Past Pandemics: What Caused William Henry Harrison's Death - Pneumonia or Typhoid Fever?
William Henry Harrison died in 1841, just 1 month after becoming the ninth president of the United States. Many historians have believed that Harrison died from pneumonia. For over a century after his death, the story was that the 68 year old president caught a fatal chill on the day that he was sworn into office while delivering the longest inaugural address ever, in wet, freezing weather without a hat, overcoat, and gloves. But this cause of death is now seen as doubtful by physicians who have reviewed the case more carefully, armed with the benefit of modern medical knowledge. A detailed case summary written by Harrison's personal physician has suggested a new diagnosis, namely that it was enteric fever, and not pneumonia, that shuffled “Old Tippecanoe” of of this mortal coil. These theorists suggest that Harrison and two other presidents of that era who exhibited similar symptoms, James K. Polk and Zachary Taylor, also may have fell victim to a similar bug, likely a consequence of the unsanitary conditions that existed in the nation's capital during most of the nineteenth century.
Harrison was 68 years old when he became president, the oldest US president until Ronald Reagan was elected nearly a century and a half later. Harrison was sworn into office on March 4, 1841 and exactly 1 month later he was dead. The most common diagnosis for his cause of death was fatal pneumonia. According to more recent medical experts however, this diagnosis is at odds with the detailed description of Harrison's final illness recorded by his personal physician, Dr Thomas Miller of Washington, DC. Harrison's illness was similar to those suffered by Polk and Taylor, which had symptoms more consistent with enteric fever than pneumonia. The more common theory today is that poor sanitation in the nation's capital during much of the nineteenth century, rather than exposure to inclement weather 3 weeks prior to becoming ill, was likely responsible for Harrison's death.
Dr. Miller reported that President Harrison first consulted him on March 26, 1841, three weeks after his inauguration. Harrison complained of several days of anxiety and fatigue, believed to be due to the intense physical and mental pressures and stresses of his office, including the ceaseless parade of office seekers that presidents of the time had to tolerate. Harrison reported to Miller that he felt unwell but that he hoped to recover soon thanks to a regimen of fasting and medicine (particulars of which are not recorded). Harrison also told Miller that he had a long history of “neuralgia, affecting his head, stomach and often his extremities,” as well as chronic dyspepsia. Harrison believed that he could control his condition with a diet consisting principally of “animal food.” Miller advised Harrison to get some rest in bed. He returned later that evening, and was told by the patient that he felt better than he had in days.
At 1:00 pm the next day, Miller was again summoned to the White House. This time Harrison complained of a severe chill. To treat this, Miller applied a mustard to the president's stomach and prescribed warm drinks along with a gentle diaphoretic draught, tartar emetic (antimony potassium tartrate), with spiritus Mindereri (acetate of ammonia). When he saw his patient later at 5:00 pm, Harrison reported that he was feeling “much improved". The doctor's notes record that "his skin warm and moist, his thirst allayed, his pulse was soft, about seventy-five.” Harrison complained of a slight pain over his right eye. Miller also prescribed a bitter apple laxative to be taken at bedtime.
Shortly after midnight the next day, Harrison developed a violent pain over his right brow and in his right side. He believed that the pain in his side was caused by constipation, and was made worse by motion but not by pressure. Harrison also complained of thirst and occasional nausea. His pulse was 80 and soft. Miller ordered enemas, mustard plasters applied to the painful side, and a Seidlitz powder (a tartaric acid/sodium bicarbonate/potassium tartrate laxative). Once again Harrison's discomfort began to ease by the following morning at 8:30 am, and by 10:00 am the pain in his side and head had nearly resolved.
Once again however, Harrison's condition worsened. At 11:30 a.m. Harrison was restless and would not allow his side to be touched. He once again experienced chills and asked for laudanum (tincture of opium) to be applied to his painful right side. Miller gave him a second laxative pill, and at 2:30 pm, Harrison's skin was warmer and drier than it had been. His pulse was slightly faster and his breathing was more hurried and his face was a little flushed. Miller concluded that "the lower lobe of the right lung was the seat of pneumonia, complicated by congestion of the liver.” But because Harrison now complained of feeling nauseated and faint, Miller decided not to bleed him, which was the standard treatment for pneumonia at the time. Instead, at 3:00 pm Miller applied a blistering preparation to Harrison's right side and gave him 20 drops of laudanum, along with another laxative pill. These relieved the president's pain but remarkably not his constipation. Miller gave him 5 grains of calomel (mercury chloride) with 10 drops of laudanum, which quieted Harrison's stomach, relieved his pain, and put him to sleep.
Harrison spent that night troubled by dyspnea and a slight dry cough. He was urinating freely, but the laxatives were not having their intended effect. The pain in his side was now mild. Miller ordered Dover's powder (ipecac plus opium) to allay Harrison's restlessness and a small dose of castor oil for his persistent constipation. When examined the next day at 2:00 pm, Harrison was breathing heavily and coughing occasionally. That evening Harrison began expectorating “pinkish mucus.”
That night Harrison slept better and seemed to be improving, though he remained constipated and distended. Miller gave him more Mars Hydrarg and ipecac, along with opium camphor. That afternoon, Harrison was again feverish and was more comfortable lying on his right side. The next day, March 31, Harrison's cough was now producing copious yellow mucus tinged with blood. Miller discontinued the laxative pills and ordered serpentaria (Virginia snake weed root) and seneka (Polygala senega) enemas. When Harrison's fever returned later in the day, Miller reinstituted alternating doses of Mars Hydrarg, ipecac, antimony, and spirits of ammonia every 3 hours.
Harrison looked worse on the morning of April 1, so Miller decided to discontinue all medicines temporarily, except for Mars Hydrarg, which he applied “over the whole abdomen and blistered surface.” That afternoon, Harrison was described as being incoherent, “muttering while dozing; picking at the bed clothes.” Miller applied blisters to the inside of Harrison's thighs, which seemed to sooth him.
Dr N. W. Worthington of Georgetown and Dr J. C. Hall of Washington City joined Miller as consultants and concurred in his diagnosis and treatment plan after a cursory examination. Harrison continued to complain of intermittent pain in his side and over his right brow. These were relieved by warm poultices over the blistered surface and Granville's lotion along the spine. Mars Hydrarg, camphor, and opium were administered sequentially every 2 hours.
On the morning of 2 April, Harrison was expectorating brownish mucus tinged with blood. Miller gave him 2 grains of blue mass (another mercury-containing medication) every 2 hours while continuing the serpentaria and seneka enemas. That night Harrison slept fitfully but was perfectly lucid when he awoke. His cough was now dry and hacking. He appeared flushed and was warm to the touch. His pulse was quicker than it had been.
At 2:30 pm Miller gave Harrison “twenty drops of laudanum to check an inclination to another passage.” Harrison was experiencing watery diarrhea and became progressively more lethargic and difficult to wake. Miller's notes indicate that Harrison's pulse was “slow, hobbling and intermittent, his skin dark and muddy,” and his abdomen distended. Miller ordered stimulants, mustard plasters applied to the extremities and abdomen.
It was at 8:45 pm on April 3, 1841, when President William Henry Harrison uttered his last words. He was recorded to have said, “Sir, I wish you to understand the true principles of government; I wish them carried out, I ask nothing more.” At half past midnight on April 4, Miller reports that “without a groan or a struggle, he ceased to breath.”
For almost two centuries after Harrison's death, Miller's diagnosis was accepted in biographies, history books, and periodicals, all ow which reported that it was pneumonia that killed the ninth president just a month after being sworn into office. Miller had written, “The disease was not viewed as a case of pure pneumonia, but as this was the most palpable affection, the term pneumonia afforded a succinct and intelligible answer to the innumerable questions as to the nature of the attack”.
But in more recent times, this diagnosis has been doubted. Although Harrison had fever, dyspnea, and cough productive of blood-tinged sputum during the course of his illness, his pulmonary symptoms didn't come about until the fifth day of his illness and were intermittent rather than progressive. His gastrointestinal complaints began on the third day of the illness and were relentless as well as progressive. They began with constipation and abdominal distension that persisted for 5 days in spite of repeated laxatives and enemas administered by Dr Miller. Although Harrison's lungs were one of the targets of the infection that took his life, his pulmonary symptoms were not as severe or as progressive as his gastrointestinal symptoms. Because of this, many physicians now conclude that it is more likely that he died of a gastrointestinal infection, specifically enteric fever, with secondary involvement of the lungs.
In an article published in the journal Clinical Infectious Diseases, the authors conclude that all of Harrison's signs and symptoms were typical of enteric fever, a severe systemic illness caused by disseminated infection with Salmonella typhi. Fever and abdominal pain are two of the most consistent complaints of patients with enteric fever and constipation and diarrhea occur with equal frequency. Harrison's chills, frontal headache, anorexia, cough, and muscle pain, are also common symptoms and respiratory symptoms are also prominent in typhoid fever patients. The authors write:
"There is ample reason to conclude that Harrison's move into the White House placed him at particular risk of contracting enteric fever. In 1841 the nation's capital had no sewer system (nor, for that matter, did any other American city). Until 1850 sewage from nearby buildings simply flowed onto public grounds a short distance from the White House, where it stagnated and formed a marsh. The White House water supply, which came from springs in the square bounded by 13th, 14th, I, and K streets NW, was situated just 7 blocks below a depository for night soil that was hauled there each day from the city at government expense. This might explain why 3 antebellum US presidents, Harrison, James Polk, and Zachary Taylor, each developed severe gastroenteritis while residing in the White House. Polk recovered only to die of presumed cholera 3 months after leaving office. Taylor, like Harrison, succumbed to his episode of gastroenteritis while president."
The theory is that Harrison's history of “dyspepsia” heightened his risk of infection caused by a particular type of bacteria that found their way from Washington's night soil depository into the White House water supply. In 1841 there was no effective treatment for enteric fever. At that time, all a physician could do for a patient with typhoid fever was to follow a physician's first rule: primum non nocere ("first do no harm"). Although the medications that Dr. Miller gave Harrison were standard for that time, many are now recognized as overtly toxic, especially those which included mercury. For someone with enteric fever, opium was especially dangerous. Opium promotes the retention of bacteria like S. typhi and S. paratyphi and facilitates their invasion into the bloodstream. Harrison's sinking pulse and cold extremities at the time of his death suggest that he succumbed to septic shock.
Harrison's premature death likely changed the course of American history. If Harrison had survived. he likely would have supported a controversial Whig measure to charter a national bank, a move that his successor John Tyler, vetoed. Unlike his successor, Harrison would have not been as aggressive as Tyler in bringing about the annexation of Texas in 1844, which precipitated the Mexican War. This in turn would have delayed disputes between North and South over the expansion of slavery into the vast territories won from Mexico, a disputes that would ultimately be settled by the Civil War. It makes for interesting speculation.
Harrison was 68 years old when he became president, the oldest US president until Ronald Reagan was elected nearly a century and a half later. Harrison was sworn into office on March 4, 1841 and exactly 1 month later he was dead. The most common diagnosis for his cause of death was fatal pneumonia. According to more recent medical experts however, this diagnosis is at odds with the detailed description of Harrison's final illness recorded by his personal physician, Dr Thomas Miller of Washington, DC. Harrison's illness was similar to those suffered by Polk and Taylor, which had symptoms more consistent with enteric fever than pneumonia. The more common theory today is that poor sanitation in the nation's capital during much of the nineteenth century, rather than exposure to inclement weather 3 weeks prior to becoming ill, was likely responsible for Harrison's death.
Dr. Miller reported that President Harrison first consulted him on March 26, 1841, three weeks after his inauguration. Harrison complained of several days of anxiety and fatigue, believed to be due to the intense physical and mental pressures and stresses of his office, including the ceaseless parade of office seekers that presidents of the time had to tolerate. Harrison reported to Miller that he felt unwell but that he hoped to recover soon thanks to a regimen of fasting and medicine (particulars of which are not recorded). Harrison also told Miller that he had a long history of “neuralgia, affecting his head, stomach and often his extremities,” as well as chronic dyspepsia. Harrison believed that he could control his condition with a diet consisting principally of “animal food.” Miller advised Harrison to get some rest in bed. He returned later that evening, and was told by the patient that he felt better than he had in days.
At 1:00 pm the next day, Miller was again summoned to the White House. This time Harrison complained of a severe chill. To treat this, Miller applied a mustard to the president's stomach and prescribed warm drinks along with a gentle diaphoretic draught, tartar emetic (antimony potassium tartrate), with spiritus Mindereri (acetate of ammonia). When he saw his patient later at 5:00 pm, Harrison reported that he was feeling “much improved". The doctor's notes record that "his skin warm and moist, his thirst allayed, his pulse was soft, about seventy-five.” Harrison complained of a slight pain over his right eye. Miller also prescribed a bitter apple laxative to be taken at bedtime.
Shortly after midnight the next day, Harrison developed a violent pain over his right brow and in his right side. He believed that the pain in his side was caused by constipation, and was made worse by motion but not by pressure. Harrison also complained of thirst and occasional nausea. His pulse was 80 and soft. Miller ordered enemas, mustard plasters applied to the painful side, and a Seidlitz powder (a tartaric acid/sodium bicarbonate/potassium tartrate laxative). Once again Harrison's discomfort began to ease by the following morning at 8:30 am, and by 10:00 am the pain in his side and head had nearly resolved.
Once again however, Harrison's condition worsened. At 11:30 a.m. Harrison was restless and would not allow his side to be touched. He once again experienced chills and asked for laudanum (tincture of opium) to be applied to his painful right side. Miller gave him a second laxative pill, and at 2:30 pm, Harrison's skin was warmer and drier than it had been. His pulse was slightly faster and his breathing was more hurried and his face was a little flushed. Miller concluded that "the lower lobe of the right lung was the seat of pneumonia, complicated by congestion of the liver.” But because Harrison now complained of feeling nauseated and faint, Miller decided not to bleed him, which was the standard treatment for pneumonia at the time. Instead, at 3:00 pm Miller applied a blistering preparation to Harrison's right side and gave him 20 drops of laudanum, along with another laxative pill. These relieved the president's pain but remarkably not his constipation. Miller gave him 5 grains of calomel (mercury chloride) with 10 drops of laudanum, which quieted Harrison's stomach, relieved his pain, and put him to sleep.
Harrison spent that night troubled by dyspnea and a slight dry cough. He was urinating freely, but the laxatives were not having their intended effect. The pain in his side was now mild. Miller ordered Dover's powder (ipecac plus opium) to allay Harrison's restlessness and a small dose of castor oil for his persistent constipation. When examined the next day at 2:00 pm, Harrison was breathing heavily and coughing occasionally. That evening Harrison began expectorating “pinkish mucus.”
That night Harrison slept better and seemed to be improving, though he remained constipated and distended. Miller gave him more Mars Hydrarg and ipecac, along with opium camphor. That afternoon, Harrison was again feverish and was more comfortable lying on his right side. The next day, March 31, Harrison's cough was now producing copious yellow mucus tinged with blood. Miller discontinued the laxative pills and ordered serpentaria (Virginia snake weed root) and seneka (Polygala senega) enemas. When Harrison's fever returned later in the day, Miller reinstituted alternating doses of Mars Hydrarg, ipecac, antimony, and spirits of ammonia every 3 hours.
Harrison looked worse on the morning of April 1, so Miller decided to discontinue all medicines temporarily, except for Mars Hydrarg, which he applied “over the whole abdomen and blistered surface.” That afternoon, Harrison was described as being incoherent, “muttering while dozing; picking at the bed clothes.” Miller applied blisters to the inside of Harrison's thighs, which seemed to sooth him.
Dr N. W. Worthington of Georgetown and Dr J. C. Hall of Washington City joined Miller as consultants and concurred in his diagnosis and treatment plan after a cursory examination. Harrison continued to complain of intermittent pain in his side and over his right brow. These were relieved by warm poultices over the blistered surface and Granville's lotion along the spine. Mars Hydrarg, camphor, and opium were administered sequentially every 2 hours.
On the morning of 2 April, Harrison was expectorating brownish mucus tinged with blood. Miller gave him 2 grains of blue mass (another mercury-containing medication) every 2 hours while continuing the serpentaria and seneka enemas. That night Harrison slept fitfully but was perfectly lucid when he awoke. His cough was now dry and hacking. He appeared flushed and was warm to the touch. His pulse was quicker than it had been.
At 2:30 pm Miller gave Harrison “twenty drops of laudanum to check an inclination to another passage.” Harrison was experiencing watery diarrhea and became progressively more lethargic and difficult to wake. Miller's notes indicate that Harrison's pulse was “slow, hobbling and intermittent, his skin dark and muddy,” and his abdomen distended. Miller ordered stimulants, mustard plasters applied to the extremities and abdomen.
It was at 8:45 pm on April 3, 1841, when President William Henry Harrison uttered his last words. He was recorded to have said, “Sir, I wish you to understand the true principles of government; I wish them carried out, I ask nothing more.” At half past midnight on April 4, Miller reports that “without a groan or a struggle, he ceased to breath.”
For almost two centuries after Harrison's death, Miller's diagnosis was accepted in biographies, history books, and periodicals, all ow which reported that it was pneumonia that killed the ninth president just a month after being sworn into office. Miller had written, “The disease was not viewed as a case of pure pneumonia, but as this was the most palpable affection, the term pneumonia afforded a succinct and intelligible answer to the innumerable questions as to the nature of the attack”.
But in more recent times, this diagnosis has been doubted. Although Harrison had fever, dyspnea, and cough productive of blood-tinged sputum during the course of his illness, his pulmonary symptoms didn't come about until the fifth day of his illness and were intermittent rather than progressive. His gastrointestinal complaints began on the third day of the illness and were relentless as well as progressive. They began with constipation and abdominal distension that persisted for 5 days in spite of repeated laxatives and enemas administered by Dr Miller. Although Harrison's lungs were one of the targets of the infection that took his life, his pulmonary symptoms were not as severe or as progressive as his gastrointestinal symptoms. Because of this, many physicians now conclude that it is more likely that he died of a gastrointestinal infection, specifically enteric fever, with secondary involvement of the lungs.
In an article published in the journal Clinical Infectious Diseases, the authors conclude that all of Harrison's signs and symptoms were typical of enteric fever, a severe systemic illness caused by disseminated infection with Salmonella typhi. Fever and abdominal pain are two of the most consistent complaints of patients with enteric fever and constipation and diarrhea occur with equal frequency. Harrison's chills, frontal headache, anorexia, cough, and muscle pain, are also common symptoms and respiratory symptoms are also prominent in typhoid fever patients. The authors write:
"There is ample reason to conclude that Harrison's move into the White House placed him at particular risk of contracting enteric fever. In 1841 the nation's capital had no sewer system (nor, for that matter, did any other American city). Until 1850 sewage from nearby buildings simply flowed onto public grounds a short distance from the White House, where it stagnated and formed a marsh. The White House water supply, which came from springs in the square bounded by 13th, 14th, I, and K streets NW, was situated just 7 blocks below a depository for night soil that was hauled there each day from the city at government expense. This might explain why 3 antebellum US presidents, Harrison, James Polk, and Zachary Taylor, each developed severe gastroenteritis while residing in the White House. Polk recovered only to die of presumed cholera 3 months after leaving office. Taylor, like Harrison, succumbed to his episode of gastroenteritis while president."
The theory is that Harrison's history of “dyspepsia” heightened his risk of infection caused by a particular type of bacteria that found their way from Washington's night soil depository into the White House water supply. In 1841 there was no effective treatment for enteric fever. At that time, all a physician could do for a patient with typhoid fever was to follow a physician's first rule: primum non nocere ("first do no harm"). Although the medications that Dr. Miller gave Harrison were standard for that time, many are now recognized as overtly toxic, especially those which included mercury. For someone with enteric fever, opium was especially dangerous. Opium promotes the retention of bacteria like S. typhi and S. paratyphi and facilitates their invasion into the bloodstream. Harrison's sinking pulse and cold extremities at the time of his death suggest that he succumbed to septic shock.
Harrison's premature death likely changed the course of American history. If Harrison had survived. he likely would have supported a controversial Whig measure to charter a national bank, a move that his successor John Tyler, vetoed. Unlike his successor, Harrison would have not been as aggressive as Tyler in bringing about the annexation of Texas in 1844, which precipitated the Mexican War. This in turn would have delayed disputes between North and South over the expansion of slavery into the vast territories won from Mexico, a disputes that would ultimately be settled by the Civil War. It makes for interesting speculation.