Nelle the Midwife and George Washington
President George Washington was plagued with a sore throat, culminating with his death in two days in 1799. Washington’s doctors performed the procedure of bloodletting, believing that the loss of offending blood would secure his health. Bloodletting was the treatment of choice for treating wealthy clients during the 18th Century. I recently spent a stifling August afternoon in Alexandria, Virginia, sharing a demonstration tent with a gentleman portraying one of the doctors who treated George Washington during his last illness. The “doctor” displayed his expensive, beautifully crafted bloodletting tools next to my section of the table where a simple mortar & pestle, wooden bowl & chopper and medicinal herbs stood, wilting in the hot sun.
Washington was considered a healthy man, riding his horse each day while supervising the activities on his plantation. He was only 67 years old, 200 pounds and 6 feet 2 ½ inches tall. Due to his personality I would consider him to have a choleric disposition with hot & dry energetics. Choleric individuals, according to Herbalist, Jim McDonald in his article “Humoural Treatments,” were extroverted leaders, who see patterns in life and know how to get to their destination in the most effective way. They are organized, pragmatic, self-motivated, and can make confident and hard decisions. Sounds like a general in the Revolutionary War. Excess imbalances show themselves as being intolerant and impatient with others (Plant Healer's Traditions in Western Herbalism, Essays & Class Notes, 2014).
There are many articles concerning Washington's last illness and the procedures the three doctors took. I read the journal of Washington’s secretary, several modern doctors’ articles describing his treatment, and notes from Washington’s letters and diary compiled by Mary Thompson, research historian at Mount Vernon’s library. His symptoms started with a sore throat and chills, hoarseness, continued with a cough (unproductive with little phlegm), chills, difficulty breathing, difficulty with swallowing (sore throat), spitting & drooling, fever, loss of voice and suffocation. My lingering thought was What if… midwives, perhaps slaves came upon the scene? What could they have done for Washington? What herbs did they have at their disposal and in what form? To answer these questions I consulted several reproduction 18th century cookery books, an 18th century herbal as well as Gervase Markham’s 1600’s The English Housewife. In describing what might have happened, I use the names of Nelle and Kate, enslaved midwives who lived during Washington’s life. Kate was owned by Washington while Nelle was owned by another founding father, George Mason, a neighbor who lived several miles away. Washington was his good friend until George Mason refused to sign the Constitution, due to its lack of Bill of Rights. Several years later this omission was rectified but not the friendship between Mason & Washington.
Earlier Serious Illness, Accidents:
During George Washington’s life he contracted many ailments but bounced back to health until his last year. When he worked as a surveyor in his early life, he developed malaria several times due to the swampy areas he was surveying and used high doses of quinine bark. He contracted smallpox when visiting an infected friend. Tuberculosis left Washington’s chest somewhat concave. He suffered from inflammation of the joints later in life and could not raise his arms above his shoulders for several weeks. While he was president, doctors cut open his thigh to drain an abscess; he was indisposed for six weeks. Washington and his family had a history of respiratory ailments, and he was plagued with chronic sore throats and ague for most of his life. Problems with his teeth began during the time of his youth when he cracked walnuts with his teeth. His teeth and gums gave him much pain, especially the last twenty years when he required false teeth. Mrs. Washington bought Laudanum and Camphire most likely for the pain. Washington still felt he was a relatively healthy man. He wrote Landon Carter in 1798 that he had been blessed with a “competent share” of good health, “without using preventatives against sickness,” and he didn’t use much medicine when he was ill (Thompson, 1997-2014).
He ate a whole foods diet— his favorite was cornmeal yeast pancakes, “swimming in butter & honey” for breakfast, a large variety of fresh vegetables, meat raised & hunted, herbs, Madeira, and whiskey. Records show that Washington consumed onions, both bought and grown, cayenne, horseradish, parsley and garlic. Virginians drifted away from the blander English cooking to stronger tastes. Washington and his family's eating habits show this by their use of garlic (Thompson, 11/6/2002). The Virginia Housewife cookery book shows what was placed on the tables of the gentry class in Virginia. The author (Mary Randolph) includes at least forty vegetables and mentions seventeen aromatic herbs in her receipts (Randolph, 1984). The question is what could Washington eat due to the pain he encountered with his teeth. He preferred fresh fish and even salted herring, a food given to the slaves. At teatime he enjoyed tea and toast. Later in his retirement a houseguest wrote, “…at 5 o’clock in the morning, [he] reads or writes until seven. He breakfasts on tea and caks [cakes] made from maize; because of his teeth he makes slices spread with butter and honey…” (Thompson, 11/6/2002).
Captain George Mercer of Virginia wrote to a friend in 1760 with a description of Washington. He has blue-grey penetrating eyes, deep heavy eyebrows, with broad round cheekbones, complimented with a strong chin. His skin is pale and burns easily in the sun, and has brown hair pulled into a queue. He has great strength due to his well-developed muscles, large bones, joints, feet and hands. His mouth is large and normally closed due to defective teeth. Washington has a commanding but benevolent countenance. “His movements and gestures are graceful, his walk majestic and he is a splendid horseman.” Later when he was much older Lady Henrietta Liston in 1799 wrote, “His figure always noble, appeared less & an approaching deafness, had in some degree affected his spirits” (Thompson, 1997-2014).
Thursday, 12 December
Washington wrote in his journal on 12 December 1799, Morning snowing about 3 inches deep. Wind at North and Mercury at 30. Continued snowing until 10:00 and at 4:00 the sky is clear. Wind in the same place but not hard. Mercury 28 at night (White McKenzie Wallenborn).
Washington’s secretary, Colonel Tobias Lear wrote in his journal how Washington rode out to his farms around 10:00 and did not return until 3:30. All this time there had been snow, hail and rain. Lear wrote how he noted that Washington’s neck was wet and snow was falling off his hair. Washington shrugged it off, and said that he didn’t get wet because he wore the great coat. Dinner was waiting for him, so he did not bother to change his clothes. All seemed fine that evening.
The next day, Friday, the snow was falling, and Washington decided to stay in the house, because his throat was sore and he felt chilled. Later in the day he went out to inspect some trees that he wanted cut down. During the evening Washington felt hoarse, which became progressively worse. He read from the papers he received from the post office, and finally had Lear finish the reading. When he went to bed at 9:00, Lear mentioned to him that perhaps he required something “to remove his cold”. Washington replied, “You know I never take anything for a cold. Let it go as it came” (Lear, 1799).
What if…a slave was nearby in the hallway and heard the discussion between Washington and Lear, especially Washington’s last statement about letting the cold “go as it came.” The slave’s name was Nelle, a midwife from Gunston Hall who was allowed to deliver slave births at plantations beyond Gunston Hall. Slaves needed permission from their masters to leave the plantation as well as practicing as midwives (Fett, 2002). According to Gunston Hall records, she received 15 shillings for each birth, because she possessed valuable expertise. Not only was she skilled in delivering births, but also like other midwives during this time, Nelle used herbal remedies grown from her garden and foraged in the nearby woods (Ulrich, 1991).
Nelle imagined brewing a ginger tea, not cayenne due to Washington's warmer constitution. She didn’t know Washington well, but ancient knowledge passed down to Nelle led her to the belief that he had a choleric constitution. Nathan and Lucy, the enslaved cooks in the kitchen had a large supply of dried ginger roots and other expensive spices for the many dishes they made. Ginger was a common spice used in Colonial America as well as in the New Republic (Sauer, 2001).. The ginger tea would warm up Washington’s chilled body and hopefully keep the cold from penetrating any deeper. But Washington went to bed without the warming tea or the ginger candy prepared in the open hearth … because “He never takes anything for a cold.”
Healthful Ginger Candy—"Take three loths of finely ground ginger, fresh lemon rinds well dried and ground to a powder, a half loth each of cinnamon and nutmeg, a quint each of cloves and mace, all of these ground to a fine powder. Then take two pounds of sugar and moisten it with rosewater. Put this in a new stoneware pot over a charcoal stove and let the sugar boil gently until it candies. Then stir in the ground spices and pour it into a pewter dish. Cool and store in a dry place. (30 grams = 2 loths = 8 quints) (Sauer, 2001) pg. 155.
During the night Washington woke up around 2 or 3:00 in the morning complaining of having ague (fever with chills). Mrs. Washington observed that her husband also had difficulty speaking and breathing. Since the room was cold, Washington did not want his wife to get up and summon for help; she had recently recovered from a cold. When the sun rose, Caroline, the house slave, came into the room to start the fire. Soon Lear was called, and he observed Washington’s labored breathing. Lear was told to send for Mr. Rawlins, one of the overseers who had the knowledge of bloodletting, and also send for Dr. Craik, the family doctor and friend.
Washington was given a mixture of molasses, vinegar and butter, one of Mrs. Washington’s favorite remedies for sore throat (Thompson, 1997-2014). Washington made distressed attempts to swallow but the results were convulsions and fighting for breath. His throat was too swollen to swallow anything. Rawlins came onto the scene but hesitated when he saw Washington’s condition. He persuaded his overseer to bleed him, believing that this form of medicine produced positive results. Washington was known to perform the task of bloodletting on himself as well as ask his doctors to attend to his ill slaves. In his 16th century herbal, Gervase Markham, states that when the blood was inflamed, it caused fever, and blood must be let. It was also thought bloodletting caused the liver to produce more blood. However, Markham used bloodletting for people whose strength would bear it (Markham, 1986). Mrs. Washington was not sure whether such a procedure would be helpful in her husband’s condition and cautioned Rawlins to not take too much blood. Washington encouraged Rawlins to take more, and about 12 oz. was taken from his arm the first time.
Washington was not relieved as he thought he might, and allowed Lear to bathe his sore throat topically with salve latola (ammonium carbonate), but very gently because Washington remarked how sore it felt. Lear also made a poultice with salve latola placed in flannel and wrapped around his neck and bathed his feet in warm water.
Dr Craig arrived and put a blister of Cantharides or beetles called “Spanish fly” on his throat, bled him the second time, gave him vinegar and hot water to inhale, as well as a gargle with vinegar and sage tea, (Thompson, 1997-2014), provoking a feeling of suffocation. Some phlegm arose, but his cough seemed to be unproductive. (Curfman, n.d.)
What if… Caroline, the house slave, told Mrs. Washington that Nelle and Kate offered to help Washington. Concerned with his failing health, Mrs. Washington sent for the midwives. Nelle saw immediately that Washington would not be able to swallow until the swelling calmed down and would require poultices to help with the pain. Instead of using the beetles called Cantharides, which may have been too hot for his sore throat, Nelle decided upon sage leaves.
She brought out the sage (Salvia officinalis), from her basket. previously dried before the fire. Nelle rubbed the leaves into powder and added bay salt and grated nutmeg. She mixed everything together, put it in a linen bag and warmed it on a tile stone, placed near the fire (Markham, 1986). When it was ready, Nelle placed the poultice upon the nape of Washington’s neck, leaving the back of his neck open to allow the sickness to leave his body. Sage had great healing power and would gently draw the swollen tissues together, and help with the pain.
Both Nelle and Kate cautioned Washington that results would not be noticed quickly; the body’s healing took time. Nelle asked Kate and Caroline to bathe his feet in warm water and add more bedclothes to keep Washington warm. Nathan and Lucy brought some distilled sweet violet (Viola odorata) water that would “defend and cool a feverish head” (Sauer, 2001).
Distilled waters were used for cooking and medicine, and records show Mrs. Washington owned a still that was used for distilling mint, rose and perhaps lavender water (Thompson, 11/6/2002). Mint water relieved children’s stomachaches, rose water flavored drinks & desserts, & cooled fevers. Lavender dispelled dizziness and kept bread from getting moldy if added to the dough (Sauer, 2001). Martha Bradley, writer of 18th century cookbooks, talks about the necessity of the still, “Nothing is more creditable to keep in a Family, and nothing more serviceable." Making simple herbal waters consisted of cutting several pounds of fresh cut leaves and putting them in a still. A couple gallons of water was added and steeped overnight. The stilling began the next day and a gallon was procured (Bradley, 1997). In the distilling process the "first waters are trifling and normally thrown away, but the spirit that follows is especially valued” (Sauer, 2001). It contained high concentrations of volatile water, and could be kept for over a year (Markham, 1986).
Mullein (Verbascum thrapsus) grew in a row on the hill overlooking the Potomac River and looked like torches in the winter waiting to be dipped into fat to light the way. In the summer, when horses hurt themselves in the brambles, Nelle washed their wounds with mullein water, after the leaves were boiled and strained. The soft but itchy leaves were stored in her cabin, waiting to be summoned, “to ease, emolliate and ease the pain.” Nelle took the dried “Great Mullein” leaves from her basket and steeped the leaves in milk and made the poultice (Sauer, 2001). Now it was the mullein poultice that calmed the pain and emolliated his throat without having to be ingested. Nelle and Kate alternated the sage & mullein poultices, making sure each poultice was warm enough when they placed it on his swollen neck.
Later when Washington could swallow without too much pain, Nelle gave him some of her mulberry syrup with an herbal gargle mixture of Brunella (Prunella vulgaris). Nelle continued to offer him spoonfuls of the mixture for both sipping and gargling as Washington could manage. Nelle had made the syrup in the summer with fresh mulberry juice, (Morus nigra) composed of “watery elements mixed with mucusy, volatile, sour salts” that eased and drew together the swollen tissues. Rows of cherry and mulberry trees grew near the paled fence of the kitchen yard, serving as a barrier or “masque” between Mason’s house and the working area of cattle pens, hay yard and the “Negro quarters” (Mason, 2004). She had added blackberry juice, honey, sweet wine, and simmered the mixture until it turned into syrup (Sauer, 2001). Nelle used one ounce of the syrup and then added three ounces of Brunella gargle, consisting of steeped Brunella leaves (also known as Self-Heal), Plantain leaves, & rose honey. Her receipt also called for mulberry juice, but it was winter, and all her juice had been steeped in wine. Whenever she thought about sore throats, the image of Brunella, growing in the nearby woods and dry pastures came to mind. Some said that the Germans in Philadelphia called the plant Braune, which translated to “quinsy” or sore throat. Nelle gathered the leaves in May-June when the moon was full and dried them for the winter (Sauer, 2001). Plantain (Plantago major) grew like weeds and was her favorite healing herb for bee stings and spider bites.
The changing of poultices on his throat continued through out the night, as well as cooling violet water compresses on his forehead. Nelle took out the remaining sage leaves that had been “dried in the shade,” and took “as much as can be grasped between five fingers.” She asked Nathan and Lucy to make a tea, sweetened with honey (Sauer, 2001). Washington’s fever was more prominent and he was producing a fine sweat. His body was fighting back! When Washington could open his mouth wider, Nelle noticed that there was a yellow layer on his tongue, indicating heat. She gave him some of the sage tea for his throat, and Kate continued placing violet water compresses on his forehead.
Oak Moss (Usnea) was one of the last two herbs they used. It was a strange plant that looked like dried moss and grew on rocks and trees with a dull green/blue color. Nelle and a fellow slave who foraged for mushrooms showed her the Oak Moss when they were on a foraging expedition in the woods. Later she decocted (simmered) the “moss” in white wine and strained it for future use. She would use it for the heat and redness in Washington’s throat (Sauer, 2001).
Dried sweet violet flowers and leaves were the last herbs Nelle used. She picked them in April when they filled the pasture. As Washington’s fever rose, she gave him the beautiful blue tea made from the violets. They cooled his inflamed throat and moistened the phlegm, so that Washington could cough it up. When the fever lowered and chills came, Kate offered him some more warm ginger tea.
The next day Washington’s throat was not so fiery red, and his tongue lacked the yellow coating. The midwives continued applying poultices, giving him the mulberry syrup with the Brunella gargle, the cooling blue violet tea, the sage tea gargle and the Oak Moss wine. Washington commented that his skin was not as tender as before. After Washington slept several hours, Nathan and Lucy brought some pureed beets and a bowl of barley soup they prepared in the morning. The soup consisted of several gills (1/4 cup) of barley, a rack of mutton, slices of lean ham, carrots, onions and turnips cut small, simmered through out the morning (Randolph, 1984). The soup would build up his strength and the puréed beets would support his liver and build up his blood supply. Nelle insisted that Washington stay in bed, keep warm and only eat simple broths and pureed foods as well as the warm teas. The fourth day the fever left him, and his throat was feeling almost normal. Nathan and Lucy brought some “Jellies from the Feet,” a beautiful gelatin made with boiled calves feet and mixed with wine and spices. Washington welcomed the special treat and asked for more. What if… Washington lived….
The real story of Washington’s illness continued, two more doctors came, blood was taken and a blister administered to drain the bowels. Dr. Dick and Dr. Brown took more blood, but this time the blood came out very slowly. A total of about 80 oz. of blood was taken in 16 hours (Thompson, 1997-2014).
It was found Washington could swallow a little, and the doctors gave him Calomel (mercury) and tartar. Calomel was made from quicksilver, salt and calcium sulphate, which is distilled and forms a toxic white powder (Markham, 1986). One hour or so later Washington requested that his wife bring the two wills, so that Washington could determine the better of the two.
Washington experienced increasing difficulty breathing, and he was in much pain. Later in the evening, the doctors found that “all that had been done was without effect.” Their last attempt was to apply cataplasms (poultices) of wheat bran and blisters to his feet & legs to no avail. Washington died around 10:00 or 11:00 that Saturday night.
Some modern doctors pronounced the cause of his demise as acute epiglottitis (supraglottitis) which is a severe, rapidly progressing infection of the epiglottis and surrounding tissues that may be quickly fatal because of sudden respiratory (airway) obstruction by the inflamed structures. Washington would have gone into respiratory distress with his breathing difficulty creating a rapid pulse and high-pitched sounds as he tried to breath due to the lack of oxygen. Less oxygen was going to his cells due to the bloodletting; blood carries oxygen to the body cells.
Modern doctors have written that it would be improper for today’s medical practitioners to be critical of the physicians of George Washington’s day if they were delivering the standard of care that other physicians of that era were giving to their patients (White McKenzie Wallenborn). However, there were traditional doctors and midwives who practiced the ancient medicine of using botanicals during this time, and despaired the needless deaths due to the practice of heroic medicine: bloodletting and poisonous mercury (Griggs, 1997). There were also slave healers like Nelle. What if… Washington survived due to Nelle and Kate’s efforts. Maybe they would have been given their freedom like Caesar, the slave. In 1750 freedom was given to Caesar and £100 a year for life for his receipt for the "Cure for Poison," using plantane (plantain) and horehound roots, boiled in water until the water was boiled down to half the amount (Smith, 1994). What if… there were slaves with the same condition as Washington but were not attended by the standard doctors; they were cared for by midwives, and they lived.
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