FORENSICS II

With the temperature hovering close to thirty degrees Fahrenheit, Mount Vernon in Fairfax County, Virginia was cold and blustery on Thursday morning, December 12, 1799, with light snow, hail, frigid rain, and sleet. Nonetheless, as was his usual practice at about ten o’clock every morning, George Washington, the now retired first president of the United States, went riding for several hours on his plantation, supervising activities on his vast estate. Washington’s two terms as president had ended thirty months earlier and he was happy to be riding his horse, most likely Nelson, since his other favorite horse, Blueskin, a half Arabian with great endurance, had been given to Colonel Benjamin Tasker Dulany after he married Elizabeth French, Washington’s ward. Priding himself on being punctual, Washington returned home at 3:00 p.m., sitting down for dinner without changing out of his wet clothes. By the next morning, Washington had developed a painful sore throat, a cough, a runny nose, and mild hoarseness. A heavy snow prevented him from riding out in the morning, but in the afternoon, after the weather had cleared, he went out again to mark some trees that needed to be cut down. That evening, after drinking a hot cup of tea, Washington spent time in his library, writing until eleven o’clock or midnight, after which he went to bed, the pain in his throat having not improved. His chief aid, Colonel Tobias Lear, suggested that Washington take something for his cold, but Washington refused. “No, you know I never take anything for a cold. Let it go as it came,” he protested. Around 2:00 a.m. on the morning of December 14, Washington awoke with a terribly painful throat, suffering shortness of breath, and clutching his throat. Seeing her husband in great distress and unable to speak or swallow, Washington’s wife, Martha, asked Lear to summon Dr. James Craik, Washington’s sixty-nine year old personal physician, as well as George Rawlins, the estate’s overseer who was well versed in the art of “bloodletting,” a common practice in the eighteenth century believed to rid the body of disease-causing pathogens by draining it of “bad blood.” By 6:00 a.m., Washington had a high fever, a raw throat, and his breathing was much more labored. Lear gave him a tonic of molasses with butter and vinegar, which Washington found difficult to swallow, almost choking due to his inflamed throat. An hour and a half later, Rawlins began to remove twelve to fourteen ounces of blood from Washington. Martha begged Rawlins not to bleed her husband too much, but Washington, a strong believer in bloodletting, encouraged Rawlins not to stop, exclaiming, “More, more.” Craik arrived at the Mount Vernon mansion at 9:00 a.m. Born in Scotland, he received his medical training at the prestigious University of Edinburgh, at the time the acknowledged international center of medicine. Craik had joined the Virginia Provincial Regiment in 1754 where he met Washington, the regiment commander. Twenty years later, he worked closely with Washington as Assistant Director of the Middle Department in the Continental Army. When the American war of independence ended, Craik opened a medical practice in Alexandria, Virginia and became Washington’s personal physician. After taking Washington’s medical history, Craik applied an agonizingly painful “blisters of cantharides” to Washington’s throat. Consisting of broken dried remains of the emerald-green Spanish fly beetle, the blistering agent was believed to draw out inflammation, a popular but painful remedy in the eighteenth century. A half hour later, Rawlins removed an additional eighteen ounces of blood from Washington, repeating the procedure at 11:00 a.m. At noon, Washington was administered an enema. When he attempted to gargle with sage tea and vinegar, he almost suffocated. Although able to walk around the room and sit up in an easy chair for two hours, Washington found it difficult to breathe when he lay down on his back. Dr. Elisha Cullen Dick, a thirty-seven year old physician, arrived at Mount Vernon at 3:00 p.m. Dick objected to further bloodletting claiming, “He needs all his strength—bleeding will diminish it.” Despite Dick’s objections, Craik overruled the younger doctor and ordered another bleeding, this time thirty-two ounces; the blood was viscous and it flowed slowly due to Washington’s significant dehydration. At 4:00 p.m., Dr. Gustave Richard Brown, a fifty-two year old physician who, like Craik, had also been trained at the University of Edinburgh, arrived at Washington’s bedside. Brown ordered that Washington receive a dose of Calomel (mercurous chloride) for constipation and tartar emetic (antimony potassium tartrate) to induce violent vomiting, but neither treatment improved Washington’s symptoms. Washington’s swallowing seemed to improve by five o’clock in the evening, but not long thereafter, he began to struggle to breathe and his condition deteriorated further. “Doctor, I die hard, but I am not afraid to go,” Washington told Craik. “I believed from my first attack that I should not survive it. My breath cannot last long.” Three hours later, blisters of cantharides were again applied, this time to Washington’s feet, arms and legs, as well as “wheat-bran poultices,” a moist concoction, similar to plaster, to his throat, but neither preparation was successful in improving Washington’s ailment. At 10:20 p.m., Washington calmly took his pulse and then, dropping his fingers from his wrist, he took his final breath and died. He was sixty-seven years old. When Washington’s wife was informed that her husband had died, she said, “Tis well. All is now over. I shall soon follow him. I have no more trials to pass through.” Later that night, Dr. William Thornton arrived. Thornton had planned to recommend performing a tracheotomy, a procedure Dick had proposed after his suggestion to stop further bloodletting was overruled by Craik and Brown. “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 [voice box], which manifestly threatened speedy resolution,” Thornton later explained. Rarely done as elective surgery in the eighteenth century, let alone on an emergency basis, this new, revolutionary and risky method to circumvent the obstruction in Washington’s larynx potentially could have prolonged his life. Sometime after Washington died, Lear described his final moments. “With perfect resignation and in full possession of his reason, he closed his well-spent life.”