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Hope this helps.

Jo

Fm: Diana Gabaldon 76530,523

To: Jo C. Harmon 103151,655

Dear Jo—

Thanks! Re your questions:

1. Damned if I know. It ain’t going to be _very_ purified, which is of course one of the difficulties with do-it-yourself penicillin. However, all the trouble in getting hold of enough of the stuff, and how, and whether it’s effective—i.e., her experimental methods—is dealt with elsewhere. With luck, by the time I write that part, I’ll have figured out how (sort of) to do it. _Penicillium_ does _grow_ on rotted melon rind, though, since one of my sources cited a picture of same.

2. Needles are no problem (unless I want them to be )—she had six of them at the end of VOYAGER, and no doubt at least a couple have survived thus far (getting more is going to be one of the later issues to be dealt with; eighteenth century technology would have been adequate; it’s just a matter of finding the proper craftsman ). Anyway, one of my earlier medical consultants informed me that to do a proper anaphylaxis, it would have to be an IV administration, because penicillin by mouth doesn’t do that.

3. Given that the patient’s illness was most assuredly fatal anyway—what did she have to lose by trying the penicillin? The urticaria, etc., might _not_ have been symptomatic of hypersensitivity; my earlier consultant tells me they could as easily be symptoms of the septicemia. Or, even if the patient did have a hypersensitivity, there would be at least a chance that a further dose would be survivable—while the infection wasn’t.

4. Yes, the other possibilities cross her mind—in this scene, in fact—pulmonary embolism, for one. However—not being a doctor, etc., myself, I’m guessing on this one—I _think_ that a doctor with a good deal of clinical experience (which Claire is, by this time) and a reputation as a diagnostician (which she has; established in earlier books) would have a very good gut feel for what was happening or had happened, even if he or she couldn’t foresee it. I.e., having seen this woman die in front of her, Claire is pretty sure that it was anaphylaxis, even though the dry recital of symptoms might fit other diagnostic scenarios.

Sound plausible?—Diana

Fm: Jo C. Harmon 103151,655

To: Diana Gabaldon 76530,523

Diana:

<< she had six of them at the end of VOYAGER, and no doubt at least a couple have survived thus far >>

Oh. My memory fails me… I’d thought she’d lost all of them in the shipwreck. I don’t recall her using or mentioning them in DRUMS… did she? (Guess I’d better go back and read it one more time—shucks.)

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I certainly defer to those who likely have more knowledge and experience than I (and there are plenty); however, my mother had anaphylaxis after IM injection of penicillin. Fortunately, epinephrine was available and on hand. I suspect that the severeness of a reaction would also depend upon the degree of hypersensitivity. (But, I digress.)

As a reader with some medical background, I’d expect if Claire’s patient developed anaphylaxis after IV push administration of penicillin, one of the most outstanding symptoms would be respiratory distress… in addition to the others that were mentioned.

<< Given that the patient’s illness was most assuredly fatal anyway—what did she have to lose by trying the penicillin? >> That’s what I suspected.

<<—I _think_ that a doctor with a good deal of clinical experience (which Claire is, by this time) and a reputation as a diagnostician (which she has; established in earlier books) would have a very good gut feel for what was happening or had happened, even if he or she couldn’t foresee it. >>

I agree. As in every part of life—that gut feel is usually truth.

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Yes, it does. I do feel, though, that the symptom