Correspondence

Death of a President

N Engl J Med 2000; 342:1222April 20, 2000

Article

To the Editor:

In his comprehensive article (Dec. 9 issue),1 Morens describes in great detail the last illness of George Washington, his suffering, the therapy rendered by his physicians, and the subsequent controversy surrounding the appropriateness of the bloodletting to which he was subjected. However, Morens does not include a discussion of Washington's medical history, which may be pertinent.

Washington is always described as a stalwart, tall, rugged person inured to the hardships of military life and capable of extraordinary feats of endurance, but in fact he had many bouts of illnesses in his life.2 His paternal forefathers were short-lived and were subject to recurrent bouts of pneumonia. In 1751, he accompanied his half-brother, Lawrence, who had tuberculosis, to Barbados, and there Washington survived an attack of smallpox. He was subject to recurrent febrile respiratory infections and other acute fevers that were probably due to pneumonia or malaria. One of his severe bouts of fever was life-threatening, and he required several weeks to recover. Shortly after Washington assumed the presidency, a large carbuncle of the thigh — at the time called anthrax — was surgically treated by Dr. Samuel Bard, an eminent New York surgeon. Washington was subject to dental problems throughout his life; eventually, all of his teeth were extracted, and he was reduced to wearing ill-fitting dental plates.

In his article, Morens describes Washington as “not a Christian.” Washington, in many of his public statements, invoked the “Almighty” and “our Creator.” He was known to attend Christ Church in Philadelphia and was an active member of the Episcopal church.3

Norman G. Schneeberg, M.D.
Hahneman University School of Medicine, Philadelphia, PA 19107

3 References

1. 1

   Morens DM. Death of a president. N Engl J Med 1999;341:1845-1849
   Full Text | Web of Science | Medline

2. 2

   Blanton WB. Medicine in Virginia in the eighteenth century. Richmond, Va.: Gant & Mason, 1931.
   

3. 3

   The New Encyclopaedia Britannica. 15th ed. Vol. 19. Chicago: Encyclopaedia Britannica, 1974:610-7.
   

Author/Editor Response

Dr. Morens replies:

To the Editor: Schneeberg notes several interesting aspects of Washington's medical history. Although space limitations precluded my addressing these points in my article, more than 20 reviews of Washington's medical history, including those by Wells1 and Estes,2 are included among the many references about Washington's health in the bibliography I offered to Journal readers. A major interpretive problem, however, is the difficulty in linking existing diseases to 18th-century conditions, which were often described succinctly and in nonspecific terms.

In addition to the dangerous carbuncle noted by Schneeberg, infectious diseases apparently brought Washington close to death at least four times, leading him to reflect frequently on his own mortality. The Barbados journey was followed by the first of a lifelong series of severe respiratory illnesses. Although Washington eventually attributed these to consumption (tuberculosis), no physician ever confirmed this possibility. Some of the episodes seem more consistent with a diagnosis of pneumonia or chronic asthma, and one, which occurred during the pandemic of 1788 to 1790, may well have been influenza. Washington also suffered gastrointestinal illnesses and “bloody fluxes” as well as recurrent bouts of malaria while residing in the malarious environs of Mount Vernon.

Although Washington's medical history does not seem obviously related to his final illness, several events are of interest. A near-fatal illness during the Revolutionary War was diagnosed as “quinsy” (then a nonspecific term). At the age of 54, Washington suffered a six-month attack of severe polyarthralgia that he called “rheumatism.” Washington may also have been a carrier of staphylococci, as suggested by recurrent skin infections and the carbuncle. In the last years of his life, he was partially deaf, had no natural teeth, and may have suffered transient bouts of confusion. Because his poorly fitting dentures made chewing and swallowing difficult, it is conceivable that he occasionally aspirated the hot teas he was fond of drinking.

Regarding Schneeberg's second question, Washington's church attendance was sometimes episodic, though legally mandated in colonial Virginia. He made occasional references to a Christian God when speaking to Christian believers. However, historians conclude that Washington's religious views — like those of Franklin, Jefferson, and others of the founding fathers — are more in accord with deism. Noted Washington biographer J.T. Flexner writes that Washington “supported the Anglican church . . . as an institution valuable in this world rather than as a window into the beyond.”3 Henriques's excellent review of Washington's religious beliefs notes his support of religion as a basis for moral values and personal virtue.4

David M. Morens, M.D.
National Institutes of Health, Bethesda, MD 20892-7630

4 References

1. 1

   Wells WA. Last illness and death of Washington. Va Med Mon 1927;53:629-642
   

2. 2

   Estes JW. George Washington and the doctors: treating America's first superhero. Medical Heritage 1985;1:44-57
   Medline

3. 3

   Flexner JT. Washington after the Revolution: V: the death of a hero. American Heritage 1969;21:33, 68-74
   

4. 4

   Henriques PR. The final struggle between George Washington and the Grim King: Washington's attitude toward death and the afterlife. The Virginia Magazine of History and Biography 1999;107:73-97