Reinventing Medicine: Beyond Mind-Body to a New Era of Healing

Chapter One
The Eras Of Medicine

Man's perceptions are not bounded by organs of perception:
he perceives far more than sense (tho' ever so acute) can discover.

"snowing and about three inches deep ... wind at northeast and mercury at 30.... Continuing snowing till one o'clock and about four it became perfectly clear.Wind in the same place but not hard.Mercury at 28 at night."

These were the last words George Washington, the first president of the United States, wrote.

On the morning of December I3, I799, at age sixty-seven, Washington had gone on his long daily ride at Mount Vernon.He was an obsessive horseman, and not even foul weather could keep him out of the saddle.When he returned later that day, his greatcoat was soaked through, and snow hung from his white hair.He sat down to dinner without changing his damp clothes, and by evening he had a sore throat.On trying to read parts of the newspaper aloud, he was hampered by hoarseness.When his secretary, Tobias Lear, suggested he take some medicine, Washington declined, saying, "No.You know I never take anything for a cold.Let it go as it came."

Between two and three in the morning, Washington woke his wife, Martha, and complained that he had a very sore throat and was feeling unwell.He could hardly talk, was shaking with chills, and had trouble breathing.At George's request, Martha sent for his lifelong friend Dr. William Craik, who had been his companion in the French and Indian War and a fellow explorer of the frontier.In the meantime, Washington asked Rawlins, theoverseer who usually took care of sick slaves, to bleed him.He bared his arm, and Rawlins made the incision, but Washington complained that the incision was not wide enough."More," he ordered.When Craik arrived he applied Spanish fly to Washington's throat, to draw blood into a blister, and bled him again.Washington was. given sage tea and vinegar to gargle and nearly choked.Craik sent for another doctor and bled him again.

Between three and four in the afternoon, two more physicians, Gustavus Brown and Elisha Cullen Dick, arrived.Craik and Brown agreed on a diagnosis of quinsy, what we today would call acute streptococcal pharyngitis, or strep throat.They decided on more bleedings, blisterings, and purges with laxatives.But Dick, a thirty-seven-year-old graduate of the University of Edinburgh School of Medicine (also Craik's alma mater), dissented.It was his view that Washington was suffering from "a violent inflammation of the membranes of the throat, which it had almost closed, and which, if not immediately arrested, would result in death." Dick urged that a radical new surgical procedure be performed that he had learned about in Scotland for cases like this--a tracheotomy below Washington's infected, swollen throat to allow him to continue to breathe.But this was too much for the senior physicians Craik and Brown, and they would not agree.

Dick took another tack.At the very least, he pleaded, do not bleed Washington again."He needs all his strength--bleeding will diminish it." Again Craik and Brown ignored the younger doctor. They asked for and obtained Washington's consent to bleed him a fourth time. Washington rallied briefly, long enough for Craik to give him calomel and other purgatives.

Shortly thereafter, George asked Martha to come to his bedside.He requested that she bring his two wills and burn the old one, which she did.

Washington continued to defer to the advice of Craik and to refuse the suggestions of the younger man.He had convinced himself early in the day that he was going to die."I find I am going.My breath cannot continue long," he whispered to Lear, to whom he gave instructions for the arrangements of all his military papers and accounts.Then Washington smiled and said with perfect resignation that death "is the debt which we must all pay." To Craik he whispered a little later, "Doctor, I die hard, but I am not afraid to go.My breath cannot last long." A lifelong stoic, he did not complain, although he must have been in terrific pain.

"'Tis well, he finally whispered.These were his last words.Five hours later, with his beloved Martha at his side, George Washington died.

Washington was hard to kill.At a muscular six-four, he was a giant for his day.His ironlike constitution enabled him to survive a volley of illnesses that would have killed weaker men--dysentery, influenza, malaria, mumps, pleurisy, pneumonia, rickets, smallpox, staph infections, tuberculosis, and typhoid fever--not even counting all the lead shot at him.It is ironic that in the end he succumbed to an illness that today is regarded more as a nuisance than a disease and that can be cured by a single injection or a handful of pills: strep throat.

It is easy to find fault with the way America's first president was treated in his final hours, but retrospective criticism is unfair.Washington's physicians were doing the best they could with the knowledge they had.To senior physicians Craik and Brown, young Dick's suggestion of a tracheotomy probably sounded like assassination.They were unwilling to make Washington, the most revered man in America, an experiment for an unproved, unfamiliar surgical intervention.Washington himself declined Dick's advice.A true man of his time, he got what he expected and what he wanted--bleeding, blistering, and purging.

The Eras Of Medicine

Washington's deathbed therapies show a gruesome side of medicine, which has prevailed for most of our Western history.His final hours reveal both the helplessness of the physicians of his day and the fact that by and large the techniques in use at the time either did not work or were actually harmful.In the early nineteenth century, there was no getting around the fact that doctors were dangerous.