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What killed George Washington? Turns out it was probably related to the bloodletting and other 18th-century medicine his doctors applied.

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Hosted by: Hank Green

Sources:
http://gwpapers.virginia.edu/history/articles/illness/
http://www.mountvernon.org/research-collections/digital-encyclopedia/article/the-death-of-george-washington/
http://www.pbs.org/newshour/updates/dec-14-1799-excruciating-final-hours-president-george-washington/
http://www.medtech.edu/blog/the-history-progression-and-modern-stance-on-bloodletting
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1065003/
http://www.britannica.com/animal/blister-beetle#ref127111
http://www.blood.co.uk/about-blood/how-the-body-replaces-blood/
http://www.nytimes.com/health/guides/disease/epiglottitis/overview.html
[SciShow intro plays]

Hank: If you ever invent a time machine and travel back to any time before, say, the 1940s, you’d better hope you don’t get sick. Olden-day medicine was bad. Like, really bad. A strep infection would often turn into scarlet fever and was fatal a lot of the time. These days you usually just get a round or two of antibiotics.

And for a long time, a doctor’s solution to practically everything would just be to take a bunch of blood out of your body, a practice known as bloodletting. They had their reasons, and they didn’t know a great deal about the world, so I’m not going to blame them too much, but a lot of the time doctors would make things worse. And if you were someone as important as George Washington, and you got lots of attention from doctors... well, that medical attention might end up killing you.

The final days of the First American President are a pretty vivid illustration of how so-called medical science just two hundred years ago often did more harm than good. On December 12, 1799, Washington spent most of the day working outside, in snow and freezing rain. When he finally got home, he was cold and wet, but he refused to change into dry clothes, because that would’ve made him late for dinner. From modern medicine, we know that being cold and wet isn’t what actually makes you sick, but it can lower your core body temperature, weakening your immune system and making you vulnerable to infection.

And that’s probably what happened to Washington, because the next day, he woke up with a sore throat and a cough. He went out to work on the plantation anyway -- even though it had snowed the night before -- to help clear some trees. By the evening of the 13th, he was a lot worse. And around 2 in the morning on the 14th, he woke up with chills, fever, and trouble breathing. His wife, Martha, wanted to go get the doctor, but she had also been sick recently, so Washington wouldn’t let her go.

They sent for the doctor in the morning -- eventually they’d end up with three different doctors -- and meanwhile, one of his staff removed about a quarter of a liter of his blood. Over the course of the following day, almost two and a half liters of Washington’s blood was drained -- -- that’s about 40 percent of all of the blood in his body. For reference, these days hospitals will do a transfusion if a patient loses more than 30% of their blood. 40%, and it’s time for serious resuscitation.

But doctors used bloodletting in Washington’s time, because medicine back then was often based on an ancient idea that health comes from a balance of bodily fluids, called humors. If you were sick, that must mean that your humors weren’t balanced -- and since bloodletting removed lots of fluid, it would help restore that balance. It was used to treat all sorts of issues, from smallpox to acne. Of course, mostly it just made things worse. Because you need your blood. It does important things, like getting oxygen to all of your tissues, and getting rid of wastes, even the simple stuff, like carbon dioxide.

Along with the bloodletting, Washington’s doctors diagnosed him with quinsy, or a pocket of pus near his tonsils. These days we call this a peritonsillar abscess -- and it was making it hard for him to breathe. So the next thing they tried was blistering his throat by applying cantharidin, a secretion that causes severe chemical burns, derived from a type of beetle called Spanish fly. If that sounds awful, it was. The doctors wanted Washington’s throat to blister, again to supposedly help draw out fluids and balance the humors in his throat, where he had symptoms. But all this did was burn his throat, giving his immune system something else to battle instead of fighting off whatever was actually wrong with him.

So, the blisters didn’t help, and then after some more bloodletting, they gave the former president an enema. Then, they gave him an emetic, to make him vomit -- thinking that his digestive fluids needed to be balanced. Now, Washington was dehydrated. This only made matters worse, because they’d removed several liters of his blood, and his body was trying to make more -- but blood is about half water. So by this point, he was not doing well. Oh god.

So they tried bleeding him again. At around 5 in the afternoon, he seemed a little better, at least for a few minutes, and then that’s when he started having a lot more trouble breathing. The doctors gave Washington some more blisters on his arms and legs, but that didn’t make him any better. He died between 10 and 11 PM on Saturday, December 14, 1799, at the age of 67.

Even back then, people thought the doctors might have gone a little overboard with the bloodletting, but for the most part, they were really just going with what they knew -- what medicine truly believed about health at the time. Ever since, doctors have been trying to figure out what was actually wrong with Washington, and how we might have cured him if it had happened today. It probably wasn’t a peritonsillar abscess, because that would mainly have affected one side of his throat. But both sides of Washington’s throat were sore and swollen.

From his symptoms, it seems like he had acute epiglottitis, an infection in the flap of cartilage that covers your windpipe when you swallow. It gets worse very quickly, and it can be fatal if it gets swollen enough to block the patient’s windpipe. Could Washington have lived if the doctors hadn’t tried to intervene? Maybe, maybe not. He definitely would have had a better chance, though. These days, we vaccinate against the bacteria that can cause epiglottitis, but it is still a serious illness. Generally, hospitals will treat patients with antibiotics to fight the infection, corticosteroids to reduce inflammation, and -- if necessary -- intubation, where a breathing tube is inserted into the throat, below the epiglottis.

In Washington’s day, intubation was still a very new procedure. One of his doctors did suggest trying it, but the other two thought it was too dangerous. In the end, the misconceptions that framed olden-day medicine probably made the president a lot worse. So if you ever do travel in time, please stay within range of evidence-based medicine.

Thank you for watching this episode of SciShow, which was brought to you by our patrons on Patreon. If you want to help support this show, you can go to Patreon.com/SciShow-- thank you to all of you that have done that, it is really wonderful. And if you just want to keep getting smarter with us, you can go to YouTube.com/SciShow and subscribe!