Health and Medical History of President

George Washington: Eyewitness Account of his Death

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epiglottitis, doctors
No one is quite sure what killed Washington. He was in fine health at age 67 when he contracted hoarseness and a sore throat a few days after helping to move a snow-mired carriage near his home. There was little alarm until he awoke in the middle of the night with difficulty breathing, almost unable to talk. A doctor was summoned, but Washington did not wait, ordering an employee to bleed him. The doctor arrived and, according to the principles of the day, bled him again. Eventually, Washington requested no further bleeding be performed, but he was bled again anyway.

First suggested in 1838, most authorities today believe Washington's final illness was acute bacterial epiglottitis 2 -- an infection of the small tissue flap that plugs the entrance to the lungs during swallowing. Since the invention of antibiotics, this infection has become rare, but even now its occurrence is exceedingly serious. When the epiglottis swells (as it will do in response to an infection) it can block airflow into the lungs -- an obviously fatal outcome.

The bleedings inflicted by Washington's doctors hastened his end. Some 80 ounces of blood were removed in 12 hours 2 (this is .63 gallons, or about 35% of all the blood in his body). One of the three doctors atteding him, Elisha Cullen Dick, objected to continued bleeding, arguing instead for tracheotomy. Tracheotomy is a surgical procedure recognized today as potentially life-saving in epiglottitis, but was then almost unworkable. Dick was overruled by the senior physician, James Craik. "Undoubtedly, the specter of failure with a grisly, painful (in the absence of anesthesia), and untried surgical experiment on the former president weighed heavily in Craik's decision to veto this radical suggestion" 2.  (It should also be remembered that "former president" does not begin to describe Washington's stature. He was the most famous man in the world, for 20 years the pre-eminent man in American life, and was held in almost religious esteem by his countrymen.)

A detailed description of Washington's agonizing final hours survives BELOW.


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A detailed, eye-witness account of Washington's death was written by his private secretary, Tobias Lear 1a:
On Thursday Decr. 12th. the General rode out to his farms about ten o'clock, and did not return home till past three. Soon after he went out the weather became very bad, rain, hail, and snow falling alternately with a cold wind: When he came in, I carried some letters to him to frank, intending to send them to the Post Office in the evening. He franked the letters; but said the Weather was too bad to send a servant to the Office that evening. I observed to him that I was afraid he had got wet; he said no, his great Coat had kept him dry; but his neck appeared to be wet, and the snow was hanging upon his hair. He came to dinner (which had been Waiting for him) without changing his dress. In the evening he appeared as well as usual.

A heavy fall of snow took place on Friday (which prevented the General from riding out as usual.) He had taken cold (undoubtedly from being so much exposed the day before) and complained of a sore throat: he however went out in the afternoon into the ground between the House and the River to mark some trees which were to be cut down in the improvement of that spot. He had a Hoarseness which increased in the evening; but he made light of it. In the evening the Papers were brought from the Post Office, and he sat in the Parlour, with Mrs. Washington & myself reading them till about nine o'clock -- when Mrs. W. went up into Mrs. Lewis's room, who was confined in Child Bed, and left the General & myself reading the papers. He was very cheerful and when he met with anything interesting or entertaining, he wd. read it aloud as well as his hoarseness would permit him. He requested me to read to him the debates of the Virginia Assembly on the election of a Senator and a Governor; -- and on hearing Mr. Madison's observations respecting Mr. Monroe, he appeared much affected and spoke with some degree of asperity on the subject, which I endeavoured to moderate, as I always did on such occasions. On his retiring I observed to him that he had better take something to remove his cold. He answered no; "you know I never take any thing for a cold. Let it go as it came."

Between two & three o'clock on Saturday morning, he awoke Mrs. Washington, and told her he was very unwell, and had had an ague. She observed that he could scarcely speak and breathed with difficulty; and would have got up to call a Servant; but he would not permit her lest she should take cold. As soon as the day appeared, the Woman (Caroline) went into the Room to make a fire, and Mrs. Washington sent her immediately to call me. I got up, put on my clothes as quickly as possible, and went to his Chamber. Mrs. Washington was then up, and related to me his being taken ill as before stated. 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 Dr. could arrive. I dispatched a servant instantly for Rawlins, and another for Dr. Craik, and returned again to the General's Chamber, 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 sun rise, 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 much might not 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 stopped after taking 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 salvolatila, which was done; and in the operation, which was with the hand, and in the gentlest manner, he observed "tis very sore." A piece of flannel dip'd in salvolatila was put around his neck, and his feet bathed in warm water; but without affording any relief.

In the mean time, before Dr. Craik arrived Mrs. Washington desired me to send for Dr. Brown of Post Tobacco, whom Dr. Craik had recommended to be called, if any case should ever occur that was seriously alarming. I dispatched a messenger (Cyrus) immediately for Dr. Brown (between 8 & 9 o'clock). Dr. Craik came in soon after, and upon examining the General, he put a blister of Cantharides on the throat, took some more blood from him, and had a gargle of Vinegar & sage tea, and ordered some Vinegar and hot water for him to inhale the steam which he did; -- but in attempting to use the gargle he was almost suffocated. When the gargle came from his throat some phlegm followed it, and he attempted to Cough, which the Doctor encouraged him to do as much as possible; but he could only attempt it. About eleven o'clock Dr. Craik requested that Dr. Dick might be sent for, as he feared Dr. Brown would 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, and he remained in the same state, unable to swallow anything. A blister was administered about 12 o'clock, which produced an evacuation; but caused no alteration in his complaint.

Dr. Dick came in about 3 o'clock, and Dr. Brown arrived soon after. Upon Dr. Dick's seeing the General 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 &c. the Physicians went out together. Dr. Craik returned soon after. The General could now swallow a little. Calomel & tarter em. were administered, but without any effect.

About half past 4 o'clock he desired me to call Mrs. Washington to his bed side, when he requested her to go down into his room, and take from his desk two Wills which she would find there, and bring them to him, which she did. Upon looking at them he gave her one which he observed was useless, as being superseded by the other, and desired her to burn it, which she did, and took the other and put it into her Closet.

After this was done, I returned to his bed side, and took his hand. He said to me, "I find I am going, my breath can not last long. I believed from the first that the disorder would prove fatal. Do you arrange and record all my late military letters and papers. Arrange my accounts and settle my books, as you know more about them than any one else, and let Mr. Rawlins finish recording my other letters which he has begun." I told him this should be done. He then asked if I recollected anything which it was essential for him to do, as he had but a very short time to continue among us. I told him I could recollect nothing; but that I hoped he was not so near his end; he observed smiling, that he certainly was, and that as it was the debt that all must pay, he looked to the event with perfect resignation.

In the course of the afternoon he appeared to be in great pain and distress, from the difficulty of breathing, and frequently changed his position in the bed. On these occasions I lay upon the bed, and endeavoured to raise him, and turn him with as much care as possible. He appeared penetrated with gratitude for my attentions, & often said, I am afraid I shall fatigue you too much, and upon my assuring him that I could feel nothing but a wish to give him ease, he replied, "Well it is a debt we must pay to each other, and I hope when you want aid of this kind you will find it."

He asked when Mr. Lewis & Washington Custis would return, (they were in New Kent) I told him about the 20th. of the month.

About 5 o'clock Dr. Craik came again into the room & upon going to the bed side the Genl. 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 can not last long.

The Doctor pressed his hand, but could not utter a word. He retired from the bed side, & sat by the fire absorbed in grief.

Between 5 & 6 o'clk Dr. Dick & Dr. Brown came into the room, and with Dr. Craik went to the bed; when Dr. Craik asked him if he could sit up in the bed? He held out his hand & I raised him up. He then said to the Physicians, "I feel myself going, I thank you for your attentions; but I pray you to take no more trouble about me, let me go off quietly, I can not last long." They found that all which had been done was without effect; he laid down again and all retired except Dr. Craik. He continued in the same situation, uneasy & restless, but without complaining; frequently asking what hour it was. When I helped him to move at this time he did not speak, but looked at me with strong expressions of gratitude.

About 8 o'clock the Physicians came again into the room and applied blisters and cataplasms of wheat bran to his legs and feet; after which they went out (except Dr. Craik) without a ray of hope. I went out about this time and wrote a line to Mr. Law & Mr. Peter, requesting them to come with their wives (Mrs. Washington's Granddaughters) as soon as possible to Mt Vernon.

About ten o'clk he made several attempts to speak to me before he could effect it, at length he said, -- "I am just going. Have me decently buried; and do not let my body be put into the Vault in less than three days after I am dead." I bowed assent, for I could not speak. He then looked at me again and said, "Do you understand me? I replied "Yes." "Tis well" said he.

About ten minutes before he expired (which was between ten & eleven o 'clk) his breathing became easier; he lay quietly; -- he withdrew his hand from mine, and felt his own pulse. I saw his countenance change. I spoke to Dr. Craik who sat by the fire; -- he came to the bed side. The General's hand fell from his wrist -- I took it in mine and put it into my bosom. Dr. Craik put his hands over his eyes and he expired without a struggle or a sigh!

While we were fixed in silent grief, Mrs. Washington (who was sitting at the foot of the bed) asked with a firm & collected voice, Is he gone? I could not speak, but held up my hand as a signal that he was no more. 'Tis well, said she in the same voice, "All is now over I shall soon follow him! I have no more trials to pass through!"

OCCURRENCES NOT NOTED IN THE PRECEDING NARRATIVE

The General's servant Christopher was in the room through the day; and in the afternoon the General directed him to sit down, as he had been standing almost the whole day; he did so.

About 8 o'clock in the morning he expressed a desire to get up. His clothes were put on and he was led to a chair by the fire. He found no relief from this position, and lay down again about 10 o'clk. About 5 P.M. he was helped up again & after sitting about half an hour desired to be undressed & put in bed; which was done.

During his whole illness he spoke but seldom, and with great difficulty; and in so low & broken a voice as at times hardly to be understood. His patience, fortitude, & resignation never forsook him for a moment. In all his distress he uttered not a sigh, nor a complaint; always endeavouring (from a sense of duty as it appeared) to take what was offered him, and to do as he was desired by the Physicians.

At the time of his decease Dr. Craik and myself were in the situation before mentioned; Mrs. Washington was sitting near the foot of the bed. Christopher was standing by the bedside. Caroline Molly & Charlotte were in the room standing near the door. Mrs. Forbes the House keeper, was frequently in the room during the day and evening.

As soon as Dr. Craik could speak after the distressing scene was closed, he desired one of the servants to ask the Gentln. below to come upstairs. When they came to the bedside; I kissed the cold hand which I had held to my bosom; laid it down, & went to the other end of the room; where I was for some time lost in profound grief; until aroused by Christopher desiring me to take care of the General's keys and other things which were taken out of his pockets; and which Mrs. Washington directed him to give to me: I wrapped them in the General's handkerchief, & took them with me to my room.

About 12 o'clk the Corpse was brought down stairs, and laid out in the large room.

[Note: the account continues to the closing of Washington's tomb on December 25th.]
Resources
Cited Resources
  1. Henriques, Peter R. The Death of George Washington: He Died as He Lived. Mt. Vernon, VA: The Mount Vernon Ladies' Association, 2000.09319170352 Libraries. app. 70-75
  2. Morens DM. Death of a President. New Engl J Med. 1999:341;1845-1849. Pubmed 10588974.
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