Bloodletting and blisters: Solving the medical mystery of George Washington’s death

Learn the gruesome details of President George Washington’s final hours on the 215th anniversary of his death. The retired commander-in-chief woke up at 2 a.m. on Dec. 14, 1799, with a sore throat. After a series of medical procedures, including the draining of nearly 40 percent of his blood, he died that evening. Dr. Howard Markel of the University of Michigan shares the story with Jeffrey Brown.

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    Finally tonight: George Washington's final hours and the medical mystery that continues to surround the death of our first president.

    This weekend marked the 215th anniversary of his passing. We posted an essay online that garnered a lot of interest about that history.

    Jeff is back with our conversation.


    In December 1799, George Washington was about two-and-a-half years into his retirement and was still very actively managing his estate at Mount Vernon, Virginia.

    In the early morning hours of the 13th, following a day on horseback in freezing rain and snow, he woke up with pain and shortness of breath. By 10:00 that night, he was dead.

    We know a lot about what happened in those hours from an account written by Washington's chief aide, from notes by his doctors, and from later detective work by medical researchers.

    Dr. Howard Markel is the director of the Center for the History of Medicine at the University of Michigan. He wrote the piece on our Web site and joins us now.

    So, Dr. Markel, a seemingly healthy George Washington wakes up in the middle of the night with shortness of breath. What happens then?

    DR. HOWARD MARKEL, University of Michigan: Well, first, you know, he was out overseeing his estate and developed a sore throat and some hoarseness.

    But when he woke up at 2:00 in the morning, he simply couldn't breathe. His throat was so inflamed, he couldn't get air in. And, of course, Martha, his wife, was very concerned. And so she sent out for his aide-de-camp, Colonel Tobias Lear, who then sent out for some doctors and a bloodletter.


    Yes, now, bloodletting is the chief kind of treatment, right? Describe — a number of doctors came in and what did they do, what kind of treatment?


    Well, it was a major modality.

    Back then, humoral physiology was the key to medicine. There were four body humors, black bile, yellow bile, phlegm and blood. And when you had an inflammation — and his throat was so inflamed, he couldn't get air through it — they thought that if you removed blood, you would reduce the inflammation.

    So, all told, his doctors took out about 80 ounces of blood over 12 hours, which is about 40 percent of an adult's blood volume.


    Forty percent. So is it possible or likely that what they did made his situation worse?


    Well, they certainly didn't help him.

    You know, other treatments they gave him during that period were enemas and drugs to make him vomit and something called blisters, where they applied Spanish fly onto his throat, which raises a painful blister, again to remove these terrible humors that are caution the inflammation.

    But if the disease itself didn't get George Washington, the doctors certainly did.


    Well, speaking of that, do we know, really, in the end, what did kill him?


    This has been argued since about two minutes after George Washington died.

    And doctors love to argue about what the greats from the past history have died of. And it's a great argument because you can never really prove it, so the argument goes on and on and on.

    But there's been many different diagnoses, including peritonsillar abscess, and pneumonia, and even epiglottitis, an infection of the epiglottis at the back of the throat from a bacterium so severe that it basically strangles you.


    It is fascinating, as you write, to go back through the detective work from that moment and then on, even close to our own time.

    What would have happened today, when you compare what happened back then to a scenario today?


    Well, regardless of the cause of this blockage of the back of his throat, viral, bacterial, what you have, we would have intubated him. We would have inserted a tube through that blockage to allow him to breathe. And if that didn't work, he would have had a tracheotomy, and that would have completely bypassed the blockage.

    And, hopefully, with some I.V. fluids, adding fluid to him, as opposed to drawing it off, that might have gotten him through the night and the day.


    It is also, of course, the never-ending interest in the man himself. And as you read the account of the time, you sort of see his character coming through up to the very end.


    He was ever the gentleman.

    And General Washington, in extremis, took the time to thank each and every doctor personally for the care they gave him. So, he was a remarkable man.


    And you — just finally, what makes this so fascinating or interesting for you?


    Well, first, it's George Washington, and so of all the founding fathers, he seems to be one of the foundingest. He was the first president of the United States and the father of our country.

    But, also, that such a great man was also all too human, and death came to him in a rather gruesome way is a fascinating story to this historian.


    All right, Dr. Howard Markel of the University of Michigan, thanks so much.


    Thank you.