Warren Harding: His Final Illness

Harding's final illness occured during an extended trip to the West in summer 1923 MORE, but the illness had started earlier: Harding told his physician [correctly] that he would not return alive from the trip 1.

After playing six holes of golf in Vancouver, Canada, Harding became so tired that, to quell any suspicions, he moved to the 17th hole, then finished the 18th. He later called for White House homeopath Sawyer, complaining of nausea and pain in the upper abdomen. Sawyer found the President had a pulse of 120 beats per minute and was breathing 40 times per minute. (Both of these readings are abnormally high.) "Intensive cardiac therapy including digitalis was started." 2

Harding died suddenly and unexpectedly in his bed in a San Francisco hotel room several days later, on August 2, 1923. Mrs. Harding refused permission for an autopsy. 2 3a Comment: It is often supposed that Harding died of an acute myocardial infarction, that is, a " heart attack" or "coronary occlusion." However, this should not be supposed merely because he died suddenly. Harding clearly had heart failure (recall the valet's statement), and persons with heart failure are prone to sudden death as well.

His physician diagnosed Harding's fatal myocardial infarct as crab meat poisoning 4a. Lyman Wilbur, who was a cardiologist and president of Stanford, forecast his death 5 SEE BELOW, as did renowned New York cardiologist Emmanuel Libman 6a. It was also reported initially that Harding died of a blood clot in the brain, complicated by pneumonia 3a.

In his memoirs Dr. Ray Lyman Wilbur wrote the following account of the days preceding President Harding's death 5a:

My only intimate contact with President Harding came at the time of his last illness and death in San Francisco in August 1923. The falsehoods given circulation regarding this illness gained credence in certain quarters in a surprising way. President Harding died of natural causes in a natural way in the presence of his devoted wife. As one of the attending physicians I saw him frequently in the days preceding his death and was in his bedroom within a minute after he had passed away.

In the latter part of July 1923, I was at our summer camp in the High Sierra taking a little vacation from my duties as president of Stanford University when President Harding with Mrs. Harding and party arrived in San Francisco from a trip to Alaska and the Northwest. Among the party were Mr. and Mrs. Herbert Hoover and three physicians, General Charles E. Sawyer (the President's physician), Lieutenant Commander [Dr.] Joel T. Boone of the U.S. Navy Medical Corps, and Dr. Hubert Work, Secretary of the Interior. I knew Dr. Work particularly well, since I was at the time president of the American Medical Association, in which organization he had preceded me as president.

Harding came to San Francisco a very sick man, and I was called in as a consultant. Perhaps the simplest way to describe that experience is to include here the following personal memorandum which I dictated for my private-record a day or so following the President's funeral:

I was awakened in the night at "The Cedars" near Summit, California, by the proprietor of the Summit Hotel, who brought two telegrams, one from Hoover and one from Mrs. Hoover. The one from Hoover asked me to come with the best internist from the Stanford Hospital to the Palace Hotel as early as possible on Sunday and to get into communication with Dr. Work, with instructions that if I could not be there to please have the internist report to him. The other telegram, likewise from Dunsmuir, [California] dated 7:50 p.m., July 28th, was from Mrs. Hoover, saying: "His apparent slight attack of ptomaine has caused change in President's plans. We will probably go to the Fairmont Hotel Sunday morning."

I at once sent telegrams to Drs. Mehrtens and Somers of the Stanford Hospital, asking them to have Dr. Harold P. Hill and Dr. Charles Miner Cooper report. I also made arrangements for Dr. Albion W. Hewlett, also of the Stanford Medical School, who was at "The Cedars," to be available in case of call, and asked that a message be sent me [sic] at Sacramento should it be desirable that I go directly to San Francisco instead of the University.

No message arriving at Sacramento, I came on to the Stanford campus and called up Dr. Mehrtens at the hospital at 5 o'clock. He said that Dr. Cooper had telephoned the Palace Hotel and had been informed that everything was going well and that there was no need of consultation. He also indicated that specimens of urine and blood were being examined at the hospital.

I had just gotten to bed and to sleep after the 250 mile drive home to the campus, when Hoover telephoned, asked me to get into my automobile and come to San Francisco as rapidly as I could for a consultation at eleven-thirty.

At the 11:30 consultation with Dr. Sawyer, the President's personal physician, Dr. Boone, Dr. Work, and Dr. Cooper, Dr. Sawyer gave a history of unsatisfactory return of strength following influenza in the spring, with increased blood pressure, attacks of dyspnoea at night, and also of indigestion particularly at night with pain and distress, relieved at times by pressure upon the upper abdomen. There was also the history of pain in the chest, radiating down the arms, particularly the left arm. The President had left Washington very tired after a long period of excessive strain. He had had several attacks of indigestion suggestive of gallstones.

While on the U.S.S. Henderson he had had digestive trouble with pain in the stomach and bowels without vomiting. After careful study of all the food that had been eaten, it was thought that some crab put on board ship on the Alaska trip might habe been responsible for the difficulty. As a matter of fact, however, careful inquiry among the members of the party showed that others had eaten freely of the crab and had had no digestive disturbance whatsoever. There was some fever and increased pulse rate associated with the pain and distress.

Apparently this attack began on Wednesday, July 25th. With treatment the symptoms were somewhat ameliorated, and in spite of weakness, some fever and pain, the President met all his engagements in Vancouver, playing also a game of golf at that time. He felt very much exhausted afterward and, even after he had rested on board ship, felt reluctant to go through the strain of meeting his program at Seattle. Nevertheless he did so. During one of his speeches at Seattle, Mrs. Harding felt that he was going to break down, but apparently his attack of weakness passed. She told me afterwards that she was terribly frightened but was determined not to show it. Mrs. Hoover told me that she could not understand at the time why Mrs. Harding seemed so pleased with the speech, which she (Mrs. Hoover) felt did not show the President at his best. The President told his associates that he felt it almost impossible to hold his hat and wave his arms when he was greeting the crowds on the street.

After he got on the train the fever and pain increased, also inability to retain food, and his exhaustion was great. He had insisted all the way through upon meeting all the demands, in spite of the advice of his physicians. He could not bear to let his own personal feelings interfere with the desires of others.

In his past history, there was a record of his having had a so-called "nervous breakdown" when a young man, shortly after his marriage. Careful questioning seemed to indicate that he seemed to have had some fever during that period. There was no complaint of headaches, his appetite was normally good, and his spirits buoyant.

I found his tongue markedly coated and foul acetone breath. The heart rate was about 120 and 130 [sic] with extra systoles from time to time. The blood pressure was about 150, the heart was enlarged both to right and left, the lungs were clear, the respiration increased and inclined to be shallow and irregular, particularly with the least repose. There was marked tenderness over the gall bladder region, which was most evident on a deep breath.

After careful review, we issued the first bulletin, Dr. Sawyer drawing up a statement which was superseded later by one drawn up by myself, indicating the location of the acute illness in the gall bladder and the state of the cardiovascular system.

In the morning, another consultation at 9 o'clock.

Every effort was made to convince the President that he must take absolute rest and stay in bed. When I saw him on Monday morning he asked whether there was any possibility of meeting any part of the rest of his speaking program. (As a matter of fact, Dr. Cooper and I were called in largely to convince the local people that it was impossible for the President to meet his engagements.) I told him that there was no possibility, that his condition demanded most careful attention and rest.

He said, "I am exceedingly sorry. I have been looking forward to meeting the people of San Francisco, and I want to give here my address on foreign relations. It is the best thing I have ever done and it is a good speech, even if I did write it myself!"

"Mr. President," I said, "I hope that you will make your address public. I think that it will be even more effective and will be read by a larger public if it comes from a sick room than if it came from a rostrum."

"That is a good idea," he replied. "I'll think it over."

So far as I know, this was the beginning of the series of events that finally culminated when orders were issued by the President to release his speech, which was already in the hands of the papers of the country.

Bulletins, at intervals, gave an idea of the progress of his illness. Our greatest concern came at the time of the development of pneumonia, which was evident clinically and was also brought out by the X ray, also by the irregular respiration, which increased far out of proportion to the lung involvement. We feared at that time a disturbance of the blood vessels of the medulla involving the respiratory center.

The most striking fact about the illness was the almost total exhaustion. As he said to me, he "had no idea that a man could be so completely exhausted." Another time, after his acute symptoms had subsided, he said, "I have been thinking back about that speech I wanted to deliver Tuesday night. Why, I couldn't have had the strength then to say even 'Mr. Chairman'!"

He was an excellent patient, very considerate of his doctors, very sorry to take so much of the time of Dr. Boone and Dr. Sawyer, who were with him much of the time.

We had a frank discussion of the case in front of Mrs. Harding at the time of our first consultation, so that she was familiar with our point of view and our fears and hopes.

The President was mentally alert, very much interested in the newspaper reports of his illness, very anxious to know just what was going on and what reception was given to his address. He had considerable difficulty in sleeping, but after the administration of caffeine and digitalis his heart action became better and his ability to sleep returned.

After the examination of his lungs on Wednesday afternoon we told him they had cleared up remarkably well. He said, "I am not so much worried about them, but what about this dilatation of my heart?" He expressed relief upon being given assurance of marked improvement in this condition after the administration of the digitalis. Evidently he was conscious of the fact that he had over-strained his heart.

During his acute illness only the physicians, nurses, and members of his family were allowed to see him, and everything troublesome was kept away.

He insisted upon having some of his program carried out and asked his secretary to go to Los Angeles to deliver his address before the Shriners. This address, which was really Harding's last public utterance, ended up with the expression, "Peace on earth, good will to men."

At the end of our consultations usually Secretary Hoover, sometimes other members of the Cabinet, joined us to learn of the real situation. On the morning before his death, President Harding had been told by Secretary Work that Mr. Hoover had joined the consultations as a "lay brother." Harding turned to Dr. Sawyer and said, "Hoover is a fine fellow." Later on, after we had withdrawn, he asked Hoover to come in and see him for a few minutes.

That morning, too it was reported to me that the President must be better, for the first thing he asked was, "Has Daugherty issued any more bulletins during the night?" The Attorney General had reached San Francisco and had given interviews on subjects of controversy.

Thursday morning the acute symptoms of his illness had largely subsided, but respirations were still fast. His pulse was even, regular, around 100; there was a slight increase in the blood pressure, which was about 40 points below his normal of 180. As the President said to Secretary Work, "It looks as though we are out of the woods now." [Just what an infarct patient says before ventricular rupture.]

Considerable discussion took place as to just what should be done with the President during the period of his convalescence. There was a desire on the part of Californians to entertain him in all parts of the state, but it was Mrs. Harding's idea that he should return to Washington as soon as possible. Dr. Cooper and I felt great concern, because we did not see how it was possible to re-establish normal heart action.

We had the regular consultation at four o'clock on Thursday afternoon. The President was in good spirits. When told by me that he was improving so much that the people of California were getting ready to claim full credit for their climate in bringing about his relief, he said, "We'll swap some stories on that tomorrow morning. I am sorry not to have had a chance to take more part in these consultations."

In the evening, shortly after seven o'clock, I was planning to go down to dinner with Secretary and Mrs. Work, together with the Hoovers, and had just gone to my room for a moment, when the assistant manager of the hotel knocked on my door, and said, "You are wanted down at the President's room."

I went down the corridor, entered the apartment, and saw at once that the President was dead.

I got firsthand stories at once from Dr. Sawyer, the nurse, and Mrs. Harding, who were all in the room.

Mrs. Harding said, "Can't you do something, Doctor?"

Dr. Sawyer had occasional attacks of breakdown, but was clearheaded clinically and saw the whole situation.

Mrs. Harding had been reading to the President from a journal and had just turned to go to another part of the room for a moment. Dr. Sawyer and the nurse were at the bedside. A short quiver suddenly went through the frame of the President and without a groan he died instantly. There had been no struggle, no hard respiration, no edema of the lungs. The pupils were even, slightly dilated.

It took nearly an hour before I could finally convince Mrs. Harding that the President was dead.

In the meantime I prepared a bulletin, informed the secretaries that they should notify Vice President Coolidge, and soon sent for the undertakers, N. Gray & Company.

The extreme sorrow of everybody was most striking. Everyone, too, seemed to be more or less confused, and it was difficult to get prompt action.

Mrs. Harding insisted that she would not break down, and, while it was pathetic to hear her call to her husband, at the same time she was clearheaded and made prompt decisions on every point brought to her. I had been interested in her statement when I assured her that the President had died in the way most men want to die, suddenly and without pain. She had turned to Dr. Sawyer and said to him, "You keep me alive as long as you can. Don't let me go if there is a spark of life left in me."

Mrs. Harding commented that her instinct to bring her sick husband to San Francisco instead of taking him to the Yosemite (as had been planned) was sound.

The day following the President's death I spent in the apartment, in order to be sure that everything went satisfactorily regarding the funeral services, and also to keep track of Mrs. Harding to see that she got out of San Francisco safely. During the afternoon I had a talk with her in which she expressed unusual gratitude for what had been done. She particularly appreciated the fact that we had been quite frank in the whole discussion of the illness. I had already been told that she had full confidence in us, saying that she looked at people's eyes instead of listening to what they said in order to see if they were telling the truth, and that we had passed her assay.

I saw every part of the funeral services for President Harding in the apartments. Afterward, Mrs. Harding came and joined me where I was standing at the window in order to watch the funeral procession leave the hotel. We stood there for over half an hour looking out across Market and up Geary Street. As my hand was on her left arm to steady her I could feel her enlarged heart beat against the back of my hand and could follow her emotions in an unusual way. In spite of her serious illness of the preceding winter (her feet were still swollen from it), she had insisted upon making the trip west with her husband with all the strain on her strength which it involved. Now in the face of her great bereavement she was still brave and undismayed. She said, "I'll have to get used to all this spectacle, and this will help me to do so."

She was deeply impressed by the services, by the procession, by the music, by the attitude of the people, by the beauty of San Francisco. She said, "This is a wonderful city." After the hearse had passed, she spoke again, "Oh, what a sad contrast! Warren and I had looked forward to greeting the people of San Francisco. We had been urged by Republicans and Democrats alike not to come; but Warren felt that if he could bring his message to the people he could accomplish most."

She noted particularly the lack of display in the funeral procession, saying that her husband was always a modest man and wanted everything on a simple basis. Her mind was going back over a lifetime of incident and detail regarding "her Warren."

When she said that she had nothing to live for now, that life was empty, that the bottom had dropped out, I told her that she had the responsibility to write a record of her husband for the benefit of the public. I told her of the great influence the funeral train would have upon the country, and of how often I remembered my mother's telling me, a small boy, about Lincoln's funeral train going through Ohio and the impression it made on her as a young woman.

Mrs. Harding said, "I know only two things: politics and publicity."

I told her that those were the only two things needed to write the right kind of a book for people in general.

One of the most troublesome problems for physicians in dealing with the illness of a prominent person is to present to the public an honest and accurate picture of just what is going on without developing too much alarm, if the illness is serious. Always to be kept in mind is that there may be recovery, complete or partial, of the patient -- or a fatal termination. In the Harding illness we had to face constantly the attitude that we should not disclose the exact condition surrounding the illness. We determined, though, to present the actual findings as to temperature, heart rate, respiration rate, and leukocyte count, describing symptoms about which there could be no dispute, and let the physicians of the country draw their own conclusions. That was particularly important, since an incomplete diagnosis had already been passed out to the press which had led many people to think that the problem was a form of food poisoning and was both insignificant and transient. It was necessary to bring out the evident arteriosclerosis and the heart condition. All five members of the medical staff agreed to all parts of every public statement made, except for the final one prepared by Dr. Cooper and myself.

We were belabored and attacked by newspapers antagonistic to Harding, and by cranks, quacks, antivivisectionists, nature healers, the Dr. Albert Abrams electronic-diagnosis group, and many others. We were accused of starving the President to death, of feeding him to death, of assisting in slowly poisoning him, and of plying him to death with pills and purgatives. We were accused of being abysmally ignorant, stupid and incompetent, and even of malpractice. We were said to have forced our way to Harding's bedside "through political pull and for political reasons."

We shall never know exactly the immediate cause of President Harding's death, since every effort that was made to secure an autopsy met with complete and final refusal. We all agreed that with the peculiar irregular type of respiration it was more likely that the difficulty was a rupture in the vessels of the brain near the respiratory center, particularly since his death was instantaneous and unassociated with contractions of any part of the body. With the history of cardiovascular disturbance the sudden death could also have been of the heart type. Normal blood pressure for him for that period was around 180. With the pneumonia and temperature rise there had been a decrease of blood pressure to around 150, and as he got better the pressure began to rise and to go back to his established normal. It was because of this that I urged Mr. Hoover and some of the other members of the party not to accept any invitations that would take them out of San Francisco but to stay close to the President. In view of the markedly irregular breathing we were not at ease and were doing what we could to keep the President quiet and free from strain, although we saw that we would have to meet a desire to get him back to Washington as soon as possible.

While there was no way of final determination as to whether it was a heart attack or cerebral apoplexy, Dr. Charles Miner Cooper in a letter to me of August 13, 1923, made the following comments:

Many physicians will naturally wonder whether the sudden ending was not anginal in character, they failing to understand that when we left the President at 4:30 the heart beat and pulse were below 100 per minute 98 [sic], that they were regular in time and character, that all air hunger had disappeared, that no chest pain had been or was present at this time, that the condition of the heart continued right up to the moment of death, so that General Sawyer, who was present and saw the President die, said that the ending was definitely apoplectic in character. I write you this as you might like to incorporate the idea in any popular report you may make.

As I indicated in my article in the Saturday Evening Post of October 13, 1923, entitled "The Last Illness of a Calm Man," President Harding had wanted Dr. Cooper and me called into consultation so that the people of California, who knew us, would be told by local physicians that he could not meet his engagements.

Neither Dr. Cooper nor I, when requested, sent an account for our services; but I made the suggestion that if Mrs. Harding felt like sending me a memento of President Harding it would be appreciated. Together with a black silk purse of her husband's (containing an old-size dollar bill which he had kept in it for taxi fare), came a letter from Mrs. Harding dated August 28, 1923:

I will be very glad if you will accept a memento of Mr. Harding which I am sending to you with its contents just as he left it. If it expresses even a very small part of my gratitude and the appreciation I know he felt for your kind services I shall be more than glad. I find words convey very little of one's real feeling at such a time, but I do want you to know of my deep appreciation of all you did for us, and that I never can forget it.
Cited Sources
  1. Anonymous. The Progress of the World. The American Review of Reviews. 1923; 68: 227.   Available on the web at: https://books.google.com/books?id=MSwIAQAAIAAJ&printsec=frontcover#v=onepage&q&f=false
  2. Deppisch, LM. Homeopathic medicine and presidential health: homeopathic influences upon two Ohio presidents. Pharos. Fall 1997;60:5-10. Pubmed: 9385827.

    Comment: Discusses the relationships of Garfield and Harding with homeopathy. Also reprints a Currier & Ives drawing of "The Death of General James A. Garfield, Twentieth President of the United States."

  3. Parks, Lillian Rogers. My Thirty Years Backstairs at the White House. New York: Fleet Publishing, 1961.
    a  p.171

    Comment: This book stayed on the New York Times best-seller list for 26 weeks, prompting Jacqueline Kennedy to require all staff at the White House to sign a pledge agreeing not to write about their experiences (NY Times, page B8, Nov. 12, 1997). Parks's mother, a maid at the White House from 1909-1939, had actually been encouraged by Eleanor Roosevelt to write and publish a memoir (p260).

  4. MacMahon, Edward B. and Curry, Leonard. Medical Cover-Ups in the White House. Washington, DC: Farragut, 1987.
    a  p.5
  5. Wilbur, Ray Lyman; with Robinson, Edgar Eugene and Edwards, Paul Carroll (eds.). The Memoirs of Ray Lyman Wilbur 1875-1949. Stanford, CA: Stanford University Press, 1960.
    a  pp.378-384
  6. Bumgarner, John R. The Health of the Presidents: The 41 United States Presidents Through 1993 from a Physician's Point of View. Jefferson, NC: MacFarland & Company, 1994.
    a  pp.190, 191

    Comment: Devotes one chapter to each President, through Clinton. Written for the layperson, well-referenced, with areas of speculation clearly identified, Dr. Zebra depends heavily on this book. Dr. Bumgarner survived the Bataan Death March and has written an unforgettable book casting a physician's eye on that experience.

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