Dr. Sam Forman (www.DrJosephWarren.com) emailed me recently with an offer to diagnosis Alan’s mysterious illness through the eyes of Dr. John Warren for all of you. It was such a delightful proposition that I had to accept!
Without further ado, I’ll let him get to it…
Just another day at the office for Dr. John...
Can we second guess what Dr. John Warren will do once he catches up to Alan Warren? Lora has agreed to my guest medical blog – a kind of time traveling house call mash-up of modern and 18th century medicine. While admittedly a questionable past-time, I am the most appropriate person to do this, as the modern biographer of Dr. Joseph Warren.
Dr. John Warren, once extracted from his surgeon’s duties by a persistent and distraught Bea, will be in clinical mode. It might be hard to remain so when dealing with his cousin and adopted brother.
If Alan has regained consciousness, John will ask many questions about symptoms and how long they have been present. If Alan remains unconscious, Dr. Warren will grill Bea and anyone else who might know. How long has Alan been sick? What is he coughing up? How much? Is it blood tinged or grossly bloody? Does he have chest pain? Fever? Sweats? Is there a skin rash? Gastro-intestinal or other symptoms?
The young doctor will examine Alan closely in a hands-on fashion. Remember, clinical thermometers, blood pressure cuffs, stethoscopes, lab tests, and chest x-rays are not of their century. To assess if puss or fluid is filling Alan’s lungs, John may listen to Alan’s chest by putting his ear right up against it, and percuss it by tapping one finger over another. He might inspect the phlegm very closely.
John would be rapidly assessing whether Alan has been afflicted with one of the contagious miasmas (“bad airs”) plaguing the Continental troops during the New York campaign, versus a more chronic disease. At one point, up to a third of the troops around New York were sick and unfit for service. Illnesses were described then as imbalances in the four humors – blood, phlegm, yellow bile, and black bile. Modern historians often cannot tell which exact diseases these were. Eighteenth century nomenclature described acute illnesses according to their most prominent symptoms: fever, “catarrh” for coughing, and “flux” for gastro-intestinal symptoms.
We readers must not be misled by the web comic format, which has seemingly prolonged Alan’s symptoms over months, as would tubercular consumption. In real time, Alan’s worsening cough has been going on for a week or two. That is consistent with a pneumonia or influenza. Even though Dr. Warren would not know about bacteria or viruses, nor have specific medications to kill the microbes, he would know than such a lung disease was of short duration in an otherwise robust young man. If the body could be brought into humeral balance and symptoms not get out of hand, the patient had a decent chance of surviving and recovering fully.
The most effective medicine to control symptoms, if it were available to Dr. John, would have been extract of Jesuit’s bark (modern quinine) to control fever. Willow bark extract for joint pains and some activity against fever (a natural salicylic acid, precursor of acetyl salicylic acid – aspirin); and preparations based on menthol, anise seed, and/or honey to clear the phlegm, were other choices. Supplies were short, and many lost, at that stage in the New York campaign.
John could also seek to reduce “phlogistic excess” of high fever by bleeding poor Alan. Hopefully, Alan will be spared the indignity.
Along the way, Alan’s clinical course could be alarming. Bone shaking chills, high fever, cough productive of pussy and blood tinged sputum, and drenching sweats as the illness reached its peak – were all par the course for pneumonias and influenzas in the pre-antibiotic era. Alan may think he’s dying. And Bea will have plenty of opportunity to emote. Nursing care, as she might provide, to encourage fluid intake and to administer the medicines could make all the difference.
Then again, this could be the end for Alan. Unlike we readers, Dr. John Warren did not observe that eerie clinical sign – the red outline – which also appeared when Knowlton was fatally shot. That is a most unusual clinical sign, which I cannot say that I have ever seen in real life.
Ms. Innes can be fairly labeled as cruel to introduce that ominous and cryptic crimson outline. As a consequence, Dreamer fangirls and boys have been on edge relative to Alan Warren’s fate. This can induce needless stress and a clinically significant anxiety. One can only imagine how 18th century Beatrice feels.
Bringing the medical mash-up full circle, what will Dr. John Warren prescribe for anxiety-ridden 21st century readers? I suspect that he would prescribe valerian root or chamomile tea to calm and restore the humeral imbalance impacting the nerves of both modern Beatrice and her afflicted 21st century fans. In peacetime, when he was an apprentice in eldest brother Joseph Warren’s practice in the early 1770s, John Warren would obtain these items from the Greenleaf pharmacy and do the final compounding under instruction. In wartime, supplies are short and many lost during the precipitous Continental Army retreats from Brooklyn and Manhattan. Bea will have to tough it out in 1776.
Modern fans can find valerian and chamomile at their local health and herbal store, used for the same purposes now as they have been for centuries. Tell then Dr. Warren sent you.
This was such a treat! Thank you so much for the diagnosis!
You are welcome! I suppose that few doctors do 18th century house calls nowadays. So my prognosis for Alan is that he will survive after a rocky course. But I’m still unsure about that ominous red outline…
This is awesome!!!!!! I didn’t realize they still refered to “humors” in the 1700′s…did they still do things like the humor balancing meals?
Also, I’m sending this link to my mom because I think she’ll LOVE this!
The humors were a reality for Drs. Joseph and John, and their patients. They still survive in speech when describing personalities:
Sanguine – excess of blood
Phlegmatic – same same for phlegm
Jaundiced – too much yellow bile
Melancholy – that black bile can really cloud your mood. “melan” for black; “cholor” for humor. Latin roots still haunting us…
It’s interesting that in modern usage, the two involving bile are still more or less bad things – jaundiced either meaning actually yellowed from liver trouble or else in a sarcastic or cynical mood, and melancholy meaning gloomy or depressed.
The other two, however, seem to have completely moderated, with phlegmatic basically meaning calm and steady, not fazed by much, and sanguine being similar, but with a leaning towards future events – content, prepared, hopeful. “He was sanguine about his chances.”
Neither blood nor phlegm really have much to do with those, so there must be a missing step somewhere.
You are picking up on the subleties. The humors could explain a range of personality attributes within a normal range. In the extreme and unbalanced among them caused disease. Complicating matters were relatively newer science uneasily grafted onto the ancient humors – boerhaave’s microscopic corpuscles, Hunter’s circulation of the blood, Boyle’s hydraulics, Priestley’s phlogistic essence of intrinsic heat, etc. One should really go to school to master it all. Dr. John W., we hear, wants to start a medical school at Harvard once all the nastiness with the Brits settles down.
Huh, I didn’t know that. that’s pretty cool
This was an awesome post, full of humor and interesting facts. One can only hope Alan won’t fall prey to crimson lines. =-)
Lora apparently is afflicted with a humeral imbalance resulting in a sadistic tendency to keep fangirls and boys in extreme suspense. She wouldn’t even reveal Alan’s fate to me. And the ominous red outline remains just that – ominous!
I concur with your theory. Or should that be “diagnosis”?
Let’s go with “theory.” Diagnoses usually rely on a thorough history, physical examination, and (in modern times) lab tests. Internet precludes the hands-on part.
Bahaha…the red outline bit made me laugh out loud. Glad I hadn’t just taken a sip of water!
Sudden aspiration of fluids is a bad thing. Dr. John W. could tell us all about that.
Clever, funny, and haven’t I said pneumonia?!?!
I share your diagnostic insight. And you were first. But are we right? Have you considered a career in health care as a sideline?
It seems that other fans, shocked into a frenzy and fits of melancholy by crimson-outlined coughing fits, have written off poor Alan. I expect that some will start taking donations toward a decent burial for him.
I recognized the symptoms of pneumonia from my own personal experiences, not from actually having extensive medical knowledge. I once considered medicine as my career but I discovered early on I wasn’t smart enough. XD
BUT I *can* write, and I can tell you for any good story, it’s way too early in the series’ run to kill off Alan. Especially not with Knowlton kicking the bucket and Nathan’s turn right around the corner.
Speaking of, Lora, when are we gonna get a Nathan fix? <3
I may or may not have drawn him recently…
Huzzah! :D <3
:-D :-D :-D :-D
Sorry to hear that your experience with pneumonia was first hand. Smarts for medicine and nursing are only part of the requirements. Empathy and judgment are even more important. I suspect that you are more of a candidate for the fields than you are admitting.
Yeah, I had my own pneumonia experience back in April 2005. I could barely move and/or breathe, was out of school for almost a week, and had a fever topping 104. Still, it wasn’t all bad – the hospital had TNT on tap, which let me watch Charmed and Angel all day long. :)
And fortunately you did not encounter the RED LINE.
Hmm. He better get a decent burial. If he’s just dumped in a field somewhere John Warren might dig him up for study…!
O.O oh my…I just had a vision of that happening to Knowlton or Nathan…. :’(
Shh, you!
pffft! You people should already know I never shut up! ;P lol…but I seriously did almost cry when I realized that.
@Lora: OH, ICK!!! LOL
Thank you for your insight into 18th century diagnosis, and your opinion on the strange symptom of red lines. I think I’ll take you up on that tea. ;)
You’re welcome!
I’ll have to get some chamomile since I’m in such a state over that ominous red outline :D
Maybe we’ll all drink chamomile together at the Anime Boston Dreamer Meet Up next month and console our nerves together. Fragile female constitutions and what not…
Haha, if I somehow inherit a small fortune between now and then I will *TOTALLY* be there! And I’ll bring the tea :D
Wonderful! Thanks so much for this, Sam! I think the only thing that can cure “red line” is Reiki, but I Dr. John would probably roll his eyes over such a concept. I’ll go drink some chamomile tea and send good thoughts Alan’s way.
I am with you for the good thoughts. A good bleeding will do Alan no good. In 1799 doctors took that approach with George Washington, who came down with a severe sore throat after riding at Mt. Vernon. My medical forbearers probably did in George. Poor Martha!
How very interesting, thank you! I’m not in medicine, but I grew up in a medical family and the topic of historical medicine never ceases to be intriguing.
And I had noticed the red outline before, it has me about convinced he’s done for.
What will folks say about current medicine 236 years from now?
Hmm… I believe the red line has something to do with eating one too many tea cozies… ;)
Actually, as an expert in TCD (tea cosy diagnosing), I can assure you that that particular line is dark yellow, not red.
Lol (but also nervous) about the Red Outline Diagnosis. Thanks for a walk around 18th century medicine! (And I’m glad I’m not there!!)
Yes. The dresses, uniforms, and courtly behavior are all appealing. But when it comes to health care, diet, and bathing practices, we are all much better off today. Weekly bathing was a big innovation in New England when it came into common practice early in the nineteenth century.
How forward thinking of them. ;)
Besides the high mortality rates and poor medical practices, I always site the extreme racism and sexism of the era. Not a society I would want to live in.
Pretty dresses can make a comeback, as well as a well tailored man, but the rest of it I’m okay with just reading about.
LMAO at the red line symptom, and the rest of it was just superb.
Why don’t we refer to the Ominous Red Outline as ORO for short?
Hmmm. Maybe think twice on that one. ORO concept might induce Lora to go “over the line” herself, feeling obligated to make bad things happen just to meet melancholy fan expectations. TCD is more upbeat. And yellow goes with more outfits.
btw, how did tea cozies become so closely identified with The Dreamer? I suspect that I am the only person here who doesn’t know…
Partly a joke about Knowlton having a collection of them and partly due to a series of INCENTIVE CAPTION!!!s I made back in issue 11 about Alan having eaten all of said collection.
I should have known that the source of Incentive Captions also claims insertion of tea cozies int Dreamer lore!
What a *fantastic* guest blog. Thanks so much!
That was THE BEST!!! He’s got some real talent there (nevermind that it’s not a common one!) LOL. The “red outline” was the point that I felt his diagnosis reached true magnificence. BRAVO!!
Pingback: New Page #35: | The Dreamer
This was an absolute TREAT to read. Thank you so much.
I don’t know about the diagnostic process back then, but I think since he’s been having paroxysms of coughing “fits” that he passed out it seems classic of B. pertussis.
Could be! But Dr. John W. doesn’t know anything about bacteria. And even if he did, he would have no antibiotics to treat them. Louis Pasteur and Dr. Koch were a century in the future. He might be thinking in terms of a seasonal feverish catarrh resulting from humeral excesses of blood and phlegm. The miasmas (“bad airs”) encountered in military camps might just have triggered Alan’s illness.