Washington's Final Hours -- Despite A Gruesome Sudden Illness, Father Of Our Country Died With Dignity

EVEN AS he was slowly strangling, in great pain, he sorted out his will, provided for his personal papers and displayed a courage and concern for those attending him that reveal his extraordinary character.

WASHINGTON - Within six days of George Washington's death on Dec. 14, 1799, an advertisement appeared in New York newspapers: artist David Edwin's "Apotheosis of George Washington" showed America's first president rising into heaven as a cherub holds a laurel-wreath halo above him.

This, apparently, was the image the public wanted of the Father of the Country. Yet a new search for the historical Washington in the bicentennial of his death argues that his mortality, not a glorified image, best reveals his extraordinary character.

The book "He Died as He Lived: George Washington's Death and Funeral" points out that Washington died a courageous and particularly ghastly death that has never been fully explained, said author Peter Henriques, a history professor at George Mason University in suburban Fairfax, Va.

Even as he was slowly strangling, in great pain, Washington sorted out his will, provided for his personal papers and showed both great self-possession and concern for those attending him.

Henriques said he came to understand the agony of Washington's last hours only after consulting a number of doctors. One of them was David Morens, a National Institutes of Health epidemiologist who was researching Washington's death for an article in the New England Journal of Medicine.

Both say that, though no one can be certain this long after the fact, 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, relatively rare today, has seldom proved fatal since the advent of antibiotics.

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.

"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 proposed in 1838 as the cause of death, but Morens said doctors continued to debate the diagnosis.

Beginning of the end

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 his Mount Vernon home in Virginia 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 damp clothes.

On Friday morning, showing signs of a cold and sore throat, he went out briefly into an afternoon sleet storm to mark some trees he wanted cut. That night he was quite hoarse, but animated enough to read aloud to his wife, Martha, and argue politics good-naturedly with his Harvard-educated secretary, Tobias Lear.

Lear left the most complete record of Washington's last hours. When Lear advised taking 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, Washington awoke with a high fever, an extremely sore throat and labored breathing. Doctors were summoned at dawn: James Craik, Washington's old friend; prominent Maryland physician Gustavus Brown; and highly regarded Elisha Cullen Dick from nearby Alexandria, Va.

Even before they arrived, Washington ordered his overseer to bleed him, having watched many of his slaves over the years recover after being bled. Craik stepped up the treatment. He applied a skin-irritating "blister" of ground Spanish fly to Washington's throat and tried 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.

His throat was so painful he could barely talk, but he rose and dressed and walked around in an effort to find a better posture for breathing. He sat upright in a chair for two hours, then returned to bed.

In all he was bled four times, losing 2 1/2 quarts - almost a third of his total body supply - in 12 hours.

"In the course of the afternoon," wrote Lear, "he appeared to be in great pain and distress." Yet, when Lear tried to help him change positions, Washington whispered, "I am afraid I shall fatigue you too much." Realizing that his personal servant, Christopher Scheels, had been standing by his bed for hours, Washington motioned him to sit.

Late in the afternoon, he 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 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, apparently trying to drain his body of the poisons they believed caused the inflammation. But he implored them 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.

Physicians under fire

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 then on, many scholars charged that the doctors' actions really caused his death.

Henriques and Morens disagree.

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 "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," he says.

Toward the end, Dick considered an emergency tracheotomy, an operation he had never performed. But it's doubtful Washington would have survived, given the absence of both anesthetic and antisepsis, Morens said: "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."

To Henriques, the most striking aspect of Washington's death is the absence of any religious observation. Washington never mentioned God, Jesus or hope of an afterlife, nor did he try 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."