Special Episode: Dr. Alanna Skuse & The Surgeon, The Midwife, The Quack

Imagine yourself as a 17th century English peasant or merchant or noble. Let’s say you’re dealing with some intense stomach pain or a cut on your leg that won’t heal. Where do you turn to for help? Today’s book club episode reveals that the answer depends on your medical needs, your wealth, your social standing, and your gender. But one thing’s for certain: you had some options up your sleeve. In The Surgeon, The Midwife, The Quack: How to Stay Alive in Renaissance England https://bookshop.org/a/3175/9781836430773, Dr. Alanna Skuse https://www.dralannaskuse.co.uk/, Associate Professor at the University of Reading https://www.reading.ac.uk/english-literature/our-staff/dr-alanna-skuse, takes readers through the layered world of Renaissance medicine and the many different healers (both licensed and self-professed) that occupied it. As Dr. Skuse demonstrates, people have always sought experts to help them return to or remain in good health, and this has in turn fueled the growth of new medical professions as people carved out their healing niche. How did this era set the stage for the birth of modern medicine? Tune in to find out. Support this podcast by shopping our latest sponsor deals and promotions at this link: https://bit.ly/3WwtIAu See omnystudio.com/listener https://omnystudio.com/listener for privacy information.

• 0:01Speaker 00

  This is Exactly Right.

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  Hi, I'm Erin Welsh, and this is This Podcast Will Kill You. Welcome to the latest episode in the TPWKY Book Club series, where I invite authors of popular science and medicine books onto the show to chat about their latest work. Over the years of making this series, we've gotten to cover some incredibly wide-ranging topics, like the story behind the secretive NIM, the insidious effects of climate change on the ways we think and behave. If there's a particular scientific or medical subject that you're interested in learning more about, chances are we've covered it in one of these episodes. To check out the full list of books we've covered so far and to see which ones will

• 3:09Speaker 04

  feature in future episodes, head over to our website, thispodcastwillkillyou.com. There, under the Extras tab, you'll find a link to our bookshop.org affiliate page. Clicking that link will get you to several podcast-related lists, including one for This Book Club and one for the TPWKY Kids Book Club, hosted by Erin Updike on our socials. Whether you've got book suggestions, topic suggestions, a firsthand account you'd like to share, or any other thoughts you have, we love hearing from you. The best way to get in touch is through the Contact Us form or the Firsthand Account form, both of which you can find on our website.

• 3:50Speaker 04

  Two last things before we move on to this week's book, and that is to please rate, review, and subscribe. It truly does help us out. And second, you can now find full video versions of most of our newest episodes on YouTube. Make sure you're subscribed to the Exactly Right Media YouTube channel so you never miss a new episode drop. Renaissance England, it was an exciting time to be alive. The arts blossomed, theater and poetry reached new heights, music and architecture thrived, educational institutions promoting humanities and sciences exploded in popularity. Unfortunately, living to adulthood to experience these wonders was far from guaranteed.

• 4:35Speaker 04

  And even if you survived the dangers of childhood illness, there were plenty more health threats confronting you as you navigated the world beyond. Plague epidemics surged, syphilis ran rampant, even something as seemingly innocuous as a splinter could turn deadly in a matter of days. Who could you turn to for help with your ailments and injuries? And how much could they actually do for you? In The Surgeon, the Midwife, the Quack: How to Stay Alive in Renaissance England, Dr. Alana Skews transports readers back to the 16th and 17th centuries, when medicine was beginning to reach beyond some of its superstitious and long-entrenched beliefs of the principles

• 5:19Speaker 04

  governing human health and disease. As a result, medical professions multiplied and diversified as people sought to carve out their niche: a qualified physician offering their services to the wealthier classes; an apothecary making a pretty penny selling proprietary remedies; a midwife whose extensive knowledge had been carried down over generations of women; or a bone setter or tooth drawer where taking a hands-on approach was the only option. Dr. Skews, who is Associate Professor of Literature at the University of Reading, presents this cast of medical characters in Renaissance England, asking how well or how often their

• 6:02Speaker 04

  interventions led to healing rather than harm. She also examines how these shifts in medical practice were experienced by the patients themselves. What determined whether you sought a surgeon versus a midwife? And how did you begin to choose among the various elixirs advertised as healing all that ails you? This was such a fun and fascinating glimpse into a time when modern medicine was just beginning to come into its own, and I'm so excited to share this conversation with you all. Let's just take a quick break and get started.

• 6:59Speaker 04

  Dr. Skews, welcome to the show. Thank you for joining me today.

• 7:02Speaker 05

  Thank you. It's great to be here.

• 7:04Speaker 04

  In The Surgeon, the Midwife, the Quack, you transport readers to Renaissance England, a time when arts and sciences, these creative works of the mind, were absolutely flourishing. And you ask, but what about the body? Who was tending to the body? I'd love to hear the origin story of this book and what first drew you to this time in history.

• 7:27Speaker 05

  This time, I always feel, and I don't know if this is just me, but this is the moment at which people from the past are becoming like us. So I look at medieval people, and I think, I don't really recognize myself in you. And I look at people in the maybe 18th, 19th century, and I think, okay, that's me, but without a smartphone. And people in the 16th, 17th century, they're just at that turning point. There's some ways in which they're so like us, and other ways in which they're really radically different, and that's what makes them so interesting to me. When I went to university to do my literature degree, I imagined that I was going to go and study modern American literature, and I was quite determined about that. And I think I got a couple of years in before I realized what I really loved was Shakespeare.

• 8:12Speaker 05

  And I was doing my master's degree, and I was getting increasingly interested in the kind of context of everything I was doing. And I came across a woman's diaries. The woman's called Sarah Calpa, and she lives just at the end of the 17th century. The diaries span from the end of the 17th century into the 18th. And she was saying, well, she says all kinds of things. She's a fantastic gossip, which we love as a historian. But she was saying, oh, Lady So-and-so has a cancer in her breast, and I heard it's because her husband pushed her down the stairs. And I thought, that's really weird. This is how all my research ideas start. That's really weird. I wonder if anybody's written anything about that. And it turned out, nobody had.

• 8:55Speaker 05

  So that was my master's thesis, this thing about breast cancer and Sarah Calpa's diaries. And then my PhD thesis, I looked at cancer in general over this period. From cancer, I was thinking about surgery and bodies, and that was the next book, thinking about, well, if you have surgery and it really radically alters your body, what does that change for you conceptually and in terms of kind of religious experiences and social experiences? When I was doing the research for that, I was finding in surgeon's accounts that sometimes they were being called in to patch people up who'd hurt themselves. So that was the next academic book. And as I was doing all of these, I was collecting this huge database of all these texts I was

• 9:38Speaker 05

  reading, and there was so much great stuff that wasn't making it into the academic books. And I thought, I want to do something with all these, and I also want to have something to present to all the people who keep telling me that Renaissance medicine is just leeches and burning people and kind of hanging frogs around their neck. So that's where the trade book was born from.

• 10:01Speaker 04

  Incredible. I mean, there are leeches and hanging frogs, but there's so much more.

• 10:06Speaker 05

  There are other things too. Yep.

• 10:09Speaker 04

  Yeah. Can we talk a little bit about Renaissance England, not just in terms of medicine, but overall? Like, what are some landmark things that happened, big, important events, whether it's the plague of 1665 or the Little Ice Age? What are some of the big things going on during this period?

• 10:28Speaker 05

  So I am late Renaissance. My interest is kind of in the 16th, 17th century, which is technically a little bit later than really we say Renaissance, but I was not going to put early modern into a book 400 times. So the bits I'm really interested in for the purposes of thinking about medicine, obviously the reformation, because it's so important, but not just from the point of view of dynasties and Tudors and all that good stuff, but because you, in one fell swoop, completely dismantle any social welfare system, completely dismantle any hospital system, at a time when infectious diseases are just getting worse and worse.

• 11:15Speaker 05

  So that's one kind of big landmark. Then around the turn of the 16th, 17th century, we have Elizabeth, who brings in the necessary act for the relief of soldiers and mariners, which doesn't sound very exciting, but is the precursor to stuff we really value, like the NHS and the social welfare system. And Elizabeth also is constantly at war with other nations, like her father in that respect. And that's really important because war is such a generator of medical advances. Then, of course, you've got kind of repeated epidemics, and you have the civil wars in the middle of the 17th century. So it's a fascinating period because there's so much turmoil. People can't have known if they were coming or going.

• 11:59Speaker 05

  Even within your own lifetime, the entire religion of the place could be changed. Your entire political affiliation could change. Must have been a pretty difficult time to live in, but it makes for really good historical, historical study.

• 12:13Speaker 04

  And with all of these changes that were happening in the background, you have medicine, which itself is changing, both in the distribution of knowledge, who's practicing medicine in diseases or things people are experiencing. And so let's just get a general lay of the land when it comes to medicine and medical practice during this period. Like, who was involved? And what was kind of known about the body? Or what was believed about the body?

• 12:40Speaker 05

  So if we say who was involved, in the broadest sense, almost everybody. A lot of people have a bit of medical knowledge. And we always forget that the biggest providers of medicine in this period are women, and they are mostly doing it either very cheaply or for free. Those are the domestic healers, probably 80, maybe 90% of all medical provision. But because they don't leave that many written sources, they've been kind of overlooked. As for what's underpinning it, it's the good old system of the humors. So the idea of four fluids that go round and round your body that are aligned on wet, cold, hot, dry. So you have phlegm, your cold and wet humor. Melancholy, your cold and dry humor. Blood, which is hot and wet.

• 13:23Speaker 05

  And yellow bile or cholera, which is hot and dry. And everybody has these four humors. Some people have more than of one than another. And they can be changed by things like your diet, how much you exercise, your emotions, how much you sleep, really almost anything you can think of. So what underpins medicine is basically trying to get your humors back in balance when they go out of whack. In some ways, it's a very, very holistic system.

• 13:50Speaker 04

  How much would an average person have thought about their humors on a day to day basis? Or even like throughout the month? Would it be something that they thought about as they prepared food, as they worked? Or would it have been more of a, in certain circumstances, when they were feeling sick or feeling like their humors were out of balance?

• 14:09Speaker 05

  I think it's a little bit like how we think about maybe carbohydrates today. Everybody kind of knows that carbohydrates are a thing. In my day to day life, I don't think very much about them. If I was to go and run a marathon, I would probably be thinking rather a lot more about them. And it kind of depends, you know, what stage you are in your life, what else you have going on in your life, how relevant this thing is to you. But it's always there like a kind of conceptual wallpaper. It's something that, like gravity, we just kind of all accept that this exists. And even if we're not thinking very much about it, it's kind of an underpinning theory for the rest of what we're doing.

• 14:50Speaker 04

  So everyone has this background knowledge of humors. Where did that come from? How is this knowledge transmitted from person to person? Whether you are someone who is not an educated individual or someone who is, you know, a trained physician, for example?

• 15:09Speaker 05

  So the physicians have got it from the ancient Greek texts, specifically a guy called Galen of Pergamon. And it's all part of the Renaissance, right? That going back to classical knowledge, harking back to the ancients because they seem to know so much better than we do now. As to how it's transmitted from person to person, how people get to have an idea of the humors themselves is slightly difficult to judge. But there are certainly books which will tell you about this stuff, tell you what kind of humor type you might be, how you should balance your humors, what kind of food you should be eating. And of course, though only a fairly small proportion of the population can read, it trickles down the same way that biblical knowledge trickles down.

• 15:54Speaker 05

  So even people who can't read will have a fairly good grasp of what stories are in the Bible. As for more specific medical knowledge, it passes between the physicians in kind of printed books. But most medical knowledge, again, belongs to those women. And it's passing between them in manuscript books, which are all recipe or receipt books. And they will usually go through matrilineal connections. So it'll be mother to daughter, aunt to niece, sometimes mistress to servants. And they're also writing letters to each other, saying, oh, look, I found this really good cure, or I tried this and it didn't work.

• 16:32Speaker 04

  So for this type of knowledge, knowledge that is shared among women, do you find yourself having to read between the lines in a way that's different than trying to read books written by physicians from this time period?

• 16:47Speaker 05

  Sometimes you're reading between the lines literally because in the best cases, they have annotated their books. And they often seem to be like us when we get a nice new notebook and you think, I'm going to keep it really nice. They start off, really good handwriting, everything spaced out, get a few pages into the book, and it is absolute scrawl. But that's the good bit because they've often written next to it, this didn't work, I had to put more of this in. The best ones, they write next to it, es probatum, which means it is proven.

• 17:19Speaker 04

  Let's take a quick break. And when we get back, there's still so much to discuss. Fall is a great season for looking like you tried harder than you did. Put on a good sweater, throw on some nice jeans, and suddenly you're an upstanding member of society. For clothes that do some of the work for you, there's Quince. Quince specializes in effortless, high quality essentials like ultra soft organic cotton and premium Mongolian cashmere sweaters. They're beautifully tailored, built to last, and transition seamlessly from morning meetings to dinner. And as the weather gets colder, Quince has everything you need to round out your wardrobe. From warm, responsibly sourced down jackets and cozy cashmere scarves and gloves, to beautiful 14 karat gold jewelry that adds the perfect finishing touch.

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• 19:16Speaker 06

  Lisa, we should tell them about our new show.

• 19:19Speaker 07

  Oh, my God, Lexi, we have a new podcast. It's called Don't Lie to Me.

• 19:23Speaker 06

  I'm Lexi Iwanu. We're two best friends, 22 years apart, but so close at heart.

• 19:29Speaker 07

  And I'm Lisi DiGiulio, the old one, which means we have wildly different references, occasionally different opinions. And at this point in my 50s, I've lived it all.

• 19:38Speaker 08

  I'm not going to get anywhere fighting. That is wild. I learned that about you today.

• 19:44Speaker 06

  Now in my 30s, being the founder of new shoes, good taste is my business. And I've always got something to say. If men were just honest about this, there would be so much more peace in the world.

• 19:56Speaker 07

  We're going to talk about dating, relationships, beauty, getting older. And a little wiser. We're best friends, but we don't always agree.

• 20:03Speaker 09

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• 20:11Speaker 06

  Don't lie to me. Don't lie to me. Don't lie to me. Don't lie to me. Don't lie to me. Don't lie to me. Liar. Listen on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts. I don't really care.

• 20:41Speaker 04

  Welcome back, everyone. I've been chatting with Dr. Alana Skews about her book, The Surgeon, the Midwife, the Quack: How to Stay Alive in Renaissance England. Let's get back into things. Where does religion and magic fit into this knowledge as well in the practice of medicine?

• 21:00Speaker 05

  So they've inherited from the medieval period, practice of medicine that has magic kind of baked into it, but they've sanitized it. So where in the medieval period, you're explicitly using charms, you're using medical items. Here, they will be using astrology. We don't think enough about how important astrology is to them in their day to day life and how important it is for medicine. As to religion, there's this conception that people in the past, they just got sick and maybe they prayed and that's all they did. But they very much say, yes, you should pray. You're only going to get better if

• 21:41Speaker 05

  God allows it. But while you're praying, also call the doctor. God helps those who help themselves.

• 21:47Speaker 04

  And how would one call a doctor?

• 21:49Speaker 05

  Well, that depends how much money you have. So if you want to go straight for the big guns, you can call a physician. But a physician's visit is about 10 shillings, which is a lot. So if you're wealthy, by all means, get a physician in. If you're not wealthy, you basically can go up the hierarchy of the medical practitioners. So first, you go to your local woman, maybe a midwife that has extra medical knowledge or a noble woman near you because they've got the time and the literacy to be making quite complicated things. Maybe that doesn't work. Maybe then you go to the apothecary. The apothecary, if you have one near you, is a very handy kind of person. They will

• 22:32Speaker 05

  sell you medicines from one penny upwards. They're supposed to only dole out things which physicians have prescribed. In fact, nearly every apothecary has got their own kind of proprietary medicines. Sometimes they'll go and see patients, they'll make diagnoses. They're a bit like chemists today. Apothecary not working, or your leg is obviously hanging off, you probably want to go to a surgeon. A surgeon is less expensive than a physician, costs about three shillings a visit, and they will do anything connected with the outside of the body, lumps, bumps, cuts, breaks. That's all the surgeon's job. And then if none of that works, then you might go and get the physician in.

• 23:15Speaker 04

  Let's say that somebody got sick and it was not an accident, it wasn't a broken bone or something like that that had a clear cause. What did they sometimes attribute that disease to? What were the range of explanations they would call upon?

• 23:30Speaker 05

  The Galenic non-naturals encompass pretty much everything that you can be doing, but the really big one is diet. So you see in people's diaries, a lot of the time, they've got ill and they attribute it to something they ate. And often, you can see that they're probably right. So Samuel Pepys repeatedly says that he's ill because he's been drinking too much cider. We've all been there. And weirdly, it's not because of the alcohol content, it's because cider is made of fruit, and fruit is supposed to be noisant to man. It's very bad for you. There's another guy called John Ward, who writes in his diary that he's ill because he's been eating loads of pickled walnuts. So the first thing people

• 24:13Speaker 05

  would look to is their diet, like, did I bring this on myself? And they know about hangovers, too. They do recognize when they've overindulged. The other thing is overexerting themselves. So especially if you've been out exercising and you've got caught in bad weather, that's quite commonly a factor. Getting into bad air, so being somewhere that's unwholesome, say, next to an abattoir, or somewhere where there's lots of laundry and dirty things hanging out. So all of these are pretty sensible. And then, of course, occasionally, you have the person who says, no, I think somebody's cursed me. I think this was a witch.

• 24:52Speaker 04

  Yikes. Yeah. And this knowledge changed over time as people acquired more information about anatomy, about physiology, about how disease actually worked in the body. Can you tell me a little bit more about the study of anatomy during this time and how it influenced our medical understanding of health and disease?

• 25:15Speaker 05

  So there's a common misconception that the church forbade anatomy. It didn't. In fact, some of the early anatomies we see are actually on holy people. So there's a great case where Chiara of Monte Falcone, who's a nun, dies. And Chiara of Monte Falcone has always said that she has God in her heart. And the other nuns think, does she? And so when she dies, they postmortem her. And apparently, they open her up and they see the sign of the cross on her heart, and they see kind of these three small stones in her body somewhere, which symbolize the Holy Trinity. So people have been doing anatomies

• 25:57Speaker 05

  for a very long time. What you get in the early modern period is urbanization. And what you get with urbanization, universities, also crime. So suddenly, you have quite a lot of hanged corpses. And that means you've got curious university students, you've got hanged corpses, anatomy takes off and you start building anatomy theatres and stuff. Now, the godfather of all this is somebody called Andreas Vesalius, who's from Brussels. And he's kind of, he's always out for himself, Andreas Vesalius. He's a man on the make, but he is also quite gifted. So for the first time, he doesn't sit up in the gods, watching

• 26:39Speaker 05

  somebody else doing the anatomy and reading from Galen's Big Book, which is what's been done prior to then. He gets down and gets wrist deep into the corpse and does all these kind of detailed drawings of what he finds, what he actually finds, rather than what he thinks he will find. And that's really important because he discovers things like the meninges of the brain. And that means that when somebody has a head injury, they know that they need to stitch up the meninges before they patch up the skull.

• 27:10Speaker 04

  These anatomies were almost performed. It was like it toe the line between entertainment and education. What was an anatomy theatre like? Like, what was it like to be in attendance?

• 27:21Speaker 05

  Thrilling, I think. The anatomy theatres were beautiful. They would be crowded. There would probably be women there if they could get in. We know that the College of Surgeons had to tell the other surgeons, stop letting women into the anatomy. So they must have been trying to get in. And then during the summer months, you can't have the anatomies because, especially in Europe, it's getting way too hot. The bodies are not nice. So they put loads of interesting stuff in there instead. They put kind of skeletons, big stuffed animals, stuff you'd never, ever have seen. One place might be Leiden. Among all their fantastic skeletons, very proud to have a piece of rhubarb shaped like a

• 28:04Speaker 05

  dog. And also, and also something they call great stilts with which the Laplanders go downhill at great pace, which I think are skis. It would be like going to the Natural History Museum, but slightly bloodier.

• 28:20Speaker 04

  And of course, like we touched on, disease was ubiquitous during this time, whether it was especially infectious disease, but but other conditions as well. People were always getting injured, probably a higher rate of many different chronic diseases, depending on the situation. Did the familiarity with disease kind of raise the threshold for when someone sought help? Did they kind of wait until like, I'm on death's door? Or did they also go as a preventative or like in early stages to see if we can change the course of disease?

• 28:52Speaker 05

  It depends on money. So as it does today, how bad you let things get before you try and seek medical attention depends on how much it's going to cost you. Is it a case of seeing the doctor or eating? If you can afford it, people will see the doctor as a preventative measure and also in very early stages of disease. So bloodletting is a classic example. There are people who say they get bloodlet in the spring and the autumn, whether they feel bad or not, because they just see it as a kind of cleansing that will set them up for the coming season. You also see people who will go to the doctor if they're having kind of pain, even if there's not an obvious cause for it. So, you know, headaches,

• 29:36Speaker 05

  sniffles, anything like that.

• 29:38Speaker 04

  And how does urban or rural kind of living come into this as well?

• 29:43Speaker 05

  It's completely different. If you're in London, some of the other big cities too, but especially London, there are loads of apothecaries. There are streets in London where every other house is an apothecary. So it's really easy to get medical care. Also, nearly all the physicians are in the cities. Most of the surgeons are in the cities, especially the qualified ones. When you get out into rural areas, you're very, very unlikely to be able to access a physician in a hurry. You may be able to access a surgeon. Probably your best bet is to go to the local kind of wise woman or domestic healer. We do see

• 30:24Speaker 05

  people with complicated conditions actually traveling to go to larger centers where they can see physicians or even go to a hospital.

• 30:33Speaker 04

  You have all these different players in medicine. How did they decide to be a surgeon or a physician or a healing woman?

• 30:42Speaker 05

  It's a mixture of necessity and opportunity. So if you're a healing woman, a midwife, you have almost certainly got that knowledge from somebody else in your family. Most midwives have learned the trade at the elbow of their aunt, their mother, whatever. And there's a huge need for those people in the community. If you are one of the kind of money-making medical trades, then it might be that this was the best opportunity for you to make a good living. Some physicians are making huge amounts of money, but it is slightly expensive to become a physician because you have to go to university. So if you want to make a bit of money,

• 31:27Speaker 05

  but you don't have the money to be going to university, or you don't have good Latin, which you really need to become a physician, then a surgeon is a pretty good option for you. And you can be apprenticed to be a surgeon or an apothecary. Those are people who might otherwise become, say, minor clerics, or they might go into a skilled trade like goldsmithing or tailoring. Those are the kind of social strata who would end up in the apothecary and the surgeon field. People who have become civil servants, kind of minor gentry, they are more likely to end up as physicians.

• 32:05Speaker 04

  So there is a huge class component to this, just in terms of opportunity. And did the relative proportions of these different groups change throughout the period that you discuss in your book?

• 32:18Speaker 05

  You're getting more medical practitioners in general, just because there are more people and there's always a demand. You know, a decent surgeon, a decent physician will always have work. You are getting more accredited medical practitioners because you have the company of barber surgeons, the College of Physicians, and they're actively recruiting. When the College of Physicians gets started in 1536, I think it is,

• 32:47Speaker 05

  there's no more than a few dozen of them. And their, their membership criteria are quite strict. But by the time you get to, say, seventeen hundred, you've got hundreds, if not thousands, of them.

• 33:00Speaker 04

  Tell me about the origins of the, this accreditation system for physicians. Like, what were, what was the, the impetus for this?

• 33:09Speaker 05

  It was basically commercial. So the physicians were getting a bit annoyed, essentially, that other people, like surgeons, like these barber surgeons, who were kind of a halfway house, were getting on their turf. Their idea was that they were going to set up a college and then they were going to be in charge of all the medical practice. As it turned out, they got their college, but they never managed to get the monopoly on medical practice that they thought they would. They couldn't control it, even in London, never mind the rest of the country. But it was still, you know, it was very prestigious. And then later on, the College of Physicians contributes to the Royal Society,

• 33:54Speaker 05

  which is the kind of, the big bad of scientific endeavor.

• 33:59Speaker 04

  How much competition was there among physicians? Obviously, there's this hierarchy, but within each level of the hierarchy, do you have apothecary saying, I'm the best apothecary there is? Was, was that necessary? You know, how did they, how did somebody stand out?

• 34:16Speaker 05

  Yeah, and they are horrifically rude about each other all the time. It's, it's more uncommon to find two of them who aren't fighting.

• 34:27Speaker 05

  There's, there's a pie and they all want to have the biggest piece of it. So they, they punch down all the time. Surgeons talk smack about the apothecaries. The, the physicians talk badly about the surgeons. But they also are always calling each other quacks, saying, he doesn't know what he's doing. I heard that he killed so and so. He always tells people they have this really bad disease, when actually there's not really anything wrong with them. They said about one guy that he'd gone to dispossess somebody of the devil, when in fact she was only troubled with wind.

• 35:01Speaker 04

  That's beautiful.

• 35:05Speaker 04

  Oh, my gosh. And, okay, quack, where does this word come from? Who's using it? Does anyone ever refer to themselves as a quack? Or is it strictly an insult?

• 35:17Speaker 05

  Oh, it's an insult. So quack comes from the Dutch word quaksalva, which means somebody who sells ointments by bragging about their medical credentials. The other word they use sometimes is mountebank, which comes from the Italian montebanco, somebody who climbs up on a bank or on a bench to hawk kind of medical cures. Quacks are, they're a broad church. So you have some people who very clearly are quacks. They're selling something often called liquid gold, arum potable. That's a particular favorite. And then they tend to not have a fixed premises. They go from market to market, kind of selling their stuff.

• 36:01Speaker 05

  Other people who get lumped in with quacks are actually pretty good at what they do. So somebody like a bone setter would be called by physicians a quack. They don't have any qualifications. They probably don't have a premises. But if you have a complex fracture, do you want to go to the surgeon, who maybe does a couple of them a year? Or do you want to go to the bone setter, who all he does is every week goes to the market in different towns, setting bones?

• 36:34Speaker 04

  So the bone setter would just sort of set up shop and say like, all right, I'll be here at the square on Sunday from nine AM to, to the sunsets.

• 36:42Speaker 05

  Yeah, exactly. Often the bone setter will also be the tooth drawer. And there's a lot of work drawing teeth, because people have horrible teeth at this time and there's really no way to fix it, other than just pulling them out. If you're the bone setter, you're probably pretty strong and you probably have quite a strong assistant who will sit on people while you kind of do whatever horrible thing you, you have to do to them. So he's all set up.

• 37:06Speaker 04

  Let's take a quick break here. We'll be back before you know it.

• 37:11Speaker 03

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• 37:43Speaker 06

  Lisa, we should tell them about our new show.

• 37:46Speaker 07

  Oh, my God, Lexi, we have a new podcast. It's called Don't Lie To Me.

• 37:50Speaker 06

  I'm Lexi Uwannu. We're two best friends, twenty-two years apart, but so close at heart.

• 37:56Speaker 07

  And I'm Lisi DiGiulio, the old one, which means we have wildly different references, occasionally different opinions. And at this point in my fifties, I've lived it all.

• 38:05Speaker 09

  I'm not going to get anywhere fighting.

• 38:07Speaker 08

  That is wild. I learned that about you today.

• 38:11Speaker 06

  Now in my thirties, being the founder of New Shoes, good taste is my business and I've always got something to say.

• 38:19Speaker 09

  If men were just honest about this, there would be so much more peace in the world.

• 38:23Speaker 07

  We're going to talk about dating, relationships, beauty, getting older.

• 38:27Speaker 06

  And a little wiser.

• 38:28Speaker 07

  We're best friends, but we don't always agree.

• 38:30Speaker 09

  Because you told us how accommodating you are. Obviously, I would do what I think I could do to, to fight the fight, but there's only so much fight I can fight.

• 38:38Speaker 07

  Don't lie to me.

• 38:39Speaker 06

  Don't lie to me.

• 38:40Speaker 07

  Don't lie to me.

• 38:42Speaker 06

  Don't lie to me.

• 38:43Speaker 07

  Don't lie to me.

• 38:44Speaker 06

  Don't lie to me.

• 38:44Speaker 07

  Liar.

• 38:45Speaker 06

  Listen on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts. I don't really care.

• 38:53Speaker 00

  Welcome aboard season six of The Girlfriends. Flight or Fight, which takes place thirty thousand feet in the sky. There's great food, comfortable chairs, and attentive stewardesses. The stewardesses were so beautiful. But in reality, the stewardess job is far less glamorous than it appears. It was the most sexist job I think you could have.

• 39:22Speaker 00

  In this era, the airlines told these stewardesses, they have to be single. They had no good excuse for why they wouldn't let women be married. They have to be skinny.

• 39:33Speaker 10

  We were starving ourselves.

• 39:36Speaker 00

  And they have to be young. You would retire at age thirty-two. But one day, a group of stewardesses said, This has got to stop. They risked it all, turning a fight for fairness into a revolution.

• 39:53Speaker 00

  Listen to The Girlfriends. Flight or Fight on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts.

• 40:15Speaker 04

  Welcome back, everyone. I'm here chatting with Dr. Alana Skews about her book, The Surgeon, the Midwife, the Quack. Let's get into some more questions. It is interesting to think about the role of diagnosis among these different professions, because you have someone like a bone setter or a tooth drawer who doesn't really need to make a diagnosis. Like, clearly, your bone is broken. Clearly, your tooth needs to be pulled. But then you have these more internal complaints where physicians, or midwives, or women healers have to then decide what is ailing you. What are some of the clues they use to make those diagnoses?

• 40:56Speaker 05

  Diagnosis is something the physicians really pride themselves on. They seem to think that this is what sets them apart from the other kinds of medical practitioner. So if you go to a physician, the first thing they will do is take a history. They'll ask you about what you've been doing, how you've been feeling, what you've been eating. They will also have a look at your wee. So uroscopy, looking at urine, is a big favorite. They will look at it, they will smell it, sometimes they will taste it. And that's quite handy, because it means that if you're in the country, but your fancy physician is still in the city, you can send the servant with a bottle of your wee, and with a letter, and take it to the physician, and he's going to say, okay, it looks like you've got so-and-so,

• 41:41Speaker 05

  and send the cure back to you. I always wonder with this, how many times the servant, like, accidentally dropped the bottle or something, and gave something completely different to the physician. The other thing they can do is take your pulse. They're really, really keen on their ability to take your pulse and read the pulse, as they put it. But weirdly, I've never seen a case where they actually effectively diagnose anything from taking the pulse. It's kind of like the white coat of the physician world. It's the kind of twiddly stuff that makes them look good. Most of it's being done, really, by the history, and by kind of looking at the person. They do internally examine people,

• 42:22Speaker 05

  especially women with gynaecological complaints. They do kind of physically manipulate or palpate people. It's another kind of myth that they wouldn't do that because of modesty. Actually, people are prepared to let the physician have a pretty good look at them.

• 42:38Speaker 04

  It brings to mind this question of trust, and how trust is built. Are individuals seeing the same physician over the period of their lives, the same healing woman, the same midwife? Or does that really depend on social status, on whether you're living in the countryside or in the city? And how did they establish trust with the person who was taking care of them?

• 43:01Speaker 05

  So there are some kind of official boundaries, which are meant to safeguard patients. So physicians are supposed to not have affairs with their patients, not talk about their patients with other people. Basically, you know, a lot of the stuff that's in the Hippocratic oath. And they can be got up in front of the College of Physicians and fined if they break those rules. And the same kind of goes for the College of Surgeons. But really, the trust operates more as a commercial thing. If you're known to be someone who gossips about your patients, you won't get any more business. There's also a kind of

• 43:40Speaker 05

  relationship aspect here. So if you can, you will keep the same medical practitioner throughout your life, or even across generations. So we see midwives, who the daughter of the midwife is bringing into the world the daughter of the person that the midwife delivered. And that's quite nice. There's a lot of recommendations as well. So you see, there's a kind of heartbreaking case with Henry Moore and Lady Anne Conway, where Henry Moore's relative is desperately ill, she's got cancer, and he pulls some strings to have a friend of Lady Conway, who's this big deal continental physician, send cures for this woman, because

• 44:25Speaker 05

  he's heard that this guy's really good. As it turns out, she probably would have been better with the local guy.

• 44:31Speaker 04

  And that's sort of another question I had, which is, does efficacy play a role in trust? You know, if you go to a physician for something that they can't probably do anything about, does that affect the trust or the relationship between patient and physician?

• 44:48Speaker 05

  It does. I think people don't have the same expectation of cure. So they don't expect to live a life that is completely free from pain. They don't expect the doctor to be able to cure anything that's wrong with them. But they do know when they think the doctor's done something wrong. There's a lady called Elizabeth Freak, and her husband's dying. She herself is not very well. She goes away for a few days to try and get some rest. She comes back, he's even worse. He's got this kind of gangrenous leg. And she says, you have murdered my husband. So people are quite willing to call out what they see as bad medical practice.

• 45:31Speaker 04

  There was a great deal of bad medicine going on. There was bloodletting that veered into the dangerous. There were purges that veered into the dangerous, plague water, toad tablets. I mean, all these things that either were misguided, or straight up just false cures. And a lot of them seem rather questionable by today's standards, if not just outright dangerous. And there was sometimes a method to the madness, but was there ever an effect to the madness? Like, did medical intervention, or when did medical intervention during Renaissance England, when did it directly help with healing?

• 46:08Speaker 05

  That's a really interesting question. We have to remember that while we say, you know, everyone believes in the humors, everyone lets blood, because the vast majority of people do, there are outliers. There are people loudly talking against bloodletting. So George Thompson is one of the kind of main ones from that school. Unfortunately, those people often also believe in other quite mad things, which rather undercuts their credibility. So I've been thinking a lot about, somebody asked me at a talk I was doing, they said, when did evidence-based medicine become a thing? And it's really difficult to answer, because in some ways, evidence-based medicine has been a thing

• 46:52Speaker 05

  for as long as there's been medicine. In the 16th century, they are trialing antidotes to poison on condemned criminals. So they are doing something that looks like experimentation. Probably what we would talk about as scientific method comes in maybe with the birth of the Royal Society, and kind of develops from there. And then famously, in 1746, you have the first modern kind of clinical trial, when James Lint tries various cures for people with scurvy. In terms of what actually helped people, probably quite a lot of the milder

• 47:31Speaker 05

  medicines. So you have a lot of remedies for coughs, colds, indigestion, which rely on stuff like sage, rosemary, that is antibacterial, that you gargle for your sore throat, or rely on things like ginger and mint for upset stomachs. And we have to slightly shift our idea of what we mean by it working. Sometimes it hasn't got rid of the disease in a clinical sense, but the person feels a lot better.

• 48:01Speaker 04

  Right, symptom relief.

• 48:02Speaker 05

  Yeah, exactly. And it's kind of narrative medicine. If the physician comes and sits by your bedside for an hour and listens to you tell him about what's been troubling you, you know, maybe you are going to sleep better that night.

• 48:16Speaker 04

  Earlier, you mentioned Lint and the scurvy trials. Let's talk about war and the role that war plays in shaping knowledge, driving knowledge forward, driving the field of medicine forward. Can you tell me a little bit about this period and war?

• 48:32Speaker 05

  Basically, England's at war with everyone all the time. Usually, in more than one war, on more than one front. So there's a huge toll on the population. Charles Carlton estimates that over 50% of all men aged 18 to 50 would have been in one of the armed forces. And the kind of effects of war are getting so much worse, because you have firearms. And it's not just getting shot with a musket, it's getting shot with a cannon at sea in a wooden ship, where splinters just go everywhere. So you have a lot of people with catastrophic,

• 49:15Speaker 05

  but survivable injuries. You have a lot of people coming back as amputees and so on. That also means that you've got a lot of surgeons who are getting way more experience of traumatic injuries than they otherwise would have. Surgeons who in their village would have seen, you know, three, four, five compound fractures in a year are seeing that number in a day working at sea. There's a guy called John Woodall, and he is a ship surgeon, which is a very good way to get a lot of experience treating injuries, as long as you don't sink. And he writes this book for other young surgeons. And he says, when you're going into battle, you need to be prepared. You should get two barrels full of water. One barrel is to dip your instruments in, in between patients.

• 50:00Speaker 05

  And the other barrel is to put all the arms and legs in until you can toss them overboard at the end of the battle.

• 50:07Speaker 04

  Oh, boy.

• 50:07Speaker 05

  Yeah. So they get much better at stopping bleeding. They get much better at amputating in such a way that the person can then use a prosthesis afterwards. You've got an injury in the calf, you have to take it up by the knee. And, and the prosthetics get better. So I think we underestimate how many people with disabilities and visible differences would have been on the streets of, say, London in this period. We always kind of imagine that they just either died or got better.

• 50:38Speaker 04

  It seems like war had a huge impact on the practice of surgery and keeping people alive. Did it also provide opportunities for an understanding of medicine outside of surgery?

• 50:52Speaker 05

  To a certain extent, I think probably the way in which it mostly affected medicine outside of surgery was in the economic effects. So you have war, and almost inevitably, in a war, some people get rich who weren't rich before. And those people are using different kinds of medicine. They're maybe not as traditional. They're going to apothecaries and asking for those exotic ingredients. War is also opening up the trading routes, which mean that we can bring in kind of plants and things from quite exotic places.

• 51:32Speaker 05

  And so as the century goes on, you see increasing use of stuff that is really powerful. You know, powerful plants, heavy metals, all that kind of stuff. The other thing war creates is refugees. So the wars in Europe, especially the persecution of the Huguenots in France, drives refugees to England. And there are a lot of skilled physicians, surgeons, apothecaries among those people who bring new ideas, who helped to set up these kind of institutions. So that's a kind of indirect effect of war.

• 52:11Speaker 04

  So far, we've mostly been talking about the ways in which healers, people involved in medicine, were focused on the body and healing the body. But there were also diseases of the mind, of course, during this time. How did physicians think about things like melancholy? And how did they approach treatment? Did they make similar distinctions then that we do today between diseases of the body and mind?

• 52:38Speaker 05

  They think a lot about diseases of the mind. At the beginning of the 17th century, there seems to be this real surge in interest in madness, as they call it, and particularly in melancholy. Obviously, the, the big player here is Robert Burton with his book, The Anatomy of Melancholy. And melancholy is an interesting one because melancholy is a disease both of the body and the mind. If you are melancholic, you have too much of the black bile humor, the melancholy humor in your body. But you might have generated the black bile humor by being habitually sad. You have this kind of, you have this kind of cycle between the body and the mind. So let's say I see something sad.

• 53:23Speaker 05

  I see a little puppy out in the rain. My mind will send vital spirits down to my heart and tell my heart, you need to recruit the appropriate humor from around the body. So the heart goes, come to me, black bile, melancholy. And then that melancholy will have kind of physical effects on me. But because it's been used, I will also be producing more melancholy. So the next time I see something sad, I'm on a hair trigger, ready to cry at this thing. Same goes if I'm kind of habitually angry or something. So it's a really kind of holistic view of mental health. And we often think that people in this period, if a person was mentally ill, they would just lock them up, beat them, put them in the dark.

• 54:06Speaker 05

  Occasionally, you get that, especially in Bedlam, Bethlehem. You have some really horrific practices. But you also have people being cared for in the communities. And most of the advice, say, in Burton's Anatomy of Melancholy, is stuff that we would recognize. So he says, can you make sure the person eats a good diet? Can you have them listen to cheerful music? Make sure they see their friends? Make sure they go out and do some exercise outdoors? This is all kind of things that we would recognize.

• 54:41Speaker 04

  I mean, there's such a growth of knowledge during this time, but there's also a tremendous cost to that knowledge. What do you see as some of the biggest costs to the advancement of, of medicine in this time?

• 54:55Speaker 05

  Oh, that is a good question. On a human level, there was great harm done by the idea of purging. Purging was the medicine. The College of Physicians calls letting blood causing vomiting and causing diarrhea the three great remedies. So God knows, I mean, how many people were on death's door and were just pushed through it by those purging remedies. And also, you know, so unpleasant, people really losing their quality of life. The cost, I guess, and this is kind of, in some ways inevitable, if you're going to

• 55:35Speaker 05

  have medical progress, but also not great for the people involved, is that surgeons, physicians, apothecaries even, are overreaching. That's how they learn stuff. And in the process of them learning stuff, a lot of people die because they're being given mercury, they're being given arsenic, they're kind of undergoing these surgeries that don't work, they're, they're going through really aggressive purging. And because it's not systemic and not kind of organized, the way in which everybody's testing this stuff, so many more people are the victims of those experiments than really needed to be.

• 56:16Speaker 04

  Like you pointed out at the beginning, there is a lot that we see ourselves in or we see modern society in during this period. And throughout the Renaissance, medicine underwent this transformation driven by so many different things, market forces, ambition, and this general quest for truth and what is the truth. How do you think this time period kind of sets the stage for medicine today?

• 56:41Speaker 05

  There's one big thing that they contribute, I suppose, which is the idea that medics should be qualified. And this might sound obvious, but it was not a thing before the Renaissance. And this is when you get the College of Physicians, the College of Surgeons, the Royal Society, the Worshipful Company of Apothecaries. And at first, those institutions aren't very effective at regulating medical practice, but they become the British Medical Association, the AMA, you know, all those other things that we rely on. And we take it now absolutely for granted that we can expect a certain standard and

• 57:24Speaker 05

  a certain conformity of opinion among the people who treat us for our illnesses. And this is the birthplace of that idea.

• 57:33Speaker 04

  Like you showed, I think there's so much we can learn and see ourselves in this time period. And Dr. Skews, I just want to thank you for taking the time to chat with me today. This was utterly fascinating. I had such a fun time exploring Renaissance England and all the different aspects of medicine.

• 57:48Speaker 05

  Thank you. I love talking about it. I never get bored of it.

• 58:09Speaker 04

  A big thank you again to Dr. Alana Skews for taking the time to chat with me. If you enjoyed today's episode and would like to learn more, check out our website, thispodcastwillkillyou.com, where I'll post a link to where you can find The Surgeon, The Midwife, The Quack: How to Stay Alive in Renaissance England, as well as a link to Dr. Skews's website, where you can find her other work. And don't forget, you can check out our website for all sorts of other cool things, including but not limited to transcripts, Quarantini recipes, show notes and references for all of our episodes, links to merch, our bookshop.org affiliate page, our Goodreads list, a firsthand account form, and music by Blood Mobile. Speaking of which, thank you to Blood Mobile for providing the music for this episode

• 58:54Speaker 04

  and all of our episodes. Thank you to Liana Scolacci and Tom Bry Fogel for our audio mixing, and thanks to you listeners for listening. I hope you liked this episode and are loving being part of the TPW KY Book Club. A special thank you, as always, to our fantastic patrons. We appreciate your support so very much. Well, until next time, keep washing those hands.

• 59:45Speaker 11

  Get ready for an unforgettable night of comedy. Jamie Foxx is back with a brand new hilarious stand-up special, Jamie Foxx Take Care of Yourself. One of comedy's most beloved storytellers brings his signature humor, unforgettable impressions, personal reflections, and sharp observations to the stage for what might be his most honest special yet. Don't miss Jamie Foxx Take Care of Yourself. Now streaming only on Hulu. Terms apply.

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• 1:00:47Speaker 06

  Lisa, tell them about our new show. We have a new podcast. It's called Don't Lie to Me. I'm Lexi Iwanu. We're two best friends, 22 years apart, but so close at heart. And I'm Lisi DiGiulio, the old one, which means we have wildly different references, occasionally different opinions. And at this point in my 50s, I've lived it all. Now in my 30s, being the founder of New Shoes, good taste is my business. Listen on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts.