Shakespeare and Medicine
(April 23, 1564 to April 23, 1616)
The Chandos portrait, one of several thought to depict William Shakespeare and to have been painted during his lifetime.
By medicine life may be prolonged, yet death Will seize the doctor too. Cymbeline: V.5.29-30
William Shakespeare’s ability to fathom the dysfunctions of the human mind has astounded theatergoers for more than four hundred years. His portraits of Hamlet, King Lear, Othello, and Macbeth all attest to his genius for reaching into the depths of the soul and pulling out its pith for all to examine. But Shakespeare also excelled at identifying and describing afflictions of the body, such as scurvy, gout, epilepsy, rheumatism, and venereal disease. Each of these afflictions – and scores more – sicken the kings and commoners of his plays; they are the Furies of old come to torment Medieval and Renaissance England.
Shakespeare’s knowledge of both physical and mental illness enabled him to enlighten audiences about the soma and psyche of a character and their failure to work in harmony. Not infrequently, Shakespeare exhibits surprising insights into medicine. For example, in Henry IV Part II, Northumberland – down with a fever – describes the principles behind immunization when he receives bad news from the battlefield.
In poison there is physic; and these news,
Having been well, that would have made me sick,
Being sick, have in some measure made me well
In The Winter’s Tale, Camillo presents a revolutionary concept: that a person can carry and spread illness even though he or she remains disease free:
There is a sickness
Which puts some of us in distemper, but
I cannot name the disease; and it is caught
Of you that yet are well.
In Richard III, after Hastings informs Richard that the king languishes with a fatal illness, Shakespeare calls attention to the importance of nutrition in the following lines spoken by Richard:
“O, he [the king] hath kept an evil diet long, / And overmuch consumed his royal person”.
In Pericles, Prince of Athens, Shakespeare demonstrates an awareness of altered states of consciousness that mimic death. In the key passage, Cerimon opens Thaisa’s coffin, observes “how fresh” she looks, and remarks,
Death may usurp on nature many hours,
And yet the fire of life kindle again
The o’erpress’d spirits. I heard of an Egyptian
That had nine hours lien dead,
Who was by good appliance recovered.
Cerimon then revives Thaisa, noting, “She hath not been entranced above five hours”.
Scholars often conjecture that Shakespeare’s knowledge of medicine was mainly the product of his relationship with John Hall, a physician and herbalist who earned a master’s degree at Cambridge University in 1597 and, after further studies on the European continent, settled in Stratford and married Shakespeare’s oldest daughter, Susanna, in 1607. However, it seems just as likely that Shakespeare gained most of his medical knowledge on his own. Supporting this view is the fact that he had already written many of his plays – including dramas with medical references – before Hall left Cambridge. More important, though, Shakespeare had lived in London in the early 1590’s. The city at that time was a prolific breeding ground of disease because of crowded, unsanitary conditions. Garbage littered streets. Residents emptied chamber pots out windows. Brothels incubated syphilis. Dung clogged gutters and waterways. Flies and rodents carried bacteria and viruses from one section of the city to another. Hygiene was almost nonexistent. Even the queen bathed only once a month. Consequently, the London of Shakespeare was dirty, raw, and noxious. When plague ravaged the city between 1592 and 1603, Shakespeare witnessed human suffering on a vast scale. The infected burned with fever of 104 degrees Fahrenheit or more, shivered incessantly, and suffered bouts of vomiting, insomnia, and delirium.
Spread from rats to humans by fleas, plague could manifest itself in three forms: bubonic plague, which caused painful swellings (buboes) in the lymph nodes of the armpits and groin; pneumonic plague, which filled the lungs with fluid; and septicemic plague, which poisoned the bloodstream. Sometimes one form of the disease killed by itself; at other times, it progressed into another of the forms before claiming a victim. Together, these three manifestations of plague were known as the Black Death because of the livid hue of corpses caused by subcutaneous hemorrhaging. As the bodies accumulated – and the rats and fleas multiplied outbreaks exponentially – Shakespeare saw it all. At his writing table, death sat at his elbow. On his walks through streets and byways, it saluted him with the flopping arms of wagon-borne corpses. Physicians were powerless against the disease. In fact, one of the most distinguished physicians of the age – William Gilbert, physician to Queen Elizabeth I and, after her death, to King James I – died of plague in 1603.
In The Medical Mind of Shakespeare, Aubrey C. Kail describes efforts to contain plague: “Special officials called ‘searchers’ were appointed, whose duty it was to go into houses and search out plague victims. They were paid a higher rate if the victims were found dead.” Kail says the practice of using searchers, along with the imposition of quarantines, provided Shakespeare a plausible explanation for a significant development in one of his most popular plays.
The use of the word ‘searcher’ in this sense appeared in 1592 in Romeo and Juliet. Friar John, suspected of being in an infected house, was shut in by the ‘searchers,’ and was thus prevented from carrying the all-important message from Friar Lawrence to Romeo. No messenger could be found to return the letter to Friar Lawrence, so afraid were the citizens of Verona of the infection. The communications breakdown precipitated events leading to the tragic ending of the play. Another common affliction in Shakespeare’s time was venereal disease – in particular, syphilis. Although the crew of Christopher Columbus is sometimes blamed for carrying syphilis from the New World to Europe, the disease probably existed in Europe long before Columbus set sail for the first time. However, it was apparently mistaken for leprosy. Giovanni Fracastro, an Italian poet and physician, coined the word syphilis in a poem in 1530. Shakespeare refers to the illness as pox in ten of his plays. Of special interest is Measure for Measure, in which three citizens of Vienna openly discuss venereal disease. One of them, Lucio, upon seeing a brothel madam approaching, says, “I have purchased many diseases under her roof”. Shakespeare first staged the play in 1604, the year after the government closed the brothels of London.
Besides plague, venereal disease, and other afflictions of the body, mental illness and its symptoms – including depression, obsessive-compulsive disorder, and recitations of gibberish – were commonplace in Shakespearean London. In fact, because treatment was virtually nonexistent for the mentally disabled and because most of the mentally disturbed roamed freely for lack of institutional care, London and other European cities teemed with the eccentric, the paranoid, the schizophrenic. When Shakespeare ventured forth on the streets of London, he entered an alfresco asylum. All he had to do was etch images in his memory and he had raw material for his plays.
.In his dramas, both mental and physical illness sometimes inhabit the same character at the same time. For example, in Richard III, Richard exhibits the symptoms of kyphosis (hunched back) and psychopathy (asocial and amoral behavior), which shape him into a grotesque killing machine. In the opening lines of the play, Richard soliloquizes on his appearance and his mindset:
But I, that am not shaped for sportive tricks,
Nor made to court an amorous looking-glass;
I, that am rudely stamp’d, and want love’s majesty
To strut before a wanton ambling nymph;
I, that am curtail’d of this fair proportion,
Cheated of feature by dissembling nature,
Deformed, unfinish’d, sent before my time
Into this breathing world, scarce half made up,
And that so lamely and unfashionable
That dogs bark at me as I halt by them;
Why, I, in this weak piping time of peace,
Have no delight to pass away the time,
Unless to spy my shadow in the sun
And descant on mine own deformity:
And therefore, since I cannot prove a lover,
To entertain these fair well-spoken days,
I am determined to prove a villain
And hate the idle pleasures of these days.
Plots have I laid, inductions dangerous,
By drunken prophecies, libels and dreams.
.For modern audiences, Shakespeare is a window on human affliction and its treatments in the late 1500’s and early 1600’s, an age when medical science was an oxymoron and gleeful germs had the run of both the king’s household and the peasant’s hovel. Some people of Shakespeare’s time believed disease was a punishment for sinful behavior. Others thought it resulted from the movement of the stars and the planets. Whatever the cause, virtually everyone agreed that it triggered illness by creating an intolerable imbalance in four vital fluids in the body: blood, phlegm, black bile, and yellow bile. Called “humors” (from a Latin word for liquids), these fluids controlled health and human behavior.
Persons in whom blood was the dominant humor were kind, loving, merry, enthusiastic, and passionate. Those ruled by phlegm were sluggish, apathetic, cowardly, and dull-witted. Persons dominated by yellow bile were stubborn, impatient, vengeful, and easy to anger, and those dominated by black bile were melancholic, depressed, irritable, brooding, and cynical.
When the body produced too much or too little of a humor – or if the humor altered its consistency or ventured beyond its normal location in the body – illness resulted. Diagnosis consisted in one or more of the following: observing symptoms such as fever and headache, evaluating urine for discoloration and frothing, plotting astrological charts, and checking the pulse for the rate and strength of the heartbeat and for rhythm abnormalities. In Hamlet, Prince of Denmark, Hamlet underscores the importance of the heartbeat as a measure of well-being when he tells Gertrude “My pulse, as yours, doth temperately keep time, And makes as healthful music”. Treatments to restore the proper balance of humors consisted mainly in ridding the body of humoral excess by blood-letting (phlebotomy), vomiting (emesis), and cleansing the bowels (purging). Blood-letting, a frequent practice, required opening a vein or applying leeches. The other treatments required administration of concoctions to induce vomiting spells or bowel movements. In the latter case, a patient could choose from oral laxatives or enemas. Medical practitioners also used a variety of preparations – with ingredients ranging from animal dung and ground gemstones (including emeralds, sapphires, garnets, and topaz) to licorice, mint, rosemary, and basil – to heal the sick. Some preparations, such as herbal remedies, occasionally worked. Patients themselves often prayed for a miraculous cure, touched their bodies with the relics of saints, or went on pilgrimages. A few turned to religious rites to rid the body of a demon. Persons offering preventive, diagnostic, and therapeutic services included well educated physicians, minimally educated surgeons, barbers, herbalists, apothecaries, exorcists, astrologers, sorcerers, soothsayers, and do-it yourself healers. At barber shops, patrons could get a haircut, then have a tooth extracted. They could also undergo blood-letting, a service advertised by a spiral red stripe on the barber pole outside the typical barber shop. The striped barber pole survives to the present day as a symbol of the tonsorial profession.
A 17th century copy of the First Folio edition of William Shakespeare’s plays. (Matt Dunham / Associated Press / April 23, 2012)