Of Authors and Ailments

John J. Ross

As an undergraduate English major, hospitalist John J. Ross, MD, spent many hours studying the works of William Shakespeare, John Milton, Jonathan Swift and other literary greats.

While more of his time is now spent reviewing patient cases than Norton Anthologies, Ross, who joined BWH in 2006, is still as connected as ever to the Great Bard. His first book, Shakespeare's Tremor and Orwell's Cough: Medical Lives of Famous Writers, published by St. Martin's Press in November, details the medical case histories of Shakespeare and nine other poetry and prose legends.

Ross calls the book a mix of literature, biography and "some rather appalling medical history" about real-life medical mysteries in the lives of famous authors. The Boston Globe described it as "lively, occasionally squirm-inducing" and "strangely fascinating," and The New York Times lauded Ross for hitting "his narrative stride . . . in chapter after chapter."  

Ross recently sat down with Clinical & Research News to answer a few questions about the book and his literary leanings.

Where did you get the idea for this book?

Before I came to the Brigham, I worked mostly in infectious diseases at another Boston-area hospital. There was an outbreak of syphilis in Boston a dozen years ago, and a number of patients presented at the hospital where I was working. The diagnosis of syphilis was missed in several of them.

Half a million people had syphilis in 1945, but it became a rare disease in the post-AIDS era. So a lot of young physicians, especially in the U.S., had never seen it. After the outbreak, I gave a medical grand rounds talk on syphilis, and to spruce up my PowerPoint presentation, I included some Shakespeare quotes. I got my undergraduate degree in English, and Shakespeare often referred to syphilis in his plays. I remember being really impressed that he had syphilis on the brain, so-to-speak. I decided to go back and read all of his plays, and I quantified the number of syphilis references. Shakespeare certainly knew an awful lot about syphilis, and he was keenly observant; I think he would have made a terrific physician.

I wrote a paper on Shakespeare and the possibility that mercury treatment for syphilis, which some people believe he may have had, caused his hand tremors later in life. We don't know much about Shakespeare's health; the only thing we know medically about him is that his handwriting deteriorated to an impressive degree over the course of his life, especially for someone who died in his 50s. Sometimes if you are exposed to a toxin like mercury, damage to the brain occurs, but only shows up later as you get older.

Was mercury commonly used as a medication during Shakespeare's time?

Mercury was used in medicine into the 20th century; it's been called the most colossal hoax in the history of medicine. Because it was a shiny, impressive metal, people thought it was a very powerful medicine, and it was used to treat scabies, constipation and syphilis for many decades. But it caused terrible damage, and side effects included profuse drooling, gum disease, tremor, and personality changes, such as irritability and social withdrawal 

How did these discoveries turn into a book?

John J. Ross’ (pictured above) first book details the medical case histories of Shakespeare and nine other poetry and prose legends.

At first, it was kind of a hobby for me. Then I published a paper on Shakespeare and syphilis in the journal Clinical Infectious Diseases in 2005. This inspired a segment on the Daily Show with Jon Stewart, which made me think that maybe people would be interested in a book about the diseases of writers.

Can you provide some examples?

Herman Melville suffered attacks of eye pain and back pain. John Milton's vision deteriorated over the course of his life, eventually leaving him blind. The Brontë sisters died from tuberculosis. A lot of these writers had problems with mental illness as well; mood disorders, specifically, are more common in writers. 

Are there theories explaining why mood disorders are more common among writers?

People with bipolar disorder are wired differently. They may be more creative, and their brains may make associations differently than other people. Patients with mood disorders also have rich emotional experiences, both good and bad, and this enriches their writing.

If you look at biographical patterns in writers, they experience childhood losses very commonly. Many of these writers are people who came from fairly comfortable backgrounds and were affected by some kind of tragedy or difficult event. Many writers had fathers that went bankrupt. Others lost one or both parents. These stressors probably do something to develop their imaginations, so they can retreat into a world of fantasy or recreate a better world in their minds.

Were there any models for this book?

Each chapter combines a short biographical essay with a medical mystery. It's a little bit gossipy as well.

Did you discovery anything unsettling while researching the book?

One of the things that was both interesting and disturbing was learning just how new an invention evidence-based medicine is. If you went to a physician before the 20th century, you were probably more likely to die than if you had stayed at home with your family, got rest, and drank fluids. Medicine was not a scientific, organized profession like it is today.

Another thing that was interesting to me is that while a lot of historical medical treatments were horrible, a few things legitimately helped patients, including treating syphilis by increasing body temperature. There was lot of interest in going to places that had natural hot baths; this was probably beneficial to people with syphilis.

What was your research process like?

I tried to read everything these authors had ever written, so there was a lot of revisiting of authors and reading authors I hadn't read before, like the Brontës. I read biographical documents and letters. For some of the more contemporary writers, including George Orwell and William Butler Yeats, we have surviving medical records, so these authors required less supposition and guess work.

What has the response from readers been like so far?

The reaction has been very positive. I tried to be very scrupulous in the book about saying what we definitively know about these authors' medical histories and how much is guess work. When possible, I tried to provide alternative explanations for symptoms and conditions.

Who is your intended audience?

The ideal reader is really a physician or health care professional who has an interest in literature and the arts; someone who can straddle those two areas.

What has the reaction from your colleagues here at BWH been like?

Incredibly positive and supportive! A great many people here love the idea of a book that mixes medicine and literature.

Did you enjoy revisiting the classics while writing the book?

Yes. When you read classic literature as you get older, you have a different perspective; what you bring to the work is different. For example, I kind of have more sympathy for King Lear than I used to-and less for Hamlet.

Who or what inspires you to write?

I am inspired and humbled by the brave patients and superb physicians I am surrounded by on a daily basis at the Brigham. I also draw inspiration from the heroic delvers in the cave of language that I chronicle in the book, particularly Melville, Hawthorne, Joyce, and Orwell.