Illnesses have long featured in literary works, many being described by authors long before they were recognised as medical entity. Shakespeare’s works are peppered with disease, many with delightfully archaic names such as dropsy or ague.

Orthopaedic problems make frequent appearances, most famously in Richard III:

But I, that am not shaped for sportive tricks,
Nor made to court an amorous looking-glass;
I, that am rudely stamp’d, and want love’s majesty
To strut before a wanton ambling nymph;
I, that am curtail’d of this fair proportion,
Cheated of feature by dissembling nature,
Deformed, unfinish’d, sent before my time
Into this breathing world, scarce half made up,
And that so lamely and unfashionable
That dogs bark at me as I halt by them;

But was Richard III the limping hunchback Shakespeare described? History is written by the victors, and at the time Shakespeare was writing, the Tudor victors still sat on the throne. (Richard III was not performed publicly until after Elizabeth I’s death, but is believed to have been written in 1592).

Since the discovery of Richard’s skeleton in 2012, 3D scans show Richard did indeed suffer from a sideways bending of his spine to the right (or “idiopathic adolescent onset scoliosis” to be give it a name us doctors understand). It was, however, mild; his head rested straight on his spine, and the curve of his back could have been easily masked by a good tailor and well-fitted armour. One shoulder sat slightly higher than the other, but there is no evidence Richard walked with a limp, or that dogs barked passed at his passing. In short, his appearance would be barely affected.

Other diseases of bone and joint to make an appearance in Shakespeare’s works include gout. First described in 2600 BC, gout results when excessive blood levels of uric acid result in the precipitation of sodium urate in joint spaces, resulting in severe pain. Commonly affecting the big toe, Hippocrates called gout “the unwalkable disease”. Untreatable at the time, this recurring inflammation and swelling of joints afflicted many, and by Shakespeare’s time gout was associated with gluttony and excess, debauchery and decadence.

“A pox of this gout!” cries Falstaff in Henry IV Pt 2 ,“or, a gout of this pox! for the one or the other plays the rogue with my great toe.”

Gout, arthritis and degenerative changes of the joints are often intermingled in historical works, and were often seen to reflect inner failings, whether the excesses of nobility, or the helplessness of the poor.

And chide the cripple tardy-gaited night
Who, like a foul and ugly witch, doth limp
So tediously away.                   (Richard III)

Not only are the poor condemned: Timon pronounces the following curse on the leaders of Athens so that their physical failings will reflect their moral ones:

Thou cold sciatica,
Cripple our senators, that their limbs may halt
As lamely as their manners.
   (Timon of Athens 4.1.25-27)

Modern political insults seem quite lame in comparison. Thankfully however, modern medicine has improved the outcome with better relief and pain medication.