WILLY THE SHAKE

By Allan M. Lansing, M.D
Presented to the Innominate Society
January 13, 1970

My talk tonight is about "Willy the Shake", the central character in a popular rock and roll song of a few years ago, but perhaps better known to Innominate Society members by his real name of William Shakespeare.  Shakespeare, who lived from 1564 to 1616, was a genius whose knowledge of every phase of human life was staggering.  It is perhaps enlightening to see that life was as troubled in Shakespeare's time as it is today.  Turmoil and wars were common and his words strike a familiar ring today in this time of international strife.  "The time is out of joint" [Hamlet I, 5]; all lands are overwhelmed by "grim-visag'd war" [Richard III, I, 1]; our hearts are "As full of sorrows as the sea of sands" [Two Gent. of Verona IV, 3]; "Each new morn new widows howl, new orphans cry, new sorrows strike heaven on the face.” [Macbeth IV, 3].

His works contain numerous references of a medical nature and it has been said that he possessed a knowledge far in advance of the members of the profession in his time.  On the other hand, critics have maintained that he knew no more than any old woman of the period could have told him.  Perhaps the truth lies somewhere between these two extremes, and a careful perusal of his literary works indicates that this great author must have had a deeper insight into biological and medical phenomena than one would have expected in the ordinary layman.  To be fair, Shakespeare's knowledge of the medical sciences must be viewed in the light of the practice of his contemporary physicians. Medicine was just emerging from chaos and licensure had just been introduced.  The Royal College of Physicians was founded in 1518, less than 50 years before his birth.  The surgeons and the barbers had been united by an act of Parliament in 1540.  Harvey first mentioned his ideas of the circulation in the week preceding Shakespeare's death and did not publish this discovery until 12 years later.  Hippocrates and Galen were still powerful influences in medical thought and as late as 1603 the College of Physicians in the University of Paris exhorted all physicians that they "constantly continue in the doctrine of Hippocrates and Galen.”

Shakespeare was familiar with the different pharmaceutical preparations used by the physicians of his time and with their modes of administration as well.  In the plays he alludes to balsams, catap1asms, caud1es, c1ysters, infusions, mixtures, oils, pills, plasters, potions, poultices, slaves, simples and syrups.  However, he understood fully the limited value of drugs, as is evident from this statement:

#1            By medicine life may be prolong'd,

yet death will seize the doctor too.

[Cymbeline V, 5]

Likewise the same idea is evident in the following conversation between the sleepless Henry IV and Warwick, as they discuss the martial ills of England:

#2            King: Then you perceive the body of our kingdom

How foul it is; what rank diseases grow,

And with what danger, near the heart of it.

Warwick: It is but as a body yet distemper'd,

Which to his former strength may be restor'd

With good advice and little medicine.

[II Henry IV, III, 1]

But the occasional need for active treatment by potent drugs or radical surgery is not overlooked, as in the lines:

#3            Diseases, desperate grown, by desperate

appliance are reliev'd or not at all.

[Hamlet IV, 3]

In Shakespeare's day, two favored forms of active treatment were bleeding and purging, which were frequently used to excess.  They are mentioned in several places.  Says the Archbishop in Henry IV, Part 2:

#4            We are all diseases and with our surfeiting

and wanton hours have brought ourselves into

a burning fever, and we must bleed for it.

[II Henry IV, IV, 1]

Similar advice is given by Biron in the lines:

#5            A fever in your blood!  Why then incision

would let her out in saucers; sweet misprison!

[Love's Labour's Lost IV, 3]

The saucer or blood porringer was the vessel in which the blood was collected during the operation of venepuncture.  It held a little more than three ounces and therefore provided a means for estimating the quantity of blood that escaped from the patient. 

In another passage, the author suggests the substitution of purgation for bleeding:

#6            Let's purge this choler without letting blood:

This we prescribe, though no physician;

Deep malice makes too deep incision.

Forget, forgive; conclude and be agreed:

Our doctors say this is no month to bleed.

[King Richard II, I, l]

This quotation also illustrates the belief that bleeding was particularly desirable at certain seasons; spring and autumn had been the approved times since the days of Hippocrates.

In the field of internal medicine, Shakespeare demonstrated his knowledge of diagnostic measures, prognosis, and of the symptoms and treatment of diseases such as scurvy, scrofula, syphilis, starvation, and infectious diseases.  Our modern diagnostic laboratories were represented in Shakespeare's time by water-casting.  This was the practice of recognizing diseases by the mere inspection of the urine without seeing the patient.  Shakespeare was apparently rather skeptical about this technique as shown by the reply of the page when Falstaff asks:

#7            Sirrah, you giant, what says the doctor to my water?

Page:  He said, Sir, the water itself was a good healthy water; but, for the party that owned it, he might have more diseases than he knew for.

[II King Henry IV, I, 2]

This was undoubtedly an honest opinion, quite at variance with the doctrines of the old "piddle-doctors" who pretended to recognize all diseases from the appearance of the urine only.  This type of examination is used as a medical simile in regard to the illness of a country.  Thus Macbeth exclaims:

#8        If thou couldst, doctor, cast the water of my land, find her disease, and purge it to a sound and pristine health, I would applaud thee to the very echo, that would applaud again - Pull't off, I say - What rhubarb, senna, or what purgative drug, would scour these English hence?

[Macbeth V, 3]

Water-casting is alleged to have arisen from ecclesiastical rulings against the medical vocations of the clergy.  The priests and monks who were unable to visit their former patients are said to have resorted to the practice of divining their maladies and directing the treatment upon simple inspection of the urine.  The custom then became a rather widespread form of quackery and an old statute of the Royal College of Physicians denounced water-casting as belonging to tricksters and imposters, and any member of the College was forbidden to give advice upon the mere inspection of the urine without also seeing the patient. 

One of the more common signs of scurvy is swelling of gums with its accompanying hemorrhage.  As you know, the disease is due to a deficiency of foods containing Vitamin C and Shakespeare demonstrated his knowledge of this in the following quotation:

#9            Friend, you must eat no white bread;

if you do, your teeth will bleed extremely.

[Two Noble Kinsmen III, 5]

While we think of scurvy as being the greatest danger that early American time explorers had to face, it was by no means confined to ships and sailors.  It was so prevalent ashore in the middle ages that the term London disease was given to it.  John Woodall [1569-1643], who lived during Shakespeare's time, suggested the use of lime and lemon juice in the treatment of scurvy, a custom which still survives in the Royal Navy today in the form of a daily free issue of lime juice in the tropical climate.  This custom has naturally given rise to the term "Limey" as applied first to English sailors and then to Englishmen in general.

Shakespeare was an expert on syphilis and a whole thesis could be composed about his references to this disease.  It was a frequent disease in his time and the symptoms were familiar.  Common names for the condition were the pox, the French disease, morbus gallicus, and the Neapolitan disease.  For a brief poetical description of the physical evils wrought by syphilis, there is nothing comparable to that uttered by Timon of Athens when he urges two mistresses to go forth and ply their trade of prostitution for the destruction of man:

#10            Consumptions sow

In hollow bones of men; strike their sharp shins,

And mar their spurring. Crack the lawyer's voice,

That he may never more false title plead,

Nor sound his quillets shrilly: hoar the flamen,

That scolds against the quality of the flesh,

And not believes himself; down with the nose,

Down with it flat; take the bridge quite away

Of him that, his particular to foresee,

Smells from the general weal: make curl 'd-pate

ruffians bald:

And let the unscarr'd braggarts of the war

Derive some pain for you; plague all;

That your activity may defeat and quell

The source of all erection.

[Tremon of Athens, N, 3]

The pathology referred to in this outstanding clinical description would appear to be syphilitic osteitis, tabes with lightning pains and impotency, syphilitic laryngitis or aneurysm with involvement of the recurrent laryngeal nerve, destruction of the nasal bones and cartilage, syphilitic alopecia, pain during the invasion and development of the disease, and finally loss of the power of erection from spinal neural syphilis. 

There were establishments or hospitals in which special treatment was given to syphilitics:

#11            …to the spital go,

And from the powdering-tub of infamy

fetch forth the lazar kite of Cressid's kind.

[King Henry V, II, 1]

#12            News have I, that Nell is dead i’ the spital

of malady of France.

[King Henry V, V, 1]

The word "spital" is probably an abbreviation of hospital but it may also be applied to places in which treatment by fumigations, baths and inunctions was given to victims of syphilis, and it is possible that the frequent salivation and spitting from the abuse of mercury may have had something to do with the origin of the name. 

The methods of treatment referred to are those of a high protein diet, sweating, and the powdering tub.  The patient was placed in a tub or barrel and exposed to the fumes from powder of cinnabar (mercury sulfide), which when thrown upon a hot plate would volatilize and condense in the form of a powder upon the body of the individual.  These aspects of treatment are represented in the next two quotations:

#13            Troth, Sir, she hath eaten up all her beef

and she is herself in the tub.

[Measure for Measure II, 2]

#14            …bring down rose-cheeked youth to the tub-fast

and the diet.

[Timon of Athens, IV, 3]

An interesting bit of medical lore relates to a condition known in Shakespeare's time as “King's evil” and later called scrofula, a type of tuberculosis of the cervical lymph glands.  This disease was named the King's evil on account of the supposed power of cure which was invested in the physical touch and prayers of the King.  This method of treatment was first introduced by Edward the Confessor in 1058 and continued until William III, who refused to apply it.  Queen Anne resumed the practice but King George I put an end to it.  During the 20 years following 1662, it is said that upwards of 100,000 persons were touched for their malady, but the number of cures is not recorded: this sounds like the forerunner of the present day Houston series!  A description of the disease and the treatment are included in Macbeth:

#15            Comes the king forth, I pray you?

Doctor: Ay, sir; there are a crew of wretched souls

That stay his cure.  Their malady convinces

the great assay of art; but at his touch,

Such sanctity hath heaven given his hand,

They presently amend.

Malcolm: I thank you, doctor.

Macduff: What's the disease he means?

Malcolm: 'Tis called the evil;

A most miraculous work in this good king,

Which often, since my here-remain in England,

I have seen him do.  How he solicits heaven,

Himself best knows; but strangely-visited people,

All swollen and ulcerous, pitiful to the eye,

The mere despair of surgery, he cures,

Hanging a golden stamp about their necks,

Put on with holy prayers; and 'tis spoken,

To the succeeding royalty he leaves

The healing benefiction.

[Macbeth IV, 3]

The golden stamp referred to was a neckpiece which at first was only a penny, but in 1505 Henry VII introduced the practice of giving a golden coin called an angel.  So many came for the "touching" that the court physicians had to be used as medical examiners to determine who were really sick and who were impostors seeking only the gold piece.  It was probably these economical considerations that led to its discontinuance by King George I, and before this William III regarded the ceremony as a silly superstition and practiced it after much urging on only one occasion when his gruff and rather impious benefiction to the sufferer was "God give you better health and more sense!"

In another field, that of metabolism, the following quotation reveals all extraordinary comprehension of the metabolism during starvation:

#16      I sup upon myself, and so shall starve with feeding. [Coriolanus IV, 2]

This statement is in accordance with present-day physiological teaching that first the reserve supplies of carbohydrate are used up, then the heart and central nervous system live upon the fat and muscles of the rest of the body.  These two "noble" tissues are subsisting upon all the others and it is therefore biologically correct to say that during starvation one feeds upon oneself.  Obviously, such a relationship cannot go on for long and so the individual actually starves while feeding.

…I sup upon myself, and so shall starve with feeding. [Coriolanus IV, 2]

Evidently Shakespeare also understood something about the undesirability of obesity for in Love’s Labour’s Lost appear these observations:

#17            Fat paunches have lean pates;

and dainty bits make rich the ribs,

but bankrupt quite the wits.

[Love's Labour's Lost I, 1]

He also had rather judicious views regarding dietary habits at a time when over-eating was common, as for example:

#18            For aught I see, they are as sick that surfeit

with too much, as they that starve with nothing.

[Merchant of Venice I, 2]

As far as public health was concerned the dramatist believed in air as a prominent form of transmission of disease:

#19            What, is Brutus sick,

And will he steal out of his wholesome bed

to dare the vile contagions of the night,

and tempt the rheumy and unpurged air

             to add unto his sickness.

[Julius Caesar II, 1]

He describes isolation as a method for limiting the spread of infection:

#20            Pursue him to his house and pluck him thence;

Lest his infection, being of catching nature spread further.

[Coriolanus ill, 1]

In this case the patient was forcibly removed from his own dwelling and shut up in a pest house, but in another instance the suspected individual was interred in the infected dwelling:

#21            The searchers of the town suspecting that we

             both were in a house where the infectious

             pestilence did reign, seal'd up the doors,

             and would not let us forth.

[Romeo and Juliet V, 2]

References of a purely surgical nature are relatively infrequent.  The lesions specified include wounds and scars, fractures, dislocations, abscesses, boils and carbuncles, wens, gangrene, fistula and harelip.  Surgical treatment by incision, amputation, cautery and the use of tents and setons is alluded to.  Owing to the character of many of the plays, the injuries of warfare are featured rather prominently.  The art of surgery was in a very primitive state, yet the skill of the surgeon was sought:

#22            Let me have a surgeon; I am cut to the brains.

[King Lear IV, 6]

#23            Have by some Surgeon, Shylock, on your charge,

To stop his wounds, lest he do bleed to death.

[Merchant of Venice IV, 1]

#24            With the help of a surgeon he might yet recover.

[Midsummer Night's Dream V, 1]

Fantasy since it is from Midsummer Night's Dream!

Tents were the precursors of surgical drains and consisted of a roll or pledget of some soft absorbent material, often medicated.  They conveyed medicine into wounds and kept them open so as to permit healing from the bottom outward.  Examples of references to tents include:

#25      Hector: The wound of peace is surety, surety secure; but modest doubt is called the beacon of the wise,

the tent that searches to the bottom of the worst.

[T. and C. II, 2]

#26            Patroclus: Who keeps the tent now?

Thersites: The surgeon's box, or the patient's wound.

[T. and C. V, 1]

The following manifestation of Shakespeare's intimate acquaintance with the principles of surgery might well be accepted as a surgical aphorism:

#27            This festered joint cut off, the rest rests sound;

This let alone, will all the rest confound.

[King Richard II, V, 3]

A premonition of neurosurgery is reflected in these lines from Macbeth:

#28            …The time has been, that, when the brains were out,

the man would die,

And there's an end; but now they rise again.

[Macbeth III, 4]

What plastic surgeon's mouth would not water at this description of rhinophyma:

#29      …one Bardolph, if you Majesty knows the man: his face is all bubukles, and whelks, and knobs, and flames 0' fire; and his lips plows at his nose, and it is like a coal fire, sometimes blue and sometimes red.

[Henry V, III, 5]

To the ophthalmologist Shakespeare may be conveying the picture of a cataract by the term "pin and web" as in:

#30            Wishing all eyes blind with the pin and web,

but theirs, theirs only, that would unseen be wicked. [Winter's Tale I, 2]

The term "sand-blind" was meant to express a dimness of sight as if sand had been thrown in the eyes, but the allusion might signify trachoma:

#31             0 heavens, this is my true-begotten father!

Who, being more than sand-blind, high-gravel blind,

knows me not.

[Merchant of Venice II, 2]

That Shakespeare recognized goiter and knew of its greater frequency in certain mountainous districts is suggested by the following reference:

#32             …There were mountaineers dew-lapp’d like bulls,

whose throats had hanging at them wallets of flesh.

[The Tempest III, 3]

Having recognized the diseases of the thyroid gland, the following line could be a description of exophthalmos:

#33             How have mine eyes out of their spheres been fitted.

[119th Sonnet]

Nowhere is Shakespeare's knowledge of medical diseases better illustrated than in the fields of neurology, psychology, and neuropsychiatry.  Several of the characters in the plays are represented as being mentally unbalanced in one way or another, and a psychiatrist would be quite capable of diagnosing the psychotic traits exhibited by Hamlet, Ophelia, Macbeth, Lady Macbeth, Othello, and King Lear to mention only a few.

Julius Ceasar seems to be the only true epileptic and his seizures are described as follows:

#34            Casca: He fell down in the marketplace,

and foamed at mouth, and was speechless.

Brutus: 'Tis very like; he hath the falling sickness...

Casca: ...when he came to himself again, he said,

If he had done or said anything amiss, he desired their worships to think it was his infirmity.

[Julius Caesar I, 2]

Othello was also portrayed as a victim of the disease and his alleged seizure was also described:

#35            My lord is fallen into an epilepsy;

This is his second fit, he had one yesterday.

Cassio: Rub him about the temples.

Iago: No, forbear; the lethargy must have his quiet course: If not, he foams at mouth; and by and by, Breaks out to savage madness.

[Othello IV, i]

Any writer might observe the physical signs of a fit, but to be aware of the mental confusion preceding and following it signifies a special understanding.

The following quotation describes the development of manic-depressive insanity. Polonius speaks of Hamlet as follows:

#36             And he, repulsed, (a short tale to make),

Fell into a sadness; then into a fast;

Thence to a lightness; and by this declension,

Into a madness, wherein now he raves.

[Hamlet II, 2]

Visual hallucinations are vividly described in Macbeth’s speech:

#37             Is this a dagger which I see before me?

The handle towards my hand. Come! let me clutch thee: I have thee not and yet I see thee still,

Art thou not, fatal vision, sensible to feeling

As to sight? or art thou but a dagger of the mind,

A false creation proceeding from the heat-oppressed brain?  I see thee yet in form as palpable as this which now I draw.

[Macbeth II, 1]

While we think of psychotherapy and psychoanalysis as quite modern, the dialogue between Macbeth and his wife's physician shows that the principles were understood many years ago:

#38             Macbeth: How does your patient, doctor?

Doctor: Not so sick, my Lord, as she is troubled

with thick coming fancies that keep her from her rest. Macbeth: Cure her of that.  Canst thou not minister to a mind diseased; pluck from the memory a rooted sorrow; raze out the written troubles of the brain; and, with some sweet oblivious antidote, cleanse the stuff'd bosom of that perilous stuff, which weighs upon the heart?

[Macbeth V, 3]

The doctor humbly replies:

#39            Therein the patient must minister to himself.

[Macbeth V, 3]

In Shakespeare's time insane persons were free to wander, unless they were kept chained up.  The treatment of mentally ill persons in his era is reflected in the lines:

#40             Not mad, but bound more than a madman is,

Shut up in prison, kept without food,

'Whipp'd and tormented.

[Romeo and Juliet I, 2]

Shakespeare apparently felt that this treatment was cruel and even seemed to have had a vision of more modern humane methods when he proposed to:

#41            Fetter strong madness in a silken thread,

Charm ache with air, and agony with words.

[Much Ado About Nothing V, 1]

Multiple references to obstetrics include premature births, quickening, deformity of the fetus, death of the fetus and its retention in utero, retarded labor from deformity of the child, strangulation by the umbilical cord, foot presentation, cesarean section, and twin births.  In the field of pediatrics one problem is rather charmingly described, that is the difficulty of weaning children.  Apparently Juliet was provided with a wet-nurse, and continued breast-feeding until she was three years old.  She was only induced to stop nursing when wormwood was applied to the nipple, a procedure that greatly displeased the little girl.  Her nurse describes the event several years later:

#42             Come Lammas-eve at night shall she be fourteen;

I remember it well. . . . . . . . . . . .

'Tis since the earthquake now eleven years;

And she was weaned, - I never shall forget it, -

Of all the days of the year, upon that day,

For I had then laid wormwood on my dug.

When it did taste the wormwood on the nipple

Of my dug, and felt it bitter, pretty fool,

To see it tetchy and fallout with the dug.

[Romeo and Juliet I, 3]

My time is up, and the references are legion.  I would like to close by suggesting that in view of his wisdom, acuteness of observation, and extensive knowledge of the medical illnesses and practices of the time, the name of William Shakespeare be proposed posthumously for fellowship in the Royal Society of Medicine, honoris causa.