Warm Diseases in Kristin Lavransdatter: An Acupuncture Student’s Take

I am at the one large table in the corner of the Starbucks 5 minutes from my house. An iced decaf Americano sits sweating onto the faux wood, my passport to a few hours of uninterrupted study. The music is always too loud for my taste, but the taste of coffee tricks me into a more alert state, and the location saves me gas and time during the precious hours my sitter is at my home with her toddler and mine. Noisy as this cafe may be, two toddlers are noisier. At least this noise doesn’t come with diaper changes or requests for snacks.

I sip my coffee and think about what I learned several months ago: that caffeine is, in part, the coffee plant’s defense. To some animals, it’s poison. But to bees, who sip nectar from the coffee plant’s flowers, it’s an elixir that makes them likelier to remember the plant’s location for future pollination. That gets me thinking about how some poisons can be medicines, and some medicines, if taken incorrectly, can be poison. 

We keep a laminated sheet on the inside of our medicine cabinet door with the correct dosage by weight for acetaminophen for our children. It’s one of the most commonly used drugs in the world, and yet because of its impact on the liver, it’s also one of the most dangerous, with a thin line between its toxic dose and a safe dose– a narrow “safety margin,” or therapeutic index. In other words, Tylenol’s common dose is close to its overdose. It’s a fact I have mostly chosen not to think about too deeply, even as we usually underdose when we do to give it to our children, for fevers that keep them from sleeping.

Like many drugs, science still hasn’t figured out exactly how acetaminophen works as an analgesic and fever reducer. The theories, like bees, hum and buzz around the possibilities: it could be due to the functions of neurotransmitters like serotonin, the body’s endocannabinoids, or ion channels in the brain and spinal cord. I look up the history of Tylenol and learn I’ve conflated its discovery with that of aspirin, maybe because when I was growing up, my parents used the words Tylenol and aspirin interchangeably. But aspirin is an entirely different substance. It comes from a compound synthesized from willow, evolving from the medieval use of willow bark as an analgesic. Acetaminophen, on the other hand, was discovered by accident in a lab in 1873, and largely ignored until it was tested as an analgesic and rebranded as Tylenol in the 1950s.

I’m thinking about medicine and fevers because my friends and their families are getting Covid, despite it being summer, and despite their being vaccinated, and fever is on all of our minds. Fever is also on my mind because of what I am here to study, in my final year of acupuncture school. Fever is the first sign of an invasion of Wind-Heat, according to the notes I made last night on the Four Stages Theory in Chinese medicine, a later school of thought than the Six Divisions, though both deal with the invasion of external pathogens. Four Stages Theory helps identify how deeply into the body a pathogen has penetrated, specifically a pathogen in the category of Warm Diseases, which are virulent diseases like flu, measles, chicken pox, SARS, Scarlet Fever, and yes, Covid. 

Long before so-called Western medicine was able to isolate the viruses causing these diseases, Chinese medicine identified their characteristics: they manifest with fever, the pathogen enters through the nose and mouth, they’re highly infectious, the onset is rapid, and if untreated they can penetrate deeply enough to be fatal.

As I read my notes, my mind scans back to the countless symptoms described in such detail in Kristin Lavransdatter. Unlike Kristin, I have an arsenal of vaccines at my disposal to protect my children against the Warm Diseases that used to take young lives indiscriminately. As a modern mother in a wealthy country, I have access to a level of precision about viruses Kristin could never have imagined, and the bold expectation that science and medicine will be there to help me should my children fall ill. In Kristin’s world, there is God and medicinal plants, and children who struggle with nameless symptoms.

“Kristin cupped the little face in her hand; it was yellowish-white, like tallow, and his eyes were always tired. Gaute had a big, heavy head and frail limbs. He had turned two years old but still couldn’t stand on his own, he had only five teeth, and he couldn’t speak a word. Sira Eiliv said that it wasn’t rickets. Everywhere the priest went he would ask advice about this illness that had overtaken Gaute. But to her he could only say that she must patiently submit to God’s will. And she should let him have warm goat milk.”

Scarlet fever? I wonder. 

A quick search: Scarlet fever was once widely feared by parents because of its harsh effects on children. Historically, septic complications such as brain abscess, meningitis, lung abscess, pneumonia, osteomyelitis (bone infection), middle ear and soft tissue infections could follow scarlet fever and cause early death. 

According to the six divisions, this is an invasion of Wind-Heat. Ye Tianshi, a 17th Qing Dynasty century doctor, who formulated the 4 Stages theory, is often credited with discovering scarlet fever first in China. Lanhousha (which literally translates to “rotten throat rash,”) was apparently non-existent in China during medieval times, and is first recorded in the largely undated records of Ye Tianshi, a busy doctor who didn’t have time to make extensive notes as he worked to treat suffering patients. 

But then I wonder if the fever Gaute suffered from was the same as the one that struck all of the children, manifesting differently in each of them– a mysterious “sickness” that would eventually infect Kristin and claim Orm’s life: 

“Kristin took the candlestick from the table and shone the light on the two sleeping boys… Bjorgulf’s eyelashes were not festering– thank God for that. The weather would stay fine for a while yet. As soon as the wind blew hard or the weather forced the children to stay inside near the hearth, his eyes would grow inflamed… They had been as healthy as little fledglings, all three of her sons, until the sickness had come to the region last summer. A fever had carried off children in homes all around the fjord; it was a terrible thing to see and to hear about. She had been allowed to keep hers– all her own children… For five days she had sat near the bed where they lay, all three of them, with red spots covering their faces and with feverish eyes that shunned the light… Gaute was then only ten months old; he was so ill that she didn’t think he’d survive.” 

Red spots, fevers, eyes with aversion to light… I Google around and hit on measles.

Measles is an infection you get from a virus. The measles virus lives in the mucus of the nose and throat. It’s spread through the air and by coming into direct contact with someone who has it. The virus can stay active on surfaces and in the air for up to 2 hours.

It’s very contagious. If you haven’t been vaccinated and are in a room with someone who has measles, you have a 90% chance of getting it.

Part of what makes measles so dangerous is that you can be contagious 4 days before you get the telltale rash. So you could easily spread the virus without knowing you have it. You’ll continue to be contagious 4 days after the rash goes away.

Initial symptoms typically include fever, often higher than 104, cough, runny nose, and inflamed eyes.

I’m deep down a rabbit hole, with a treatise on scarlet fever in indigenous Chinese medicine open in one tab, and an analysis of measles using the four stages in another tab, when a man sits down at the table next to me and sneezes loudly and untidily into his sleeve. I’m instantly on guard. It’s probably innocuous, but I pick up my things and decide to head to the library anyway. Besides, maybe I’m getting off track. 

Or maybe I’m deepening my learning by making connections between this medicine and my real life– where the story of a new warm disease is unfolding in real time– and between my story and Kristin’s, where the descriptions of symptoms without a diagnosis practically leap off the page. Maybe we get more on track the more we bring what we’re interested in into other areas of our lives, applying and comparing and testing. This connection-making is what we’ve been doing here, as writers, for the past seven months: bringing Kristin Lavransdatter along with us into our lives, seeing what her story might have to say about ours. 

PS If you liked this very cursory look at TCM diagnosis, check out this video on diagnosing and treating sadness and grief with TCM. It’s a series that goes through case studies using Star Wars characters! This one’s for Senator Amidala, but I feel like it would apply to Kristin at any number of points in the book…

Photo credit: Photo by Katherine Hanlon on Unsplash