KV Sahasranam MD, DM, FACC
Baby Memorial Hospital, Kozhikode, Kerala, India. PIN:
673004
Address for Correspondence: Prof. Dr. KV Sahasranam MD,
DM, FACC, Senior Consultant Cardiologist, Baby Memorial
Hospital, Kozhikode, Kerala, India. PIN: 673004. E-mail:
ramani2911@gmail.com
Keywords: heart failure, management
Medicine and literature have always been connected over the
ages. William Shakespeare (1564-1616) is no exception. There
are plenty of references to medicine and diseases in the works
of Shakespeare. The knowledge which Shakespeare has of medical
conditions is much more than is expected of a common man. This
is attributed to his association with practitioners of his
time and reading of contemporary texts in medicine. Also his
son in law Dr. John Hall who married Susanna, Shakespeare's
eldest daughter would have contributed substantially to the
knowledge of medicine in Shakespeare's compositions. Surgery
at the Elizabethan times was well known and is reflected to a
large extent in his plays [1].
There were many diseases known in the days of Shakespeare and
have a mention in his plays.
"Now the rotten disease of the south (
Syphilis)
guts-gripping (
colic), ruptures (
hernia),
catarrh (
rhinitis), lethargies (
stroke), raw
eyes (
conjunctivitis), dirt-ridden liver (
cirrhosis),
wheezing lungs (
COPD / asthma), bladder full of
imposthume (
bladder stones), sciaticas (
osteoarthritis
lumbar spine), lime-kilns in the palms (
palmar
arthritis / gout), incurable bone ache and take against
such preposterous discoveries' [Troilus and Cressida
5.1. 17-21]. The above account describes most of the illnesses
found in Shakespeare's England.
William Harvey is credited with the discovery of the
circulation of blood in 1616, when he gave the Lumleian
lecture to the London College of Physicians on the subject.
But there are indications that this concept was known even
before and has been reflected in Shakespeare's play
Julius
Caesar where Brutus says to Portia: "You are
my true and honorable wife, as dear to me as are those ruddy
drops that visit my sad heart" [Julius Caesar: 11.1. 288-290].
In the play
Othello, Iago, the villain
says: "Not poppy not mandragora nor all the drowsy syrup
of the world shall ever medicine thee to that sweet sleep
which thou owedst yesterday" [ Othello: 3.3
334-337]. This refers to the surgical anesthesia /
analgesia practiced in those days when extracts of Papaver
somniferum and Atropa mandragora were used for surgical
anesthesia.
Heart attack caused by excessive sorrow and emotion which
remains suppressed, has been graphically described by
Shakespeare thus in his
Macbeth: "Give sorrow
words. The grief that does not speak. Whispers the o'er
fraught heart and bids it break" [Macbeth: IV 3
209-210]
In one of his plays, Shakespeare equated the third ventricle
of the brain with memory. In his work
Love's Labour
Lost, one of his characters, Holfernes makes a
statement "these are begot in the ventricle of memory,
nourished in the womb of the piamater [Love's Labour Lost. IV.
2. 70-71]. This quote also endorses Shakespeare's acquaintance
with the anatomy of the human body.
In
Henry IV, he describes dislocation of the
shoulder: "I would to God that I may die. That I might have
thee hanged. Thou hast drawn my shoulder out of joint."
[Henry IV 5.4 1-3].
The practice of using a tourniquet to stop hemorrhage followed
by hypovolemic shock was known to Shakespeare as is evident in
this verse from
Othello:
Cassio: My leg is cut in two
Iago : Marry,
heaven forbid! Light, gentlemen
I'll bind it with
my shirt. So lend me a garter.
O for a chair, to
bear him easily hence.
Bianca: Alas he faints. O Cassio,
Cassio, Cassio
How do you,
Cassio.
Iago : O, that's
well sad, the chair!
Some good men
bear him carefully from hence
I'll fetch the
general's surgeon [Othello. 5.1
73-102]
Sprengel's deformity of the shoulder and congenital
kyphoscoliosis was described in one of Shakespeare's works
where Richard III was described as:
"Little of stature, left shoulder much
higher than right
Crook backed, hard visage, body greatly
deformed
Small face, cruel
countenance". [Henry VI
3.3 155-170]
Shakespeare's character, Gloucester in
Henry VI
describes his birth, "For I have often heard my mother say, I
came into this world with feet forward". This
characteristically describes a breech delivery.
Brutus in
Julius Caesar describes a fit of
seizures that Caesar had thus:
"He had a fever when he was in Spain
And when the fit was on him, I did mark
How he did shake: 'tis true, this god did
shake." [Julius Caesar. 1.2 127-129]
Epilepsy has also been described in many situations in various
plays of Shakespeare like
Othello,
King
Lear and
Macbeth.
Interestingly, there are very few medical conditions that were
not described by Shakespeare in his works mentioning that one
or other of his characters suffered from them. One of them
widespread in Elizabethan England was Syphilis which
Shakespeare refers to as "pox" or the "rotten disease of the
south" in many of his plays. He has described the disease and
its complications in various stages, in his characters.
Syphilis gains a mention in many of his plays like,
All's
Well that ends Well,
Cymbeline,
Measure
for measure,
Othello,
Hamlet,
Henry IV,
Henry V and
Pericles,
Prince of Athens. This emphasizes the importance
and rampancy of the disease in his times.
Even a simple disorder like bedwetting did not miss
Shakespeare's pen. In
All's well that ends well,
his character Parolles mentions about his friend,
"For he will be swine drunk;
And in his sleep, he does little harm,
Save to his bed clothes about him;
But they know his conditions and lay him in
straw". [All's well that ends well. 4.3.109]
Shakespeare's characters, many of them were wont to heavy
bouts of alcohol and many a work of his has a mention of this
malady. Sir John Falstaff and Bardolf, two of his characters
from
Henry IV are typical examples. The word of
a porter who tells Macduff in Macbeth is an oft quoted verse
regarding the effects of alcohol:
"Drink sir, is a great provoker of three things
Nose painting, sleep and urine.
Lechery sir, it provokes and unprovokes:
It provokes the desire, but takes away the
performance." [Macbeth. 2.3. 9]
Hysteria is described in
Hamlet, Prince of
Denmark where Ophelia, Hamlet's fiance exhibits typical
symptoms of hysteria over the death of her father and the
separation of Hamlet. Claudius describes it thus "divided from
herself" [Hamlet. 4.5.54].
Despite Shakespeare's interest in medicine, his works
give the impression that doctors were not held in high esteem
in those days. He did show doctors in poor light in some of
his plays, though in one he caricatured a doctor as a buffoon.
In many instances he has passed mild but categorical criticism
of doctors thus:
"Trust not the physician:
His antidotes are poison,
And he slays more than you rob."
[Timon of Athens. 4.3. 433 -434]
Shakespeare's knowledge of medicine and diseases was vast and
he has portrayed most of the common illnesses of his time in
his various plays. Suffice it to say the genius in him has
been the source of inspiration to generations of students who
still find newer and newer literary gems hidden in many of his
plays.
What is given above is only a very short review of the myriads
of conditions described in his works and an in-depth study of
medical conditions referred to by Shakespeare would be a
Herculean task by itself.
(
I fondly dedicate this short article to the memory of
my beloved teacher, Professor MG Sahadevan, who was
instrumental in inculcating in me a love for Shakespearean
literature)
References
1. Fu KT. The healing hand in literature: Shakespeare
and surgery. Hong Kong Med J. 1998. 4 : 77-88.
Selected Bibliography
1. Stearns CW, Shakespeare's Medical Knowledge. New York
Appleton 1865.
2. Field R. Medical Thoughts of Shakespeare, Easton PA:
Andrews 1885.
3. Kail AC. The Medical Mind of Shakespeare. Balgowlah
NSW. William and Wilkins. 1986.
4. Simpson RR. Shakespeare and Medicine. Edinburgh.
Livingstone. 1959.