Many famous artists, writers and musicians – from Watteau to Chopin – have died of tuberculosis. The illness typically begins slowly and insidiously, with weakness, increasing exhaustion, sore throat, and general malaise, developing into a fluctuating fever accompanied by a constant dry and painful cough, pulmonary haemorrhages, swollen joints, wasting of the muscles and rapid weight loss; a Roman doctor of the second century AD, Aretaeus, described one of his tubercular patients as having ‘shoulder blades like the wings of birds’.
Keats’s experience of the disease followed this predictably distressing course. One February evening in 1820 he coughed up a little blood and calmly declared ‘It is arterial blood … my death warrant.’ The tubercle bacilli in his lungs had weakened the lining of a blood vessel. Later that night he had a severe haemorrhage. His medical training meant that he knew exactly what this signified – and he had recently nursed his younger brother Tom through the terminal stages of the illness.
Unfortunately, the standard treatment in Keats’s day only added to his suffering. Over the following months he spent long hours on a sofa, weak from the near-starvation diet prescribed him, coughing up blood and submitting to regular ‘bleedings’ from his doctor. In Rome his Scottish physician, Dr James Clark, at first prescribed exercise, with regular bleedings, and forbade any pain-killing laudanum. He mistakenly thought that the problem was with Keats’s stomach, but his post-mortem recorded that ‘both lungs had completely gone’.
Keat’s short life-span, at the beginning of the Industrial Revolution, marked the first peak in the incidence of pulmonary tuberculosis – also known as phthisis (the Greek word for ‘wasting’), consumption and ‘the white death’ (partly because of the severe anaemia associated with it). The disease was not recognised as being contagious until the mid 1850s, and it was only after the development of effective drugs such as streptomycin in the 1940s that it ceased to have such a devastating effect on the human condition.