What killed George Washington? A U. of Maryland medical school expert makes a diagnosis

Every school kid in America can rattle off a few things about the life of George Washington.

He was a military leader, became the first president of the United States in 1789, and if you believe the hit musical “Hamilton,” he also was wise and fearless and had quite the singing voice.

But what do people know about his death? For all the volumes written about the man, the consensus has been these vague and somewhat forgettable words: sore throat.

Dr. Rodney J. Taylor, chair of the department of otorhinolaryngology at the University of Maryland School of Medicine, decided to give a more satisfactory explanation. He made his case to a room full of doctors during a recent scientific program presented by the university’s Medical Alumni Association.

First, a Maryland medical resident was deployed to describe the documented symptoms and timeline.

Washington spent five hours surveying his farm on a Thursday in mid-December 1799 on horseback in Mount Vernon, Virginia, in inclement weather. Harsh, but hardly Valley Forge.

He woke with a sore throat Friday morning, but tapped that famous work ethic and headed back out, this time into snow that had fallen overnight.

Early Saturday, he developed trouble breathing. This time, he was offered a concoction of molasses, vinegar and butter — a home remedy currently listed on Food.com as “Ma’s Cough Syrup Recipe” along with the review, “It tastes good.”

Washington couldn’t swallow it. So his attendants turned to the treatment of the day, bloodletting, taking about a half-pint.

When doctors were summoned, they applied another go-to treatment, Spanish fly, a poisonous agent made from blister beetles. And for good measure, they let out a bunch more blood, ordered a gargle, along with a vomiting agent and enema. Then they went back to draining Washington’s blood from his body.

For his part, Taylor endorsed none of this.

The 67-year-old Washington — who had previously overcome malaria, flu and several rounds of dysentery, according to his medical record — died less than 48 hours after becoming ill.

The cause of death was ruled cynanche trachealis, or inflammation of the tonsils, throat or trachea. Any parent who has heard the telltale barking cough from the crib in the next room knows this as croup.

“But croup usually affects kids,” said Taylor, who wasn’t buying the diagnosis. Adults have bigger airways, and croup doesn’t kill them.

Taylor went on to list a whole lot of other illnesses and why they wouldn’t have killed Washington, either.

It wasn’t neurological because there were no signs his brain was impaired. Most infections take longer than two days to kill a healthy adult. An autoimmune disease would have taken years.

A congenital issue would have likely surfaced previously, but Washington was considered healthy. A metabolic syndrome would have had other symptoms.

There were no signs of trauma to the neck or foreign body lodged anywhere.

But going back over the list, Taylor said, “There is an infection that merits more consideration.”

That infection is most commonly caused by a bacteria and leads the small bit of tissue that covers the windpipe in the back of the mouth to swell and block air into the lungs.

The symptoms: sore throat, trouble breathing, hoarse voice and difficulty swallowing. It can kill an adult or child quickly if their airway isn’t reopened with machinery or even a tracheotomy.

Check, check and check to all that, Taylor said.

“Diagnosis today would be quite easy,” he said. Basically examine the back of the throat. “It’s 100% cure rate if caught early enough.”

The mystery ailment? Epiglottitis.

Treatment is antibiotics — which were in common use about a century-and-a-half after Washington died.

meredith@thebaltimorebanner.com

Meredith Cohn

meredith.cohn@thebaltimorebanner.com

Meredith Cohn is a health and medicine reporter for The Baltimore Banner, covering the latest research, public health developments and other news. She has been covering the beat in Baltimore for more than two decades.

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