Medical Department #18 - Lee's Health at Gettysburg

With the 145th Anniversary of the Battle of Gettysburg upon us, I thought it would be appropriate to post a previous "Medical Department" column from The Civil War News, that discusses the health of Robert E. Lee. While, in the main, the column describes Lee's last days, it also touches on some of the health problems he may have been experiencing at Gettysburg. This has been a source of debate for some time and was recently a thread on the Gettysburg Discussion Group.

By the way, if any of you are in Gettysburg this weekend, make sure you stop by and say "hi" to Bill Christen, a fellow Edinborough Press author (of Pauline Cushman: Spy of the Cumberland). He'll also be displaying copies of my forthcoming (August 1!) book, Lincoln's Labels: America's Best Known Brands and the Civil War (see the dust jacket here).

"BROKENHEARTED"
By James M. Schmidt
The Civil War News – “Medical Department” – December 2005

“October 11 – Evidently sinking; less observant; pulse 120; very feeble; respiration hurried. Still recognized whoever approached him. Refuses to take anything unless presented by his physicians. It soon became evident from his rapid and feeble pulse, deepening unconsiousness and accelerated breathing, that his case was hopeless.”

Those are the words of two physicians, Howard T. Barton and Robert L. Madison, both of Lexington, VA, detailing the last hours of their patient, none other than General Robert E. Lee, who died early the following day, October 12, 1870.

The lives of Drs. Barton and Madison, a review of the heart problems that plagued Lee since the spring of 1863, and finally (and most interesting), a detailed review of the symptoms, care, and circumstances surrounding Lee’s terminal illness, are the subject of an excellent article, “The Lexington Physicians of General Robert E. Lee,” in a recent issue of Southern Medical Journal (August 2005, 98(8), pp. 800-4), by Drs. Richard D. Mainwaring and Harris D. Riley, Jr.

The authors drew on primary resources in the archives of Virginia Military Institute (VMI), the Museum of the Confederacy, and Washington and Lee University, as well as period newspaper and medical journal accounts. The article also includes a heretofore unpublished photograph of Barton.

Both of the authors had written about General Lee’s health before, but separately. Dr. Riley published an article entitled “General Robert E. Lee: His Medical Profile” (Va Med, July 1978, Vol. 105, No. 7, pp. 495-500), and Dr. Mainwaring co-authored an article entitled “The Cardiac Illness of General Robert E. Lee” (Surg Gynecol Obstet, March 1992, Vol. 174, No. 3, pp. 237-244).

Dr. Riley obtained his MD from Vanderbilt University in 1948. He served in both WW II and the Korean War, with the Navy and Air Force, respectively. He is a pediatrician and Professor of Pediatrics at the Vanderbilt University School of Medicine and the Children's Hospital of Vanderbilt. Dr. Riley is interested in all aspects of the Civil War, particularly medicine, and has penned book reviews for The Civil War News.

Dr. Mainwaring is a pediatric cardiovascular surgeon in Sacramento, CA. He received his MD from Duke University School of Medicine, and did residencies in adult and pediatric cardiothoracic surgery at the University of Virginia and the University of Pennsylvania. He was kind enough to answer my questions about his interests in General Lee and provided some additional information and opinions not included in the journal article.

Dr. Mainwaring began by telling me he did most of the research for his 1992 article while he was a general surgery resident at the University of Virginia. It was while doing that research that he first contacted Dr. Riley to see if he had any additional information. “Thus began more than ten years of on-again-off-again collaboration between Dr. Riley and myself,” he told me, adding: “We both felt that an article focusing on Barton and Madison would be worth publishing, partly because there did seem to be a lot of conflicting information out there regarding these two individuals.” Mainwaring found it interesting that new information about Civil War medicine continues to be unearthed even though the events occurred more than 140 years ago.

Barton was born in 1823 in Fredericksburg, VA, attended VMI, graduated from the University of Pennsylvania medical school in 1848, and then had a successful private practice in Berryville, VA. When the Civil War started, Barton organized a volunteer company and received the rank of captain. He was soon drafted into medical service where he served throughout the war, most notably as Surgeon-in-Charge of a hospital established at the Old St. Charles Hotel in Richmond.

Madison was born in 1828 in Orange County, VA, attended William and Mary College, and received his medical degree from Jefferson Medical College in Philadelphia in 1851. After a period in private practice, Madison was appointed to the faculty at VMI, where he also served as personal physician to professor and Major Thomas J. Jackson. Madison remained at VMI throughout the war, and was present with the cadets at the Battle of New Market in 1864.

Personal circumstances found both doctors in Lexington a few years after the war. Indeed, after his wife died in 1866, Barton courted Robert E. Lee’s daughter, Mildred. Both men were members of Grace Episcopal Church, where the Lee family also attended. They were in charge of Lee’s medical care beginning in 1869 when he began to complain of chest pains that had not plagued him since 1863. Barton, Madison, and at least nine other physicians diagnosed Lee as having pericarditis, an inflammation of the membrane that surrounds the heart and its major blood vessels.

In his 1992 article, Dr. Mainwaring proposed that this was an incorrect diagnosis. He suggested that Lee actually suffered a heart attack in 1863, and that his illness had a major influence on the Battle of Gettysburg. As for the chest pains Lee began experiencing in 1869, Mainwaring told me: “Lee’s symptoms are so classic for angina pectoris but were not recognized for what they were. We take for granted, in this age where atherosclerosis has become epidemic, not so long ago physicians were dealing with different diseases than we see now.” In other words, coronary artery disease was less common, maybe even rare, at that time, and Barton and Madison did not recognize the symptoms of angina or stroke as doctors would today. Mainwaring isn’t sure that a more correct diagnosis would have changed Lee’s outcome, since treatment was not readily available in the 19th century.

One of the especially interesting circumstances mentioned in the present article is a severe storm that struck the Shenandoah Valley area in early October 1870, just days after Lee’s condition began to deteriorate. “That was a ‘storm-of-the-century’ type event,” Dr. Mainwaring told me. There was terrible flooding, and in those days it meant that Lexington was completely cut off and isolated, with no communication – in or out. The consequence for Lee was that Madison and Barton could not consult with other physicians and had to do the best they could on their own. He continued: “I am confident that if weather conditions had been more favorable there would have been a whole council of physicians at Lee’s bedside.”

Dr. Mainwaring contrasted the October 1870 storm with the recent storms that have struck the Gulf Coast, telling me: “Today, with the hurricane season having wreaked havoc, we see how nature can change all of the best-laid plans. One big difference is the fact that modern communications have taken away the isolation effect, so that even when roads, bridges, and even airports are closed, information is still available.”

In the main, the article concentrates on the care the doctors gave Lee in his last weeks. They quote extensively from an article that Barton and Madison published in the Richmond and Louisville Medical Journal in late 1870, in which they reported their observations and treatment in detail. While reading the excerpts, I was intrigued that they felt so free to share such private and possibly sensitive information. It is in great contrast with the modern emphasis on privacy, especially concerning medical records. Given Lee’s popularity, perhaps we can compare it with the attention given to the Vice President’s heart condition or other celebrity health news.

Dr. Mainwaring suggested an interesting, if practical, reason as to why Barton and Madison published an account of their care of the General, telling me: “Perhaps they wanted to exonerate themselves since they did not have the opportunity to call for consultants. They must have been mortified at the thought that they had ‘lost’ their famous patient.”

Nevertheless, Drs. Mainwaring and Riley conclude their article with the judgment that Drs. Barton and Madison “were keen observers and dispatched their responsibility faithfully,” adding “we are indebted to them for documenting [General Lee’s] clinical course and their care.”