The Science of Shakespeare (42 page)

Fig. 12.1
This depiction of an anatomy lecture, including the dissection of a human corpse, dates from the early 1580s. (Note the prominence of the book, likely the writings of the second-century A.D. Greek physician Galen.)
The Bridgeman Art Library, London

Finally there were the apothecaries and midwives, lower still in the social ranks than either physicians or surgeons. Like the surgeons, apothecaries learned their craft via apprenticeship. They could fill prescriptions given by a physician; and since they charged less than either physicians or surgeons, they were more readily accessible.

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 fever. 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.