History · History of Medicine · Medicine & Doctors

How did George Washington, the first US President, die? (Hint: much blood was spilled)

[Reference for the details below and image: Death of a President | NEJM]

The year is 1799, the month December. A wealthy old man somewhere in Virginia begins to feel some discomfort in his throat and runs a temperature. He is fragile, often gasping for air as he finds breathing more and more difficult. Not long after, his doctor is right there beside him in the bedroom. And then another. And then yet other. Our patient is such an elite old man that he has three doctors taking care of him, and a fourth on his way.

The doctors have taken the medical history and are considering the options for treatment (it is 1799, there’s no paracetamol – or Tylenol as some people call it – yet). They decide to try out the best, most tried and tested, and most trusted option: bloodletting.

At around 7.30am, our 67-year-old patient had already undergone the procedure: some 400ml of his blood had been eased out of his veins (again, it is 1799, so no needles and syringes etc. – just a simple lancet and a cut). At 9.30am, the seniormost among the doctors took out another 530ml blood. At 11am, yet another 500ml. At 3pm the veteran doctor, in all his wisdom, draws out some more blood – 946 ml to be exact – despite some misgivings of the other doctors.

All in all, the bed-ridden Washington had about 2.5 litres of blood taken out of his body in the span of half a day. That is around half of an adult human’s entire blood volume.

Despite the ‘heroic’ efforts, the patient died in the night around 10.30pm. The next morning, newspapers carried front page news of his death. After all, the much young and proud nation of the United States of America had lost its much-loved and feted general, and first president, George Washington.

How very bizarre?!

Well, bizarre for perhaps just us. One of the most amazing things that historians of medicine have accomplished over the past few decades is to look at doctors and people in the past through more empathetic and reasonable lenses, and try to understand why exactly it made sense for them to do the things they did. As against judgmentally tut-tutting at them.

In this case, however bizarre it sounds to us, it absolutely made sense for Washington’s doctors AND for Washington himself to perform the bleedings. After the 7.30am bloodletting, the former President himself had, in fact, requested for more blood to be taken out. Such was his – and of people then in general – confidence in the healing powers of bloodletting. The doctors who attended him were the most experienced and respected in their fields. They too did not think there was anything problematic or bizarre in drawing blood from an old patient running a fever and having throat discomfort (though there was some debate on exactly how much blood needed to be drawn out).

Today of course we believe that Washington died most probably of a combination of epiglottitis and its complications, to which was added the hypovolemia from the bloodletting.

To know more about why exactly people in the past, for thousands of years and in multiple civilizations, believed bloodletting to be a legitimate therapeutic practice, this particular piece will be helpful: British Columbia Medical Journal.

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