How Keats coped with fever.

In 1821, three months after he learned of Keats’s death, Percy Shelley wrote Adonaïs: An Elegy on the Death of John Keats, in which he described the poet as a delicate, fragile young flower of a man:

Oh gentle child, beautiful as thou wert,

Why didst thou leave the trodden paths of men

Too soon, and with weak hands though mighty heart

Dare the unpastured dragon in his den?

That dragon was a cruel critic who had mocked Keats’s literary ambitions—John Gibson Lockhart, who, writing under the pseudonym Z, had scolded Keats as if he were a child, insisting in a review of Endymion that “it is a better and a wiser thing to be a starved apothecary than a starved poet; so back to the shop, Mr John, back to the ‘plasters, pills, and ointment boxes.’ ” Lockhart had classed Keats among the Cockney School of politics, versification, and morality, known—at least by readers of Blackwood’s Magazine—for its “exquisitely bad taste” and “vulgar modes of thinking.” In Shelley’s formulation, it was this bad review that sent Keats to an early grave, and gazing back through history, one begins to accept this two-part narrative of Keats’s legacy. The fallen poet had lived a life of abstractions—he was not only an aesthete, but the aesthete—and he had been, as Byron quipped, “snuffed out by an article,” too beautiful and frail for this harsh world.

But Keats was immersed in the realities of life; his poetry and letters reveal an allegiance to radical politics as well as a concern with economic and scientific issues. Far from childlike and apolitical, he’s now thought of as having been “dangerous … a poet who embodied and gave voice to the anxieties and insecurities of his times … a poet whom the establishment would be obliged to silence,” as the scholar Nicholas Roe puts it. We often overlook, for instance, that Keats spent six years studying medicine, successfully earning a license to practice in London from the Society of Apothecaries—hence Lockhart’s insult about the “plasters, pills, and ointment boxes.” To think that he was “snuffed out by an article” trivializes the intense pain he experienced as his lungs were slowly consumed by tuberculosis, robbing him of his work, his love, and his life at the age of twenty-five.

The myth of the frail genius is attractive, even to contemporary readers, because of its quintessential Romanticism. But the truth is that Keats’s writings—especially when they seem fanciful or escapist—are grounded in real-world concerns. And nowhere is this more evident than in the letters and poems of his that deal with feverish suffering.

During the early nineteenth century, London had fallen into the grip of fever mania. The city was working to combat a host of diseases associated with the colonies: yellow fever, typhus, influenza, smallpox, child-bed fevers, agues, and St. Anthony’s fire, among many others. With almost a million people living in the city in the early 1800s, including more than ten thousand prostitutes, disease spread quickly, inducing public panic. Between 1816 and 1817, the number of admissions to the Fever Hospital spiked from 124 to 781, and the fever epidemic remained a major news story for the duration of Keats’s life. Whereas some historians have viewed the fever as a foreign invader, striking from the colonies upon the homeland, Keats would have recognized it as a recurrent, intimate presence that followed him throughout his life.

The patients whom he attended at Guy’s Hospital haunted him, as did the memory of his mother’s fatal consumptive fever, which he would relive as he nursed his brother, Tom, throughout 1818. Because of his family’s history of illness, his own medical training, and the epidemic of fever that spread throughout London, Keats was intimately familiar with feverish suffering; he used his writing to make sense of a pain for which there was no reasonable explanation. Two letters—one written before Tom’s death and one after—outline Keats’s philosophy of suffering as a creative force.

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On May 3, 1818, Keats wrote a letter to his friend, John Hamilton Reynolds, comparing a human lifespan to “a large Mansion of Many Apartments.” He imagined two rooms in a mansion through which one must pass before confronting a vast number of potential third rooms. For an unspecified length of time, one remains unthinkingly in the first apartment, in spite of the fact that the doors leading to the second are wide open. Eventually, the impetus to think moves one from the first chamber into this second, called the “Chamber of Maiden-Thought,” which is full of intoxicating delights and thus initially very pleasing. But time spent within it leads to a “sharpening [of] one’s vision into the heart and nature of Man … convincing ones nerves that the World is full of Misery and Heartbreak, Pain, Sickness and oppression.”

One becomes aware of one’s own fever and the suffering that afflicts humanity—which were present all the while, even amid the delights. Keats thought he’d only made it to the end of this second room. He saw nothing but darkness and mist in the hallway beyond it. He told Reynolds that he wished to explore the dark passages to seek out some form of salvation by way of his poetry, though he offered no compelling evidence that any of the unexplored rooms might contain something redemptive, or even pleasant.

Surrounding this philosophical discussion are the details of Tom’s illness. The letter begins with what appears to be good news: “After a Night without a Wink of sleep, and overburdened with fever, [Tom] has got up after a refreshing day sleep and is better than he has been for a long time,” and ends with restrained melancholy: “Tom has spit a leetle [for little] blood this afternoon, and that is rather a damper.” But insofar as Keats was hoping to justify the purpose of suffering to himself, both of these statements are heartbreaking. Because of his extensive experience with ill patients, Keats surely knew that his brother’s condition was grim, even in May 1818. His reactions hint at a kind of denial—an insistence that there be an identifiable purpose to justify the trauma he continued to witness and endure. And once he has convinced himself that there is a purpose to suffering, it is only another small leap to start thinking of the fever as something constructive. Indeed, as odd as it may seem, it was his brother’s grim condition that prompted, even forced, Keats to expand his philosophy of suffering to embrace fever as beneficial. The search for the third room, undertaken in the midst of suffering, had to lead to the creation of something meaningful and redemptive, as Keats would try to convince himself after Tom’s death in December 1818.

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In the spring of 1819, Keats was at the height of his genius; within the next few months he would write his finest poems. In a letter from April 21, 1819 to his other brother, George, who had emigrated to America, Keats revisited his philosophy, unveiling the “system of Spirit-creation” that he’d been designing and testing for more than a year: the world as the “vale of Soul-making.”

Keats argued that any attempts to improve one’s life still end in death—a fate that he acknowledged as unbearable without some notion of redemption. And yet he rejected the idea of the afterlife or religious salvation—those, in his view, devalue the act of suffering, because they serve no creative purpose and teach nothing to the human individual.

Instead, he referred to the raw material of a soul as an “intelligence.” All humans have (or are) an intelligence, but they’re not considered souls until they develop an individual identity. Soul creation takes place over the span of many years and requires two components—the human heart and the world of feverish suffering—comprising a process that Keats likens to an education:

I will call the world a School instituted for the purpose of teaching little children to read—I will call the human heart the horn Book used in that School—and I will call the Child able to read, the Soul made from that school and its hornbook. Do you not see how necessary a World of Pains and troubles is to school an Intelligence and make it a soul? A Place where the heart must feel and suffer in a thousand diverse ways!

The “vale of Soul-making” celebrated the fever that had followed him through his life. And yet what Keats could not, or refused to, see is that the irrationality he perceived in religious salvation is present in his own system, too. There’s no ultimate purpose to the suffering that he, his family, and his patients have had to endure; it’s not as if the fever of tuberculosis consciously, benevolently struck Keats’s mother and brother to help them shape their souls. But Keats went to great lengths to convince himself of just that.

While the fever had surrounded him for most of his life, it consumed Keats during the months following Tom’s death, insisting that he find some way to rationalize its irrational effects. In fact, compared with other medical terms, Keats uses the word fever sparingly in his poems: blood is explicitly referenced forty-seven times (and implicitly in at least a dozen other instances), and there are 157 variations of heart, but only twenty-three instances of fever appear across the body of Keats’s poetry.

This shouldn’t mislead us into thinking that it’s a less potent image for him. His prudent use of the term demonstrates its importance—it’s loaded with personal significance. All but five of these uses of “fever” occur after Tom became ill, the most poignant of which comes in “Ode to a Nightingale,” written only a few days after the “vale of Soul-making” letter.

The feverish heart overwhelms the speaker of the “Ode to a Nightingale,” who suffers a heartache as he listens to the nightingale’s song, hoping to mirror the bird’s ability to transcend real-world circumstances. The speaker describes the world as

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 spectre-thin, and dies;

Where but to think is to be full of sorrow

And leaden-eyed despairs.

Keats must have had Tom’s death in mind when he composed these lines; every phrase is loaded with the common suffering of humanity from which the nightingale’s song seems to escape.

Less than two years later, Keats died of tuberculosis in Italy, where he’d traveled in the hope of recovering, accompanied by the artist Joseph Severn. Even as he grew shorter and shorter of breath in early 1821, Keats repeatedly rejected his dear friend Severn’s belief in the afterlife, suggesting that he was committed to his philosophy of Soul-making until the end. Severn wrote in mid-January: “this noble fellow lying on the bed—is dying in horror—no kind hope smoothing down his suffering—no philosophy—no religion to support him.”

When the end came, it was the fever, and not an article with obvious political motivations, that killed Keats. The pleasures of his life—beauty, love, poetry—had always been bundled up with suffering and death, and we may empathize with him in his desire to articulate a purpose to it all. He was not too frail for the world: his devotion to making the most of his mortality drove his creative process. He was a man who had a deep need to create meaning where there was none.

Jeffrey C. Johnson is a writer living in California. His writing can be found on his website, and he is on Twitter.