Shakespeare, Smith, and Medicine
Shakespeare has long been known for his medical knowledge. References to disease, doctors, and treatments occur in almost every play––in some, like Hamlet, Troilus, Coriolanus, Lear and Timon, to the extent that they permeate the atmosphere with morbidity. Hamlet’s muttered remark: “Something is rotten in the State of Denmark” initiates a theme that the author descants on throughout the play. And although other writers of his time have medical references––illness and its cure being a fact of life for everyone––Shakespeare expands his use into areas of imagery and metaphor, just as he does with the Law and gardening. Like Jaques, it seems that Shakespeare himself, if “invested in motley,” the jester’s uniform, could, shaman-like, “purge the foul body of the infected world”––infected, that is, with cruelty, ignorance, and folly.
Surprisingly, Shakespeare seems to have medical knowledge that goes beyond what a layman might acquire through ordinary commerce with doctors and apothecaries. Although his accurate use of medical terms like cicatrix, impostume, hectic, cataplasm, hysteria, prescription, infection, infusion, among others, is not a sure sign that his knowledge was any greater than other layman, there’s evidence in several places that, long before Harvey, he was aware of the circulation of the blood (Davis 51-3).
Shakespeare’s medical knowledge was in advance of practising physicians in other areas as well. When most doctors still relied on the authority of the second-century Greek Galen, Shakespeare shows evidence of following Paracelsus (“the Father of Pharmacology”), who relied on distillations of herbs and minerals rather than on bloodletting and purges. In the late 16th and early 17th centuries, the medical establishment, the College of Physicians, was determinedly against allowing any practise of this new method.
Shakespeare also shows experience of being present, at least, while medical procedures were performed. His medical references include accurate descriptions of death, accurate knowledge of poisons and their beneficial uses (Spurgeon 153), of the pia mater in the brain and its function (Davis 50-1), of tumours and ulcers, and of the coagulation of blood, the way it separates into two streams, bright and dark, clots and serum as shown in The Rape of Lucrece (Buckmill 283). Robert Grudin claims to see evidence of his knowledge of homeopathy in Shrew, As You Like It, Cymbeline, and The Winter’s Tale. The plots of some plays actually turn on medical issues, such as the healing of the King’s fistula in All’s Well, and the use (and misuse) of “the little western flower” to bring the silly lovers to their senses in A Midsummer Night’s Dream.
Arguments have arisen, of course, over where Shakespeare acquired his knowledge of medicine, for there is no evidence that William of Stratford had medical training of any sort––knowledge of methods, drugs and cures being closely held secrets of a profession that scrutinized and licensed its practitioners.
Smith and Paracelsus
In 1540, Cambridge University sent young Thomas Smith to the University of Padua where he was to brush up on the subject he’d been assigned as the first Henrician Professor of Civil Law. While there, he would also have investigated the latest in medical science, Padua being the home of Europe’s top medical authorities as well. Having suffered from serious illness in youth (Dewar 11), Smith’s health was always a great concern to him, and as a confirmed do-it-yourselfer, he would have been eager to know how best to maintain it without resorting to the kind of expensive and often dangerously misguided practitioners that were all England had to offer at that time. As a result he became a confirmed Paracelsian, planting herbal gardens wherever he lived, and maintaining a laboratory for distilling his own medicines––“strong waters,” as he called them (probably because they contained a good deal of alcohol) (Dewar 140).
Smith’s library list of 1566 reveals his interest in the 21 titles he listed under Medicine and Surgery (at that time still seen as separate professions). Among these are four titles by or about Galen (in Latin), and two by or about Dioscorides, the ancient Greek botanist, whose book de Materia Medica was the pharmacologists’ bible. Smith’s copy was bound with Nikander, an ancient Greek physician and herbalist who was still the leading authority on poisons. In a letter written from France in 1572 to his lab manager, Smith spoke glowingly of Raymond Llull, the great Majorcan physician, alchemist, astrologer, and mathematician, yet another magus of the Wisdom Tradition (Dewar 140).
The primary expert on Shakespeare’s references to medicine in each of his plays is still the frequently quoted John Charles Bucknill (The Medical Knowledge of Shakespeare, 1860), who details Shakespeare’s perfect knowledge of horse diseases as shown by his over-the-top description of the broken down nag Petruccio rides to his wedding in Act III Scene 2 of Taming of the Shrew (85-6). As noted by Carolyn Spurgeon (Shakespeare’s Imagery and What it Tells Us, 1935), Shakespeare showed more knowledge of horses than other writers, and more sympathy for them (108-9). Smith’s library list reveals several titles on veterinary medicine, such as one by Ruellius, in Latin, published in 1539, and four in both French and Latin by or about French veterinarian Laurent Ruse, who specialized in cures for horse diseases.
Smith shares with Shakespeare a belief that moderation is the key to good health. Bucknill notes ‘the constant reference to the effects of surfeit” (89), as does Spurgeon (132, 136), both suggesting that Shakespeare was very aware of the ill effects of over-indulgence. Smith’s stand is clear from his letters. Writing to Sir James Croft from France in 1572, regarding the food at the French Court, he complains: “I assure you that I should . . . have died of hunger amongst all the delicate dishes for I abhor much meat and if I had not had plenty of fruit I should not have eaten enough to keep up my body . . .” (Dewar 133). Spurgeon notes Shakespeare’s disgust at grease and greasy foods (85, 118, 320), while Smith, continuing to Croft, yearns for: “. . . a good piece of court beef and mustard . . . [or fish] instead of all these pheasants and partridges . . . and all other such fine meats, covered and seethened with [cooked in] lard” (133).
Shakespeare’s surprising knowledge of the pia mater, the lining of the brain, and its function is attributed by Bucknill to “a happy accident” (79), since its true nature had only just been discovered in the mid-19th century. However, considering the extent of Smith’s medical library, it’s more likely that it came to Shakespeare through Smith, who could have learned of it through lectures by one of the great medical authorities at the University of Padua.
Living with Smith for eight years, Oxford would surely have acquired his tutor’s attitude towards health, his knowledge of Paraselsian medicine, of herbal preparations, and of horse medicine. He would have imbibed his tutor’s ideas on proper nutrition at the dinner table. Medicine and prevention would have been important to Oxford, for it seems that from early in life he had health problems of his own, probably due to malaria.
“I freeze and then I fry”
Malaria is far and away the disease most frequently mentioned by Shakespeare, a favorite metaphor for all things wicked. His references to the ill effects of “poisoned air” and “the reek of rotten fens,” to the agues, chills, and fevers that are the primary symptoms of malaria, and, as noted by both Spurgeon and Bucknill, suggest that the author had more than a passing acquaintance with the disease that for hundreds of years was the scouge of the marsh parishes along the shores of the Thames estuaries in Essex and Kent. Records show it as their leading cause of death for centuries. As Paul Reiter informs us:
Five indigenous species of Anopheles mosquito are capable of transmitting malaria in England. The most competent, An. atroparvus, prefers to breed in brackish water along river estuaries. Contemporary accounts of the distribution of ague in 16th and 17th century England reflect the ecology and distribution of this species. For example, the anaerobic bacterial flora of saline mud produces a strong and distinctive sulfurous odor . . . widely perceived to be the actual cause of agues in salt marsh areas—Shakespeare’s “unwholesome fens”––hence the Italian term mala aria (bad air).
Nor was the malaria of that period merely a distressing but non-fatal disease. According to Reiter, the strain that tormented Europe for centuries (now eradicated) was particularly deadly, especially to children. Causing more deaths to young people in the estuarial counties than all other diseases, it was a “debilitating chronic disease characterized by febrile episodes, headache, lymphadenopathy [swollen lymph nodes], body aches and general malaise. Fever is periodic (every two days) with intermittent chills and profuse sweating.”
One bite from an infected mosquito and the parasite enters the bloodstream, then finds its way to the liver where it continues to live and proliferate, periodically releasing new infection into the bloodstream and thus bringing on recurring bouts over the years, particularly during youth. An effective cure would not be discovered until the late 17th century when powder from the bark of a Peruvian tree was exported to Spain, later the source of the ultimate cure we know as quinine. According to Reiter, in England: “its effective use for malaria therapy was first developed in tests with ague patients living in the salt marshes of Essex, less than 50 km from the center of London.”
“Miry slime” in The Tempest
Spurgeon notes Shakespeare’s frequent references to rivers: “Three pictures . . . he draws in simile again and again: the irresistable force of a river in flood, . . .; the heavy rain on “an unseasonable stormy day,” which accompanies the flood and aggravates it; and the appearance of the meadow after a ‘bated and retired flood,’ rank and ‘stain’d . . . with miry slime.’” She finds 59 river images in Shakespeare, a number unusual in other Elizabethan dramatists, “quite peculiar to Shakespeare,” and half are of a river in flood,” how it “swells, rages, overflows its bounds, drowns its shores and floods the neighboring meadows” (92-6).
Because the mosquitoes breed in brackish water where rotting vegetation gives off a nauseating sulphurous smell, it was assumed for centuries that it was the bad air that caused the disease and that got it named mal aria. Shakespeare dwells on this in several plays, most notably in The Tempest, where images of a rotting fen abound. In Act I Scene 2, Caliban makes his entrance displaying his knavish nature by wishing that disease would attack Prospero and Ariel: “As wicked dew as e’er my mother [the witch Sycorax] brush’d with raven’s feather from unwholesome fen, drop on you both!”
Caliban opens Act II Scene 2 by, again, cursing Prospero: “All the infections that the sun sucks up from bogs, fens, flats, on Prosper fall and make him, by inch-meal [little by little] a disease!” Shortly Stephano mistakes Caliban’s shaking (from fear) for the onset of an ague, giving him liquor to help ease it, a common medication then for the uncontrollable shivering that attends a fit of malaria.
In Act III Scene 3, Alonso goes to seek his son Ferdinand, whom he supposes has been drowned: “my son i’the ooze is bedded, and I’ll seek him deeper than e’er plummet sounded, and with him there lie mudded.” That he was speaking of a marsh and not the seashore is clear from words like ooze and mud. In Act IV Scene 1, Ariel leads the conspirators astray: “at last I left them i’ the filthy-mantled pool beyond your cell, there dancing up to the chins, that the foul lake o’erstunk their feet.” In Act V, Scene 1, Prospero speaks of the return of the senses to the charmed villains: “the approaching tide will shortly fill the reasonable shore that now lies foul and muddy.”
Shakespeare was so struck by the noisome smells and diseased nature of a watersoaked flood plain that he used the image a number of times throughout the plays, often as an imprecation. Act IV Scene 3 of Timon, where, crazed with fury at his discovery of the true nature of his false friends, having taken to the woods, he rages: “O blessed breeding sun, draw from the earth rotten humidity; below thy sister’s orb [the moon’s sphere] infect the air!”
In his metaphorical style, Shakespeare often used infect and infection for strong emotions like love, fear, joy, delight, and melancholy. The Schmidt lexicon describes this secondary use as: “to affect in any manner, but always contrary to wishes” (1.584), which suggests that having learned how blood could be so poisoned that it could never after be totally purified, the poet transferred the image of infection to any emotion so potent that, the heart, having once had its natural defenses overwhelmed, remains forever after vulnerable to that particular emotion. That he uses it so often as a metaphor for falling in love suggests that he had reason to see a similarity between the physical sensations of malaria with it’s alternating cold chills and hot fever and the emotional sensations of alternating fear and exhilaration that go with falling in love.
Not so merry in Windsor
From age four to eight or nine, de Vere lived on the north bank of the Thames across from Runnymede, a water meadow (or wetlands, in todays parlance). Although apparently no longer so wet––the Thames has shrunk considerably in size and volume since the 16th century––the area is still open and undeveloped, most likely due to its centuries-long history as a marsh. Although Ankerwycke was some distance from the malarial estuarial parishes near the shores of Kent and Essex, as described by Reiter, that the anopheles mosquite was so prevalent at that time suggests that malaria would certainly have been a danger after flooding when a hot sun caused an infestation of vermin of all sorts. Smith complained that while living at Ankerwycke, which was “low” and “waterish,” he suffered from “agues” and “rheums” (Strype 170), ague being the Elizabethan term for malaria.
Thus Shakespeare’s experience with a flood plain and the smelly mud that covers the rotting vegetation once the water recedes is something that, as a boy, de Vere would have seen whenever the Thames flooded its banks and the adjoining meadow, whether through a storm surge on the river or a spell of heavy rains. Considering how many men and women suffered from malaria in his day, it’s well within reason that de Vere too was infected at some point. And despite Smith’s interest in medicine, and his exceptional medical library, that his student would adopt his interest as thoroughly as it appears he did (if he was Shakespeare), is unlikely unless the boy had some reason of his own, which suffering from periodic bouts with the chills and fever of malaria would certainly provide.
A recurrence of malaria in his late teens may explain his sojourn at an inn in Windsor in 1569, when he was sick enough to require £15 worth of medicine and “the hire of a hothouse,” described by Mark Anderson as an “Elizabethan sweat lodge,” adding that it sometimes involved the use of “chemical vapors . . . that treated illnesses ranging from agues and consumption to venereal disease” (40). Reiter notes that a recurrence of Malaria can take place in autumn at the outset of a cold spell. The winter of 1569-70 was extremely cold in Northern Europe.
Another recurrence may have taken place while he was in Italy in 1575. From Venice, Oxford wrote Burghley in September that he’d been “grieved with a fever, yet with the help of God now I have recovered the same and am past the danger thereof, though brought very weak thereby . . .” (Anderson 93). Words like danger and weak suggest that his fever was something worse than a passing case of the flu.
On the Italian peninsula, the disease reigned supreme, dubbed the “Roman fever” malingering around the notorious Pontine swamps. Every summer, hundreds perished while scores were weakened to the point that they easily sickened and died from other pathogens.
Having accompanied Oxford on his Italian adventure in ’75, Nathanial Baxter alluded to his illness in a poem he wrote in 1606 for Oxford’s daughter Susan, Countess of Montgomery (Anderson 138-9). Baxter’s tortured syntax seems to imply that it was this heavensent bout with fever that forced the fun-loving Earl to return to England so that, his health recovered, he was in shape to beget the Countess. Silly stuff, but we must accept our clues wheresoever we find them. (The initials of these first three stanzas are an acrostic on the de Vere motto: Vera Nihil Verius.)
Valiant whilom the Prince that bare this mot [motto],
Engraved round about his golden Ring:
Roaming in VENICE ere [before] thou wast begot,
Among the gallants of th’Italian spring.
Never omitting what might pastime bring,
Italian sports, and Siren’s melody:
Hopping Helena with her warbling [humming] sting,
Infested th’Albanian dignity [English dignitary],
Like as they [it] poisoned all Italy.
Vigilant then th’eternall majesty
Enthralled souls to free from infamy:
Remembring thy sacred virginity,
Induced us to make speedy repair,
Unto thy mother everlasting fair,
So did this Prince beget thee debonaire.
Although the phrase “hopping Helena” remains a problem (all dangerous diseases were given nicknames––notably “Stoop Knave,” short for “Stoop Knave, and know thy master”––but this one is unusually opaque), and officially it wouldn’t be known for certain that the disease was caused by a mosquito until 1898, the fact that it always struck when mosquitoes were plentiful could not have passed unnoticed for the centuries before modern science confirmed their true role in transmitting the disease.
For more on Shakespeare and medicine, check out Michael Cummings website, Frank Davis’s article, Shakespeare’s Medical Knowledge: How did he acquire it?, first published in The Oxfordian 3.2000; and John Charles Bucknill’s The Medical Knowledge of Shakespeare at books.google.com.