Why Keats’s haunting reflections on tuberculosis resonate in the age of Covid-19

Through some of the finest poetry in the English language, John Keats distilled the horrifying impact of the TB pandemic.

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He knew that the persistent cough spelled his end. The fever had preceded it, just as it had in his mother, brother and dozens around him. The contagion that was devastating society had him in its throes. When he finally died, a postmortem showed his lungs had been decimated. He’d suffocated, drowning in his own inflammatory fluids. The young English poet John Keats died aged just 25 in Rome on 23 February 1821, having been diagnosed with tuberculosis, or consumption as it was then known, just over a year before. In 1819, inspired by his medical training and acute observation of his disease, Keats captured the essence of its impact on society.

“Ode to a Nightingale” (1819), written as his symptoms took hold, speaks of “the weariness, the fever and the fret” associated with his condition where “youth grows pale, and spectre-thin, and dies; where but to think is to be full of sorrow and leaden-eyed despairs”, and where the “the dull brain perplexes and retards”. He envies the nightingale, free from disease and able to fly through the woodland skies, while Keats wishes to alleviate his suffering through death: “for many a time I have been half in love with easeful Death, Call’d him soft names in many a mused rhyme, To take into the air my quiet breath; Now more than ever seems it rich to die, To cease upon the midnight with no pain, While thou art pouring forth thy soul abroad In such an ecstasy!”

Tuberculosis is caused by a bacterium (Mycobacterium tuberculosis – or the tubercle bacillus), transmitted from infected individuals. The bacteria can lodge in different organs, particularly the lungs, where they first enter the host, breathed in on tiny droplets of saliva or sputum emerging during coughing fits associated with the illness. Covid-19 spreads in the same way but can create serious disease within days. The slow-growing tubercle bacillus takes years.

Inflammation in the lungs induces severe coughing; lung function is diminished and pronounced breathlessness ensues. The bacteria induce fevers and sweats, particularly at night. Eventually, blood vessels feeding the lungs rupture, further diminishing function and contributing to increasing anaemia. Apart from tuberculosis, or consumption, the disease has had many synonyms. Medically, the term phthisis (“a wasting disease” in Greek), preceded tuberculosis. 

Epidemic tuberculosis emerged during the Industrial Revolution as ever-expanding cities accumulated filth and previously unknown proximity between humans fuelled transmission. In 1801, a third of all Londoners died from the disease. Covid-19, too, is a disease of close proximity. Before the 19th-century, social distancing was the norm.

[See also: Rowan Williams on how Keats lives on]

Keats, himself a Londoner, first encountered TB when he was 14 and his mother died of consumption. His father had died in an accident several years before. After school, the orphaned Keats served an apprenticeship as an apothecary (a kind of pharmacist) before studying medicine at Guy’s Hospital in Southwark. He never took to the profession and abandoned medicine to pursue a career in poetry.

Keats’s writing matured throughout 1817 and 1818, but when his youngest brother, Tom, also died from tuberculosis aged only 19, Keats entered a state of poetic paralysis. During this time the infection, probably acquired from Tom, took hold within Keats himself. The following spring he was still mourning his lost brother, growing fearful about his own health and tumbling headlong into love with Fanny Brawne, the girl next door to his Hampstead home. This grief, fear and romantic turmoil appear to have been the engine that drove a period of extraordinary creativity. It was the summer of 1819 that Keats wrote much of his best-loved verse. 

In addition to the Nightingale ode, another of his 1819 poems, “La Belle Dame sans Merci”, appears to describe his fears of tuberculosis. In a first draft it follows the plight of a knight-at-arms, although by the time the poem was published in 1820, the knight had become a “wretched wight” – a kind of unkempt sickly person commonplace in medieval verse. The knight-at-arms transformed to a wretched wight just as Keats had descended from a poet with high aspirations into a blood-coughing wreck. The wight falls in love with a fair maiden, but the relationship leaves him drained, feverish and dreaming of others who had shared his fate.

Keats, all too aware of the symptoms of TB from his own medical education and from witnessing the decline of his mother and brother, suspected the worst. One night, in February 1820, while returning to Hampstead on a horse-drawn coach from London he endured a terrible coughing fit that ended with him bringing up blood on to his handkerchief. Turning to his house mate, Charles Brown, he said in horror: “It is arterial blood. I cannot be deceived in that colour – that drop of blood is my death warrant – I must die!” 

When, last November, I awoke one morning with terrible shivers, a piercing headache and persistent cough, I suspected I must have caught Covid-19. A test told me I had. For a few days I felt a surreal apprehension, knowing this could be bad. Unlike in the case of TB, however, most people of my age (56) survive Covid-19 and my apprehension was short-lived. I did, though, briefly glimpse the terror that contagion can bring. Russell T Davies’s recent Channel 4 drama It’s a Sin, which depicts the horrific emergence of the Aids pandemic in the 1980s, may be closer to some of Keats’s fears. That disease, of mysterious cause at the time, was more insidious in its development and always fatal.  

It was over 60 years after Keats’s death that the tubercle bacillus was finally discovered, in 1882 by the German scientist Robert Koch. Keats wondered about a psychosomatic cause, linking his own decline to an obsessive love for Fanny Brawne. But “La Belle Dame Sans Merci” suggests that the poet also had other thoughts on causation. Sexual transmission was considered a possibility by many in the early 19th century. Keats was troubled by the fact that romantic love and bestial lust were so closely allied. Could the combined effects of a psychosomatic cause and venereal disease have precipitated his decline? Comments scribbled in the margin of a passage from Robert Burton’s The Anatomy of Melancholy beside the phrase, “Love universally taken, is defined to be desire” are an indication of his thoughts:

Here is the old plague spot; the pestilence, the raw scrofula.  I mean that there is nothing disgraces me in my own eyes so much as being one of a race of eyes, nose and mouth beings in a planet called the earth who all from Plato to Wesley have mingled goatish, winnyish, lust filled love with the abstract  adoration of the deity.

The poem carries an unmistakably erotic message. “She looked at me as she did love/ And made sweet moan,” he says in one verse, then: “I sat her on my pacing steed/ And nothing else saw all day long” in the next, and later: “She took me to her elfin grot.” But the pale knight/wight “so haggard and so woe-begone” believes his encounter with La Belle Dame, like so many others before, has left him in this terrible state. It is this merging of sex and disease that, I think, suggests Keats considered his consumption to have been acquired venereally. In a letter written to his friend Benjamin Bailey in Oxford on 8 October 1817, Keats mentions that: “The little mercury I have taken has corrected the poison”. The physician who prescribed Keats with mercury was Dr Solomon Sawrey, who had earlier written a treatise on its use for venereal disease. Unfortunately, mercury has no healing impact on TB. Nor did Keats’s departure for Rome, where he hoped that the better climate would heal his lungs.

The first drug for tuberculosis, streptomycin was isolated from soil bacteria in the US in 1943. George Orwell was among the first British patients to receive it in 1948. He was, alas, allergic to it and died in 1950. 

Today’s treatment for TB is still far from satisfactory. A medley of drugs must be prescribed for months before a cure is achieved, and the bacteria are becoming resistant to these drugs with few new ones in development. Over a quarter of the world’s population carry tuberculosis bacteria today and 1.4 million people died of the disease in 2019. Its impact is likely to endure long after Covid-19.

Michael Barrett is professor of biochemical parasitology at the University of Glasgow

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