Let us go then, you and I,
When the evening is spread out against the sky
Like a patient etherised upon a table...
—from "The Love Song of J. Alfred Prufrock" by T.S. Eliot
No lover of imaginative writing or poetry should be surprised about the voluminous literature on doctors and diseases. Illness is a universal human experience, almost as certain as death, taxes, and romantic disappointment, and one's response to it is often a mix of normal concern, perplexity, fear, and false bravado, occasionally leavened with philosophical reflection. Some of history's most profound poems are responses to the pain and suffering of others, the foibles and heroics of physicians and care-givers, the nature of illness and the wisdom of the body. Keats was 22 years old and nursing his brother Tom when he sent a letter to J.H. Reynolds in which he said, "Until we are sick, we understand not; - in fine, as Byron says, 'Knowledge is Sorrow'; and I go on to say that 'Sorrow is Wisdom'." The drama of the sick room has been the subject of much poetry.
Much of the best of this literature developed during the past two centuries, para passu with the evolution of the modern hospital and the surgical operating theater. But the advent of scientific medicine did not remove the almost surrealistic fear and mystery felt by the general public about the workings of the body; in some cases, it served to intensify it. The introduction of general anesthesia in the mid-nineteenth century exposed patients to a new and not necessarily pleasant means of unconsciously letting go. The opening lines of Eliot's Prufrock, above, reflect this.
At the start of the Western poetic canon (c. 800 BCE), when both the Hebrew Bible and the Homeric epics were codified, doctors and diseases are present only to a circumscribed degree. In The Iliad, Homer mentions 150 different wounds, and explains with some degree of anatomical accuracy why some are fatal; spears and arrows strike specific internal organs according to entry point and trajectory. Although the Hebrew Bible mentions a variety of diseases and their treatments, no physicians are named. The ten plagues in Exodus are described with poetic concision, and at least four involve possible medical ailments: infestation by lice, a livestock epidemic like anthrax, painful boils, and the death of the first born. The Bible mentions a relatively limited number of salves and medications.
Other classical texts include Ovid's Medicamina Faciei Femineae or The Art of Beauty, the final half of which contains five complete recipes for cosmetics and dermatological treatments guaranteed to cure blackheads, pimples, wrinkles, and spots. Ovid's close contemporary, Virgil, the author of the Georgics and the Aeneid, studied medicine, philosophy, and poetry. Other polymaths include Yehuda Halevi, Spanish philosopher-physician and the finest poet of the Golden Age in Iberia prior to the Jewish expulsion, and Dante, author of the Vita Nuova, who started out on a political career by inscribing himself in the guild of physicians and apothecaries. In the Commedia he rarely mentions physicians, and then usually because of their importance as philosophers. Except for Michael Scot, a physician and astrologer, the medical figures in the Inferno are found in the First Circle (limbo), either because they lived in the pre-Christian era or in non-Christian lands without benefit of baptism.
The Plague
Until recent times, infectious diseases were the most important causes of death and disability; therefore, the great epidemics and contagions provide a useful scaffold upon which to hang the history of poetry in medicine. The first detailed description of Bubonic Plague (1351) is found in the one hundred stories of Giovanni Boccaccio's masterpiece, The Decameron, itself a possible source for several of the stories in Chaucer's Canterbury Tales. Boccaccio opens his book with a wide-ranging description of the Bubonic Plague including its physical, psychological, and social effects. His reportage is remarkable because the Black Death had only very recently arrived in Europe (c. 1347), probably from Asia, most likely as an invisible immigrant accompanying gangs of slaves and laborers delivering bales of Chinese silk at a Black Sea port. Between December 1347 and September 1348, the Black Death killed three-quarters of the European population in the Crimea and half the population of Venice. In 1563, 20,000 Londoners died of the disease.
Thomas Campion, an early Renaissance poet and physician, probably died in one of the first Bubonic Plague outbreaks. Much later, and much like Boccaccio's refugees, Sir Isaac Newton was driven to the countryside where he saw the apple fall; plague was raging in his home city and Cambridge University was closed for almost two years. Petrarch, a friend of Boccaccio, lost at least one child to the Plague and was so exorcised about the limited knowledge available to medieval physicians that he devoted the first of his four Invectives to an argument on behalf of the Humanities against Medicine. Petrarch's skepticism was shared by Chaucer, who included a physician as one of his pilgrims in The Canterbury Tales. It is thought that Chaucer, in the course of his governmental duties, met both Petrarch and Boccaccio. Chaucer’s physician, clad in taffeta, bases his practice on a thorough understanding of astrology and the four humors. The later foundations of scientific medicine depended as much on a proper understanding of the body, its anatomy and physiology, as it did on an understanding of disease, but in most of Christian Europe at that time, it was not possible to carry out human autopsies.
Shakespeare was intimately familiar with Bubonic Plague; he lost three sisters to the disease, his brother Edmund, and his son Hamnet, who was only eleven. As Michael Cummings writes, "[London] at that time was a prolific breeding ground of disease because of crowded, unsanitary conditions. Garbage littered the streets. Residents emptied chamber pots out windows. Brothels incubated syphilis. Dung clotted gutters and waterways. Flies and rodents carried bacteria and viruses from one section of the city to another....Even the queen bathed only once a month." Special officials called "searchers" were empowered to enter and search houses for possible victims and were paid to enforce quarantine. In Romeo and Juliet, Friar John, suspected of having plague, is shut up in a house by the searchers; this action prevents him from delivering a critical message from Friar Lawrence to Romeo, with tragic consequences. Outbreaks of plague caused the London theaters to be shut down in 1593, 1603, 1608, and again in 1665.
In his plays, Shakespeare makes reference to a large number of other diseases, including scurvy, gout, epilepsy, rheumatism, and venereal disease, as well as several varieties of madness. Syphilis, first coined as a medical term in 1530, appears as the pox in 10 of Shakespeare’s plays. In Julius Caesar (1599), Act I, Scene 2, Cassius, Casca, and Brutus discuss the possibility that Caesar suffers from "the falling sickness" or epilepsy; Shakespeare's accurate description of a seizure is turned into a pun for political weakness. His portrayals of various forms of psychopathology, madness, and depression in King Lear, Macbeth, Hamlet, and Coriolanus are beyond compare, although Shakespeare's sonnets rarely refer to medical matters.
Given the ineffectiveness and risk of medical treatment in this era, not to mention the pomposity of some practitioners, physicians became frequent objects of dramatic fun and literary satire, as in Moliere's comedies. John Dryden, a master of satiric verse, frequently chose physicians as his targets; his apothegms remain a staple of holistic web sites. The tendency towards satire is also reflected in eighteenth and nineteenth century nursery rhymes, where one encounters sly criticism of the doctor's self-importance. On the other hand, the death of a physician occasioned a heart-felt encomium by Samuel Johnson, who wrote in praise of his recently deceased friend Dr. Levet:
When fainting nature call'd for aid, And hov'ring death prepar'd the blow, His vig'rous remedy display'd The power of art without the show.
Early physician-poets writing in English, like the aforementioned Thomas Campion, did not often write about their medical experiences. This was true of Arthur Johnson, a Scot, who studied medicine in Padua and wrote a version of the Psalms in Latin; and Henry Vaughan, a Welsh physician and mystical poet. University-trained physicians more often turned to religious verse, as happened with Vaughan, especially after his conversion.
Tuberculosis
Known as "consumption" or "the wasting disease," tuberculosis, like the plague before it, was spread by crowding and the unsanitary conditions of modern urban centers; this truly gruesome and almost invariably fatal illness further exposed the general ineffectiveness of medicine as practiced prior to the mid-nineteenth century. John Keats, the greatest of all physician-poets, trained as an apprentice surgeon or apothecary but never practiced and rarely spoke of his own experience with the illness, except to close friends and in his letters; the poems are nearly devoid of references to hospital and disease. In the "infamous" Blackwoods review of Endymion, the young poet was advised to return to his former occupation: "It is a better and wiser thing to be a starved apothecary than a starved poet. So back to the shop, Mr. John, back to 'plasters, pills and ointment boxes'."
When Keats first coughed up bright arterial blood, he knew enough medicine to quickly realize he would die of consumption. His doctors, supposedly expert in the treatment of tuberculosis, one and all ascribed his wasting illness to a combination of melancholia and stomach disorder, and further compounded his difficulties by bleeding and starving him. A particularly grim description of blood-letting by a ship’s surgeon is found in Byron's Don Juan.
Keats, in his various roles as nurse, physician, writer, and patient, was all-too familiar with the status of medical practice at this time. His close experience with the bare facts of existence as displayed in the autopsy room and operating theater must have conditioned his development as a poet. He watched his mother die of consumption and nursed his younger brother Tom through the final months of the illness. In his revised version of Hyperion, Keats joined his two professions in an admirable example of negative capability. Here, the Poet is speaking to the muse Moneta:
Majestic shadow, tell me: sure not all Those melodies sung into the world's ear Are useless: sure a poet is a sage; A humanist, physician to all men.
Other Romantic poets had close knowledge of medical subjects and the primitive pharmacopeia. Friedrich Schiller trained as a physician and spent most of his life mistakenly attempting to treat his own illnesses; in this he was notably less successful than he was in his literary pursuits.
Typhus, Typhoid, Cholera, and Dysentery
During wartime in the nineteenth century, new epidemics appeared; cholera and typhus rivaled tuberculosis as a cause of illness and death. Adam Mickiewicz (1798-1855), the national poet of Poland and one of the founders of Romanticism, died of cholera in Constantinople, organizing troops to fight against the Russians in the Crimean War. Ten times as many soldiers died from typhus, typhoid, cholera, and dysentery as were lost to battle wounds. Gerard Manley Hopkins died of typhoid fever while working in the slums of Dublin.
The public's general opinion of hospitals was not much better than their view of most physicians. The hospital was seen as a place of suffering, infection, and death; in Paris Spleen, Baudelaire used the hospital to exemplify helplessness: "Life is a hospital in which each patient is possessed by the desire to change his bed." Constantine Cavafy, who spent his life in Alexandria living above a brothel with a clear view of a church and the gardens of the Greek Hospital, put it this way: "Where could I live better? Below, the brothel caters to the flesh. And there is the church which forgives sin. And there is the hospital where we die."
The majority of hospital nursing continued to be given by family members and volunteers. Walt Whitman, who had no medical training, served as a volunteer nurse during the Civil War and wrote eloquently about the value of tender, loving care in the treatment of injured soldiers. His first collection, Drum Taps, and several essays fully describe his experience.
In the nineteenth century, the best poems about medicine and illness were written by non-physicians, professional poets who kept body, soul, and home together by engaging in other avocations: pastor, lawyer, banker, editor, private person and public scold. Both Emily Dickinson and Walt Whitman devoted a number of poems to medical subjects such as melancholia and grief and grieving. Towards the end of the nineteenth century, the increasing professionalization of medicine and the elaboration of its scientific method allowed some writer-physicians to support their artistic pursuits through active and prolonged medical practice. In a letter to a friend, Anton Chekhov, who spent seven years working in a tuberculosis sanitarium, described his dual-career in the following manner:
Medicine is my lawful wife, and literature is my mistress. When I get fed up with one, I spend the night with the other. Though it is irregular, it is less boring this way, and besides, neither of them loses anything through my infidelity.
The Victorian author of "Invictus," William Ernest Henley, developed tuberculosis in his legs and underwent amputation at age 25; he was perhaps the first to devote a sequence of poems to a medical subject, "In Hospital." Written from the perspective of a patient, the poems in his collection, A Book of Verses, are realistic in tone. One of the poems, most of which are sonnet variants, is a description of his doctor, Joseph Lister, the father of antisepsis.
More Recent Plagues
During the twentieth century, other contagions and wasting diseases have come to occupy the metaphoric space tuberculosis and consumption previously filled. In World War I, not all of the famous British poets who died were killed on the battlefield. Rupert Brooke died of sepsis from an infected mosquito bite on his way to Gallipoli. Wilfred Owen famously wrote, "My subject is War, and the pity of War. The poetry is in the pity."
The war was followed by an outbreak of viral encephalitis (influenza) that left many of its survivors with late-onset Parkinson's disease. Typhus and typhoid make their appearance in numerous poems and memoirs about the European concentration camps and the prisons of the Gulag. Anne Frank and her sister died of louse-borne typhus at Bergen-Belsen, as did Robert Desnos, the French surrealist poet, who died at Terezín two days after liberation. During the German occupation, two Polish poets, Jerzy Hordynski and Zbigniew Herbert, actually worked as "lice-feeders" at Rudolf Weigl's Institute of Typhus Studies. Anna Akhmatova became seriously ill with typhus after her evacuation from Leningrad in 1941; as a young woman she had already suffered with tuberculosis and chronic bronchitis. Freud's writings in the early twentieth century increased general frankness about the body and psychological processes. Profound attention to the interior mental life of literary characters became a commonplace in the poetry of Thomas Hardy, Robert Frost, and Wallace Stevens.
William Carlos Williams, a central member of the pioneering Modernist generation, remained a practicing physician all his life and wrote many of his poems while making his rounds in Paterson, New Jersey. His manner of gathering experience about the self in the sick room probably informed "The World Contracted to a Recognizable Image," one of his more mysterious poems with a medical reference, almost certainly about an illness of his own.
Some of the early European Modernists were also physicians, including Gottfried Benn, a major exponent of German expressionism; Miroslav Holub, equally famous as immunologist and poet; and Dannie Abse, a British pulmonologist and eminent writer of plays, memoirs, and poems. Paul Celan briefly studied medicine before majoring in literature. More recent physician-writers have followed the lead of Williams, Holub, and Abse, fully pursuing joint careers in medicine and poetry. The devotion of Williams to both poetry and medicine exemplified the ideals put forth by W.H. Auden, himself the son of a physician:
"A doctor, like anyone else who has to deal with human beings, each of them unique, cannot be a scientist: he is either, like the surgeon, a craftsman, or, like the physician and the psychologist, an artist. This means that in order to be a good doctor a man must also have a good character, that is to say, whatever weaknesses and foibles he may have, he must," as W.H. Auden wrote, "love his fellow human beings in the concrete and desire their good before his own."
Mental Illness, Breast Cancer, and HIV
In the late twentieth century, the rise of identity art in all media, that is to say artistic production based on the membership of its creator in a particular social group, produced a great flowering of powerful and well-informed poems devoted to subjects of special interest. The high incidence of mental illness, alcoholism, suicide, and depression in this generation of poets has been the subject of frequent comment: Elizabeth Bishop, Robert Lowell, Sylvia Plath, Anne Sexton, Delmore Schwartz, Theodore Roethke, and John Berryman all suffered from a variety of such conditions. The black dog of despond is rarely coded in their work but, as Adam Kirsch points out, their purpose in writing of it and other disturbing matters was not confession but aesthetics.
Kirsch uses The Wounded Surgeon, the title of his study, as a new and more suitable metaphor for the heroic stance of poets in subjecting their most intimate concerns to the objective fire of art. The metaphor comes from Eliot's "East Coker": "The wounded surgeon plies the steel / That questions the distempered part."
Poets such as Alicia Ostriker, Lucille Clifton, and Marilyn Hacker have movingly written of body image and the impact of breast cancer on self-esteem and personal relationships. References to the details of surgical procedures, modern diagnostic techniques, and theories of pathophysiology have entered the poet's vocabulary. Thom Gunn, David Bergman, Alfred Corn, and Mark Doty have explicitly documented the horrors of HIV-related illnesses. Poems devoted to HIV are in the long tradition of poems about contagious and infectious illnesses, including the Black Plague, tuberculosis, typhus, polio, and the influenza pandemic.
Our latest epidemic, that of Alzheimer's disease and related dementias, is an unintended consequence of the increased longevity conferred by the recent successes and triumphs of modern medicine, a public health crisis movingly addressed by Rachel Hadas, C.K. Williams, and other poets. They provide ample evidence that doctors and diseases remain central and compelling subjects in contemporary poetry.