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
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
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
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
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
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
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)
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."
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.
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
Aaron, THE LIFE OF GEORGE WASHINGTON (Two Volumes in One), Phillips
& Sampson, 206 - 214,Worcester, Mass., 1848.
Tobias, PERSONAL ACCOUNT OF THE FINAL Hours OF GENERAL WASHINGTON,
Benson J., THE HOME OF WASHINGTON, 330 - 338 A. S. Hale & Company,
Hartford, Conn., 1870.
Samuel E., M.D., A SKETCH OF MEDICINE AND PHARMACY, 182 -184,300
- 301, 408 - 409, The S. E. Massengill Company, Bristol, Tenn.,
W Levi, M.D. and Fitchett, Claiborne W, M.D., SURGERY AND SURGEONS
IN VIRGINIA (1607 - 1995), 6, Eastern Virginia Medical School,
Heinz H. E., M. D., DID GEORGE WASHINGTON DIE OF QUINSY?, Arch.
Oto., (102), 519 - 521, Sept., 1976.
M.J.V., M.D., THE FATHER WHO WAS NOT A FATHER,Va. Med. Mon., (103),
14 - 33, jan, 1976.
C. Keith, M.D., REVOLUTIONARY MEDICINE 1700 - 1800 (Second Edition),
10-13,The Globe Pequot Press, Old Saybrook, Conn., 1997.