Medicine in Shakespearean Plays: Compilation of Descriptions of Clinical Features and Pathophysiology

William Shakespeare’s plays provide an invaluable compendium of medical terminology in the form of brief to detailed descriptions of clinical features and pathophysiology of various medical conditions. Shakespeare’s ability to describe dysfunctions of the human body and mind is astounding and has remained so for almost four centuries. The afflictions appear in the characters of kings, princes’ and commoners in his plays and their clinical features described in verse are more or less true even to this day. The aim of this study is to present a comprehensive compilation of medical afflictions from Shakespearean plays in alphabetical order containing verses that specifically depict clinical features, pathophysiology of medical conditions and medical ethics, and to provide short clinical explanations of relevance of passages in modern times as appropriate. Most passages do not reflect on the clinical conditions of actual patients, but deal with figurative expressions, drawn from clinical relevance in medicine during the Shakespearean era and used figuratively by the bard to illustrate those expressions through characters in the plays.


Introduction
Shakespeare's literary legacy of plays is so informative, intricate and stimulating, that even after four centuries, they are regarded with conspicuous veneration. For modern audiences who are either professionals in the medical field or have an interest in medicine, Shakespearean plays are a portal on human afflictions, and the figurative descriptions made by the bard in his plays at a time when the term 'medical science' was oxymoronic and people believed disease was a punishment for sinful behaviour and when afflictions on health were perceived to be the result of movement of stars and the planets, have indeed been most ingenious. Whatever the cause, virtually everyone agreed at the time that these maladies were triggered by an imbalance in the four vital fluids in the body -blood, phlegm, black bile, and yellow bile called "humours" (Latin word for liquids), and that these fluids controlled health and behaviour by the subtleties of their overall balance in the body.
Shakespearean plays convey a profound insight into scientific knowledge and it is in this regard noteworthy, that it would indeed be very unusual, had the issue of health and disease found no place in his literary collection. Shakespeare was born in 1564, just about the time medicine was moving out of the ivory towers of the medieval world. The low status barber-surgeon was becoming a respected medical practitioner with a new arsenal of techniques for dealing with wounds and illness ¹³. Shakespeare had lived in London in the early 1590s. The city at that time was a prolific breeding ground of pestilence because of profound unsanitary conditions, and hygiene was almost a non-entity and consequently, Shakespeare's London was the embodiment of filth. It is important to state in context that caution is required while attempting to interpret Shakespeare's description of clinical features in the light of modern medicine where his descriptions are at best figurative albeit the similarity to the modern medical view, and diseases including clinical features are used metaphorically as a means to project the Bard's superlative genius. This is by no means the first study looking into the description of health and medicine in Shakespearean plays. The earliest reference in context is from 1865 ¹⁶ which documents a limited selection of passages out of which only a few, truly reflect description of clinical features or their underlying mechanisms. This was followed almost a century later by brief commentaries from Kail ¹² regarding a compilation of extracts presenting descriptions of mental illness in Shakespearean plays; by Goens & Gheeraert ⁸ regarding extracts dealing with skin infections and Owen ˡ⁴, regarding description of the circulation of blood. Articles by Andreasen ³ dealing with psychiatric And pithless arms, like to a withered vine That droops his sapless branches to the ground.
Yet are these feet, whose strengthless stay is numb, Unable to support this lump of clay, Swift-winged with desire to get a grave, As witting I no other comfort have. 16 Age-related physical features of senility have been described to characterize enophthalmos, wasting of proximal appendicular musculature that are unable to support a lifeless trunk has been made apparently insensitive to normal sensory stimuli. 10.
King Henry The Sixth, Part One, Act IV, Scene V, That Talbot's name might be in thee revived 3 When sapless age and weak unable limbs Should bring thy father to his drooping chair. 5 This description repeats the age-related degenerative features of decreased musculoskeletal functions with kyphosis of the spinal column.

11.
Much Ado About Nothing, Act III, Scene V, A good old man, sir, he will be talking; as they say "when the age is 33 in the wit is out". God help us, it is a world to see. 34 The verse refers to the direct relationship between old age and dwindling cerebral functions of intellect.

12.
As You Like It, Act II, Scene II, Though I look old, yet I am strong and lusty, 47 For in my youth I never did apply Hot and rebellious liquors in my blood, Nor did not with unbashful forehead woo The means of weakness and debility; Therefore my age is as a lusty winter. 52 Age-related general debility has been described here.

13.
Hamlet, Act II, Scene II, That old men have gray beards, that their faces are 198 wrinkled, their eyes purging thick amber and plumtree gum, and that they have a plentiful lack of wit' together with most weak hams. 201 Repeated mention of loss of skin turgor, reduced intellect and muscle weakness is depicted in this verse.

Alcohol and effects
14.
The Merchant of Venice, Act I, Scene I, With mirth and laughter let old wrinkles come 80 And let my liver rather heat with wine Than my heart cool with mortifying groans.
Why should a man whose blood is warm within Sit like his grandsire cut in alabaster, Sleep when he wakes? And creep into jaundice 85 The deleterious effect of alcohol on the liver is mentioned here along with the fact that an ill-functioning liver is related to icterus (jaundice). Alabaster (fine white material derived from limestone) refers to the profound degree of paleness of the face (anaemia) which is a feature of chronic alcoholism.

15.
King Henry the Fourth, Part Two, Act II, Scene IV,   I'faith, sweetheart, me thinks now you are in an excellent good 22 temporality. Your pulsidge beats as extraordinarily as heart would desire; and your color, I warrant you, is as red as any rose, in good truth, la! But, i'faith, you have drunk too much canaries: and that's a marvelous searching wine, and it perfumes the blood ere one can say "What's this?" 28 The effect of alcohol on sympathetic stimulation causing tachycardia and peripheral vasodilatation is stated in the verse.

16.
King Henry the Fourth, Part Two, Act IV, Scene III, There's never none of these demure boys come to any proof; for thin 90 drink doth so over-cool their blood, and making many fish meals, that they fall into a kind of male green-sickness; and then, when they marry, they get wenches. They are generally fools and cowardswhich some of us should be too, but for inflammation. A good sherris-sack hath a twofold operation in it. It ascends me into the brain; dries me there all the foolish and dull and crudy vapours which environ it; makes it apprehensive, quick, forgetive, full of nimble, fiery, and delectable shapes; which delivered o'er the voice, the tongue, which is the birth, becomes excellent wit.
The second property of your excellent sherris is the warming of the blood, which, before cold and settled, left the liver white and pale, which is the badge of pusillanimity and cowardice.
But the sherris warms it and makes it course from the inwards to the parts extremes. It illumineth the face, which as a beacon gives warning to all the rest of this little kingdom, man, to arm, and then the vital commoners and inland petty spirits muster me all to their captain, the heart, who, great and puffed up with this retinue, doth any deed of courage, and this valor comes of sherris. 114 The above verse states the side effect of nausea and the autonomic effect of erectile dysfunction even in young adults. It goes on to elaborate other deleterious functions on the central nervous system wherein the features of dulling of higher functions to the extent of inducing hallucinogenic symptoms. The effect on warming of the blood due to increased peripheral circulation is mentioned and so are the flushing effects of vasodilatation on the face and readying the body for action by stimulating cardiac functions (fight and flight phenomenon). The lofty desire for hope is being compared to drunkenness and the severity is compared to the hangover that follows such a binge where the person swoons and nauseates (looks so green as in sea-sickness) and the face is robbed of its blood supply thus appearing pale.

23.
Macbeth, Act I, Scene VII, Will I with wine and wassail so convince 64 That memory, the warder of the brain, Shall be a fume, and the receipt of reason A limbek only 67 The effect of too much alcohol on suppression of memory which appears to leave the body as vapours from a retort (limbek) has been described.
unprovokes: it provokes the desire, but it takes away the performance. Therefore, much drink may be said to be an equivocator with lechery: it makes him, and it mars him; it sets him on, and it takes him off; it persuades him, and disheartens him; makes him stand to, and not stand to; in conclusion, equivocates him in a sleep, and, giving him the lie, leaves him. 36 The effects of alcohol on the body has been described in detail. It causes nasal flush, induces sleep and makes one lose control of the urinary bladder leading to incontinence. It provokes lewd and lustful behavior (lechery). It stimulates libido but causes erectile dysfunction.

25.
Timon of Athens, Act I, Scene II, If I were a huge man I should fear to drink at meals, 48 Lest they should spy my windpipe's dangerous notes.
Great men should drink with harness on their throats. 51 Getting drunk sways the head in extension while a person is sitting thereby exposing the trachea which is easy to reach with a knife for example. The midline anatomy of the neck is thus exposed.

26.
Coriolanus, Act V, Scene I,(Hangover) He was not taken well; he had not dined. 50 The veins unfilled, our blood is cold, and then We pout upon the morning, are unapt To give or to forgive; but when we have stuffed These pipes and these conveyances of our blood With wine and feeding, we have suppler souls Than our priestlike fasts. 55 The relationship here is drawn between the temperament in the unfed versus the fed states. In the unfed state the circulation is sluggish and the mind is unable to concentrate and even judge properly. In the fed state the circulation is adequate and judgment is better.

27.
All's well that ends well, Act I, Scene I, The suffering and lack of proper treatment of anorectal fistula despite repeated application of medication, makes the cure debatable.

28.
Coriolanos, Act IV, Scene V, Peace is a very apoplexy, lethargy; mull'd, deaf, sleepy, insensible; 235 a getter of more bastard children than war's a destroyer of men 237 Peace is akin to a state of speechlessness, deafness and sleepy nature that is insensitive to normal stimulus but sparks the libido; thus, more bastard children are born during peacetime than men dying in war.

29.
King Henry The Fourth, Part Two, Act I, Scene II, And I hear, moreover, his highness is fall'n into the same whoreson apoplexy. 108 This apoplexy, as I take it, is a kind of lethargy, an't please your lordship, a kind 112 of sleeping in the blood, a whoreson tingling. 114, and continues 130 It hath it original from much grief, from study, and perturbation of the brain. I 116 have read the cause of his effects in Galen; it is a kind of deafness. 118 The clinical features of a stroke are described herein which include a state of inaction, and sensory disturbances including loss of hearing (brainstem lesion). It is the result of disturbances in the brain.

30.
Richard II, Act II, Scene III, O, then, how quickly should this arm of mine, 102 Now a prisoner to the palsy, chastise thee, 103 The paralysing effect of monoplegia or possibly hemiplegia have been referred to.

31.
Richard III, Act III, Scene IV, Look how I am bewitched. Behold, mine arm 67 Is like a blasted sapling withered up; 68 The long term effect of muscle wasting following a stroke and replacement by fibrosis has resulted in a rigid ('withered') extremity.

32.
Hamlet, Act III, Scene IV, The suppression of the special senses resulting from a stroke are being described. The relationship between injured muscles and back pain has been described here, and it is known that reflex spasm of muscles (muscle injury) resulting from vertebral injury, is a major cause of back pain. To catch my death with jaunting up and down! 47

Back Injury
The relationship between a pulsating (throbbing) headache and back pain related to excessive physical activity has been described. That what a man cannot smell out, he may spy into. 23

Binocular vision
The reference here is made to the fact that both eyes and the nose being organs of special senses, the sense of smell is less lateralizing (functional) while that of vision is far more developed and the eyes being located apart, offer a greater depth of vision (stereoscopic) and thus accuracy.

36.
Coriolanus, Act I, Scene I, That I receive the general food at first 133 Which you do live upon; and fit it is, Because I am the storehouse and the shop of the whole body.
But if you do remember, I send it through the rivers of your blood, Even to the court, the heart, to th' seat o' th' brain; And, through the cranks and offices of man,

The strongest nerves and small inferior veins
From me receive that natural competency whereby they live; 143 This verse states the functions of the systemic circulation and relates the fact that blood goes back to the heart and from thence is pumped to the brain and this circulation provides all the necessary ingredients (nutrition) for the body to sustain itself.

37.
Troilus and Cressida, Act V, Scene 1, With too much blood and too little brain these two may run mad; 49 but, if with too much brain and too little blood they do, I'll be a curer of madmen. 51 The reference is with respect to a state of hyper-dynamic systemic circulation with insufficient blood supply to the brain in a diseased state that can reduce mental functions. Conversely, increased cerebral function can be sustained with a reduction in cerebral blood flow (auto-regulation).

38.
Henry VI, Part Two, Act III, Scene II, See how the blood is settled in his face. 160 Oft have I seen a timely parted ghost, Of ashy semblance, meager, pale, and bloodless, Being all descended to the laboring heart, Who in conflict that it holds with death, Attracts the same for aidence 'gainst the enemy; Which with the heart there cools, and ne'er returneth To blush and beautify the cheek again. 167 The verse describes a state of shock where the blood is diverted to the heart due to sympathetic response leaving the face ashen, lifeless and ghostly. The roses in thy lips and cheeks shall fade To wanny ashes, 100 The effects of a certain unknown potion have been described here that slows the circulation and makes the vital signs including the pulse to become imperceptible as if to mimic a state of death.

40.
King John, Act III, Scene III, Or if that surly spirit, melancholy, 52 Had baked thy blood and made it heavy, thick, Which else runs tickling up and down the veins, Making that idiot, laughter, keep men's eyes And strain their cheeks to idle merriment. 56 This verse refers to the relationship between melancholy (depression) and the vascular effects of inactivity causing slowing of the circulation. The reduced circulation to the brain in consequence, results in altered behaviour which in this case has been described as idiotic.

41.
Twelfth Night, Act I, Scene I, How will she love when the rich golden shaft 36 Hath killed the flock of all affections else That live in her; when liver, brain, and heart, These sovereign thrones, are all supplied and filled 39 Each one of the three organs has been referred to as precious kingdoms which in context states the functional importance of the circulation in these organs for maintaining a healthy state of the mind and emotions which can be affected if these were to be injured figuratively as in this case by Cupid's golden arrow. The verse states the fact that in spite of having joints that help the hands and fingers to move, the affliction has so affected these small joints that they present the features of gouty (rheumatoid) arthritis that also affects vision through xerophthalmia (corneal dryness). And crook the pregnant hinges of the knee. 61

Bones & Joints
The morphology of the knee has been depicted as the "hinge" variety, and describing its functions as very potent (significant) but which is affected by disease due to an uncontrolled diet.

47.
King Henry The Fourth, Part Two, Act I, Scene I, And as the wretch whose fever-weak'ned joints, 140 Like strengthless hinges, buckle under life 141 This description befits the state of the body in Rheumatoid arthritis where fever and joint involvement causes loss of stability in the joints that make them functionless and thus prone to deformities.

48.
As You Like It, Act III, Scene II, With a priest that lacks Latin and a rich 319 man that hath not the gout; for the one sleeps easily because he cannot study, and the other lives merrily because he feels no pain; the one lacking the burden of lean and wasteful learning, the other knowing no burden of heavy tedious penury. 324 The comparison here is between the lifestyle of a religious scholar and the relaxed life of the rich who in the absence of hard work do not suffer profound pain in the affliction with gout. The increased sympathetic stimulation as a result of increased physical activity makes one hungry for breath (breathlessness).

51.
Timon of Athens, Act V, Scene I, Thou sun that comforts, burn! Speak and be hanged. 131 For each true word a blister, and each false Be as a cauterizing to the root o' th' tongue 132 The figurative effect of uncontrolled speech has been likened to a thermal injury that blisters the tongue.

Castration (Effects -Somatic and psychological)
52. Antony and Cleopatra, Act I, Scene V, Cleopatra-I take no pleasure 9 In aught an eunuch has: 'tis well for thee The verse states clearly that the physical disablity of being a eunuch does not have any reduction in the 'libido' but incapacitates the physical ability due to castration. The explanation that appears here is the supportive and protective role of the ventricles (and CSF) and the meningeal layer of pia mater between which lie the frontal and temporal cortices including the hippocampus that are associated with memory and higher cognitive functions.

54.
Love's labor's Lost, Act IV, Scene III, Lives not alone immured in the brain, 325 But with the motion of all elements, Courses as swift as thought in every power, And gives to every power a double power Above their functions and their offices. 329 This stanza explains the authoritative role of the brain on the direct activation of all motor functions by transfer of energy ("motion of all elements').

55.
Timon of Athens, Act I, Scene II, The five best senses 123 Acknowledge thee their patron, and come freely 124 To gratulate thy plenteous bosom. Th' ear 125 The feeling of fulfillment as a result of all the special senses working normally has been alluded to here.

56.
Antony and Cleopatra, Act IV, Scene VIII, ha 'we 20 A brain that nourishes our nerves, and can 21 Get goal for goal for youth. 22 The connection and control of the brain on the peripheral nervous system is described here.

57.
Henry VI, Part Three, Act III, Scene II, Why, love forswore me in my mother's womb: 153 And, for I should not deal in her soft laws, 154 She did corrupt frail nature with some bribe, 155 To shrink mine arm up like a withered shrub; 156 To make an envious mountain on my back, 157 Where sits deformity to mock my body; 158 To shape my legs of unequal size; 159 To disproportion me in every part, 160 The verse describes the possible cause of some teratogenic influence ("She did corrupt frail nature with some bribe") that causes a widespread skeletal malformations. The significance of port wine stain and its relationship with congenital features of mental illness and weakness of a part of the body is stated in this verse. An uncommon disorder known as Sturge-Weber syndrome is associated with port-wine stain along with defects in the brain that can lead to ocular abnormalities, mental retardation, fitting, one-sided weakness of the body (hemiplegia) or other neurological signs and symptoms later in life ¹⁷.
Upon the sweetest flower of all the field. 28 The effect of rigor mortis causing rigidity of the limbs (stiff joints) that confirms that death has ocurred some time ago has been described here.

61.
King Lear, Act V, Scene III, I know when one is dead and when one lives; 262 She's dead as earth. Lend me a looking-glass; If her breath will mist or stain the stone, Why, then she lives. 264 The absence of moisture on a mirror held close to the nostrils (cessation of breathing) is described as a sign of death.

62.
Henry VI, Part Two, Act III, Scene II, (Medico-legal) But see, his face is black and full of blood, 168 His eyeballs further out than when he lived, Staring full ghastly like a strangled man; His hair upreared, his nostrils stretched with struggling; His hands abroad displayed, as one that grasped And tugged for life, and was by strength subdued.
Look, on the sheets his hair, you see, is sticking; His well-proportioned beard made rough and rugged, Like to the summer's corn by tempest lodged.
It cannot be but he was murdered here: The least of all these signs were probable. 178 The post-mortem signs of asphyxiation have been described here that confirm the cause of death.

63.
Twelfth Night, Act IV, Scene II, (Post-mortem changes) Nay, I'll ne'er believe a madman 'till I see his brains. 118 The reference is to the pathological changes in the cortex (cortical thinning and enlarged ventricles) that are associated with senile dementia. The physician does not believe that the wife of Pericle, Thaissa is dead and believes that she is in a state of catatonia or in a state of asystole that mimics death and after a lapse of a few hours, the person comes back to life.

67.
The Anxiety of not being in the right mind is a feature of senility. Inability to recognize people, to identify known places and even remember what clothes one wears or where one sleeps the previous night, are features of dementia.

70.
Macbeth, Act V, Scene III, The profundity of hopelessness and anguish in dementia are mentioned here. Endless pain and suffering akin to burns and scalds are described with a hint of dejection and loss of hope to continue living are also stated.

72.
Love's Labor's Lost, Act I, Scene I, The mind shall banquet through the body pine. 25 Fat paunches have lean pates, and dainty bits Make rich the ribs, but bankrout quite the wits. 27 The mind functions even in a state of hunger. Fat people are stupid, and delicious things makes the stomach larger, but intelligence and wit smaller. Relationship between obesity and foolishness is stated. This verse describes the ill-effects of malnutrition. Fortune either gives one a hungry stomach and no food, which is the case of the poor, or it offers a feast that takes away the appetite, which is the case of rich people who have plenty, but can't enjoy it.
75. Love's Labor's Lost, Act IV, Scene III, To fast, to study, and to see no woman-289 Flat treason 'gainst the kingly state of youth.
Say, can you fast? Your stomachs are too young, And abstinence engenders maladies. 292 The disadvantages of fasting at a very young age that causes ailments has been described.

76.
Antony and Cleopatra, Act II, Scene I, Hemp is cannabis (marijuana). Long-term consumption of marijuana is associated with an increased risk of some respiratory problems, including an increase in cough, sputum production, airway inflammation, and wheeze (airway obstruction) ⁹. The poison Black henbane (BH) (Hyoscyamus niger) has been used as a medicine since last centuries and has been described in all traditional medicines. All part of BH including leaves, seeds and roots contain some alkaloids such as Hyoscyamine, Atropine, Tropane and Scopolamine. Severe intoxication is accompanied by hypertension, respiratory arrest, coma, convulsions and death ².

80.
Antony and Cleopatra, Act 5, Scene II, Caesar-If they had swallow'd poison 'twould appear 344 By external swelling; but she looks like sleep,

As she would catch another Antony
In her strong toil of grace.

Dolabella-Here on her breast
There is a vent of blood, and something blown; The like is on her arm. The physical change of swelling of the body following traditional poisoning is described here but is suppressed since Cleopatra was most likely bitten by a serpent whose venom produced severe paralysis, deep coma, absent brainstem reflexes and thus the body appeared to be relaxed as if in a state of sleep.

81.
Romeo and Juliet, Act V, Scene I,

Let me have 59
A dram of poison, such soon-speeding gear As will disperse itself through all the veins That the life-weary taker may fall dead, And that the trunk may be discharged of breath As violently as hasty powder fired Doth hurry from the fatal cannon's womb. 65 This verse desribes the effects of a rapidly acting poison that results in violent respiratory failure.

Not poppy nor mandragora, 327
Nor all the dropsy syrups of the world, Shall ever medicine thee to that sweet sleep 329 Mandrake (mandragora), a relative of Atropa belladonna contains hyoscyamine and atropine, and is known to be hallucinogenic, narcotic, emetic and purgative, and the verse states that no drug can cause as effective and deathly sleep like it. 141 go near to remove his fit. If I can recover him, and keep him tame, I will not take too much for him 78

Epilepsy
Alcohol (CNS depressant) as a treatment of a debilitating seizure is described here.

84.
Othello, Act IV, Scene I, Iago-My lord is fall'n into an epilepsy. 51 This is his second fit; he had one yesterday.
Cassio-Rub him about the temples.
The lethargy must have his quiet course; If not, he foams at the mouth, and by and by Breaks out to savage madness. Look, he stirs.
Do you withdraw yourself a little while; He will recover straight; when he is gone 58 The verse describes the clinical features of grand mal epilepsy.

85.
Othello, Act V, Scene II, And yet I fear you; for you're fatal then 36 When your eyes roll so. 37 and continues Alas why gnaw you so your nether lip? 43 Some bloody passion shakes your very frame. 44 Features of lip-biting and violent shaking during a seizure has been described.

86.
Julius Caesar, Act I, Scene II, When our most learned doctors leave us, and 119 The congregated College have concluded That laboring art can never ransom nature From her inaidable estate. I say we must not So stain our judgment or corrupt our hope, To prostitute our past-cure malady To empirics, or to dissever so Our great self and our credit, to esteem A senseless help, when help past sense we deem. 127 Not to cast aside judgement, or overreach hope to offer up incurable sickness to quacks, or to divide one's selfrespect and reputation, and to pursue an impossible cure when called, are the ardent qualities of ethics of the profession.

For there is boundless theft 428
In limited professions. Rascal thieves, Here's gold. Go, suck the subtle blood o' th' grape, Till the high fever seethe your blood to froth, And so 'scape hanging. Trust not the physician; His antidotes are poison, and he slays Moe than you rob. Take wealth and lives together' Do, villain, do, since you protest to do't. 435 The unethical practices of doctors have been alluded to in this verse which tells not to trust the doctor, because his cures are poisonous and he kills men even more often than thieves rob them, taking both money and lives.

91.
Macbeth, Act IV, Scene III, There are a crew of wretched souls 141 That stay his cure: their malady convinces The great assay of art; but at his touch, Such sanctity hath heaven given his hand, They presently amend. 144 The wretched sick wait for the doctor to heal them. Their illness doesn't respond to the efforts of medicine, but when he touches them, they are healed. Shows the effect of compassion and empathy. Look when he fawns he bites; and when he bites His venom tooth will rankle to death.
Have not to do with him, beware of him.
Sin, death, and hell have set their marks on him And all their ministers attend to him. 293 The figurative description of lethality of a rabid dog's bite has been stated here.
Against the wind a mile! 44 The widespread affliction with furuncles (skin absessess), disfiguraing of the body and its contagious.nature have been stated here. Unless to spy my shadow in the sun 28

Madness / Depression / Schizophrenia
And descant on mine own deformity: 29 And therefore, since I cannot prove a lover, 30 To entertain these fair well-spoken days, 31 I am determined to prove a villain 32 And hate the idle pleasures of these days. 33 Plots have I laid, inductions dangerous, 34 By drunken prophecies, libels and dreams. 35 The verse describes an altered mental status and personality (psychosis) developed from sheer hate and envy from one's own physical deformity whereby the person plans to harm others.

112.
Twelfth Night, Act I, Scene III, (related to Creujfeld-Jacob disease!) But I am a great eater of beef, and I believe that does 83 harm to my wit. 84 This is a surprising description of the mental state associated with the consumption of beef. Other than draw a relationship of beef consumption to indigestion as a cause for sickness, one cannot but think of the unique coincidence to Creujfeld-Jacob disease/Bovine spongiform encephalitis (Mad cow disease). Say-The palsy, and not fear, provokes me.

Palpitation
Cade-Nay, he nods at us, as who should say, 'I'll be even with you'. I'll see if his head will stand steadier on a pole, or no: 97 In this case, a neurodegenerative disorder has been alluded to rather than fear being the cause for the tremor. Here, the tremor appears to be cerebellar in origin involving the head (titubation) as a distinctive feature.

117.
The Two Gentlemen of Verona, Act IV, Scene IV, She hath been fairer, madam, than she is. 149 When she did think my master loved her well, She, in my judgment, was as fair as you.
But since she did neglect her looking glass, And threw her sun-expelling mask away, The air hath starved the roses in her cheeks And pinched the lily-tincture of her face, And now she is become as black as I. 156 Reference is likely to be the ill-effects of sun burn on the unprotected facial skin in the cold climatic conditions of Italy that result in dry scaly skin with hyperpigmentation. To burn the errors that these princes hold 162 The redness of the face is drained away with paleness due to sympathetic activity.

128.
Cymbeline, Act III, Scene III, The princely blood flows in his cheek, he sweats, 93 Strains his young nerves, and puts himself in posture 94 Preparation of the body for the 'fight and flight' response.

129.
The Merchant of Venice, Act I, Scene II, The brain may 17 devise laws for the blood, but a hot temper leaps o'er a cold decree; such a hare is madness the youth to skip o'er the meshes of good counsel the cripple. 20 The brain controls the sympathetic system that causes heated temperament that cripples wisdom.

130.
Troilus and Cressida, Act V, Scene I, Why, his masculine whore. Now the 18 rotten diseases of the south, the gut-ripping ruptures, catarrhs, loads o' gravel in the back, lethargies, cold bladders full of imposthume, sciaticas, lime-kilns i' the palm, incurable bone-ache, and the riveled feesimple of the tetter, and the like, take and take again such preposterous discoveries! 25 Reference to male gay sex and its association with syphilis with all its maladies are stated here.

131.
Timon of Athens, Act IV, Scene III, Be a whore still; they love thee not that use thee. 84 Give them diseases, leaving with thee their lust.
Make use of thy salt hours. Season the slaves For tubs and baths; bring down rose-cheeked youth To the tub-fast and the diet. 87 The cause of venereal disease is mentioned and the curing effect of diet and salt baths has been described. Tertiary syphilis can affect multiple organ systems, including the brain, nerves, eyes, heart, blood vessels, liver, bones, and joints. On the face, it can cause destruction of the nasal bridge and flatten the nose. It can cause Stroke, Meningitis, Hearing loss, Visual problems, Dementia, Loss of pain and temperature sensations, Sexual dysfunction in men (impotence), Bladder incontinence, sudden lightning-like pains in bones. Syphilitic laryngitis is also a known entity.

133.
King Lear, Act III, Scene VI, Causes of hardening of hearts is stated here. This appears to be an example of hypertrophy of cardiac muscle (hardening) as opposed to hypoplasia (softening).

Conclusion
Many of Shakespeare's medical references and imagery were important components of his writing style, and he used them more often than his contemporaries did at the time, and his genius was beyond that of any other bard and playwright in history. A study of Shakespeare's images of sickness shows that he had a distinct interest and acumen in describing medical conditions with accuracy, probity and incorporating clinical features both figuratively as well as succinctly through characters in his plays. It is unlikely that any other single author has been as thoroughly scrutinized as William Shakespeare, and this comprehensive work attempts to validate it further by drawing a parallel on modern day medical symptomatology, pathophysiology and management in light of Shakespeare's ingenious, immaculate and unmatched poetic brilliance.