Hektoen International

A Journal of Medical Humanities

Where no birds sing: tuberculosis in Keats’ “La Belle Dame Sans Merci”

Putzer Hung
St. Louis, Missouri, United States

O what can ail thee, knight-at-arms,
Alone and palely loitering?
The sedge has wither’d from the lake,
And no birds sing.

O what can ail thee, knight-at-arms!
So haggard and so woe-begone?
The squirrel’s granary is full,
And the harvest’s done.

I see a lily on thy brow
With anguish moist and fever dew,
And on thy cheeks a fading rose
Fast withereth too.

La Belle Dame Sans Merci, 1901 Henry Meynell Rheam
La Belle Dame Sans Merci, 1901
Henry Meynell Rheam

When John Keats wrote La Belle Dame Sans Merci in the spring of 1819 he had only begun to realize his full literary potential—honed and matured through a lifetime of poverty, rejection, and loss. In the following months he would compose his greatest works: a series of melancholic odes that not only challenged the boundaries of lyrical innovation but also embodied his artistic vision of capturing meaningful experiences through “Sensations rather than Thoughts.”1 Tragically, it was also during this period of extraordinary introspection and productivity that Keats exhibited the first symptoms of a disease that would be remembered as his “family curse.”

Consumption—as pulmonary tuberculosis was commonly known by—had evolved into a major public health concern throughout Europe at the turn of the nineteenth century because of increasing urbanization. Before the discovery of the intracellular pathogen M. tuberculosis by Robert Koch in 1882, consumption was widely believed to be a hereditary illness rather than a contagious one, and precautions against its transmission were rarely taken. At its peak incidence, tuberculosis affected 70-90% of the urban population in Europe and accounted for nearly 40% of all deaths among the working class.2 Keats’ family was one of the many households ravaged by the White Plague. Fostered by his maternal kin from early childhood, Keats lost his uncle to “a decline” (another contemporary name for tuberculosis) at the age of twelve and his mother two years later to the same condition. The family curse then struck again in 1817, when Keats’ beloved brother Tom began spitting blood and having bouts of fever.3 Keats personally attended to the care of his brother, but despite his best efforts Tom died in December 1818. Devastated by Tom’s death and troubled by a recurring sore throat,4 Keats moved into the newly built Wentworth Place, where he devoted himself entirely to poetry—La Belle Dame being one of the first works he produced there.5

Reflecting Keats’ painful familiarity with consumption, La Belle Dame depicts a chance encounter between a nameless passerby and a dying knight on the banks of a secluded lake. Immediately, the first three stanzas of the ballad render a detailed sketch of the knight’s ailment, which bears an uncanny resemblance to tubercular illness. His sickly pallor is highlighted by a cold pale forehead (“a lily on thy brow”) and colorless cheeks (“on thy cheeks a fading rose”), and he is tormented by fatigue (“haggard”), fever, and night sweats (“anguish moist and fever dew”)— all signs of active tuberculosis.6,7 The knight later reveals that he had met and fallen in love with a beautiful “faery’s child” while traveling through the wilderness, and after spending a night with her in an idyllic grotto he had woke up to find himself drained of his youthful vitality. Here, Keats alludes to Eastern European folklore, which often associated consumption with vampirism.8 The poem thus begins, at the end of the knight’s journey, in a place where “no birds sing.”

La Belle Dame is remarkable for both its rich sensual imagery and prophetic insight. Keats’ desire for companionship, his fear of obscurity, and his awareness of imminent death are all allegorically encoded into the knight’s struggle with solitude and mortality. Forsaken and terminally ill, Keats’ knight has lost his sense of purpose and is reduced to living a “posthumous existence”—an experience Keats would share during the final months of his life.9 Like his forlorn knight, Keats died virtually unknown in 1821, at the age of twenty-five. No birds sang of his name, and it would take another thirty years for his talent to be recognized.10 Though Keats long upheld the notion that poets should be “unpoetical” and strive to separate their personal identities from their narratives,11 La Belle Dame shows us that the complete disengagement of an artist from his art is nigh impossible. Keats failed to elude his own demons in the labyrinths of verse, yet one could argue that it is this union of imagination and raw humanity which makes poetry so fascinating to read.


  1. John Keats to Benjamin Bailey, November 22, 1817, in Letters of John Keats to His Friends and Family, ed. Sidney Colvin, http://ebooks.adelaide.edu.au/k/keats/john/letters/complete.html.
  2. “Tuberculosis in Europe and North America, 1800–1922” in Contagion: Historical Views of Diseases and Epidemics (Cambridge, MA: Harvard University Library Open Collections Program), accessed November 17, 2013, http://ocp.hul.harvard.edu/contagion/tuberculosis.html.
  3. John Keats to George and Thomas Keats, January 5, 1818.
  4. John Keats to George and Georgiana Keats, December 29, 1818.
  5. John Keats to George and Georgiana Keats, April 28, 1818.
  6. Barbara C. Cahill and David H. Ingbar, “Massive hemoptysis. Assessment and management,” Clin Chest Med 15, no. 1 (1994): 147-67.
  7. Jatin M. Vyas, “Disseminated tuberculosis,”  U.S. National Library of Medicine, last modified October 31, 2013, accessed November 18, 2013, http://www.nlm.nih.gov/medlineplus/ency/article/000624.htm.
  8. Paul Barber, “Vampires, Burial, and Death: Folklore and Reality” (New Haven, CT: Yale University Press, 1988), 115.
  9. John Keats to Charles Brown, November 30, 1820.
  10. Encyclopedia Britannica Online, s.v. “John Keats,” accessed November 20, 2013, http://www.britannica.com/%20EBchecked/topic/314020/John-Keats.
  11. John Keats to Richard Woodhouse, October 27, 1818.

PUTZER J. HUNG is currently a MD/PhD student in his first year of graduate study at Washington University. He grew up on the beautiful tropical island of Taiwan and graduated from Brown University in 2006.

Highlighted in Frontispiece Spring 2015 – Volume 7, Issue 2 and Highlighted Vignette Volume 14, Issue 1 – Winter 2022

Spring 2015



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