George Washington’s death on December 14, 1799, has been attributed to a combination of factors, but modern medical experts suggest that he likely suffered from acute bacterial epiglottitis or another severe throat infection.
This condition could have led to a rapid onset of symptoms, including difficulty breathing and severe inflammation of the throat, which would align with the sudden and severe nature of his illness.
Washington’s physicians, practicing by the medical standards of the time, attempted to treat him through bloodletting, which may have worsened his condition.
The excessive blood loss from this practice likely contributed to his decline, but it wasn’t the primary cause of his illness.
In sum, while the bloodletting might have accelerated his death, the root cause was probably a severe infection that went untreated due to the limited medical knowledge of the era.
Based on contemporary accounts, including those of Tobias Lear, George Washington’s illness began suddenly after he rode around his estate in inclement weather and stayed in wet clothes.
This exposure to cold and wet conditions likely contributed to his rapid onset of illness.
Washington’s symptoms included severe respiratory distress and difficulty speaking, which suggests a serious throat infection or respiratory condition.
The decision to perform bloodletting, a common medical practice of the time, was based on the belief that it could help balance bodily humors.
However, the excessive blood loss—amounting to about 40 percent of his blood volume—likely exacerbated his condition and contributed to his rapid decline.
In modern terms, Washington’s illness could have been caused by a severe infection such as acute epiglottitis or laryngitis, which would explain his breathing difficulties and rapid deterioration.
The bloodletting, while intended to help, probably hastened his death by causing significant blood loss and weakening his already compromised state.
The range of treatments George Washington underwent reflects the medical practices of his time, which were often based on limited understanding and sometimes dubious remedies.
Gargling with molasses, vinegar, and butter, inhaling steam, and swabbing the throat with various substances were all attempts to alleviate his symptoms, though they were unlikely to address the underlying cause of his illness effectively.
The use of an enema and other methods like vinegar steam inhalation were consistent with the common medical practices of the 18th century, aimed at cleansing and balancing the body’s humors.
Despite these efforts, Washington’s condition continued to worsen.
By the late afternoon, Washington recognized the severity of his situation and requested his will, which indicates his awareness of the gravity of his illness.
Ultimately, the combination of his initial infection and the aggressive, but ineffective, treatments contributed to his death.
Washington’s last words, said Lear, were spoken around 10 p.m. on December 14:
“I am just going! Have me decently buried; and do not let my body be put into the vault less than three days after I am dead.” Then, “Do you understand me? . . . Tis well!”
Dr. Howard Markel’s summary, citing research by Dr. David Morens, suggests that George Washington’s death might have been caused by acute epiglottitis, a severe bacterial infection that causes inflammation of the epiglottis—the flap at the base of the tongue that keeps food from entering the airway.
This condition could rapidly obstruct the airway, leading to the breathing difficulties and symptoms Washington experienced.
Acute epiglottitis, which was not well understood in the 18th century, would align with the sudden onset of severe throat pain, difficulty breathing, and the rapid decline observed in Washington.
This diagnosis fits with the historical account of his symptoms and the treatments he underwent, including the failure to alleviate his condition with contemporary medical practices.
“In the 215 years since Washington died, several retrospective diagnoses have been offered ranging from croup, quinsy, Ludwig’s angina, Vincent’s angina, diphtheria, and streptococcal throat infection to acute pneumonia. But Dr. Morens’s suggestion of acute bacterial epiglottitis seems most likely,” said Markel.
Yes, inflammatory quinsy, or a peritonsillar abscess, is another plausible theory regarding George Washington’s cause of death.
This condition involves a painful collection of pus near the tonsils, which can lead to severe throat pain, difficulty swallowing, and breathing difficulties—symptoms consistent with Washington’s reported illness.
The rapid progression and severity of his symptoms could be explained by a peritonsillar abscess, which could have caused significant swelling and obstruction of the airway.
In summary, while acute epiglottitis remains a strong candidate for Washington’s cause of death, a peritonsillar abscess also fits the clinical picture described in historical accounts.
Both conditions involve severe throat inflammation and obstruction, aligning with the sudden and severe nature of Washington’s illness.
“However none of these diagnoses quite fit the description of Washington’s terminal illness but on the other hand acute epiglottitis does explain all of his symptoms and his demise.
His illness is a classic ‘textbook’ case of acute epiglottitis,” wrote Dr. White McKenzie Wallenborn, for the University of Virginiaback in 1997.
Dr. David Morens’ perspective on the potential impact of bloodletting and the omission of a tracheotomy is significant in understanding Washington’s death.
Bloodletting, while detrimental and contributing to Washington’s weakened state, was a common practice of the time and might not have been the sole cause of death for someone of his size.
However, the substantial blood loss could have exacerbated his condition and contributed to his rapid decline.
The tracheotomy, a procedure that involves creating an incision in the trachea to open the airway, could have been a viable option to alleviate Washington’s breathing difficulties.
Although it was not widely used at the time and had mixed success, its omission might have contributed to his inability to breathe effectively.
The lack of this intervention, combined with the aggressive bloodletting and ineffective treatments, likely played a role in his swift deterioration and death.
“The truth of the matter is that they did the best they could, against a pathologically implacable foe, using now antiquated and discredited theories of medical practice,” Markel said.
