Sunday, November 10, 2013

When Robert E. Lee Began to Die

by Martha M. Boltz

In a somewhat different way to look at Robert E. Lee’s life, it is interesting to look at his death and do some reading between the lines in the light of today’s medical knowledge.

Throughout the numerous writings about Lee,  the basic stories revolve around his actions in camp and on the field, before and after battles, and what he accomplished.

Writers and historians are prone to stick to the subject matter at hand — the battles — and adjunctive aspects such as the health of the leader are given short shrift, bare mentions as they tell the story of the war.

And thus it was with Robert E. Lee.  Looking  at Lee’s life and picking out different phases in it, an interesting story evolves of a man who apparently was beset by physical problems all of his adult life,  which were given scant diagnosis and treatment commensurate with the medical knowledge of the time.

Lee’s stamina  often appeared  hearty during the War years,  but had always been unpredictable at best.  And he had learned to live with it.

During the Mexican War, the healthy and robust Lee had fainted for the first and only time in his life. He had been, in his own words, “almost paralyzed” by the strain of battle and the sleeplessness of preparations for the attack on Chapultepec. However,  he was described as  looking strong and ruddy.

It was the silent forerunner of things to come, as in hindsight we are able  to look back, and predict.

Two years later while supervising construction of Fort Carroll in Baltimore Harbor, he developed a fairly high fever, temporarily debilitating him.  It was most likely a malarial strain, and would recur later in life, although at the time he seemed to be back to full strength.

In March 1863, around the time of Chancellorsville, he developed a very sore throat, then stabbing  pains in his chest, back, and arm. Moved from headquarters to a private home on March 30, he tried to recover, writing Mrs. Lee that he was simply “suffering with a bad cold.”

The doctors thought the throat infection had settled into pericarditis, or an inflammation of the pericardium - the sac surrounding  the heart. He continued to complain of “paroxysms of pain,” or stabbing sensations, so recognizable now in many cardiac patients.

Though he seemed to recover, all through the siege of  Gettysburg he suffered from the loosely diagnosed “rheumatism,” worse during damp weather. Some records indicate that the malaria  returned again later on, though diarrhea and dysentery were common physical complaints, North or South.

The Chancellorsville illness was particularly significant, and while it seemed to disappear, it also seemed to  affect him permanently.  His health was erratic thereafter, alternating between periods of almost debilitating discomfort  and relative good health.

On August 8,1863, he felt that his health was problematic enough to write President Jefferson Davis asking that he be relieved of command. Davis declined the request.

Less than a month later, he suffered violent pains in his back, which were attributed to lumbago, sciatica or — again — rheumatism.  In the light of current medical knowledge, they were probably the  precursor to angina pectoris, the temporary decrease in blood supply to the heart musculature, with resulting pain and discomfort.

It was at this time that horseback riding became almost unbearable for the General best known astride Traveller. Many campaigns were conducted with Lee doing his best, but riding in a wagon.
Several other attacks occurred during the Wilderness Campaign. Still he attempted to continue his position of leadership. Incidences of illness and near collapse continued, often attributed to “bad food and long hours.”  The duration and effect seems to have been more in line with a primary intestinal infection such as bacillary dysentery rather than just “bad food.”

From June 1864 through Appomattox, Lee seems to have been in relatively good health, including the nine-month siege of Petersburg; he had gained weight and his face looked “ruddy” again,   a description that should be remembered.

When he came to head Washington College (later Washington and Lee) he again seemed in fairly good health, but the so-called rheumatism of old continued.  As early as 1868 he began talking of getting old and having only a short span of life left.

In March 1869 he fell ill to a severe respiratory infection and although he seemed to recover, records indicate that in reality, his health steadily declined.  He had some strong reservations if he could attend the college’s graduation ceremony that year, for fear that the happy proceedings might prove his undoing.  Not uniquely, the patient was more aware of the serious condition of his health than his physicians were.

A year passed and the doctors would again diagnose the initial problem first mentioned at Chancellorsville — inflammation of the heart sac, or pericarditis.  He again had the pain on the right side, chest and back, and difficulty breathing.  His walking was restricted to about 200 yards.

He decided to take a trip as a rest, going on a six week tour through North and South Carolina, Georgia and Florida. Instead of resting,  he was overwhelmed with crowds everywhere he went, complete with receptions, dinners and crowds of people. It was hardly a restful trip. He began having  worse chest pain. Examined in Savannah, and then back home in Richmond, as well as Norfolk, the diagnosis confirmed “chronic pericarditis”.

September 28, 1870 was the beginning of the end. He’d left a faculty meeting and insisted on walking to church for a 4:00 p.m. vestry meeting in the rain, to an unheated Church.  Around 7:00 p.m. he walked back home through the rain, and while Mrs. Lee noticed he looked unwell, she only chided him gently that he rarely made them late for dinner.

Sitting down in his chair, he bowed his head to say Grace, and was unable to speak. He leaned back further in his chair, and still could not say a word. Mrs. Lee was stricken with concern and fear.

Sensing the seriousness of his condition, servants carried him to a couch and the physicians were called immediately. He would never rise from his bed again.  The doctors came and went, his family attended closely, but life was ebbing from the valiant general.  He spoke only occasionally, and that in a delirious state.

Modern physicians, reviewing all the records in the light of current knowledge, seem to think that actually a cerebral thrombosis (a clot in a blood vessel of the brain) had occurred.  This, they believe, was due to a degree of atherosclerosis (or thickening of the arterial walls, the buildup of plaque) which he had probably had for years.

This would have led to the description of his complexion being “ruddy” or “florid.”  What they saw as a healthy appearance then, we now know is possibly symptomatic of medical trouble brewing.  Most likely hypertension accompanied this, but in this era the taking of blood pressure was unknown — sphygmomanometers had yet to be invented.

He was attended by Drs. Robert Lewis Madison and H. T. Barton of Lexington, VA. who waited by his bedside, unable to minister further. It was said by those who watched that their anguish was palpable. They could do nothing for Lee.

At the very end, at 9:30 a.m. on Wednesday, October 12, 1870, the noble General of the South breathed his last.  His final words were quite clearly, “Strike the tent.”  General Robert E. Lee had gone home.



An interesting read. Thank you.

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