What is the dramatic significance of Act 5 Scene 1 in Macbeth?Macbeth by William Shakespeare

In Shakespeare's Macbeth, Act V,
Scene I, the theme of guilt and the motif of blood is furthered by the delusional Lady
Macbeth's famous lines,

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Out, damned spot! Out, I say! One: two: why,
then 'tis time to do 't.  Hell is murky.  ...What need we fear who know it, when none
can call our pow'r to accompt?  yet who would have thought the old man to have had so
much blood in him?
(5.1.31-35)

Her guilt and
mounting madness are clearly evident in this passage as Lady Macbeth becomes obsessed
with her imagined blood-stained upon her hand; "Hell is murky" suggests that Lady
Macbeth has already seen hell. Even the gentlewoman remarks, "She has spoke what she
should not" (5.1.41). Also, it may be a reflection of her increasing insanity as she
does not speak in verse as it is most unusual for a major character in a Shakespearean
play to speak in something other than iambic pentatmeter. The doctor echoes this sense
of impending doom expressed by Lady Macbeth as he
says,

Foul
whisp'rings are abroad.  Unnatural deeds

Do breed
unnnatural troubles.
(5.1.65-66)

This theme of
guilt is also felt by Macbeth himself later in Scene 3 as he, too, has a sense of
fatality when he says,

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...I am sick at
heart...

....My way of life

Is
fall'n into the sear, the yellow leaf,...

As honor, love,
obedience, troops of friends,

I must not look to have; but
in their stead,

Curses not lou loud by
deep...(5.3.222-29)