The death of America’s first president has puzzled doctors for centuries, but experts have now seemingly cracked the conundrum.

It’s December 14, 1799, and in a candle-lit chamber in Mount Vernon, Virginia, a group huddle around George Washington’s bedside. Bloodstained instruments have been used to slice open the former president’s body, meaning his skin is now demarcated with scores of crimson lines. And the stench of sickness lies heavy in the air as doctors debate the cause of their charge’s mysterious illness in hushed voices. Their efforts are in vain, though: Washington won’t see out the night.

But how did America’s first president find himself in this dire position? Well, December 12 – just two days before his death – began like any other. Washington had left office several years earlier, and he now devoted his time to running his sizable estate of Mount Vernon. And as you may expect, overseeing hundreds of slaves and thousands of acres of land was no easy task. So, as was his custom, the former leader set out to survey his land on horseback.

On this particular day, though, the weather was terrible. Icy rain, sleet and snow each lashed down on Mount Vernon in turn, soaking the former president straight through. When Washington finally arrived back for his evening meal, then, snow had settled in the 67-year-old’s hair, while his apparel was thoroughly sodden. But he had invited company over that evening, and it seems that he felt he had no time to change into dry clothes before everyone ate.

The following day, the former president again ventured outside to tour his estate – despite complaining of a painful throat. Yet as the snow continued to fall, Washington’s condition deteriorated. As the hours progressed, you see, his voice began to grate and rasp. And to make matters worse, later that night he was finding it harder and harder to breathe.

Then, at around 2:00 a.m. the following morning, Washington woke up in a worrying state. His breathing had become even more troubled, and at dawn the former president’s personal physician Dr. James Craik was duly summoned. The doctor tried everything in his power, too, to diagnose and treat his illustrious patient, including the use of a number of medical procedures that may seem brutal by today’s standards. But nothing apparently worked.

With Washington’s health quickly failing, then, a further two doctors were drafted in to assist Craik. Yet all three proved powerless, meaning the former president ultimately succumbed to his mysterious condition on the evening of December 14, 1799. And since then, medical professionals have put forward a number of explanations for his demise – with one in particular gaining credence. But before we find out what’s believed to have killed Washington, let’s first take a closer look at his fascinating life.

Washington entered the world on February 22, 1732, to parents Augustine and Mary. But the future president wasn’t exactly the all-American citizen whom you may believe him to be. He actually came from British stock, as his great-grandfather had emigrated to the U.S. from Northamptonshire, England, in 1656. Washington was also the eldest of six, although he had three older half-siblings from Augustine’s previous marriage. Yet precious little else is known about the founding father’s childhood.

We can say with some certainty, however, that Washington spent much of his life in Virginia. He moved around the state throughout his childhood, living on a number of farms. And following his father’s death in 1743, the then 11-year-old became the legal owner of the last of his childhood homes: Ferry Farm. As a young man, meanwhile, the future president became interested in surveying, and he subsequently obtained his professional license from the Virginian College of William & Mary.

Washington was then made surveyor of Culpeper County, VA, but he left this role in 1750. And in the following year, he ventured outside the States for the first – and last – time. Specifically, Washington chose to accompany his brother Lawrence to Barbados, as they apparently hoped that the tropical air would alleviate Lawrence’s tuberculosis. Sadly, though, he passed away the very next year. After his brother’s demise, then, Washington relocated to his late sibling’s estate of Mount Vernon.

At first, Washington rented the property from Lawrence’s grieving wife, Anne Fairfax. But following her passing in 1761, the future president then owned Mount Vernon himself. The enormous estate – which came with a sprawling manor house, thousands of acres of land and hundreds of slaves – would later become the focus of his life. Before he concentrated on managing his plantation, though, Washington first opted for a spell in the military.

You see, Lawrence had been an important administrative officer in the state militia prior to his death, and this impressive role seemingly motivated Washington to enrol himself. In 1752 he was subsequently made a major, and he later worked to help protect parts of Britain’s local territories from French encroachment. Then, after six years of service, Washington achieved the rank of brevet brigadier general. Yet he was never granted a royal commission – a rejection that he apparently never got over.

So Washington decided to leave the military and settled down on his plantation. But he didn’t enjoy a quiet life for long; in 1759 the future president wed Martha Dandridge Custis – his first and only wife. His 28-year-old bride had already been married once before, and she boasted her own plantation from this previous union. As a result of these nuptials, then, Washington emerged as one of the state’s richest men. Politics soon beckoned, too.

In fact, in 1758 Washington became a member of Virginia’s provincial government when he was elected a representative of Frederick County, VA. And during his early political career, he supported a number of anti-British laws and bills. The future president wasn’t alone in his ill-feeling toward the Brits, either. By the spring of 1775 Americans had finally had enough of their colonial rulers, and the Revolutionary War broke out – giving Washington the perfect opportunity to return to the military.

Yes, Washington quickly made his way to Philadelphia – America’s capital at the time. And just over a month after the experienced soldier had arrived, he became commander-in-chief of the Continental Army. Then, following eight years of brutal fighting, the Americans eventually won out. The war’s last skirmish – staged in the future president’s home state – began with a bullet launched from Washington’s firearm and ended with the Brits’ capitulation in October 1781.

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However, it would take a further two years of peace negotiations before America could truly call itself independent. And once the Treaty of Paris was agreed to by all parties in 1783, Washington finally stepped down from his military post. He then returned to Mount Vernon, seemingly expecting to peacefully live out the rest of his days there. Indeed, the veteran wrote in 1784, “I will move gently down the stream of life until I sleep with my fathers.”

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Yet despite the fact that Washington had apparently envisioned an uneventful life for himself, he still took an active interest in governmental matters. He argued, for instance, that a constitution was necessary to promote national unity. And in light of Washington’s bold open letter defending this position, Congress held a convention to debate what should be included in such a document. Furthermore, the former commander-in-chief was not only nominated to attend the event, but he was also asked to head up the Virginia group.

All in all, then, Washington proved instrumental to the creation – and approval – of the American Constitution. And just two years later, the veteran was elected the first ever president of the United States. He stayed in office for two terms before eventually stepping down in 1797. Along the way, he helped to unify a country that had been ravaged by war, while his administration also created the national State and Treasury departments.

And Washington came up with further innovations that all went on to become some of the cornerstones of American society. The politician insisted on being called “Mr. President,” for one, and he also introduced the first official Thanksgiving on November 26 to help build nationwide solidarity. But Washington’s presidency wasn’t always smooth sailing. In 1791, for instance, the leader had to deal with a violent uprising that has come to be known as the Whiskey Rebellion.

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Triggered in part by dissatisfaction toward government taxation of distilled spirits, the rebellion lasted for three long years. But Washington emerged victorious, proving in turn that the new administration was a force to be reckoned with. And in the same year that the president successfully quashed this insurrection, he also created the nation’s navy and passed legislation to restrict the U.S.’ role in transatlantic slavery.

Then, two years later, Washington’s presidency reached its end. The politician left office in 1797 – and thus introduced the notion of a two-term cap that is now enforced on all American presidencies. And it seems that Washington planned this, as he apparently didn’t want to imply that the position was a lifelong one. So the politician returned to Mount Vernon as arguably America’s most popular leader to date; he remains the only president to ever receive 100 percent of electoral votes, for instance.

Once back at Mount Vernon, Washington oversaw daily operations at the enormous plantation. The former leader clearly took his duties seriously, too. He would ride out to manage projects for hours at a time every day – whatever the weather. And come the evening, he would regularly play host to dinner guests who were eager to rub elbows with an erstwhile president. Washington’s estate has since claimed that the number of visitors who came to the plantation in 1798 could have totaled close to 700.

So when Washington was greeted with pounding sleet, snow and rain on December 12, 1799, he decided to head out regardless. He even elected to remain outdoors for longer than he was accustomed to, it seems. And when the Virginian finally arrived back, that evening’s company had already made themselves at home. To avoid upsetting his guests, then, Washington sat straight down for dinner – damp attire and all.

When the plantation owner stirred with a painful throat the next morning, however, he may have thought nothing of it. At the very least, Washington subsequently went about his day as usual, braving the snow to investigate his estate. But later that evening, he mentioned that his chest was hurting. And it wasn’t until the former president had gone to bed that events took a turn for the worse: his breathing had become so labored that he could no longer sleep.

Dr. James Craik was then summoned to help the ailing Washington. But before the physician arrived, the former president asked one of his staff to bleed him. And this 18th-century practice entails exactly what you think: one of the patient’s veins is opened, and a quantity of blood is subsequently drained. Back at the time, you see, many believed in the procedure’s healing qualities – with Washington among these proponents. Apparently, bleeding was considered to help bring down any swelling.

And once Craik and two other doctors arrived at Washington’s bedside, they employed some additional medical treatments that may seem bizarre today. For a start, to help soothe the man’s sore throat, one physician administered a liquid that was intended to create blisters. At the time, medics would use such a technique to help cleanse their patients’ bodies of unpleasant toxins. Yet it seems that the ordeal did little to help the former president.

Washington also nearly asphyxiated when he was directed to consume a combination of vinegar, butter and molasses. The doctors bled their patient several more times to boot and even administered an enema – but all to no avail. According to accounts, the attending physicians couldn’t even agree on the cause of the mysterious illness. In addition, they were apparently stumped when none of their cures worked. Perhaps unsurprisingly, then, the ex-president’s condition worsened.

And while the doctors continued to treat Washington with a diverse range of cures – including the use of a potion made from insects – none of their techniques produced any positive effects. All that seemed to happen, in fact, was that Washington lost an astounding 40 percent of his blood volume. Even the man himself realized the severity of his situation. He reportedly told Dr. Craik, “I die hard, but I am not afraid to go.”

Tragically, Washington passed away on December 14, 1799. Before succumbing to the strange sickness at some point between 10:00 p.m. to 11:00 p.m., though, he uttered some specific burial instructions. In particular, the founding father asked for a three-day grace period between his death and interment, as he was reportedly afraid of being buried alive. And Washington’s estate respected this request, meaning his funeral ultimately took place on December 18, 1799. But what had really caused his death?

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Well, while we may now have an answer, it’s hardly surprising that physicians of the time weren’t on the right track. After all, 18th-century medicine was far less developed than today’s equivalent. And given that there was no proper anesthesia, antibiotics or advanced knowledge of germs at the time, even a simple virus was often a death sentence. Indeed, according to a 2017 Smithsonian report, Americans in the 18th century “could primarily expect to die from pneumonia, influenza, tuberculosis, gastrointestinal infections, heart disease and cerebrovascular disease.”

So, staying alive for any period of time in the 18th century could be quite difficult. But, it seems, Washington hadn’t passed away as a result of these common ailments. Back then, the former president’s physicians seemed to blame an inflamed windpipe for his death. And they pointed to croup – a condition that causes swelling of the throat and breathing issues – in particular.

As well as croup, quinsy was also mooted as a possible cause of Washington’s death. This rare ailment can occur as a result of tonsillitis. An abscess appears in the throat, causing pain, inflammation and – when particularly advanced – breathing problems. Conversely, in 1917 a medic named diphtheria as the culprit. This infection – for which there is fortunately now a vaccine – commonly makes a sufferer’s throat hurt and can ultimately obstruct their windpipe.

And then in the 1920s a new theory emerged. According to this hypothesis, America’s first president had died from a tracheal infection – most likely strep throat. You see, what we now consider to be a mild affliction that’s easily cured with antibiotics could very well have proven deadly in the 18th century. What’s more, it’s easy to see why this condition was believed to be a candidate for Washington’s mysterious ailment, given that it is typically characterized by a painful throat and inflamed tonsils.

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But more than 70 years later, a new idea gained credence. During a review of the medical literature surrounding Washington’s mysterious death, Dr. Howard Markel made a pivotal discovery. It seems that another physician – Dr. David Morens – had done some research of his own, with his conclusions then published in the New England Journal of Medicine in 1999. And for Markel, it seems that these results proved quite convincing.

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Indeed, in an interview published on the National Constitution Center’s website in 2018, Markel said, “In the 215 years since Washington died, several retrospective diagnoses have been offered… But Dr. Morens’ suggestion of acute bacterial epiglottitis seems most likely.” So, what is this strange condition that’s now believed by some to have caused the founding father’s untimely death?

Well, epiglottitis is a severe throat infection that can prove deadly if left for too long. As the condition progresses, the section of flesh that hangs over the windpipe swells up. Then, if this becomes too enlarged, air cannot reach the lungs, meaning the patient can asphyxiate. Other symptoms include experiencing problems with swallowing and speaking properly as well as an elevated pulse rate.

Image: via The Charlottesville Center for History and Culture

And Markel and Morens aren’t alone in their belief that the bacterial infection killed the founding father, either. Indeed, as the University of Virginia’s Dr. White McKenzie Wallenborn put it in 1997, “[Washington’s] illness is a classic ‘textbook’ case of acute epiglottitis.” Thanks to modern medication, today’s mortality rate for the condition is under one percent of sufferers; in the 18th century, by contrast, epiglottitis would have been far deadlier.

Yet while much of the medical community is in agreement that the founding father definitely had an infection, not everyone believes that it ended his life. Some have posited, in fact, that the treatments of the time were the ones to hasten – if not outright cause – Washington’s demise. And as we’ve seen, the strange procedures and prescribed lotions and potions administered to him could all be on the suspect list.

There’s one procedure in particular that a number of experts have suggested could be responsible: bleeding. It seems that during Washington’s final hours, over 80 ounces of blood reportedly left his body. And to the layman, this sounds like an enormous amount for anyone to lose – especially someone who’s so ill. But Morens seemed to be unconvinced by this argument.

Yes, according to the National Constitution Center, in 1999 Morens stated that “the bloodletting likely [wouldn’t] kill a man of Washington’s size.” And according to a 2018 post on the same site, Markel feels that blaming the erstwhile leader’s physicians for his death is unfair. “The truth of the matter is that [the doctors] did the best they could using now-antiquated and discredited theories of medical practice,” he said.

So, it seems that the mystery of Washington’s untimely death has finally been solved, with a simple bacterial infection most likely to blame. And with this puzzle apparently put to rest, we can once more focus on remembering the politician as a great man who helped found a nation.