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July 31, 2010

Epiglottitis Killed President George Washington?

I came across a great blog post by Michael Hebert regarding a book review of Joseph Ellis' biography His Excellency: George Washington.

Apparently, at the age of 67, President George Washington died in 1799. I quote from the blog post the following account:
"One morning in mid-December 1799, Washington went out, as it was his daily habit, on horseback from his home to inspect his Mount Vernon property. That particular day the weather was very cold and there was an ice storm. It is said that Washington spent five hours out in freezing rain, then returned home and dined with guests in his wet clothes because he did not want to keep them waiting. The next day he complained of a sore throat and was hoarse, but otherwise appeared well. The following night he awakened Martha to tell her that he felt a severe pain in his throat, and was having trouble breathing.
The next day his personal physician, Dr. James Craik, was summoned. Craik diagnosed the condition as life threatening, and hastily assembled a team of doctors for aggressive treatment. They bled him of five pints of blood, burned his neck, and gave him calomel, a mercury compound used as a purgative but which probably did little more than induce mercury poisoning. Finally, after several days of this torture, Washington displayed the judgment that made him a great president and told them to stop. According to Ellis: “Eventually Washington ordered his doctors to cease their barbarisms and let him go in peace. ‘Doctor,’ he muttered, ‘I die hard, but I am not afraid to go” (p.269). He expired a few hours later."
According to the biographer, Pres. George Washington died of a serious childhood infection called epiglottitis which is an infection of the soft tissue flap (epiglottis) guarding the entrance of the voicebox. It is for which the Hib vaccine given to all kids now makes this type of infection a rarity (in fact, in my entire 10 year career so far as an ENT, I've seen only 3 cases so far).

However, I do agree with the blog article that epiglottitis is unlikely to be the actual cause for Pres. George Washington's sore throat and eventual death. Given his ripe age of 67, he would have developed natural immunity to the germ (Haemophilus influenzae type B) that causes epiglottitis and as such, it would be highly unusual (but not impossible) cause of infection and death. As the blogger stated, a more likely cause of the sore throat that eventually lead to his death is a peritonsillar abscess, a far more common cause of sore throats that could lead to death if not treated. Indeed, I see about 3-4 peritonsillar abscesses in my clinic per month during the winter season. It is also not unusual for a person to go from normal to developing a peritonsillar abscess within 1-2 days.

Ludwig's angina is the other possible culprit the blog post addressed which I also find unlikely. Ludwig's angina in essence is an infection of the submandibular salivary gland and would have presented with a huge swelling under the tongue and under the jawline (see picture to right)... two symptoms I would think that would have been documented in George Washington's history.

In any case, it is entirely possible that his physicians may have contributed to his death... blood-letting of 3.75 liters... Gosh... a human adult has about 5 liters of blood. As far as I'm concerned... that's medical malpractice and one could argue first degree murder. Add mercury poisoning as well.

You can purchase the biography of George Washington here.

Fauquier blog
Fauquier ENT

Dr. Christopher Chang is a private practice otolaryngology, head & neck surgeon specializing in the treatment of problems related to the ear, nose, and throat. Located in Warrenton, VA about 45 minutes west of Washington DC, he also provides inhalant allergy testing/treatment, hearing tests, and dispenses hearing aids. Google+ Christopher Chang, MD Bio

1 comment:

  1. I just got back from Mount Vernon, and as a physician, the description of his agonizing last days intrigued me. It sounded first like a cold with a sore throats but then rapidly progressed to what sounded like eppiglottitis. In the elderly (>65), especially in a debilitated state (he had malaria and tuberculosis, two then incurable diseases already), plus the acute shock of being out in wet winter weather (30 degrees and snowing 3 inches for five hours), in addition to being bled of 5 pints of blood was plenty enough to explain getting Hib with early flu and pharyngitis symptoms rapidly progressing to epiglottitis and death. Since there's no record of him being exposed to anyone sick prior to coming down with it, my suspicion is that he was a carrier of Hib just waiting for the opportune time to overwhelm the poor man's weakened immune system. It's very likely that had the 3 docs who took care of him back then had all our modern antibiotics available to them, he would have died anyway. Providence, it seems, had his death date in mind just as surely as Providence had protected him from death during the prior wars.

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