March 23, 2012
Every school kid learns about Paul Revere’s famous ride at the beginning of the Revolutionary War, when he raced on his horse from Boston toward Concord to warn revolutionaries there that the British were planning to raid ammunition stores and arrest prominent patriots John Hancock and Samuel Adams.
But Americans are less likely to recognize the name of the man who actually sent Revere on his midnight mission—Joseph Warren. Warren was a Boston physician who cared for rich and poor, American and English, free and slave. He was also a patriot; an accomplished writer and speaker; a proponent of high standards in medical care; and a man whose family members played a central role in the founding of Harvard Medical School, Massachusetts General Hospital, and The New England Journal of Medicine.
Samuel Forman, a visiting scientist in the Department of Environmental Health at Harvard School of Public Health (HSPH) and president of Oak and Ivy Health Systems, a health management consulting firm, spoke about his new book, Dr. Joseph Warren: The Boston Tea Party, Bunker Hill, and the Birth of American Liberty at the Dean’s Distinguished Lecture Series on March 21, 2012. Leading off the lecture was HSPH Dean Julio Frenk, who introduced Forman as “an exemplar of the scholar-physician,” and Atul Gawande, associate professor in the Department of Health Policy and Management, who discussed some of the highlights of Forman’s book.
Warren died during the Battle of Bunker Hill at age 34. Forman thinks that, had Warren lived, he would likely have gone on to do more great things—perhaps start Harvard Medical School himself; become governor of Massachusetts; or even become president of the new nation.
“Warren is a seminal figure not only for his participation in proto-public health activities, but more generally in the founding of medically related institutions of all types at Harvard,” said Forman in a recent interview. “He was a proponent of disciplined medical education, and pushed for the most up-to-date knowledge and techniques in medicine—both in individual cases and in public health.”
Educated also as an historian, Forman became intrigued with Warren because “he was the go-to person in the early revolutionary period. His name is all over the source documents. I was just fascinated by that. I thought to myself, ‘Who was this guy Warren? How did he make a difference?’ ”
A respected physician, Warren participated in one of the earliest public health efforts in Boston. In 1764, he worked with other local physicians and the government to contain the spread of a smallpox outbreak by large-scale inoculation of susceptible people coordinated with aggressive case reporting and quarantine measures. The following year, he wrote articles calling for the establishment of an organization of Massachusetts physicians (the Massachusetts Medical Society would be established in 1782 by Warren’s youngest brother John). Over the course of a dozen years, he cared for roughly 1,500 people—“future American presidents, governors, and senators, enemy leaders, and children, women and men from the highest station to the most humble slaves,” Forman writes in his book.
Warren was also deeply involved with the group of Boston patriots, including John Hancock and Samuel Adams, who were chafing under British rule. In February 1770, when a young boy named Christopher Seider was killed by a British official during a protest against the British Customs House, Warren was the doctor who performed the autopsy, confirming that Seider’s death was the first in the American Revolution. Outrage in the wake of that killing led to the Boston Massacre five days later. Warren then served on the Boston committee that reported on the Boston Massacre deaths. He subsequently rose to serve as president of the Massachusetts Provincial Congress—a sort of shadow government operating while the British were still nominally in charge—and as de facto head of the Massachusetts militia at the outset of the revolution.
It was insider information from Warren that led to Paul Revere’s ride the night of April 18, 1775. Warren found out what the British were planning probably because, as a doctor caring for British military family members, Loyalists, even servants in Loyalist households, he was able to learn of the British plan to raid Concord. The doctor-patient relationship—unfettered by anything like today’s privacy rules—allowed Warren “to build what was essentially a spy ring,” Gawande said.
After Warren’s death, his brother and descendants continued to operate at the forefront of medicine and public health. Warren’s brother John, a renowned surgeon, founded Harvard Medical School. John’s son John Collins Warren, also a surgeon, founded the New England Journal of Medicine, co-founded Massachusetts General Hospital, and was among the first to conduct an operation with ether anesthesia. Joseph Warren, noted Gawande, was the first of eight generations of “extraordinary Boston physicians”—all Harvard alumni.
It’s worth noting, Forman told the audience, that there was general agreement in Warren’s time that it made sense for the government to pay for medical care for the indigent. For about three years, Warren received reimbursements for poor patients from a government-run program that Forman called “Medicaid-like.” It’s ironic, he said, that today’s Tea Party appears to claim that the nation’s founding fathers would have been against any sort of government involvement in health care. “That’s just not true,” Forman said.
photo: Aubrey LaMedica