The Health Of The President: George Washington

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George Washington (1732 — 1799)

If you look closely at the best-known portrait of George Washington by Gilbert Stuart, you will observe a bulging of the cheeks, as if they had been stuffed with cotton. It has been reported that Gilbert Stuart actually did use cotton to fill out the sunken cheeks of the illustrious sitter of this portrait, who at the time was wearing a set of ill-fitting dentures. In 1795, when the portrait was painted, Washington was the proud possessor of two sets of these awkward and noisy contraptions made of hippopotamus ivory.

Up to the nineteenth century, dentistry in the modern sense was unknown. If something was wrong with a tooth, it was pulled out. At the age of twenty-two, Washington had a tooth-ache which was relieved by having the tooth pulled. The same treatment was used for every aching tooth over the years, so that by the age of fifty-seven he had hardly any teeth left and had to wear dentures. Six years later his one remaining tooth was pulled.

The blue eyes of the Father of our Country look down from the portrait with his proverbial Olympian serenity. Yet these eyes had flashed angry lightning at Brandywine and Germantown when they saw the Continental Army break and flee.

What appears to be a white wig in the picture, is reported to have been Washington’s own hair, well powdered. It had been reddish in his youth, turning, as he had said, an early gray in the service of his country. In the picture the face of the President is covered with a rosy glaze. His real complexion was described by his contemporaries as sallow.

The painter also carefully left out the pockmarks which deeply pitted Washington’s features. These blemishes he had acquired at the age of nineteen during an ill-fated journey to the Barbados. He was then accompanying Lawrence, his brother and guardian, who was suffering from tuberculosis of the lungs and was vainly looking for salvation in the balmy climate of the West Indies.

In his diary, Washington notes that he was “strongly attacked” by smallpox and was in bed for three weeks. He carried the marks of the disease to his grave.

In most portraits, the Father of his Country is shown with chest bulging with well-deserved pride. The chest, too, must have been tailor-made. Actually, Washington’s chest was flat and somewhat hollow in the center, probably from early rickets.

Other physical characteristics of the President are more realistically painted in the Gilbert Stuart pictures. They are the strong nose, jutting chin, and the large strong hands. Many are the tales of his athletic prowess. Every child knows the story of how young George once threw a silver dollar across the Rappahannock River, which seems incredible in view of the great width of the river at the point described, and also because Washington was not one to throw silver dollars around.

Like Lincoln, with whom he had many physical characteristics in common, Washington in his youth was a champion wrestler and rail-splitter. It is curious that the two greatest Presidents of the United States were also physical giants. During the times of both, the average man was considerably smaller.

In spite of great physical strength and endurance, Washington was subjected to a host of diseases in his lifetime. He suffered at least ten attacks of serious illness which on several occasions brought him to the brink of death. The question is whether Washington had more than his share of sickness in a period of history when a number of diseases were taken for granted, diseases which modern science has practically conquered and which we have almost forgotten.

Concerning the medical history of Washington’s progenitors, we know that his grandfather died at thirty-seven, his father at forty-nine, probably from infectious diseases; on his maternal side we only know that his mother reached the age of eighty-two, to die from cancer of the breast a year before Washington’s death. From her, George, her first-born son, inherited not only his physical features but also his unusually strong constitution and power of endurance. However, he was born with little natural immunity against most of the diseases to which he was exposed. And if we consider his medical history, we marvel that he ever reached the age of sixty-seven, when he succumbed to a streptococcic throat infection—and to the medical mistreatment he received.

We know nothing about Washington’s childhood diseases. They were taken for granted and no one bothered to record them. From the diaries and letters of Washington and from the reports of his doctors and friends, we have an exact knowledge of the illnesses which attacked him after his sixteenth year. At seventeen Washington was licensed from William and Mary College in Virginia as a public surveyor, a profession he practiced for several years in Fairfax County. At that time great stretches of Virginia were dotted with swamps infested with malaria-carrying mosquitoes. Of the original thirteen colonies, the southernmost, Virginia, had the largest population, the majority of which was infected with malaria. Camping outdoors as a surveyor, Washington was bitten by mosquitoes and suffered his first attack of malaria, called “ague.” During his later life Washington had numerous additional bouts of this intermittent fever.

We have already mentioned the severe case of smallpox which he contracted at nineteen during a visit to the Barbados. This calamitous trip not only failed to cure his brother, who died a few months later, but, nursing his sick brother, George came in close contact with the tuberculosis bacilli and they promptly invaded his body. He had barely recovered from his smallpox attack and returned to Mt. Vernon when the tuberculosis flared up in the form of acute pleurisy. He recovered slowly and was in poor health for two years. By that time the disease must have been arrested, as Washington felt strong enough to enter military service. In October 1753, he received a commission as major in the Virginia militia and was immediately ordered on a fruitless mission to the French commander of the Ohio Territory. During the next year he led a military expedition against the French at Fort Duquesne and was badly defeated. He had hardly returned when he was stricken with a severe attack of malaria.

In 1755, the English general Edward Braddock arrived in Virginia with several battalions of British troops. Braddock was told of Washington’s experience in frontier fighting and of his intimate knowledge of the terrain, and asked him to join his expedition against the French and Indians as his personal aide-de-camp and leader of the Virginia Auxiliaries. The campaign had not progressed far when Washington fell ill, apparently of influenza.

On the day before the battle of Monongahela, Washington rose from his sickbed, still weak and barely able to sit on his horse. The leading column under Braddock fell into a French-Indian ambush and was almost annihilated. Trying to rally his troops, Braddock received a mortal wound. Washington managed to extricate the remainder of the detachment after two horses had been killed under him and his uniform pierced by four balls. He returned to Mt. Vernon exhausted, and wrote to one of his half-brothers: “I am not able were I ever so willing, to meet you in town for I assure you that it is with some difficulty and much fatigue that I visit my plantations in the Neck; so much has a sickness of five weeks duration reduced me.” Two years later Washington contracted a severe type of dysentery accompanied by high fever and deep prostration which lasted several months. Recovery was slow and Washington was worried about his condition.

In the meantime the British government had sent a new general, John Forbes, with considerable reinforcements for a new campaign against the French and Indians in the Ohio Basin. The twenty-six-year-old Colonel Washington was roused from his “apprehensions of decay” by the drums of war. The tonic of excitement invigorated him enough to accompany Forbes as commander of the advance guard. Washington had the great satisfaction that this, the third attempt to defeat the French in which he participated, was successful. Fort Duquesne was taken and renamed Fort Pitt, later Pittsburgh.

After this campaign Washington resigned his commission, returned, and in January 1759 married the widow Martha Custis. Martha brought to Mt. Vernon the two surviving children from her first marriage. The marriage was happy though childless. Apparently it had a beneficial influence on Washington’s health. No sickness is recorded in his diaries until 1761, when he had another attack which he believed to be malaria, though it may have been typhoid fever. He was in bed for several weeks with pain and great prostration. Barely recovered, he had a relapse of fever which made him quite despondent and fearful that he was very near his “last gasp.”

Scanning the diaries of Washington, one is astonished by his gloomy outlook each time he was stricken with serious illness, and by his readiness to anticipate a fatal outcome. A superficial reader might suspect that Washington was a hypochondriac, but the medical history of Washington’s family makes it clear that Washington’s apprehensions were justified. He saw the toll that disease took of his own generation in his family. Of his nine brothers, half-brothers and sisters, two died in infancy, the other seven between the ages of thirteen and sixty-four. George survived them all, as well as his two adopted children. How could he expect to outlive all his near relatives, except his wife, Martha?

Sickness affects different people in different ways. Long periods of disease accompanied by disability, pain and danger, such as Washington had to endure, exert a profound influence in molding a person’s character. They are times of trial which soften the weak and temper the strong. Suffering and heartache bring out in small men selfishness and self-pity, in great souls humanity and compassion.

The loneliness of the sickbed gives the patient an opportunity to know himself, take stock of his capabilities, and to crystallize his dreams and ambitions. Long periods of physical disability gave Washington the time to find himself, and to plan his role in life.

Men’s virtues are not born with them; they must be attained with great effort. Much has been written about the self-control and patience of Washington as a leader. Self-control and patience are masks which are acquired by long and painstaking practice in suppressing natural outbursts of emotion and impatience. The sickbed is the best school in which to learn patience. Knowing that healthy people do not like to hear others complain and moan, the sick man tries to hide his resentment and pain under a forced smile, and to play the good sport. In time he learns self-control.

It can be assumed that other qualities which the mature Washington exhibited, his courage and unyielding determination, were also conditioned by his state of health. A man who has repeatedly faced death from mysterious diseases is relieved to encounter enemies he can see and fight. Washington’s singleness of purpose may have derived its force from the store of energy dammed up by the frustrations of sickness.

There exists only one report that Washington was incapacitated by sickness during the Revolutionary War. At Valley Forge there was not a day when Washington was not at his post, keeping together and encouraging his ill-armed, ill-clothed, ill-fed little army, far outnumbered by the well-nourished and well-equipped British troops. His sense of responsibility and the consciousness of his mission gave stimulation to his adrenal glands, raised his normal powers of endurance, resistance and immunity. Destiny kept alive and well the only man of his time who could lead the American Revolution to victory. The General’s life seemed charmed. He was never touched by a bullet though he was exposed at all times to enemy fire, leading and rallying his troops.

Washington remained free of disabling disease until 1786. Then, after the war and his election to the Presidency, came a letdown. Once more he fell ill with “ague and fever.” He was treated by Dr. James Craik, his physician and close personal friend for thirty-two years. Craik was born in Scotland and had graduated from the University of Edinburgh, the most renowned medical school of the time. After his graduation, he had migrated to the New World. He had accompanied Washington on the Braddock expedition and all during the War of Independence had been connected with the Continental Army, serving as second in command to the medical director general. Through Craik’s agency, the Conway Cabal, a conspiracy to replace Washington with General Horatio Gates, had been exposed.

In 1786 Dr. Craik for the first time employed “the bark” on Washington for malaria, with excellent results. This was quinine, from the bark of the cinchona tree, used for a hundred and fifty years against malaria in South America and Europe, but apparently it had not yet been introduced in North America. It was given in the form of a powder, decoction or extract, and was one of the first specific remedies employed for any disease.

During his first year as President, there developed what the doctors called “a malignant carbuncle” on Washington’s left hip, probably of staphylococcic origin. For several weeks he was desperately ill. He was cared for by Dr. Samuel Bard, a well-known New York physician, who watched over the patient constantly for many days and nights.

Finally Dr. Bard summoned all his courage, incised the carbuncle and drained the pus, with immediate improvement. When the President was able to go out after six weeks, his coach had to be rebuilt to enable him to lie at full length.

In 1789 Washington went on an official visit to New England. At the outskirts of Boston he was delayed a considerable time in. rain and stormy weather; it seemed the city and state authorities were unable to decide on the etiquette of receiving the Chief of State, for which there was no precedent. As a result of the delay, Washington developed a bad cold, with inflammation of the eyes. Following this visit, an epidemic of respiratory infections spread through the city. The die-hard Loyalists of Boston promptly named it “the Washington Influenza.”

Numerous colds and the large doses of quinine taken for his malaria affected Washington’s hearing noticeably during the last decade of his life. The deafness made it difficult for him to carry on conversations at public affairs, and increased his native diffidence. Thus he acquired a reputation of being cold and aloof.

After reaching middle age, Washington had to wear glasses for reading. In those days, glasses were just as unfashionable as wearing hearing aids has been until quite recently. People were ashamed to wear glasses, considering them a humiliating disfigurement like a clubfoot or hunchback. Washington used his reading glasses only in the privacy of his family or among intimate friends.

In 1790 the federal government was removed from New York to Philadelphia. In the spring of the same year Washington was brought down with pneumonia followed by a relapse which almost proved fatal. He wrote: “I have already within less than a year had two severe attacks, the last worse than the first. A third probably will put me to sleep with my fathers.”

No doubt the pressures and frictions of the Presidency were a great drain on the health of the aging Washington, as on most other Presidents since. He was galled by the ingratitude of the people and the press, who assailed him bitterly during his second term.

Sixty-five years old, sick, and tired of public service, Washington declined to be nominated for a third term and retired to the seclusion of Mt. Vernon in the spring of 1797. There he was allowed only two and a half years of well-deserved rest. In 1798 his old nemesis malaria recurred, and responded only tardily to “the bark.”

On December 12, 1799, as was his custom, Washington was riding about his farm from 10 A.M. until 3 P.M. The weather was bad, with rain, hail and snow falling alternately, driven by an icy wind. Washington was a stickler for punctuality in all his activities, including meal hours. But on this day, Washington was late for dinner. Served promptly at three o’clock, the meal was on the table when he entered the house. Colonel Lear, his faithful friend and secretary, observed that the collar of the General’s jacket appeared wet and that snow was sticking to his hair, but Washington refused to change his clothes and sat down to dinner. The next day he complained of a cold and sore throat and did not go out in the morning as usual. During the afternoon, in spite of his cold, he went outside to mark some trees he wanted cut down. In the evening a severe hoarseness developed, but he made light of it. Upon retiring, Colonel Lear suggested that the General take something for his cold, but Washington answered, “No, you know I never take anything for a cold; let it go as it came.”

Next day at 3 o’clock in the morning, Washington told Martha that he was very unwell, that he had the ague. He could hardly speak, and he breathed with difficulty. Martha begged him to let her awaken the servants and fetch him a home remedy. But Washington sternly refused to let her get up for fear she, too, would catch cold. At daybreak a servant lighted the fire. Colonel Lear presently arrived and found the General unable to speak. A loathsome mixture of molasses, vinegar and butter was offered to him but Washington could not swallow a drop. In trying to get it down, he started to cough convulsively, and almost suffocated.

Rawlins, the overseer of the farm, was sent for to bleed the President. The overseer had acquired his surgical acumen in the practice of veterinary medicine on the farm. He took a pint of blood from Washington, but there was no relief. Colonel Lear next applied “sal volatile,” the menthol rub of the time, to the sick man’s throat, upon which the patient complained that his throat was very sore. A piece of flannel saturated with the same evil-smelling salve was wound around his neck, and the feet immersed in warm water—all to no avail. At about eight o’clock Washington got up for two hours, but obtained no relief from the changed position. Dr. Craik arrived shortly after nine o’clock.

He applied a blister of Spanish flies (derived from dried and powdered blister beetles) to the throat, took some more blood, and prescribed a gargle of vinegar and sage tea. He also ordered vinegar and hot water for steam inhalation. In attempting to gargle, the patient choked and regurgitated the liquid. At eleven o’clock the bleeding was repeated but the difficulty in swallowing and breathing was not eased. In the meantime Dr. Gustave Richard Brown of Fort Tobacco, and Dr. Elisha Cullen Dick of Alexandria, had been summoned as consultants.

Dr. Brown, the son of a doctor, had been born in Maryland and, like Dr. Craik, had been graduated from the University of Edinburgh. Dr, Dick, the youngest of the attending physicians, was born in Pennsylvania and graduated from the recently founded Medical School of Pennsylvania at Philadelphia.

Both consultants arrived around three o’clock and sat down at the patient’s bedside. The most elementary diagnostic methods were not practiced at the time. There is not even a record that the interior of Washington’s throat was ever inspected by the physicians. A diagnosis was arrived at by watching the patient, taking his pulse, and observing his external symptoms. The three doctors attending Washington sat helpless while their patient struggled for breath, each inspiration producing a shrill, harsh sound as the air was painfully forced through the obstructed air passage. His skin was blue and the nostrils dilated and contracted with the effort of breathing. He also had great difficulty in swallowing.

The first diagnosis thought of was quinsy, which meant peritonsillar abscess. Later on the diagnosis was changed to “cynanche trachealis,” a vague medical term of the time for a severe sore throat involving the voice box, in which the inflammatory swelling of the vocal cords encroaches upon the breathing space. Dr. Brown suggested using the standard treatment recommended by the bloodthirsty medical school of Edinburgh for this condition—additional copious bleeding. The young American doctor, Dick, objected. He argued, “He needs all his strength—bleeding will diminish it.” He was overruled by his two senior colleagues, who were supported by the good soldier Washington. A whole quart of blood was taken this time and it was observed that the blood came “slow and thick,” the effect of dehydration.

To add insult to injury, the laxative calomel, and the emetic antimony tartrate, were administered, weakening the patient still further by producing vomiting and diarrhea, increasing his dehydration. About half past four Washington gave instructions about his will, and about five o’clock he tried to sit up but was too weak to remain upright for more than half an hour. In the course of the afternoon he appeared in great distress and pain, and frequently changed his position in bed, struggling for breath.

As a last resort Dr. Dick suggested the use of a daring surgical method, the only one available which could have saved the patient from slow suffocation caused by the obstruction of the larynx, tracheotomy—the surgical cutting of an opening into the windpipe below the point of obstruction. In a communication several years later Dr. Dick reasoned, “I proposed to perforate the trachea as means of prolonging life and of affording time for the removal of the obstruction to respiration in the larynx which manifestly threatened immediate dissolution.” He argued that the method recommended was imperative at this crucial moment because there was not yet any evidence of involvement of the lower air passages, in which case it would have been too late. He even offered to take personal responsibility for failure.

The older colleagues refused to take a chance on their illustrious patient by using such an unproved and risky procedure which had been successfully employed in only a few instances up to that time. The urgent entreaties of Dr. Dick were in vain. Instead, the senior physicians continued their futile measures by applying blisters and poultices of wheat bran to the legs and. feet of the dying patient. The process of gradual suffocation progressed inexorably until about ten minutes before the General expired; then the breathing became easier. The exhausted heart stopped beating between ten and eleven o’clock on the night of December 14, 1799.

From the first, Washington as usual had been exceedingly pessimistic about his illness. He had made up his mind that he was going to die and did what he could to dissuade his doctors from making special efforts for him, begging them only to let him die in peace. “I find I am going,” he whispered to Colonel Lear. “My breath cannot last long. I believed from the first that the disorder would prove fatal.” A little later he repeated to Dr. Craik: “Doctor, I die hard, but I am not afraid to go.” When Dr. Brown came into the room: “I feel myself going,” he said. “I thank you for your attention but I pray you to take no more trouble for me. Let me go quietly. I cannot last long.”

The exact diagnosis of George Washington’s last sickness is still disputed among medical historians. The most convincing study was made by Dr. W. A. Wells of Washington, D.C., in 1927. Up to that time it was believed that Washington had died from diphtheria, corresponding to the diagnosis of “croup,” which Dr. Dick had suggested in retrospect. A definite diagnosis cannot be made with certainty as no clinical description of the appearance of the inflammatory process was given. Bacteriological confirmation of a diagnosis was of course unknown. Despite this lack of evidence, Dr. Wells concluded from all the known data that Washington died from a streptococcic laryngitis, an inflammatory swelling of larynx and the vocal cords caused by a strain of virulent streptococci. It is impossible to estimate how much the treatment, with depleting venesections and dehydrating cathartics and emetics, contributed to the fatal outcome.

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Rudolph Marx M.D.

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