by Dan Falk
Shakespeare famously makes use of a rustic apothecary in Romeo and Juliet, a reclusive man who, in spite of being a hermit-like figure—his hovel is littered with “empty boxes”—manages to stock a remarkably diverse array of tonics and potions:
I do remember an apothecary –
And hereabouts ’a dwells—which late I noted
In tatter’d weeds, with overwhelming brows,
Culling of simples. Meagre were his looks,
Sharp misery had worn him to the bones,
And in his needy shop a tortoise hung,
An alligator stuff’d, and other skins
Of ill-shap’d fishes; and about his shelves
A beggarly account of empty boxes,
Green earthen pots, bladders, and musty seeds,
Remnants of packthread and old cakes of roses
Were thinly scatter’d to make up a show.
(5.1.37–48)
The midwife was perhaps a more respected figure than the apothecary. She could be relied on to examine suspected witches, rape victims, and female prisoners. As Kirstin Olsen notes, however, if something went wrong with a delivery, it might well be the midwife who initiated rumors of a “monstrous birth.” Along with the apothecaries and midwives, there were unlicensed “empirics” and alewives, and a vast array of amateur healers of all stripes, promising all manner of cures. Quackery was rampant. In all, these unlicensed medical men and women no doubt greatly outnumbered the licensed practitioners.
HUMORING GALEN
The Greek physician and philosopher known as Galen of Pergamon (A.D. 129–199), dead for fourteen centuries, was the leading medical authority in Shakespeare’s England. His writings were perennially sought after; by one estimate, more than six hundred editions of his works were published between 1490 and 1598. Galen’s theory focused on the four “humors” thought to govern the body: blood, phlegm, black bile, and yellow bile. These mirrored the Earth’s own constituents, the elements earth, water, air, and fire, via the properties that they shared. Each humor, and each element, was associated with a particular combination of hot, cold, wet, and dry. Thus, blood was hot and wet; phlegm was cold and wet; black bile was cold and dry; and yellow bile was hot and dry. The key to good health was the maintenance of a proper balance or “temperature” among the four humors. “Distemperature”—of the body or of the nation—was a sure sign of more serious ills to come. In Henry IV, Part 2, the king complains that “rank diseases grew near the heart” of his kingdom; Warwick reassures him that
It is but as a body yet distempered,
Which to his former strength may be restored
With good advice and little medicine.
(3.1.40–42)
Galen also proposed three “souls”: the rational soul, governed by the brain; the emotional, controlled by the heart; and the vegetative, controlled by the liver. It turns out that Galen greatly overestimated the importance of the liver. He thought it was the first organ to form in the fetus, and believed that it governed the entire circulatory system. He also thought that the liver wrapped around the stomach, warming it so as to aid in digestion. In fact, although the liver has this shape in certain animals, it does not take this form in humans; as Olsen points out, this is one of the mistakes that suggests that Galen examined only animals, not actual human corpses.
Galen’s mistakes went unnoticed (or at least, uncorrected) for centuries. The first person to take Galen to task, in print, was the Flemish physician Andreas Vesalius (1514–1564). Born in Brussels, Vesalius studied in France and in Italy, and learned both from his classically trained professors and from his own investigations. His dissections of human cadavers at the University of Padua showed, among other things, that Galen was wrong about the shape and function of the liver. (Vesalius was also something of a showman: His dissections were open to the public, and drew crowds of curious onlookers.) He published his findings in a groundbreaking book, De humani corporis fabrica (On the Fabric of the Human Body), the first modern anatomy textbook, complete with detailed drawings based on the author’s own work. (As historians like to point out, Vesalius’s book was published in 1543, the same year that saw Copernicus’s De revolutionibus—a good year indeed for science publishing!) Even so, Galen was so revered that his errors were only slowly coming to light.
Galen’s biggest mistakes were physiological rather than anatomical. For one thing, he failed to deduce the circulation of the blood, which would have to wait for the work of William Harvey in 1628 (a dozen years after Shakespeare’s death). The tendency to animate all forms of matter didn’t help. We have already noted this tendency in astronomy—for example, Kepler’s insistence on planetary “souls.” The human body was equally susceptible to such theorizing, and, as Olsen notes, by the sixteenth century Galen’s followers imagined that each organ had not only a physiological function, but also a kind of personality. The spleen, for example, was thought to be filled with black bile, which was cold and dry; and so the organ was imagined to be the seat of irritability, impulsiveness, and quick-changing passions. Shakespeare mentions the spleen in this sense quite a few times—for example, Lady Percy’s retort to Hotspur, in Henry IV, Part 1:
Out, you mad-headed ape!
A weasel hath not such a deal of spleen
As you are tossed with.
(2.3.74–76)
This also leads to some rather confusing passages; as Olsen points out, the modern reader may have trouble with the line from Venus and Adonis in which Shakespeare writes of Venus that “A thousand spleens bear her a thousand ways” (line 907). It just means that the goddess is in a highly changeable mood—but the phrasing, as Olsen playfully notes, calls to mind “an angry mob of tiny internal organs traipsing about with a bewildered goddess on their backs.”
Yellow bile, believed to be hot and dry, was also known as choler. Too much choler was thought to make a person impatient and argumentative, and Shakespeare uses the word in exactly this sense—for example, in Henry V, where the king describes the Welsh captain Fluellen as “touched with choler, hot as gunpowder” (4.7.175). Similarly, words like “phlegmatic” (too much phlegm), “melancholic” (too much black bile), and “sanguine” (an excess of blood) crop up throughout the canon, describing not only medical conditions but also aspects of personality.
LET IT BLEED
A doctor’s motto in Elizabethan England might well have been “When in doubt, bleed.” Ailments were attributed to an imbalance in the humors, and if the problem seemed to be an excess of blood, the answer was obvious—let some of it out. Doctors urged even healthy people to be bled on a regular basis, to keep their humors in balance. A letter from a German student to his mother, dating from 1578, is illuminating: “I ask you to send me a blood-letting lancet,” he wrote, noting that “the other students have their own special lancets” so that they don’t need to go to the bathhouse and submit to the tools “used to bleed the peasants and everyone else.”
Aside from the imagined medical benefits, there was a religious motivation for bloodletting: Some churchmen believed that by ridding himself of excess blood, a man could rid himself of sin. There was also an astrological motivation: Bleeding was recommended when the Earth itself was “growing,” as it was imagined to be in springtime (the season associated with “cold” and “wet” weather), while bleeding in hot weather was discouraged. One relic from this blood-obsessed period can still often be seen, in the form of the red-and-white stripes on the barbershop pole: The white represented the foamy shaving cream; the red symbolized bloodletting.
Today the idea of intentionally causing a patient to bleed seems absurd, but there was a certain logic to it in Shakespeare’s time. Blood was imagined to be the most refined form of food and drink, carried to all parts of the body through the veins. But it had to get “used up,” so to speak, along the way—which is why, in Coriolanus, we hear that the “great toe” is “the worst in blood” (1.1.153). Excess blood could erupt in pimples or boils; it could also cause a f
ever. One solution was to stop eating (hence the expression “starve a fever”); but an even faster way to bring down the patient’s temperature was to draw blood. Conversely, someone who seemed pale, or cold to the touch, might be told to eat more food (this producing more blood); red meat, in particular, might be recommended.
“They didn’t have the insight into diseases that we have today,” Flude says, as we sit at a desk nestled among the museum’s exhibits. “They tended to confuse symptoms with causes. So, if you get a red face when you have a fever, they thought that was caused by blood. And blood does cause red faces. So they thought that was the cause of the fever.” Either the patient’s blood was bad, or there was too much of it; either way, the solution was to get rid of some of it. (They understood that the body could generate blood anew.) “So it was a quite simple cause-and-effect, as they saw it,” says Flude. “And it kind of worked: When someone has a fever, and they’re bled, they would likely go pale, and the symptom was relieved. It kind of makes sense. We know it doesn’t make sense now, but at the time it made sense.”
* * *
Doctors in Elizabethan England did what they could for their patients, but they lacked for real medical knowledge: They had little chance of deducing what was actually making a person sick. Luck almost certainly played as important a role as the work of the physician. Some patients were treated and got better—but perhaps they would have recovered just as quickly (or even more quickly) with no treatment. By the same token, some patients got steadily worse, and, in spite of treatment, they eventually died—but very likely they would have died even if no treatment had been given (and just the fact that some treatment was offered may well have brought comfort). Illnesses were not categorized in a rigorous way, and, worse, the symptoms themselves were often conflated with the disease. For example, fever is today recognized as a symptom common to many diseases; but in Shakespeare’s day it was seen as an illness in itself. As Olsen notes, “No wonder that any one type of treatment, when applied to all fevers of whatever origin, usually failed to work.” Diseases like tuberculosis, influenza, dysentery, smallpox, malaria, and syphilis were killers, while scurvy was particularly common among sailors. (The queen herself nearly died from smallpox in 1562, two years before Shakespeare’s birth.) And of course there was the plague; because of its unpredictability, it was even more feared than the others.
THE PLAGUE’S THE THING
Even though Shakespeare was fortunate enough to be spared personally from the plague’s terrifying effects, the dreaded disease would have been an integral part of daily life, as familiar as the weather. As mentioned, there were at least five outbreaks in Shakespeare’s lifetime. Europe had in fact been subject to two distinct varieties of plague, bubonic and pneumonic (and we can’t be sure which is being referred to in records from the time, which often use “plague” for both). The bubonic was the more common form; it took about six days to incubate, leading to nausea, fever, and swellings in the groin or armpit known as “buboes.” Once the plague was contracted, the outlook was not good; the disease killed about six in ten of its victims. The pneumonic form attacked the lungs, and was even more deadly, killing virtually all of those who contracted it.
How the disease spread was a matter of conjecture. People blamed everything from bad air to inauspicious planetary alignments to (no surprise) foreigners; many also attributed the disease to the wrath of God.* We now know that the disease was spread by fleas that in turn had bitten infected rats. At the time, no one thought to blame the rats or the insects that hitched rides on them, perhaps because both were a ubiquitous presence in the towns and cities of Elizabethan England.† As Kristin Olsen notes, doctors were on the right track when they blamed animals, but they blamed the wrong animals, indicting dogs and cats instead of rats and fleas. The result was a government-ordered cull of stray dogs and cats—which in turn resulted in an increase in the rat population, and further outbreaks of the plague. The overall lack of sanitation and hygiene was the other major culprit. In cities and towns, waste was dumped onto the streets or into nearby ditches.
At least the contagious nature of the disease was recognized. It was believed to be spread—somehow—through the air, and people caught it from others who were infected. During outbreaks, foreign ships were kept at anchor, and travelers on foot were either turned back by guards posted well outside a town’s limits, or forced to stay in makeshift hospitals for forty days—in Latin, quarantina—until they could be confirmed not to pose a risk. (It is from this practice, of course, that we have the word “quarantine.”)
Houses in which someone had contracted the disease were sealed off, and family members were trapped inside with the afflicted person (hopefully aiding in the patient’s recovery without catching the disease themselves). Overcrowding was recognized as a problem, and those who had the means fled to the countryside with each outbreak. Of course, nothing drew crowds like the theater, which, as mentioned, could attract as many as three thousand people for each performance. When plague deaths exceeded thirty per week, authorities in London closed the theaters in an effort to slow the spread of the disease. This of course had an enormous impact on Shakespeare and the actors in his company, who would have been forced to look for work in the country when the theaters shut down. Records show that the theaters were closed for some seventy-eight months between 1603 and 1613—closed, in other words, more than half the time. During an outbreak in 1609, Thomas Dekker noted that the playhouses stood with their “dores locked up, the Flagges … taken down”; in the surrounding neighborhoods one saw “houses lately infected, from which the affrighted dwellers are fled, in hope to live better in the Country.”
Shakespeare makes only a handful of direct references to the plague, and usually it is at least somewhat metaphorical—for example, in Timon of Athens, where Timon is less than thrilled to hear that the Athenian ambassadors are at his doorstep: “I thank them; and would send them back the plague, / Could I but catch it” (5.1.137–38). None of Shakespeare’s characters die from the plague; in fact, none of them even catch it. Perhaps the subject was simply too close to home. Nonetheless, more general references to disease, infection, and fevers are everywhere in the canon, and this surely reflected the concerns that ordinary people had with their health and well-being—neither of which was guaranteed to last you through to next Tuesday. “Mortality and anxiety,” notes Peter Ackroyd, “were part of the air that the citizens breathed.”
“THAT WAY MADNESS LIES”
There were, of course, mental ailments along with physical ones, and their effects were equally frightening. The causes of mental illness were not well understood; it was thought that madness could be triggered by emotional trauma, severe anxiety, and even unrequited love. There could also be physical causes, such as a fever or a bite from a mad dog. Or, as Shakespeare suggests in Macbeth, it could come from eating “the insane root” (1.3.82)—a reference, perhaps, to the root of the mandrake plant; similar to nightshade, it was known to have hallucinogenic properties. Even the the moon was thought to play a role, either due to its phase or (more rarely) due to its distance from Earth (hence “lunacy,” from the Latin word for moon, luna). Shakespeare frequently alludes to the moon’s influence on human affairs. In Othello, for example, the title character reacts to the news that “foul murders” have been committed:
It is the very error of the moon:
She comes more nearer earth than she was wont,
And makes men mad.*
(5.2.111–13)
(Not that Othello is one to talk; he murdered Desdemona barely a dozen lines earlier.)
There was little to be offered in the way of treatment. Some of those deemed “mad” were cared for by their families; others, as Olsen notes, “simply wandered from town to town, blamed for any increase in local crime.” There were hospitals for the insane, but the level of care was appalling; patients could be beaten or even put on display as public entertainment. The most famous mental facility was London’s Beth
lehem Hospital, known by its nickname, Bedlam. In King Lear, Edgar aims to pass for a “Bedlam beggar” by smearing his face with dirt, messing up his hair, and speaking in riddles and nonsense rhymes. While Edgar is faking it, the king is terrified that he is losing his mind for real: “O let me not be mad,” he moans, “not mad, sweet heaven! / Keep me in temper, I would not be mad” (1.5.37). To add insult to injury, madness was seen not only as a medical condition but as a character flaw. Whether Hamlet’s madness is real or feigned (or both) is a matter for endless debate, but either way, his uncle is ashamed of the prince’s behavior, chiding him for displaying “unmanly grief”; he tells Hamlet that his disposition reflects “a will most incorrect to heaven” (1.2.94–95).
The lack of any viable treatment for madness haunts act 5 of Macbeth, as Lady Macbeth’s condition steadily deteriorates. Already in scene 1, the doctor declares that “This disease is beyond my practice” (5.1.49), and that “More needs she the divine than the physician” (line 64). By scene 3, the end is near, and Macbeth’s frustration is palpable:
MACBETH
Cure her of that.
Canst thou not minister to a mind diseased,
Pluck from memory a rooted sorrow,
Raze out the written troubles of the brain,
And with some sweet oblivious antidote
Cleanse the stuffed bosom of that perilous stuff
Which weighs upon the heart?
DOCTOR
Therein the patient
Must minister to himself.
MACBETH
Throw physic to the dogs, I’ll none of it.
(5.3.41–48)
* * *
Macbeth’s doctor is just one of the physicians we meet in Shakespeare’s plays. Medical men of various kinds appear frequently in the canon—more often, in fact, than workers of any other profession. We often hear their diagnoses and treatments; and they appear on stage not only in Macbeth but also in King Lear and Two Noble Kinsmen. We might take particular note of All’s Well That Ends Well, in which the heroine, Helena, is the daughter of a famous doctor; she has learned many skills from her father, and uses her knowledge to save the king’s life. But the medical talk does not sound forced in any of the plays; rather, it comes up naturally as the characters go about their business. It is, as Maurice Pope puts it, “unobtrusive.”
