Revolutionary Medicine

The Founding Fathers and Mothers in Sickness and in Health

Jeanne E. Abrams

• Publisher: NYU Press
• Year: 2013
• ISBN:
  9780814759363
• Topic: Medicine
• Subtopic: Medical Theory, Practice & Reference

Before the advent of modern antibiotics, one’s life could beabruptly shattered by contagion and death, and debility from infectiousdiseases and epidemics was commonplace for early Americans, regardless ofsocial status. Concerns over health affected the founding fathers and theirfamilies as it did slaves, merchants, immigrants, and everyone else in NorthAmerica. As both victims of illness and national leaders, the Founders occupieda unique position regarding the development of public health in America. Revolutionary Medicine refocuses thestudy of the lives of George and Martha Washington, Benjamin Franklin, ThomasJefferson, John and Abigail Adams, and James and Dolley Madison away from theusual lens of politics to the unique perspective of sickness, health, andmedicine in their era. For the founders, republican ideals fostered a reciprocalconnection between individual health and the “health” of the nation. Studyingthe encounters of these American founders with illness and disease, as well astheir viewpoints about good health, not only provides us with a richer and morenuanced insight into their lives, but also opens a window into the practice ofmedicine in the eighteenth century, which is at once intimate, personal, andfirst hand. Perhaps most importantly, today’s American public healthinitiatives have their roots in the work of America’s founders, for theyrecognized early on that government had compelling reasons to shoulder some newresponsibilities with respect to ensuring the health and well-being of itscitizenry. The state of medicine and public healthcare today is still awork in progress, but these founders played a significant role in beginning theconversation that shaped the contours of its development.

1
George and Martha Washington

Health, Illness, and the First Family

The General has nothing more at heart, than the Health of the Troops.

—General Orders Issued by George Washington, August 5, 1776

In passing down the vale of time, and in journeying through such a mutable world as that in which we are placed, we must expect to meet with a great and continual mixture of afflictions and blessings.

—Martha Washington to Mercy Otis Warren, June 12, 1790

Against the effect of time, and age, no remedy has yet been discovered; and like the rest of my fellow mortals, I must (if life is prolonged) submit.

—George Washington to Landon Carter, October 5, 1798

In his many portraits, America’s first president and “Foundingest Father,”¹ George Washington, is depicted as a tall, commanding figure, with an elegantly slim but strong, muscular physique. Indeed, at a little over six feet, Washington towered above most of his contemporaries, and by all accounts was a revered and imposing man who commanded great respect. However, noticeably absent from the paintings are the lightly pockmarked skin, which remained with him through adulthood as a result of smallpox contracted in his teens, the sunken cheeks that resulted from the eventual loss of all of his teeth due to decay, which was only partially relieved by ill-fitting dentures, and increasing debility as he aged due to numerous often vague but serious illnesses, including several severe bouts with malaria, pleurisy, influenza, and intestinal dysentery.

It was undoubtedly Washington’s many personal illnesses and close friendships with many of the leading physicians of the day, coupled with his responsibilities as a plantation owner and commander of troops, that made him especially interested in medical matters. A largely self-educated man, Washington reflected the republican vision that American citizens could and should take a direct role in managing their own health and that of their communities and that individual health and the health of the nation were intertwined. Like so many of America’s colonial leaders who had been influenced by Enlightenment philosophy, Washington looked forward to the development of a progressive medicine in a benevolent republic that would benefit all Americans.

Washington became quite familiar with symptoms and contemporary treatment of many diseases, and one early medical historian maintained that Washington’s influence “in the prevention of smallpox in America was probably as great as that of Cotton Mather, Benjamin Franklin, or Thomas Jefferson.”² Certainly in his military and political roles, Washington perceived the compelling need for government to take a role in health intervention, demonstrated most visibly in his insistence that his troops be inoculated against smallpox during the Revolutionary War. And it was as “warrior healer” that Washington made his most important medical contribution to America.

Personal health issues sometimes left Washington predisposed to intermittent depression and preoccupation with illness, although he was fearless on the battlefield. Considering his paternal genetic inheritance, which left the males in his family especially prone to tuberculosis, and the rather primitive state of contemporary medical treatment, it is a testament to Washington’s underlying good health, his stoicism, and his determination that he lived to the age of sixty-seven, as his father died at age forty-eight, and his many siblings all predeceased him. Before Washington was three years old, he lost his older half-sister, Jane, and his baby sister, Mildred, passed away as an infant when George was still a young boy. Washington himself would later observe that “though I was blessed with a good constitution, I was of a short lived family.”³ The average life expectancy in Virginia when Washington was born was only about twenty-eight to thirty-five years of age.⁴

Washington’s Early Health

George Washington was born in Wakefield, Virginia, on February 22, 1732, to the English-born Augustine Washington, a modestly successful planter, and his second wife, Mary Ball Washington, a strong-willed woman and often demanding mother. Augustine and his first wife had three sons and a daughter before he became a widower in 1729 at the age of twenty-nine. He soon remarried, and Augustine and Mary became the parents of six children. While there is scarce documentation, it is likely that the young George Washington contracted and survived the common and often life-threatening childhood illnesses of the time, including mumps and measles, because when he was exposed to those diseases as an adult he did not succumb to infection. Washington did not develop measles when his wife, Martha, contracted the illness during their marriage, and he was said to have been stricken with diphtheria, also known as “black canker,” as a boy.⁵

As a young man, Washington developed an affinity for the outdoors and particularly enjoyed fox hunting and horseback riding, which probably helped to keep him fit and athletic. He was the first-born of his father’s second marriage, and he felt a keen lifelong responsibility to all his siblings, but he developed an especially close relationship with his half-brothers. His father, Augustine, died of a respiratory ailment, possibly the result of underlying tuberculosis, contracted after a ride in stormy weather when George Washington was eleven. His half-brother Lawrence became a surrogate father to George, but Mary Washington was left to manage the family slaves and estate at Ferry Farm and to keep daily watch over her other five children. The death of his father put an end to formal studies for young Washington, who received only what we would consider an elementary school education. However, he read widely, including works of the Enlightenment philosophers, eventually acquired a library of some nine hundred books, and enjoyed cultural pursuits. At the age of sixteen, Washington trained for a practical occupation as a surveyor and acquired a license from the College of William and Mary, which launched him on his ambitious path to becoming a successful landowner.⁶

The young Washington’s first experience with surveying, a respectable occupation at the time, began with his association with the aristocratic Fairfax family of Virginia, which was made possible by his half-brother Lawrence’s marriage to Ann Fairfax, daughter of a wealthy aristocratic family. As a young man, Washington was successful both at surveying and at acquiring his own increasing parcels of land. Lawrence’s sons all died as infants, and when he succumbed to tuberculosis at the age of thirty-four, he left to his two-year-old daughter his estate at Mount Vernon, which ultimately passed to the disciplined and capable George.

In 1749, in the course of his work as a surveyor in Virginia, the seventeen-year-old Washington first became exposed to what was termed “ague” at the time, which we know today as malaria. As he wrote to his sister-in-law, “I am deprived of the pleasure of waiting on you . . . by ague and fever which I have had to extremity.”⁷ “Ague” was also a contemporary catch-all term used to describe a variety of both fevers and chills. At the time Washington was growing up a number of diseases were rampant in America, including tuberculosis, typhoid, smallpox, influenza, and malaria. Seasonal outbreaks of amoebic dysentery and typhoid fever as a result of pollution of tidewater water sources especially contributed to the high mortality rate in the southern colonies and encouraged many residents to move farther inland to higher, healthier locations.⁸ Early Virginia swamplands were particularly hospitable breeding grounds for malaria-carrying mosquitoes. However, in colonial America most sicknesses, such as malaria, were still attributed to “malignant” or “bad air” and humors gone awry, and there was little understanding of the true origin of the etymology of the disease.

During his lifetime, Washington would suffer numerous reoccurrences of malarial fever, which was characterized by a cycle of painful chills, high fever, and weakness. The disease taxed the blood system, and active episodes often occurred over several days and weeks. Malaria parasites often lay dormant in their victims, only to flare up in the summer and fall. It was still some time after Washington’s first encounter with malaria as a young man before quinine derived from Peruvian Cinchona Bark, or the “Bark” as it was referred to at the time, would be used consistently and widely to treat the illness. However, we do know it would become one of Washington’s favored medications, and the drug was used successfully for soldiers during the Revolutionary War.⁹

Throughout his lifetime, Washington exhibited a deep faith in the efficacy of bark. Many years later, in 1798, Washington would advise his secretary, Colonel Tobias Lear, that in regard to the treatment of ague and various fevers, “Bark is necessary to prevent a relapse.”¹⁰ By the time Washington’s neighbor and personal physician, Dr. James Craik, began treating Washington’s flareups of malaria, it was common for the doctor to first prescribe a cleansing cathartic followed by eight doses of bark. As he aged, the symptoms of malaria took a greater toll on Washington’s health, and in his later years he is said to have lost twenty pounds while experiencing one attack in 1797.¹¹

Following his first encounter with malaria, Washington’s next experience with serious disease occurred in 1751 at the age of nineteen after he accompanied his sick brother Lawrence on a rough, 37-day voyage to Barbados in the futile hope of seeking a cure for the latter’s tuberculosis in the warm West Indies climate. As early as 1749, Washington had alluded to Lawrence’s illness when he wrote, “Dear Brother, I hope your cough is much mended since I saw you last.”¹² Neither Lawrence’s health-seeking trip to England nor an excursion to “take the healthful waters” at Warm Springs, Virginia, accompanied by George, succeeded in improving Lawrence’s condition. In the eighteenth and nineteenth centuries, immersing in healing springs was thought not only to be curative for the sick but also invigorating for people in good health. Philadelphia’s early leading physician, Dr. Benjamin Rush, for example, was a great proponent of taking mineral water internally, for both its healing and its tonic properties.¹³

A trip to the West Indies was Lawrence’s last attempt to recover his health. After receiving an encouraging diagnosis from a local doctor after they docked in Barbados, both brothers were hopeful that the temperate climate and lush surroundings would cure Lawrence. Shortly after they found lodgings near Bridgetown, the two brothers accepted a dinner invitation from Gedney Clarke, a prominent local planter. It would prove an unwise decision, for as Washington remarked in his diary, “We went,—myself with some reluctance, as the smallpox was in his family.” Even though he did not know the exact mechanism of transference, clearly George understood that smallpox was a dangerous and contagious disease. Two weeks later, on November 16th, he recorded in his diary that he had been “strongly attacked with the small Pox” and treated and nursed back to health by a local physician, Dr. John Lanahan.¹⁴

We cannot be sure of the exact trajectory of Washington’s encounter with the smallpox virus, but it probably spread to his respiratory tract either through direct droplet contact with an infected Clarke family member or, less likely, through particles left in the air or on clothing or furniture, as the Variola virus can remain active for weeks outside the human body. A sneeze or a cough can be enough to transmit the infection. Smallpox is spread only from person to person, and unlike other diseases such as malaria or bubonic plague, it involves no animal vector. Washington’s case was serious but relatively mild compared to those experienced by others in his day. The incubation period for the virus was normally ten to fourteen days. Typically the course of smallpox lasted three to four weeks from the initial fever to the separation of the telltale scabs.

According to his diary, Washington was confined to bed for three weeks, during which time he probably experienced the common symptoms of smallpox, including raging fever, unquenchable thirst, excruciating headache, and backache. This would have been followed by the infamous red sores and often spectacular rash, which in turn would evolve into pustules and scabs, leaving him at least lightly scarred for life. The most a doctor could do for a patient was to provide cold compresses, administer laudanum to dull the pain, and apply generally ineffective ointments for the rash. On the positive side, exposure to the disease also provided Washington with the lifetime immunity to withstand future smallpox epidemics when they ravaged the American colonies.¹⁵

Washington left Barbados in mid-December of 1751, but Lawrence remained. Unfortunately, the prolonged stay did little to improve Lawrence’s health, and he died within the year. Clearly, the contagious nature of tuberculosis was not understood at the time. In nursing his brother, George Washington may have acquired a relatively mild case of pulmonary tuberculosis, which flared up when he returned to Mount Vernon and resulted in uncertain health for years. In May of 1752, at the age of twenty, Washington wrote to the father of a friend, “I was taken with a Violent Pleurisie which has reduced me very low.”¹⁶ The use of the word “pleurisy” at the time referred to a wide variety of respiratory ailments, so we cannot determine the exact nature of his illness, but incipient tuberculosis is possible.

Health and Illness on the Battlefield

Washington began his military career in earnest after Lawrence’s death, first being appointed an adjutant general of the southern district of Virginia and then being promoted to the rank of major of the Virginia militia with a respectable salary at the age of twenty-one. By 1754, he had become a lieutenant-colonel, fighting on behalf of the British to repel increased French incursions in the area. Unsanitary, crowded conditions made military camps fertile breeding grounds for sickness and disease, and Washington contracted many common illnesses that often passed among the troops. For some time Washington’s military fortunes during the French and Indian War waxed and waned, and during this period he suffered several episodes of bloody flux, or dysentery, an intestinal inflammation that produces severe diarrhea. It was often treated with some success by “Dr. James’s Powders,” a popular concoction of phosphate of lime, antimony, and the by now ubiquitous bark (quinine) introduced by an English physician in 1746 to combat fevers.

That first major bout with debilitating dysentery began in the summer of 1755 and left Washington extremely weak and in so much pain as a result of spasms and hemorrhoids that he could not ride his horse. Due to the illness, under his commander’s orders and doctor’s advice, Washington was at first left behind in the army camp. Subsequently, the 23-year-old Washington had to be carried by covered wagon to a battle near Fort Duquesne, where he was fortunate to be one of the few survivors of the bloody skirmish commanded by General Edward Braddock that left the French and Indians victorious and the British forces decimated. Washington had two horses shot out from under him and four bullets ripped through his jacket. Because so many of the officers were either wounded or died, Washington was forced to take charge despite his illness. By early July, he wrote optimistically to a friend (prematurely it turned out) that “I have been excessively ill, but am now recovering from violent Fevers & Pains, of wch my disorder consisted.”¹⁷

After the battle Washington recovered at Fort Cumberland, Maryland, and on July 18th he reported the details of the battle and the state of his health to his mother, Mary: “I was not half recovered from a violent illness that had confin’d me to my Bed, and a Waggon, for above 10 Days; I am still in a weak and Feeble condn which induced me to halt here 2 or 3 Days in hopes of recovg a little Strength.” Still, his sense of humor remained intact, for on the same day h...