The Medical History of the Father of our Country - General George Washington
by David R. Curfman, M.S., A

Dr. David R. Curfman, a neurological surgeon in private practice in Washington, D.C. lectures extensively throughout the United States on the medical history of several presidents while maintaining his clinical appointments and surgical schedule in the nation's capital. He has presented the following address to many groups during the celebration of the bicentennial commemorating the death of General Washington i n 1799. Dr. Curfman served as national chairman, General Society Sons of the Revolution for this special commemoration assisting in the funeral reenactment at Mount Vernon on December 18, 1999 and Fully planning the reenactment of the memorial service held on December 29 at the Old Presbyterian Church in historic Alexandria, Virginia. He is a biographee in "Who's Who in Medicine and Healthcare" and numerous other publications.

George Washington was born on February 11, 1732 (Old Julian Calendar) February 22,1732 (new Gregorian Calendar adopted in 1752) in Westmoreland County, Bridges Creek, Virginia as the third child of Augustine Washington and his second wife Mary Ball. There is no recorded history of complications surrounding this birth which occurred at approximately 10 O'clock in the morning. By age 15 the young Washington had had measles, mumps and "black canker" (diphtheria). He qualified through William and Mary College to become a surveyor in 1747. He laid out the City of Alexandria and swamplands south of that seaport and by 1748 was experiencing symptoms of "ague and fever" later described as malaria. These swamplands were infested by breeding mosquitoes. He was treated with cichona (Jesuit Peruvian Bark) which contained the agent quinine. It is thought that his severe loss of hearing (hypoacusis) in later life was attributed to high doses of the Jesuit Bark.

A Victim of Smallpox
In 1751, Washington accompanied his ailing half-brother Lawrence to the Barbados seeking environmental conditions regarded more favorable for treatment of tuberculosis. While they were on the island, Lawrence and George went to a home for dinner where a known member of the host family had active small pox. Although George was aware of the disease existing in that home, he attended as a gentleman with good manners. He contracted the disease and carried the scars of that experience all of his life. A pastel painting made in 1794 created by a fellow Mason depicts the only known picture illustrating the pockmarks over the nasal bridge and also a skin lesion (mole vs. basal cell epithelioma) is visible anterior to the right ear lobe.

Tuberculosis in the Family
On January 6, 1759 Washington married widow Martha Dandridge Custis in New Kent County Virginia and they took up residence at Mount Vernon in May with Martha's two children. In 1761 George Washington was taken seriously ill with a return bout of malarial fever. By 1764 he began practicing medicine, securing medical books and medications from England. He treated many servants on the plantation and later, when the Stabler-Leadbetter Apothecary was established in Alexandria, Washington ordered his medical supplies from this local facility. In 1769 he went to Berkeley Springs with Mrs. Washington and her daughter "Patsy" in hopes that the failing health of the young teenager could be improved. She had tuberculosis and was know to have had a seizure disorder. It is thought that around this time Washington himself may have acquired tuberculosis.

Bloodletting

Tools of Bloodletting

In 1775 Washington was made commander-in-chief of the colonial forces. By this time he was known to favor the use of venesection (bloodletting) as a treatment for numerous illnesses and even practiced it on himself when a skilled person was not readily available. Venesection dates back to the second century A.D. to Greek physician Galen. It was based upon the concept that blood contained excessive "irritants" or "bad humours" and when a person was sick there was need to dilute these irritants as new "healthy" blood cells were formed to overpower the remaining bad cells. The procedure consisted of placing the patient's arm in warm water to engorge the veins, followed by application of a tourniquet near perception of the pulse while rapidly opening and closing the hand in a fist formation to further swell the veins. A lancet pierced the engorged vein, which was further opened to allow drainage of blood. Unfortunately, this treatment was not only frought with scientific error in treating disease but also there was a miscalculation as to the volume of blood contained in the human body. The ancients calculated there were twelve quarts when in actuality there are six to eight. Consequently, when a volume of blood was removed during venesection there was always removal of more volume than what was assumed! Although this practice had persisted for centuries it came to an end shortly before the Civil War. However, it should be mentioned that in today's modern medicine there are a few rare circumstances when blood is removed as a form of treatment.

Dentures as an Adult
As an adult George Washington was 6 feet 2 1/4 inches tall with his weight approximately 200 pounds. He had blue-grey eyes with broad round cheekbones and deep heavy eyebrows. His hair was dark brown and his chest was somewhat concave which may have been caused by a prior bout of tuberculosis. Defective teeth, attributed by Washington to cracking walnuts during his youth, required him to be fitted with dentures made of Whalebone, not wood. He had teeth shaped from hippopotamus teeth and had springs to assist their action. One of Washington's dentists was Paul Revere, not only a silversmith and dedicated patriot, but highly skilled in this profession. Washington's dentures made a clicking noise and must have been very uncomfortable. This may account for all of the drawings and paintings of Washington showing him without a smile.

Arthritis and Pneumonia
In 1787 Washington had a severe bout with what is described as a rheumatic like condition in that he could not raise his arms above his shoulders and spent much time in bed. This may have been due to a type of arthritis arising from an inflammatory condition of the blood vessels surrounding the bony joints. In 1789 approximately six months after his inauguration as our first president, he developed cramps, fever and chills and was found to have a carbuncle (inflamed mass under the skin) near the thigh bone which was crudely removed by surgery without anesthesia. During this time he also developed conjunctivitis and pneumonia and was unable to perform his presidential duties for 109 days! As far as is recorded General Washington continued his presidency without medical problems thereafter.

Although he retired to his beloved Mount Vernon following his presidency he was reactivated into military service in 1798 when war with France was felt to be imminent. He spent most of November of that year in Philadelphia planning for a possible conflict.

His Final Illness
On Thursday, December 12, 1799 Washington spent the day on horseback supervising his farming activities. A mix of snow, sleet and cold rain fell soaking his clothing. When he arrived back at his home for dinner he did not change his damp attire so as not to delay the meal. On Friday, December 13, he began noticing a sore throat as he did further work on his estate. He became hoarse (dysphonic) in the evening while reading his mail and the printed news of the day. He retired early, noting that he was suffering with a cold. At around 2 a.m. on Saturday, he awakened with a sore neck (cervicalgia) stridor (strained voice) and fever.

Martha Washington sent for his secretary Tobias Lear who found the General in distress. The farm overseer, Mr. George Rawlings, was requested to come to Washington's bedside. By 7 a.m. Rawlings, who was skilled as a bloodletter of the servants, was requested to bleed the General. Martha pleaded with George not to be bled but was rejected and approximately 14 ounces were removed. Rawlings who also practiced allopathy (therapeutic practice of treating one disease process by producing a morbid reaction upon the patient) attempted to administer a mixture of molasses, butter and vinegar but the formula was impossible to swallow and caused choking and near suffocation.

Dr. Craik

Long-time friend and surgeon general of the Continental Army, Dr. James Craik arrived at 9 a.m. who induced a second bleeding of about a quart of blood. A third bleeding of about the same volume was removed at 11 a.m. With no noticeable improvement, blisters (flannel dipped in cantharides, ammonia solution) were wrapped around the neck with the feet bathed in warm water. A gargle concoction of vinegar and sage tea provided for the sore throat.

At noon an enema was given. Martha Washington became more alarmed and requested Lear to send for a second physician, Dr. Gustavus Brown of Port Tobacco, Maryland. Since he didn't arrive with dispatch, Lear sent for another young physician Dr. Elisha Dick who arrived at 3 p.m. At about the same time Dr. Brown arrived. A discussion ensued with Drs. Cralk and Brown favoring a fourth bleeding which was performed over the objections of Dr. Dick. Dr. Dick made the plea that the General should not be depleted of more of his blood but should undergo tracheotomy for what he thought was an inflammation of the throat membranes (acute epiglottitis) rather than either quinsy (peritonsillar abscess) or cynanche trachealis (croup). Although unknown as a treatment in the United States, tracheotomy/tracheostomy was a well-accepted procedure in Europe since 1718 to relieve breathing distress. Ancient Eqypt (4400-4166 B.C.) was known to have used it as treatment! The two senior physicians were certainly concerned about treating their famous patient and did not want to perform any type of treatment never attempted in this country.

At 4:30 p.m. Washington called for review of his wills one of which was burned in the bedroom fireplace. By 5 p.m. he arose from the chair in which he was sitting, undressed himself and took to his bed for the last time realizing his approaching demise. More blisters and cataplasms (wheat bran paste or flaxseed applied to the skin and covered with flannel).

Death of Washington

Shortly afterward, Washington thanked his doctors for all they had done and requested that nothing further be done. As his demise approached, he spoke in a whisper giving directions to Tobias Lear about plans for his burial. He spoke in a soft but lucid manner indicating he did not want to be buried before three days had lapsed with the last words "tis well". While taking his own pulse he departed from this world at approximately 10:22 p.m. that Saturday night.

On Monday Dr. William Thornton, architect of the Capitol and well-trained physician originally from England dispatched a message to Mount Vernon requesting of Martha Washington that he be permitted to warm the corpse of Washington and perform a tracheotomy in an effort to restore Washington's life! Appropriately Mrs. Washington refused. After Washington's burial on December 18, 1799 his medical treatment continued to be discussed for several years. Of interest, an abstract of a letter addressed to Dr. James Cralk from Dr. Brown attempted to put to rest that there was any controversy surrounding Washington's medical care. Dr. Brown states:

Letter from Dr. Gustavus Brown to Dr. James Cralk (abstract), Port Tobacco, Maryland, January 21, 1800

Sir:
I have lately met Dr. Dick again in consultation and high opinion that I formed of him when we were in conference last month, concerning the situation Of our Illustrious friend, has been confirmed. You remember how, by his clear reasoning and evident knowledge of the cause of certain symptoms after the examination of the General, he assured us that it was not really quinsy, which we supposed it to be, but a violent inflammation of the membranes of the throat, which it had almost closed, and which if not immediately arrested would result in his death. You must remember he was averse to bleeding the General, and I have often thought that if we had acted accordingly to his suggestion, when he said, "he needs all his strength - bleeding will diminish it", and taken no more blood from him, our good friend might have been alive now. But we were governed by the best light we had: we thought we were right, and so we were justified.

However, in a medical journal published in 1809 Dr. Dick makes it indelibly clear that he was not in agreement with Dr. Craik and Brown concerning the treatment plans that fateful day in 1799.

Philadelphia Medical and Physical journal Dr. Elisha C. Dick's Letter to the Editor dated October 7, 1808 Published May, 1809 - Page 253 (supplement)

"Facts and Observations relative to the Disease of Cynanche Trachealis, or Croup" (abstract) "I pronounced decisively that death was inevitable, unless it could be arrested by the operation of tracheotomy, to which I strenuously recommended an immediate resort, as the only expedient that could possibly preserve the life of a man, whose loss every virtuous man in the community would deplore. " (Then Dr Dick goes on to discuss the unfavorable opinion of Drs. Craik and Brown.) "I know not what might have been the result and it would be presumption to pronounce upon it; but I shall never cease to regret that the operation was not performed."

With respiratory diseases prevalent in the Washington ancestoral line, General Washington never expected to live as many years as he did. In fact on numerous anniversaries of his birthday, he felt he would not live to see another. By current medical assessment, Washington most likely was experiencing an attack of acute epigottitis. His symptoms of restlessness, intermittent euphoric state probably due to loss of oxygen carrying capacity by decreased blood volume, coupled with some difficulty breathing in oxygen while more easily exhaling carbon dioxide and his ability to speak intelligible to the very end would confirm this diagnosis. A tracheotomy would have been appropriate. What ever the source of the infection, it is possible Washington could have survived the malady as he had successfully survived numerous infections in the past. The time frame for quinsy (peritonsillar abscess) was too short and the possibility of croup (cynanche trachealis) did not occur in older adults. There was no mention of chest pain therefore it was unlikely that a lung disease such as pneumonia was present. Another concern, which may have factored in his demise, was that the extensive exsanguination could have caused the heart pumping action to stop.

Although Washington experienced numerous ravaging illnesses during his lifetime, any of which could easily have led to the early demise of many of his fellow citizens, his longevity far surpassed his own expectations based upon the average lifespan of all of his paternal ancestors.

BIBLIOGRAPHY
Bancroft, Aaron, THE LIFE OF GEORGE WASHINGTON (Two Volumes in One), Phillips & Sampson, 206 - 214,Worcester, Mass., 1848.

Lear, Tobias, PERSONAL ACCOUNT OF THE FINAL Hours OF GENERAL WASHINGTON, (manuscript).

Lossing, Benson J., THE HOME OF WASHINGTON, 330 - 338 A. S. Hale & Company, Hartford, Conn., 1870.

Massengill, Samuel E., M.D., A SKETCH OF MEDICINE AND PHARMACY, 182 -184,300 - 301, 408 - 409, The S. E. Massengill Company, Bristol, Tenn., 1943.

Old, W Levi, M.D. and Fitchett, Claiborne W, M.D., SURGERY AND SURGEONS IN VIRGINIA (1607 - 1995), 6, Eastern Virginia Medical School, NorFolk,Va., 1997.

Scheidemandel, Heinz H. E., M. D., DID GEORGE WASHINGTON DIE OF QUINSY?, Arch. Oto., (102), 519 - 521, Sept., 1976.

Smith, M.J.V., M.D., THE FATHER WHO WAS NOT A FATHER,Va. Med. Mon., (103), 14 - 33, jan, 1976.

Wilbur, C. Keith, M.D., REVOLUTIONARY MEDICINE 1700 - 1800 (Second Edition), 10-13,The Globe Pequot Press, Old Saybrook, Conn., 1997.