Within six days of George Washington's death on Dec. 14, 1799, an advertisement appeared in New York newspapers for a portrait of America's first president. David Edwin's "Apotheosis of George Washington" showed the deceased leader rising bodily into Heaven, while light streams from overhead and a cherub holds above him a laurel wreath halo.
This, apparently was the image the public wanted of the Father of the Country--a godlike figure remote from the lives and cares of ordinary mortals.
Yet a new search for the historical Washington argues that it was the mortality of America's first great leader, not the glorified image in the minds of his fellow citizens, that best reveals his extraordinary character.
In "He Died as He Lived: George Washington's Death and Funeral," George Mason University history professor Peter R. Henriques points out that Washington died a very human, courageous and particularly ghastly death--a death whose excruciating dimensions have never been fully explained to his countrymen.
Even as he was slowly strangling, in great pain, he sorted out details of his will, provided for his personal papers and showed both great self-possession and concern for those attending him, including his personal slave.
Though he apparently had no confidence in an afterlife, describing death in his letters with terms like "the grim king" or "the dreary mansion of my fathers," he told those at his bedside, "I die hard, but I am not afraid to go."
A major bicentennial observance of Washington's death is planned next week at his Mount Vernon home, complete with an elaborate reenactment of his funeral. But Henriques, whose book was commissioned by Mount Vernon, says even programs there understate the agony of Washington's last hours--an agony Henriques himself came to understand only after consulting a number of doctors.
One of those doctors was David Morens, a National Institutes of Health epidemiologist who, Henriques learned, was researching Washington's death for an article in the New England Journal of Medicine. Independently, the two men reached the same conclusion about how and why Washington died.
Though no one can be certain this long after the fact, Morens and Henriques say, the latest and most convincing medical studies suggest Washington was a victim of acute epiglottitis--a virulent bacterial inflammation of the flap at the back of the throat that closes the windpipe when we swallow.
Epiglottitis is relatively rare today, is seen most frequently in children and has seldom proved fatal since the advent of antibiotics. "A doctor might practice his whole career and never see a case," Morens said.
But its classic symptoms--rapid onset, high fever, an extremely sore throat, great difficulty in swallowing and speaking, increased airway obstruction (particularly when leaning backward) and restlessness despite a weakened condition--were the very picture of Washington's condition during his final day of life.
"It's really quite a frightening disease," Henriques said. "The epiglottis may swell to more than 10 times its normal size, gradually shutting off the patient's ability to either breathe or swallow."
Epiglottitis was first proposed as the cause of Washington's death in 1838, but Morens said doctors have continued to debate the diagnosis, in part because the symptoms of the disease resemble those of other, more common ailments.
"We have to understand the microbial basis of disease wasn't discovered until 1840 and wasn't really accepted in medical circles until about 1870. So there was a good deal of confusion involved in identifying a specific disease."
Though the streptococcal bacteria that would kill him was probably already in his system, Washington appeared in vigorous health less than 48 hours before he died.
On Thursday, Dec. 12, 1799, less than three years after concluding his second presidential term, he rode out from Mount Vernon to check his farms, remaining outside five hours despite a constant fall of rain, snow and hail with a high wind. He came to dinner with snowflakes in his hair and his clothes still damp.
The next morning he showed the first signs of a cold and sore throat, but went out briefly into an afternoon sleet storm to mark some trees he wanted cut. Friday night he was quite hoarse, but animated enough to read aloud to his wife, Martha, after dinner and, when she left to attend to their granddaughter, to argue politics good-naturedly with his Harvard-educated secretary, Tobias Lear.
Lear, who lived at Mount Vernon as almost a surrogate son, would leave the most complete record of Washington's last hours. When he advised the former president to take something for his throat, Washington, who believed most minor illnesses cured themselves, dismissed his affliction saying, "Let it go as it came."
By the early hours of Saturday, Dec. 14, however, the illness was obviously no minor thing. Washington awoke with a high fever, an extremely sore throat and labored breathing. Doctors were summoned at dawn.
The first to arrive was James Craik, an Edinburgh-trained physician who was Washington's contemporary and one of his oldest friends. Martha Washington had summoned as well Gustavus Brown of Port Tobacco, one of Maryland's most prominent physicians, but Craik, fearful Brown might not arrive in time, sent for Elisha Cullen Dick, a highly regarded younger physician from Alexandria.
Even before they arrived, Washington ordered his overseer to bleed him, having watched many of his slaves over the years recover from illness after being bled. Craik stepped up the treatment. He applied a skin-irritating "blister" of ground Spanish fly to Washington's throat and attempted to feed him a mixture of molasses, vinegar and butter. The mixture brought on a bout of nearly fatal choking.
After two more bleedings in midmorning, Washington was given sage tea with vinegar to gargle. When he tilted his head to do so, he nearly suffocated, being unable to cough up the fluid.
At this point his throat was so painful he could barely talk, but he rose and dressed and walked around the room in an effort to find a better posture for breathing. He sat upright in a chair for two hours, then returned to bed, squirming to find a comfortable position.
When Washington was able to swallow a little, the physicians dosed him with tartar to induce vomiting, and calomel, which produced a "copious discharge of the bowels." All this while the former president was finding it harder and harder to take a breath.
In all he was bled four times, losing 2 1/2 quarts--or almost a third of his total body supply--in a 12-hour period.
"In the course of the afternoon," wrote Lear, "he appeared to be in great pain and distress." Yet, when Lear tried to help Washington change positions, he whispered, "I am afraid I shall fatigue you too much." Realizing that his personal body servant, Christopher Scheels, had been standing by his bed for hours, Washington motioned for him to sit down.
Late in the afternoon, as he realized the end was near, the former president had his wife fetch two wills from his desk. He chose one and had her burn the other. Then he ordered Lear to "arrange and record all my late military letters and papers. . . . Arrange my accounts and settle my books."
Around 5 p.m., he rose and sat in a chair again, struggling for breath, but soon returned to bed as his condition deteriorated. His physicians applied more blisters and poultices to his throat, feet, arms and legs, in an apparent effort to drain his body of the poisons they believed caused the inflammation. But at this point he implored his physicians to "let me go off quietly."
At 10 p.m., he whispered burial instructions to Lear. Fearing being buried alive, he asked that he not be entombed for at least two days. Twenty minutes later, he was dead.
Craik and Dick later would publish an open letter to the nation describing their treatment, to try to stem the then-common suspicion that physicians killed more patients than they cured. But from that time on, many scholars have charged that the doctors' actions--especially their bleeding of Washington--was what really caused his death.
Henriques and Morens don't think so.
Morens points out that Washington never displayed the lightheadedness normally associated with excessive blood loss, and actually appeared to breathe a bit easier after his final bleeding.
Washington's doctors, he says, "were as educated as almost any medical man of their day. Their diagnosis and treatment was precisely what was prescribed at the time. It is doubtful they could have done more in the absence of any understanding of the infectious nature of disease."
Toward the end, Dick considered an emergency tracheotomy--an operation he had never performed. But it's doubtful Washington would have survived that, Morens said, given the absence of both anesthetic and antisepsis: "Many doctors in such cases literally stuck their finger down the patient's throat in an effort to help him breathe. And that really would have killed him." The state of medical understanding at the time is perhaps best illustrated by the proposal of a William Thornton, a physician who arrived the next morning in the bitter cold and "found [Washington] laid out a stiffened corpse." Thornton proposed to "attempt his restoration" by thawing the body in cold water and "by degrees and by friction to give him warmth . . . to open a passage to the lungs by the trachea and to inflate them with air to produce an artificial respiration." At that point, Thornton said, he would "attempt a transfusion of warm blood from a live lamb."
Not surprisingly, Martha Washington said no to all this, even though she knew that her husband had once revived a slave, frozen and believed dead. George Washington, she decided, was gone for good: "I shall soon follow him and I shall rejoice when the moment arrives."
To Morens, Washington's death is a reminder that medicine remains an art as well as a science. Modern medical practices, he says, may someday appear as ill informed as those attempted by Washington's physicians.
To Henriques, the most striking aspect of Washington's death is the absence of any religious observation. In contrast to his wife, who when facing her own death three years later found comfort in calling in a clergyman and taking Communion, Washington never mentioned God or Jesus or the hope of an afterlife, nor did he attempt to find comfort in prayer.
"He believed in a divine providence, sort of like the clockwork universe," Henriques said. "And he believed that recognizing that divine power was a matter of good citizenship as well as good character. Religion, by encouraging humility, functioned as a social good."
But privately, Henriques said, Washington believed that "just as providence was all powerful, it was also unknowable, and the best one could do was to accept it with courage, with grace and with dignity."
That, Henriques says, makes Washington's last hours all the more remarkable. The first president, he says, met the test of Marcus Aurelius, the Stoic philosopher whose works he owned, who said: "It is the duty of a thinking man to be neither superficial nor impatient, nor yet contemptuous in his attitude towards death, but to await it as one of the operations of Nature which he will have to undergo."