President George Washington was born Feb. 22, 1732, at Wakefield Plantation, and raised on Pope's Creek Farm, both in Westmoreland County, VA.

He spent his early adult years as a surveyor, in the military, and also tending to his plantation, Mount Vernon, which he inherited after his older brother died. Mount Vernon is located along the Potomac River in northern Virginia, just outside Washington, DC.

On Jan. 16, 1759, at age 26, Washington married Martha Dandridge Custis, a widow with two small children.

Washington's life as a colonist, statesman and commanding general of the Continental Army propelled him to greatness.

Many wanted him to be king following the Revolutionary War, but Washington resisted. Instead, he agreed to be the first president of the United States of America, which helped solidify his legacy as "father of his country."

In the spring of 1797, after declining a third term as president, Washington retired to Mount Vernon. Two and a half years later, on Dec. 25, 1799, he was buried there.

Sickness Strikes

Washington was a tall man of more than 6 feet in height and possessed much stamina, as evidenced by the winter he and his troops spent encamped at Valley Forge, near Philadelphia, in 1777-1778.

Yet throughout most of his adult life, Washington suffered from various ailments, including malaria, pneumonia, dysentery, carbuncles and dental problems, among others. Ultimatley, the nation's patriarch would suffer a painful passing.  

On Thursday, Dec. 12, 1799, Washington rode his horse around his beloved Mount Vernon for more than five hours in a winter weather mix of cold, rain, sleet and snow. The following evening, as the president sat by the fire reading, he complained of a sore throat and his voice was hoarse.

At 3 a.m. Saturday, Dec. 14, Washington awoke with his throat so swollen he had difficulty breathing and speaking. He would not permit Martha to call for a doctor until daybreak, however, as the weather was not good for travel. Instead, the plantation's overseer, Colonel Tobias Lear, at the behest of the president, performed the first of several misguided bleedings Washington would endure.

Shortly after daybreak, Dr. James Craik, a physician from nearby Alexandria, VA, was summoned to Mount Vernon. Drs. Elisha Cullen Dick and Gustavs Richard Brown joined Dr. Craik at Washington's bedside in short order. The trio of physicians diagnosed the president with peritonsillar abscess or "quinsy."

Bad Medicine

The term "quinsy" describes an inflammation of the tonsils with fever, swelling, pain and a local accumulation of pus. Treatment was not well defined in the 18th century, though it was the consensus among most physicians that bleeding by "cupping" was warranted.

Bleeding by cupping required a tourniquet applied to an extremity, usually an arm. A lancet is used to make small cuts in the patient's skin to produce bleeding. A cupping glass is heated and placed over the lacerated area. As the cupping glass cools, a partial vacuum is formed, which draws blood up into the cup. The blood taken was deposited into a larger container and measured.

A total of 80 ounces, or 35 percent of Washington's blood volume, was taken from the president in less than 24 hours.

Washington's physicians also subjected him to purging by administering calomel to induce diarrhea and vomiting. Of course, the combination of bleeding, diarrhea and vomiting made the president extremely dehydrated and hypoglycemic.

Worse, Washington's physicians prescribed powdered Spanish fly, a concoction made of blister beetle and vesicant, which was applied to the afflicted area of the president's throat to act as a counterirritant, and undoubtedly added to his discomfort.

After several hours enduring the treatments prescribed by his physicians, the deeply religious Washington resigned himself to his fate and ordered the bleeding and purging stopped. At around 10 p.m., Washington died. He was 67.

Change is Constant

During Washington's final hours, Dr. Dick, a young surgeon, suggested a tracheotomy for the president. It was a relatively new procedure at the time, however, and neither of the other more experienced physicians was familiar with it.

The senior physicians overruled Dr. Dick and ignored his other suggestion, that the bleeding and purging be stopped. Historians have often speculated about whether following Dr. Dick's suggestions might have extended Washington's life.

Many believe Washington's clinical picture describes a case of acute streptococcal infection of the throat, involving the larynx and vocal chords. Others believe the president had acute bacterial epiglottis, an infection of the small tissue flap that occludes the entry to the lungs upon swallowing. When the epiglottis swells, it can block the flow of oxygen into the lungs.¹

Today, of course, whatever Washington's illness was, he would not be subjected to the torturous treatments prescribed by his physicians. Unfortunately, the concept of bacteriology had not been cultivated and antibiotics did not exist.

Hence, Washington's death illustrates an interesting fact about medicine - healthcare is a constantly changing field.

References
1. Bumgarner, J.R. (1994). The health of the presidents: The 41 United States presidents from a physician's perspective. Jefferson, NC: McFarland & Company.
2. MacMahon, E., & Curry, L. (1987). Medical cover-ups in the White House. Washington, DC: Farragut Publishing Company.
3. Morens, D. (1999). Death of a president. New England Journal of Medicine, 341, 1845-1849.

Cynthia Blank-Reid is trauma clinical nurse specialist at Temple University Hospital and clinical adjunct professor at Drexel University College of Nursing, both in Philadelphia.