The following was written by Daniel J. Glunk, M.D., Chairman of the Board of Trustees at the Pennsylvania Medical Society. Dr. Glunk is also a practicing internal medicine specialist from Williamsport, Pa. This is a second story in a planned series of articles that takes a look at the history and advancement of medicine through the lives of historical figures. In December 2005, Dr. Glunk released his first story titled ?Diagnosing Tiny Tim: What the Internet's medical sleuths say ailed Scrooge's little friend, and one doctor's opinion.?

Presidents' Day: a day to honor American leaders and to reflect upon their lives and our country's history.

When most think of Presidents' Day, they often think of George Washington. Considered our country's founding father, he is best remembered for his roles as both a soldier and a president.

What might be less well known is that Washington's life was filled with medical hurdles. The medical experiences of this famous American highlight how health care has improved in the United States over time with the help of research and advancements in medicine, dentistry, and public health.

George Washington and his health

According to historical sources, our founding father faced a variety of illnesses. He survived malaria, dysentery, and pneumonia. Some reports indicate he dealt with tuberculosis, arthritis, and boils. There are also reports of surgery without anesthesia.

In particular, three areas of his health care - dental care, smallpox, and bloodletting - best demonstrate how George Washington would have benefited from modern health care.

Washington's teeth

Throughout his life, Washington experienced problems with the deterioration of his teeth. These problems likely caused him pain and embarrassment. At the time, the solution to bad teeth was to simply have them pulled. Reports suggest that Washington started losing his teeth at a relatively early age and by middle age had no teeth. At that point, he had to rely on dentures that were clumsy, didn't fit well, and distorted his lips.

For years there has been chatter that his teeth were made of wood. However, this is a myth. According to a non-profit organization that now runs George Washington's Mount Vernon Estate, Washington had several sets of false teeth, likely for different purposes, but they were not made of wood. One set, now at Mount Vernon, is made from human and cow teeth and elephant ivory. It is set in a lead base and includes heavy metal springs. Other sets were made from hippopotamus ivory.

Dentistry today can realign, rebuild, restore and replace our teeth. Advances in prevention have decreased the chance of developing tooth decay. While false teeth still are necessary, they have become less clumsy, better fitting, and more cosmetically pleasing than they were in Washington's time period. If Washington had only known to floss, he might have been spared his dental woes.

Smallpox

Reports indicate that in 1751, Washington traveled to Barbados with his sick half-brother Lawrence to find a location that would be more favorable for treating tuberculosis. While on the island, Washington contracted smallpox. He recuperated but carried the scars for the rest of his life. Some scholars suggest that the father of our country was childless because he became sterile as a result of this illness.

Smallpox was unknown to America until the Europeans arrived. With the exception of places like Philadelphia and Boston, most colonial Americans were isolated, living on farms or plantations. Thus, exposure was minimal.

However, later in Washington's life, the Revolutionary War made the threat of smallpox much more serious. Washington once described smallpox as potentially a greater threat ?than?the Sword of the Enemy.?

First, enemy soldiers from England and Germany likely carried smallpox with them. Second, as the colonies formed their army, men from throughout America came together to fight, but they also likely brought with them certain diseases. This increased the likelihood of spreading illness.

As a result, smallpox plagued the American Army and the civilian population. The summer of 1776 saw epidemics in Boston and Philadelphia. While an inoculation serving as a vaccination was available, many feared that the inoculation actually could help spread the disease since it required introducing the disease in a small quantity to healthy individuals to stimulate immunity. In fact, some colonies banned or restricted inoculations.

However, having experienced it early in his life, and due to fear of having it paralyze his army, Washington eventually required new recruits to be inoculated upon enlistment.

Today, through public health vaccination programs, smallpox is not the threat it was during Washington's life. In fact, according to the Centers for Disease Control and Prevention, smallpox was declared globally eradicated in 1980. There are, however, concerns that the smallpox virus could be used for bioterrorism. After the disease was eliminated from the world, routine vaccination against smallpox among the general public was stopped because it was no longer necessary for prevention.

Washington may have been a visionary to require his recruits to be inoculated upon enlistment. If alive today, smallpox would not have been a threat to his health or fertility. The absence of this disease in Washington could certainly have changed our history.

Bloodletting

Bloodletting was a standard of care in the 1700s, and George Washington believed in its benefits and experienced it firsthand.

At age 67, President Washington was considered to be in fine health. However, during the early morning hours of December 14, 1799, he awoke from a sleep with a sore neck, strained voice, and fever.

Initially, President Washington ordered one of his employees to bleed him, which according to the principles of the day was considered appropriate. The employee also provided President Washington with a mixture of molasses, butter, and vinegar, but in his condition, President Washington was unable to swallow the concoction.

As the morning hours passed, Dr. James Craik arrived. Dr. Craik was a long-time friend of the president and also surgeon general of the Continental Army. Again, following protocol of the day, President Washington was bled a second and third time.

Washington failed to improve so other treatments were started, including a solution-soaked neck wrap and warm water feet bathing. A gargle mix of vinegar and sage tea was provided. President Washington was also given an enema.

Reports suggest that as treatments failed, Martha Washington became more concerned and called for a second physician, Dr. Gustavus Brown. As Dr. Brown was being summoned, Dr. Elisha Dick, a young physician, also was called. Both Dr. Brown and Dr. Dick arrived at about the same time.

Dr. Brown proposed yet another bleeding; however, Dr. Dick protested. Instead, Dr. Dick felt that the president should undergo a tracheotomy, as he believed the problem was inflamed membranes in the throat. At the time, tracheotomies were being practiced in Europe, but not in the newly formed United States of America, thus a dilemma was presented.

With a patient as famous as President Washington, the senior doctors did not feel comfortable performing a treatment that was yet to be practiced in the country. So they vetoed Dr. Dick's recommendation, and a fourth and final bleeding was performed.

Recognizing his terminal condition, President Washington retired to his bed. He is said to have thanked his doctors for their efforts and requested that nothing further be done. He died later that same evening.

Since about 1838, many medical authorities believe President Washington's final sickness was an infection of the small tissue flap at the back of the tongue that closes the entrance to the lungs when a person swallows. Essentially, as this flap swelled, Washington suffocated as his airway became blocked.

Another possibility is that, since reports indicate President Washington had about nine pints of blood drained from his body, these multiple bloodlettings resulted in his demise. Regardless, bloodletting clearly was not the solution. This type of practice is now considered quackery.

If Washington were alive today, doctors likely would recognize the symptoms of epiglottitis and treat the bacterial infection early with antibiotics. If the swelling were to reach the point of a life-or-death situation, then doctors would explore the need for laryngoscopy (inserting a tube with a miniature camera into the larynx through the mouth to observe the interior of the larynx), cricothyrotomy (inserting a breathing tube through the neck), or tracheotomy (surgical incision of the trachea through the neck for breathing).

Conclusion

We are truly fortunate to be living in the 21st Century. With history as our guide we can look forward to the health care improvements of tomorrow. I suspect that future physicians may view our standard practice today the way bloodletting is now viewed by us.

George Washington was a great man. And, while he'll always be remembered as the father of our country, we shouldn't forget that in becoming a great man, he endured the hardships of the 1700s that included primitive health care.

Medical challenges remain, but we should be thankful for modern health care with its scientific underpinnings. Many skilled doctors, nurses, dentists, scientists, and others keep us productive and healthy in ways colonial Americans could only have imagined.

There's little doubt that if Washington were alive today, he would have enjoyed better health and longevity through such improvements in medicine, dental care, and public health. And, just perhaps, Washington's Mona Lisa smile on our dollar bill would be traded for a toothy grin!

Pennsylvania Medical Societ