On John Keats and Blue Zones
John Davis Cantwell, MD
E
n route to Sardinia, to visit hill towns in the so-called
longevity “Blue Zones,” we had a brief stopover in Rome.
It allowed time only to see the apartment where physician-poet John Keats spent the last 3 months of his
life (separated from his fiancee, Fanny Brawne) and to reflect
upon his all-too-brief life. I also wanted to visit his grave, to
place some daisies on it, as did his physician, Dr. James Clark.
It seemed to me the least the latter could have done, having
misdiagnosed his pulmonary consumption and maltreating the
weak and severely ill patient with “blood lettings” and a nearstarvation diet.
JOHN KEATS
Keats was just 5′1″, a handsome lad (Figure 1) who seemed
anything but an athlete and a fighter. He was good at games
and (according to a classmate) “would fight anyone, morning,
noon, and night.” He flailed away at the butcher’s son when he
caught the latter tormenting a kitten.
Born in 1795, he was orphaned at a young age, after his
father had a fatal riding accident and his mother succumbed to
“consumption” (tuberculosis). Keats nursed his dying mother
and probably contracted the disease as a result. A year after her
death, Keats became an apprentice to Thomas Hammond, an
apothecary-surgeon practicing in a northern suburb of London.
He clashed with Hammond, apparently an alcohol abuser, and
moved to separate lodging.
Keats began to write poetry in his teens. Several years later he
continued to pursue a medical career at Guy’s Hospital, where
he met a lifelong friend, Joseph Severn. The patients at Guy’s
Hospital were largely drawn from the nearby slums. Observing
the various diseases, Keats once concluded that worldly honors
seemed meaningless when one considers young women with
cancer.
While at the hospital, Keats discovered the great books and
became influenced by the likes of Shakespeare and Wordsworth.
He differed from his fellow medical students in expression,
dress, and actions. The stomach appeared to him “like a brood
of callow nestlings, opening their capacious mouths, yearning
and gasping for sustenance.” He started to dress like poets did,
turning his collar down and wearing a ribbon around his neck.
He also grew a moustache.
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Figure 1. John Keats. Source: National Portrait Gallery, London.
In the lecture hall, Keats “seemed to sit apart and to be
absorbed in something else.” During one lecture he observed “a
sunbeam into the room and with it a whole troop of creatures
floating in the ray; and I was off with them to fairyland.”
From Piedmont Heart Institute, Atlanta, Georgia.
Corresponding author: John Davis Cantwell, MD, Piedmont Heart Institute,
275 Collier Road, NW, Suite 500, Atlanta, GA 30309 (e-mail: john.cantwell@
piedmont.org).
Proc (Bayl Univ Med Cent) 2016;29(2):220–223
His physician in Rome, Dr. Clark, initially thought a gastric
condition was causing “mental exertion.” A detailed family
history should have alerted Clark as to the correct diagnosis.
Clark’s treatment likely hastened Keats’ death. He was “bled”
(despite his weakness and bloody sputum) and placed on a
literally starvation diet, consisting of an anchovy and a piece
of bread daily.
As a poet, Keats sold only several hundred copies of his
books in his brief lifetime. Several were severely criticized in
reviews. In one, published in Blackwood’s Magazine, the reviewer wrote:
It is better and a wiser thing to be a starved apothecary (and
physician) than a starved poet; so back to the shop, Mr. John,
back to the plasters, pills and ointments.
Figure 2. Keats’ apartment building in Rome (on the right of the Spanish Steps).
A rotation with Dr. William Lucas, Jr., called by some “the
butcher of the hospital,” seemed to turn Keats away from medicine. Lucas “cut amongst the most important parts as though
they were only skin, making us all shutter from apprehension
of his opening arteries or committing some other error.” Keats
felt his own dexterity was limited, so he put down the lancet
for good and turned to poetry.
Keats met Fanny Brawne, the love of his life, in 1818, the
same year his brother died of tuberculosis. In February 1820,
Keats began having hemoptysis into the bedsheets. He illuminated the latter with a candle and, drawing from his medical
background, stated: “This is very unfortunate. I know the color
of that blood. It’s arterial blood. There’s no mistaking that color.
That blood is my death warrant. I must die.”
His physician sent him to Rome, thinking that the warm
weather would help. Joseph Severn accompanied him. It took
several months to arrive, in November, when the weather had
turned cold. Keats and Severn rented an apartment on the second floor of a building near the Spanish Steps (Figure 2). He was
essentially confined to a small bedroom (Figure 3), nursed by
Severn. It became too painful for Keats to read Fanny Brawne’s
last letters, which remained unopened and were later buried
with him.
Figure 3. The bedroom where Keats was confined in Rome.
April 2016
Little wonder that for his epitaph Keats requested that no
name be placed on his tomb in the Protestant Cemetery in Rome
(Figure 4), only “Here lies one whose name was writ in water.”
In his own mind, however, Keats had confidence in his writing
skills, once correctly defiantly declaring to one of his brothers
that he would be “among the English poets after his death.” Keats
died quietly in Severn’s arms. Years later Severn would request
to be buried next to Keats.
One of Keats’ biggest champions was Percy Shelley, who
continued to correspond with Keats while the latter was in
Rome, and who wrote an elegy (“Adonais”) to Keats a few
months after the latter’s death. Shelley was to die in a boating
accident only a year after Keats, his body washing ashore “with
a copy of Keats’ poems open in his pocket.”
Keats’ works have endured the test of time. His Endymion
(“A thing of beauty is a joy forever”) and Ode on a Grecian Urn
(“Beauty is truth, truth beauty”) will no doubt remain popular
for years to come.
Figure 4. Keats’ grave in the Protestant Cemetery in Rome.
On John Keats and Blue Zones
221
BLUE ZONES
Leaving Keats behind, we flew to Sardinia to experience
one of the so-called “Blue Zones” of longevity, popularized by
Dan Buettner, a National Geographic fellow, and his team of
researchers. They have identified at least five areas around the
world where individuals have a multifold likelihood of living
to age 100 compared to most Americans. These Blue Zones
include 1) the Greek island of Ikaria, 2) the Nicoya Peninsula
of Costa Rica, 3) Loma Linda, California, 4) Okinawa, and 5)
Sardinia, the focus of our trip. A greeting in Sardinia is akea,
meaning “may you live to 100.”
Along with Dr. Ocie and Jo Ella Harris, friends from internship days, my wife, Marilyn, and I wanted to view personally
the lifestyle of the Sardinian inhabitants which enabled many
to remain active and vibrant well into old age. What did Dan
Buettner find in his research and what did we observe in our
hiking trip with Classic Journeys?
In the Supramonte and Barbagia mountainous villages,
Buettner’s staff found 21 centenarians per 10,000 population, versus only 4 per 10,000 Americans. The men:women
ratio was about even, unlike in America where it is 1:4.
In the village of Perdasdefogu, nine living siblings in the
Melis family hold the Guinness world record of combined
age–828 years.
In studying the lifestyles of the Sardinians, Buettner highlighted seven key findings:
1. Their diet was lean, plant-based, with little meat.
2. They drank goat’s milk, which they felt might help combat
inflammation.
3. Their family ties were strong.
4. They celebrated and cared for their elders.
5. They typically walked about 5 miles per day.
6. They drank several glasses of Cannonau red wine, believed
to be high in flavonoids.
7. They had a sardonic sense of humor, laughing with and at
each other and themselves.
Missing from Buettner’s books was information on the
smoking habits in the Blue Zones (beyond the Seventh Day
Adventists from Loma Linda) and the results of blood pressure,
blood sugar, and lipid levels.
Our experience
We spent 3 nights in the Blue Zone area of Barbagia, in
the small hilltop town of Oliena, and drove cross-country to the
town of Silanus, in hopes of visiting a shepherd featured in the
Buettner publications. With the help of our guide, Fabricio,
who seemed to know everyone in town, we tried to visit several
extremely elderly shepherds. Two possibilities, both in their
mid-80s, were unavailable. One was high in the Supramonte
Mountains with his sheep and goats. The other was off at a
cattle auction.
We did enjoy meeting 93-year-old Francesca (Figure 5),
who was walking back from a shopping trip. Her grandson
was graduating from the medical school in Sassari, so the
grandmother and other family members were celebrating with
a dinner the next evening. Francesca had a sparkling person222
Figure 5. The author with 93-year-old Francesca.
ality, walked and stood erect, and showed a good recall for
recent and remote events, the latter including trips to Mexico,
Israel, and Egypt.
Our group hiked for nearly an hour up to a shepherd’s hut
and a view of the nearby Nuragic ruins (dating back over 3500
years). The shepherd, Giovanni, was 50 and took care of 100
sheep and 15 goats. His father, also a shepherd, had died of
throat cancer in his late 70s. Giovanni’s mother had adult-onset
diabetes but was otherwise in good health at age 88. Giovanni
had some central obesity, but otherwise seemed robust but at
risk for future diabetes.
We headed west, across Sardinia, passing through the “Valley
of the Nuraghe.” We stopped at the village of Silanus, in hopes
of meeting the shepherd, Tonino Tola. Our contact, who knew
him, stated he was now age 93. He gave us Tonino’s telephone
number. Our guide spoke with Tonino’s wife, who said he was
off working in the fields with his sheep and goats and would
be unable to meet with us. It seems that he had become sort of
famous since the publications, and multiple groups had sought
him out. One, from Japan, stayed all week and kept him from
his work, so his wife now protected him from outside interference. In any event, I was happy to learn that he was still not
only alive but thriving.
I made a list of Blue Zone foods and drinks (Figure 6) I
wanted to try:
• Pasta
• Pecorino cheese (from sheep’s milk)
• Fava beans
• Chickpeas, zucchini, tomatoes, eggplant
• Fennel
• Milk thistle tea
• Sourdough bread
• Papassini cookies (with raisins, grape juice, almonds, and
fennel)
• Local olive oils
• Minestrone soup
We visited a home in Oliena to see how they made Carasau
bread (Figure 7), also known as shepherd’s bread. Shepherds
take it with them up high in the Supramonte Mountains, for
Baylor University Medical Center Proceedings
Volume 29, Number 2
Figure 7. Ladies in Oliena making Carasau bread, also known as “shepherd's
bread.”
In the Blue Zone area of Sardinia, we were able to sample the
food, especially the Cannonau wine, and view the active lifestyle
of the inhabitants. I found it both disappointing and amusing
that the few elderly shepherds we hoped to meet and to interview
were too busy to accommodate us, still tending their sheep and
goats in their 80s and early 90s, high in the mountains.
Acknowledgment
My thanks to Karen Galloway for preparing the manuscript
and to Stacie Waddell for gathering the figures.
Figure 6. A buffet of some “Blue Zone” foods.
it will provide nourishment for weeks at a time (washed down
with Cannonau wine).
SUMMARY
A trip to Italy enabled me to visit the small apartment in
Rome where John Keats spent his final months and to visit his
grave in the Protestant Cemetery. I was only sorry that I was
unable to find a nice bouquet of daisies to lay on his grave.
April 2016
SOURCES
Gittings R. John Keats, physician and poet. JAMA 1973;224(1):51–55.
Cantwell JD. Six physicians and their common mistress. Atlanta Med 1994;68
65–70.
John Keats. Wikipedia. Available at https://en.wikipedia.org/wiki/John_Keats;
accessed December 28 2015.
Buettner D. The Blue Zone. Washington, DC: National Geographic, 2008.
Buettner D. The Blue Zones Solution. Washington, DC: National Geographic,
2015.
On John Keats and Blue Zones
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