Robert Smith

is an instructor in Widener University's Osher Lifelong Learning Institute, where he specializes in the history of the presidency and medicines

Among other firsts, George Washington could be remembered as America's "First Dodger."

At one time or another, the greatest of the men whom we honor Monday on Presidents Day dodged possibly fatal outcomes from malaria, smallpox, tuberculosis, dysentery, and pneumonia. He escaped harm from dangerous wildwood critters, would-be assassins, and military enemies in units much larger than his. Amid all this dodging, he accomplished more in his 67 years than many other Americans.

Washington's successes occurred against a backdrop of an unhealthy environment and a family history of premature death. His father, Augustine, died at Ferry Farm at 49 of "gout of the stomach"; grandfather Lawrence died at 37 of an infection. His half-brother and mentor, also named Lawrence, died at Mount Vernon at 33 of tuberculosis. By 1792, when George turned 60, he had outlived all his male ancestors, all his brothers, and the average Virginian of his time (by 15 years).

Little is known of Washington's early diseases; he probably had mumps, rickets, and diphtheria. His extensive diaries, starting in his teens, commonly discuss illnesses. One early entry (1749) cited a case of ague (malaria, endemic to tidewater Virginia) that caused him "fever in extremity." His next illness (1751) came when he traveled to Barbados with Lawrence, who was looking for relief from his tuberculosis. George contracted smallpox that did not kill him but left him scarred for life (and, fortunately, immune to further episodes). He put this experience to good use as commander-in-chief of the Continental Army, ordering the inoculation of all his soldiers against that widespread disease.

The most striking aspect of Washington's medical history was survival - without a scratch - through many military campaigns.

At the Battle of the Monongahela (1755), he was the only British officer (among 86) who was not wounded, although four bullets passed through his coat and two of his horses were shot out from under him. One Indian chief later said that he had 11 clear shots at Washington, all without effect; the Indian stopped shooting because he thought his target was protected by the gods. The worst that happened to Washington at that time was dysentery, which was caused by eating rotten meat sent by unscrupulous suppliers. Surprisingly, he endured the Revolution in complete health, despite the brutal conditions at Valley Forge and elsewhere.

In June 1789, shortly after Washington became president, he developed a "malignant carbuncle" of the hip and was bedridden for six weeks after surgical removal (without anesthesia). In May 1790 he developed a near-fatal case of pneumonia. His only treatment was laudanum - a combination of opium and honey - which acted as a sleep aid (but had no antimicrobial effect).

Washington's eyesight when he was president grew progressively weaker and his hearing also failed, due at least in part to the increasing use of quinine to treat his episodes of malaria. By age 63 he was also toothless - a favorite food was walnuts, and he cracked the shells with his teeth. One set of dentures was made of hippopotamus bone, a notoriously porous material that blackened with the port wine Washington liked (another reason he did not like to smile).

Washington's last day on Earth - Dec. 14, 1799 - bore gruesome testimony to the state of the art of medicine at that time.

Early that day he complained of severe sore throat and shortness of breath. A coterie of physicians treated him with onions boiled in molasses, butter dissolved in vinegar, a piece of flannel impregnated with menthol and wrapped around the throat, a blister of cantharidin (Spanish fly, stimulated urination), an injection of calomel ("resulted in copious discharges from both ends of the gastrointestinal system").

That day, Washington was subjected to bleeding four times, removing 80 ounces of blood, or nearly half of his total circulation. The practice of bloodletting and the use of laxatives were cornerstones of "heroic medicine," which dated from the Roman era and advocated a balance among the "four humors" - blood, phlegm, yellow bile (urine), and black bile (feces). That form of medicine fell into disfavor only in the 19th century, when the experiments of Ignatz Semmelweis, Joseph Lister, Louis Pasteur, Robert Koch, and others proved the microbial origin of many diseases.

Washington's original diagnosis that fateful day was "inflammatory quinsy," or peritonsillar abscesses. The second diagnosis was "cynanche trachealis," a vague term used to denote severe sore throat involving the voice box. Only one physician, Elisha Dick, recognized the situation for what it was and recommended a tracheotomy; he was overruled by the other physicians, James Craik and Gustavus Brown. The modern diagnosis would have been inflammation of the epiglottis, a true medical emergency, but treatable with antibiotics.

Given the times, it was one ailment too many for this great man to dodge.