Looking at the National Health Service today, it is clear that despite economic constraints it offers a standard of care that renders incomprehensible to us the dreadful conditions under which people of all classes were treated in the early 19th century. Even the enlightened views that had encouraged and funded the development of Guy’s and St Thomas’ Hospitals (the ‘United’ hospitals) in London and offered facilities encouraging the very best and most innovative medical practitioners, could not compensate for the general ignorance of simple medical facts that we take for granted in the 21st century. Anaesthesia, infection control and delicate surgical procedures for example were all the subject of study at this centre of excellence in English medicine. But in 1815 when Keats started his studies much was still to be learned and treatments were highly experimental.
In his early weeks in London, having completed his apprenticeship in Edmonton, Keats became concerned that he might be too squeamish to become a surgeon. Even the excitement of the city could not wipe from his mind the images of pain he was witnessing daily.
Andrew Motion, in his biography Keats describes a typical day for the young student. The day began at 7.30am, with lectures on subjects as diverse as midwifery, philosophy and dentistry. On three days a week (including Saturdays) he attended lectures in chemistry. Six days a week he would then spend time in the hospitals before an afternoon session studying anatomy. Evenings were spent in the dissecting room.
The use of bodies for teaching anatomy was illegal. The bodies the students used for dissection were bought, at a cost of three or four guineas from body-snatchers , or “resurrection men” , who robbed local graves at night and touted the bodies around the local teaching establishments in sacks, or baskets. The bodies were naked – stealing a corpse was a misdemeanour but stealing a shroud was a criminal offence. Medical practitioners (including Astley Cooper) encouraged this practice, to a point where they ceased even to question why bodies were arriving ‘fresh’ (most likely murdered).
It was in the dissection room that Keats would have witnessed some of the most gruesome aspects of his medical studies, although at least the poor souls they cut up were dead. Bodies were laid out on the tables with body parts and organs in jars and tubs. The smell would have been appalling, but a contemporary account suggests the students became inured to the horrors.
Keats scholar Donald C. Goellnicht quotes the uncle of famous 19th century doctor William Osler:
“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.’
Keats was faced with these scenes on a daily basis, and worse was to come.
Senior surgeon Astley Cooper was one of the most admired doctors in Britain. He was also an inspirational lecturer, offering students the opportunity to learn from his experiences and scientific observations occasionally interrupted by his love of a joke. His commitment to the idea that knowledge can only be based on observation, not on conjecture was an emphasis that made a lasting impression on Keats and his poetical philosophy. The test of belief can only be truly ‘proved upon the pulses’. However, 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.”
It is difficult to imagine the Romantic poet in those situations and although his studies and the horrors he witnessed would inform his greatest work, at this time he began to seriously question his future not only as a doctor but as that poet he dreamed of becoming. He sank into something of a depression and even ‘dressing a la Byron’ and taking himself off into a fantasy ‘fairyland’ could not stop his melancholy becoming increasingly intense.
It was inevitable that the conflict between his life at Guys and his desire to be a poet was reaching a climax.