White House Post-Mortem: What Really Killed 5 Presidents?

While six of 45 American presidents made it into their 90s, another 19 didn’t live to reach their 70s. The culprits behind most of their early deaths are well-established, but questions still remain about the causes of five unexpected presidential deaths: A bowl of cherries or arsenic? Assassination or medical malpractice? Carelessness in the cold or typhoid fever?

Here’s a look at 5 top presidential medical mysteries and the lessons they can teach us today.

George Washington: Was He Bled to Death?

The father of the nation was supposed to live forever, or at least die a noble death in his sleep at a ripe old age. Instead, George Washington died at his Mount Vernon home within 24 hours of falling ill, apparently of suffocation. He was just 67 years old, only 3 years out of office, and his demise deeply shocked the nation.

Washington’s symptoms included shortness of breath, a sore throat, and fever. The treatments, typical for the time, were excruciating. Aiming to restore the balance of “humors” in his body, physicians repeatedly drained his blood, applied a blistering substance to his throat and other body parts, and gave him an enema. But Washington wasn’t optimistic.

“Doctor, I die hard; but I am not afraid to go,” he said. “I believed from my first attack that I should not survive it; my breath cannot last long.” It didn’t.

According to a 2014 PBS article by Howard Markel, MD, PhD, of the University of Michigan, retrospective diagnoses include croup (swelling in the airways), quinsy (an abscess between a tonsil and the throat), Ludwig’s angina and Vincent’s angina (infections in the throat — not chest pain), diphtheria, and pneumonia. Washington’s doctors have also been blamed for reportedly bleeding him of some 40% of his blood volume.

That certainly didn’t help, Markel writes. But he believes Washington’s cause of death on Dec. 14, 1799 was something else — acute bacterial epiglottitis, the swelling of a flap of tissue that keeps food from going into the windpipe.

Medical historian Philip A. Mackowiak, MD, MBA, of the University of Maryland, told MedPage Today that this diagnosis makes sense, although a staphylococcal retropharyngeal abscess – an infection deep in the neck — is another possibility. Today, as then, the proper treatment would be to lance the swollen tissue, Mackowiak said. However, “his physicians apparently never examined his throat to see if there was swelling there.”

Mackowiak, who wrote a 2021 report about Washington’s death, doubts that blood loss killed him. It’s unlikely that 40% of Washington’s blood was drained since he didn’t show lightheadedness when he was helped to a chair, he said.

According to Mackowiak, Washington’s death reveals the age-old importance of the clinical examination. “Even 2,500 years ago, an astute physician with a patient with an illness similar to George Washington’s would have had the wisdom to look in the back of his throat to make sure that there wasn’t something back there obstructing his upper airway.”

William Henry Harrison: Out in the Cold

Inauguration Day in Washington D.C. on March 4, 1841, was windy and a bit chilly with temperatures in the 40s, but the new president didn’t bother to wear an overcoat or even a hat or gloves. Within a month, war hero William Henry Harrison was dead at the age of 68, and generations of history buffs have known exactly whom to blame: Harrison himself. If only he’d bundled up and not gotten pneumonia!

Mackowiak suspects that Harrison actually died of typhoid fever – an intestinal infection caused by contaminated food or water — making him a victim of pestilence instead of carelessness.

As Mackowiak wrote in a 2014 report about Harrison’s death, the president became ill 3 weeks after his inauguration with fatigue, anxiety, a severe chill, constipation, and cough. The initial treatment included multiple laxatives and the emetic antimony potassium tartrate, which is still used today to cause vomiting.

Then came enemas, more laxatives, mustard plasters, even more laxatives, a blistering agent, calomel, and laudanum (opium) … and even more laxatives. Some of Harrison’s treatments, such as camphor and senna, are still used today.

At last, the president died on April 3, 1841, after days of agony.

Mackowiak believes that Harrison’s symptoms, including his respiratory illness, fit enteric fever and death from septic shock. The president, he thinks, was likely at risk because the White House’s water supply was 7 blocks below a repository for “night soil” – sewage hauled from local homes and businesses.

Harrison’s doctors followed the standards of the time, Mackowiak said, although the mixture of drugs – including opium, which can be constipating — didn’t make sense.

Today, Mackowiak said, it’s possible that Harrison could have been cured, although it’s not clear how robust his health was. As for lessons, the case points to the dangers of prescribing too many drugs. “We don’t use many of these drugs anymore, but we use equally toxic drugs. They should always be used with discretion.”

Mackowiak quoted 19th-century American physician Oliver Wendell Holmes, MD: “I firmly believe that if the whole materia medica [medications] as now used could be sunk to the bottom of the sea, it would be all the better for mankind — and all the worse for the fishes.”

Zachary Taylor: No Jubilee From These Cherries

It was Independence Day in 1850, and Washington D.C. was its usual miserable summer self. President Zachary Taylor ate fresh cherries and iced milk, and then he felt sick with cramps and diarrhea. Physicians turned to the usual suspects — laxatives, bloodletting, blistering – but Taylor died 5 days later at the age of 65. He saw it coming: “I should not be surprised if this were to terminate in my death.”

Almost exactly 141 years later, in 1991, Taylor’s body was exhumed from a Louisville cemetery to test a theory that he’d been poisoned by arsenic. Testing revealed no sign of unusual levels of arsenic in Taylor’s body, which was recognizable by his “protruding eyebrows.”

The generally accepted theory is that Taylor died of gastroenteritis instead of a plot by Southerners to knock him off to preserve slavery.

San Francisco cardiologist John G. Sotos, MD, who manages a presidential medical history website, told MedPage Today that Taylor’s cause of death is especially difficult to retrospectively diagnose because there’s little information about his illness. Still, it’s likely that he would have been successfully treated today with antibiotics, and any intestinal perforation could be repaired, Sotos said.

James Garfield: A Doctor Named Doctor Gets the Blame

President James Garfield endured the most agonizing, drawn-out, horrific death of any president: He lived for more than 2 months in the summer of 1881 after being shot in Washington D.C. in the arm and abdomen by a deranged office-seeker on July 2. His assassin is the ultimate culprit – never mind that the killer blamed Garfield’s doctors — but historians have long blamed medical misadventure for his demise.

Garfield’s physicians dug around his wound with unwashed fingers. A stubborn surgeon named Doctor Willard Bliss missed the true location of the bullet in the abdomen. An attempt to use a new-fangled x-ray machine only turned up static, possibly because metal bed springs were causing interference. Garfield, fed rectally, fell from 210 to 130 pounds and died on Sept. 18, 1881, at the age of just 49.

In an interview, Jeffrey S. Reznick, PhD, senior historian with the National Library of Medicine, said “at the time, American doctors did not believe in germs because they did not accept the theory of germs embraced by the British surgeon Joseph Lister beginning in the early 1860s. American doctors of the period subscribed to the miasma theory, the belief that bad air caused disease and illness.”

Even so, Reznick said, the “the arrogance and ambition of Dr. Bliss did not allow any second opinions. The autopsy confirmed what Bliss publicly and adamantly denied, that the bullet was on the left side of the president’s body.”

So did the doctors screw up? In a 2013 report, surgeons Theodore N. Pappas, MD, of Duke University, and Shahrzad Joharifard, MD, MPH, of BC Children’s Hospital in Canada, mainly let the physicians off the hook. While the apparent cause of death was “a late rupture of a traumatic splenic artery pseudoaneurysm” (an injured blood vessel), they think a gallbladder abscess “was the most logical source of the President’s sepsis, which was, in turn, the cause of Garfield’s unrelenting downhill course.”

Warren Harding: The Heart of the Matter

The New York Times blared the news in a front-page headline on August 3, 1923: “President Harding Dies Suddenly/Stroke of Apoplexy at 7:30 P.M./Calvin Coolidge Is President.”

Harding succumbed to something – a stroke, perhaps, or heart failure, or poisoning – the night before at a hotel in San Francisco while touring the West Coast.

The president certainly had enough energy to enjoy extra-marital activity galore during his term in the White House. (You don’t want to know what he called his penis in erotic love letters.) But, as medical historian Markel noted in a 2015 PBS article, the president “was never a well man.”

He suffered from “neurasthenia,” a vague term for general nervousness, and symptoms of congestive heart disease, Markel wrote.

In an interview, Duke University surgeon Pappas, who wrote a 2020 report about Harding’s death, said uncontrolled hypertension and atherosclerosis likely contributed to his heart disease.

His symptoms worsened in 1923, Pappas said, as Harding developed angina and suffered from the stress of a gallbladder attack. “He clearly had some heart damage because he could not sleep flat in bed without getting short of breath. He slept on several pillows.”

As to the cause of death, “the only question was whether he had a stroke as he died,” Pappas said. “A stroke was not likely. It is much more likely that his terminal event was a heart arrhythmia, which is very common when individuals have damage to their heart due to blocked arteries to the heart.”

Pappas added that there was no sign of poisoning, although no autopsy was performed.

“This was a time when we did not have antibiotics to treat the gallbladder attack and no heart surgery, strong heart medications, or blood pressure control,” he said. “Today he would have been on antihypertensive meds. He would have gotten a cardiac catheterization at the first sign of chest pain and would have had stents put in his coronary arteries if necessary. If stents were not possible, he might have had heart surgery to do a bypass of the blocked blood vessels. He would have received antibiotics for his gallbladder and likely have his gallbladder removed if his heart improved.”

Instead, Harding died at the age of 57. Only 2 presidents who weren’t assassinated failed to live as long — James Polk, who died at 53, apparently of cholera, and Chester Arthur, who died at 57 of Bright’s disease, a kidney ailment. In contrast, the president who’s lived the longest – Jimmy Carter – turned 99 last October.

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