John Keats, one of the great poets of all times, was born near Moorgate in London in 1795. His father was an inn stable keeper (an ostler), who one night fell off a horse and fatally fractured his skull, leaving his family somewhat impecunious.1 John, sibling of four, was far from a model pupil in school – he was somewhat aggressive, even to the point of once striking a master. Some expected him to follow a career in the army, but at fourteen his interests turned to literature. He won several prizes – one for his translations from Latin and French. He read books from the school library continuously, during meals and even while walking.1 Not very tall, a little over five feet, he was handsome, vivacious, and well proportioned. When his mother became seriously ill during the Christmas holidays of 1809, he sat up long hours reading to her and cooking her meals. She died in 1810, probably from tuberculosis. 1
Soon after his mother’s death Keats was apprenticed to the surgeon Thomas Hammond. He visited patients with his master, swept the rooms, and took care of the surgeon’s horses. His duties seem to have been light, he had plenty of spare time, and in the evenings would walk across the fields to visit a friend and discuss books and poetry. He stayed with Hammond for four years and then left, perhaps after a disagreement.1,2
In 1815 he enrolled at the United Hospitals’ medical school, the combined teaching institution of Guy’s and St Thomas’ hospitals. Midwifery, medicine, and therapeutics were taught at Guy’s; anatomy and surgery at St. Thomas’.1 Keats led the typical drudging life of a medical student,4 but was fortunate at Guy’s to come under the influence of Sir Astley Cooper, one of the great founders of modern surgical technique, who noticed “little Keats” and at one time placed him under the special care of one of his relatives.1-5 Another surgical tutor, William Lucas, whose dresser he had been, was described as no more than a butcher, in whose hands the horrors of surgery without anesthesia were well exemplified.1,2
In those days medical education for primary care was brief and straightforward. Each student spent six months pupil in surgery, and there were four pupils assigned to every surgeon. After six months the students were promoted to become dressers.4 Again, each surgeon had four dressers assigned to him. The dressers made rounds with the surgeon, functioned as scribes by taking notes of the patients’ illnesses and operations, carried the plaster box, performed minor surgical procedures, and saw the patient with the surgeon once a week.2
Keats passed the examination to become a Licentiate of the Society of Apothecaries in July 1816. He never practiced medicine after graduation but first went to the seaside town of Margate to write.4 In September he returned having decided to give up medicine and devote himself entirely to poetry. But his early poems were not well received, and for the young poet with very slender means life was difficult. In October he wrote his famous poem on “First Looking into Chapman’s Homer.”
In April 1817 he abandoned his damp rooms in London and moved to Hampstead. There followed three years of wonder that elevated Keats to the first rank of the world’s poets. Yet he did not abandon the idea of practicing medicine, and as late as 1819 considered going to Edinburgh for a degree with the thought of practicing as a physician. He wrote that studying or practicing medicine would not interfere with his poetry but could actually be beneficial, and he was glad not to have given away his medical books.5
In the summer of 1818 Keats took a walking tour in Northern England and Scotland. He returned with a harsh cough and an ulcerated throat; and it has been suggested that this was a manifestation of mercury poisoning.6 Mercury was widely prescribed then in the form of pills, vapors, ointments, plasters, and injections, somewhat later replaced by arsenic, and used to treat venereal diseases at a time when gonorrhea was thought to be an early stage of syphilis. It is not clear whether Keats had contracted a venereal infection, but at various times, as early as 1818 and even shortly before his death Keats was treated with mercury in varying doses. It has been suggested that mercury intoxication may have been responsible for various symptoms Keats experienced during his short life, namely sore throats,1 stomatitis, toothache, upset stomach, at one time tremors, palpitations, and “nervous irritability.” As mercury compounds have been shown to have toxic effects on the immune system, it is conceivable that they contributed to him becoming infected with tuberculosis and having the disease progress so rapidly.1, 6
The year 1819 was the great productive period in Keats’s life. In January he wrote “The Eve of St. Agnes” and later “La Belle Dame Sans Merci.” Before May he had written the three great odes, “Ode to Psyche,” “Ode on a Grecian Urn,” and “Ode to a Nightingale.”1,4 Nursing his terminally ill brother, who like their mother had died from tuberculosis, he may have, by close contact, caught the disease himself. In some of his poetry that year he wrote about young people wasting and falling mortally ill, reflecting his experience with sick people at the hospital, or the death of his brother, or perhaps intimations of his own mortality.
Fade far away, dissolve, and quite forget
What thou among the leaves hast never known,
The weariness, the fever, and the fret
Here, where men sit and hear each other groan;
Where palsy shakes a few, sad, last gray hairs,
Where youth grows pale, and specter-thin, and dies;
Where but to think is to be full of sorrow
And leaden-eyed despairs,
Where Beauty cannot keep her lustrous eyes,
Or new Love pine at them beyond to-morrow.
“Ode to a Nightingale”
I saw pale kings and princes too,
Pale warriors, death-pale were they all;
They cried— ‘La Belle Dame Sans Merci
Hath thee in thrall!’
I saw their starved lips in the gloam,
With horrid warning gapèd wide…
“La Belle Dame Sans Merci”
At the beginning of 1820, Keats lived in Hampstead with his friend Brown. His health began to deteriorate. Brown describes how one evening on arriving home Keats looked ill and he advised him to go to bed immediately. When Brown went to his bedroom to bring him a glass of spirits, Keats coughed slightly and as a small spot of blood appeared on the sheet, he heard him say: “That is blood from my mouth. Bring me the candle, Brown, and let me see the blood. [Then, looking up at Brown,] I know the color of that blood; it is arterial blood. I cannot be deceived in that color. That drop of blood is my death warrant. I must die.”1
His friends supported him as best they could, but as he was getting worse all the doctors agreed that his only hope was to go to Italy, to a better climate. His voyage in September 1820 has been described as horrific. They were delayed by adverse winds in the Channel and had to put into Portsmouth. On board there was also traveling another woman with advanced tuberculosis; and it is reported that if the portholes were closed, she would faint and if they were open Keats coughed until he spat blood.1 In Naples they spent six weeks in quarantine before landing because the authorities had heard of an outbreak of typhus in London.1
Arriving in Rome on 15 November 1821, Keats was accommodated in a pleasant flat by the Spanish Steps, but his condition became critical as he became wasted and suffered from bouts of fever and night sweats. He died on Feb. 27. His friend wrote that he died with the most perfect ease, saying “I shall die easy; don’t be frightened – be firm, and thank God it has come” – and he just seemed to go to sleep. At autopsy his lungs were said to have been completely destroyed by disease.1 He was buried at the Protestant cemetery in Rome and had asked that his epitaph be “here lies one whose name was writ in water.”4
- Smith H. John Keats: Poet, Patient, Physician. Review of Infectious Disease. 1984;6:390 (May-June).
- Banerjee AK. John Keats: his medical student years at the United Hospitals of Guy’s and St Thomas’. J. Roy. Soc. Med. 1989;82:620. (Oct).
- John Keats, Medical Student. BMJ. 1925;1:035 (May 16).
- Scarlett EP. John Keats: Medical student. Arch Intern Med. 1962;110:535 (Nov).
- Davis SL. John Keats and “The Poison.” Venereal or Mercurial? Keats-Shelley Journal, 2004;53:86.
- Lord Evans of Hungershall. Keats-the Man, Medicine, Poetry. BMJ 1969:2:7 (5 July).
GEORGE DUNEA, MD, Editor-in-Chief