Healthy Living: Bye, George

The Atlanta Journal-Constitution, 22 February 2005
By Virginia Anderson

On the anniversary of his birth, it's worth noting modern medicine could have saved our nation's foremost Founding Father from a fatal infection.

George Washington survived hundreds of slings, arrows and musket balls over his 67 years.

He survived smallpox when he was 21.

Three horses allegedly were shot out from under him.

An Indian chief once ordered 14 braves to fire at the young soldier for 20 minutes, legend has it. The assault stopped only because the chief became scared that harming such a soldier would anger the Great Spirit, so the legend goes.

Yet, after all that, it was a run-of-the-mill infection that felled the man who was arguably the greatest American to ever live.

The story of the death of George Washington, who was born on Feb. 22, 1732, gives a chance to ask a health question as pressing now as then: Can you really get sick from being outdoors in bad weather?

While in Washington's case the answer was a resounding "yes," the answer for most of us is "no." A little bad weather does not make a person sick.

His case was extreme, however.

Washington, 67 at the time, rode his horse in a sleet and snowstorm for five hours on Dec. 12, 1799. He came home from his ride, stayed in his wet clothes, and greeted guests at Mount Vernon.

He died two days later. Historians believe the cause of death to be epiglottitis, an inflammation of the small flap of cartilage at the entrance of the larynx.

On the morning of Dec. 12, a driving sleet storm had iced Mount Vernon. But Washington, who had a taste for control and routine, was not going to let a pesky storm deter him from his morning chores, overseeing various farms, according to historian and Pulitzer Prize-winning author Joseph Ellis.

Soaked when he arrived home, he also did not let discomfort interfere with duty. Mount Vernon at the time was virtually a living museum, Ellis recounts in his best-selling Washington biography "His Excellency."

The Washingtons each day welcomed a throng of pilgrims who journeyed to Mount Vernon to see the living legend, entertaining and feeding them.

That December day, Washington did not want to inconvenience the dinner guests, so he went straight from his ride to his ceremonial duties. He stayed in the saturated clothes through dinner, apparently only shedding them when he changed into his nightclothes.

The next day, he again went out into the bad weather to mark some trees for cutting, according to Ellis. (They were locust, not cherry, trees.)

That night, Washington roused his wife, Martha, to tell her that he was having trouble breathing.

Three doctors did all they knew to do. Unfortunately for Washington, what they knew to do was horrific.

Doctors bled him, slitting his wrists and draining a pint of blood every few hours.

They blistered his throat by putting scorching hot, wet cloths on it, hoping to express the infection from his body.

Toward the same goal, they also repeatedly gave him laxatives. Washington's personal secretary, Tobias Lear, recorded the scene.

While Lear may have been spinning, it is clear that Washington went to great lengths to comfort and console the grieving, incredulous circle of friends and family, said Philander Chase, senior editor of the papers of George Washington at the University of Virginia.

Washington finally told doctors to stop the torturing treatment, that he was "just going," Ellis said.

The grief-stricken group couldn't believe he was fading. One doctor friend wanted to slit Washington's throat.

"They thought if they made this Herculean effort to slit his throat, that they could save him," said Ellis. And that may have been after he was already dead, Ellis said.

As it was, Washington told his loved ones, "'Tis well," took his pulse and then his last breath on the night of Dec. 14, 1799.

Doctors and historians over the years have debated the exact cause of Washington's death. Some believe it was due to an abscess that developed on his tonsils. Others, in more recent years, have settled on epiglottitis.

Regardless, both infections would have responded well to antibiotics, researchers of history and medicine said.

And, in recent years, a vaccine has been developed to thwart the bacterium that can lead to epiglottitis, said Dr. William Schaffner, chief of preventive medicine at Vanderbilt University Medical Center. Haemophilus influenzae, type B, the deadly bacterium that causes epiglottitis, is now part of the childhood schedule of vaccines.

"It was at one time the thing that mothers dreaded, and it was the one call that would get doctors up in the middle of the night to get to emergency rooms," Schaffner said. About one in 200 children was affected by the virulent bacterium, Schaffner said. "And vaccine has changed that."

Medical researchers live for such advances, like antibiotics and vaccines that would have prolonged Washington's life, Schaffner said.

"That's what keeps the lights on in the research laboratories at night," he said.

© 2005 The Atlanta Journal-Constitution