Washington would say quality has definitely improved

Too bad for the father of our country that 212 years ago the fields of patient safety, healthcare quality improvement and comparative effectiveness weren't very advanced—or even in existence.

On Dec. 14, 1799, Gen. George Washington died after enduring the torture of what was considered standard medical treatment at the time: Bleeding, taking about five pints worth of his blood in just 16 hours.

Just two days earlier, reports have the 67-year-old Washington riding about his farm on horseback in snowy 30-degree weather. The next day, he was suffering from a sore throat. The remedies of the time that were tried included drinking a mixture of molasses, vinegar and butter and gargling a mix of vinegar and sage tea.

The potency of these elixirs may have been offset by the bleedings, which were followed by more bleedings until his blood was flowing "slow and thick," according to a 1997 analysis of Washington's death by Dr. White McKenzie Wallenborn, a former University of Virginia School of Medicine clinical professor.

Wallenborn combined textbook and journal articles and used his own clinical analysis to diagnose what was happening with Washington, whose symptoms were given, in order of occurrence, as severe sore throat, hoarseness, cough, chills, difficulty breathing, difficulty swallowing, expectoration, fever, loss of voice and suffocation.

White speculated that Washington might have lived had his doctors performed a tracheotomy, considered a new and controversial procedure at the time, though he withholds any criticism.

"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," wrote Wallenborn (who later gained some notoriety for writing a report disputing the findings of a study showing Thomas Jefferson's paternity of Sally Hemings' children). "It would appear that Dr. James Craik, Dr. Elisha Cullen Dick and Dr. Gustavus Richard Brown were well-trained as physicians, were honest and caring, and gave the kind of medical care that their peers would have given. Today we know that many of their methods were wrong and we would do things differently."

When I hear of complaints about evidence-based medicine and comparative-effectiveness research, I think of George Washington and wonder what would have been the fallout if a root-cause analysis was performed of his death.

And sometimes I also think of that forgotten healer of yore, Theodoric of York, medieval barber.

Follow Andis Robeznieks on Twitter: @MHARobeznieks.