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Logo of bmjThis ArticleThe BMJ
BMJ. 2007 April 14; 334(7597): 803.
PMCID: PMC1852010
Medical Classics

La Belle Dame Sans Merci

Tamzin Cuming, specialist registrar, general surgery

Keats, it is well known, had some medical training. He completed his house jobs at Guy's Hospital after becoming one of the first people to pass the licence of the Society of Apothecaries—a GP of the era. His experience of the family tuberculosis that would eventually kill him at the age of 25 and his early years of surgical assistance gave him knowledge and experience of death, the only clue to his medical background that can be seen in his work.

In La Belle Dame Sans Merci, an imitation of a medieval ballad, an alluring, otherworldly damsel has fatally tempted the “knight-at-arms” who is found, at the poem's beginning, “alone and palely loitering.” The narrator who addresses the opening line to the knight could be a medic taking a history—“Oh what can ail thee”—and goes on to a physical inspection of the lovelorn and possibly hallucinating knight (changed to “wretched wight,” or creature, for the first publication of the poem, perhaps to augment pity over the picturesque): “I see a lily on thy brow/With anguish moist and fever-dew.” The flower, a symbol of death, connects in the next line to another flower, a rose, seen fading on his cheeks, which “fast withereth too.” When consumption was at its height, the pallor of the skin was felt to be in beautiful contrast with the rosy cheeks. These changes, however attractive, Keats knew were a death warrant. Tuberculosis had no cure. Indeed it was steeped in mythology involving spirits and even vampires.

The knight's reply to these inquiries—the rest of the poem—is his story of the faery lady, followed by his recounting a sinister dream populated by “pale warriors, death-pale were they all,” who inform him ghoulishly that “La Belle Dame Sans Merci/Hath thee in thrall.” He finishes by reflecting on his captive, hopeless state, repeating the famous first verse with a subtle change in rhythm, “And this is why I sojourn here/Alone and palely loitering/Though the sedge is withered from the lake/And no birds sing.”

A mysterious poem of seemingly endless interpretations, it uses images of death to straddle the supernatural and make it eerily present. Keats, by his own account, was not the most attentive of students: “The other day, during the lecture, there came a sunbeam into the room, and with it a whole troop of creatures floating in the ray; and I was off with them to Oberon and fairy-land.” Eventually he deemed himself unfit for surgery, saying of his last operation, “The opening of a man's temporal artery . . . I did it with the utmost nicety, but reflecting on what passed through my mind at the time, my dexterity seemed a miracle, and I never took up the lancet again.”

Not every desultory junior doctor has such insight. Keats was a doctor for whom medicine could not compete with poetry. Our literature is the greater for it. Few doctor writers found a balance as Chekhov did: “Medicine is my lawful wife, and literature my mistress; when I get tired of one, I spend the night with the other.”

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