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…
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.