Friday, February 17, 2012

Did Physicians Kill George Washington?

President’s Day, also known as Washington’s birthday, is a celebration of the life of George Washington. While it is well known that he was the first U.S. President, crossed the Delaware River, and helped defeat the British, many people do not know about the noble and fascinating medical aspects surrounding his death (see comparison story on Abraham Lincoln).

On December 12, 1799, Washington had been riding his horse at Mt. Vernon for a prolonged period of time (10:00 am to 3:00 pm) in cold weather and precipitation. He came in and ate dinner without changing his clothes. Washington denied that his clothes were wet but his secretary, Tobias Lear, stated his neck seemed wet and that there was snow in his hair. At night, he reportedly appeared well.

The next day, it snowed heavily. Despite developing a cold and sore throat, Washington still went outside to do some yard work. According to George Washington Custis (a relative), Washington came inside, developed chills and nausea in the afternoon, changed his wet clothes, and continued to work. At night, he did not feel well and drank a cup of tea to soothe his hoarse throat, which had worsened. Lear told him to take something for his cold at night, but Washington declined. He tried to rest at night, but he tossed and turned with fever and pain. He awoke his wife between 2 to 3 am to say he was sick. He could barely speak and had labored breathing. Despite his discomfort, he did not want outside help to be called because he did not want to disturb anyone else’s rest.

On 12/14/79, Washington allowed for help to be sought at dawn. Lear came to the scene and stated he could hardly utter an intelligible word. He requested that an employee be called to help him by bloodletting. Bloodletting was a common medical practice for over 2,000 years and involved drawing blood out of the patient’s body (usually through a vein in the arm or neck) with the hopes that it would cure or prevent disease by removing the offending agent. This ancient medical practice was based on the belief that a woman’s menstruation purged the body of bad substances. Despite the good intentions of bloodletting, it was usually harmful to patients. As such, it was not helpful to Washington and his conditions worsened.

A molasses-butter-vinegar mixture was prepared for his sore throat, but he could not swallow it. Any attempt to do so caused distress, convulsions, and near-suffocation. He was bled again. His wife tried to intervene, questioning whether this was appropriate treatment, but Washington insisted more blood be let out. After half of a pint of blood was removed, the blood letting was stopped as it provided no relief and his wife remained uneasy.

Since oral intake was impossible and the standard treatment of the day (bloodletting) was not working, his throat was gently bathed with a salve. His feet were bathed in warm water. neither treatment helped. Another doctor tried to treat his throat with a blister of Cantharides, more blood letting, and inhaling steam from water and vinegar. He almost suffocated when trying to gargle. As the day progressed, Washington did not speak much but stated he was very ill. He was bled two more times. The blood came out slow and thick at this point, but he did not faint. His multiple doctors then treated him with calomel and tartar emetic.

A book in 2002 entitled Doctors Killed George Washington alleged that doctors took a “mild” complaint and bled Washington to death. It has been suggested that the focus of bloodletting may have killed Washington by preventing a search for other remedies. However, Washington did not have a mild complaint, but had clearly been severely ill before the bloodletting. He likely became ill in the first place by making his body more vulnerable to illness after prolonged exposure to the winter elements. Third, other remedies were indeed tried as noted above and by Custis:

“The medical gentlemen spared not their skill, and all the resources of their art were exhausted in unwearied endeavors to preserve this noblest work of nature.”

While the bloodletting was clearly excessive and would not be done today, doctors were treating Washington with the limited medical techniques of colonial times and should not be accused of killing him anymore than doctors of today should be accused of killing patients who have incurable diseases with current technology yet attempt to treat it with methods that will be considered outdated hundreds of years from now.

At 4:00 pm, Washington provided instructions for his will and wake. He was in great pain and distress in the afternoon, had difficulty breathing, and was restless. When his secretary tried to reposition him for comfort, he was concerned about causing his secretary fatigue. He thanked his doctors and others for help but asked that they let him die in peace. Regardless, at 8:00 pm, the doctors tried to treat him with a hot medicated cloth and applied wheat brain to his legs and feet.

Custis describes Washington’s very last moments in such an elegant way that it would be a disservice to paraphrase it. As you will read, the founding father left the world between 10 and 11pm that evening in the noble way that he lived it,

“The patient bore his acute sufferings with fortitude and perfect resignation to the Divine will, while as the night advanced it became evident that he was sinking, and he seemed fully aware that 'his hour was nigh.' He inquired the time, and was answered a few minutes to ten. He spoke no more - the hand of death was upon him, and he was conscious that 'his hour was come.' With surprising self-possession he prepared to die. Composing his form at length, and folding his arms on his bosom, without a sigh, without a groan, the Father of his Country died. No pang or struggle told when the noble spirit took its noiseless flight; while so tranquil appeared the manly features in the repose of death, that some moments had passed ere those around could believe that the patriarch was no more."

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