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Dec
14

George Washington dies

By
When:
December 14, 2019 @ 11:00 pm – December 15, 2019 @ 12:00 am
2019-12-14T23:00:00-05:00
2019-12-15T00:00:00-05:00

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George Washington

Dies Fast

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Touch or Click to Enlarge. From Hutchinson’s History of the Nations, published 1915.

In a letter to

Dr. Craik

on 2 Jan. 1800,

Dr. Brown

was high in his praise of

Dr. Dick, and wrote:

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“You must remember he was averse to bleeding the General, and I have often thought that if we had acted according to his suggestion when he said, ‘he needs all his strength—bleeding will diminish it,’ and taken no more blood from him, our good friend might have been alive now”

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Founders Online footnote:

https://founders.archives.gov/documents/Washington/06-04-02-0406-0002#GEWN-06-04-02-0406-0002-fn-0006

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Mrs Washington, not knowing whether bleeding was proper or not in the Generals situation;

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beg’d that much might not be taken from him, lest it should be injurious, and desired me to stop it

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Source:

https://founders.archives.gov/documents/Washington/06-04-02-0406-0001

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A Summary


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Touch or Click to Enlarge Painted in 1851 by Junius Brutus Stearns

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George Washington…suddenly fell ill and died in December 14 of 1799 after an illness lasting only 21 hours.

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His problem was first diagnosed as “quinsy” and later modified to Cynanche trachealis.

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A review of the signs, symptoms, and clinical course of his fatal illness suggests that the cause of death was most likely an otolaryngologic emergency known as “acute epiglottitis.””

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Source

https://jamanetwork.com/journals/jamaotolaryngology/article-abstract/606405

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To say George Washington died  suffocating, like a swimmer drowning is not so appealing.

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Not being able to breathe is not to go gently  into the night, a night that ended 14 December 1799, ten to eleven pm.

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Acute Epiglottis is the diagnosis.

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But so is all the shock from that bloodletting.

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The following is from this source:

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http://gwpapers.virginia.edu/history/articles/illness/

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Chronology of Death


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On December 12th, 1799,

George Washington in his 68th year of life, rode out around his farms on horseback

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See George Washington’s December 1799 diary:

https://founders.archives.gov/documents/Washington/01-06-02-0008-0012

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from ten a.m. until about three p.m.

The weather that day according to General Washington was snowing in the morning and about three inches deep. Wind at NE and mercury at 30 (30 degrees Fahrenheit). Continued snowing until about one o’clock, and

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at about four o’clock

it became perfectly clear. Wind at same place-not hard. Mercury 28 (28 degrees Fahrenheit) at night. Colonel Tobias Lear, George Washington’s secretary, stated that the weather that day was bad, rain, hail, and snow falling alternately with a cold wind. When George Washington returned from his ride, the General’s neck appeared wet, snow was hanging from his hair, and he came to dinner without changing his dress (clothes wet?).

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The next day, Friday December 13th, 1799,

the General did not go out as usual for he had taken cold and complained of a severe sore throat. He did go out in the afternoon to mark some trees which had to be cut down. He now had hoarseness which increased in the evening. He spent the evening reading the papers, and when he met anything interesting, he read it as loud as his hoarseness would permit.

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On the next day, Saturday the 14th, at three o’clock in the morning,

he told Mrs. Washington that he was very unwell and that he had an “ague” (paroxysmal chills). It was observed that he could hardly speak and that he breathed with difficulty.

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At daybreak on the 14th,

Colonel Tobias Lear came in and found the General breathing with difficulty and hardly able to utter a word intelligently. A mixture of molasses, vinegar, and butter was given but he (GW) could not swallow a drop and when attempted, he appeared to be distressed, convulsive, and almost suffocated. Later he tried to use a gargle of vinegar and sage tea but in attempting to gargle, he almost suffocated and when the gargle came back from the throat some phlegm followed.

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At eleven a.m.,

his swallowing had not improved. After the last bleeding it was noted that the blood came “slow and thick” but there was no fainting (his physicians had ordered that he be bled a number of times in the course of his illness and an incredible amount about eighty two ounces or about five pints or units of blood were removed from him).

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At half past four o’clock,

Washington gave directions about his will and at about five he again tried sitting up but remained so only half an hour. In the course of the afternoon, he appeared in great pain and distress from difficulty in breathing, and frequently changed his position in bed.

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Touch or Click to Enlarge. May 2,1933, file photo from Channel 9 Abc News Mon 4:23 PM, Nov 25, 2019 shows the carved face of U.S. president George Washington on Mt. Rushmore, in South Dakota See National Parks historical pictures.

At about eight o’clock

it was noted

that his condition

remained unchanged

and did so

until about

ten minutes

before his decease (death)

when breathing

became easier.

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He died between ten and eleven p.m. December 14th, 1799.

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SYMPTOMS


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His primary symptoms in the order of their occurrence were –

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severe sore throat;

hoarseness; cough,

chills,

difficulty with breathing;

difficulty with swallowing;

expectoration (spitting-? drooling);

fever; loss of voice-,

and suffocation.

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EYEWITNESSES:

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From the observations of

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Colonel [Tobias] Lear,

Dr. James Craik,

Dr. Elisha Cullen Dick,

and

Dr. Gustavus Richard Brown,

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and the clinical course of his illness, I think that it is very reasonable and possible to make a determination of the disease process that was the cause of George Washington’s death.

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DIAGNOSIS


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He had acute epiglottitis (supraglottitis)

which is a severe, rapidly progressing infection of the epiglottis and surrounding tissues that may be quickly fatal because of sudden respiratory (airway) obstruction by the inflamed structures.

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The epiglottis

is located at the base of the tongue and is the most superior part of the larynx (voice box). It is at the very entrance to the airway which goes through the larynx to the trachea and lungs. Swelling of this structure is painful and tends to rapidly obstruct the airway and also the entrance to the hypopharynx (area just above the esophagus) and the esophagus (gullet). With acute epiglottitis, George Washington would have had great difficulty breathing, talking, and swallowing and these he certainly had.

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The onset of epiglottitis

is usually acute and fulminating. Sore throat, hoarseness, dysphagia (difficulty swallowing) , and respiratory distress accompanied by drooling, shortness of breath, rapid pulse, and inspiratory stridor (harsh high pitched respiratory noise heard while the patient is inhaling [breathing in]) develop in rapid order. Death from this dysorder is caused by obstruction of the patient’s airway and is very painful and frightening

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The other possible dysorders

suggested by some as being the disease process that caused George Washington’s death were

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acute diphtheria (laryngeal diphtheria),

quinsy,

acute laryngitis,

and Ludwig’s angina.

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However none of these diagnoses quite fit the description of Washington’s terminal illness but on the other hand acute epiglottitis does explain all of his symptoms and his demise.

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His illness is a classic “textbook” case of acute epiglottitis.

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WRONG DIAGNOSIS


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Laryngeal diphtheria

is an unlikely diagnosis for several reasons.  General Washington was reported to have survived a case of “black canker” as a child. This would have been diphtheria and would have given him lifetime immunity against future attacks of diphtheria more than likely. There were no other reported cases of diphtheria in his household or farm population so the likelihood that he would have picked up a case of diphtheria was remote. Diphtheria in an adult is a very rare occurrence. Although this diagnosis is a possibility because it can produce laryngeal obstruction and respiratory distress, it just doesn’t fit the picture.

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Quinsy

is the term used to describe a peritonsillar abscess. Quinsy produces a sore throat but it is almost always unilateral (on only one side of the throat) and produces symptoms referable to that side only e.g. soreness; swelling of the neck on that side; and another symptom: trismus (a lockjaw-like symptom where the patient cannot open their mouth). This diagnosis also does not fit the disease process from which General Washington died.

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Acute laryngitis

in an adult is not usually a life threatening dysorder.

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Ludwig’s Angina

is an infection in the floor of the mouth in front of or lateral to the tongue. It usually results from a dental or periodontal infection. George Washington had no teeth..ergo.. not a likely diagnosis.

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JUDGING THE DOCTORS


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It would be improper for today’s medical practitioners to be critical of the physicians of George Washington’s day if they were delivering the standard of care that other physicians of that era were giving to their patients.

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The Three Doctors

It would appear that Dr. James Craik, Dr. Elisha Cullen Dick, and Dr. Gustavus Richard Brown were well trained as physicians, were honest and caring, and gave the kind of medical care that their peers would have given.

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Today we know that many of their methods were wrong

and we would do things differently.

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DR DICK  was Right:

If Drs. Craik and Brown would have encouraged Dr. Dick to perforate Washington’s trachea (tracheostomy), it might have allowed him to survive the acute illness and live on for sometime afterwards.

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However this procedure was new and controversial so they were not totally wrong to oppose it. Technically it might not have worked anyway … but who knows?

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BLOOD LETTING

Today we find the removal of about eighty two ounces of blood (about five pints or units of blood) from a sick patient in less than sixteen hours to be incredible.

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However this was the method of treatment being taught in those days. It was the treatment of choice for many diseases and the complications of using this method were not comprehended by the physicians of that day. I certainly have a great deal of compassion for George Washington’s physicians who were attempting to save his life by using the methods that they thought best for him.

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FRIGHTENING END

I am also filled with sadness that such a remarkable man and leader should have such a painful and frightening end to his life.

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AUTHOR:

White McKenzie Wallenborn, M.D.
Clinical Professor (Ret.)
Department of Otolaryngology-Head & Neck Surgery
University of Virginia School of Medicine
November 5, 1997

 

References

In the study of George Washington’s terminal illness, a number of textbooks of Otolaryngology were consulted. William Abbot and Dorothy Twohig, Editor in Chief of The Papers of George Washington at the University of Virginia, provided a number of valuable articles written about George Washington’s death and his overall medical history. By combining the textbook articles, the journal articles, and my own clinical experiences, I was able to reach the conclusions noted above. The journals used are listed below:

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  • Barker, Creighton. “A Case Report,” The Yale Journal of Biology and Medicine, 9 (1936), 185-87.

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  • Blanton, Wyndham B. “Washington’s Medical Knowledge and Its Sources,” Annals of Medical History, 4 (1932), 52-61.

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  • Brickell, John. “Observations on the Medical Treatment of General Washington in His Illness,” Transactions of the College of Physicians, 25 (1903), 90-93.

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  • Courtney, John F. “George Washington’s Final Illness,” Resident and Staff Physician, 15 (1969), 84-.

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  • Knox, J. H. Mason, Jr. “The Medical History of George Washington, His Physicians, Friends and Advisers,” Bullentin of the Institute of the History of Medicine, 1 (1933), 174-91.

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  • Lewis, Fielding 0. “Washington’s Last Illness,” Annals of Medical History, 4 (1932), 245-48.

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  • Nydegger, James A. “The Last Illness of George Washington,” Medical Record, 92 (1917), 1128.

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  • Wells, Walter A. “Last Illness and Death of Washington,” Virginia Medical Monthly, 53 (1926-27), 629-42.

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  • Willius, F. A., and Keys, T. E. “The Medical History of George Washington (1732-1799),” Proceedings of the Staff Meetings of the Mayo Clinic, 17 (1942), 92-96, 107-112, 116-121.

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© 1999 White McKenzie Wallenborn

http://gwpapers.virginia.edu/history/articles/illness/

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George Washington’s

Last Day and

Last Will and Testament


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At his deathbed, he instructed his private secretary Tobias Lear to wait three days before his burial, out of fear of being entombed alive. 

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Source:

 Chernow 2010, p. 808.

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Tobias Lear wrote 2 accounts of the day GW died:

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The following circumstantial account of the last illness and death of General Washington was noted by T. Lear, on Sunday following his death, which happened on Saturday Eveng Decr 14th 1799 between the hours of ten and eleven.

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https://founders.archives.gov/documents/Washington/06-04-02-0406-0002

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Tobias Lear wrote two accounts of the illness and death of Washington. The original account, now at the William L. Clements Library in Ann Arbor, Michigan, and printed first of the two here, Lear indicates was written on 15 Dec., the day after Washington’s death. The other account, which Lear entered in his diary under the date 14 Dec., was drawn from his original account and is printed second here. The second, or diary account, which is deposited in the Pennsylvania Historical Society in Philadelphia, is in part a verbatim copy of the original account, but Lear has changed the timing and sequence of events in a number of cases, altered quotations and introduced new ones, omitted bits of information, and added a good deal of new information. James Craik endorsed the diary account on 15 Dec. as correct, “so far as I can recollect,” indicating that it was written shortly after the original account and suggesting that it was essentially an amplification and corrected version of the original.

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https://founders.archives.gov/documents/Washington/06-04-02-0406-0001

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George Washington’s Last Will and Testament, 9 July 1799:

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https://founders.archives.gov/documents/Washington/06-04-02-0404-0001

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Do not go gentle into that good night
Dylan Thomas


 

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Do not go gentle into that good night,
Old age should burn and rave at close of day;
Rage, rage against the dying of the light.

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Though wise men

at their end know dark is right,
Because their words had forked no lightning they
Do not go gentle into that good night.

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Good men,

the last wave by, crying how bright
Their frail deeds might have danced in a green bay,
Rage, rage against the dying of the light.

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Wild men

who caught and sang the sun in flight,
And learn, too late, they grieved it on its way,
Do not go gentle into that good night.

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Grave men,

near death, who see with blinding sight
Blind eyes could blaze like meteors and be gay,
Rage, rage against the dying of the light.

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And you, my father,

there on the sad height,
Curse, bless, me now with your fierce tears, I pray.
Do not go gentle into that good night.
Rage, rage against the dying of the light.

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Sunday Word 1
James Craik lived on the walking mall in Winchester VA.

He was a lifelong friend of George Washington and was there at the end.
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And to that End of George Washington we look.
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Last night at around 10 to 11pm, 14 December 1799, suffocation and shock.
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We got a table of the various stages of shock from blood letting.
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We also got the sequence for acute epiglottis:
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His primary symptoms in the order of their occurrence were –
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severe sore throat;
hoarseness; cough,
chills,
difficulty with breathing;
difficulty with swallowing;
expectoration (spitting-? drooling);
fever; loss of voice-,
and suffocation.
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The intense emotions on Dr Dick wanting the bloodletting to stop and Mrs Washington begging it to stop are understated in all the source documents.
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Dr Dick wanted to open a hole in the General’s throat so he could breathe.
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There was deep emotion and principle felt by all.
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And regret later.
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The Story.
http://frenchandindianwarfoundation.org/…/george-washingto…/
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Dr James Craik
http://frenchandindianwarfoundation.org/dr-james-craik/

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