1. THE HARDEST KNIFE ILL-USED:

Shakespeare's Tremor


The real mystery of Shakespeare, a thousand times more mysterious than any matter of the will, is: why is it that—unlike Dante, Cervantes, Chaucer, Tolstoy, whomever you wish—he makes what seems a voluntary choice to stop writing?
—Harold Bloom
In Shakespeare's tomb lies infinitely more than Shakespeare ever wrote.
—Herman Melville, "Hawthorne and His Mosses"
Twenty years he lived in London … Twenty years he dallied there between conjugal love and its chaste delights and scortatory love and its foul pleasures.
—James Joyce, Ulysses
His fitful fever returned. Master Shakespeare pulled the hood of his cloak down low over his eyes and hurried from his lodgings in Bishopsgate, walking as quickly as he could on his hobbled legs. He awkwardly dodged a pair of rambling pigs and picked his way through the dung and muck of the city streets. The stench and filth rarely troubled him now, as they had when he first came here from the country. Nearer the bridge, the clamor of the city increased: the clatter of carts, the cries of street peddlers, the gossip of alewives, the drunken braggadocio of London gallants. A black-clad Puritan surveyed the scene sourly and made brief eye contact with Will. The player hung his head and balled his hands into fists—to hide the telltale rash on his palms.
London Bridge was marvelous and strange, a massive structure built over with splendid houses. With relief he entered the dark, claustrophobic tunnel beneath the dwellings. Inside, a continual roar of noise: the tidal rush of water between the ancient piers; waterwheels creaking; apprentices brawling; carters disputing the right-of-way; a blind fiddler playing; sheep bleating on their way to Eastcheap, bound for slaughter. He left the shelter of the bridge, and emerged into painful sunlight on the other side. His shins throbbed and his muscles ached. In spite of himself, he peered up at the great stone gate at the end of the bridge, adorned with traitors' heads on pikes. Shreds of moldy flesh clung to the grinning skulls, their tattered hair bleached by sun and rain.
In Southwark, he heard the barking mastiffs and the howling crowd at the Bear Garden. He imagined old Sackerson the bear bellowing, lashing out with his claws, chained to a post, set on by dogs. A glimpse of ragged children playing in an alley filled him with thoughts of home and a pang of loneliness and shame. Before a row of brothels he saw a scabby beggarwoman with sunken nose and ulcerated shins. After years of faithful service in the stews, she has been turned out in the street to die of the pox. A chill of fear ran up his spine, and he looked away.
There was a pounding in his head and he felt dull and stupid. He circled many times through a maze of flyblown houses before he stumbled on the place. A servant showed him down a set of stairs. The bard descended into a hot cellar reeking of sulfur. A vast oven filled the room with flickering orange light. The sweaty heads of groaning men peered out from large wooden tubs. But the tubs were not filled with water. A sallow and emaciated man carrying iron tongs scurried round, feeding hot bricks into the tubs through a trapdoor. He poured vinegar onto the heaps of bricks and acrid steam rose up, making the glistening men within moan and shake.
The doctor suddenly appeared beside Will, startling him. He was sleek and prosperous, with a dainty goatee. Though he smiled reassuringly, the poet noticed that he kept a safe distance. In a soothing, urbane voice, the physician explained the treatment: stewed prunes to evacuate the bowels; succulent meats to ease digestion; cinnabar and the sweating tub to cleanse the disease from the skin. The doctor warned of minor side effects: uncontrolled drooling, fetid breath, bloody gums, shakes and palsies. Yet desperate diseases called for desperate remedies, of course.
Shakespeare extended a handful of silver coins. The physician took them with a gloved hand, scrutinized them carefully, and put them in his purse with the hint of a smirk. He pointed Will toward the skinny, pallid man tending bricks at the great oven. When the poet looked round again, the doctor had vanished.
The gaunt man tending the bricks was not quite right in the head. His hands shook, and he seemed both timorous and irritable. When he saw the poet's rash, he cackled and slobbered, revealing a mouth full of rotten teeth. "Bit by a Winchester goose, eh? Ha-ha! A few good sweats will fix that, my lad. Into the powdering tub with you, then!"
The poet stripped and stood ashamed, his flesh covered in scaly blots. He nervously clambered over the side of a tub, and sat down on a plank nailed to the side. Under the plank, the wooden bottom had been removed, leaving an earthen pit. The queer thin man clumsily secured a heavy lid over the top of the tub, leaving an opening just large enough for the poet's head. Then he popped open the trapdoor at the base of the tub and placed a hot metal plate at the poet's feet. He tossed red powder on the plate. The dust disappeared in a mephitic bloom of hissing fumes. The doctor's man repeated this again and again, until Will began to gag. A fine metallic powder settled on his body. The thin man piled hot bricks into the pit under the seat, and doused them with vinegar. As the acid waves of steam billowed upward, the bard started to tremble and sweat. This week would not be a pleasant one.
* * *
Even those who know little about Shakespeare are aware that there is a sort of controversy about the authorship of his plays. A vocal and eccentric minority doubts that a man of Shakespeare's background could possess literary genius, and speculates his plays were really written by an aristocrat who wished for some reason to remain anonymous. This belief rests on two snobbish and mistaken assumptions: first, that a great deal of formal education is essential for great writing; and second, that creativity depends on wealth and comfort. A good case could be made that the exact opposite is true. Many great authors were largely self-taught, and either did not attend university or dropped out. Furthermore, a dose of youthful misery may help a writer by serving as a powerful stimulus to fantasy and imagination. A recurrent biographical pattern in great writers is a happy early childhood, followed by an adolescence made insecure by financial catastrophe, the loss of a parent, or other traumas. Such was the case with William Shakespeare.
Shakespeare was born in April 1564, in the market town of Stratford. We know almost nothing about his mother Mary, but quite a lot about his father. John Shakespeare combined something of Falstaff's wit and rascality, Kent's stubbornness and loyalty, and Lear's feckless ill judgment. He made a lawful fortune from the glove trade, and an illegal one from usury and black market wool dealing. His fellow citizens liked him well enough to elect him the town's bailiff, an office akin to that of mayor today. However, the gossamer prosperity of the Shakespeares unraveled in William's teenage years, as John ran afoul of the law and lost much of his money and his lands. Elizabethan England was something between a modern constitutional monarchy and a police state. Spies and informers enforced religious orthodoxy and an oppressive system of trade regulations and monopolies. John Shakespeare was fined heavily, not only for his shady business practices, but also for his repeated failures to attend Protestant services, one of several signs that the family were probably closet Catholics.
If John Shakespeare once hoped to send his brilliant oldest son to get a gentleman's university education, near bankruptcy now made this impossible. Young Will would have studied Latin and rhetoric in the local grammar school until the age of fifteen or sixteen, probably getting more formal education than Dickens, Yeats, or Herman Melville would receive. He then may have served as a tutor in a noble Catholic household in Lancashire. By age eighteen, he was back in Stratford and hastily wed to Anne Hathaway, twenty-six years old and two months pregnant at the time of the marriage. According to tradition, Will toiled in his father's glove shop, and might also have moonlighted as a scrivener or a law clerk. Anne gave birth to the couple's daughter Susannah in May 1583, followed by the twins, Hamnet and Judith, in February 1585. Shortly thereafter, Shakespeare went to seek his fortune in London. According to a durable—if somewhat dubious—Stratford legend, Shakespeare was whipped for poaching deer on the lands of one Sir Thomas Lucy, a notorious persecutor of local Catholics. Will made matters worse by posting a lampoon of Lucy on his park gate, and fled town one step ahead of Lucy's thugs.
London was home to a burgeoning and intensely competitive theater scene. Some playwrights were college graduates; others, such as Shakespeare, Kyd, and Jonson, were not. Shakespeare's quick success, rural origins, and lack of a university degree made him the natural target of jealous attacks from the University Wits. These included Robert Greene, George Peele, and that great spendthrift of language, Thomas Nashe, a trio as noted for their depravity as for their abundant literary talents. All three would soon be dead. Their enemies blamed their passing on the pox, or syphilis, the dread disease that became a Shakespearian obsession.
By the early 1590s, Shakespeare had obtained the patronage of Henry Wriothesley, the Earl of Southampton. Wriothesley was an effete dandy of flexible sexuality, with a penchant for poetry. Both of Shakespeare's racy, best-selling narrative poems, Venus and Adonis and The Rape of Lucrece, are dedicated to him. The dedication for Lucrece, published in 1594, suggests that by then Shakespeare and Southampton were on familiar terms: "The love I dedicate to your Lordship is without end … what I have done is yours; what I have to do is yours." According to Shakespeare's earliest biographer, Nicholas Rowe, Southampton once presented Shakespeare with £1000, a staggering (and almost certainly exaggerated) sum of money. Thus, by the time Shakespeare was middle-aged, he had achieved substantial wealth and fame. However, his success was blighted by the death of his only son Hamnet in 1596, and perhaps also by a serious health scare that may have left deep marks on his writing.
D. H. Lawrence was struck by how saturated some of Shakespeare's work is with venereal disease: "I am convinced that some of Shakespeare's horror and despair, in his tragedies, arose from the shock of his consciousness of syphilis." Anthony Burgess was probably the first commentator with the effrontery to suggest that Shakespeare himself had syphilis. In his novel Nothing Like the Sun, Burgess depicted the poor bard as a pocky cuckold. He later characterized Shakespeare as having a "gratuitous venereal obsession," an observation subsequently echoed by scholars Katherine Duncan-Jones and Harold Bloom.
References to syphilis in Shakespeare are more abundant, intrusive and clinically exact than those of his contemporaries. For example, there are only six lines referring to venereal disease in all seven plays of Christopher Marlowe. However, forty-three lines in Measure for Measure, fifty-one lines in Troilus and Cressida, and sixty-five lines in Timon of Athens unequivocally allude to syphilis and other sexually transmitted diseases (STDs).
References to syphilis and STDs are not uniformly distributed throughout Shakespeare's plays. In his first fourteen plays, up to The Merchant of Venice in 1596, there is an average of only three lines per play on venereal disease. (Most of these occur in The Comedy of Errors, dated from 1592–3, which contains twenty-three lines referring to STDs.) In the next twenty plays, from 1597's Henry IV Part 1 to Cymbeline in 1609, there is an average of fifteen lines per play. The final four plays, The Winter's Tale, The Tempest, Henry VIII, and Two Noble Kinsmen, average less than two lines per play referring to syphilis and other STDs. (These last two plays are generally accepted as being roughly equal collaborations between Shakespeare and John Fletcher.)
Could Shakespeare's mid-career explosion of syphilitic content be explained by a general increase in bawdry on the Jacobean and late Elizabethan stages? Perhaps, but this would not explain why Shakespeare takes up the subject of syphilis in the early play Comedy of Errors, only to drop it and return to it with a vengeance later on. Of course, Shakespeare's interest in syphilis does not mean that he was personally infected. Shakespeare would be well aware of the effects of syphilis on London's literary bohemia of the 1590s, just as an observer of the New York arts scene of the 1980s would be unpleasantly familiar with the ravages of AIDS. But is there evidence that Shakespeare's own lifestyle put him at risk for syphilis?
Shakespeare's marriage to Anne Hathaway was marked by long periods of separation. For most of their life, Will lived and worked in London, while Anne was home in Stratford. They had no children after 1585, when Anne was only twenty-nine. Perhaps this was related to obstetrical complications from the birth of the twins, but it might also suggest that their sexual congress was infrequent. Infamously, he bequeathed her only the "second-best bed." (Despite the ingeniously benign explanations of Shakespeare's biographers, it is hard to believe that the supreme master of the English language intended this as anything other than a sly, final insult.) Away from home, did Shakespeare expend much energy seeking better beds? In a 1602 diary entry, a law student, John Manningham, recorded this salacious anecdote about the playwright and the actor Richard Burbage:
Upon a time when Burbage played Richard the Third, there was a citizen grew so far in liking with him that before she went from the play she appointed him to come that night unto her by the name of Richard the Third. Shakespeare, overhearing their conversation, went before, was entertained, and at his game ere Burbage came. Then message being brought that Richard the Third was at the door, Shakespeare caused return to be made that William the Conqueror was before Richard the Third.
Even if this story seems too clever to be true, it suggests Shakespeare enjoyed a popular reputation as something less than a paragon of marital fidelity. Shakespeare's high sexual alertness is also borne out by his robust ribald vocabulary. In Shakespeare's Bawdy, Eric Partridge defines 1418 sexual or vulgar expressions in the works of Shakespeare, in a glossary of over 200 pages. Shakespeare's amorous reputation is further reinforced in the Sonnets, and especially in a peculiar poem entitled Willobie His Avisa, published in 1594.
Willobie His Avisa purports to be an earnest moral tract about a virtuous wife who spurns the advances of her would-be seducers. The book was popular and went through several printings, probably because it was actually a literary hoax and satire of the sexual mores of prominent Elizabethans. Authorities found it subversive, and enhanced its scandalous cachet by confiscating and burning copies of it in 1599.
The origins of Willobie His Avisa are obscure. In the book's introduction, one Hadrian Dorrell claims to have found the manuscript of Avisa in the bedchamber of his friend and fellow Oxford student Henry Willobie. Willobie is away on military service, and Dorrell is so impressed with the epic poem that he cannot resist preparing it for publication. Needless to say, there is no record of a Hadrian Dorrell having attended Oxford at this time, although there was a real Henry Willobie (or Willoughby) at Oxford, who conveniently died in 1596. It remains unclear whether Willobie was the real author of Avisa, whether he was the butt of a sophomoric prank, or whether he was only a handy stalking horse for the actual author.
Various failed suitors of Avisa are mocked in the first half of the poem. For example, "Caveleiro," who may represent an Elizabethan noble with the equestrian moniker of Sir Ralph Horsey, is ridiculed as syphilitic: his "wanny cheeks" and "shaggy locks" make Avisa "fear the piles, or else the pox." The second half of the poem concerns the vain attempts of "H. W." to woo Avisa. H.W. is given cynical romantic advice by a man expert in the arts of seduction, the "old player" "W.S.," his "familiar friend." In this passage, the passion of H.W. for the chaste Avisa is described in vocabulary evocative of venereal disease:
H.W. being suddenly infected with the contagion of a fantastical fit … at length not able any longer to endure the burning heat of so fervent a humor, betrayed the secrecy of his disease unto his familiar friend W.S. who not long before had tried the courtesy of like passion, and was now recovered of the like infection … he now would secretly laugh at his friend's folly, that had given occasion not long before unto others to laugh at his own … he determined to see whether it would sort to a happier end for this new actor, than it did for the old player. But at length this Comedy was liken to have grown to a Tragedy, by the weak and feeble estate H.W. was brought into … until Time and Necessity, being his best physicians brought him a plaster, if not to heal, yet in part to ease his malady. In all which discourse is lively represented the unruly rage of unbridled fancy, having the reins to rove at liberty, with the diverse and sundry changes of affections and temptations, which Will, set loose from Reason, can devise …
The pointed references to a "new actor," an "old player," "Comedy," "Tragedy," "Will," and a doggerel parody of Shakespeare that follows, strongly suggest that the "old player" is William Shakespeare. Could H.W., the "new actor," be Shakespeare's pansexual patron, Henry Wriothesley? If Wriothesley, one of the kingdom's most prominent nobles, had been the major target of the book's satire, this would explain why the Elizabethan authorities were compelled to burn it. The overbearing medical metaphor, and the striking word choices, "contagion," "disease," "burning," "infection," and "malady," intimate that the "weak and feeble" Wriothesley and Shakespeare are suffering from a sexually transmitted infection, rather than the pangs of unrequited love. "Having the reins to rove at liberty" suggests "running of the reins [kidneys]," Elizabethan slang for gonorrhea.
The eminent Shakespearian scholar Samuel Schoenbaum was perplexed by Willobie His Avisa, but did allow that "this curious work seems to have something to do with the Sonnets … one can appreciate the temptation to identify ‘W.S.' with William Shakespeare, and ‘H.W.' with Henry Wriothesley, the proposed Fair Youth of the Sonnets." The scenario in Avisa—Shakespeare and Southampton in love with the same woman, with the innuendo that she has infected them both with venereal disease—is remarkably similar to the love triangle, and the obsession with sexual pollution, of Shakespeare's Sonnets.
Four hundred years later, critical and popular opinion is still sharply divided on Shakespeare's dense, knotty Sonnets. Are they confessional and autobiographical? Is Shakespeare just flattering a vain and wealthy patron? Is he riffing with emotion and personae in a series of consummate poetic performances? Or do the Sonnets contain elements of all these possibilities?
The Sonnets can be divided into three parts. In the first seventeen sonnets, the lovely youth is urged to marry and procreate; perhaps the youth's family, who were trying to get him to agree to an arranged marriage, commissioned these poems. Such a circumstance would apply to both of the leading candidates for the lovely youth: Southampton and William Herbert, the Earl of Pembroke. Sonnets 18–126 concern the poet's passionate attachment to the callous and selfish youth. (The homoerotic drift of these poems has inspired many comically defensive assertions of Shakespeare's manliness by critics and biographers.) The final poems, Sonnets 127–154, chronicle the poet's sexual enslavement to his dark mistress, who is cruel, capricious, unfaithful, unbeautiful, and infected with venereal disease.
The Sonnets are filled with imagery of sin, infection, and defilement: the word "disgrace" occurs nine times; "shame" appears fourteen times. Sexual transgression lies at the heart of the Sonnets. The poet and his mistress are lustful and sexually voracious (Sonnets 129, 135, and 151, the "gross" sonnet); hypocritical enemies accuse the poet of promiscuity (Sonnet 121). The lovely youth is also sexually reckless. In Sonnet 35, the poet forgives the youth for his "sensual fault." In Sonnets 40–42, it is made clear that the youth has been sleeping with the poet's mistress, leading the masochistic poet to respond: "Take all my loves, my love" (Sonnet 40). In Sonnet 94, the fair youth is sternly warned of the dangers of venereal disease: "But if that flower with base infection meet/The basest weed outbraves his dignity … lilies that fester smell far worse than weeds." This admonition is repeated in Sonnet 95, where the youth's "sins" and lascivious "sport" are associated with cankers, spots, and blots. The poet closes with a priapic warning: "The hardest knife ill-used doth lose his edge."
In Sonnet 144, the poet frets that his "better angel," or "a man right fair," will be "fired out," or venereally infected, by his "bad angel," or "female evil." The Sonnets conclude with two variations on a classical theme: a nymph igniting the waters of love with Cupid's stolen torch. Shakespeare transforms this into an ironic metaphor for venereal disease: Cupid's "fire" is the dysuria, or painful urination, of gonorrhea, and the hot bath is the tub treatment of syphilis. In Sonnet 153, the poet, "a sad distempered guest," seeks this "seething bath, which yet men prove/Against strange maladies a sovereign cure." Specifically, the poet seeks a remedy for the "new fire" acquired from his "mistress' eye." Here, the "eye" of his mistress is her pudendum. In Sonnet 154, the unfortunate poet laments, "Love's fire heats water," or causes burning urine, leading him to seek "a bath and healthful remedy/For men diseased." This bath—as we have seen—was the treatment of choice for a terrifying new epidemic disease: syphilis.
The source of syphilis, a devastating infection caused by the spiral bacterium Treponema pallidum, has long been controversial. Witnesses of the epidemic that swept Europe in 1495 believed it was a "new disease." Most agreed that it had come to Europe with Columbus' crew on their return from Hispaniola in 1493. Recent studies support this tradition. Investigators found no traces of syphilis in several thousand fifteenth-century European skeletons. However, up to 14 percent of skeletons from pre-Columbian sites in the Dominican Republic (in the former Hispaniola) had signs of syphilitic bone damage. If syphilis came from the New World, it was a small revenge on the Europeans, who brought measles, malaria, mumps, typhoid, typhus, influenza, diphtheria, yellow fever, and most fatally, smallpox to American shores. The combined effects of these European plagues nearly wiped out the Native Americans. For a while, it looked like syphilis might do the same for Europe.
In 1494, the daft Charles VIII of France invaded Italy with a motley army of international mercenaries. The French rolled through Italy with little difficulty until they reached Naples. The Spanish defenders of Naples had brought syphilis to Italy with them, and allegedly practiced a novel form of germ warfare. According to the eponymous anatomist Gabriel Fallopius, the Spaniards "drove their harlots and women out of the citadel, and especially the most beautiful ones, whom they knew to be suffering from the infectious disease … and the French, gripped by compassion and bewitched by their beauty, took them in." The French soon had cause to regret their compassion. When the vastly outnumbered Spanish surrendered Naples without a fight on February 22, 1495, the French lost themselves in drunkenness and debauchery. In a few months, Charles's magnificent army disintegrated into a diseased rabble. The French were defeated at the battle of Fornovo in July 1495, and Charles lost both his looted treasures and his Italian kingdoms. His troops were left with only the pox. On their ignominious return to their native lands, the syphilitic soldiers of fortune set off a global pandemic. The great pox soon spread to every nation in Europe. Syphilis came to India with Vasco de Gama as early as 1498, and by 1512 it had spread as far as Osaka, Japan. (Charles VIII died three years after his retreat from Italy, but not from syphilis. He smashed his head into the stone lintel of a doorway while rushing to a tennis match.)
Despite its globetrotting status, syphilis may be "the most disowned infection in history." The Russians blamed it on the Poles, and the Poles blamed it on the Germans. The Germans, the English and the Italians blamed it on the French, and called it the French disease. The French called it the Neapolitan disease, and blamed it on the Italians. In Japan and India, they blamed it on the Portuguese, while the Portuguese, the Dutch, the Belgians, and the Moroccans agreed to blame it on the Spanish. The Spanish shrugged and called it the malady of the Indies, or the bubas, after the nasty skin sores it produced.
The term "syphilis" was not used in English until the nineteenth century. Shakespeare calls syphilis "the pox," "the malady of France," "the infinite malady," "the incurable bone-ache," "the hoar leprosy," "the good-year" or "the goujere," and "Winchester goose." (London's red-light district in Southwark was once under the jurisdiction of the Bishop of Winchester, an episcopal pimp who profited from licensing its prostitutes. A lady of the evening was known as a Winchester goose, a term that came to refer to the pox as well.)
Because of its protean manifestations, syphilis has been called "the great imitator." William Osler, the godfather of internal medicine, said that he who knew syphilis, knew medicine: "Know syphilis in all its manifestations and relations, and all other things clinical will be added unto you." Syphilis has three phases. In primary syphilis, the patient develops a "hard chancre," a genital ulcer with a firm raised border, about two weeks after infection. (Hard chancres may also appear in the mouth or rectum after oral or anal sex.) Today, chancres are usually painless, although in Shakespeare's time, they could be agonizingly painful and highly aggressive, even leading to penile auto-amputation. Although there are no definite references to genital chancres in Shakespeare, the "embossed sores" of As You Like It (2.7.67) and the "cankers" in the Sonnets are suggestive.
Once the invading army of spirochetes makes its beachhead in the chancre, they multiply explosively over subsequent weeks, leading to secondary syphilis. The patient has severe flu-like symptoms: high fever, joint pain, swollen lymph nodes, loss of appetite, headache, and neck pain. But the hallmark of secondary syphilis is a copper-colored rash over the entire body, including the palms and soles. This rash is usually flat and scaly (squamous), but may be pustular. The hair on the scalp, beard, and eyebrows may become thin and mangy; the inside of the mouth may ulcerate; warty lesions known as condylomata lata may blossom about the anus and genitalia. Condylomata lata resemble hemorrhoids, and were popularly known as the "piles." A catalog of the secondary manifestations of syphilis in Troilus and Cressida (5.1.17–23) includes "raw eyes" (syphilis can attack any of the structures of the eye), "limekilns in the palm" (the scaly palmar rash of secondary syphilis), and "bone-ache" (inflammation of the surface of bone, or periosteum). Bone pain from the pox was common in Shakespeare's time, and could keep sufferers awake all night. The shins were a typical location, as noted in Timon's curse from Timon of Athens (4.3.151–3):
Consumptions sow
In hollow bones of man; strike their sharp shins,
And mar men's spurring.
If allowed to progress, syphilis reaches its late or tertiary stage. It may involve any organ in the body, though physicians are probably most aware of its propensity to attack the cardiovascular system—causing aortic aneurysms—and its fondness for the central nervous system. It can cause strokes, dementia and insanity (general paresis of the insane), as well as damage to the spinal cord (tabes dorsalis). Shakespeare refers to another classic manifestation of neurosyphilis in Measure for Measure (1.2.101–2). Pompey the pimp notes that Mistress Overdone has "worn [her] eyes almost out in the service" because of syphilitic atrophy of the optic nerve. The syphilitic develops relentless loss of peripheral vision, an effect described as "squinting down the gunbarrel sight."
Another form of tertiary syphilis, gummatous syphilis, attacks skin, connective tissue, and bones. Gummatous syphilis is rare today, but it was the most common, violent, and destructive form of syphilis in Shakespeare's time. Its effects were gruesome: "Large rounded tumors [gummas] start to appear at random in muscles or bones, eating away cavities within them … they ulcerate the body extensively, exposing the bones and eating away at the nose, the lips, the palate, the larynx, and the genitals." The gravedigger in Hamlet (5.1.159–62) explains how busy he is burying patients with gummatous syphilis that are "rotten before they die": "We have many pocky corpses now-a-days, that will scarce hold the laying in." Mad Timon calls for syphilis to rot the lawyer's larynx, "that he may never more false title plead," and to flatten the noses and "take the bridge quite away" of speculators that sniff out profits at society's expense (Timon, 4.3.153–9).
Gummatous syphilis was so widespread that it spawned a new and lucrative branch of medicine: dermatology. Shakespeare accurately describes many of the great variety of syphilitic skin lesions. In Comedy of Errors (3.2.137–8), a woman of dubious beauty and virtue has "her nose all o'er embellished with rubies, carbuncles, sapphires." Shakespeare is referring to the syphilid of late syphilis, a "deep indurated nodule that varies from pinhead to pea size and is brownish red in color," found primarily on the face, upper back, and extremities. Lesions of nodular syphilis may also scale and produce plaques, mimicking psoriasis. This white, frost-like appearance may explain Shakespeare's use of the term "hoar leprosy" for syphilis in Timon (4.3.36), with a pun on "whore." Alopecia, or hair loss, is also common in advanced syphilis. Timon calls on syphilis to "make curl'd-pate ruffians bald" (Timon, 4.3.160). Shakespeare often jokes about "French crowns," a type of gold coin, but also baldness from the French disease. Perhaps, in all this jesting about hair loss and the pox, the follicularly-challenged Shakespeare was having a nervous laugh at his own expense.
Death from syphilis was common in Elizabethan England. Of course, no antibiotics were available in Shakespeare's time, but it also seems that syphilis was then a more fulminant infection. Older strains of Treponema pallidum may have been more virulent than those circulating today. The lack of immunity in the population probably contributed to the disease's rapid spread and worse outcomes. Poor hygiene increased the risk of syphilitic ulcers becoming infected with streptococcal and staphylococcal bacteria, while poor nutrition, and a higher prevalence of scurvy and other vitamin deficiencies, may have aggravated the damage done by spirochetes.
The Renaissance mind struggled to comprehend this terrifying new epidemic. Although the transmission of syphilis by sex (and less commonly, by nonsexual body contact with infected skin ulcers) was well understood in Shakespeare's time, germ theory didn't really emerge until the nineteenth century. (Some doctors came close to formulating a germ theory, but lacked the practical tools to develop it, such as the microscope.) Theories abounded. The syphilis epidemic was blamed on everything from the inauspicious conjunction of the heavenly bodies (Timon calls upon a "planetary plague" to bring the pox to Athens in Timon of Athens, 4.3.117), bad air and evil humors, and that old favorite of fundamentalists ancient and modern, divine punishment of human wickedness.
By the sixteenth century, the French disease was rife in England, especially in the boisterous merchant city of London. As syphilis waxed and leprosy faded away, London's leper houses were converted to care for victims of the great pox. (The decline of leprosy in Europe is something of a historical medical mystery. Did the cruel policy of isolating lepers gradually end disease transmission? Did natural selection reduce the number of susceptible individuals in the population? Did the epidemics of bubonic plague that swept Europe preferentially kill off the weaker lepers? Did the rise of tuberculosis, caused by a related bacterium, confer immunity to leprosy to those who survived exposure?) In 1548, surviving records indicate that 24 percent of the patients of St. Bartholomew's Hospital in London, now known as Bart's, were syphilitic; by 1579, the royal physician William Clowes claimed that up to 75 percent of the patients at Bart's had the French disease.
The low standard of sexual morality in Shakespeare's London abetted the spread of the pox. Times were tough in the final years of Elizabeth's reign. The population surged, wages sunk, and poverty drove thousands of women into the world's oldest profession. Brothels abounded in the London suburbs and across the river in Southwark. Illegitimate births spiked between 1590 and 1610. Prostitutes, and even "gentlewomen virgins," sought male attention with dresses that bared their nipples. Conditions were ideal for the rapid spread of an STD that went by many names.
In his work, Shakespeare echoed the conventional wisdom that syphilis was relentless and untreatable. Troilus and Cressida (5.1.22) refers to syphilis as the "incurable bone-ache," and Timon of Athens (3.7.97) as the "infinite malady." Despite this popular perception, hazardous but reasonably effective treatment for syphilis was available in Shakepeare's England.
In 1539, the Spanish physician Ruy Diaz de Isla observed that high fevers often halted the progression of syphilis and might even cure the disease. The reason why was only recently discovered: not only does Treponema pallidum lack a protective feature known as the heat shock response, but at least one key metabolic enzyme is highly heat sensitive. A prolonged high spike in body temperature in a syphilitic patient may cause Treponema pallidum to literally blow apart.
Elizabethan physicians treated syphilis with a diet of bland, easily digested foods, with mercury, and most effectively, with the sweating treatment. Shakespeare often associates syphilis with stewed prunes: pocky patients were forbidden to eat raw fruit, but could "broil in … broths prunes, raisins of the sun, and currants" to purge the bowels. In Timon of Athens (4.3.87–8), Timon urges Alcibiades' harlots to "bring down rose-cheeked youth/To the tub-fast and diet." In the sweating treatment, several methods were used to raise the patient's body temperature for as long as he or she could stand it. These included being swaddled in blankets and surrounded by heated bricks or stones; being immersed in a scalding bath; or the tub treatment with mercury steam, as described in the introduction. In Measure for Measure, Mistress Overdone's name derives not only from her innumerable sexual encounters, but also because she is "overdone" from too many sessions in the sweating tub. In Cymbeline (1.6.126), prostitutes are "boiled stuff"; in Timon of Athens (2.2.68), a madam's clients are "chickens" waiting to be scalded. In Henry V (2.1.73), Falstaff's mistress Doll Tearsheet sits in "the powdering tub of infamy." The "powder" is the mercury ore cinnabar (mercuric sulfide, HgS). Thrown onto a hot plate and volatilized to mercury vapor, it was absorbed into the body by the respiratory tract; some mercury vapor also condensed on the skin.
For a long time, mercury treatment was the standard of care for syphilis, despite side effects of nerve damage, diarrhea, rotten gums, loose teeth, and uncontrolled drooling. Salivation was used as a barometer of effectiveness. Savvy physicians adjusted the mercury dose to produce three pints of saliva a day for two weeks. The toxicity of mercury varies, depending on its chemical form, route of administration, and dose. Organic forms of mercury, such as the industrial waste product methylmercury, are the most hazardous to human health. Inorganic forms of mercury, such as cinnabar and the obsolete medication calomel, are moderately dangerous. Pure elemental mercury, or liquid quicksilver, is the least poisonous. Whopping doses of quicksilver by mouth were once used as a treatment for severe constipation; it pushed out stool by sheer force of weight. In most patients, quicksilver was excreted in the feces unchanged, and toxicity was mild. There are cases on record of patients drinking up to four pounds of liquid mercury, without lasting ill effects.
However, liquid mercury becomes highly toxic when it evaporates, as mercury vapor is readily absorbed by the lungs. During the Napoleonic Wars, the sailors of the HMS Triumph salvaged 130 tons of quicksilver from a Spanish man-of-war that had run aground. This plunder proved deadly. The liquid mercury had been poured into leather bags, which were packed into kegs, which were stowed in strongboxes. But the damp leather bladders rotted and burst, the quicksilver seeped out of the the barrels and boxes, and soon several tons of mercury were sloshing about the holds of the Triumph. A slimy film of mercury amalgam formed on the ship's copper and brasswork. Quicksilver fouled the biscuits, which had to be thrown overboard. The ship became a floating deathtrap, especially for those on the poorly ventilated lower decks, where the air was full of mercury vapor. Mouths swelled and ulcerated, teeth fell out, jaws rotted, faces became gangrenous. Able-bodied sailors became shambling, trembling, paralytic wrecks. Even the rats and cockroaches died before the ship limped back into port.
Despite its nasty side effects, mercury was used to treat syphilis well into the twentieth century. Whether it did any good is unclear. Leonard Goldwater, a modern toxicologist, called the medicinal use of mercury a colossal hoax. Mercury is probably mildly helpful for the skin lesions of syphilis, but relapse rates are high, and it fails to prevent neurosyphilis. The use of mercury for syphilis finally ended when it was shown to be clearly inferior to the first modern antibiotic, Paul Ehrlich's arsenic compound salvarsan.
Aside from the obvious dangers of injecting people with arsenic, salvarsan had one major limitation: it also did not reliably prevent neurosyphilis. However, two doctors in the nineteenth century who treated syphilitic Austrian army officers noted that neurosyphilis did not develop in officers who developed a high fever from another infection, such as malaria, erysipelas, typhoid, or pneumonia. Drawing on this observation, an Austrian psychiatrist named Julius Wagner-Jauregg had a creative, risky idea. Why not treat syphilitics by deliberately giving them other infections to cause high fevers? Wagner-Jauregg tried injecting strep bacteria at first, but this seems to have killed off too many patients. In 1917, he hit on using a moderately dangerous strain of malaria (specifically, Plasmodium vivax) to produce several weeks of recurrent high fevers, followed by quinine treatment to rid the patient of malaria. This treatment, known as malariotherapy, cured many patients with neurosyphilis, while only dispatching a mere 9 percent of those treated. Wagner-Jauregg became the first (and only) psychiatrist to win the Nobel Prize in Medicine.
By the 1940s, though, doctors had realized that neither malaria nor arsenic were ideal treatment for syphilis. Incredibly, the Elizabethan treatment of syphilis—external heating—was revived, albeit with a more high-tech spin. Fever cabinets were devised, employing radiant light, electrical diathermy, or shortwave radio as heat sources. However, neurosyphilis was also still successfully treated with hot baths of 110°F (43.3°C) to raise body temperature to 105–106°F (40.5–41.1°C) for one hour daily for two to three weeks. These alternative forms of fever therapy were more controllable than malaria and had a mortality rate of only 1 to 2 percent. Thus, before penicillin, the treatment of syphilis evolved little beyond Shakespeare's "seething bath."
If Shakespeare was a philanderer, in keeping with his reputation, he would have been at high risk of syphilis and other sexually transmitted infections. Moreover, both the Sonnets and Willobie His Avisa seem to tell the same story: Shakespeare and another man share the same mistress, who infects them both with venereal disease. However, if Shakespeare had developed syphilis, his outcome would likely have been better than that of many of his contemporaries. He was all too aware of the symptoms of syphilis, and had the financial means to get access to treatment. Twentieth-century experience suggests that fever therapy for syphilis was reasonably effective, making it less likely that Shakespeare died of syphilis. Moreover, it seems implausible that Shakespeare could have produced a steady stream of works of genius, or occasionally acted in major productions, such as Ben Jonson's Sejanus in 1603, if he was suffering from the disfiguring ravages of syphilis.
Syphilis, gonorrhea, and herpes simplex were frequently confused in Shakespeare's day, as many people were infected with more than one venereal disease. Syphilis and gonorrhea were wrongly regarded as different manifestations of the same disease. The Scottish surgeon John Hunter perpetuated this confusion. In a misbegotten experiment in 1767, Hunter inoculated his own member with gonorrheal pus. Unfortunately, his source patient had both syphilis and gonorrrhea, and Hunter contracted both conditions. More sensibly, but less ethically, Benjamin Bell, another pugnacious Lowland Scot, subsequently conducted a series of equally awful experiments on his medical students, finally establishing that syphilis and gonorrhea were different diseases.
However, Shakespeare could not have known this. His repeated references to "fire" and urinary symptoms in the Sonnets suggest that perhaps he only had gonorrhea, which is more likely to cause dysuria than syphilis. If he was not also infected with syphilis, then he might have received sweating therapy and mercury unnecessarily. Either way, his experience of illness likely had psychological repercussions.
The seventeenth-century writer John Aubrey made contradictory comments on Shakespeare's demeanor, based on interviews with his acquaintances. Aubrey stated that Shakespeare was a "handsome, well-shap't man: very good company," but also scribbled that he "was not a company keeper," and "wouldn't be debauched, and if invited to writ that he was in pain." There are several potential explanations for this discrepancy. Aubrey, or his informants, may have gotten their information wrong. Or perhaps Shakespeare had a mercurial personality, and suffered from mood swings or bipolar disorder. Did he become depressed after Hamnet's death? Did some other momentous event change Shakespeare from the merry seducer of Manningham's diary to the withdrawn loner of Aubrey's jottings? And could that event have been related to the uptick in references to venereal disease in his work?
Up to 85 percent of patients with venereal disease suffer psychological symptoms, including anger, anxiety, depression, and sexual dysfunction. Psychological side effects of STDs are especially common when patients feel guilty about promiscuity, homosexuality, or extramarital sex. Today's AIDS patients often shoulder a heavy psychological burden, but depressive symptoms and sexual dysfunction are common today even in patients with less menacing STDs, such as herpes. Perhaps the withdrawal described by Aubrey, and the misogyny that crops up in Hamlet and Lear, were psychological aftershocks of venereal disease.
Alternatively, Shakespeare's preoccupation with venereal disease could have been due to an overactive imagination, rather than a physical ailment. Infectious diseases physicians occasionally see patients who believe they have a sexually transmitted disease, despite every reassurance to the contrary. Typically, they are sensitive young men with obsessive-compulsive tendencies—sometimes from strict religious upbringings—who become guilt-wracked after an adulterous episode, a gay encounter, or sex with a prostitute. They are convinced they have AIDS, despite having no trace of HIV in their bloodstream; they obsess about nonexistent penile sores; their urine still burns after multiple courses of antibiotics, and multiple negative tests for gonorrhea and chlamydia. I do not think this is the most likely reason for Shakespeare's obsession with syphilis, but it is worth mentioning, as English physicians did report cases of venereal disease phobia in the seventeenth century, when syphilis was as terrifying and relentless as AIDS was in the 1980s.
If Shakespeare did undergo a personality change, there is one other potential explanation. To understand this more fully, we will need to examine Shakespeare's need for help in completing his last plays, and the problem of his deteriorating handwriting.
Collaboration in playwriting was common in Shakespeare's time. Perhaps Shakespeare got his start this way; the early plays, especially the three parts of Henry VI, may show traces of other hands besides Shakespeare's. Yet while the mature Shakespeare was occasionally called in to help salvage other plays—much like a modern Hollywood script doctor—he showed little inclination to seek help with his own. One of the striking features of the Sonnets is Shakespeare's confidence in his own poetic ability, no matter what setbacks and humiliations assail him in his personal life. Why, then, does Shakespeare enlist the aid of John Fletcher in his final three plays, Henry VIII, Two Noble Kinsmen, and the lost Cardenio? It cannot be because he had lost his gift. While his late style was increasingly idiosyncratic, he was still capable of writing poetry of startling originality and power. It is unfair to compare the intricate and masterful verse in Shakespeare's share of Two Noble Kinsmen, his last play, with Fletcher's featherweight portion. The gap between his writing and Fletcher's in these plays must have been painfully obvious to Shakespeare, and it is hard to believe he would not have completed these works himself, had he been able.
It is also surprising that Shakespeare sought outside help for his final plays, as they held particular importance for him. In Henry VIII, Shakespeare examines the squalid roots of the English Reformation, and portrays Henry as heartless and shallow. Even in the reign of King James, this was dangerous territory. There may be payback here: the Protestant reforms of Henry VIII indirectly brought Shakespeare's Catholic father to the brink of bankruptcy, thus ruining young Will's hopes to attend university and advance to the status of a gentleman. Two Noble Kinsmen, a tale of cousins who become mortal enemies, is Shakespeare's pessimistic final word on warring humankind. According to his biographer Park Honan, "he looks for what is valid, worthy, or possible in human nature, and comes at last to a darkening … yet at the end of Noble Kinsmen in Theseus's speeches, Shakespeare perhaps implicitly gives thanks for life itself." It seems unlikely that Shakespeare farmed out work on such personally resonant plays out of indifference.
A better explanation for Shakespeare's reliance on Fletcher is that he was physically unable to finish them without help. Perhaps Shakespeare lacked the stamina for sustained writing because of depression, alcohol, or illness, or perhaps he struggled with a handicap that hampered his ability to write. Surviving samples of Shakespeare's handwriting give us a clue as to what might have gone wrong.
The only medical fact known with certainty about William Shakespeare is that his handwriting deteriorated in his last years. There are six signatures by Shakespeare that are agreed to be authentic. Three of these are found on the will that he signed a month before he died, in March 1616. The signature of the first page of his will has been badly degraded by time, and is almost illegible. The signature on the second page is slow, shaky, and tortuous. The worst of his signatures occurs on the third and final page of the will. It reads "By me William Shakspeare" (Shakespeare, like many Elizabethans, was not particular about the spelling of his name). The "William" of this signature is neat and elegant, and looks unlike those of Shakespeare's other signatures, including the clumsy one on the preceding page. Perhaps some kindly clerk or scrivener, watching the poet struggle with his quill, tried to help him out by writing the first three words, leaving only the "Shakspeare" to be filled in. This final "Shakspeare" starts hesitantly but legibly, before tailing off into an unintelligible scribble.
The other three Shakespeare signatures date from 1612–13, and are better than those of the will. However, they are "somewhat nervous," marred by inkblots, and lack the ease and elegance of the one other sample that we have of Shakespeare's handwriting. This is the so-called "Hand D" from the manuscript of Sir Thomas More, written primarily by Anthony Munday in 1592–3. Not surprisingly, this play about the iconic English Catholic and martyr ran afoul of Elizabethan censorship, and four different playwrights were called in to help patch it up. The three pages in Hand D are Shakespearian in style and tone, have the bard's typical spelling quirks, and the handwriting resembles those of the signatures. The Oxford edition of Shakespeare's works dates his contribution to 1603–4, although other scholars, including Ernst Honigmann, believe Hand D dates back to 1593–4. Honigmann has argued that the misreading errors common in the early printed versions of many of the later plays, including Othello, Hamlet, and Lear, are a direct result of "a general deterioration in Shakespeare's writing." If Honigmann's hypothesis is correct, Shakespeare's handwriting gradually worsened beginning at age thirty-six, when he wrote Hamlet in 1600, until his death at age fifty-two in 1616. Perhaps his handwriting difficulties were related to the fall in his writing output after 1603, from averaging two new plays per year to only one.
Why would Shakespeare have had shaky handwriting? Parkinson's disease is intriguing, but seems unlikely. For one thing, it was not described until after the Industrial Revolution (it is sometimes blamed on as-yet unidentified pollutants). Furthermore, patients with Parkinson's disease have tiny handwriting (micrographia), whereas Shakespeare's tremulous writing is normal in size. Writer's cramp has been invoked, but this is also doubtful. Patients with writer's cramp primarily suffer from muscle spasm, although they can have mild tremor as well. True writer's cramp is a disease of professional scribes (it was originally known as scrivener's palsy) who write for long hours on a daily basis. This does not seem to have been Shakespeare's pattern of composition. He seems to have written in short frantic bursts ("he never blotted out a line," as Ben Jonson sourly observed), with more leisurely periods of revision.
Another possible cause of Shakespeare's worsening handwriting is essential tremor, a common condition that affected the late Katharine Hepburn. Its age of onset is often in the mid-thirties, which matches the age when Shakespeare's handwriting began to deteriorate. Essential tremor worsens with stress and exertion, and can impair handwriting. Patients often find that alcohol alleviates essential tremor. They may dabble in alcohol as self-medication, which might fit with the tales of Shakespeare's drinking that circulated in Stratford in the decades after his death.
To complicate matters, alcohol itself can damage the cerebellum and produce an intention tremor—a tremor that worsens while the patient is engaged in a task. There is some evidence for intention tremor in Shakespeare's writing: his signatures are legible at the beginning, but undecipherable at the end. While the cause of Shakespeare's tremulous handwriting cannot be known with certainty, there is one more diagnosis that would be consistent with an intention tremor, social withdrawal, and treatment for venereal disease: mercury poisoning.
Mercury poisoning was common in Shakespeare's time. Sir George Carey, patron of Shakespeare's acting company from 1597 to 1603, developed tremor, mental torpor, and weight loss after mercury therapy for syphilis. John Webster refers to mercury poisoning in his 1612 play The White Devil (1.2.27–8), where Camillo is described as "a gilder that hath his brains perished with quicksilver." Mercury poisoning was an occupational hazard of gilders, who used quicksilver in the manufacture of gold leaf; in the context of the play, the insinuation is that the balding and licentious Camillo has mercury poisoning from syphilis treatment.
Chronic poisoning with mercury vapor has three major manifestations: intention tremor, gingivitis (gum disease), and a constellation of personality changes known as erethism. Erethism was first described in hatters, who used mercuric nitrate solution in the making of fine felt, leading to the expressions "hatter's shakes" and "mad as a hatter." (Felt was once made by treating fur with camel urine, or with more readily available human urine. Supposedly, mercury came to be used when it was realized that exceptionally lustrous felt resulted from the use of urine from a hatter who was being treated for syphilis with mercury, which he was excreting in his urine.) Personality changes in hatters included timidity, social phobia, and irritability. The word erethism is derived from the Greek word for red, from the tendency of the patient to blush in embarassment. Perhaps erethism explains why Shakespeare was no longer a "company keeper."
THE MERCURY POISONING OF SIR ISAAC NEWTON
Isaac Newton, that other great universal genius that England has produced, suffered from a prolonged episode of paranoia, insomnia, and social withdrawal in 1693, when he was fifty years old. Old friends came under attack: the virginal Newton accused the philosopher John Locke of trying to "embroil me with women." In addition to his pioneering work in physics and mathematics, Newton was also an enthusiastic alchemist. His months of derangement coincided with a period of absorption in chemical experiments, during which he would stay up late and even fall sleep in his fume-filled laboratory. Mercury use in alchemy was ubiquitous, and Newton once joked that his prematurely gray hair was due to quicksilver exposure. Testing of surviving samples of Newton's hair have shown poisonously high levels of mercury. One hair showed 197 parts per million (ppm) of mercury, compared to typical modern values of less than 1.4 ppm. Newton set aside alchemy, and recovered to become Master of the Royal Mint and President of the Royal Society, although his eccentricities and occult speculations increased. Reassuringly, he calculated that the end of the world would come no sooner than A.D. 2060.
The severity of mercury poisoning is directly related to the intensity of exposure. If Shakespeare was treated just once for syphilis, he probably had only a moderate degree of mercury exposure. This may not have had any immediate effects on his nervous system. However, an intention tremor from mercury exposure may only appear years after exposure, as the effects of aging unmask prior damage to the brain. This is consistent with the gradual worsening in Shakespeare's handwriting as he gets older. Mercury vapor does not usually affect cognition and intelligence unless exposure is particularly severe. It is tempting to speculate that the tangled syntax and "clotted verse" of Shakespeare's last plays was somehow related to mercury exposure, but this may just represent a natural evolution into greater stylistic complexity with age.
Shakespeare's death was probably not directly related to syphilis or mercury. According to Stratford lore, Shakespeare died of a fever contracted after a drinking bout. Perhaps this was typhoid: the death rate was unusually high in Stratford that spring, and the Avon River basin was endemic for typhoid even into modern times. Evidence from the plays suggests that Shakespeare was familiar with typhoid fever. Dr. Abraham Verghese has noted that Falstaff's fatal illness is a classic depiction of the characteristic "muttering delirium" of typhoid. (This condition can also be seen with other infections, however, and is not diagnostic of typhoid fever.)
Shakespeare's obsession with syphilis in the plays and Sonnets—and the contemporary gossip about his promiscuity—provides circumstantial evidence that he may have had an STD. The Elizabethan sweating treatment for syphilis could be surprisingly effective in curing syphilis, given Treponema pallidum's exquisite sensitivity to heat. However, Shakespeare might have been cured of syphilis only to be poisoned by mercury vapor, eventually leading to a tremor and personality changes. Shakespeare's suppressed rage at this experience may surface in plays such as Timon of Athens and Troilus and Cressida and certain of the Sonnets. However, it appears that Shakespeare's unusually large capacity for empathy enabled him to overcome his bitterness and anger. His final plays, which he may have physically struggled to complete, are characterized by a mood of acceptance and reconciliation, and a lessened preoccupation with sexual pollution. Perhaps Shakespeare's chancre ultimately enlarged his understanding of the moral complexities of character and circumstance, and increased his sympathy and tolerance for the failings and weaknesses of others.


Copyright © 2012 by John J. Ross