Presidents under the knife: The first president

When George Washington was sworn in as the first president of the United States, New York City was the capital. The new president was inaugurated on the balcony of Federal Hall on April 30, 1789. Less than two months later, Washington was ill with a condition that could have killed him. He had developed a tender and extremely painful swelling on his left thigh, accompanied by chills and high fever. Although most historical accounts indicate that the president’s ailment was a huge abscess on his left thigh, the exact nature, and even its location, have remained somewhat of a controversy among biographers. Some have called it “a large and painful tumor on his left thigh,” others “a fast-growing tumor,” a “carbuncle” or “malignant carbuncle.” In a book, published about seventy years after the event, the lesion was described as a “painful tumor … upon his thigh,” and a reason was proposed why the illness had developed, explaining that, “it was brought on by the excitements and labors which he had undergone since his inauguration.”1

Whereas most writings suggest that the abscess was on Washington’s left thigh, recently some historians have suggested that it was “an irritation on his left buttock that began as a minor saddle-sore (Washington was an avid horseback rider) and became a painful infected boil,” which ultimately developed into a “very large tumor.”2 The same authors suggested that most previous accounts, placing the abscess on the president’s leg rather than on the buttock, did so to spare Washington from the embarrassment of being reported to have a medical problem close to his private parts.

Regardless of its exact location and cause, taken together, most previous accounts support the notion that the newly inaugurated president suffered from immense pain and “threatening” fever from a large abscess on his left thigh.

When the citizens of New York realized that their president (and hero) was ill, they worried. Their concern increased when they found the street in front of Washington’s residency blocked off with a “chain … stretched across the street,” and the sidewalk being “laid with straw” to give Washington as much quiet as possible and improve his recuperation. The people felt increasingly convinced that “the President’s case was … extremely dangerous.” Washington was also concerned and understood he may die from the condition. On one occasion he asked his doctor about “the probable termination of his disease,” and instructed him, “Do not flatter me with vain hopes; I am not afraid to die and therefore can bear the worst.” Stoically he added, “Whether to-night or twenty years hence, makes no difference; I know that I am in the hands of a good Providence.”

The pain and fevers grew worse, and finally Washington could not stand it any longer. He requested a surgeon to be called. When asked whether his old friend and longstanding personal physician, Dr. James Craik, should be sent for, the president, realizing that Craik was too far away to make it to his bedside in a short time, answered that he would have been gratified to have his old friend with him but in lieu of that, he felt fortunate to be in such good hands as Dr. Bard’s.

Drs. John and Samuel Bard were father and son surgeons, well-known and busy physicians in New York during the mid-1700s. Bard Senior had moved to New York from Philadelphia in 1746 after being advised by his friend Benjamin Franklin to leave his practice in the City of Brotherly Love for better opportunities in New York City. He was missed in his old hometown where he was known as “a man who will not be quickly forgotten where he was once known.”3 Samuel Bard had been educated in England and Scotland and when returning from his training had joined his father to build a busy and successful medical practice in New York.

When Washington’s condition came to a head, Samuel Bard was already aware of the president’s situation. He had attended the patient “night and day” for several days. When he was called upon on the 17th of June, he understood that more drastic measures would be needed. He brought his knife for the handiwork – and his father (who was retired since more than ten years) for moral support. Both surgeons understood that it was important to open and drain the abscess to ease Washington’s suffering but were also anxious when facing the need to cut into the flesh of the newly inaugurated president. Just imagining the terrible pain they were about to inflict on the patient made them very uncomfortable – but they felt they had no choice.

Bard senior was probably the most nervous of the two surgeons: “The elder being somewhat doubtful of his nerves, gave the knife to his son, bidding him to ‘cut away – deeper, deeper still; don’t be afraid; you see how well he bears it.’”4 Opening the abscess and draining it of the pus was probably what saved the president’s life. Luckily enough, the operation proved successful, and the patient’s recovery removed “all cause of alarm.” It would be a while, however, before Washington was back to normal. For a couple of weeks after the surgery, he could not lie on his left side. To calm the New Yorkers, the president was driven around in a wagon lying on his right side on a mattress and was able to wave to the cheering crowds. Soon he was able to take up plans for more extensive travel and set out for a tour through New England. The nation could take a deep breath being relieved from the fear of losing their first President already a couple of months into his term.

Although the surgery had been successful, it would only take two years before Washington had a relapse as described by Thomas Jefferson in a letter to James Madison: “The President is indisposed with the same blind tumour, & in the same place which he had the year before last in New York.”5 Most likely, however, surgery did not have to be employed this time, because, as Jefferson explained, although the President “has at times a little fever,” the carbuncle “does not promise to suppurate.”

It would be almost a decade before Washington would need another operation. At that time, however, he was less lucky and did not get the necessary surgery. He was choked to death by epiglottitis and although he may have been saved by a tracheotomy, his doctors did not have the courage to put the president under the knife.