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The Shakespeare Conference: SHK 16.0154  Wednesday, 26 January 2005

From:           John Ross <John_Ross_MD@cchcs.org>
Date:           Tuesday, 25 Jan 2005 15:19:01 -0500
Subject:        Did the Bard Have Syphilis?

Academic response to my recent suggestion in Clinical Infectious
Diseases that Shakespeare suffered from mercury poisoning has been
universally negative, regarding it as offensive, ill-informed
speculation of the "Authorship Question" type. It has been asserted that
I wish to dig up Shakespeare's remains for toxicological analysis
(certainly not true) and that my personal interest in syphilis may be
pathological (not true, but probably debatable). I'd like to respond,
and clarify my position.

First, I welcome your skepticism. My case is unavoidably based on
ambiguous and circumstantial evidence. However, so is much of the
reputable biographical speculation, for example, the youthful
Shakespeare's supposed sojourn in Lancashire.

Second, my primary objective was to present an interesting hypothesis to
a medical audience. My paper has two uncontroversial take-home messages
for clinicians: venereal disease may be psychologically devastating, and
the use of toxic and poorly validated medications such as mercury is
bad. This may seem simple-minded, but the recent market withdrawals of
Vioxx, Rezulin, and Trovan show that regulatory agencies are failing to
protect the public from inadequately studied, potentially lethal and
moreover redundant drugs.

I am certainly not the first to speculate that Shakespeare suffered from
a venereal disease. Commentators as diverse as Anthony Burgess, Harold
Bloom, and Katherine Duncan-Jones have previously suggested this.
Burgess noted the intrusive and emotionally charged nature of
Shakespeare's references to syphilis, stating that Shakespeare had a
"gratuitous venereal obsession." I owe a particular debt to Johannes
Fabricius' fascinating Syphilis in Shakespeare's England, with its
exhaustive analysis of syphilis and the psychological associations it
dredges up in Shakespeare's writings, as well as its documentation of
the high prevalence of the French Pox in Shakespeare's London.
Shakespeare's recurrent, clinically precise references to syphilis are,
of course, meaningless in themselves.  Shakespeare was more observant,
intelligent, and sensitive than his peers; so what? However, Fabricius
points out the contemporary innuendo in the satirical Willobie His Avisa
(1594) that Shakespeare and his close friend "H.W." have contracted
venereal disease, and notes the thematic parallels between this gossip
and the venereal concerns of the Sonnets.

I never definitively state that Shakespeare had syphilis, rather that he
may have received treatment for syphilis, and may have suffered untoward
side effects. Gonorrhea and syphilis were not differentiated clinically
until the eighteenth century, and the Elizabethans regarded them as a
single disease entity. This is because co-infection with more than one
type of venereal disease is a common phenomenon, then as now. If
Shakespeare had only a less dangerous venereal disease, such as
gonorrhea, he likely still would have underwent conventional therapy for
syphilis, namely, "the powdering tub of infamy." The unfortunate
"scalded chickens" and "boiled stuff" were immersed in hot baths, and
exposed to mercury vapor, in the form of volatilized cinnabar. The
toxicity of mercury is dose-dependent.  The inorganic mercury once used
to treat syphilis is not highly toxic in low doses, but modern
experience has shown that the symptoms of mild mercury poisoning may
become manifest as the nervous system ages.

I don't think Shakespeare died of syphilis, or that it affected his
cognitive and creative abilities. The Elizabethan treatment for syphilis
was probably surprisingly effective, for those that could afford it.
Treponema pallidum lacks heat shock proteins, and is thus susceptible to
thermal lysis. The German psychiatrist Julius Wagner-Jauregg won the
Nobel Prize for Medicine in 1927 for his use of deliberate malaria
infection as a treatment for neurosyphilis. (The high fevers provoked by
malaria killed off the spirochetes, but killed about 9% of patients.)
Dissatisfaction with the toxicity of malaria therapy and arsenic therapy
led to the revival of the Elizabethan hot bath treatment in the 1940s,
just prior to the phenomenal success of penicillin.

Mercury poisoning was common from Renaissance times until the twentieth
century, given its wide variety of medicinal, cosmetic, industrial, and
scientific uses. For an overview of the very bitter debate about medical
mercury in the seventeenth century, I would refer readers to Fabricius.
  Mercury poisoning was common enough in Jacobean times that Webster
refers to it in The White Devil 1.2, where Camillo is described as "a
gilder that hath his brains perished with quicksilver." The insinuation
in this passage is that the balding, licentious Camillo is syphilitic.
One Elizabethan victim of medical mercury poisoning well-known to
Shakespeare: Sir George Carey, patron of the Lord Chamberlain's Men. One
court lampoon of Carey notes his mercurial tremor and mental torpor: He
did "quake in every limb/Quicksilver's in his head/But his wit's as dull
as lead."

My supposition that Shakespeare had a mild case of mercury poisoning is
largely based on the tremulousness of his final signature. Deterioration
in his signature is also noted in the earlier Bellott documents. Such
tremor in a 52-year-old is unusual. Other diagnoses are certainly
possible, including alcoholism or hereditary (essential) tremor.
Parkinson's disease is unlikely, given the absence of micrographia
(Parkinson's disease was not described until after the Industrial
Revolution, and it has been suggested that exposure to some as-yet
unknown environmental toxin is involved).  Perhaps Shakespeare's
increasing reliance on Fletcher is simply due to a worsening physical
handicap.

John Aubrey, admittedly not the most reliable authority, recorded two
contradictory impressions of Shakespeare. He was a "handsome,
well-shap't man, very good company," but also was "not a company
keeper." Did Shakespeare suffer from erethism, the personality changes
associated with mercury exposure, which include "excessive timidity,
embarrassment in the presence of strangers, and irritability"?

Mercury may cause hair loss, as does syphilis, although syphilitic
alopecia is typically patchy in distribution. Mercury may also cause
kidney damage and the nephrotic syndrome, perhaps accounting for the
puffy, bloated appearance of Shakespeare's Stratford bust (OK, so this
is a stretch).

Finally, I apologize to any that have been offended. The Teflon Bard has
survived, and will survive, worse assaults on his dignity than mine. And
as Brendan Behan noted, "There's no such thing as bad publicity, except
your own obituary."

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