Shakespeare’s medical world

Why should a library that specialises in the history and culture of medicine commemorate the 400th anniversary of Shakespeare’s death? Dr Anna Maerker, who provides a Shakespeare and Medicine lecture at the Wellcome Library for acting students, kicks off our Shakespeare-inspired blog series with some good reasons ‘why?’.

Students from RADA at the Shakespeare and Medicine lecture run by Dr Anna Maerker. Wellcome Library, February 2016. Image credit: Lalita Kaplish.

The Bard is everywhere – and the Wellcome Library is no exception. A deed of 1654, ucovered in the Wellcome archives, provided an unexpected piece of ‘Shakespeareana’. Produced a generation after Shakespeare himself, it is evidence of the playwright’s London property, passed on to his daughter Susanna and her husband, the physician John Hall. But Shakespeare’s presence in medical history goes far beyond the coincidence of his son-in-law’s qualification.

In some of Shakespeare’s plays, medicine is integral to the plot. Thus Helena uses her remedy for the king’s fistula as a bargaining chip for Bertram’s hand in All’s Well That Ends Well, while Romeo and Juliet meet their tragic end due to Friar Laurence’s coma-inducing drug and the apothecary’s poison.

The scene of Romeo and the apothecary in the 5th Act of Romeo and Juliet. Mezzotint print, London, 18th Century.

Beyond these plot machinations, Shakespeare’s protagonists are steeped in the medical culture of their day. They draw on medical imagery and medical theories, to express their understanding of human temperament and human behaviour, and the origins of disease both literal and metaphorical.Three ways of thinking about disease in Elizabethan England are particularly prominent in Shakespeare’s plays: the concept of the four humours, the notion of miasma as a disease-causing environmental factor, and the influence of the stars on human health.

Sir Toby: Does not our lives consist of the four elements?
Sir Andrew: Faith, so they say, but I think it rather consists of eating and drinking.
Twelfth Night, Act 2 scene 3:9-10)

Elizabethans adopted the ancient theory that the body was composed of four humours: blood, yellow bile, black bile, and phlegm. An imbalance of those four substances was the cause of disease. Perfect balance, by contrast, was the sign of a truly special individual, as Antony claims for Brutus:

“His life was gentle, and the elements
So mix’d in him that Nature might stand up
And say to all the world ‘This was a man!'”
(Julius Caesar, Act 5 scene 5: 73-75)

For Shakespeare and his contemporaries, both body and mind were affected by this balance. A surfeit of one humour would result not only in physical signs and symptoms, but also shape an individual’s character. Thus, Elizabethans distinguished four temperaments: the sanguine with an excess of blood, the choleric who contained too much yellow bile, the melancholy who suffered from too much black bile, and the phlegmatic.

Lutenist corresponding to temperament based on sanguine humour. Woodcut
circa 1610  Iconologia by Cesare Ripa.

Shakespeare’s contemporary John Harington, for instance, characterised the sanguine predisposition both physically and temperamentally:

The Sanguine gamesome is, and nothing nice,
Love Wine, and Women, and all recreation,
Likes pleasant tales, and news, plays, cards and dice,
Fit for all company, and every fashion:
Though bold, not apt to take offence, not ireful,
But bountiful, and kind, and looking cheerful
Inclining to be fat, and prone to laughter,
Loves mirth and music, cares not what comes after.
The English mans Doctor, or The School of Salerne (1608).

Shakespeare’s audiences would have recognised these temperaments on stage.

Balance of the four humours could be restored through means such as bloodletting and purging, but also maintained through a careful diet. This could affect both the body and the mind, as Sir Andrew realised in Twelfth Night (Act 1 scene 3:81-83): “I am a great eater of beef, and I believe that does harm to my wit.”

Bloodletting illustration from a compendium of popular medicine and surgery, receipts, etc. by Arzneibuch ca. 1675. Wellcome Library reference: MS. 990.

The language of purging and the restoration of balance is also present in the plays in metaphorical ways. Thus in Love’s Labours Lost, Biron recommends bloodletting to Dumain to cure his infatuation with Katharine:

Dumain: I would forget her; but a fever she
Reigns in my blood and will remember’d be.
Biron: A fever in your blood! why, then incision
Would let her out in saucers: sweet misprision!
(Love’s Labours Lost, Act 4 scene 3:93-96)Beyond the concept of the four humours, Elizabethans had other ways of explaining the origins of diseases. Environmental factors such as bad air (miasma) were often identified as possible causes. Thus Leontes urges:

“The blessed gods
Purge all infection from our air whilst you
Do climate here!”
(The Winter’s Tale, Act 5 scene 1:167-169)

Another factor considered to cause disease was the ‘influence’ of the stars. Bad astronomical constellations were believed to cause a literal flow or in-flux of disease. God could use the stars to bring on diseases as a form of punishment. Berowne in Love’s Labour’s Lost, Act 5 Scene 2:2316: “Thus pour the stars down plagues for perjury”.

The planets and signs of the zodiac send down their influence on to the body of a man on earth. Print, 1699. Wellcome Library reference: 643131i.

Medical practitioners could also use astrology to devise cures for their patients. Each body part corresponded to a sign of the zodiac, as illustrated in the schematic Zodiac Man of the period. Predictably, Sir Andrew and Sir Toby get it wrong.

The carousing of Sir Toby Belch and Sir Anthony Aguecheek from William Shakespeare’s Twelfth Night. By William Hamilton, 1792. Image Source/Photographer Folger Shakespeare Library Digital Image Collection.

Sir Toby: Were we not born under Taurus?
Sir Andrew: Taurus? That’s sides and heart.
Sir Toby: No sir; it is legs and thighs. Let me see thee caper. Ha,
Higher! Ha, ha, excellent!
(Twelfth Night, Act I scene 3)

Author: Dr Anna Maerker is Senior Lecturer in the History of Medicine at the Department of History, King’s College London.

Further reading: David Hoeniger. Medicine and Shakespeare in the English Renaissance. Associated University Presses, 1992.