Revolutionary War Historical Article
Death of General George Washington
by Donald N. Moran
Part of this eye witness account of the last moments of George Washington's life is from his adopted grandson, George Washington Custis. It is augmented by numerous other sources. George Washington Custis was the son of John Custis, the son of Martha Washington from her first marriage to Daniel Custis. John Custis, his father, served as an Aide-de-Camp to Gen. George Washington during the Yorktown campaign and died from camp fever there. General Washington immediately adopted the six-month-old Custis and his sister Eleanor as his own children. George Washington Custis was nineteen at the time of his adopted grandfather's death.
General Washington had been riding about his estate from 10:00 a.m. to 3:00 p.m. He recorded in his diary that it had snowed, hailed and rained and the outside temperature was 28°F. After dinner he worked in his library until almost midnight and had complained of a sore throat, he made light of his developing hoarseness and spent the evening perusing newspapers in the company of his wife, Martha, and his personal secretary, Colonel Tobias Lear. He appeared cheerful and read aloud several newspaper passages insofar as his increasing hoarseness permitted. When Colonel Lear suggested that he take medication, he protested: "You know I never take anything for a cold. Let it go as it came."
In the early morning of Saturday, December 14th, 1799, around 2:00 a.m., Washington awoke in distress and told Martha, his wife, that he was ill. His breathing was labored and he could hardly speak. Martha offered to get their maid, Caroline, but Washington forbid it as he did not want Martha to go out in the cold to fetch Caroline whose quarters were outside the mansion. He was nursed by Martha until daylight, when Caroline arrived to light a fire in the fireplace. Martha sent her to fetch Colonel Lear. When Lear arrived in Washington's bedroom, he observed Washington was struggling for each breath. Lear sent for Albin Rawlins, the estate overseer. Rawlins prepared a medicinal mixture of molasses, vinegar, and butter. When the General tried to swallow the concoction, he almost choked to death, being unable to swallow. Washington then decided that bloodletting would be a better course and ordered Rawlins to perform venesection on his arm to remove half a pint of blood. General Washington was a strong believer in bloodletting, having used it successfully to cure various maladies affecting his Negro slaves. When Rawlins showed reluctance to perform the procedure, Washington provided gentle encouragement. "Don't be afraid. The orifice is not large enough. More, more." Colonel Lear noted that Martha Washington was against bloodletting and begged that not too much blood be removed. When the procedure was completed, a compress of a piece of cloth dipped in Salve Latola was wrapped around his neck, and his feet were warmed with wet towels.
Messengers were dispatched on horseback to the home of Doctor James Craik, his long time friend and personal physician, as well as to the residences of Doctor Gustavus R. Brown at Port Tobacco, Maryland and of Doctor Elisha C. Dick, a prominent physician residing in Alexandria, Virginia. Finding the condition of the President alarming, Doctor Craik placed a blister of cantharides (a preparation of dried beetles) on his throat and performed two venesections of 20 ounces each. To treat the severe sore throat and dysphagia, a solution of vinegar in hot water was prepared. However, attempts to gargle with this solution led again to near suffocation, followed by a severe coughing spell. Venesection was repeated with removal of 40 ounces of blood. Application of blister of cantharides to the General 's throat was followed by spontaneous bowel evacuation. Doctor Dick arrived at 3:00 p.m. and proceeded to remove 32 ounces of blood shortly thereafter and took the General's pulse. The three physicians decided to administer calomel and tartar.
The Final Moments of George Washington -- Doctors Dick and Craik,
Tobias Lear, Martha Washington and George Washington Custis Attending Him
At 4:30 p.m., realizing the futility of the various therapeutic measures applied to him, Washington called Tobias Lear to his bedside and gave his dying instruction. "I find I am going, my breath cannot last long; I believed from the first that the disorder would prove fatal. Arrange and record all my late military letters and papers, arrange my accounts and settle my books, as you know more about them than anyone else. Let Mr. Rawlins finish recording my other letters which he has begun." When Doctor Craik came back into the room, General Washington said to him: "Doctor, I die hard but I am not afraid to go. I believed from my first attack that I should not survive it. My breath cannot last long."
Finally, as he felt the approach of death, he again spoke to the three attending physicians, "I feel myself going. I thank you for your attentions but I pray you take no more troubles about me. Let me go off quietly, I cannot last long."
The physicians remained with Washington well into the night. At 8:00 p.m., they applied blisters and poultices of wheat bran to his legs. Doctor Dick proposed that Washington's worsening respiratory condition made it imperative that his trachea be perforated. This newly described procedure, attempted as a last therapeutic resort, had been reported to save the lives of patients. Both Doctors Craik and Brown objected to the new procedure. Doctor Dick assured them that he would assume all responsibility in case of unfavorable outcome. Doctor Dick subsequently noted in a personal correspondence: "I proposed to perforate the trachea as a means of prolonging life and of affording time for the removal of the obstruction to respiration in the larynx which manifestly threatened speedy resolution."
Sensing the inevitability of death, Washington again summoned Colonel Lear and gave him some additional instruction. "I am just going. Have me decently buried and do not let my body be put into the vault less than three days after I am dead. Do you understand me?" (In the 18th century there was a common fear of being buried alive).
According to Colonel Lear's account the General's breathing became less labored by about 10:00 p.m. and he was able to lie quietly. At exactly 10:10 p.m., he lifted his hands to check his own pulse, then expired peacefully.
Martha Washington was sitting at the foot of the bed when he died. When Doctor Craik pronounced George Washington dead, she said: "Is he gone? 'Tis well. All is now over. I shall soon follow him. I have no more trials to pass through." They had been married for forty years.
On December 19th, 1799, five days later, Doctors Craik and Dick published in the local newspaper, The Times of Alexandria, the following account: "Some time in the night of Friday, the 13th, having been exposed to rain on the preceding day, General Washington was attacked with an inflammatory affection of the upper part of the windpipe, called in technical language, cynanche trachealis. The disease commenced with a violent ague, accompanied with some pain in the upper and forepart of the throat, a sense of stricture in the same part, a cough, and a difficult rather than painful deglutition, which were soon succeeded by fever and a quick and laborious respiration. The necessity of bloodletting suggesting itself to the General, he procured a bleeder in the neighborhood, who took from the arm in the night, 12 or 14 ounces of blood; he would not by any means be prevailed upon by the family to send for the attending physician till the following morning, who arrived at Mount Vernon at 11:00 a.m. on Saturday morning. Discovering the case to be highly alarming, and foreseeing the fatal tendency of the disease, two consulting physicians were immediately sent for, who arrIved, one at half past three and the other at 4:00 p.m. in the afternoon. In the interim were employed two copious bleedings; a blister was applied to the part affected, two moderate doses of calomel were given, an injection was administered which operated on the lower intestines, but all without any perceptible advantage, the respiration becoming still more difficult and distressing. Upon the arrival of the first consulting physician, it was agreed, as there were yet no signs of accumulation in the bronchial vessels of the lungs, to try the result of another bleeding, when about 32 ounces were drawn, without the smallest apparent alleviation of the disease. Vapors of vinegar and water were frequently inhaled, ten grains of calomel were given, succeeded by repeated doses of emetic tartar, amounting in all to 5 or 6 grains, with no other effect than a copious discharge from the bowels. The powers of life seemed now manifestly yielding to the force of the disorder. Blisters were applied to the extremities, together with a cataplasm of bran and vinegar to the throat. Speaking, which was painful from the beginning, now became almost impracticable, respiration grew more and more contracted and imperfect, till half after 11:00 on Saturday night, when, retaining the full possession of his intellect, he expired without a struggle."
"He was fully impressed at the beginning of his complaint as well as through every succeeding stage of it, that its conclusion would be fatal, submitting to the several exertions made for his recovery, rather as a duty than from any expectation of their efficacy. He considered the operation of death upon his system as coeval with the disease; and several hours before his decease, after repeated efforts to be understood, succeeded in expressing a desire that he might be permitted to die without interruption. During the short period of his illness he economized his time in the arrangement of such few concerns as required his attention, with the utmost serenity, and anticipated his approaching dissolution with every demonstration of that equanimity for which his whole life had been so uniformly and singularly conspicuous."
The exact cause of General Washington's death has been the subject of much debate by many in the medical profession. Most modern people can not help but think that the blood letting was a major contributing factor. The total quantity of blood removed from General Washington has been estimated to be 5 to 7 pints.
Six weeks after the death of General Washington, Doctor James Brickell wrote an article expressing vehement disagreement with the blood letting procedure. This article was not made public until 1903. Estimating the quantity of blood removed to be 82 ounces - - much less then the amount of blood actually drawn - - he bemoaned the lack of clinical wisdom and appropriateness. "... 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. . . 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." Doctor Brickell was not entirely against venesection and bloodletting. However, he preferred removal of a lesser quantity of blood from a site closer to the inflamed organ. ". . . to have attacked the disease as near its seat as possible the vein under the tongue might have been opened; the tonsils might have been sacrificed; the scarificator and cup might have been applied on or near the thyroid cartilage."
The exact quantity of blood removed from the ailing George Washington can be derived at as follows: Albin Rawlins drew 12 - 14 ounces; Dr. James Craik drew 20 ounces, then he drew another 20 ounces, and finally he drew another 40 ounces. Dr. Elisha Dick drew 32 ounces. The total quantity of blood taken amounted to 124 - 126 ounces drawn over a period of nine to ten hours on Saturday, December 14th, 1799.
History tells us that General Washington was a physically impressive man, measuring 6 feet 3 inches in height and weighing 230 pounds. Knowing his size we can calculate that his total blood volume should be about seven quarts. The removal of more than half of his blood volume within a few hours led to contributing causes in his death. The fact that General Washington appeared physically calm just before his death may have been due to profound hypertension and shock induced by the blood letting.
The last minutes of George Washington was described by his adopted grandson George Washington Custis: "... as the night advanced it became evident that he was sinking, and he seemed fully aware that 'his hour was nigh.' He inquired the time, and was answered a few minutes to ten. He spoke no more - - the hand of death was upon him, and he was conscious that 'his hour has come.' With surprising self-possession he prepared to die. Composing his form at length, and folding his arms on his bosom, without a sigh, without a groan, the Father of his Country died. No pang or struggle told when the noble spirit took its noiseless flight; while so tranquil appeared the manly features in the repose of death, that some moments had passed ere those around could believe that the patriarch was no more."
Our Chapter's Surgeon, Dr. Francis P. Powers, advised that in today's Emergency Rooms, the Doctors would go through the normal procedures for diagnosis and then administer antibiotics for what would be presumed to be a virulent strep throat infection.
George Washington may or may not have blood work done depending on perceived degree of illness at time of examination, one or two vials, but not numerous pints. He may or may not receive IV fluids depending on his vital signs and whether or not they indicated dehydration. IV fluid administration to the elderly must be done with prudent care as their tolerance in limited. George Washington may not have even required hospitalization - - just sent home to rest. The Presumptive Diagnosis: Acute Streptococcal Pharyngitis. Prognosis: Patient would live.
Donald N. Moran
A special thanks to Dr. Powers for his assistance.
A MATTER OF RESPECT
(Editor's Note: The following is a related article from the same December 2005 edition of the Liberty Tree. )
During a summer visit to Mount Vernon, your editor and his wife, Linda, walked down the walkway and paid our respects to George Washington and other family members entombed there. It was a beautiful day and the area at the vault is serene. We sat on one of the benches and were lost in our thoughts. From the trail coming from the mansion there arose a a loud commotion - - it was a bus load - perhaps forty middle school age youngsters, apparently without adult supervision. Typical of their age, they were rowdy and generally having a good time. As they came around the bend in the walkway, and could see the tomb, the young girl leading the pack, turned, put her finger to her lips and said Sssssh! Every one of them instantly went quiet.
They milled around the crypt, some taking photographs, read the inscriptions and whispered comments to each other. After about 15 to 20 minutes they left, taking the walkway heading to the South. As soon as they were out of sight of the crypt, they reverted back to being rowdy, noisy kids!
Linda and I marveled at the respect they had shown the Father of our Country.