On John Keats and Blue Zones

En 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 near-starvation 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.

Figure 1.

John Keats. Source: National Portrait Gallery, London.

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.

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.”

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 2.

Keats' apartment building in Rome (on the right of the Spanish Steps).

Figure 3.

The bedroom where Keats was confined in Rome.

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.

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.

Figure 4.

Keats' grave in the Protestant Cemetery in Rome.

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.

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 personality, walked and stood erect, and showed a good recall for recent and remote events, the latter including trips to Mexico, Israel, and Egypt.

Figure 5.

The author with 93-year-old Francesca.

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:

Figure 6.

A buffet of some “Blue Zone” foods.

• 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 it will provide nourishment for weeks at a time (washed down with Cannonau wine).

Figure 7.

Ladies in Oliena making Carasau bread, also known as “shepherd's bread.”

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.

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.