Elizabethan Medicine

Shakespeare Unlimited: Episode 55 

 
Being a patient in Shakespeare’s time was an adventure. You might be told to drink liquid gold or syrup of violets.  You might undergo a violent purgation to take the bad humors out of your body. They might draw blood from your ankle or your arm.  But while these prescriptions seem laughable today, elements of the thinking they were based on have come all the way down to us in the 21st century.  That thinking, though it might seem unrelated to Shakespeare's stories, is surprisingly present in his writing.
 
Neva Grant interviews Gail Kern Paster and Barbara Traister about medicine in the era when Shakespeare was writing. Gail Kern Paster is the Folger’s director emerita, and Barbara Traister is professor emeritus of English at Lehigh University and the author of The Notorious Astrological Physician of London: Works and Days of Simon Forman.
 
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From the Shakespeare Unlimited podcast series. Published August 23, 2016. © Folger Shakespeare Library. All rights reserved. “I Know My Physic Will Work With Him” was produced by Richard Paul. Garland Scott is the associate producer.  It was edited by Gail Kern Paster and Esther Ferington. Esther French is the web producer. We had technical help from the News Operations Staff at NPR in Washington, DC.

Interested in learning more about Elizabethan medicine? Read our blog post at Shakespeare & Beyond.

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Transcript

MICHAEL WITMORE: From the Folger Shakespeare Library, this is Shakespeare Unlimited. I’m Michael Witmore, the Folger’s director.

This podcast is called "I Know My Physic Will Work with Him." In addition to being home to the world’s largest Shakespeare collection, the Folger also houses a huge assortment of other rare books and manuscripts about the world in which Shakespeare lived and wrote—books on early modern politics, exploration and trade, and the subject of this podcast, medicine.

Being a patient in Shakespeare’s time was an adventure. You might be told to drink liquid gold or syrup of violets. You might undergo a violent purgation to take the bad humors out of your body. They might draw blood from your ankle or your arm with leeches. But while these prescriptions seem laughable today, elements of the thinking they were based on have come all the way down to us in the 21st century. That thinking, though it might seem unrelated to Shakespeare’s stories, is surprisingly present in his writing.

Considering all of this, we brought in two guests to take a look at medicine in the era when Shakespeare was writing. One is my predecessor in this job, the Folger’s Director Emerita Gail Kern Paster. Along with her extensive knowledge of Shakespeare’s work, Gail has an abiding interest in how the Elizabethans understood the physical world, along with metaphysics, and their impact on the functions of the human body. Along with Gail is Barbara Traister, professor emerita of English at Lehigh University. Barbara is an authority on the life and work of Simon Forman, whose case notes are the earliest surviving records of an English medical practitioner. Barbara and Gail are interviewed by Neva Grant.

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NEVA GRANT: I want to imagine that I’m waking up in Shakespeare’s time and I feel sick. I’m not feeling well, maybe a little flu-ish. What would my options be, Barbara?

BARBARA TRAISTER: Well, you might want to think a couple of times before you went to anyone, and I think probably people got pretty sick before they went to a doctor. But if you were wealthy, you could call in a member of the College of Physicians, men who were certified as licensed for medicine in London. But, if you were not of the upper classes and didn’t have a lot of money, you would probably find a local practitioner, somebody called an empiric, who didn’t have a license, but who probably knew quite a bit about ordinary medical practice in the period.

GRANT: And then?

TRAISTER: Well, you’d have to take your urine with you, or if you were really sick and didn’t want to get out of bed, you could send somebody with your urine. You didn’t have to show up in person. There was very little physical examination. They would listen to your symptoms, or your courier could explain your symptoms.

GRANT: Your urine, the person… This was a job I didn’t even know existed, but your urine courier would explain on your behalf the symptoms that you had?

TRAISTER: Right, and all sorts of things. Some people used the time you got sick as an important marker, and they would cast an astrological horoscope. Now, other doctors did not use that as much, but some of the empirics, especially, did. And so you’d need to go with quite a bit of information, if you really wanted to get a good diagnosis.

GRANT: Because astrology was part of the practice of some medicine at that time?

TRAISTER: Almost everybody, including the doctors of the College of Physicians, used astrology, but they tended to use it more for timing medical doses—like you would take it, you know, at the full moon, or the quarter moon, or something like that. Some people actually diagnosed by casting a horoscope and trying to decide what the ailment was.

GRANT: Right, but there were a lot of different kinds of doctors at that time, just as there are today. So if I suddenly fell down the stairs and broke my leg, I wouldn’t go to one of the people that you have just described. I’d go to somebody entirely different, right?

TRAISTER: Right. You would go to, probably, a barber surgeon.

GRANT: Which sounds dangerous already.

TRAISTER: Well, they don’t always do surgery, but they do set bones. And of course, if you had a compound fracture and the bone was sticking out of the skin, then you might need a little bit of surgery if you broke your leg. But yes, people who required hands-on manipulation of the body, even a shave, often went to barber surgeons.

GRANT: And how well were they trained to do these things? And I’m not so worried about the shaving at this point—I’m worried about the setting of the bones.

TRAISTER: Well, a lot of it was by apprenticeship, a practice. You worked with somebody else. You learned from other people, by going with them, whether it was a midwife, or a physician, or a surgeon.

GRANT: Gail, I’d like to bring you into the conversation. Were there occasions where the person wouldn’t even venture out to see the doctor, but would, in fact, just be treated in their home?

GAIL KERN PASTER: Oh, absolutely. I mean, your home was really the first place of medical treatment, because women were really in charge of the care of their families—sometime, their neighbors. There would be often a woman in a village—let’s assume a rural setting. There would be a woman called a wise woman or a cunning woman, who really had taken on the task of being the local healer. She had recipes, she might have medicines in her home, so that if you couldn’t really be treated in the home, you would go to a neighbor. Again, you might go to the lady of the manor, the high-born lady of the area. We have diaries and casebooks from some such women, who really were as skilled as a lot of doctors were, because they took their responsibilities for taking care of local folks extremely seriously, and really had pretty substantial medicine cabinets in their homes.

GRANT: There were some clues about the way people got medical care from the notes of a gentleman named Simon Forman, who, in fact, Barbara, you wrote an entire book about, right?

TRAISTER: Yes, I spent a number of years of my life with Simon Forman.

GRANT: Who was not, in fact, a doctor, but he spent a lot of time looking after sick people.

TRAISTER: Yes, he was one of the empirics that I talked about before, who had no formal medical training, but he had read a lot, and he did a lot of practicing, sometimes on himself. He took some medicines and did some cures for himself, and if it worked on him, he figured it would work on other people. And so, he had developed some specialty things. A lot of doctors in the period were people who practiced medicine—I mean, maybe it’s even too strong to use the word "doctor" in the case of someone like Forman.

They would develop specialty things, which people would come to them for.

For example, Forman contracted the plague when he was fairly young and just starting out in his medical practice. He survived it, and he believed he survived it because he brewed up what’s called a strong water, a combination of ingredients, and he survived. And he got a huge reputation for being somebody who could help people who contracted the plague.

GRANT: And word must have travelled, word of mouth?

TRAISTER: I think to a degree, it did. It helped that he had, I think, an intuition that because he survived it once, he probably wouldn’t get it again. And so, when the really severe plagues hit, the ones that closed the theaters and were really terrible, he stayed in London and helped people during that period, practiced medicine. Whereas a lot of the more high-class doctors left, because, obviously, they were terrified of getting it themselves. And so, I think Forman’s reputation was enhanced by his willingness to stay and work with people.

GRANT: There’s some really graphic descriptions in your book of other things he did to rid people of various ailments. I mean, you know, pulling worms out of somebody’s neck, was it?

TRAISTER: Yeah, well that was a case I think of scrofula, which is a kind of tuberculosis of the neck. And if it’s really severe, the skin will erupt, and be raw, and sort of little holes, almost little tunnels, in the skin will appear, and I’ve always assumed that those worms… and he was very impressed with himself because he pulled out 86 in one person. I’ve always assumed those little worms were probably maggots, that a fly had gotten in and laid eggs in the raw skin, and he took those maggots out.

GRANT: How much time did you spend studying Simon Forman?

TRAISTER: Well, it took me about 17 years, I think, to do the book, but he left 40 volumes of manuscript.

GRANT: Right. That’s a lot of time to spend with worms, and pestilence, and bleeding, and leeches, and whatever else he had in his…

TRAISTER: Yes, he’s a character. I enjoyed it. He was an extraordinary personality.

GRANT: Gail, I’d like to turn to you, because there was sort of a prevailing theory of medicine at the time that we haven’t really touched on, but it had to do with the humors, right? And I think there were four of them.

PASTER: There were four humors that really characterized the tissue of every living thing—not just people, but animals and plants, all had humors. There was blood, phlegm, yellow bile or choler, and black bile or melancholy. And these are all, with one exception, these are real bodily fluids; blood, phlegm, choler, that’s produced by the gallbladder, and then melancholy, which in fact is not real, but they certainly thought it was real.

And they wanted four humors to match up with the four elements, and those humors had qualities of hot, cold, wet, and dry in combination. So blood was hot and wet, and melancholy was cold and dry, and in each person’s body, there was a particular individual balance of the humors. And so, if you were sick, one of the first aspects of diagnosis was to find out what kind of illness you had, whether it was an illness that was bred of too much cold and wet, or too much hot and dry.

If you were choleric or excessively choleric, you were too hot and too dry, and what do you do if you’re looking to heal that? And the answer is, you find a medicine that is cooling and moistening, and so you seek for a kind of balance of the humors.

GRANT: So earlier, Barbara mentioned the urine courier, who would bring a sample of urine to a physician—to an empiric or to a doctor. Would the urine or perhaps someone’s blood be analyzed to see what the balance of humors was?

PASTER: There’s a category of book at the Folger. The Folger Library has many books of early modern medicine and there’s several treatises of urine, and if you read the treatises of urine, which is actually sort of a hoot to do, you’ll discover that there are 21 colors of urine, and that they range in color from lemon yellow, to leek green, to a raven black. Raven black is…

TRAISTER: Very serious.

PASTER: Not a good thing, and so based on the color, often the color of the urine and also, of course…

TRAISTER: And they tasted it too, some of them did, too.

PASTER: There you go.

TRAISTER: There was actually a taste test, and that helped them, too.

PASTER: So the color, the limpidity, if it was clear, if it was cloudy. They would really make a diagnosis based on that, and then decide what the humoral result was and what to do about it.

GRANT: Well what’s so interesting about that? I mean you’re right, it is kind of a hoot, but also, I mean, they do analyses like that today, too. A doctor would probably look at the color of your urine to make kind of a, you know, a basic determination about your health, right?

PASTER: I think it’s wrong to think of this medicine as merely foolish. I mean, in other words, they looked for evidence where they could find it, and they were interested in the color of your urine. They were interested in the color of your blood. They were interested in your pulse.

TRAISTER: Yeah, given what they knew, and what they could know, they did a pretty good job. I mean, remember, they had no antibiotics. So even with wound care and things, they knew to keep it clean, they knew to keep it bandaged, but, of course, they weren’t antiseptic, and so a lot of it... There still was an enormous amount of infection and that kind of thing. But intuitively and by experience, they had managed to work out some pretty reasonable and sensible approaches to certain things.

GRANT: And, of course, William Shakespeare would’ve probably at some point in his life consulted a physician or an empiric and would certainly have known about the humors, right, Gail?

PASTER: Nobody failed to know about the humors. It just was part of the things you knew about the world. The fact is that Shakespeare’s son-in-law is a doctor, John Hall, and would that we had his casebooks, because if we had his casebooks, we would actually know what Shakespeare died of.

TRAISTER: We have a few cases, and he picked out... Often doctors, to advertise their skills, would pick out maybe half a dozen really impressive cases that they had dealt with. And we do have a list, I think, of six or eight of his cases, but not, certainly, of his father-in-law Shakespeare.

GRANT: But how did some of these medical theories and ideas that we’re talking about, how did they figure in to Shakespeare’s plays, Gail?

PASTER: If you’re interested in reading Shakespeare’s plays and getting some kind of sense of the humors from them, you’re going to look for the language of hot and cold, and wet and dry. In other words, it was those qualities that actually tended to govern behavior.

So, for example, take a character like Hotspur. What is Hotspur? His name tells us everything; that he is, in fact, a hot, choleric, impulsive, combative human being. And Hal, for example, in the same play, by contrast describes himself as a kind of phlegmatic; he talks about his idle humor. So that what you are looking for… Because the plays aren’t going to come out and say, Oh, by the way, we’re talking about the humors now. They’re going instead to simply use the language of their time to describe behavior as hot, or cold, or wet, or dry.

GRANT: Can you give me another example from another play?

PASTER: What the humors did, of course, was to create the character of your body and your mind. And so, for example, if you’re choleric, you’re going to be of a hot and dry, and therefore fairly hard and obdurate, kind of nature, and a very good example of such a character is Shylock. And so Shylock, when he is anxious to get his pound of flesh from Antonio in The Merchant of Venice is asked to be merciful, and he says no. He’s not going to be merciful. He has no interest in being merciful, and so his cruelty is described as being hard of heart. And when Portia says in that famous speech, "The quality of mercy is not strained. / It droppeth as the gentle rain" upon the Earth beneath, she’s really comparing Shylock’s hardness to an Earth that cannot absorb rain. In this case, the metaphor is really the rain of mercy.

It’s as if he’s so hardened by anger, both the natural anger that he seems to have in his character, and the anger, of course, that’s been produced by the fact that the Venetians have stolen away his daughter, that he is too hard of heart to be merciful.

GRANT: You know, some of the character traits you describe and some of the plays seem permanent and irreversible, but in real life, in Shakespeare’s actual time, people had to go to healers with the hope and expectation that their humors somehow could be put into balance, right?

PASTER: There were some pretty violent remedies. In one way, of course, to get your humors in balance, if you were thought, for example, to have too little of something or mostly too much of something else, was to get rid of it. And you would do that by opening a vein and letting blood, to get the bad blood out. Or you might do it by taking some kind of purgative drug and getting rid of it that way. People seem to have equated strong medicine with strong effects, and so a lot of the medicine was pretty violent, but you would have the sensation that you were doing something about it.

GRANT: Right, and generally, in Shakespeare’s plays, are doctors and healers, empirics, or what have you, are they portrayed, Barbara, as being sort of successful, as being able to actually accomplish something?

TRAISTER: I guess I’d say some of them do and some of them don’t. A physician is called in Macbeth to treat Lady Macbeth, and he says there’s nothing I can do for her.

The physician who heals Thaisa in Pericles is successful. They’ve thrown her overboard, because they think she’s dead, and her husband doesn’t want to do it, but the sailors say you must. So they put her in a coffin and throw her overboard, she’s dead.

And she washes up on a shore. And she is found by people, and brought to the local doctor. And he managed to heal her through a combination of what we would call, I think, or what they called, magic and medicine. It was a combination. He played the right kind of music. He had special smelling herbs. And she revives and she goes to a nunnery, I believe. And at the end of the play, she’s reunited with her husband, and the daughter that she died supposedly giving birth to, onboard the ship.

PASTER: King Lear, it seems to me, has a pretty effective episode of healing. In King Lear, there is a moment when the king has been mad. He’s been out on the heath. He’s exhausted. He’s been exposed to the storm. He’s cold. He’s found. He’s brought to the care of a doctor.

Cordelia is waiting for him to wake up. And there’s a very sympathetic portrait at that moment in the play of the doctors taking care of him, letting him rest, letting him listen to music, giving him warm clothes, warming him up, and when Cordelia is waiting for him to wake up and recognize her, the doctors say, not yet, madam, not yet.

It’s a lovely moment, I think, of doctors seeming humane and wise and caring. Because there are also moments in the plays, like The Comedy of Errors, for example, where the doctor is just a figure of ridicule. So, I think Shakespeare has a pretty whole and complicated view of the medical profession.

TRAISTER: There’s one other we should mention, because there is a woman healer in Shakespeare who is quite remarkable, and that’s Helena in All’s Well That Ends Well. She is the daughter of a physician. The physician has died. One of the things he has left his daughter is this special remedy. And the king of the country is suffering, and she believes that this recipe that she got from her father will heal him. And she goes to court and everyone laughs at her.

The king, by this time, is so sick and has been worked on by every kind of physician that’s available in the period. He doesn’t want anybody to touch him. He’s just assuming he’s going to die. And she comes in and says, I think I might be able to help you. And at first, he’s really negative because, first of all, she’s a woman, and no woman should be able to help him when all these male doctors have failed.

But she persists, and she says, finally she says, if I don’t heal you, you can kill me. And he’s so impressed by the length to which she is willing to go, that he agrees to take her remedy. We don’t know what it is. We don’t know how she administers it. We don’t know anything about it, but the next time we see them, the king is dancing.

GRANT: [LAUGH]

TRAISTER: And so it’s a kind of miracle cure, I guess you would say, but Shakespeare gives that to a female, which is very unusual. And, you know, we all look at it or study medicine in the period, and say, Oh, look at that, very nice.

GRANT: Well, you know, it’s funny, Gail, you touched on this earlier, but it sounds to me like we can really pick up on some clues about how people felt about doctors by reading Shakespeare’s plays. There must have been respect, as you say, ridicule, there was fear, and probably, relief, on the occasions when doctors and healers could provide relief.

PASTER: I think you’re right to say that there’s a range of attitudes in the plays that is probably pretty reflective of the range of attitudes in the period. I don’t think that people had necessarily very high hopes of cures. Where else were they going to turn, but to the people who had set themselves up as the people who knew what to do, and they, especially if you lived in London, you had ready access to a great many ingredients, and a great many medicines, that you could just go to the local apothecary and get, and so…

GRANT: And cross your fingers.

PASTER: Cross your fingers, and, you know, rub it on and hope for the best, and if that didn’t work, you might go to the doctor.

TRAISTER: There was a lot of shopping around. Medical care was very much a marketplace thing. You really shopped for somebody who would help you, and you might go to one person one day, and the next person the next day, and you might compare their cures, and, you know, that sort of thing. The other thing I was thinking of when Gail was talking was that an enormous percentage of Forman’s clients…

GRANT: This is Simon Forman, the healer that you wrote an entire book about.

TRAISTER: Right. People came to him often just to find out, and this was through his astrological side of his practice, not his medical side. What they wanted him to do was cast a horoscope and see whether they would die or not, or when they would die.

GRANT: Right, how soon they would die.

TRAISTER: Right, right. This was especially true for children. Gail and I’ve talked about this a lot in the past, and we think that one of the reasons that many doctors don’t have much record of treating children is that the kind of medicine that Gail talked about earlier was too harsh for children, that you really couldn’t give them the kind of purging that you gave adults. And so parents would come and want to know if a child was going to live or die.

GRANT: And, as you point out in the book, it cost something to go to the doctor, right? It wasn’t free and it wasn’t even necessarily cheap.

TRAISTER: No, it wasn’t, given what people earned in that period. It wasn’t cheap, and then, of course, if you got medicine, that was additional.

GRANT: You know, I’m wondering as we’re talking. Both of you know so much about the way medicine was practiced in a time that most of us don’t think anything about, and certainly don’t know much about. So when you go to seek out the help of a modern doctor today and walk into a modern doctor’s office, does any of this go through your mind? I mean, are you grateful? Do you reflect back on what it could have been like, you know, with someone opening up your neck to pull the worms out?

TRAISTER: Having worked and seen how medicine has evolved, when I go to a doctor, I ask a number of questions, because medicine is always evolving. Doing the study of medicine from era to era, you see what is one generation’s wisdom is the next generation's... You know, they laugh at it, because it seems so old-fashioned, and so it’s been replaced by something much more effective. And I don’t think that’s stopped happening now. So I always am a little bit skeptical. I also appreciate having someone who can listen, and who is willing to discuss a variety of parts of my life, but I also want to ask a lot of questions.

PASTER: Well, I guess I’m glad that nobody’s wanting to let blood, at least not too often, but I think there’s another element here that may relate both to modern and early modern medicine. And that is that we know, for example, from the casebook of another physician named Richard Napier, that people went to the doctor not only for a physical ailment, but very often for a psychological and emotional one. And that Napier would hear cases of young women who were mope-ish, or melancholy, or who wanted to kill themselves even. And that one of his jobs was of course to listen. To listen, to be sympathetic, to give them advice, to tell them perhaps, to take some medicine.

And I would think that, in some ways, that takes us to the relationship that we so cherish and treasure with our own doctors. Because if we have a really wonderful relationship with our doctor, our doctor is not only interested in our arthritis, they’re interested in our mood. They’re interested in how we’re feeling, generally. They’re interested in, are we happy, are we eating well, are we sleeping well? And I think that for doctors like Forman, and for doctors, certainly, like Richard Napier, we know that they were treating the whole person.

GRANT: This is such a fascinating topic and a wonderful conversation. Thank you to you both.

PASTER: Thank you.

TRAISTER: Thanks, very much.

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WITMORE: Gail Kern Paster is the Folger’s director emerita. Barbara Traister is professor emerita of English at Lehigh University. Her book, The Notorious Astrological Physician of London: Works and Days of Simon Forman was published in 2001 by the University of Chicago Press. "I Know My Physic Will Work with Him" was produced by Richard Paul. Garland Scott is the associate producer. It was edited by Esther Ferington. We had technical help from the news operations staff at NPR in Washington, DC.

Shakespeare Unlimited comes to you from the Folger Shakespeare Library. Home to the world’s largest Shakespeare collection, the Folger is dedicated to advancing knowledge and the arts. You can find more about the Folger at our website, folger.edu. For the Folger Shakespeare Library, I’m Folger Director Michael Witmore.