Keats at Guy’s Hospital

By Suzie Grogan
The ‘spirit of place’ is important to many of us. We feel rooted in certain landscapes, or are most creative when working in a particular environment.  It is also something that links poets, writers and artists to a place or time which can, when their work is examined, be seen to resonate in their work and inform it. This may be conscious or subconscious, but it is there. For John Keats, these psychic links are to his time as an apothecary’s apprentice, and at medical school at Guy’s Hospital in London.

In July 1815, as Keats finished his apprenticeship with Thomas Hammond in Enfield, legislation was passed requiring medical men to study at a hospital before they could set up in practice as an apothecary, so at the cost of 1 2s he signed up for a year as a surgical pupil at one of the best and most innovative of teaching hospitals, situated in Southwark, a notoriously squalid area just south of the River Thames. Keats shared lodgings with fellow medical students at 28 St Thomas St, in an area known as the Borough, which he described as ‘a beastly place in dirt, turnings and windings’.

Nearby could be found the ruined Clink prison, the old and new Marshelsea and King’s Bench prisons, reached via the slum district known as the ‘mint’. The area was the haunt of grave robbers and body-snatchers who provided Guy’s and nearby St Thomas’s with cadavers in various states of putrefaction, which as a student Keats was required to examine in detail. In these circumstances he completed his apprenticeship as a medical man, and as a poet.

19th century doctor William Osler described the horrors of the dissecting room:

“On entering the room, the stink was most abominable. About 20 chaps were at work, carving limbs and bodies, in all stages of putrefaction, and of all colours; black, green, yellow or blue, while the pupils carved them apparently, with as much pleasure, as they would carve their dinners. One, was pouring Terebinth on his subject, and amused himself with striking with his scalpel at the maggots, as they issued from their retreats.”

Can we see these experiences reflected in Stanza LX of Isabella? As her brothers remove Lorenzo’s head from the basil pot in which Isabella had planted her lover’s head, having removed it from the  ‘wormy circumstance’ of his grave, Keats tells us:

The thing was vile with green and livid spot,          
 And yet they knew it was Lorenzo’s face
Or perhaps in the fabulous description of Lamia’s change from serpent to human:
Her eyes in torture fix’d, and anguish drear,            
Hot, glaz’d, and wide, with lid-lashes all sear,    
Flash’d phosphor and sharp sparks, without one cooling tear.    
The colours all inflam’d throughout her train,    
She writh’d about, convuls’d with scarlet pain:    
A deep volcanian yellow took the place            
Of all her milder-mooned body’s grace;

Despite the enlightened views under which Guy’s and St Thomas’s had been developed, the latest facilities on offer there could not compensate for the continued gross ignorance of basic medical facts that we now take for granted. When Keats started there in 1815, there was no anaesthesia, infection control or delicacy in surgical procedures, although great doctors such as Astley Cooper (who took a personal interest in Keats) made significant discoveries over the coming decades. Cooper was an inspirational lecturer and offered students the opportunity to learn from his experiences and observations. His commitment to the idea that knowledge can only be based on observation, not on conjecture, made a lasting impression on Keats and his poetical philosophy. The test of belief can only be truly ‘proved upon the pulses’. In one significant case study Cooper said:

“I shall have occasion to mention to you a most extraordinary case, in which the functions of the mind were suspended from an interruption of the circulation in the brain, for upwards of thirteen months; the patient having as it were, drunk the cup of Lethe during all that period from that moment…his mind had remained in a state of perfect oblivion. He had drunk as it were the cup of Lethe.”

Compare this to the opening line of Ode to a Nightingale, written in 1819:

My heart aches, and a drowsy numbness pains
    My sense, as though of hemlock I had drunk,
Or emptied some dull opiate to the drains
    One minute past, and Lethe-wards had sunk

When Keats was offered an early ‘dressership’ (acting as an assistant to a surgeon) he was not as he had hoped assigned to Cooper but to William Lucas Junior. Described as a ‘tall ungainly man, with stooping shoulders and shuffling gait, as deaf as a post, [and] not overburdened with brains of any kind’ he had a reputation as a clumsy and inept surgeon. Astley Cooper broke protocol to agree that Lucas was:

“. . . neat handed but rash in the extreme, cutting amongst most important parts as though they were only skin, and making us all shudder from the apprehension of his opening arteries or committing some other horror.”

Keats had to hold the poor patients down on the operating table and stifle their cries, in the semi-circular theatres crammed with students observing the procedure. He had to attend on the wards, change dressings and found that ‘almost every wound was or quickly became a foul-smelling festering sore’. One of Keats’s fellow-pupils at Guy’s, John Flint South, described in detail the duties of a dresser, a role that was seen as something of an honour amongst students:

“He attended to all the accidents and cases of hernia which came in during his week of office, and he dressed hosts of out-patients, drew innumerable teeth, and performed countless venesections, till two or three o’clock, as might be, till the surgery was emptied. . . . When the surgeon arrived the dresser on duty would show him, among the outpatients, any case about which he needed further help or which he thought advisable to be admitted, as likely to issue in an operation.. . . Cases of strangulated hernia, retention of urine, and other accidents, were admitted at the discretion of the dresser.”

Keats, witnessing these horrors, began to question his future as a doctor. He had by this time been introduced to a London literary circle that would influence him in other ways over the coming months. He became depressed and his fellow students noticed him ‘dressing a la Byron’ and drifting into daydreams. His medical notebooks show doodles in the margins. There is no clear date when he ceased his medical career (he had passed his apothecary’s exams but did not go on to become a surgeon) and when in dire need of money towards the end of his short life he even considered returning to the career he had abandoned. Still, it is likely that by early 1817 he had cut all ties with the hospital and taken his first steps as a professional poet.

It is clear that any remaining view of Keats as a swooning, frail Romantic must be dismissed in light of the sights he saw and the horrors he endured. But how did it influence his poetry?
Nicholas Roe, in the most recent biography of the poet, examines Keats’s medical notebooks in detail. He notes his ‘small fine hand’ and evidence of a ‘neat and orderly student’. The most interesting impressions however are of the notebooks as source material.

Where his earliest poems, written whilst at medical school, use such words as ‘despair’ and ‘hope’ to describe emotions, Roe notes how his knowledge of anatomy and physiology gives him a whole new vocabulary, as the very life force throbbing through veins and arteries offer alternatives to conventional expressions of life and love.  He used it to describe the violence of his feelings for Fanny Brawne, as in To Fanny:

Physician Nature! Let my spirit blood;
Oh ease my heart of verse and let me rest;
Throw me upon the tripod till the flood
Of stifling members ebbs from my full breast.

The appeal to a ‘physician Nature’ is significant. Keats was fascinated by the healing powers of poetry, adopting Apollo, a deity associated with both poetry and healing as his muse. The fragment Fall of Hyperion debates the value of the poet as healer and perhaps many of the references to health in his work can be explained by his search for a role as poet and healer. In the poem, the goddess Moneta asks:

What benefit canst thou do, or all thy tribe,
‘To the great world? Thou art a dreaming thing,
‘A fever of thyself think of the Earth;

To which the poet replies:

‘If it please,
‘Majestic shadow, tell me: sure not all
‘Those melodies sung into the world’s ear
‘Are useless: sure a poet is a sage;
‘A humanist, physician to all men.

In essence Keats was a true Romantic, crossing lines drawn between science and the arts. Whilst studying at Guy’s he may have already felt his vocation lay elsewhere, but he passed his exams where roommates failed them. He was living his life in two worlds, and that recognition of the connections between the realities of bodily suffering and mental pain would serve him well as his poetic talents came to fruition.

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 grey hairs,      
  Where youth grows pale, and spectre-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
(Stanza III Ode to a Nightingale 1819)
Suzie Grogan
Suzie Grogan is a London-born professional writer and researcher, working in the fields of social and family history and mental health. Her first book Dandelions and Bad Hair Days: Untangling lives affected by depression and anxiety was published in 2012 and her second, Shell Shocked Britain, will be published by Pen & Sword History in October 2014. She has two further commissions, including one on the life of an apprentice surgeon-apothecary in the early 19th century.

A lover of the written word in all its forms, Suzie has a popular blog at No wriggling out of writing and also presents a local radio show ‘Talking Books’ . Married with two children – one a philosopher, one a high jumper – she lives in Somerset but has her heart in the Lake District and London. Her long-standing passion for poetry, especially John Keats, has led to the wicked rumour that there are three people in her marriage….