21 November 2012

Medicine: How Eighteenth Century Medicine Killed George Washington

When I get a sore throat, I stay at home, gargle warm salt water, and choose some of the various potions in my home ‘medicine chest’ for pain relief, fever, and decongestion. If there’s no improvement within a few days, I visit my doctor, and sometimes get antibiotics to treat a bacterial infection. End of story.

In December of 1799, at age 67, George Washington got a sore throat. It developed in just the circumstances that mothers still warn their children about today: He spent five hours outdoors in sleet and cold rain. He was riding around checking on his five farms near Mount Vernon on horseback, and returned home for the mid-day meal damp to the skin, and chilled.

The next day, though he was hoarse and congested, he hiked down the slope from Mount Vernon toward the Potomac River and marked out the location for a gravel walk and fishpond he planned to install. Tobias Lear, who had been Washington’s personal secretary for the previous fifteen years, urged him to take some medicine, but Washington told him, “You know I never take anything for a cold.” He stayed up late writing letters that evening.

He woke during the night with his throat inflamed, having difficulty breathing. His slaves built up the fire and tried to make him comfortable, but turned down Martha’s entreaties to send for a doctor. Lear was awakened at dawn, and wrote this account:  

I found the General breathing with difficulty, and hardly able to utter a word intelligibly. He desired that Mr Rawlins (One of the overseers) might be sent for to bleed him before the Doctors could arrive. I dispatched a Servant immediately for Rawlins, and another for Dr. Craik, and returned again to the General's Chambr, where I found him in the same situation as I had left him -A mixture of Molasses, vinegar & butter was prepared to try its effects in the throat; but he could not swallow a drop; whenever he attempted it he appeared to be distressed, convulsed and almost suffocated. Rawlins came in soon after Sunrise, and prepared to bleed him. When the Arm was ready the General observing that Rawlins appeared to be agitated said, as well as he could speak

"Don't be afraid." And after the incision was made, he observed "The Orifice is not large enough. However the blood ran pretty freely. Mrs. Washington not knowing whether bleeding was proper or not in the General's situation, begged that not much be taken from him lest it should be injurious, and desired me to stop it; but when I was about to untie the string, the General put up his hand to prevent it, and as soon as he could speak, said "more, more." Mrs. Washington being still very uneasy lest too much blood should be taken, it was stopt after about half a pint. Finding that no relief was obtained from bleeding, and that nothing would go down the throat, I proposed bathing it externally, with salve latola, which was done; and in the operation, which was done with hand, in the gentlest manner, he observed, " 'tis very sore." A piece of flannel dip'd in salve-latola was put around his neck, and his feet bathed in warm waters; but without affording any relief.

In the meantime, before Dr. Craik arrived, Mrs. Washington desired of me to send for Dr. Brown of Port Tobacco whom Dr. Craik had recommended to be called if any case should occur that was seriously alarming. I dispatched a messenger (Cyrus) immediately for Dr. Brown (between 8 and 9 o'clock). Dr. Craik came in soon after, upon examining the General, he put a blister of Cantharides, [Cantharides, in case you didn’t know, is derived from a beetle, has been used to treat warts, and is used as an aphrodisiac, a.k.a. Spanish fly. I’m not sure what Dr. Craik’s goal was in this instance] on the throat, took some more blood from him and some Vinegar and hot water for him to inhale the steam, which he did, but in attempting to use this gargle he almost suffocated. When the gargle came from the throat some phlegm followed it, and he attempted to cough, which the Doctor encourage him to do as much as possible; but he could only attempt it. About 11 o'clock Dr. Craik requested that Dr. Dick might be sent for, as he feared Dr. Brown might not come in time. A messenger was accordingly dispatched for him. About this time the General was bled again. No effect, however, was produced by it. A Blister was administered about 12 o'clock, which produced an evacuation....

Doctor Dick came in about 3 o'clock, and Dr. Brown arrived soon after. Upon Dr. Dick's seeing and consulting a few minutes with Dr. Craik, he was bled again. The blood came very slow, was thick and did not produce any symptoms of fainting. Dr. Brown came into the Chamber soon after; and upon feeling the General's pulse, the physicians went out together. Dr. Craik returned soon after. The General could now swallow a little. Calomel [mercury chloride, a laxative] and tartar em [antimony potassium tartrate, a poison, used at one time to induce vomiting] were administered....”

By late afternoon, Washington had resigned himself to his imminent death, and in his usual pragmatic way, set about finalizing his affairs. He saw that an older version of his will was destroyed to establish clearly his final wishes, and gave instructions about his burial. At 10:10 p.m. George Washington breathed his last.

“Blood-letting is a remedy which, when judiciously employed, it is hardly possible to estimate too highly,” according to Dr. Henry Clutterbuck, writing in 1838. However, it is possible that Drs. Craik, Dick, and Brown did estimate too highly the value of bloodletting. According to Dr. Vibal Vadakan, a pediatric oncologist and hematologist from Los Angeles, the former president was relieved of more than half his blood in the twelve hours or so before his death, in addition to the various toxic purgatives used on him.

Dr. Vadakan is not the first to question the value of the treatments given George Washington. Just six weeks after Washington’s death, Dr. James Brickell wrote an article—which remained unpublished until 1903—critical of the procedures. Vadakan quotes the following from Brickell:

“... I think it my duty to point out what appears to me a most fatal error in their plan ... old people can not bear bleeding as well as the young ... we see ... that they drew from a man in the 69th year of his age the enormous quantity of 82 ounces, or above two quarts and a half of blood in about 13 hours.

Very few of the most robust young men in the world could survive such a loss of blood; but the body of an aged person must be so exhausted, and all his power so weakened by it as to make his death speedy and inevitable.”

From firsthand accounts, Dr. Vadakan estimates: “The total quantity of blood taken amounted to 124-126 ounces or 3.75 liters, drawn over a period of nine to ten hours on Saturday, December 14, 1799.

General Washington was a physically impressive man measuring 6 feet 3 inches in height and weighing 230 pounds. Because adult blood volume is 70 ml/kg, one can estimate the blood volume of President Washington at seven liters. The extraction of more than half of his blood volume within a short period of time inevitably led to preterminal anemia, hypovolemia, and hypotension. The fact that General Washington stopped struggling and appeared physically calm shortly before his death may have been due to profound hypotension and shock.”

While it is easy to criticize the physicians of the 18th century, they were following the best medical practices of their time, and all had the former President’s best interests at heart. I can only say, I’m glad that any illness I suffer is taking place in the 21st century, when, though not every attempted cure is successful, at least I am not likely to be bled to death by my doctor.