William Shakespeare lived from 1564 to 1616, and his lifetime overlapped with some of the deadliest disease outbreaks in English history. The bubonic plague dominated this era, but it was far from the only threat. Smallpox, syphilis, typhus, malaria, and dysentery all circulated through Elizabethan and Jacobean England, shaping daily life, closing theaters, and killing tens of thousands.
The Bubonic Plague
No disease defined Shakespeare’s world more than the plague. It arrived in waves, and when it hit, it was catastrophic. In 1603, the year Queen Elizabeth I died and James I took the throne, plague was responsible for an estimated 86 percent of all deaths in London. That wasn’t a typical year. For most years between 1603 and 1680, plague caused less than one percent of deaths in the city. But when epidemics broke out, they could account for more than half of all deaths in a single year.
The plague repeatedly shut down London’s theaters, directly affecting Shakespeare’s livelihood as a playwright and shareholder in acting companies. Authorities closed playhouses when weekly death tolls climbed past a certain threshold, sometimes for months at a time. The disease spread through flea bites carried by rats, though no one understood that at the time. Victims developed painful swollen lymph nodes called buboes, followed by fever, chills, and often death within days.
Smallpox
Smallpox was a constant presence in Elizabethan England. On average, 3 out of every 10 people who contracted it died. Those who survived usually carried scars for the rest of their lives, sometimes severe ones. Queen Elizabeth I herself caught smallpox in 1562, two years before Shakespeare was born, and famously used heavy white makeup afterward to cover the pockmarks it left on her face. Blindness was another common complication. There was no treatment and no vaccine until Edward Jenner’s work nearly two centuries later.
Syphilis: The “French Pox”
Syphilis swept through Europe in the late 1400s and was still rampant during Shakespeare’s lifetime. The English called it the “French pox” or the “French disease.” The French, naturally, called it the “Neapolitan disease.” The Germans called it the “French evil,” the Russians called it the “Polish disease,” and the Turks called it the “Christian disease.” Nearly every nation blamed someone else for it.
Shakespeare referenced syphilis repeatedly in his plays, often through dark humor. The available treatments were brutal. Doctors applied mercury directly to the skin or forced patients to inhale mercury vapor in enclosed spaces. These treatments were painful, largely ineffective, and frequently fatal on their own. Many patients died of mercury poisoning rather than the disease itself. Without antibiotics, syphilis progressed through stages that could eventually cause disfigurement, madness, and death.
Malaria: The “Ague”
Malaria was endemic in parts of England during Shakespeare’s lifetime, particularly in the marshy lowlands along the Thames estuary in Essex and Kent. People called it “the ague,” and it was characterized by recurring cycles of fever and chills, either every two days (tertian) or every three days (quartan). Shakespeare mentions agues several times in his plays, and the disease would have been familiar to his audiences.
Parish vicars in coastal marsh communities described their towns as “so very agueish” that they could barely find clergy willing to serve there. One wrote that residents were “so violently afflicted with the worst of agues and languishing so long under it till our constitutions were almost broke.” Another observer noted that in parts of Essex, “you will find but few persons but either are, or have been afflicted with a tedious quartan.” The connection between standing water, mosquitoes, and the disease wouldn’t be understood for another 300 years.
Typhus and “Gaol Fever”
Typhus thrived in the cramped, filthy conditions of Elizabethan cities, prisons, and ships. It went by many names: “putrid fever,” “jail fever,” “ship fever,” and “camp fever.” The disease spread through body lice, which meant it was directly linked to overcrowding, unwashed clothing, and shared beds. It was especially dangerous in cold weather, when poorer people piled on every piece of clothing they owned and huddled together for warmth.
Symptoms included headache, body pain, chills, high fever, and delirium. In the crowded conditions of London’s slums and jails, typhus was a genuine killer. Courtrooms were sometimes deadly places to visit, as prisoners brought lice-borne typhus with them when they appeared before judges.
Dysentery and Waterborne Illness
London’s water supply was essentially an open sewer system. Many residents drew their drinking water directly from the Thames, the same river that received the city’s waste. In some neighborhoods, dipping a pail into the river was the only available water source. Centuries of accumulated waste sat in the waterways, and as temperatures rose, it fermented. Dysentery, a severe and sometimes fatal intestinal infection, was a predictable result. It killed soldiers, sailors, and city dwellers alike, and was one of the leading causes of death among young children.
How Elizabethans Understood Disease
None of these diseases were understood the way we understand them today. Germ theory wouldn’t arrive until the mid-1800s. In Shakespeare’s time, physicians still relied on a medical framework dating back more than 2,000 years to the ancient Greeks. The dominant theory held that the body contained four fluids, or “humors”: blood, phlegm, yellow bile, and black bile. Health meant these four were in balance. Illness meant one had become excessive or deficient.
Each humor corresponded to a season. Phlegm, which was considered cold and wet, was thought to increase during winter, causing bronchitis and pneumonia. Blood increased in spring, supposedly causing nosebleeds and dysentery. Doctors diagnosed which humor was out of balance and then tried to restore equilibrium, often through bloodletting, purging, or changes in diet. Environmental factors like bad air, swamp vapors, and shifts in weather were considered primary causes of epidemics.
This framework meant that doctors were essentially powerless against infectious disease. They couldn’t identify what actually caused plague, smallpox, or typhus, and their treatments frequently made things worse. Shakespeare lived in a world where a trip to the theater, a drink of water, or a flea bite could be fatal, and where the best medical minds in the country had no real explanation for why.