The health and controversial death of George Washington - Brief Article

Ear, Nose & Throat Journal, Feb, 2001 by Charles B. Witt Jr.

George Washington was born on Feb. 22, 1732, in Westmoreland County, Va. He died of a larynx-related illness in Mount Vernon, Va., on Dec. 14, 1799, at age 67, nearly 3 years after completing his second term as President.

Assume that medical practice in George Washington's day had paralleled that of the 21st century. Washington's physician would have had his medical records on file, complete with his personal and family history, physical examination findings, and test results. Such a record would have shown that although Washington's mother had survived until the then-exceptional age of 82, his inheritance with respect to health was otherwise essentially poor. Members of the Washington family were generally short-lived. George's great-grandfather John Washington died at age 46, his grandfather Lawrence at 38, and his father Augustine at 49.

An impressive array of illnesses

Washington's strong and stalwart appearance notwithstanding, his personal medical history included an impressive array of illnesses, some of them serious. Once he was grown, the earliest entry in his chart would probably have been made in November 1751, when at age 19 he was "strongly attacked with the Small Pox" during his stay on the island of Barbados in the West Indies. [1]

Soon after Washington returned to America in March 1752, he suffered an attack of pleurisy. Aware of young Washington's exposure to tuberculosis, with which his brother Lawrence had been afflicted, his physician might have suspected that George had also contracted this malady and had eventually overcome it over a period of years. Auscultation and x-ray might have detected the presence of healed scar tissue or an active lesion.

The recurrent chills and fever that had plagued Washington at intervals of many years and that mercifully receded with doses of "the bark" would have been identified as malaria.

During the summer of 1755, Washington had been wracked with pain and fever of another sort that yielded neither to determination nor to doctoring until British General Edward Braddock ordered him to take Dr. James's Powders. This bout with "bloody flux" left Washington's strength much impaired. In the summer of 1757, he experienced a dysentery that persisted for months and forced him to seek a "change of air." Washington obtained no relief from this weakening illness until March 1758.

In 1761, Washington contracted a severe cold and intermittent fever that "stirred up old maladies," evidently pulmonary. [2] This attack prompted him to seek relief in the mineral baths at Berkeley Springs in what is now West Virginia. Except for a digestive disturbance of 5 days' duration in early 1768, Washington was singularly free of all but minor illness for most of the remainder of his life. (Washington was wearing false teeth by 1789, although he had not lost his last tooth until 1795).

Overcoming his diathesis

Even with his poor health inheritance and history, Washington by his own efforts was able to alter his body's diathesis and thus lessen his susceptibility to respiratory infection, to build up a measure of resistance to disease and exposure, and to strengthen his recuperative powers. Otherwise, he would not have been able to endure the rigorous demands of the War of Independence with an almost perfect health record or survived the other strains of his military and political life. His personal habits were good. He arose at dawn and usually retired at 9p.m. He did not smoke and he was not given to excessive eating or drinking, although he did partake of the wine usually served at his dinner table and often after dinner. Throughout his life, he was an ardent disciple of exercise in the open, and always after an illness he returned to the saddle as soon as possible.

This self-imposed regimen of outdoor exercise, careful diet, and regular rest had been in a sense his best medicine. It was both preventive and therapeutic. Although he had already suffered many illnesses and had considered himself at age 54 to have reached his declining years, at age 65 he took up a vigorous schedule at Mount Vernon upon leaving the presidency. At the time he was last stricken, the prospective plans on his desk were those of an active man.

Washington's death

When Dr. James Craik examined Washington on the morning of Dec. 14, 1799, he pronounced a diagnosis of "inflammatory quinsy." Craik's consultants, Dr. Gustavus Richard Brown and Dr. Elisha Cullen Dick, agreed with Craik that the seat of the infection lay in the larynx. However, Dick suggested that his elder colleague's diagnosis was too vague, and he proposed that Washington's condition should be specified as "tracheitis stridula suffocatis--or laryngen." Craik and Brown preferred the original diagnosis.

Doubtless, the two older men, graduates of the School of Medicine at Edinburgh, were familiar with the writings of Dr. William Cullen. At that time, Edinburgh was the internationally acknowledged center of medicine, as London was of surgery. Cullen, a professor of medicine at Edinburgh, was regarded as being without peer in his field, and his textbook was "the bible" for physicians of the 1790s. [3] Despite Dick's misgivings, the diagnosis and handling of Washington's illness were made in accordance with Cullen's description of symptoms and his recommendations for treatment. One of the prescribed treatments that was administered-phlebotomy--would become the center of a searing controversy when Washington died later that day.