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Sunday, November 14, 2021

George Washington and slavery

From Wikipedia, the free encyclopedia
 
painting
George Washington (John Trumbull, 1780), with William Lee, Washington's enslaved personal servant

The history of George Washington and slavery reflects Washington's changing attitude toward enslavement. The preeminent Founding Father of the United States and a slaveowner, Washington became increasingly uneasy with that longstanding institution during the course of his life, and provided for the emancipation of his slaves in his will.

Slavery in colonial America was ingrained in the economic and social fabric of several colonies including his native Virginia. At 11 years of age, upon the death of his father in 1743, Washington inherited his first ten slaves. In adulthood his personal slaveholding grew through inheritance, purchase and the natural increase of children born into slavery. In 1759, he gained control of dower slaves belonging to the Custis estate on his marriage to Martha Dandridge Custis. Washington's early attitudes to slavery reflected the prevailing Virginia planter views of the day and he initially demonstrated no moral qualms about the institution. He became skeptical about the economic efficacy of slavery before the American Revolutionary War when his transition from tobacco to grain crops in the 1760s left him with a costly surplus of enslaved workers. In 1774, Washington publicly denounced the slave trade on moral grounds in the Fairfax Resolves. After the war, he expressed support for the abolition of slavery by a gradual legislative process, a view he shared widely but always in private, and he remained dependent on enslaved labor. By the time of his death in 1799 there were 317 enslaved people at his Mount Vernon estate, 124 owned by Washington and the remainder managed by him as his own property but belonging to other people.

Washington had a strong work ethic and demanded the same from both hired workers and from the enslaved people who were forced to work at his command. He provided his enslaved population with basic food, clothing and accommodation comparable to general practice at the time, which was not always adequate, and with medical care. In return, he expected them to work diligently from sunrise to sunset over the six-day working week that was standard at the time. Some three-quarters of his enslaved workers labored in the fields, while the remainder worked at the main residence as domestic servants and artisans. They supplemented their diet by hunting, trapping, and growing vegetables in their free time, and bought extra rations, clothing and housewares with income from the sale of game and produce. They built their own community around marriage and family, though because Washington allocated the enslaved to farms according to the demands of the business generally without regard for their relationships, many husbands lived separately from their wives and children during the work week. Washington used both reward and punishment to manage his enslaved population, but was constantly disappointed when they failed to meet his exacting standards. A significant proportion of the enslaved population at Mount Vernon resisted their enslavement by various means, such as theft to supplement food and clothing and to provide income, feigning illness, and escaping.

As commander-in-chief of the Continental Army in 1775, he initially refused to accept African-Americans, free or enslaved, into the ranks, but bowed to the demands of war, and thereafter led a racially integrated army. Moral doubt about the institution first appeared in 1778 when Washington expressed reluctance to sell some of his enslaved workers at a public venue or split their families. At war’s end, Washington demanded without success that the British respect the preliminary peace treaty which he said required return of escaped slaves without exception. His public statement on resigning his commission, addressing challenges facing the new confederation, made no explicit mention of slavery. Politically, Washington felt that the divisive issue of American slavery threatened national cohesion, and he never spoke publicly about it. Privately, Washington considered plans in the mid 1790s to free his enslaved population. Those plans failed because of his inability to raise the finances necessary, the refusal of his family to approve emancipation of the dower slaves, and his own aversion to separating enslaved families. His will was widely published upon his death in 1799, and provided for the emancipation of the enslaved population he owned, one of the few slave-owning founders to set them free. Because many of his slaves were married to the dower slaves, whom he could not legally free, the will stipulated that, except for his valet William Lee who was freed immediately, his enslaved workers be emancipated on the death of his wife Martha. She freed them in 1801, a year before her own death, but she had no option to free the dower slaves, who were inherited by her grandchildren.

Background

Black and white illustration
First enslaved Africans arriving in Virginia

Slavery was introduced into the English colony of Virginia when the first Africans were transported to Point Comfort in 1619. Those who accepted Christianity became "Christian servants" with time-limited servitude, or even freed, but this mechanism for ending bondage was gradually shut down. In 1667, the Virginia Assembly passed a law that barred baptism as a means of conferring freedom. Africans who had been baptised before arriving in Virginia could be granted the status of indentured servant until 1682, when another law declared them to be slaves. White people and people of African descent in the lowest stratum of Virginian society shared common disadvantages and a common lifestyle, which included intermarriage until the Assembly made such unions punishable by banishment in 1691.

In 1671, Virginia counted 6,000 white indentured servants among its 40,000 population but only 2,000 people of African descent, up to a third of whom in some counties were free. Towards the end of the 17th century, English policy shifted in favor of retaining cheap labor rather than shipping it to the colonies, and the supply of indentured servants in Virginia began to dry up; by 1715, annual immigration was in the hundreds, compared with 1,500–2,000 in the 1680s. As tobacco planters put more land under cultivation, they made up the shortfall in labor with increasing numbers of enslaved workers. The institution was rooted in race with the Virginia Slave Codes of 1705, and from around 1710 the growth in the enslaved population was fueled by natural increase. Between 1700 and 1750 the number of enslaved people in the colony increased from 13,000 to 105,000, nearly eighty percent of them born in Virginia. In Washington's lifetime, slavery was deeply ingrained in the economic and social fabric of Virginia, where some forty percent of the population and virtually all African Americans were enslaved.

George Washington was born in 1732, the first child of his father Augustine's second marriage. Augustine was a tobacco planter with some 10,000 acres (4,000 ha) of land and 50 slaves. On his death in 1743, he left his 2,500-acre (1,000 ha) Little Hunting Creek to George's older half-brother Lawrence, who renamed it Mount Vernon. Washington inherited the 260-acre (110 ha) Ferry Farm and ten slaves. He leased Mount Vernon from Lawrence's widow two years after his brother's death in 1752 and inherited it in 1761. He was an aggressive land speculator, and by 1774 he had amassed some 32,000 acres (13,000 ha) of land in the Ohio Country on Virginia's western frontier. At his death he possessed over 80,000 acres (32,000 ha). In 1757, he began a program of expansion at Mount Vernon that would ultimately result in an 8,000-acre (3,200 ha) estate with five separate farms, on which he initially grew tobacco.

Black and white map showing farms at Mount Vernon
Mount Vernon estate

Agricultural land required labor to be productive, and in the 18th-century American south that meant slave labor. Washington inherited slaves from Lawrence, acquired more as part of the terms of leasing Mount Vernon, and inherited slaves again on the death of Lawrence's widow in 1761. On his marriage in 1759 to Martha Dandridge Custis, Washington gained control of eighty-four dower slaves. They belonged to the Custis estate and were held in trust by Martha for the Custis heirs, and although Washington had no legal title to them, he managed them as his own property. Between 1752 and 1773, he purchased at least seventy-one slaves – men, women and children. He scaled back significantly his purchasing of enslaved workers after the American Revolution but continued to acquire them, mostly through natural increase and occasionally in settlement of debts. In 1786, he listed 216 enslaved people – 122 men and women and 88 children. – making him one of the largest slaveholders in Fairfax County. Of that total, 103 belonged to Washington, the remainder being dower slaves. By the time of Washington's death in 1799, the population enslaved at Mount Vernon had increased to 317 people, including 143 children. Of that total, he owned 124, leased 40 and controlled 153 dower slaves.

Slavery at Mount Vernon

Washington thought of his workers as part of an extended family with him the father figure at its head. He displayed elements of both patriarchy and paternalism in his attitudes to the slaves he controlled. The patriarch in him expected absolute obedience and manifested itself in a strict, rigorous control of the enslaved workers and the emotional distance he maintained from them. There are examples of genuine affection between master and enslaved, such as was the case with his valet William Lee, but such cases were the exception. The paternalist in him saw his relationship with his enslaved people as one of mutual obligations; he provided for them and they in return served him, a relationship in which the enslaved were able to approach Washington with their concerns and grievances. Paternal masters regarded themselves as generous and deserving of gratitude. When Martha's maid Oney Judge escaped in 1796, Washington complained about "the ingratitude of the girl, who was brought up and treated more like a child than a Servant".

George Washington is a hard master, very severe, a hard husband, a hard father, a hard governor. From his childhood he always ruled and ruled severely. He was first brought up to govern slaves, he then governed an army, then a nation. He thinks hard of all, is despotic in every respect, he mistrusts every man, thinks every man a rogue and nothing but severity will do.

Thomas Jefferson, 1799

I think I knew General Washington intimately and thoroughly; and were I called on to delineate his character it should be in terms like these....He was, indeed, in every sense of the words, a wise, a good, and a great man....in nothing bad, in few points indifferent; and it may truly be said that never did nature and fortune combine more perfectly to make a man great and to place him in the same constellation with whatever worthies have merited from man an everlasting remembrance.

Thomas Jefferson, 1814

Although Washington employed a farm manager to run the estate and an overseer at each of the farms, he was a hands-on manager who ran his business with a military discipline and involved himself in the minutiae of everyday work. During extended absences while on official business, he maintained close control through weekly reports from the farm manager and overseers. He demanded from all of his workers the same meticulous eye for detail that he exercised himself; a former enslaved worker would later recall that the "slaves...did not quite like" Washington, primarily because "he was so exact and so strict...if a rail, a clapboard, or a stone was permitted to remain out of its place, he complained; sometimes in language of severity." In Washington's view, "lost labour is never to be regained", and he required "every labourer (male or female) [do] as much in the 24 hours as their strength without endangering the health, or constitution will allow of". He had a strong work ethic and expected the same from his workers, enslaved and hired. He was constantly disappointed with enslaved workers who did not share his motivation and resisted his demands, leading him to regard them as indolent and insist that his overseers supervise them closely at all times.

In 1799, nearly three-quarters of the enslaved population, over half of them female, worked in the fields. They were kept busy year round, their tasks varying with the season. The remainder worked as domestic servants in the main residence or as artisans, such as carpenters, joiners, coopers, spinners and seamstresses. Between 1766 and 1799, seven dower slaves worked at one time or another as overseers. The enslaved were expected to work from sunrise to sunset over a six-day work week that was standard on Virginia plantations. With two hours off for meals, their workdays would range between seven and a half hours to thirteen hours, depending on season. They were given three or four days off at Christmas and a day each at Easter and Whitsunday. Domestic slaves started early, worked into the evenings and did not necessarily have Sundays and holidays free. On special occasions when enslaved workers were required to put in extra effort, such as working through a holiday or bringing in the harvest, they were paid or compensated with extra time off.

Washington instructed his overseers to treat enslaved people "with humanity and tenderness" when sick. Enslaved people who were less able, through injury, disability or age, were given light duties, while those too sick to work were generally, though not always, excused work while they recovered. Washington provided them with good, sometimes costly medical care – when an enslaved person named Cupid fell ill with pleurisy, Washington had him taken to the main house where he could be better cared for and personally checked on him throughout the day. The paternal concern for the welfare of his enslaved workers was mixed with an economic consideration for the lost productivity arising from sickness and death among the labor force.

Living conditions

Photograph
Modern reconstruction of a slave cabin at Mount Vernon

At Mansion House Farm, most of the enslaved people were housed in a two-story frame building known as the "Quarters for Families". This was replaced in 1792 by brick-built accommodation wings either side of the greenhouse comprising four rooms in total, each some 600 square feet (56 m2). The Mount Vernon Ladies' Association have concluded these rooms were communal areas furnished with bunks that allowed little privacy for the predominantly male occupants. Other enslaved people at Mansion House Farm lived over the outbuildings where they worked or in log cabins. Such cabins were the standard slave accommodation at the outlying farms, comparable to the accommodation occupied by the lower strata of free white society across the Chesapeake area and by the enslaved on other Virginia plantations. They provided a single room that ranged in size from 168 square feet (15.6 m2) to 246 square feet (22.9 m2) to house a family. The cabins were often poorly constructed, daubed with mud for draft- and water-proofing, with dirt floors. Some cabins were built as duplexes; some single-unit cabins were small enough to be moved on carts. There are few sources which shed light on living conditions in these cabins, but one visitor in 1798 wrote, "husband and wife sleep on a mean pallet, the children on the ground; a very bad fireplace, some utensils for cooking, but in the middle of this poverty some cups and a teapot". Other sources suggest the interiors were smoky, dirty and dark, with only a shuttered opening for a window and the fireplace for illumination at night.

Washington provided his enslaved people with a blanket each fall at most, which they used for their own bedding and which they were required to use to gather leaves for livestock bedding. Enslaved people at the outlying farms were issued with a basic set of clothing each year, comparable to the clothing issued on other Virginia plantations. The enslaved slept and worked in their clothes, leaving them to spend many months in garments that were worn, ripped and tattered. Domestic slaves at the main residence who came into regular contact with visitors were better clothed; butlers, waiters and body servants were dressed in a livery based on the three-piece suit of an 18th-century gentleman, and maids were provided with finer quality clothing than their counterparts in the fields.

Washington desired his enslaved workers to be fed adequately but no more. Each enslaved person was provided with a basic daily food ration of one US quart (0.95 l) or more of cornmeal, up to eight ounces (230 g) of herring and occasionally some meat, a fairly typical ration for the enslaved population in Virginia that was adequate in terms of the calorie requirement for a young man engaged in moderately heavy agricultural labor but nutritionally deficient. The basic ration was supplemented by enslaved people's own efforts hunting (for which some were allowed guns) and trapping game. They grew their own vegetables in small garden plots they were permitted to maintain in their own time, on which they also reared poultry.

Washington often tipped enslaved people on his visits to other estates, and it is likely that his own enslaved workers were similarly rewarded by visitors to Mount Vernon. Enslaved people occasionally earned money through their normal work or for particular services rendered – for example, Washington rewarded three of his own enslaved with cash for good service in 1775, an enslaved person received a fee for the care of a mare that was being bred in 1798 and the chef Hercules profited well by selling slops from the presidential kitchen. Enslaved people also earned money from their own endeavors, by selling to Washington or at the market in Alexandria food they had caught or grown and small items they had made. They used the proceeds to purchase from Washington or the shops in Alexandria better clothing, housewares and extra provisions such as flour, pork, whiskey, tea, coffee and sugar.

Family and community

Photograph showing single bedding on a pallet on a dirt floor
Interior of the reconstructed slave cabin at Mount Vernon

Although the law did not recognize slave marriages, Washington did, and by 1799 some two-thirds of the enslaved adult population at Mount Vernon were married. To minimize time lost in getting to the workplace and thus increase productivity, enslaved people were accommodated at the farm on which they worked. Because of the unequal distribution of males and females across the five farms, enslaved people often found partners on different farms, and in their day-to-day lives husbands were routinely separated from their wives and children. Washington occasionally rescinded orders so as not to separate spouses, but the historian Henry Wiencek writes, "as a general management practice [Washington] institutionalized an indifference to the stability of enslaved families." Only thirty-six of the ninety-six married slaves at Mount Vernon in 1799 lived together, while thirty-eight had spouses who lived on separate farms and twenty-two had spouses who lived on other plantations. The evidence suggests couples that were separated did not regularly visit during the week, and doing so prompted complaints from Washington that enslaved people were too exhausted to work after such "night walking", leaving Saturday nights, Sundays and holidays as the main time such families could spend together. Despite the stress and anxiety caused by this indifference to family stability – on one occasion an overseer wrote that the separation of families "seems like death to them" – marriage was the foundation on which the enslaved population established their own community, and longevity in these unions was not uncommon.

Large families that covered multiple generations, along with their attendant marriages, were part of an enslaved community-building process that transcended ownership. Washington's head carpenter Isaac, for example, lived with his wife Kitty, a dower-slave milkmaid, at Mansion House Farm. The couple had nine daughters ranging in age from six to twenty-seven in 1799, and the marriages of four of those daughters had extended the family to other farms within and outside the Mount Vernon estate and produced three grandchildren. Children were born into slavery, their ownership determined by the ownership of their mothers. The value attached to the birth of an enslaved child, if it was noted at all, is indicated in the weekly report of one overseer, which stated, "Increase 9 Lambs & 1 male child of Lynnas." New mothers received a new blanket and three to five weeks of light duties to recover. An infant remained with its mother at her place of work. Older children, the majority of whom lived in single-parent households in which the mother worked from dawn to dusk, performed small family chores but were otherwise left to play largely unsupervised until they reached an age when they could begin to be put to work for Washington, usually somewhere between eleven and fourteen years old. In 1799, nearly sixty percent of the slave population was under nineteen years old and nearly thirty-five percent under nine.

There is evidence that enslaved people passed on their African cultural values through telling stories, among them the tales of Br'er Rabbit which, with their origins in Africa and stories of a powerless individual triumphing through wit and intelligence over powerful authority, would have resonated with the enslaved. African-born slaves brought with them some of the religious rituals of their ancestral home, and there is an undocumented tradition of voodoo being practiced at one of the Mount Vernon farms. Although the slave condition made it impossible to adhere to the Five Pillars of Islam, some slave names betray a Muslim cultural origin. Anglicans reached out to American-born slaves in Virginia, and some of the Mount Vernon enslaved population are known to have been christened before Washington acquired the estate. There is evidence in the historical record from 1797 that the enslaved population at Mount Vernon had contacts with Baptists, Methodists and Quakers. The three religions advocated abolition, raising hopes of freedom among the enslaved, and the congregation of the Alexandria Baptist Church, founded in 1803, included enslaved people formerly owned by Washington.

Interracial sexual relations

In 1799 there were some twenty mulatto (mixed race) enslaved people at Mount Vernon. However, there is no credible evidence that George Washington took sexual advantage of any slave.

The probability of paternal relationships between enslaved and hired white workers is indicated by some surnames: Betty and Tom Davis, probably the children of Thomas Davis, a white weaver at Mount Vernon in the 1760s; George Young, likely the son of a man of the same name who was a clerk at Mount Vernon in 1774; and Judge and her sister Delphy, the daughters of Andrew Judge, an indentured tailor at Mount Vernon in the 1770s and 1780s. There is evidence to suggest that white overseers – working in close proximity to enslaved people under the same demanding master and physically and socially isolated from their own peer group, a situation that drove some to drink – had sexual relations with the enslaved people they supervised. Some white visitors to Mount Vernon seemed to have expected enslaved women to provide sexual favors. The living arrangements left some enslaved females alone and vulnerable, and the Mount Vernon research historian Mary V. Thompson writes that relationships "could have been the result of mutual attraction and affection, very real demonstrations of power and control, or even exercises in the manipulation of an authority figure".

Resistance

Newspaper clipping
Advertisement placed in the Pennsylvania Gazette after Oney Judge absconded from the President's House in 1796

Although some of the enslaved population at Mount Vernon came to feel a (coerced) loyalty toward Washington, the resistance displayed by a significant percentage of them is indicated by the frequent assertions Washington made about "rogueries" and "old tricks". The most common act of resistance was theft (e.g. as a form of self-help) which was so common that Washington made allowances for it as part of normal wastage. Food was stolen both to supplement rations and to sell, and Washington believed the selling of tools was another source of income for enslaved people. Because cloth and clothing were commonly taken without permission, Washington required seamstresses to show the results of their work and the leftover scraps before issuing them more material. Sheep were washed before shearing to prevent the theft of wool, and storage areas were kept locked and keys left with trusted individuals. In 1792, Washington ordered the culling of enslaved people's dogs he believed were being used in a spate of livestock theft and ruled that enslaved people who kept dogs without authorization were to be "severely punished" and their dogs hanged.

Another means by which enslaved people resisted, one that was virtually impossible to prove, was feigning illness. Over the years Washington became increasingly skeptical about absenteeism due to sickness among his enslaved population and concerned about the diligence or ability of his overseers in recognizing genuine cases of physical illness. Between 1792 and 1794, while Washington was away from Mount Vernon as President, the number of days lost to sickness increased tenfold compared to 1786, when he was resident at Mount Vernon and able to exert control over the situation personally. In one case, Washington suspected an enslaved person of frequently avoiding work over a period of decades through acts of deliberate self harm.

Enslaved people asserted some independence and frustrated Washington by the pace and quality of their work. In 1760, Washington noted that four of his carpenters quadrupled their output of timber under his personal supervision. Thirty-five years later, he denigrated his carpenters as an "idle...set of rascals" who would take a month or more to complete at Mount Vernon work that was being done in two or three days in Philadelphia. The output of seamstresses dropped off when Martha was away, and spinners found they could slow their pace by playing the overseers off against her. Tools were regularly lost or damaged, thus stopping work, and Washington despaired of employing innovations that might improve efficiency because he assumed enslaved workers were too clumsy to operate the new machinery involved.

The most emphatic act of resistance was to run away, and between 1760 and 1799 at least forty-seven enslaved people under Washington's control did so. Seventeen of these, fourteen men and three women, escaped to a British warship that anchored in the Potomac River near Mount Vernon in 1781. In general, the best chance of success lay with second- or third-generation African-American enslaved people who had good English, possessed skills that would allow them to support themselves as free people and were in close enough contact with their masters to receive special privileges. Thus it was that Judge, an especially talented seamstress, and Hercules escaped in 1796 and 1797 respectively and eluded recapture. Washington took seriously the recapture of these brave fugitives, and in three cases enslaved people who had escaped were sold off in the West Indies after recapture, effectively a death sentence in the severe conditions the enslaved were subjected to there.

Control

Slavery was a system in which enslaved people lived in fear; fear of being sold, fear of being separated from their families or their children or their parents, fear of not being in control of their bodies or their lives, fear of never knowing freedom. No matter what their clothing was like, no matter what food they ate, no matter what their quarters looked like, enslaved people lived with that fear. And that was the psychological violence of slavery. That's how slave owners maintained control over enslaved people.

Jessie MacLeod
Associate Curator
George Washington's Mount Vernon

Washington used both reward and punishment to encourage discipline and productivity in his enslaved population. In one case, he suggested "admonition and advice" would be more effective than "further correction", and he occasionally appealed to an enslaved person's sense of pride to encourage better performance. Rewards in the form of better blankets and clothing fabric were given to the "most deserving", and there are examples of cash payments being awarded for good behavior. He opposed the use of the lash in principle, but saw the practice as a necessary evil and sanctioned its occasional use, generally as a last resort, on enslaved people, both male and female, if they did not, in his words, "do their duty by fair means". There are accounts of carpenters being whipped in 1758 when the overseer "could see a fault", of an enslaved person called Jemmy being whipped for stealing corn and escaping in 1773 and of a seamstress called Charlotte being whipped in 1793 by an overseer "determined to lower Spirit or skin her Back" for impudence and refusing to work.

Washington regarded the 'passion' with which one of his overseers administered floggings to be counter-productive, and Charlotte's protest that she had not been whipped in fourteen years indicates the frequency with which physical punishment was used. Whippings were administered by overseers after review, a system Washington required to ensure enslaved people were spared capricious and extreme punishment. Washington did not himself flog enslaved people, but he did at times use verbal abuse and physical violence when they failed to perform as he expected. Contemporaries generally described Washington as having a calm demeanor, but there are several reports from those who knew him privately that mention his temper. One wrote that "in private and particularly with his servants, its violence sometimes broke out". Another reported that Washington's servants "seemed to watch his eye and to anticipate his every wish; hence a look was equivalent to a command". Threats of demotion to fieldwork, corporal punishment and being shipped to the West Indies were part of the system by which he controlled his enslaved population.

Evolution of Washington's attitudes

Painting
Life of George Washington: The Farmer by Junius Brutus Stearns (1851)

Washington's early views on slavery were no different from any Virginia planter of the time. He demonstrated no moral qualms about the institution, and referred to slaves as "a Species of Property" during those years as he would later in life when he favored abolition. The economics of slavery prompted the first doubts in Washington about the institution, marking the beginning of a slow evolution in his attitude towards it. By 1766, he had transitioned his business from the labor-intensive planting of tobacco to the less demanding farming of grain crops. His slaves were employed on a greater variety of tasks that needed more skills than tobacco planting required of them; as well as the cultivation of grains and vegetables, they were employed in cattle herding, spinning, weaving and carpentry. The transition left Washington with a surplus of slaves and revealed to him the inefficiencies of the slave labor system.

There is little evidence that Washington seriously questioned the ethics of slavery before the Revolution. In the 1760s he often participated in tavern lotteries, events in which defaulters' debts were settled by raffling off their assets to a high-spirited crowd. In 1769, Washington co-managed one such lottery in which fifty-five slaves were sold, among them six families and five females with children. The more valuable married males were raffled together with their wives and children; less valuable slaves were separated from their families into different lots. Robin and Bella, for example, were raffled together as husband and wife while their children, twelve-year-old Sukey and seven-year-old Betty, were listed in a separate lot. Only chance dictated whether the family would remain together, and with 1,840 tickets on sale the odds were not good.

The historian Henry Wiencek concludes that the repugnance Washington felt at this cruelty in which he had participated prompted his decision not to break up slave families by sale or purchase, and marks the beginning of a transformation in Washington's thinking about the morality of slavery. Wiencek writes that in 1775 Washington took more slaves than he needed rather than break up the family of a slave he had agreed to accept in payment of a debt. The historians Philip D. Morgan and Peter Henriques are skeptical of Wiencek's conclusion and believe there is no evidence of any change in Washington's moral thinking at this stage. Morgan writes that in 1772, Washington was "all business" and "might have been buying livestock" in purchasing more slaves who were to be, in Washington's words, "strait Limb'd, & in every respect strong & likely, with good Teeth & good Countenance". Morgan gives a different account of the 1775 purchase, writing that Washington resold the slave because of the slave's resistance to being separated from family and that the decision to do so was "no more than the conventional piety of large Virginia planters who usually said they did not want to break up slave families – and often did it anyway".

American Revolution

Original document
Washington's taxable property in April 1788: 121 slaves ("Blacks above 12 years of age"), 98 horses, 4 mules, 1 stud ("covering horse") and 1 chariot

From the late 1760s, Washington became increasingly radicalized against the North American colonies' subservient status within the British Empire. In 1774 he was a key participant in the adoption of the Fairfax Resolves which, alongside the assertion of colonial rights, condemned the transatlantic slave trade on moral grounds. Washington was a signatory to that entire document, and thus publicly endorsed clause 17 "declaring our earnest wishes to see an entire stop forever put to such wicked, cruel, and unnatural trade."

He began to express the growing rift with Great Britain in terms of slavery, stating in the summer of 1774 that the British authorities were "endeavouring by every piece of Art & despotism to fix the Shackles of Slavry [sic]" upon the colonies. Two years later, on taking command of the Continental Army at Cambridge at the start of the American Revolutionary War, he wrote in orders to his troops that "it is a noble Cause we are engaged in, it is the Cause of virtue and mankind...freedom or Slavery must be the result of our conduct." The hypocrisy or paradox inherent in slave owners characterizing a war of independence as a struggle for their own freedom from slavery was not lost on the British writer Samuel Johnson, who asked, "How is it that we hear the loudest yelps for liberty among the drivers of Negroes?" As if answering Johnson, Washington wrote to a friend in August 1774, "The crisis is arrived when we must assert our rights, or submit to every imposition that can be heaped upon us, till custom and use shall make us tame and abject slaves, as the blacks we rule over with such arbitrary sway."

Washington shared the common Southern concern about arming African Americans, enslaved or free, and initially refused to accept either into the ranks of the Continental Army. He reversed his position on free African Americans when the royal governor of Virginia, Lord Dunmore, issued a proclamation in November 1775 offering freedom to rebel-owned slaves who enlisted in the British forces. Three years later and facing acute manpower shortages, Washington approved a Rhode Island initiative to raise a battalion of African-American soldiers

Washington gave a cautious response to a 1779 proposal from his young aide John Laurens for the recruitment of 3,000 South Carolinian enslaved workers who would be rewarded with emancipation. He was concerned that such a move would prompt the British to do the same, leading to an arms race in which the Americans would be at a disadvantage, and that it would promote discontent among those who remained enslaved. In 1780, he suggested to one of his commanders the integration of African-American recruits "to abolish the name and appearance of a Black Corps."

During the war, some 5,000 African Americans served in a Continental Army that was more integrated than any American force before the Vietnam War, and another 1,000 served in the Continental Navy. They represented less than three percent of all American forces mobilized, though in 1778 they provided as much as 13% of the Continental Army. By the end of the war African-Americans were serving alongside whites in virtually all units other than those raised in the deep south.

The first indication of a shift in Washington's attitude on slavery appeared during the war, in correspondence of 1778 and 1779 with Lund Washington, who managed Mount Vernon in Washington's absence. In the exchange of letters, a conflicted Washington expressed a desire "to get quit of Negroes", but made clear his reluctance to sell them at a public venue and his wish that "husband and wife, and Parents and children are not separated from each other". His determination not to separate families became a major complication in his deliberations on the sale, purchase and, in due course, emancipation of his own slaves. Washington's restrictions put Lund in a difficult position with two female slaves he had already all but sold in 1778, and Lund's irritation was evident in his request to Washington for clear instructions. Despite Washington's reluctance to break up families, there is little evidence that moral considerations played any part in his thinking at this stage. He sought to liberate himself from an economically unviable system, not to liberate his slaves. They were still a property from which he expected to profit. During a period of severe wartime depreciation, the question was not whether to sell his enslaved people, but when, where, and how best to sell them. Lund sold nine enslaved including the two females, in January 1779.

Washington's actions at the war's end reveal little in the way of antislavery inclinations. He was anxious to recover his own slaves, and refused to consider British offers of compensation for the upwards of 80,000 formerly enslaved people evacuated by the British; Washington insisted without success that the British return them to their owners as per a clause in the Preliminary Articles of Peace which prohibited the British from "carrying away any Negroes, or other Property of the American Inhabitants”. Before resigning his commission in 1783, Washington took the opportunity to give his opinion on the challenges that threatened the existence of the new nation, in his Circular to the States. That circular letter inveighed against “local prejudices” but explicitly declined to name any of them, “leaving the last to the good sense and serious consideration of those immediately concerned.”

Confederation years

Painting

Emancipation became a major issue in Virginia after liberalization in 1782 of the law regarding manumission, which is the act of an owner freeing his slaves. Before 1782, a manumission had required obtaining consent from the state legislature, which was arduous and rarely granted. After 1782, inspired by the rhetoric that had driven the revolution, it became popular to free slaves. The free African-American population in Virginia rose from some 3,000 to more than 20,000 between 1780 and 1800; the 1800 United States Census tallied about 350,000 slaves in Virginia, and the proslavery interest re-asserted itself around that time. The historian Kenneth Morgan writes, "...the revolutionary war was the crucial turning-point in [Washington's] thinking about slavery. After 1783...he began to express inner tensions about the problem of slavery more frequently, though always in private..." Although Philip Morgan identifies several turning points and believes no single one was pivotal, most historians agree the Revolution was central to the evolution of Washington's attitudes on slavery. It is likely that revolutionary rhetoric about the rights of men, the close contact with young antislavery officers who served with Washington – such as Laurens, the Marquis de Lafayette and Alexander Hamilton – and the influence of northern colleagues were contributory factors in that process.

Washington was drawn into the postwar abolitionist discourse through his contacts with antislavery friends, their transatlantic network of leading abolitionists and the literature produced by the antislavery movement, though he was reluctant to volunteer his own opinion on the matter and generally did so only when the subject was first raised with him. At his death, Washington's extensive library included at least seventeen publications on slavery. Six of them had been collated into an expensively bound volume titled Tracts on Slavery, indicating that he attached some importance to that selection. Five of the six were published in or after 1788. All six shared common themes that slaves first had to be educated about the obligations of liberty before they could be emancipated, a belief Washington is reported to have expressed himself in 1798, and that abolition should be realized by a gradual legislative process, an idea that began to appear in Washington's correspondence during the Confederation period.

Washington was not impressed by what Dorothy Twohig – a former editor-in-chief of The Washington Papers – described as the "imperious demands" and "evangelical piety" of Quaker efforts to advance abolition, and in 1786 he complained about their "tamper[ing] with & seduc[ing]" slaves who "are happy & content to remain with their present masters". Only the most radical of abolitionists called for immediate emancipation. The disruption to the labor market and the care of the elderly and infirm would have created enormous problems. Large numbers of unemployed poor, of whatever color, was a cause for concern in 18th-century America, to the extent that expulsion and foreign resettlement was often part of the discourse on emancipation. A sudden end to slavery would also have caused a significant financial loss to slaveowners whose human property represented a valuable asset. Gradual emancipation was seen as a way of mitigating such a loss and reducing opposition from those with a financial self-interest in maintaining slavery.

In 1783, Lafayette proposed a joint venture to establish an experimental settlement for freed slaves which, with Washington's example, "might render it a general practise", but Washington demurred. As Lafayette forged ahead with his plan, Washington offered encouragement but expressed concern in 1786 about "much inconvenience and mischief" an abrupt emancipation might generate, and he gave no tangible support to the idea.

Washington expressed support for emancipation legislation to prominent Methodists Thomas Coke and Francis Asbury in 1785, but declined to sign their petition which (as Coke put it) asked "the General Assembly of Virginia, to pass a law for the immediate or gradual emancipation of all the slaves". Washington privately conveyed his support for such legislation to most of the great men of Virginia, and promised to comment publicly on the matter by letter to the Virginia Assembly if the Assembly would begin serious deliberation about the Methodists' petition. The historian Lacy Ford writes that Washington may have dissembled: "In all likelihood, Washington was honest about his general desire for gradual emancipation but dissembled about his willingness to speak publicly on its behalf; the Mount Vernon master almost certainly reasoned that the legislature would table the petition immediately and thus release him from any obligation to comment publicly on the matter." The measure was rejected without any dissent in the Virginia House of Delegates, because abolitionist legislators quickly backed down rather than suffer inevitable defeat. Washington wrote in despair to Lafayette: "Some petitions were presented to the Assembly at its last session for the abolition of slavery, but they could scarce obtain a reading." James Thomas Flexner’s interpretation is somewhat different from Lacy Ford’s: "Washington was willing to back publicly the Methodists' petition for gradual emancipation if the proposal showed the slightest possibility of being given consideration by the Virginia legislature." Flexner adds that, if Washington had been more audacious in pursuing emancipation in Virginia, then "he undoubtedly would have failed to achieve the end of slavery, and he would certainly have made impossible the role he played in the Constitutional Convention and the Presidency."

Henriques identifies Washington's concern for the judgement of posterity as a significant factor in Washington's thinking on slavery, writing, "No man had a greater desire for secular immortality, and [Washington] understood that his place in history would be tarnished by his ownership of slaves." Philip Morgan similarly identifies the importance of Washington's driving ambition for fame and public respect as a man of honor; in December 1785, the Quaker and fellow Virginian Robert Pleasants "[hit] Washington where it hurt most", Morgan writes, when he told Washington that to remain a slaveholder would forever tarnish his reputation. In correspondence the next year with Maryland politician John Francis Mercer, Washington expressed "great repugnance" at buying slaves, stated that he would not buy any more "unless some peculiar circumstances should compel me to it" and made clear his desire to see the institution of slavery ended by a gradual legislative process. He expressed his support for abolitionist legislation privately, but widely, sharing those views with leading Virginians, and with other leaders including Mercer and founding father Robert Morris of Pennsylvania to whom Washington wrote:

I can only say that there is not a man living who wishes more sincerely than I do, to see a plan adopted for the abolition of it – but there is only one proper and effectual mode by which it can be accomplished, and that is by Legislative authority: and this, as far as my suffrage will go, shall never be wanting.

Washington still needed labor to work his farms, and there was little alternative to slavery. Hired labor south of Pennsylvania was scarce and expensive, and the Revolution had cut off the supply of indentured servants and convict labor from Great Britain. Washington significantly reduced his slave purchases after the war, though it is not clear whether this was a moral or practical decision; he repeatedly stated that his inventory and its potential progeny were adequate for his current and foreseeable needs. Nevertheless, he negotiated with John Mercer to accept six slaves in payment of a debt in 1786 and expressed to Henry Lee a desire to purchase a bricklayer the next year. In 1788, Washington acquired thirty-three slaves from the estate of Bartholomew Dandridge in settlement of a debt and left them with Dandridge's widow on her estate at Pamocra, New Kent County, Virginia. Later the same year, he declined a suggestion from the leading French abolitionist Jacques Brissot to form and become president of an abolitionist society in Virginia, stating that although he was in favor of such a society and would support it, the time was not yet right to confront the issue. Historian James Flexner has written that, generally speaking, "Washington limited himself to stating that, if an authentic movement toward emancipation could be started in Virginia, he would spring to its support. No such movement could be started."

Creation of the U.S. Constitution

Washington presided over the Constitutional Convention in 1787, during which it became obvious how explosive the slavery issue was, and how willing the antislavery faction was to accept the preservation of this oppressive institution to ensure national unity and the establishment of a strong federal government. The Constitution allowed but did not require the preservation of slavery, and it deliberately avoided use of the word "slave" which could have been interpreted as authorizing the treatment of human beings as property throughout the country. Each state was allowed to keep it, change it, or eliminate it as they wished, though Congress could make various policies that would affect this decision in each state. As of 1776, slavery was legal in all 13 colonies, but by Washington's death in December 1799 there were eight free states and nine slave states, and that split was considered entirely constitutional.

The support of the southern states for the new constitution was secured by granting them concessions that protected slavery, including the Fugitive Slave Clause, plus clauses that promised Congress would not prohibit the transatlantic slave trade for twenty years, and that empowered (but did not require) Congress to authorize suppression of insurrections such as slave rebellions. The Constitution also included the Three-Fifths Compromise which cut both ways: for purposes of taxation and representation, three out of every five slaves would be counted, which meant that each slave state would have to pay less taxes but would also have less representation in Congress than if every slave was counted. After the convention, Washington's support was critical for getting the states to ratify the document.

Presidential years

The unfortunate condition of the persons, whose labour in part I employed, has been the only unavoidable subject of regret. To make the Adults among them as easy & as comfortable in their circumstances as their actual state of ignorance & improvidence would admit; & to lay a foundation to prepare the rising generation for a destiny different from that in which they were born; afforded some satisfaction to my mind, & could not I hoped be displeasing to the justice of the Creator.

Statement attributed to George Washington that appears in the notebook of David Humphreys, c.1788/1789[212]

Washington's preeminent position ensured that any actions he took with regard to his own slaves would become a statement in a national debate about slavery that threatened to divide the country. Wiencek suggests Washington considered making precisely such a statement on taking up the presidency in 1789. A passage in the notebook of Washington's biographer David Humphreys[m] dated to late 1788 or early 1789 recorded a statement that resembled the emancipation clause in Washington's will a decade later. Wiencek argues the passage was a draft for a public announcement Washington was considering in which he would declare the emancipation of some of his slaves. It marks, Wiencek believes, a moral epiphany in Washington's thinking, the moment he decided not only to emancipate his slaves but also to use the occasion to set the example Lafayette had urged in 1783.[214] Other historians dispute Wiencek's conclusion; Henriques and Joseph Ellis concur with Philip Morgan's opinion that Washington experienced no epiphanies in a "long and hard-headed struggle" in which there was no single turning point. Morgan argues that Humphreys' passage is the "private expression of remorse" from a man unable to extricate himself from the "tangled web" of "mutual dependency" on slavery, and that Washington believed public comment on such a divisive subject was best avoided for the sake of national unity.

As president

Portrait painting
President George Washington by Gilbert Stuart (1795)

Washington took up the presidency at a time when revolutionary sentiment against slavery was giving way to a resurgence of proslavery interests. No state considered making slavery an issue during the ratification of the new constitution, southern states reinforced their slavery legislation and prominent antislavery figures were muted about the issue in public. Washington understood there was little widespread organized support for abolition. He had a keen sense both of the fragility of the fledgling Republic and of his place as a unifying figure, and he was determined not to endanger either by confronting an issue as divisive and entrenched as slavery.

He was president of a government that provided materiel and financial support for French efforts to suppress the Saint Domingue slave revolt in 1791, and which also implemented the proslavery Fugitive Slave Act of 1793. The Fugitive Slave Act gave effect to the Constitution's Fugitive Slave Clause, the Act was passed overwhelmingly in Congress (e.g. the vote was 48 to 7 in the House), it was then signed by Washington, and the Act was decried by free blacks who believed it would allow bounty hunting and kidnapping.

On the anti-slavery side of the ledger, in 1789 Washington signed a reenactment of the Northwest Ordinance which freed all new slaves brought after 1787 into a vast expanse of federal territory north of the Ohio River, except for slaves escaping from slave states. Washington also signed into law the Slave Trade Act of 1794 that banned the involvement of American ships and American exporters in the international slave trade. Moreover, according to Washington biographer James Thomas Flexner, Washington as President weakened slavery by favoring Hamilton's economic plans over Jefferson's agrarian economics.

Washington never spoke publicly on the issue of slavery during his eight years as president, nor did he respond to, much less act upon, any of the antislavery petitions he received. He described a 1790 Quaker petition to Congress urging an immediate end to the slave trade as "an illjudged piece of business" that "occasioned a great waste of time", although historian Paul F. Boller has observed that Congress extensively debated that petition only to conclude it had no power to do anything about it, so "The Quaker Memorial may have been a waste of time so far as immediate practical results were concerned."

Late in his presidency, Washington told his Secretary of State, Edmund Randolph, that in the event of a confrontation between North and South, he had "made up his mind to remove and be of the Northern" (i.e. leave Virginia and move up north). In 1798, he imagined just such a conflict when he said, "I can clearly foresee that nothing but the rooting out of slavery can perpetuate the existence of our union." But there is no indication Washington ever favored an immediate rather than gradual end to slavery. His abolitionist aspirations for the nation centered around the hope that slavery would disappear naturally over time with the prohibition of slave imports in 1808, the earliest date such legislation could be passed as agreed at the Constitutional Convention. Indeed, the dying out of slavery remained possible, until Eli Whitney invented the cotton gin in 1793 which led within five years to a vastly greater demand for slave labor.

As Virginia farmer

As well as political caution, economic imperatives remained an important consideration with regard to Washington's personal position as a slaveholder and his efforts to free himself from his dependency on slavery. He was one of the largest debtors in Virginia at the end of the war, and by 1787 the business at Mount Vernon had failed to make a profit for more than a decade. Persistently poor crop yields due to pestilence and poor weather, the cost of renovations at his Mount Vernon residence, the expense of entertaining a constant stream of visitors, the failure of Lund to collect rent from Washington's tenant farmers and wartime depreciation all helped to make Washington cash poor.

It is demonstrably clear that on this Estate I have more working Negroes by a full moiety, than can be employed to any advantage in the farming system; and I shall never turn to Planter thereon...To sell the surplus I cannot, because I am principled against this kind of traffic in the human species...

George Washington to Robert Lewis, August 17, 1799

The overheads of maintaining a surplus of slaves, including the care of the young and elderly, made a substantial contribution to his financial difficulties. In 1786, the ratio of productive to non-productive slaves was approaching 1:1, and the c. 7,300-acre (3,000 ha) Mount Vernon estate was being operated with 122 working slaves. Although the ratio had improved by 1799 to around 2:1, the Mount Vernon estate had grown by only 10 percent to some 8,000 acres (3,200 ha) while the working slave population had grown by 65 percent to 201. It was a trend that threatened to bankrupt Washington. The slaves Washington had bought early in the development of his business were beyond their prime and nearly impossible to sell, and from 1782 Virginia law made slaveowners liable for the financial support of slaves they freed who were too young, too old or otherwise incapable of working.

During his second term, Washington began planning for a retirement that would provide him "tranquillity with a certain income". In December 1793, he sought the aid of the British agriculturalist Arthur Young in finding farmers to whom he would lease all but one of his farms, on which his slaves would then be employed as laborers. The next year, he instructed his secretary Tobias Lear to sell his western lands, ostensibly to consolidate his operations and put his financial affairs in order. Washington concluded his instructions to Lear with a private passage in which he expressed repugnance at owning slaves and declared that the principal reason for selling the land was to raise the finances that would allow him to liberate them. It is the first clear indication that Washington's thinking had shifted from selling his slaves to freeing them. In November the same year (1794), Washington declared in a letter to his friend and neighbor Alexander Spotswood: "Were it not then, that I am principled agt. [sic] selling Negroes, as you would Cattle in the market, I would not, in twelve months from this date, be possessed of one as a slave."

In 1795 and 1796, Washington devised a complicated plan that involved renting out his western lands to tenant farmers to whom he would lease his own slaves, and a similar scheme to lease the dower slaves he controlled to Dr. David Stuart for work on Stuart's Eastern Shore plantation. This plan would have involved breaking up slave families, but it was designed with an end goal of raising enough finances to fund their eventual emancipation (a detail Washington kept secret) and prevent the Custis heirs from permanently splitting up families by sale.

None of these schemes could be realized because of his failure to sell or rent land at the right prices, the refusal of the Custis heirs to agree to them and his own reluctance to separate families. Wiencek speculates that, because Washington gave such serious consideration to freeing his slaves knowing full well the political ramifications that would follow, one of his goals was to make a public statement that would sway opinion towards abolition. Philip Morgan argues that Washington freeing his slaves while President in 1794 or 1796 would have had no profound effect, and would have been greeted with public silence and private derision by white southerners.

Wiencek writes that if Washington had found buyers for his land at what seemed like a fair price, this plan would have ultimately freed "both his own and the slaves controlled by Martha’s family", and to accomplish this goal Washington would "yield up his most valuable remaining asset, his western lands, the wherewithal for his retirement." Ellis concludes that Washington prioritized his own financial security over the freedom of the enslaved population under his control, and writes, on Washington's failure to sell the land at prices he thought fair, "He had spent a lifetime acquiring an impressive estate, and he was extremely reluctant to give it up except on his terms." In discussing another of Washington's plans, drawn up after he had written his will, to transfer enslaved workers to his estates in western Virginia, Philip Morgan writes, "Indisputably, then, even on the eve of his death, Washington was far from giving up on slavery. To the last, he was committed to making profits, even at the expense of the disruptions such transfers would indisputably have wrought on his slaves."

As Washington subordinated his desire for emancipation to his efforts to secure financial independence, he took care to retain his slaves. From 1791, he arranged for those who served in his personal retinue in Philadelphia while he was President to be rotated out of the state before they became eligible for emancipation after six months residence per Pennsylvanian law. Not only would Washington have been deprived of their services if they were freed, most of the slaves he took with him to Philadelphia were dower slaves, which meant that he would have had to compensate the Custis estate for the loss. Because of his concerns for his public image and that the prospect of emancipation would generate discontent among the slaves before they became eligible for emancipation, he instructed that they be shuffled back to Mount Vernon "under pretext that may deceive both them and the Public".

Washington spared no expense in efforts to recover Hercules and Judge when they absconded. In Judge's case, Washington persisted for three years. He tried to persuade her to return when his agent eventually tracked her to New Hampshire, but refused to promise her freedom after his death; "However well disposed I might be to a gradual emancipation", he said, "or even to an entire emancipation of that description of People (if the latter was in itself practicable at this moment) it would neither be politic or just to reward unfaithfulness with a premature preference". Both Hercules and Judge eluded capture. Washington's search for a new chef to replace Hercules in 1797 is the last known instance in which he considered buying a slave, despite his resolve "never to become the Master of another Slave by purchase"; in the end he chose to hire a white chef.

Attitude to race

The Washington Family, printed and engraved by Edward Savage in the 1790s, George and Martha are seated, their children by her first marriage had already died, they were raising these grandchildren, Washy and Nelly, and the servant may be the enslaved Christopher Sheels

Historian Joseph Ellis writes that Washington did not favor the continuation of legal slavery, and adds "[n]or did he ever embrace the racial arguments for black inferiority that Jefferson advanced....He saw slavery as the culprit, preventing the development of diligence and responsibility that would emerge gradually and naturally after emancipation." Other historians, such as Stuart Leibinger, agree with Ellis that, "Unlike Jefferson, Washington and Madison rejected innate black inferiority...."

The historian James Thomas Flexner says that the charge of racism has come from historical revisionism and lack of investigation. Flexner has pointed out that slavery was, "Not invented for blacks, the institution was as old as history and had not, when Washington was a child, been officially challenged anywhere."

Kenneth Morgan writes that, "Washington's engrained sense of racial superiority to African Americans did not lead to expressions of negrophobia...Yet Washington wanted his white workers to be housed away from the blacks at Mt. Vernon, believing that close racial intermixture was undesirable." According to historian Albert Tillson, one reason why enslaved black people were lodged separately at Mount Vernon is because Washington felt that some white workers had habits that were "not good" (e.g., Tillson mentions instances of "interracial drinking" in the Chesapeake area), and another reason is that, Tillson reports, Washington "expected such accommodations would eventually disgust the white family."

Philip Morgan writes that "The youthful Washington revealed prejudices toward blacks, quite natural for the day" and that "blackness, in his mind, was synonymous with uncivilized behaviour." Washington's prejudices were not hard and fast; his retention of African-Americans in the Virginia Regiment contrary to the rules, his employment of African-American overseers, his use of African-American doctors and his praise for the "great poetical Talents" of the African-American poet Phillis Wheatley, who had lauded him in a poem in 1775, show that he recognized the skills and talents of African-Americans. Historian Henry Wiencek rendered this judgment:

“If you look at Washington’s will, he’s not conflicted over the place of African Americans at all,” Wiencek said in an interview. “From one end of his papers to the other, I looked for some sense of racism and found none, unlike Jefferson, who’s explicit on his belief in the inferiority of Black people. In his will, Washington authored a bill of rights for Black people and said they should be taught to read and write. They were Americans, with the right to live here, to be educated, and to work productively as free people.”

The views of Martha Washington about slavery and race were different from her husband's, and were less favorable to African Americans. For example, she said in 1795 that, "The Blacks are so bad in their nature that they have not the least grat[i]tude for the kindness that may be shewed to them." She refused to follow the example he set by emancipating his slaves, and instead she bequeathed the only slave she directly owned (named Elish) to her grandson.

Posthumous emancipation

newspaper clipping
Washington's will published in the Connecticut Journal, February 20, 1800

In July 1799, five months before his death, Washington wrote his will, in which he stipulated that his slaves should be freed. In the months that followed, he considered a plan to repossess tenancies in Berkeley and Frederick Counties and transferring half of his Mount Vernon slaves to work them. It would, Washington hoped, "yield more nett profit" which might "benefit myself and not render the [slaves'] condition worse", despite the disruption such relocation would have had on the slave families. The plan died with Washington on December 14, 1799.

Washington's slaves were the subjects of the longest provisions in the 29-page will, taking three pages in which his instructions were more forceful than in the rest of the document. His valet, William Lee, was freed immediately and his remaining 123 slaves were to be emancipated on the death of Martha. The deferral was intended to postpone the pain of separation that would occur when his slaves were freed but their spouses among the dower slaves remained in bondage, a situation which affected 20 couples and their children. It is possible Washington hoped Martha and her heirs who would inherit the dower slaves would solve this problem by following his example and emancipating them. Those too old or infirm to work were to be supported by his estate, as mandated by state law. In the late 1790s, about half the enslaved population at Mount Vernon was too old, too young, or too infirm to be productive.

Washington went beyond the legal requirement to support and maintain younger slaves until adulthood, stipulating that those children whose education could not be undertaken by parents were to be taught reading, writing, and a useful trade by their masters and then be freed at the age of 25. He forbade the sale or transportation of any of his slaves out of Virginia before their emancipation. Including the Dandridge slaves, who were to be emancipated under similar terms, more than 160 slaves would be freed. Although Washington was not alone among Virginian slaveowners in freeing their slaves, he was unusual among those doing it for doing it so late, after the post-revolutionary support for emancipation in Virginia had faded. He was also unusual for being one of the few slaveowning founders to do so. Other founders who freed their slaves include John Dickinson and Caesar Rodney, both of Delaware.

Aftermath

Photograph
Slave burial ground memorial at Mount Vernon

Any hopes Washington may have had that his example and prestige would influence the thinking of others, including his own family, proved to be unfounded. His action was ignored by southern slaveholders, and slavery continued at Mount Vernon. Already from 1795, dower slaves were being transferred to Martha's three granddaughters as the Custis heirs married. Martha felt threatened by being surrounded with slaves whose freedom depended on her death and freed her late husband's slaves on January 1, 1801.

Able-bodied slaves were freed and left to support themselves and their families. Within a few months, almost all of Washington's former slaves had left Mount Vernon, leaving 121 adult and working-age children still working the estate. Five freedwomen were listed as remaining: an unmarried mother of two children; two women, one of them with three children, married to Washington slaves too old to work; and two women who were married to dower slaves. William Lee remained at Mount Vernon, where he worked as a shoemaker. After Martha's death on May 22, 1802, most of the remaining dower slaves passed to her grandson, George Washington Parke Custis, to whom she bequeathed the only slave she held in her own name.

There are few records of how the newly freed slaves fared. Custis later wrote that "although many of them, with a view to their liberation, had been instructed in mechanic trades, yet they succeeded very badly as freemen; so true is the axiom, 'that the hour which makes man a slave, takes half his worth away'". The son-in-law of Custis's sister wrote in 1853 that the descendants of those who remained slaves, many of them now in his possession, had been "prosperous, contented and happy", while those who had been freed had led a life of "vice, dissipation and idleness" and had, in their "sickness, age and poverty", become a burden to his in-laws. Such reports were influenced by the innate racism of the well-educated, upper-class authors and ignored the social and legal impediments that prejudiced the chances of prosperity for former slaves, which included laws that made it illegal to teach freedpeople to read and write and, in 1806, required newly freed slaves to leave the state.

There is evidence that some of Washington's former slaves were able to buy land, support their families and prosper as free people. By 1812, Free Town in Truro Parish, the earliest known free African-American settlement in Fairfax County, contained seven households of former Washington slaves. By the mid 1800s, a son of Washington's carpenter Davy Jones and two grandsons of his postilion Joe Richardson had each bought land in Virginia. Francis Lee, younger brother of William, was well known and respected enough to have his obituary printed in the Alexandria Gazette on his death at Mount Vernon in 1821. Sambo Anderson – who hunted game, as he had while Washington's slave, and prospered for a while by selling it to the most respectable families in Alexandria – was similarly noted by the Gazette when he died near Mount Vernon in 1845. Research published in 2019 has concluded that Hercules worked as a cook in New York, where he died on May 15, 1812.

A decade after Washington's death, the Pennsylvanian jurist Richard Peters wrote that Washington's servants "were devoted to him; and especially those more immediately about his person. The survivors of them still venerate and adore his memory." In his old age, Anderson said he was "a much happier man when he was a slave than he had ever been since", because he then "had a good kind master to look after all my wants, but now I have no one to care for me". When Judge was interviewed in the 1840s, she expressed considerable bitterness, not at the way she he had been treated as a slave, but at the fact that she had been enslaved. When asked, having experienced the hardships of being a freewoman and having outlived both husband and children, whether she regretted her escape, she replied, "No, I am free, and have, I trust, been made a child of God by [that] means."

Political legacy

Washington's will was both private testament and public statement on the institution. It was published widely – in newspapers nationwide, as a pamphlet which, in 1800 alone, extended to thirteen separate editions, and included in other works – and became part of the nationalist narrative. In the eulogies of the antislavery faction, the inconvenient fact of Washington's slaveholding was downplayed in favor of his final act of emancipation. Washington "disdained to hold his fellow-creatures in abject domestic servitude," wrote the Massachusetts Federalist Timothy Bigelow before calling on "fellow-citizens in the South" to emulate Washington's example. In this narrative, Washington was a proto-abolitionist who, having added the freedom of his slaves to the freedom from British slavery he had won for the nation, would be mobilized to serve the antislavery cause.

An alternative narrative more in line with proslavery sentiments embraced rather than excised Washington's ownership of slaves. Washington was cast as a paternal figure, the benevolent father not only of his country but also of a family of slaves bound to him by affection rather than coercion. In this narrative, slaves idolized Washington and wept at his deathbed, and in an 1807 biography, Aaron Bancroft wrote, "In domestick [sic] and private life, he blended the authority of the master with the care and kindness of the guardian and friend." The competing narratives allowed both North and South to claim Washington as the father of their countries during the American Civil War that ended slavery more than half a century after his death.

There is tension between Washington's stance on slavery, and his broader historical role as a proponent of liberty. He was a slaveholder who led a war for liberty, and then led the establishment of a national government that secured liberty for many of its citizens, and historians have considered this a paradox. The historian Edmund Sears Morgan explained that Washington was not alone in this regard: "Virginia produced the most eloquent spokesmen for freedom and equality in the entire United States: George Washington, James Madison, and, above all, Thomas Jefferson. They were all slaveholders and remained so throughout their lives." Washington recognized this paradox, rejected the notion of black inferiority, and was somewhat more humane than other slaveowners, but failed to publicly become an active supporter of emancipation laws due to Washington's fears of disunion, the racism of many other Virginians, the problem of compensating owners, slaves' lack of education, and the unwillingness of Virginia’s leaders to seriously consider such a step.

Memorial

In 1929, a plaque was embedded in the ground at Mount Vernon less than 50 yards (45 m) from the crypt housing the remains of Washington and Martha, marking a plot neglected by both groundsmen and tourist guides where slaves had been buried in unmarked graves. The inscription read, "In memory of the many faithful colored servants of the Washington family, buried at Mount Vernon from 1760 to 1860. Their unidentified graves surround this spot." The site remained untended and ignored in the visitor literature until the Mount Vernon Ladies' Association erected a more prominent monument surrounded with plantings and inscribed, "In memory of the Afro Americans who served as slaves at Mount Vernon this monument marking their burial ground dedicated September 21, 1983." In 1985, a ground-penetrating radar survey identified sixty-six possible burials. As of late 2017, an archaeological project begun in 2014 has identified, without disturbing the contents, sixty-three burial plots in addition to seven plots known before the project began.

 

Acute coronary syndrome

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Acute coronary syndrome
Heart attack diagram.png
Blockage of a coronary artery
SpecialtyCardiology

Acute coronary syndrome (ACS) is a syndrome (a set of signs and symptoms) due to decreased blood flow in the coronary arteries such that part of the heart muscle is unable to function properly or dies. The most common symptom is centrally located chest pain, often radiating to the left shoulder or angle of the jaw, crushing, central and associated with nausea and sweating. Many people with acute coronary syndromes present with symptoms other than chest pain, particularly women, older patients, and patients with diabetes mellitus.

Acute coronary syndrome is subdivided in three scenarios depending on the duration of symptoms, the presence of ECG changes and blood test results: ST elevation myocardial infarction (STEMI, 30%), non-ST elevation myocardial infarction (NSTEMI, 25%), or unstable angina (38%). Generally, when symptoms occur for less than 30 minutes, it is unstable angina. When symptoms are prolonged for more than 30 minutes, the diagnosis is acute myocardial infarction.

ACS should be distinguished from stable angina, which develops during physical activity or stress and resolves at rest. In contrast with stable angina, unstable angina occurs suddenly, often at rest or with minimal exertion, or at lesser degrees of exertion than the individual's previous angina ("crescendo angina"). New-onset angina is also considered unstable angina, since it suggests a new problem in a coronary artery.

Signs and symptoms

The cardinal symptom of critically decreased blood flow to the heart is chest pain, experienced as tightness around or over the chest and (often, but not always) radiating to the left arm and the left angle of the jaw. This may be associated with diaphoresis (sweating), nausea and vomiting, as well as shortness of breath. In many cases, the sensation is "atypical", with pain experienced in different ways or even being completely absent (which is more likely in female patients and those with diabetes). Some may report palpitations, anxiety or a sense of impending doom (angor animi) and a feeling of being acutely ill. The description of the chest discomfort as a pressure has little utility in aiding a diagnosis as it is not specific for ACS.

Though ACS is usually associated with coronary thrombosis, it can also be associated with cocaine use. Chest pain with features characteristic of cardiac origin (angina) can also be precipitated by profound anemia, brady- or tachycardia (excessively slow or rapid heart rate), low or high blood pressure, severe aortic valve stenosis (narrowing of the valve at the beginning of the aorta), pulmonary artery hypertension and a number of other conditions.

Pathophysiology

In those who have ACS, atheroma rupture is most commonly found 60% when compared to atheroma erosion (30%), thus causes the formation of thrombus which block the coronary arteries. Plaque rupture is responsible for 60% in ST elevated myocardial infarction (STEMI) while plaque erosion is responsible for 30% of the STEMI and vice versa for Non ST elevated myocardial infarction (NSTEMI). In plaque rupture, the content of the plaque are lipid rich, collagen poor, with abundant inflammation which is macrophage predominant, and covered with a thin fibrous cap. Meanwhile, in plaque erosion, the plaque is rich with extracellular matrix, proteoglycan, glycoaminoglycan, but without fibrous caps, no inflammatory cells, and no large lipid core. After the coronary arteries are unblocked, there is a risk of reperfusion injury due spreading inflammatory mediators throughout the body. Investigations is still underway on the role of Cyclophilin D in reducing the reperfusion injury. Other causes of acute coronary syndrome include spontaneous coronary artery dissection  and myocardial infarction in the absence of obstructive coronary artery disease (MINOCA), however these are far less common.

Diagnosis

Classification of acute coronary syndromes.

Electrocardiogram

In the setting of acute chest pain, the electrocardiogram is the investigation that most reliably distinguishes between various causes. The ECG should be done as early as practicable, including in the ambulance if possible. If this indicates acute heart damage (elevation in the ST segment, new left bundle branch block), treatment for a heart attack in the form of angioplasty or thrombolysis is indicated immediately (see below). In the absence of such changes, it is not possible to immediately distinguish between unstable angina and NSTEMI.

Imaging and blood tests

As it is only one of the many potential causes of chest pain, the patient usually has a number of tests in the emergency department, such as a chest X-ray, blood tests (including myocardial markers such as troponin I or T, and H-FABP and/or a D-dimer if a pulmonary embolism is suspected), and telemetry (monitoring of the heart rhythm).

Combination of troponin levels (less than 5 ng/l) with low TIMI scores can help to predict those with low possibility of myocardial infarction and discharge them safely from the emergency department. Coronary CT angiography combined with Troponin levels is also helpful to triage those who are susceptible to ACS. F-fluoride positron emission tomography is also helpful in identifying those with high risk, lipid-rich coronary plaques.

Prediction scores

The ACI-TIPI score can be used to aid diagnosis; using seven variables from the admission record, this score predicts crudely which patients are likely to have myocardial ischemia. For example, according to a randomized controlled trial, males having chest pain with normal or non-diagnostic ECG are at higher risk for having acute coronary syndrome than women. In this study, the sensitivity was 65.2% and specificity was 44%. This particular study had an 8.4% prevalence of acute coronary syndrome, which means the positive predictive value of being a male with chest pain and having coronary syndrome is 9.6% and negative predictive value is 93.2% ( click here to adjust these results for patients at higher or lower risk of acute coronary syndrome). In a second cohort study, exercise electrocardiography was similarly found to be a poor predictor of acute coronary syndrome at follow-up. Of the patients who had a coronary event at 6 years of follow up, 47% had a negative ECG at the start of the study. With an average follow up of 2.21 years the receiver operating characteristic curves gave resting ECG a score of 0.72 and exercise ECG a score of 0.74.

There are not only prediction scores for diagnosis of ACS, but also prognosis. Most notably, the GRACE ACS Risk and Mortality score helps diagnose, and based upon that score predicts mortality rate of a given patient. It takes into account both clinical (blood pressure, heart rate, EKG findings) and medical history in its scoring system.

Prevention

Acute coronary syndrome often reflects a degree of damage to the coronaries by atherosclerosis. Primary prevention of atherosclerosis is controlling the risk factors: healthy eating, exercise, treatment for hypertension and diabetes, avoiding smoking and controlling cholesterol levels; in patients with significant risk factors, aspirin has been shown to reduce the risk of cardiovascular events. Secondary prevention is discussed in myocardial infarction.

After a ban on smoking in all enclosed public places was introduced in Scotland in March 2006, there was a 17% reduction in hospital admissions for acute coronary syndrome. 67% of the decrease occurred in non-smokers.

Treatment

People with presumed ACS are typically treated with aspirin, clopidogrel or ticagrelor, nitroglycerin, and if the chest discomfort persists morphine. Other analgesics such as nitrous oxide are of unknown benefit. Angiography is recommended in those who have either new ST elevation or a new left or right bundle branch block on their ECG. Unless the person has low oxygen levels additional oxygen does not appear to be useful.

STEMI

If the ECG confirms changes suggestive of myocardial infarction (ST elevations in specific leads, a new left bundle branch block or a true posterior MI pattern), thrombolytics may be administered or primary coronary angioplasty may be performed. In the former, medication is injected that stimulates fibrinolysis, destroying blood clots obstructing the coronary arteries. In the latter, a flexible catheter is passed via the femoral or radial arteries and advanced to the heart to identify blockages in the coronaries. When occlusions are found, they can be intervened upon mechanically with angioplasty and usually stent deployment if a lesion, termed the culprit lesion, is thought to be causing myocardial damage. Data suggest that rapid triage, transfer and treatment is essential. The time frame for door-to-needle thrombolytic administration according to American College of Cardiology (ACC) guidelines should be within 30 minutes, whereas the door-to-balloon Percutaneous Coronary Intervention (PCI) time should be less than 90 minutes. It was found that thrombolysis is more likely to be delivered within the established ACC guidelines among patients with STEMI as compared to PCI according to a case control study.

NSTEMI and NSTE-ACS

If the ECG does not show typical changes, the term "non-ST segment elevation ACS" is applied. The patient may still have suffered a "non-ST elevation MI" (NSTEMI). The accepted management of unstable angina and acute coronary syndrome is therefore empirical treatment with aspirin, a second platelet inhibitor such as clopidogrel, prasugrel or ticagrelor, and heparin (usually a low-molecular weight heparin), with intravenous nitroglycerin and opioids if the pain persists. The heparin-like drug known as fondaparinux appears to be better than enoxaparin.

A blood test is generally performed for cardiac troponins twelve hours after onset of the pain. If this is positive, coronary angiography is typically performed on an urgent basis, as this is highly predictive of a heart attack in the near-future. If the troponin is negative, a treadmill exercise test or a thallium scintigram may be requested.

If there is no evidence of ST segment elevation on the electrocardiogram, delaying urgent angioplasty until the next morning is not inferior to doing so immediately. Using statins in the first 14 days after ACS reduces the risk of further ACS.

In a cohort study comparing NSTEMI and STEMI, people with NSTEMI had a similar risk of death at one year after PCI as compared to people with STEMI (3.4% vs 4.4%). However, NSTEMI had significantly more "major cardiac events" (death, myocardial infarction, disabling stroke, or requiring revascularization) at one year (24.0% vs 16.6%).

Cocaine-associated ACS should be managed in a manner similar to other patients with acute coronary syndrome except beta blockers should not be used and benzodiazepines should be administered early.

Prognosis

TIMI score

The TIMI risk score can identify high risk patients in non-ST segment elevation MI ACS and has been independently validated.

Global Registry of Acute Coronary Events (GRACE) score

Based on a global registry of 102,341 patients, the GRACE Risk Score estimates in-hospital, 6 months, 1 year, and 3-year mortality risk after a heart attack. GRACE Score 2.0 Calculator.

Killip class

The Killip classification consists of 4 classes based on clinical symptoms. It predicts 30-day mortality after myocardial infarction.

Biomarkers for diagnosis

The aim of diagnostic markers is to identify patients with ACS even when there is no evidence of heart muscle damage.

  • Ischemia-Modified Albumin (IMA) – In cases of Ischemia – Albumin undergoes a conformational change and loses its ability to bind transitional metals (copper or cobalt). IMA can be used to assess the proportion of modified albumin in ischemia. Its use is limited to ruling out ischemia rather than a diagnostic test for the occurrence of ischemia.
  • Myeloperoxidase (MPO) – The levels of circulating MPO, a leukocyte enzyme, elevate early after ACS and can be used as an early marker for the condition.
  • Glycogen Phosphorylase Isoenzyme BB-(GPBB) is an early marker of cardiac ischemia and is one of three isoenzyme of Glycogen Phosphorylase.
  • Troponin is a late cardiac marker of ACS

Biomarkers for risk determination

The aim of prognostic markers is to reflect different components of pathophysiology of ACS. For example:

  • Natriuretic peptide – Both B-type natriuretic peptide (BNP) and N-terminal Pro BNP can be applied to predict the risk of death and heart failure following ACS.
  • Monocyte chemo attractive protein (MCP)-1 – has been shown in a number of studies to identify patients with a higher risk of adverse outcomes after ACS.

Day of admission

Studies have shown that for ACS patients, weekend admission is associated with higher mortality and lower utilization of invasive cardiac procedures, and those who did undergo these interventions had higher rates of mortality and complications than their weekday counterparts. This data leads to the possible conclusion that access to diagnostic/interventional procedures may be contingent upon the day of admission, which may impact mortality. This phenomenon is described as weekend effect.

Valvular heart disease

Valvular heart disease is characterized by damage to or defective in one of the four heart valves: the mitral, aortic, tricuspid or pulmonary. Some types of valvular heart disease include valvular stenosis, vascular prolapse and regurgitation.

Oral manifestations

Oral infections may pose risk during postoperative period of heart valve surgery. Oral health in patients scheduled for heart valve surgery is poorer than in individuals without valve disease. Most of them suffer periodontitis due to high dental plaque scores, reflecting poorer dental hygiene. This situation could favour the appearance of bacteremia following tooth brushing in these individuals. Bacteremia secondary to periodontal infection is known to be one of the primary causes of infectious endocarditis, particularly in patient with heart valve disorders. Therefore, treatment of dental disease should be done prior to performing heart surgery. Periodontal treatment is advised in patients with advanced periodontitis, followed by root planing and ultrasound treatment. Those teeth not amenable to treatment and with poor prognosis should be removed as pre-surgical preventive measures.

Dental management

The two main concerns during dental treatment for people of patient with valvular heart disease are the risk of infective endocarditis and bleeding in anti coagulated patients. Endocarditis is more likely to occur in patients who have previously had endocarditis and those with certain cardiac lesions. Risk of a normally functioning prosthesis being infected after a dental procedure is probably no higher than risk in patient with damaged native valves. However, mortality and morbidity is much higher should prosthesis become infected. Patient with native valve disease can often stop or reduce their anticoagulants, but those with prosthetic valves should not discontinue anticoagulants without cardiological advice. Mechanical mitral valves are prone to thrombosis, which cause emboli if adequate anti-coagulation is not maintained, although short term modification may be possible.

Heart failure

Heart failure (HF) is defined as the incapacity of the heart to function properly, pumping insufficient blood towards the tissues and leading to fluid accumulation within the lungs, liver and peripheral tissues.

Oral manifestations

    Most if not all patients with heart failure will be undergoing drug treatments for their condition and these drugs can produce a series of oral manifestation. In this context, angiotensin-converting enzyme (ACE) inhibitors such as captopril and enalapril can produce burning mouth sensation lichenoid reactions and a loss of taste sensation, while diuretics like furosemide can produce xerostomia.

Dental management

    Consultation with the supervising physician is highly advised in order to understand the patient's current condition and the medication prescribed. The patient should be receiving medical care, and heart failure should be compensated. Dental treatment is to be limited to patients who are in stable condition, since these people are at a high risk of developing questionable arrhythmias and even sudden death secondary to cardiopulmonary arrest. Stress and anxiety are to be avoided during the visits, which in turn should be brief (< 30 minutes) and are to be scheduled for the morning sessions. The patient should be seated on the chair in a semi-supine position, with control of body movements (which should be slow), to avoid orthostatic hypotension. In patients who has been administered with digitalis agents (digoxin, methyl-digoxin), the vasoconstrictor dose should be limited to two anaesthetic carpules, since this drug combination can cause arrhythmias. Aspirin (acetylsalicylic acid) can lead to fluid and sodium retention, and therefore should not be prescribed in patients with heart failure.

In emergency (i.e., lung edema), after contacting the emergency service, the patient should be seated with the legs lowered, and receiving nasal oxygen at a rate of 4–6 liters/minute. Sublingual nitroglycerin tablets are indicated (0.4-0.8 mg), and the dose may be repeated every 5 or 10 minutes if blood pressure is maintained.

Arrhythmia

Arrhythmias are variations in normal heart rate due to cardiac rhythm, frequency or contraction disorders. The most common type of cardiac arrhythmia is atrial fibrillation.

Oral manifestations

Many anti-arrhythmic drugs have side effects such as gingival hyperplasia or xerostomia.

Dental management

Consultation with the supervising physician is also advised in order to understand the patient's current condition and the type of arrhythmia involved, as well as the medication prescribed. It must be checked that the patient uses the medication correctly. Stress and anxiety can be reduced with anxiolytics. Short visits in the morning are to be preferred. Patient monitoring, with recording of the pulse, is indicated before treatment. It is very important to limit the use of vasoconstrictor in local anesthesia, with no more than two carpules. The treatment planned should not be too long or complicated. Although modern pacemakers are more resistant to electromagnetic interferences, caution is required when using electrical devices like ultrasound and electric scalpels that might interfere with pacemakers – especially the older models, since such devices developed in the last 30 years are bipolar and are generally not affected by the small electromagnetic fields generated by dental equipment. It is therefore important to know the type of pacemaker, the degree of electromagnetic protection of the generator, and the nature of the arrhythmia. If arrhythmia develops during dental treatment, the procedure should be suspended, oxygen is to be given, and the patient vital signs are to be assessed: body temperature (normal values: 35.5-37oC), pulse (normal values: 60-100 bpm), respiratory frequency (normal values in adults: 14-20 cycles or respirations per minute), blood pressure (normal values: systolic blood pressure under 140 mmHg and diastolic blood pressure under 90 mmHg). Sublingual nitrites are to be administered if there is chest pain. The patient should be placed in the Trendelenburg position, with vagal maneuvering where necessary (valsalva maneuver, massage in the carotid pulse region). The dental team should be prepared for basic cardiopulmonary resuscitation and initiation of the emergency procedure for evacuation to a hospital centre, if necessary.

 

Apraxia of speech

From Wikipedia, the free encyclopedia
 
Apraxia of speech
Other namesVerbal apraxia, speech sound disorder, developmental speech sound disorder
SymptomsOral motor planning, speech delay

Apraxia of speech (AOS, also called verbal apraxia) is a speech sound disorder affecting an individual's ability to translate conscious speech plans into motor plans, which results in limited and difficult speech ability. By the definition of apraxia, AOS affects volitional (willful or purposeful) movement patterns, however AOS usually also affects automatic speech.

Individuals with AOS have difficulty connecting speech messages from the brain to the mouth. AOS is a loss of prior speech ability resulting from a brain injury such as a stroke or progressive illness.

Developmental verbal dyspraxia (DVD), also known as childhood apraxia of speech (CAS) and developmental apraxia of speech (DAS), is an inability to utilize motor planning to perform movements necessary for speech during a child's language learning process. Although the causes differ between AOS and DVD, the main characteristics and treatments are similar.

Presentation

Apraxia of speech (AOS) is a neurogenic communication disorder affecting the motor programming system for speech production. Individuals with AOS demonstrate difficulty in speech production, specifically with sequencing and forming sounds. The Levelt model describes the speech production process in the following three consecutive stages: conceptualization, formulation, and articulation. According to the Levelt model, apraxia of speech would fall into the articulation region. The individual does not suffer from a language deficiency, but has difficulty in the production of language in an audible manner. Notably, this difficulty is limited to vocal speech, and does not affect sign-language production. The individual knows exactly what they want to say, but there is a disruption in the part of the brain that sends the signal to the muscle for the specific movement. Individuals with acquired AOS demonstrate hallmark characteristics of articulation and prosody (rhythm, stress or intonation) errors. Coexisting characteristics may include groping and effortful speech production with self-correction, difficulty initiating speech, abnormal stress, intonation and rhythm errors, and inconsistency with articulation.

Wertz et al., (1984) describe the following five speech characteristics that an individual with apraxia of speech may exhibit:

Effortful trial and error with groping
Groping is when the mouth searches for the position needed to create a sound. When this trial and error process occurs, sounds may be held out longer, repeated or silently voiced. In some cases, an AOS sufferer may be able to produce certain sounds on their own, easily and unconsciously, but when prompted by another to produce the same sound the patient may grope with their lips, using volitional control (conscious awareness of the attempted speech movements), while struggling to produce the sound.
Self correction of errors
Patients are aware of their speech errors and can attempt to correct themselves. This can involve distorted consonants, vowels, and sound substitutions. People with AOS often have a much greater understanding of speech than they are able to express. This receptive ability allows them to attempt self correction.
Abnormal rhythm, stress and intonation
Sufferers of AOS present with prosodic errors which include irregular pitch, rate, and rhythm. This impaired prosody causes their speech to be: too slow or too fast and highly segmented (many pauses). An AOS speaker also stresses syllables incorrectly and in a monotone. As a result, the speech is often described as 'robotic'. When words are produced in a monotone with equal syllabic stress, a word such as 'tectonic' may sound like 'tec-ton-ic' as opposed to 'tec-TON-ic'. These patterns occur even though the speakers are aware of the prosodic patterns that should be used.
Inconsistent articulation errors on repeated speech productions of the same utterance
When producing the same utterance in different instances, a person with AOS may have difficulty using and maintaining the same articulation that was previously used for that utterance. On some days, people with AOS may have more errors, or seem to "lose" the ability to produce certain sounds for an amount of time. Articulation also becomes more difficult when a word or phrase requires an articulation adjustment, in which the lips and tongue must move in order to shift between sounds. For example, the word "baby" needs less mouth adjustment than the word "dog" requires, since producing "dog" requires two tongue/lips movements to articulate.
Difficulty initiating utterances
Producing utterances becomes a difficult task in patients with AOS, which results in various speech errors. The errors in completing a speech movement gesture may increase as the length of the utterance increases. Since multisyllabic words are difficult, those with AOS use simple syllables and a limited range of consonants and vowels.

Causes

Apraxia of speech can be caused by impairment to parts of the brain that control muscle movement and speech. However, identifying a particular region of the brain in which AOS always occurs has been controversial. Various patients with damage to left subcortical structures, regions of the insula, and Broca’s area have been diagnosed with AOS. Most commonly it is triggered by vascular lesions, but AOS can also arise due to tumors and trauma.

Acute apraxia of speech

Stroke-associated AOS is the most common form of acquired AOS, making up about 60% of all reported acquired AOS cases. This is one of the several possible disorders that can result from a stroke, but only about 11% of stroke cases involve this disorder. Brain damage to the neural connections, and especially the neural synapses, during the stroke can lead to acquired AOS. Most cases of stroke-associated AOS are minor, but in the most severe cases, all linguistic motor function can be lost and must be relearned. Since most with this form of AOS are at least fifty years old, few fully recover to their previous level of ability to produce speech.

Other disorders and injuries of the brain that can lead to AOS include (traumatic) dementia, progressive neurological disorders, and traumatic brain injury.

Progressive apraxia of speech

Recent research has established the existence of primary progressive apraxia of speech caused by neuroanatomic motor atrophy. For a long time, this disorder was not distinguished from other motor speech disorders such as dysarthria and in particular primary progressive aphasia. Many studies have been done trying to identify areas in the brain in which this particular disorder occurs or at least to show that it occurs in different areas of the brain than other disorders. One study observed 37 patients with neurodegenerative speech disorders to determine whether or not it is distinguishable from other disorders, and if so where in the brain it can be found. Using speech and language, neurological, neuropsychological and neuroimaging testing, the researchers came to the conclusion that PAS does exist and that it correlates to superior lateral premotor and supplementary motor atrophy. However, because PAS is such a rare and recently discovered disorder, many studies do not have enough subjects to observe to make data entirely conclusive.

Diagnosis

Apraxia of speech can be diagnosed by a speech language pathologist (SLP) through specific exams that measure oral mechanisms of speech. The oral mechanisms exam involves tasks such as pursing lips, blowing, licking lips, elevating the tongue, and also involves an examination of the mouth. A complete exam also involves observation of the patient eating and talking. SLPs do not agree on a specific set of characteristics that make up the apraxia of speech diagnosis, so any of the characteristics from the section above could be used to form a diagnosis. Patients may be asked to perform other daily tasks such as reading, writing, and conversing with others. In situations involving brain damage, an MRI brain scan also helps identify damaged areas of the brain.

A differential diagnosis must be used in order to rule out other similar or alternative disorders. Although disorders such as expressive aphasia, conduction aphasia, and dysarthria involve similar symptoms as apraxia of speech, the disorders must be distinguished in order to correctly treat the patients.[citation needed] While AOS involves the motor planning or processing stage of speech, aphasic disorders can involve other language processes.

According to Ziegler et al., this difficulty in diagnosis derives from the unknown causes and function of the disorder, making it hard to set definite parameters for AOS identification. Specifically, he explains that oral-facial apraxia, dysarthria, and aphasic phonological impairment are the three distinctly different disorders that cause individuals to display symptoms that are often similar to those of someone with AOS, and that these close relatives must be correctly ruled out by a Speech Language Pathologist before AOS can be given as a diagnosis. In this way, AOS is a diagnosis of exclusion, and is generally recognized when all other similar speech sound production disorders are eliminated.

Possible co-morbid aphasias

AOS and expressive aphasia (also known as Broca's aphasia) are commonly mistaken as the same disorder mainly because they often occur together in patients. Although both disorders present with symptoms such as a difficulty producing sounds due to damage in the language parts of the brain, they are not the same. The main difference between these disorders lies in the ability to comprehend spoken language; patients with apraxia are able to fully comprehend speech, while patients with aphasia are not always fully able to comprehend others' speech.

Conduction aphasia is another speech disorder that is similar to, but not the same as, apraxia of speech. Although patients who suffer from conduction aphasia have full comprehension of speech, as do AOS sufferers, there are differences between the two disorders. Patients with conduction aphasia are typically able to speak fluently, but they do not have the ability to repeat what they hear.

Similarly, dysarthria, another motor speech disorder, is characterized by difficulty articulating sounds. The difficulty in articulation does not occur due in planning the motor movement, as happens with AOS. Instead, dysarthria is caused by inability in or weakness of the muscles in the mouth, face, and respiratory system.

Management

In cases of acute AOS (stroke), spontaneous recovery may occur, in which previous speech abilities reappear on their own. All other cases of acquired AOS require a form of therapy; however the therapy varies with the individual needs of the patient. Typically, treatment involves one-on-one therapy with a speech language pathologist (SLP). For severe forms of AOS, therapy may involve multiple sessions per week, which is reduced with speech improvement. Another main theme in AOS treatment is the use of repetition in order to achieve a large number of target utterances, or desired speech usages.

There are various treatment techniques for AOS. One technique, called the Linguistic Approach, utilizes the rules for sounds and sequences. This approach focuses on the placement of the mouth in forming speech sounds. Another type of treatment is the Motor-Programming Approach, in which the motor movements necessary for speech are practiced. This technique utilizes a great amount of repetition in order to practice the sequences and transitions that are necessary in between production of sounds.

Research about the treatment of apraxia has revealed four main categories: articulatory-kinematic, rate/rhythm control, intersystemic facilitation/reorganization treatments, and alternative/augmentative communication.

  • Articulatory-kinematic treatments almost always require verbal production in order to bring about improvement of speech. One common technique for this is modeling or repetition in order to establish the desired speech behavior. Articulatory-kinematic treatments are based on the importance of patients to improve spatial and temporal aspects of speech production.
  • Rate and rhythm control treatments exist to improve errors in patients’ timing of speech, a common characteristic of Apraxia. These techniques often include an external source of control like metronomic pacing, for example, in repeated speech productions.
  • Intersystemic reorganization/facilitation techniques often involve physical body or limb gestural approaches to improve speech. Gestures are usually combined with verbalization. It is thought that limb gestures may improve the organization of speech production.
  • Finally, alternative and augmentative communication approaches to treatment of apraxia are highly individualized for each patient. However, they often involve a "comprehensive communication system" that may include "speech, a communication book aid, a spelling system, a drawing system, a gestural system, technologies, and informed speech partners".

One specific treatment method is referred to as PROMPT. This acronym stands for Prompts for Restructuring Oral Muscular Phonetic Targets, and takes a hands on multidimensional approach at treating speech production disorders. PROMPT therapists integrate physical-sensory, cognitive-linguistic, and social-emotional aspects of motor performance. The main focus is developing language interaction through this tactile-kinetic approach by using touch cues to facilitate the articulatory movements associated with individual phonemes, and eventually words.

One study describes the use of electropalatography (EPG) to treat a patient with severe acquired apraxia of speech. EPG is a computer-based tool for assessment and treatment of speech motor issues. The program allows patients to see the placement of articulators during speech production thus aiding them in attempting to correct errors. Originally after two years of speech therapy, the patient exhibited speech motor and production problems including problems with phonation, articulation, and resonance. This study showed that EPG therapy gave the patient valuable visual feedback to clarify speech movements that had been difficult for the patient to complete when given only auditory feedback.

While many studies are still exploring the various treatment methods, a few suggestions from ASHA for treating apraxia patients include the integration of objective treatment evidence, theoretical rationale, clinical knowledge and experience, and the needs and goals of the patient

History and terminology

The term apraxia was first defined by Hugo Karl Liepmann in 1908 as the "inability to perform voluntary acts despite preserved muscle strength." In 1969, Frederic L. Darley coined the term "apraxia of speech", replacing Liepmann's original term "apraxia of the glosso-labio-pharyngeal structures." Paul Broca had also identified this speech disorder in 1861, which he referred to as "aphemia": a disorder involving difficulty of articulation despite having intact language skills and muscular function.

The disorder is currently referred to as "apraxia of speech", but was also formerly termed "verbal dyspraxia". The term apraxia comes from the Greek root "praxis," meaning the performance of action or skilled movement. Adding the prefix "a", meaning absence, or "dys", meaning abnormal or difficult, to the root "praxis", both function to imply speech difficulties related to movement.

Research

Many researchers are investigating the characteristics of apraxia of speech and the most effective treatment methods. Below are a couple of the recent findings:

Sound Production Treatment: Articulatory-kinematic treatments have the strongest evidence of their use in treating Acquired Apraxia of Speech. These treatments use the facilitation of movement, positioning, timing, and articulators to improve speech production. Sound Production Treatment (SPT) is an articulatory-kinematic treatment that has received more research than many other methods. It combines modeling, repetition, minimal pair contrast, integral stimulation, articulatory placement cueing, and verbal feedback. It was developed to improve the articulation of targeted sounds in the mid-1990s. SPT shows consistent improvement of trained sounds in trained and untrained words. The best results occur with eight to ten exemplars of the targeted sound to promote generalization to untrained exemplars of trained sounds. In addition, maintenance effects are the strongest with 1–2 months post-treatment with sounds that reached high accuracy during treatment. Therefore, the termination of treatment should not be determined by performance criteria, and not by the number of sessions the client completes, in order to have the greatest long-term effects. While there are many parts of SPT that should receive further investigation, it can be expected that it will improve the production of targeted sounds for speakers with apraxia of Speech.

Repeated Practice & Rate/Rhythm Control Treatments: Julie Wambaugh’s research focuses on clinically applicable treatments for acquired apraxia of speech. She recently published an article examining the effects of repeated practice and rate/rhythm control on sound production accuracy. Wambaugh and colleagues studied the effects of such treatment for 10 individuals with acquired apraxia of speech. The results indicate that repeated practice treatment results in significant improvements in articulation for most clients. In addition, rate/rhythm control helped some clients, but not others. Thus, incorporating repeated practice treatment into therapy would likely help individuals with AOS.

Nuffield Dyspraxia Programme-3 (NDP-3) and Rapid Syllable Transition Treatment (ReST): A 2018 Cochrane review found that when delivered intensively both the NDP-3 and ReST may effect improvement in word accuracy in 4 - 12 year old children with CAS.

 

Classical radicalism

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