When George Washington developed laryngitis and shortness of breath in 1799, his doctors used poultices, enemas, and opened his veins to remove almost half of all his blood in 12 hours. Shown on his deathbed in a painting recently dubbed Death by Malpractice, the first president of the United States was 67 years old at the time of his death.

After leaving the presidency, Washington continued to lead an active life, spending much time outdoors on various projects for his property. He was vigorous and had remained in good health. In November and early December he was making plans for building a gravel walk and a fish pond by the Potomac, cutting down some trees to improve the landscape. Despite the cold winter and much snow, he persisted in inspecting his domain by horseback, and even helped move a carriage that had become stuck in the snow. On Thursday, December 12, he developed a sore throat and that evening did not change his wet clothes. The next day he became hoarse. During the night he awoke with great difficulty in breathing and was barely able to speak.

It was decided to send for Dr. James Craik, the 37-year-old Scottish physician, an old friend who had attended on Washington ever since the days of the French and Indian War and at the time was physician general (precursor of the surgeon general of the US Army). Meanwhile Washington was given a mixture of vinegar, butter, and molasses to relieve his painful throat, but could not swallow it and nearly choked while trying to do so. While waiting for Dr. Craik, Martha Washington also called for the highly respected Dr. Gustavus Richard Brown. On arriving, Dr. Craik was alarmed by Washington’s condition and also summoned Dr. Elisha C. Dick, a young physician who had studied under Benjamin Rush. Together, these physicians set about instituting the standard treatments of the time: throat cantharides (made from dried beetles and designed to draw out the inflammation); gargles of tea mixed with vinegar; and steam inhalations. Dr. Craik made a diagnosis of “cynanche trachealis.” As Washington could not swallow medicines, poultices were applied and a rectal solution of calomel and tartar was administered. Bloodletting was promptly instituted and repeated four times. An estimated 5 pints of blood were removed, amounting to about one half of the total blood volume. As the difficulty in breathing increased, Dr. Dick proposed a tracheotomy, at the time a highly experimental procedure that was rarely carried out. He was overruled by the other doctors, who thought the procedure was too radical. Continuing to deteriorate, Washington said his breath would not last long, but he was not afraid to die. By six o’clock he thanked his attendants for their attentions, but asked them not to take any more trouble with him but to let him go off quietly. “Tis well,” were his last words, and he died at about ten o’clock on December 14, 1799.

It is generally believed that Washington had severe laryngitis and epiglottis, often fatal in the days before antibiotics. The immediate cause of death was asphyxia. In those days a tracheotomy would not have been practical, and he most likely would not have survived the operation. The treatments to which he was subjected, though standard practice at the time, were clearly not beneficial. Blood letting, though of occasional transient benefit in severe hypertension or heart failure, was still based on Galen’s theory of maintaining balance between the four fluid humors of the body. It lowered patients’ resistance and contributed to their death. But the winds of medical fashion, tempestuous in some respects, are slow to change in others, and doctors continued for an inordinate time to indiscriminately let blood out of their patients.

The Christian Death (1853) by Junius Brutus Stearns, in Life of George Washington emphasizes a general air of piety, showing Washington surrounded by family and attendants, including his two adopted children not present at his death. Between 1847 to 1856, Stearns had painted a five-part series illustrating episodes from Washington’s life and career.