A Modern Medical Analysis of the Last Illness and
Death of George Washington
George Washington's Terminal Illness
White McKenzie Wallenborn, M.D.
29 March 1999
On December 12th, 1799, George Washington in his 67th year of
life, rode out around his farms on horseback from ten a.m. until
about three p.m. The weather that day according to General
Washington was snowing in the morning and about three inches deep.
Wind at NE and mercury at 30 (30 degrees Fahrenheit). Continued
snowing until about one o'clock, and at about four o'clock it
became perfectly clear. Wind at same place-not hard. Mercury 28 (28
degrees Fahrenheit) at night. Colonel Tobias Lear, George
Washington's secretary, stated that the weather that day was bad,
rain, hail, and snow falling alternately with a cold wind. When
George Washington returned from his ride, the General's neck
appeared wet, snow was hanging from his hair, and he came to dinner
without changing his dress (clothes wet?).
The next day, Friday December 13th, 1799, the General did not go
out as usual for he had taken cold and complained of a severe sore
throat. He did go out in the afternoon to mark some trees which had
to be cut down. He now had hoarseness which increased in the
evening. He spent the evening reading the papers, and when he met
anything interesting, he read it as loud as his hoarseness would
On the next day, Saturday the 14th, at three o'clock in the
morning, he told Mrs. Washington that he was very unwell and that
he had an "ague" (paroxysmal chills). It was observed that he could
hardly speak and that he breathed with difficulty. At daybreak on
the 14th, Colonel Tobias Lear came in and found the General
breathing with difficulty and hardly able to utter a word
intelligently. A mixture of molasses, vinegar, and butter was given
but he (GW) could not swallow a drop and when attempted, he
appeared to be distressed, convulsive, and almost suffocated. Later
he tried to use a gargle of vinegar and sage tea but in attempting
to gargle, he almost suffocated and when the gargle came back from
the throat some phlegm followed. At eleven a.m., his swallowing had
not improved. After the last bleeding it was noted that the blood
came "slow and thick" but there was no fainting (his physicians
had ordered that he be bled a number of times in the course of his
illness and an incredible amount, about eighty-two ounces or about
five pints or units, of blood were removed from him). At half past
four o'clock, Washington gave directions about his will and at
about five he again tried sitting up but remained so only half an
hour. In the course of the afternoon, he appeared in great pain and
distress from difficulty in breathing, and frequently changed his
position in bed. At about eight o'clock it was noted that his
condition remained unchanged and did so until about ten minutes
before his decease (death) when breathing became easier. He died
between ten and eleven p.m. December 14th, 1799.
His primary symptoms in the order of their occurrence were -- severe
sore throat, hoarseness, cough, chills, difficulty with breathing,
difficulty with swallowing, expectoration (spitting-? drooling),
fever, loss of voice, and suffocation.
From the observations of Colonel Lear, Dr. James Craik, Dr.
Elisha Cullen Dick, an Dr. Gustavus Richard Brown, and the clinical
course of his illness, I think that it is very reasonable and
possible to make a determination of the disease process that was
the cause of George Washington's death. He had acute epiglottitis
(supraglottitis) which is a severe, rapidly progressing infection
of the epiglottis and surrounding tissues that may be quickly fatal
because of sudden respiratory (airway) obstruction by the inflamed
structures. The epiglottis is located at the base of the tongue and
is the most superior part of the larynx (voice box). It is at the
very entrance to the airway which goes through the larynx to the
trachea and lungs. Swelling of this structure is painful and tends
to rapidly obstruct the airway and also the entrance to the
hypopharynx (area just above the esophagus) and the esophagus
(gullet). With acute epiglottitis, George Washington would have had
great difficulty breathing, talking, and swallowing and these he
The onset of epiglottitis is usually acute and fulminating. Sore
throat, hoarseness, dysphagia (difficulty swallowing), and
respiratory distress accompanied by drooling, shortness of breath,
rapid pulse, and inspiratory stridor (harsh high pitched
respiratory noise heard while the patient is inhaling [breathing
in]) develop in rapid order. Death from this dysorder is caused by
obstruction of the patient's airway and is very painful and
The other possible dysorders suggested by some as being the disease
process that caused George Washington's death were acute diphtheria
(laryngeal diphtheria), quinsy, acute laryngitis, and Ludwig's
angina. However none of these diagnoses quite fit the description
of Washington's terminal illness but on the other hand acute
epiglottitis does explain all of his symptoms and his demise. His
illness is a classic "textbook" case of acute epiglottitis.
Laryngeal diphtheria is an unlikely diagnosis for several
reasons. General Washington was reported to have survived a case of
"black canker" as a child. This would have been diphtheria and
would have given him lifetime immunity against future attacks of
diphtheria more than likely. There were no other reported cases of
diphtheria in his household or farm population so the likelihood
that he would have picked up a case of diphtheria was remote.
Diphtheria in an adult is a very rare occurrence. Although this
diagnosis is a possibility because it can produce laryngeal
obstruction and respiratory distress, it just doesn't fit the
Quinsy is the term used to describe a peritonsillar abscess.
Quinsy produces a sore throat but it is almost always unilateral
(on only one side of the throat) and produces symptoms referable to
that side only, e.g. soreness, swelling of the neck on that side,
and another symptom: trismus (a lockjaw-like symptom where the
patient cannot open their mouth). This diagnosis also does not fit
the disease process from which General Washington died.
Acute laryngitis in an adult is not usually a life threatening
Ludwig's Angina is an infection in the floor of the mouth in front
of or lateral to the tongue. It usually results from a dental or
periodontal infection. George Washington had no teeth, ergo not
a likely diagnosis.
It would be improper for today's medical practitioners to be
critical of the physicians of George Washington's day if they were
delivering the standard of care that other physicians of that era
were giving to their patients. It would appear that Dr. James
Craik, Dr. Elisha Cullen Dick, and Dr. Gustavus Richard Brown were
well trained as physicians, were honest and caring, and gave the
kind of medical care that their peers would have given. Today we
know that many of their methods were wrong and we would do things
differently. If Drs. Craik and Brown would have encouraged Dr. Dick
to perforate Washington's trachea (tracheostomy), it might have
allowed him to survive the acute illness and live on for sometime
afterwards. However this procedure was new and controversial so
they were not totally wrong to oppose it. Technically it might not
have worked anyway . . . but who knows? Today we find the removal of
about eighty-two ounces of blood (about five pints or units of
blood) from a sick patient in less than sixteen hours to be
incredible. However this was the method of treatment being taught
in those days. It was the treatment of choice for many diseases and
the complications of using this method were not comprehended by the
physicians of that day. I certainly have a great deal of compassion
for George Washington's physicians who were attempting to save his
life by using the methods that they thought best for him. I am also
filled with sadness that such a remarkable man and leader should
have such a painful and frightening end to his life.
White McKenzie Wallenborn, M.D.
Clinical Professor (Ret.)
Department of Otolaryngology-Head & Neck Surgery
University of Virginia School of Medicine
November 5, 1997
In the study of George Washington's terminal illness, a number
of textbooks of Otolaryngology were consulted. William Abbot and
Dorothy Twohig, Editor in Chief of The Papers of George Washington
at the University of Virginia, provided a number of valuable
articles written about George Washington's death and his overall
medical history. By combining the textbook articles, the journal
articles, and my own clinical experiences, I was able to reach the
conclusions noted above. The journals used are listed below:
- Barker, Creighton. "A Case Report," The Yale Journal of
Biology and Medicine, 9 (1936), 185-87.
- Blanton, Wyndham B. "Washington's Medical Knowledge and Its
Sources," Annals of Medical History, 4 (1932), 52-61.
- Brickell, John. "Observations on the Medical Treatment of
General Washington in His Illness," Transactions of the
College of Physicians, 25 (1903), 90-93.
- Courtney, John F. "George Washington's Final Illness,"
Resident and Staff Physician, 15 (1969), 84-.
- Knox, J. H. Mason, Jr. "The Medical History of George
Washington, His Physicians, Friends and Advisers," Bullentin of
the Institute of the History of Medicine, 1 (1933), 174-91.
- Lewis, Fielding 0. "Washington's Last Illness," Annals of
Medical History, 4 (1932), 245-48.
- Nydegger, James A. "The Last Illness of George Washington,"
Medical Record, 92 (1917), 1128.
- Wells, Walter A. "Last Illness and Death of Washington,"
Virginia Medical Monthly, 53 (1926-27), 629-42.
- Willius, F. A., and Keys, T. E. "The Medical History of George
Washington (1732-1799)," Proceedings of the Staff Meetings of
the Mayo Clinic, 17 (1942), 92-96, 107-112, 116-121.