatre production with some people who'd experienced mental ill health. And over six months, we kind of talked about these historical cases, and they created an amazing production from that. And it was both a way to talk about it without talking about it, right? So you can talk about Julius Caesar's Porsche, who cuts her leg, without talking about your own self-injury. It's a way in that's de-stigmatized.

• 39:09Speaker 02

  And it's also something you do with other people. You achieve something at the end, and there's not the pressure of the traditional ways of achieving things, which would be, right, school, jobs, those kinds of environments. So there are lessons there that we can use, I think, probably more widely in mental health.

• 39:29Dan Snow?

  So this is what's so interesting about your work is there are real lessons. I mean, I think all history's got lessons, including sort of discussions of Habsburg Castle building in a century up in the 16th century. But with yours, there's so many obvious things that stimulate thought about the world that we live in today and the arguments about healthcare and mental health and physical health and all that kind of thing. As you're doing this work, what are some of your big lessons that you draw out and think might be useful for us all to know about as we go on debate healthcare?

• 39:54Speaker 02

  Yeah, that's interesting. The thing I'm very interested in at the moment is the idea of proof and evidence. And I'm really curious about where evidence-based medicine starts to be used and how we decide which medicine is proven and which isn't. There's this fascinating guy in the 1660s. He comes over from Ireland in 1665 and his name is Valentine Greatrakes, but they call him the stroker. And that's because, say you have a headache, he'll stroke, little strokes from your head down to your fingertips or your mouth, and he'll stroke the headache out of your body.

• 40:34Speaker 02

  Now, Greatrakes, he's brought over to cure Lady Anne Conway, who suffers with these terrible migraines. But it doesn't work. But he cures lots of other people and he becomes really, really popular. He's actually summoned to Whitehall for Charles II to see his stroking. That doesn't work either, but he goes into London and he's in the parks, he's in St. James's Park, absolutely thronged with would-be strokeys. It's so crowded that one woman can't get near enough to be stroked, so she buys, what she says is a jar of his urine and pours it into her ears. So in some ways, Greatrakes is the quintessential quack. He has all the hallmarks of a quack.

• 41:19Speaker 02

  But he's going home and the same week is writing to Robert Boyle, is in correspondence with members of the Royal Society. And they are saying, well, actually, we think there's something in this, we just don't really understand quite how it works. So he's right on that cusp between alternative medicine, quackery and mainstream medicine. And for me, that's a source of curiosity. I don't know if I've learned from it, but it certainly makes me want to investigate more where our ideas of what is and isn't legitimate medicine come from.

• 41:53Dan Snow?

  And I guess you've thought a lot about regulation and ensuring that these places, we're protecting the rights of those who are ill in these institutions.

• 42:02Speaker 02

  Yes, in St Bart's Hospital, there's, I think it's John Woodall, he's the surgeon there. And he writes in one of his books that he's seen this experiment described somewhere where amputees are given reeds as prostheses. I think he's describing maybe bamboo, but he says they attach great reeds to them as prostheses. And then he says, but you know, I couldn't find anyone who wanted to have that done, so I had to let it go. And he describes this as really to his credit, that he's not experimented on people against their will. I mean, one of the good things that Thomas Allen does when he's the keeper of Bedlam, is when the blood transfusionists come and they say, we want a mad person

• 42:47Speaker 02

  so we can do our transfusing a sheep's blood into them. He says, no, no, you're not taking one of these people out of the hospital so you can do experiments on them. So there is some good in them.

• 42:58Dan Snow?

  Well, I'm glad to hear there's some good in them. Alana, thank you so much for coming on the podcast. Tell everyone what your book is called.

• 43:03Speaker 02

  It's called The Surgeon, the Midwife, the Quack. How to Stay Alive in Renaissance England.

• 43:08Dan Snow?

  It's useful, folks. Very useful. Stay alive. Thank you very much for coming on the podcast.

• 43:12Speaker 02

  Thank you.

• 43:14Dan Snow?

  Thanks for listening, folks. I've got some news, got some big news. We're going to be changing to a renewed release schedule in November with new episodes dropping on Mondays and Thursdays. Bonus episodes on Friday, if you're a subscriber, which you should be by now. We're going to change things up because we want to, well, deliver the best podcast we can, make sure you get the best of us. So fewer episodes, but we're going to do deeper dives, going to do more of those explainers, more on location adventures, more focus on the history you love. Look, if we're doing fewer episodes, we can make sure they're high quality. That's the laws of physics, folks. And also because we're doing lots of stuff across history in general, got the YouTube channel, which I hope you subscribe to. Well, I've got a couple of YouTube channels now. The TV channel. And we're also making some old school TV as well for National Geographic and Channel

• 43:56Dan Snow?

  Five in the UK. So we're all embarked on some pretty big adventures. Mariana Day Forge, the producer, has upped her shoe game. She is ready. I'm ready. I can't say too much now, but she's gonna need those shoes. That's what I'm saying. We're gonna be traversing the Great Wall of China. We're gonna be following in Napoleon's footsteps across chunks of Europe. And if I get my way, if I get my way, and I better, we're gonna be tracing the story of the Odyssey from Troy to Ithaca, which actually, if you think about it, is the ultimate historical adventure. That's it. You told me that when I was a kid, that I'd be doing that in my slightly advanced years. Well, I'd have been happy. That's as good as it gets. That's winning the World Cup of history. So worry not, folks. The podcast isn't changing. It's just getting even better.

• 44:47Speaker 03

  Hey, we're Nick and Jack, hosts of The Best One Yet. Behind every episode, there's research, emails, spreadsheets, and our shared Google Doc, the headline hammer.

• 44:55Speaker 01

  With Google Workspace with Gemini, Google's AI is built right into the premium versions of tools we already use, like Gmail, Docs, and Sheets. No new tools or extra logins, just personalized AI for the way we work.

• 45:06Speaker 03

  That means less time on the work around the work and more time finding the stories worth talking about.

• 45:10Speaker 01

  Get AI tools for work. Upgrade to Google Workspace with Gemini at goo.gle/workspacewithgemini.

• 45:17Speaker 03

  That's goo.gle/workspacewithgemini.

• 45:23Dan Snow?

  Have you been enjoying my podcast and now want even more history? Sign up to History and watch the world's best history documentaries on subjects like how William conquered England, what it was like to live in the Georgian era, and you can even hear the voice of Richard the Third. We've got hundreds of hours of original documentaries, plus new releases every week, and there's always something more to discover. Sign up to join us in historic locations around the world and explore the past. Just visit historyhit.com/subscribe.