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Washington’s doctors absolved

Aug. 19, 2008
Special to World Science  

Poor medical care didn’t kill George Washington, a new study con­cludes—his fi­nal ill­ness was a hope­less situa­tion.

The death of the U.S. found­ing fa­ther from a throat in­fec­tion at 67 trig­gered an im­me­di­ate and still-smoul­der­ing de­bate over wheth­er doc­tors con­tri­but­ed to his de­mise, in par­tic­u­lar through their co­pi­ous blood ex­trac­tions. Blood­let­ting was stand­ard med­i­cal prac­tice then, though it was al­ready ques­tioned in some quar­ters.

Sculpture of Wash­ing­ton by French art­ist Jean-Antoine Hou­don, based on a life mask. (Cour­tesy Nat'l Port­rait Gal­lery)
The au­thor of the new study claims Wash­ing­ton would al­most cer­tain­ly have died no mat­ter what his three phys­i­cians did.

Wash­ing­ton fell ill af­ter a day out in bad weath­er and did­n’t call the doc­tors un­til the next morn­ing. His con­di­tion by then was al­ready dis­as­trous, ac­cord­ing to the re­search­er, Mi­chael Chea­tham of the Sur­gi­cal In­ten­sive Care Un­its at Or­lan­do Re­gion­al Med­i­cal Cen­ter in Flor­i­da.

Wash­ing­ton was dead by the day’s end.

Writ­ing in the Au­gust is­sue of the re­search jour­nal The Amer­i­can Sur­geon, Cheatham notes that Wash­ing­ton’s di­ag­no­sis is to­day be­lieved to have been ful­mi­nant acute epiglot­ti­tis, a se­vere in­flamma­t­ion cen­tered on a flap of car­ti­lage that shields the wind­pipe dur­ing swal­low­ing. 

Wash­ing­ton’s adopt­ed son George Cus­tis, pre­s­ent at the fi­nal hours, lat­er wrote rev­er­ently of the “man­ly” self-pos­ses­sion with which the pa­tient en­dured his ill­ness and the pain­ful therapies. Cus­tis’ ac­count al­so makes plain that this sto­i­cism and re­luc­tance to trou­ble any­one are what caused the de­lays in get­ting help.

The case as his doc­tors found it would have posed a ma­jor chal­lenge to any physi­cians to­day, let alone then, Cheatham con­clud­ed based on his re­view. 

This did­n’t stop some con­tem­po­rar­ies from crit­i­ciz­ing Wash­ing­ton’s doc­tors—one of whom had op­posed the blood­let­ting—af­ter the fact. One of the oth­er doc­tors him­self lat­er wrote of re­grets for not hav­ing lis­tened to his young­er, an­ti-blood­let­ting col­league. 

The Wash­ing­ton bi­og­ra­pher Paul Ford a cen­tu­ry lat­er called the case “noth­ing short of mur­der.” Oth­er com­men­ta­tors took a kinder view, ar­gu­ing that blood­let­ting and the oth­er contro­versial treat­ments were stand­ard prac­tice of the day and that Wash­ing­ton him­self be­lieved in it.

Cheatham ar­gues that none of this really makes a dif­fer­ence, as death was “in­evi­ta­ble” by the time med­i­cal at­ten­tion came, though that care cer­tain­ly com­pounded his suf­fer­ing. Cheatham rolls out the list of chal­lenges Wash­ing­ton’s three doc­tors had to face: “pro­longed Class IV hem­or­rhag­ic shock, acute res­pi­ra­to­ry fail­ure, and prob­a­ble sep­tic shock” in an eld­erly man with a his­to­ry of health prob­lems. Such a di­ag­no­sis “has a high mor­tal­ity rate to­day and would have been ir­re­vers­i­ble in 1799,” he wrote.

* * *

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George Washington’s doctors did not “murder” him with poor medical care, though it was certainly that by today’s standards, a study concludes. The death of the U.S. founding father from a throat infection at 67 triggered a controversy over whether doctors contributed to his demise, in particular through their copious blood extractions. That was a standard medical practice at the time, though it was already questioned in some quarters. The author of the new study concludes Washington would have probably died no matter what his three physicians did. Washington fell ill after a day out in bad weather and didn’t call the doctors until the next morning. His condition by then was already rather disastrous, according to Michael Cheatham of the Surgical Intensive Care Units at Orlando Regional Medical Center in Florida. Washington was dead by the day’s end. Writing in the August issue of the research journal The American Surgeon, Cheatham notes that Washington’s diagnosis is today believed to have been fulminant acute epiglottitis, a severe inflammation centered on a flap of cartilage that shields the windpipe during swallowing. His adopted son George Washington Custis, present at the final hours, later wrote reverently of the “manly” self-possession with which the patient endured his sufferings. The account also makes plain that this stoicism and Washington’s reluctance to trouble anyone caused the delays in getting help. The case as his doctors found it would have posed a major challenge to physicians today, let alone then, Cheatham concluded based on his review. This didn’t stop some contemporaries from criticizing Washington’s doctors—one of whom had opposed the bloodletting—after the fact. One of the other doctors himself later wrote of regrets for not having listened to his younger, anti-bloodletting colleague. The Washington biographer Paul Ford a century later called the case “nothing short of murder.” Other commentators took a kinder view, arguing that bloodletting and the other controversial treatments were standard practice of the day and that Washington himself believed in bloodletting. Cheatham argues that none of this really makes a difference, as death was “inevitable” by the time Washington got medical attention, although that care could have compounded his suffering. Cheatham rolls out the list of challenges Washington’s three doctors had to contend with: “prolonged Class IV hemorrhagic shock, acute respiratory failure, and probable septic shock in a 67 year old” with a history of health problems. Such a diagnosis “has a high mortality rate today and would have been irreversible in 1799,” he wrote.