Barely two months after winning election as the nation's 15th president, James Buchanan traveled from his home state of Pennsylvania to Washington and checked into the plush National Hotel in January 1857 to prepare for his inauguration in March.

Known as a Northerner with Southern principles, Buchanan served in both houses of Congress and as secretary of state, earning a reputation for insisting that the Constitution supported giving the states authority over the institution of slavery. Soon after winning the presidency, he even lobbied the Supreme Court to rule against Dred Scott, the enslaved man who tried to sue to win his freedom. The court's now-infamous decision infuriated antislavery Americans — including Buchanan's fellow Northern Democrats — and contributed to sparking the Civil War.

James Buchanan
Library of Congress
James Buchanan

One morning, Buchanan awoke in his bed at the National with abdominal cramps and often-bloody diarrhea. He developed profound weakness, vomiting, and loss of appetite. Other hotel guests developed similar symptoms, which also included mouth pain and tongue swelling. Curiously, those who drank at the hotel bar seemed unaffected, but those who ate in the dining room became terribly ill with what was soon known as National Hotel Disease.

As many as 400 hotel guests took ill and three dozen died, including three members of Congress (two from Pennsylvania, one from Mississippi) and Buchanan's nephew, who served as his secretary. Buchanan slowly improved enough to go home to Lancaster County, where he recuperated.

Rumors swirled as to the cause of the outbreak. Some suspected radical abolitionists of adding arsenic to the hotel's water supply in order to strike at Buchanan and his proslavery supporters.

As the National Hotel owner was a friend and supporter, Buchanan checked in again just before the inauguration and attended a party to demonstrate his confidence in the place.

The next day, Buchanan's illness was back. By Feb. 26, he thought he would miss the inauguration. But he did manage to take the oath of office at the Capitol Rotunda on March 4, 1857.

What caused Buchanan and many others to become so ill before his inauguration?


Poisoned water was thought improbable because the National Hotel's water tank was used only for washing. Drinking water was brought to the hotel in containers from a distance.

However, rat poison containing arsenic had been used at the hotel, and a poisoned rat was discovered in the water tank after guests became ill, fueling rumors eagerly reported by newspapers.

A special committee appointed by the mayor contended that the disease was transmitted by inhalation of a poison in the form of "miasma," "noxious vapors," or "bad air" emanating from decomposing vegetables and animals. They thought the infection entered the National Hotel from a sewer connection.

Today, experts speculate that the National Hotel outbreak was most likely connected to its primitive sewer system. Two likely suspects: salmonella — a bacteria that plagues us still, as with the recent reports of salmonella poisoning in Goldfish crackers; and cholera (caused by infection with vibrio cholerae), which was a huge danger before modern water and sewer systems essentially did away with it in the United States. It still is a serious threat in the developing world.

In his inaugural address, Buchanan announced he would serve only one term. He deplored the growing divisions over slavery and stated that Congress should play no role in determining the status of slavery in the states or territories, leaving it up to state governments.

Buchanan's inability to help bridge the divisions that drove the nation to civil war has earned him a consistent ranking as one of the worst presidents in American history. After he left the White House and war broke out, Buchanan continued to insist that he bore no responsibility for the war.

The only president to remain a lifelong bachelor, he died three years after the Civil War ended, in 1868 at age 77, of respiratory distress. He is buried in Lancaster.

Allan B. Schwartz, M.D., is a professor of medicine in the Division of Nephrology & Hypertension at Drexel University College of Medicine