Two hundred years ago, on 23 February 1821, the poet John Keats died of consumption (tuberculosis) in a small rented apartment overlooking the Spanish Steps in Rome (now the Keats-Shelley House). He was just 25. In the last few months of his life, he was cared for by the painter Joseph Severn, and by James Clark, physician to the English-speaking community in Rome. Given the limited understanding of consumption at the time and the advanced state of Keats’ illness, Clark did all he could to help the young poet.
Just a year earlier, in February 1820, Keats first coughed blood, a clear symptom of consumption. On 3 February, he caught the late coach back to Hampstead, to the house in Wentworth Place (now Keats House), where he was lodging with his friend Charles Armitage Brown. Keats didn’t have his winter coat with him and, to save money, travelled on the outside of the coach. The weather was freezing and, by the time he stumbled back to the house, he was feverish.
Brown immediately ordered Keats to bed, and saw him cough slightly as he got under the covers. He later remembered:
‘I heard him say “This is blood from my mouth.” I went towards him; he was examining a single drop of blood upon the sheet. “Bring me the candle, Brown; and let me see this blood.” After regarding it steadfastly, he looked up in my face, with a calmness of countenance that I can never forget, and said, “I know the colour of that blood, – it is arterial blood; – I cannot be deceived in that colour; – that drop of blood is my death warrant; – I must die.”’
Tragically, Keats would have been acutely aware of the symptoms and prognosis of the disease: he had trained as an apothecary, had spent a year at Guy’s Hospital as a medical student and had nursed his younger brother Tom before he died of consumption in 1818. Keats saw several doctors in London over the next few months, including Robert Bree, William Lambe and George Darling. They differed in their diagnoses – some felt he was suffering from a disorder of the stomach, at least one believed he had anxiety – but all agreed he should avoid the harsh English winter and spend some months abroad, specifically in Italy.
Keats was initially reluctant to leave London and his fiancée, Fanny Brawne, but let his friends arrange the journey to Rome and the introduction to Clark. He wrote to Brown in August 1820:
‘I am to be introduced, before I set out, to a Dr Clarke [sic], a physician settled at Rome, who promises to befriend me in every way…’
Although he was just 32 at the time, James Clark was exceptionally well qualified and experienced. Born in Banffshire, Scotland, he studied medicine in Edinburgh and qualified as a member of the Royal College of Surgeons of Edinburgh in 1809. He joined the Royal Navy as an assistant surgeon, survived two shipwrecks, off New Jersey and Jamaica, and then, at the end of the Napoleonic Wars in 1815, was put on half pay. He returned to Scotland, where he gained an MD from the University of Edinburgh in 1817. The next year he accompanied a patient suffering from consumption to the south of France, Lausanne and Florence. He stayed on the continent and, by 1819, had established a flourishing practice in Rome. A cultured man, he already knew about Keats and his poetry – he owned a copy of Keats’ poem ‘Endymion’ and had a subscription to the Edinburgh Review, which had reviewed the poet’s work.
Keats and Severn left London in September 1820 and travelled by sea to Naples (where they were held in quarantine for ten days in the harbour) and then on overland to Rome. Once in the city, they went immediately to Clark’s rooms in the Piazza di Spagna, in the centre of the English-speaking community, arriving just as the doctor was writing to a friend in Naples enquiring of the poet.
Clark has been criticised for his care of Keats – specifically that he failed to diagnose him properly, put him on an overly harsh regime and neglected to tell him he was dying. Little was known about the causes and prognosis of pulmonary consumption in the early 19th century and, crucially, diagnosis was not straightforward. René Laënnec had invented the stethoscope in Paris just four years earlier, in 1816. Clark had met a colleague of Laënnec’s, a Dr Cayol, on his travels and was an early adopter of the instrument when he eventually returned to Britain, but it is unlikely that Clark had a stethoscope when he examined Keats in Rome. Initially at least, Clark focused on Keats’ stomach and did not diagnose consumption. He wrote to a colleague:
‘The chief part of his disease, as far as I can yet see, seems seated in his stomach. I have some suspicion of the heart and it may be of the lungs…’
Clark used recognised treatments of the time in his attempts to help Keats: he bled him regularly, put him on a minimal diet (sometimes just a single anchovy and some bread a day) and tried to shield him from anxiety. He went further in his care of the poet: he arranged for lodgings for the English travellers close by his own and helped with the hire of a ‘little horse’ so that Keats could have some exercise. Despite the starvation diet, when Keats had a desire for a particular kind of fish, Clark searched all over Rome for one, having it cooked and ‘delicately prepared’ by his wife, Minnie (Barbara Clark née Stephen). He also did all he could to lessen the (dire) financial worries of the poet; he wrote to John Taylor, Keats’ publisher, who had partly arranged the trip to Rome, to try to untangle a misunderstanding over money.
Keats recognised the care that Clark have given him. In his last letter, written to Brown on 30 November 1820, he made a point of writing: ‘Dr Clarke is very attentive to me…’ Keats – the trained apothecary – must have known he had a short time to live and, when he asked of Clark ‘How long is this posthumous life of mine to last?’, perhaps recognised the good doctor was extending his life.
Despite Clark’s attentions and Severn’s constant nursing, Keats’ condition eventually deteriorated and he died at around 11pm on Friday 23 February. Clark immediately took over, taking in and caring for the distraught, exhausted Severn and arranging for casts to be made of Keats’ hands, feet and face. With a Dr Luby, he carried out an autopsy, finding that Keats’ lungs were almost completely destroyed; it was the worst case of consumption he had seen. Clark then planned a bleak, early morning funeral for the poet in the Protestant cemetery on the outskirts of Rome.
James Clark moved to London in 1826, became a physician at St George’s Infirmary and was eventually appointed as a physician to Queen Victoria and Prince Albert. His major, popular work, A treatise on pulmonary consumption, specifically on the prevention of tuberculosis, was published in 1835. He became a baronet and died aged 81 in 1870. Keats, who died believing he was a failure, insisting his gravestone should be inscribed with the enigmatic words, ‘Here lies one whose name was writ in water’, has had a far longer, more celebrated, posthumous life.
Sarah Gillam, Editor Inspiring Physicians
Resources used in writing this post:
- Dubos R, Dubos J. The white plague: tuberculosis, man and society. New Brunswick, NJ, Rutgers University Press, 1952.
- Motion A. Keats. London, Faber and Faber, 1997.
- Oxford Dictionary of National Biography. Bree, Robert (Bap 1758-1839).
- Oxford Dictionary of National Biography. Clark, Sir James, first baronet (1788-1870).
- Oxford Dictionary of National Biography. Darling, George (1779-1862).
- Oxford Dictionary of National Biography. Keats, John (1795-1821).
- Oxford Dictionary of National Biography. Lambe, William (1765-1847).
- Scott GF (ed). Selected Letters of John Keats. Cambridge, MA, London, Harvard University Press, 2002.
- Smith H. ‘The strange case of Mr Keats’s tuberculosis’. Clinical Infectious Diseases, Volume 38, Issue 7, 1 April 2004, 991-3 [accessed 15 February 2021]
- Warfield, C. ‘Sir James Clark: death, treatment, and a society doctor’. History Imagined 17 April 2015 [accessed 15 February 2021]