Wall Street Journal
October 1, 2013
by Tevi Troy
George Washington died in 1799 following a horse ride in the rain. The precise cause of death is uncertain, but it was probably an infection, strep or staph. Epiglottitis followed, making it hard for him to swallow or breathe. And the medical treatment he received from his neighbor and physician, Dr. James Craik, only made things worse: The patient was bled four times, removing approximately half of his blood supply.
As Jeanne E. Abrams shows in "Revolutionary Medicine: The Founding Fathers and Mothers in Sickness and in Health," Washington's treatment was typical of the state of medical science and technology in those days. Indeed, Washington was far from the only Founding Father who had to endure primitive and dangerous medicine. All of the Founders, Ms. Abrams writes, "experienced dramatic and often tragic personal encounters with disease and epidemics."
The book chronicles the health, well-being and interactions with medicine of the Founding Fathers, to give us a sense both of the medical treatment of the time and of the Founders' thoughts on health care. After an introductory chapter on the state of health in revolutionary America, Ms. Abrams provides chapters on each of the Founders that she covers: George and Martha Washington, Benjamin Franklin, John and Abigail Adams, and Thomas Jefferson. She concludes with some lessons we can learn from this tour.
The founding generation's afflictions ranged from the annoying to the fatal: All four of Martha Washington's children, and George Washington's stepchildren, died of disease. Washington's father and brother died young, as did his sister and half-sister. Washington himself was afflicted at different times by smallpox, pleurisy, hemorrhoids, dysentery and possibly tuberculosis. Franklin suffered gout, gallstones, psoriasis and frequent colds. Jefferson outlived five of his six children. Dolley Todd's husband, John Todd, died from yellow fever in 1793. Were it not for this tragedy, she wouldn't have become the wife of James Madison and one of our best-remembered first ladies.
Our fourth president, Madison had it particularly tough. In addition to an awful stomach and malaria, he may have had epilepsy. He was also terribly frail, at 5-foot-4 and less than 100 pounds. Despite all this, he managed to live to 85.
The Founders were aware that the medicine of their day left much to be desired. Jefferson observed that doctors did "more harm than good." His prodigious reading included works on science and medicine. Jefferson knew medicine as well as many doctors of the time. This may not have been that difficult: Of the 3,500 or so doctors in revolutionary America, only 10% had degrees. Throughout their careers, both Franklin and Jefferson sought to promote the use of scientific methods in medicine. Jefferson was also a critic of the barbarity of bloodletting, writing in a letter in 1814 that "in his theory of bleeding . . . I was very much opposed to my friend [Dr. Benjamin] Rush, whom I greatly loved; but who has done much harm, in the sincerest persuasion that he was preserving life."
The problem of primitive medicine would continue to plague American politics through the 19th century. James A. Garfield, our 20th president, died in 1881 after his doctors probed his bullet hole with unsterile fingers and metal instruments. The wound, if it had been left untreated, would likely have not been fatal. It wasn't the would-be assassin who killed him—it was the horrific medical treatment he received.
Ms. Abrams, a professor of Jewish studies at the University of Denver, also explores the Founders' approaches to what we would now call health policy. The farsighted Washington understood that the most pernicious threat to his army during the Revolutionary War wasn't the British. It was disease. He tried to expose his men to weaker forms of smallpox and strictly enforced rules that led to a healthier camp environment. As president, John Adams signed legislation that led to the creation of the Public Health Service and the post of surgeon general. Jefferson insisted that students at the University of Virginia, which he founded, be taught the basics of medicine. Franklin invented bifocals and the first American catheter.
Such innovations were sorely needed. The public-health system in early America was abysmal. As Ms. Abrams explains, local legislators in Philadelphia proposed clearing the bad air that was thought to bring yellow fever by firing cannons into the sky. With ideas such as these governing public health, it seems miraculous that any of the Founders lived as long as they did.
The book stumbles a bit toward the end, as the author tries to tell us what the Founders would have thought of health-care policy in the 21st century. This is always a dangerous move, and Ms. Abrams steps on the biggest health-care land mine of them all: Obamacare. According to the author, "the founders' commitment to the public good undoubtedly meant that they would've looked with approval on providing the opportunity to access good health care for all Americans." This is a dubious claim at best, made worse by the fact that there is no way to verify it. The Founders carry so much sway today precisely because they were visionaries whose view of limited government and the ingenuity of the people helped redefine the world. But it is presumptuous to say definitively where they would have stood on any single modern controversy.
Fortunately, this kind of speculation takes place only on the last page of "Revolutionary Medicine," and the rest is a readable and eye-opening account. We know so much about the Founders, but we rarely pause to think just how difficult "life, liberty, and the pursuit of happiness" can be when you lack a good doctor or science-based care.
Tevi Troy is a Visiting Fellow at Hudson Institute and served as the Deputy Secretary of the U.S. Department of Health and Human Services from 2007 until 2009.
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