Booker T. Washington Died of Complications from Severe Hypertension

For immediate release: May 05, 2006

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Diagnosis Made in Historical Conference Sponsored by the University of Maryland School of Medicine and the VA Maryland Health Care System

Booker T. Washington, the founding father of the Tuskegee Institute and a leader in the aftermath of the Civil War who fought for African American rights, died of complications from hypertension in a New York City hospital in 1915 at the age of 59. The mystery of Washington's death, which had previously been attributed to “racial characteristics,” is the focus of this year's historical clinicopathological conference (CPC) sponsored by the University of Maryland School of Medicine and the Veterans Affairs (VA) Maryland Health Care System in Baltimore.

The 2006 Historical CPC will be held Friday, May 5, from 1:30 to 3:00 p.m., in Davidge Hall (522 W. Lombard Street) at the University of Maryland School of Medicine. More than 300 faculty members, students and alumni are expected to attend the annual event, where the case of an unnamed but famous historical person is presented for discussion in an academic setting.

Booker T. Washington was a former slave who rose to international prominence as an orator, educator and a spokesman for the rights of African Americans. Born in Franklin County, Virginia, to a slave mother and an unidentified white father, Washington taught himself to read and attended the Hampton Normal and Agricultural Institute in Virginia (now Hampton University) after emancipation. He flourished at the school and in 1881 was recommended by the school's white principal to build an institute in Tuskegee, Alabama, to educate former slaves. He became a national figure who advocated that blacks and whites work separately for their common good.

It was previously thought that Washington might have suffered from syphilis, based on his physician's comment that his death was due at least in part to “racial characteristics.” But a thorough review of his medical record obtained from the Rockefeller Hospital in New York City by CPC organizers, shows a different diagnosis when examined by modern day standards.

According to his medical record, when Washington was admitted to the hospital two weeks before his death, he suffered from headaches, fatigue, weight loss and failing vision. He had a history of frequent urination and an avid thirst.

“When he was admitted to the hospital, Mr. Washington most certainly presented with malignant hypertension which resulted in kidney failure,” says Jackson T. Wright, Jr., M.D., Ph.D., a professor of medicine at Case Western Reserve University in Cleveland, Ohio. “If his physicians had been able to lower his blood pressure, they most likely would have saved both his kidneys and his life.”

According to Dr. Wright, there were no effective therapies for high blood pressure in 1915 and the five-year survival rate for malignant hypertension was less than one percent. “The importance of treating elevated blood pressure was not yet well recognized and would not be generally accepted by the medical community until the latter half of the 20th century,” he says. “Although blood pressure measurements were routinely performed in 1915 and elevated blood pressure was often seen in patients with heart disease, stroke and renal disease, many clinicians still did not appreciate the role that hypertension played in causing those conditions. When hypertension was treated, the interventions generally consisted of warm salt baths, rest, potassium tablets, nitrates and barbiturates.”

Hypertension is the most common cause of death and morbidity in African Americans today and occurs at an earlier age and follows a more severe course than among whites. Dr. Wright says that experts are not much closer to identifying the reasons for the higher incidence and greater severity of hypertension in African Americans in 2006 than they were in 1915. “Many hypotheses have been proposed to explain the predisposition of African Americans to hypertension, including lower socioeconomic status, exposure to certain environmental factors, a higher rate of premature births, increased salt sensitivity and an uncharacterized genetic susceptibility,” he says.

As part of the historical clinicopathological conference, historian W. Fitzhugh Brundage, Ph.D., the William B. Umstead Professor of History at the University of North Carolina, Chapel Hill, will discuss Washington's historical significance. “Washington was the most celebrated and discussed African American of his generation. His remarkable rise from slavery to international prominence, his abilities as an orator, and his successes as an educator captivated the era,” says Dr. Brundage. “During a crucial period when discrimination and racism intensified in the United States, Washington offered a controversial solution to the nation's ”˜race problem.' We can only speculate how Washington might have revised his program of racial uplift had he not died while still at the height of his power. Indeed, Washington's death and its causes illuminate much about the era that is often called the nadir of American race relations.”

The historical clinicopathological conference is presented as part of the 131st annual reunion of the Medical Alumni Association of the University of Maryland School of Medicine. “This conference is unique in its approach to the history of medicine,” says Philip A. Mackowiak, M.D., professor and vice chair of the Department of Medicine at the University of Maryland School of Medicine and director of medical care at the VA Maryland Health Care System. The historical CPC is the brainchild of Dr. Mackowiak, who adds, “No other conference I know of brings together some of the world's brightest clinicians and most knowledgeable historians to dissect and debate history's great medical mysteries.”

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