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Death at the Palace
President Warren G. Harding died at the Palace Hotel in San Francisco on August 2, 1923. That his basic physical problem was cardiovascular disease should have admitted of no doubt. To use the description of his personal physician, Dr. Charles E. Sawyer, it was this trouble that allowed the president "to pass over the last rapids on his way to Eternity." Perhaps the earliest evidence, or at least the earliest clear evidence, that he was suffering from cardiovascular disease appeared in 1916 when the then senator visited his brother, Dr. George T. Harding II, a cardiologist in Columbus, Ohio, who tested his blood pressure. "I called upon my brother while in Columbus," Harding wrote Sawyer in Marion. "Blood pressure test scored 160. He thought this was greater than it ought to be, but I think that is about normal for me, so I shall not give it any considerable worry." It thus was apparent well before his death that his systolic pressure was moving upward, beyond the safe range that might be defined as 140 or less. By the time he became president it had reached an alarming 180. Years later, in the 1970s, two cardiologists published a much noticed article that said people with hardworking traitsindividuals who work incessantly, push with their lives, and never seem to restwere describable as "type A" and were therefore at greater risk of developing cardiovascular problems. Early in his life Harding displayed such traits. His sister Charity Harding Remsberg wrote after her brother's death that as a youth he was large and strong, and "we thought him ableto carry out anything he would undertake. He was taught to work at a very early age. The chores of a family home fell upon him as he was eldest and a boy." When only fourteen he spent vacation days from school helping neighbors thresh grain, working with the men. He did the plowing on the farm and much of the orchard work. When the Toledo and Ohio Central Railroad was being constructed he worked with a team, for the railroad's engineers paid extra for men with teams. Charity Remsberg thought he overworked at too early an age and remembered nights he sometimes was too tired to rest. "He would drive those horses all night long, for we could hear him in his slumber."
Another indication of a type A person was presence of cardiovascular disease among close relatives. Several of his close relatives died of the disease.
In youth Harding suffered from what was diagnosed as a problem of nerves, or nervous breakdown. He visited the Battle Creek Sanitarium in Michigan several times: in 1889 (two days); 1894 (twenty-nine days); again that year (dates unknown); 1897 (similarly); and 1903 (seven days). Whether these illnesses had any connection with cardiovascular disease is impossible to say. In his adult years Harding moved to Marion, then a bustling town of several thousand inhabitants, fifty miles north of Columbus. There he purchased a newspaper, the Marion Star. As the town grew into a city, the Star prospered. Life in Marion admittedly was more complicated, one might say faster, than in the village of Blooming Grove, near which Harding was born, in Caledonia where his father had been half-owner of a local sheet, the Argus, and in Iberia where he attended an academy, what later would have been described as a high school, Ohio Central College. But surely, even in Marion, Harding's life must not have been subject to heavy pressures, and this may be the explanation for the virtual disappearance of any concern for physical problems until after he entered national politics. He served two terms in the state senate at the turn of the century, one two-year term as lieutenant governor, and entered the U.S. Senate in 1915.
As he told his brother, he gave no attention to blood pressure. He later confided to the assistant White House physician, a U.S. Navy doctor, Joel T. Boone, that when his pressure was high it was a sign he was not working hard enough. "In Ohio," he said, "my doctors used to get after me about my high blood pressure and tell me not to continue making campaign speeches, but every time I went campaigning it always went down; so I don't know if I ought to pay any attention to the advice to not make any speeches when you say I shouldn't, because I inherited it; it doesn't worry me."
But the White House proved quite another experience for the newspaperman and politician. When he came into the presidency in 1921 he found the work far more confining than he had anticipated. It was almost exhausting, even though he had spent the preceding six years as senator from a populous state and knew what it meant to deal with constituents in person or through letters and then, when back in Ohio, attend functions and make speeches. The sheer volume of White House work undoubtedly did him no good, physically speaking, as it encouraged him (and he hardly needed encouragement) to overwork. After the world war the prominence of the federal government in the lives of Americans had not lessened. The work of the president increased, so one of the White House secretaries told Dr. Boone. Rudolph Forster had been in the White House since the time of William McKinley and estimated that the presidential workload was five times greater than when the Spanish- American War occupied the then president. He said it was many times greater than during the era of Theodore Rooseveltwhen to observe the peripatetic activities of "T.R." was to make any White House newspaper reporter subject, some observers thought, to a headache: the president after McKinley had seemed that busy. William H. Taft when in the White House never worked very hard. Nor did Woodrow Wilson, at least before American entrance into the war; he worked three or four hours a day and took long and frequent vacations. It was Harding, Forster said, who discovered real busyness.
Harding's correspondence testified to his activity and so did people who watched him. It was possible to contend that he did not manage well, that he had little experience with the work of a large and top-level office and did not know how to handle it. The White House, some people said, was not his newspaper. In opposition to such a theory was the statement of Forster, who ought to have known, and the president certainly agreed with his assistant. In the second year of his administration he wrote his Marion friend and next- door neighbor George B. Christian Sr., "Our days are full here, and as time goes on our duties instead of lessening, seem to increase." He wrote a golfing companion, Henry P. Fletcher, that "matters have been rather strenuous of late and have riveted me to my job." The White House chief usher, Irwin H. (Ike) Hoover, admittedly no neutral observer, who in his memoirs, Forty-Two Years in the White House, said he considered Harding a "sport," wrote that he worked all the time.
With all the work came increasing tiredness. A reporter for the St. Louis Post-Dispatch, Charles G. Ross, who many years later would become President Harry S. Truman's press secretary and was his paper's Washington correspondent, wrote toward the end of 1922, "The President has aged perceptibly during the last 18 months. There is more gray in his hair, more bagginess under his eyes ... After a long cabinet meeting he sometimes looks extremely tired." That winter Harding told his brother-in-law Heber H. Votaw, "I am not well, Heber." Votaw suggested he go to a hospital, and the president said that word would get out and the stock market would go down.
Parenthetically let it be said that two physicians later testified that they knew Harding was in cardiovascular trouble and that his problems were so serious they expected him not to live out his first term. But it is difficult to know how much credence to give their testimonies, since although they both made the comments to friends at the time, their warnings passed into print long after Harding died. When President Ray Lyman Wilbur of Stanford University, former dean of the Stanford University Medical School, who was present in Chicago at the 1920 Republican National Convention, learned that Harding would receive the nomination (Wilbur was hoping that his Stanford friend Herbert Hoover would get it), he declared the intelligence impossible and told his informant, one of the leading Ohio politicians, "It doesn't seem possible! Anyone who knows the situation from a medical standpoint realizes that Harding could not last through the trials of a single term. He is not a well enough man to live through four years of the punishment that a president must take. Just to look at him you can see that he has cardiovascular disease and high blood pressure!" His friend answered, "If what you say is so, then we'll just have to pay a little more attention to who goes in for vice president. It is going to be done." The only trouble with this testimony is that Wilbur dictated it in 1944 (and may have been thinking, although the dictation does not reveal the point, of the then president, Franklin D. Roosevelt, whose cardiovascular disease was similarly serious). Wilbur's remarks were published in 1960. After Harding was elected, the New York cardiologist Emanuel Libman saw a full-page photograph of Harding in the Sunday New York Times and told two Washington friends, Eugene and Agnes Meyer, later owners of the Washington Post, that the president- elect looked unhealthy and that he did not believe he would finish his term. This commentary was not made public until 1939 and then in garbled form.
On August 1, 1923, or thereabouts, Harding's sister Mrs. Remsberg told Malcolm A. Fraser, an acquaintance, just before she left to see her brother, ill in San Francisco, that he was in deplorable condition because of heart trouble. The acquaintance was a representative of Orange County and about to attend a meeting in Los Angeles to make plans for receiving the president when he went south from San Francisco. "Tell the Committee" the president's sister said, "to make no plans until they learn of a change for the better in Warren's condition. He has had bad heart trouble for several years and I fear he is on his deathbed at San Francisco. I am taking the train tonight to be with him." Mrs. Remsberg lived in Santa Ana and spoke over the telephone to Fraser. The latter did not reveal the conversation until 1939.
It is an unfortunate fact that Harding's personal physician at this time, and until his death, was hardly qualified to make the diagnosis privately offered by Wilbur and Libman or perhaps guessed at by Charity Remsberg. In Marion, Dr. Sawyer was well known as the proprietor of a successful hospital, the Sawyer Sanatorium, located in splendid quarters at what the doctor called White Oaks Farm on the outskirts of the city. He was a small, wizened man, with a conspicuous goatee, and his patients including the presidential couple put much faith in him and his prescriptions. The latter often took the form of "a dose of soda water at least three times a day" together with two pink pills left on the dresser, or little yellow tablets, flat white tablets, and green medicine in a bottle. The faith the doctor inspired came because of his confident, ebullient personality. He was a homeopath, and his patients may have expected more gentle treatment from him than from more conventional physicians, for he would be more diagnostic, more analytical (although many homeopaths practiced in those days and their prescriptions were not so carefully noticed by their patients, who considered them medical, just as those of any physician). But beyond the analysis was Sawyer's confidence, which was infectious. He once set it out on a card, sent at Christmas 1916 to his grandson, in which he enclosed a coin that would buy a ticket on the Railroad of Progress, from his Marion farm to Prosperity, Worthy Man's Land, Universe. Stopovers were allowed at Good Health and its substations, Exercise, Rest, Recuperation, Good Cheer, and Smile. Also Achievement and its suburbs, Energy, Enthusiasm, Resolution, Determination, Opportunity, and Ambition. Satisfaction and its Burroughs, Accomplishment, Influence, Prestige, Honor, and Renown. A ticket holder would be able to carry the following baggage: Hope, Good Cheer, Joy, Courtesy, Confidence, and Self-respect, each without limit. Owing to an embargo of practical experience the following baggage was prohibited: Suspicion, Complaint, Dissatisfaction, Fault-finding, and Blues. It was a one-track railroad, Grandfather Sawyer told young Warren.
This was Harding's physician, appointed the president's physician in 1921 virtually by the president's wife whom Sawyer had brought back from near death not long before the Hardings went to the White House. Mrs. Harding informed her husband that if "Old Doc" did not accompany them, she might die in Washington. The president installed him in the army medical corps, with the instant rank of brigadier generalwhich may not have been much more instant, so regular physicians in the army and navy in Washington whispered to each other, than the raising by Harding's presidential predecessor, Wilson, of Lt. Comdr. Cary T. Grayson to the rank of rear admiral a few years before.
Sawyer, one might add, took much pleasure in his Washington role. He was not a self-important man or a stupid man and possessed a large fund of common sense, but he had come suddenly to Washington, late in his life, and found the capital's ways, the attention directed to people close to the president, difficult to resist. A White House employee of long standing wrote in his memoirs, a bit uncharitably, that Sawyer liked to strut and talking to newspapermen was like strutting. He watched him during Sawyer's first day at the White House, dressed in his brigadier general's uniform, walking back and forth next to the executive offices, with photographers running after him taking pictures. Remonstrating with the photographers, whom he knew well, about wasting film, he learned from their responses and impish grins that they had no film in their cameras and were, they said, exercising the general, watching him strut.
It was unfortunate that not merely Sawyer but the Marion physician's assistant during the Harding administration, Dr. Boone, was unable to discern the meaning of Harding's tiredness. Boone took up his duties as physician aboard the presidential yacht Mayflower and as Sawyer's assistant in the autumn of 1922. An observant man, also methodical, he was to provide a massive amount of information for later historians. Upon his death many years after Harding had passed on, in 1974, he left a diary, an oral history, a huge unpublished autobiography, and a massive collection of correspondence, all all testifying to what he thought and observed during the course of a long and very distinguished career in which he traversed the U.S. Navy's ranks to vice admiral. He saw action in Haiti in 1916, in the world war at Saissons with the marine brigade of the Second Division when he won the Congressional Medal of Honor, afterward serving in the White House during the administrations of Harding, Coolidge, Hoover, and (for a short time) Franklin Roosevelt, and in World War II was fleet medical officer in the Pacific and at war's end the first American to go ashore in the Tokyo Bay area.
Like Sawyer, Boone was a homeopath, having graduated from Hahnemann Medical College in Philadelphia in 1913, but there the similarity between the two physicians ended, for Boone was a much younger man and much better trained. A descendant of the famous frontiersman, he had grown up in modest circumstances in Pennsylvania and after medical school joined the navy. The diminutive (he was 5'6") lieutenant commander took up his Washington duties with the same thoroughness with which he approached everything else. When in his first weeks he became acquainted with President and Mrs. Harding he gave them the best care he could, as much attention as he was capable of. Noticing the president's tiredness he worried about it and later might have wondered if it related to the illness that developed at the end of the Alaska trip. If so, he never made mention of it, though Harding's tiredness and increasingly high blood pressure could have had a connection, and cardiologists in later years surely would have remarked these two symptoms. All this, to be sure, had no connection with ptomaine poisoning, which was what Sawyer at first diagnosed as being Harding's trouble in San Francisco, or for that matter poisoning of any sort.
Boone worried about a cold the president caught in mid-January 1923 that worsened and verged, the physician thought, on influenza. According to the listing of daily events in the mansion by Ike Hoover, Harding remained in his room from Tuesday, January 16, through Sunday, January 21. Twice the assistant White House doctor stayed overnight, looking in on the president every two hours. Even after Harding returned to his desk there were no engagements until the following Friday, January 26, when the cabinet met. Boone thought the cold could have been a form of influenza; it was obstinate, and its effects lingered, "causing considerable and persistent fatigue." "I might observe," he wrote years later in his autobiography, "that influenza toxemia definitely affects the musculature of the heart, which accounts for a lot of the fatigability that accompanies it and follows it."
During this persistent illness Florence Harding worried, as she wrote relatives and friends. She told her sister-in-law, Dr. Harding's wife, perhaps in knowledge that her brother-in-law was a cardiologist, that "Of course you know Warren is under the weather. It took some effort to get the President of the U.S. on his back." She did have him where, she hoped, "we can accomplish something for his recovery." He still had a fever and weakness, and she believed that if he stayed in bed a few days more it would do him much good. Two days later she told her friend Evalyn McLean, wife of the Washington Post's publisher, that "Mr. Harding is up today with his clothes on." He looked fine in the face but was weak and wobbly, for the "aftermath of grippe" was far more annoying than the disease. After a few more days she wrote another friend that his convalescence had been slow, but "he is really better and is back in the office today" The attack, of whatever it was, lingered into February, and Florence Harding wrote on February 5 that after a siege of three weeks "I take notice that he seeks a couch every day after lunch for a few minutes, which convinces me that he is not at par yet, although he does not say much about it." Sawyer and Boone remonstrated with him, telling him he needed to take things easy for a while, but he said he had had very little illness in his life and, as Boone put it, "really did not know how to give in to himself when he felt below par." Boone remembered that he was "most cooperative in carrying out prescribed therapy, except in the matter of getting adequate rest."
By late February 1923 it was plain to the president's physicians that his stamina was flagging, that his will was strong, indeed almost indomitable, but something physically was holding him back. It was something long-term, for weeks had passed and he only became more tired. At this juncture they allowed himthey really had no governance over him, he was his own man, as everyone who saw him knewto go on a trip to Florida, in the company of a group of friends, and if anything the trip must have given him even less rest than the duties of the White House, duties that as Forster said were increasing so rapidly.
The plan was to go by train to Ormond where the presidential party would board the Pioneer, the houseboat of Evalyn McLean and her husband, Edward, and journey from place to place, seeing the sights and playing golf when possible. The plan sounded fine, but carrying it out was not easy. For one thing, Boone heard that life on the Pioneer was unpleasant; that the boat, though sizable, almost as wide as the Mayflower and 130 feet long, allowed too much togetherness and did not permit sufficient privacy. For another, the Pioneer grounded several times on sandbars. And last, the president forced the pace; the vacationers' boat trip lost its purpose of leisure, turning into a busily moving boatload of people who passed along the Florida waterways from golf course to golf course, as quickly as possible. The women in the party were able to stay behind and rest, but the men were constantly on the move.
The trip aboard the Pioneer was something Boone did not observe but only heard about. He received the special task of watching over Attorney General Harry M. Daugherty, whose health was poor.
All thisthe extraordinary duties of the presidency, the marked illness of the president in January-February 1923, the (in terms of rest that the president needed) fast-paced Florida boat trippreceded the trip the president planned for midsummer, the journey by train and ship to Alaska and back.
Prior to the Alaskan trip there was a notable sign of the cardiovascular trouble that the president was suffering from, and one of the members of the White House Secret Service detail, Col. Edmund W. Starling, learned about it from the president's valet. One day Maj. Arthur Brooks took Starling aside and said, "Colonel, something is going to happen to our boss."
"What's the matter?" Starling asked.
"He can't sleep at night" was the response. "He can't lie down. He has to be propped up with pillows and he sits up that way all night. If he lies down he can't get his breath."
Starling thought this was what was known at the time as "high stomach." A cardiologist would have defined it as cardiac asthma, in which the heart of the sufferer is unable to pump blood out of the lungs, so the blood puddles there, making breathing difficult. It is possible to relieve the heaviness, the lack of breath, by putting the patient in a sitting position, allowing fluid to gravitate to the abdomen. An individual with this malady breathes more easily and can sleep only until he or she slides down in bed. Cardiac asthma is an ominous sign.
Harding's golf game was affected, and the president said to Starling, "Colonel, why after playing eleven or twelve holes do I drag my feet and feel so tired?"
"You are working too hard" the colonel responded. "You need a vacation. Why don't you confine your game to nine holes until you rest up?"
"Hell!" the president said disgustedly. "If I can't play eighteen holes I won't play at all!"
Harding similarly wrote George Christian that he had shortness of breath while playing golf.
During these crucial months the president's physician did not worry. "The presidential family" Sawyer wrote Boone in April, "are in very good condition .... They both are doing splendidly. In fact, I have never known them to be better since coming to Washington than they seem to be now." Sawyer was visiting in Marion when he wrote Boone this intelligence.
There is no possibility that Florence Harding saw the above communication from Sawyer to Boone, but it is clear that on the forthcoming trip she wanted more medical assistance than her Marion physician could provide. She told the president, who said to Boone, "That's it. You are going along." If Boone was not worried sufficiently about Harding's health, he was indeed worried about the president's wife, because she had had another and very serious bout with her kidney disease in the autumn of the preceding year, and after his inclusion in the presidential party he quietly arranged that the naval transport USS Henderson, then at the Brooklyn navy yard, designated to make the presidential trip (the Mayflower's draft was too shallow), take on board a coffin.
Florence Harding at this juncture was thinking of the president, and on the Sunday prior to departure, she and Colonel Starling were at the First Baptist Church in Washington and had arrived late and were waiting for the opening prayer to end before being seated. She asked the colonel, "You are leaving soon to make arrangements for the trip?"
"On the twelfth," Starling said.
"I want you to promise me something" she said. "Wherever we are to stop I want the doctors, General Sawyer and Captain [she meant Lieutenant Commander] Boone, as close to the president's room as possible...."
She looked at him steadily. "You understand?" she asked. "Are you sure you understand? It is not for myself that I want this done but for Warren."
"I understand" he said.
Given what preceded the Alaska trip, the signs of impending physical trouble, it was clear that the president's death in San Francisco was no sudden development, no crisis for which some speculative cause was possible. There had been every evidence of a rapidly developing crisis in the president's physical condition. The fateful trip was only a logical end to what preceded.
The purpose of the trip was very clear in the president's mind, for it was to set out what he proposed the government should do for the people of the United States. Mrs. Harding earlier had written a friend that the people of the West did not know they had a president, and she wanted her husband to show himself to them, which doubtless was some part of the presidential plan although the trip was also intended to accomplish far more than that. The Harding biographer Robert K. Murray, a first-rate scholar, has pointed out that the speeches along the way were excellent statements of purpose and if taken together set out an entire program on which not merely the American people could have instructed their congressmen to secure legislation but a program on which Harding could have stirred his countrymen and run for reelection the next year as well. Harding's Marion friend Malcolm Jennings received advice from a correspondent that it would not be wise for the president to speak, as press dispatches said he would, about foreign relations and organization of the nation's railways. "These issues," wrote William R. Clarke, a westerner, "are as popular here as mad dogs. He ought to talk American manhood, less graft in the next war, better conditions for the agricultural producers, and give some hope and counsel, etc. Then he would ring twelve." Jennings passed the letter to Harding, who in reply was outspokenly frank.
I fear Mr. Clarke is greatly lacking in confidence and has a bargain sale appraisal for the President. However, that does not greatly disturb me. It might be pleasing to Mr. Clarke to have me address him with an Old Glory talk and appropriate related remarks, but if his vision were as broad as is necessary in planning the Presidential speaking tour he will have to get off the one subject and say some things relating to the problems of government which we are facing day by day.
The president's plan was admirable, much to his credit, but he was hardly up to it physically, as became evident. Boone in his papers described in detail what happened once the presidential party left Washington at 2:00 P.M. on June 20, 1923, a very hot dayninety in the shade it was reportedover the Baltimore and Ohio Railroad, arriving in St. Louis the next day, thence to Kansas City and points west to Tacoma where the Henderson waited to take the president to Alaska. Harding left tired and must have become more so as he encountered thousands of people who lined the tracks to wave or, if there were short stops, see him go out on the back of the presidential car, the Superb, and say a few words. At longer stopovers city officials and reception committees greeted the party, automobiles conveyed them through the principal streets, a reception was held in the lobby of a hotel, after which he would dine, motor to where he was to deliver an address, then drive back to the train. Nor did the president get any rest between stops, for governors, senators, and congressmen joined the party to accompany him through their electoral districts.
There were two special expeditions. To keep Sen. Reed Smoot of Utah in good humor the president and his party rode horseback through clouds of dust to obtain a glimpse of what was to be Zion National Park. Afterward the president was exhausted. He was forced then to endure Yellowstone Park. At the park there was a platform, reached by steps, and Dr. Sawyer told the superintendent not to ask the president to go up the steps. Harding, he said, had not felt too well the night before.
The plan was to cross the country by rail and after the Alaska trip return by ship from California via the Panama Canal. Harding knew the reason for that, as he told Jennings: "This will avoid the excess of speech-making incident to two rail trips across the continent." But even one rail trip was too much, and Boone remembered that when the party went to the hotel in Tacoma he saw Harding talking with his advance man, Walter F. Brown, postmaster general in the Hoover administration, and with "great emphasis" telling Brown he could not stand such a heavy schedule, adding that if necessary Brown should make a whole new schedule. "Unless it is radically modified and changed in many respects following my Alaskan visit," the president said, "it will kill me. I just cannot keep up such a pace without dire consequences to me." Boone thought Harding said this in part so Boone could hear himthe president made no effort to keep the conversation private.
The trip to Alaska aboard the Henderson, which involved a presidential party of sixty-seven people, fortunately turned out to be relaxing, perhaps because unlike the transcontinental journey the Alaskan requirements were almost entirely celebratory and there were not many people with whom to celebrate. The entire population of Alaska was sixty thousand, half of whom were Indians. There were ten towns in Alaska, the largest being the territorial capital, Juneau, population two thousand. Harding and the group could stroll about, and the presidential speeches could be casual utterances, with concern only that they made general sense to the accompanying newspapermen who themselves were more interested in the trip's varied sights.
The voyage was delightful, with what was called "Harding weather." On the second day at sea not a cloud was visible, and the Henderson seemed to float along at twelve knots, gliding over a calm, narrow channel with towering cliffs that were snow capped or covered with green dwarf pines. Here and there the channel widened at mouths of rivers. Bays and coves lined the water's edge, with little picturesque islands that forced the ship to change course and detour to port or starboard.
The first stop was at the village of Metlakatla, and the proceedings there set the pace. The president was met by Indians, including Edward Marsdon, who had studied at Marietta College in Marietta, Ohio, before taking a theological course at a university in Cincinnati. So wrote Ernest Chapman, a Baltimore and Ohio Railroad police captain, who accompanied the Harding party on the entire Alaska trip. Marsdon was a musician, having worked his way through college tuning pianos. He also had a good voice, and he and his charges sang and played, among other selections singing parts of Hallelujah and other oratorios, according to Captain Chapman. Marsdon had adopted a daughter named Marietta, whom he intended to send to Marietta College.
The rest of the trip went similarly. Ketchikan was a primitive place, with fifty automobiles and three miles of roads, the principal mode of transportation throughout southeastern Alaska being motorboats. The population of whites at Ketchikan was more in evidence than the natives and had erected welcoming arches, and the native band from Metlakatla came over to join in the celebration. At Wrangel (population one thousand, mostly natives, who did not seem as far advanced in civilization as those at Metlakatla) the party saw the totem poles, some of them 150 feet high, others as small as one inch. Juneau's main attraction was the glacier, sixteen miles out of town. The governor's house was a large white building on an eminence above the harbor and resembled the White House, with large white columns. At Anchorage the party saw Mount McKinley, even after eleven at night, 150 miles away. From Seward to Fairbanks, the group traveled aboard a special train. A Dodge speedster on steel wheels followed the train. It fascinated Mrs. Harding who rode in it most of the afternoon.
All along the way, by ship or rail, members of the presidential party enjoyed themselves. At a little store along the railroad from Seward to Fairbanks, Secretary of the Interior Hubert Work purchased a big plug of chewing tobacco, and the president unwrapped his parcel, eyes lighted with amazement, and said, "I haven't seen Star tobacco for a great, great many years." Harding and Work each cut themselves big pieces and began chewing. Aboard ship things were equally relaxed. Seventy-five moving picture films had been taken along and were shown in the dining room. The president viewed them through a window as he stood on deck smoking his pipe. The U.S. Navy Band was aboard and played during luncheon and dinner hours, and people got up and danced. Mrs. Hoover asked Boone to teach her to dance, which he did. Evenings passengers could hear the Hardings, Sawyers ("Mandy and the doctor," as they were known to the Hardings), and other Harding intimates singing old tunes such as "Maggie" and "Genevieve."
Mrs. Harding momentarily worried Boone when she took ill in Fairbanks where medical facilities were extremely limited. He remembered the casket he had quietly stowed in the Henderson. Fortunately the symptomsthey were of the old malady, nephritissubsided after she went by train back to Seward and soon was safely aboard.
Nothing really untoward happened, and everything went well after the president finished the transcontinental rail trip and the Henderson left Tacoma, until on the way down from Alaska the ship stopped at Vancouver. There Harding took part in a parade, held a reception at a local hotel, and resumed serious speeches. The tiredness returned, becoming evident when the president was at the Shaughnessy Heights Golf Club. An observer watching the first presidential visit to Canada, marked by the day-long visit, might have noticed that he did not finish his golf game but walked carefully from the sixth to the seventeenth hole. Boone was in the second foursome when the president played. Harding at one point was looking for a ball. Boone strolled over and cheerily called to him, "How are things going, Mr. President?" He said, "Not at all well, Boone. I just can't get on my game today. I don't feel too well." Boone talked to him as he was dressing to leave the club and he still did not feel well, did not know what it was, thought he had some gastrointestinal upset. Boone suggested he go to the hotel and rest. Harding demurred, as there was a speech that evening.
The Vancouver visit was unsettling, and Boone told Sawyer what Harding had said. That evening Brooks, the valet, whom Boone considered a very wise man, told him he and Sawyer should hold the president down, or "He will break. He is hurrying too much." All that night Harding was ill, and he looked drawn the next morning.
The ceremonies before and during the Seattle visit nearly prostrated the president. The ship passed through dense fog, arriving in early afternoon, several hours late, just in time to review the massed ships, more than fifty, of the Pacific Fleet and endure a series of twenty-one-gun salutes as the ships passed by. As the Henderson approached the city, Boone overheard Mrs. Harding say to her husband, "Oh, Warren, please cancel our going ashore. You are not physically up to it since you were sick last night." He answered, "Of course, I would not disappoint that great outpouring of humanity, many of whom have traveled far and wide to come and see their president. I would not disappoint them for anything, Florence. Of course, we are going to go ashore."
After arrival at the dock and welcoming ceremonies had come the parade, during which the president waved to tens of thousands of people, raising his hand high, doffing his hat. Sawyer and Boone rode in cars behind the presidential car and observed the constant movement of the president's right arm. Each time Boone sought out the president he would ask how he was. The answer: "I am tired. Of course, I am thrilled with this reception and I wouldn't want to have missed a moment of it!" There were several speeches, including a long oration, written in large part by Secretary of Commerce Hoover, given in the stadium of the University of Washington before forty thousand people, with the president standing in the hot sun. Auditors noticed that he delivered the address listlessly. The topic was Alaska, and he confused the name, reading it as Nebraska. At one point he dropped the sheets of the address, which sprawled across the platform, but Hoover who was nearby managed to retrieve and sort them.
The day at Seattle would have exhausted a well man, but for Harding it was an ordeal, for after thinking that his program in the city had been abbreviated because of his late arrival he discovered it only had been telescoped, meaning that a luncheon planned by the local press club was in fact held even though the time was that for a dinner. After the meal, which the president was observed as hardly touching, he spoke with graceful references to his audience for perhaps twenty minutes and sank into his chair for the meeting's final moments. At the train, prior to leaving (the rest of the trip into California was to be made by train), he found a crowd of well-wishers and suitably bade them farewell and clambered back into his private car from the observation platform. Boone was standing immediately behind him as he made the talk from the car, and held the screen door open for him when he came in. He remembered the scene indelibly forty years later when he recalled it for his autobiography. "He took his straw hat. He threw it across the car. He said, `Doctor, I'll tell the world that one Warren Harding has had a most strenuous and fatiguing day and he is an exhausted man.'" With that he went to his compartment where Brooks was waiting to put him to bed.
It was after Seattle that the president's advisers decided he had had enough and canceled a stopover in Portland, sending the train straight down to San Francisco. It was necessary to change engines at Grants Pass in Oregon, and it was there that Sawyer and Workthe secretary of the interior in private life had been a doctorspoke of ptomaine poisoning. En route from Vancouver, Sawyer had thought Harding had ptomaine poisoning, this from eating crabs taken aboard ship at Sitka as a gift from the citizens. Harding himself had mentioned this possibility to the mayor of Vancouver. According to Sawyer, the attack had no serious aspects. All the president needed was a short rest to bring him back to normal. When Sawyer made this announcement he was seconded by Work. The latter declared he was not sure the problem had been crabmeat but rather something, he was uncertain what, that had been in a can. "I will not say," he remarked, what the item of food was, "for otherwise I might depress the price of the canned product." He said that all the consumers of this unnamed food in the presidential party had recovered, and the president had almost recovered.
At Grants Pass the president's private secretary, George B. Christian Jr., son of the president's Marion neighbor, explained the decision to go to San Francisco as the need of a few days of rest to refresh the president. Members of the party said no consideration had been given to abandoning the schedule thereafter, which called for the voyage on the Henderson southward from San Diego, via the canal, to the East Coast. Christian said that nothing in the president's condition was alarming.
Everything thereafter was downhill. The first night on the train Sawyer and Mrs. Harding had stayed up with the president, who was violently ill. Sawyer somewhat casually told Boone about the problem the next day. On the Henderson there had been an altercation between Boone and Sawyer when at Harding's request Boone had lanced the president's infected finger. Boone thought the president had asked him rather than his personal physician because Sawyer's eyesight was poor. Sawyer had taken offense, and the younger man presumed he had not asked for help with Harding the first night on the train from Seattle because of this incident. But when Boone found out how ill Harding really was, and spoke with Secretaries Work and Hoover about it, the three went to see Florence Harding and arranged for Boone to take her place with the president that next night, and Sawyer's too, for both needed the sleep.
The second night out of Seattle, Boone made the discovery that came too late to save Harding's life. The discovery had nothing to do with ptomaine poisoning. Like the scene inside the president's private car after Harding walked in after saying good-bye to the crowd in the Seattle station, that second night out, watching the president, was unforgettable. As he sat there, just outside the stateroom, hour after hour, Harding was restless and uncomfortable. His breathing was heavy. The doctor heard the continuous pounding of the train wheels on the tracks, jumping one joint after the other. In the middle of the night the train stopped, perhaps for water, at what Boone thought was Redding, California, and there was silence, and Harding was awake. Boone thought it was a good time to take his blood pressure. He did not like what he found, for it was lower than he had ever taken it. He knew about Harding's high pressure and had heard the president's explanation of how it was in the family and did not matter and that when Harding went out campaigning it went down. This time it was too lowsomething had happened. He opened the president's pajamas, had him lie on his back, and percussed his chest. He found the left border of the heart well to the left of normal, almost midway between the usual left border and the right axillary line of his left chest. The heart sounds were muffled with irregularity as he heard them and noted them through his pulse. The president had a dilated heart.
Just as Boone made the discovery of dilatation the train began to move, picking up speed quickly and making considerable noise, and he could no longer continue his examination, but when morning came he informed Sawyer and then Work. Hoover was brought in, and Christian, and members of Harding's staff who worked with the railroad, and the train was directed to the San Francisco yards rather than the station, together with a request for an ambulance to be brought up to the observation platform.
In preparation for arrival in the yards, Boone and Sawyer told the president not to get dressed. He scowled and said nothing, but unbeknownst to them called Brooks and dressed himself, and appeared fully clothed, with his hat, ready to walk off the train. "Don't think for a minute," he told the doctors, "that I am going to receive the governor of the sovereign state of California and the mayor of our host city, San Francisco, in pajamas! That I shall not do. I will not be carried off this train!"
A photographer caught the president walking down the steps of the observation car, clad in morning dress and hat. Alighting, he shook hands with the mayor and one or two other officials and walked a short distance to a limousine, stepping into the back seat with Mrs. Harding. Upon arrival at the Palace Hotel on Market Street the president got out of the limousine and walked up the steps. A photographer took what was to prove Harding's last picture as he was going up the steps.
The president passed through the lobby and took an elevator to the ninth floor. Beyond the view of onlookers he walked to the presidential suite and entered it. An assistant at once closed the door.
Outwardly nothing seemed amiss. But that was not what insiders saw. When the president arrived on the ninth floor it turned out that the presidential suite was far from the elevator, down one long corridor, then down another. Boone, following the president, was very concerned. After Harding entered the suite and walked into the bedroom he threw his arms up in the air and fell across the bed with all his clothes on. His hat fell off and rolled on the floor on the other side of the bed. The doctors, shaken, saw he was so exhausted they made no attempt to undress him and let him lie there for some time before Brooks removed his clothes and put on his pajamas.
General Sawyer received a large group of newspapermen in a room at the hotel that afternoon and explained that there was nothing serious about the president's condition. He admitted that Harding was suffering a "violent case of ptomaine poisoning." Sawyer that afternoon was not altogether clear. He explained that crabs in Alaska frequently were tinctured by heavy copper deposits. This phase of copper poisoning, he said, usually did not become apparent until a week or ten days after eating the crabs. But to the correspondent of the New York Times he offered another interpretation of what ailed the president, which he said was exhaustion. It was the matter of casting off the poison from the crabmeat that caused the tiredness. "The first stage comes when one is tired out." The effects of tiredness might pass with a simple rest-hence the rest being taken at that moment by the president. "The second stage is extreme fatigue." This was a difficult stage, for patient and physician had to combat the exhaustion. "In the third stage, which is prostration, we must await developments before we can know if the body is casting off the poison." This last stage seemed to display an element of uncertainty, as if the presidential physician was uncertain how to assist his patient in the casting off.
From that juncture, Sunday afternoon, until the fatal Thursday evening, stories about the president's condition gradually changed, from the diagnosis of food poisoning to pneumonia, with an underlying possibility of a stroke. The president's physicians at first numbered three: Sawyer, Boone, and Work. The secretary of the interior, one should add, had been a neurologist and psychiatrist and had held the presidency of the American Medical Association. On Monday two consultants joined them. Dr. Wilbur, an internist, in 1923 was not merely president of his university but also president of the American Medical Association. Wilbur chose the other consultant, Dr. Charles M. Cooper, a distinguished San Francisco cardiologist.
On Monday, Sawyer befuddled the correspondents as he had the previous day yet prepared them for something more serious. He spoke of the president's toxic condition, which created a liability for complications affecting almost any organ in the body. He said Harding's heart had been working at fifty beats above normal. He did not give the number, the systolic pressure, and if he was calculating normal as the president's normal, which a bulletin on the following Thursday related was a systolic pressure of 180, he may have been saying the systolic was 230, which would or should have been alarming, indeed desperate in that day long before the time of blood pressure pills and other medication, not to mention heart pumps and surgery. At that point he carefully repeated himself: "The liabilities are such as would come from an increase in the toxic condition of the President's system, and complications caused by the inability of some of the organs to function." He spoke of something becoming serious because it was becoming dangerous, not that it was dangerous. An X ray showed congestion, the complication he most feared. The president's heart was overstrained, presumably from fighting the toxic effects of the congestion.
The Monday bulletin at 10:30 A.M. put the case more tersely: "While his condition is acute, he has temporarily overstrained his cardiovascular system by carrying on his speaking engagements while ill." This must have meant the speeches in Seattle. What happened during them, perhaps on the occasion when the president dropped the pages of his address during his speech in the stadium, the bulletin chose not to say.
Such were the first two days at the Palace Hotel in San Francisco, in which the pronouncements of Sawyer dominated newspapers, yet if a reader combined the words of Sawyer with the words of the Monday morning bulletin he or she could see a shift from homeopathic formulas and the jollities of the country doctor to something more modern, with stress not on toxic effects and behind them the consumption of crabmeat but on the cardiovascular system. The full team of physicians was changing the diagnosis from what one might describe as the nineteenth century to the twentieth.
As if in confirmation of the physicians' new concern, on Monday pneumonia set in. The physicians administered digitalis and caffeine. Dr. Wilbur who was writing the bulletins told Hoover, who asked, that Harding's chances were "Not one in ten." Monday night marked the president's worst period since arrival in San Francisco. Pneumonia in the 1920s was deadly serious, as it carried off patients in ways incomprehensible to a later generation accustomed to drugs not then available. The reporters that swarmed about the Palace got their cue, and next day's newspapers spoke of a black night and related that for the first time the president's doctors had used the medical word so feared at the time, "grave."
Tuesday morning the inveterate willingness of physicians treating important patients reasserted itself, willingness to put the best face on medical conditions, and the bulletin of 9:00 A.M., July 31, said, "There has been no extension of the pneumonic areas, and the heart action is definitely improved." The bulletin at 4:00 P.M. related the same points, "The President has maintained the ground gained since last night." And what the physicians did not say to cheer readers throughout the nation, the reporters or their copy editors arranged, for a caption in the New York Times said, "Everything Looks Promising for the Patient's Full Recovery From Illness." Tuesday evening Sawyer took reassurance from an hour of sleep that Harding managed: "The President has just had a sleep of more than an hourthe most refreshing and satisfactory sleep since his illness began."
Wednesday was up and down, no basic change. The first bulletin related the president fairly comfortable after "a few hours" of sleep, with less labored breathing, little cough, exhaustion but maintaining buoyancy, his normal buoyancy. The 4:30 P.M. bulletin found the president resting "after a somewhat restless day." He had sought to consume two boiled eggs and suffered indigestion; two were too many, for he had been eating only a single egg. For a while his fever came down to normal. As Wilbur related two months later, in an article in the Saturday Evening Post, Harding that day jested with his physicians. When his wife asked if his feet were warm, and one of the doctors asked the president, he responded, "This is no time to get cold feet."
It was on Wednesday that Harding felt so much better, according to newspaper reports, that he suggested he leave San Francisco for Washington the following Sunday, that is, a week after he had been put to bed at the Palace Hotel. Apparently the reports were accompanied by talk that Harding had been meeting his advisers and discussing administration matters. "But this man has been a sick man," said one of the doctors. "He is not capable of transacting any business." As Dr. Sawyer explained that day, "We can never tell what sideshows may develop. By that I mean that unexpected complications may turn up, such as indigestion or nervousness, which are always probable in such a case as this." Sawyer remained confident, again speaking privately to the New York Times correspondent: "I think I may say that he is out of danger, barring complications."
On Wednesday, August 1, Wilbur said privately that the chances had turned around and were now estimated to be nine in ten. But that afternoon when the doctors told the president his lungs had cleared remarkably well he said, for he knew his real trouble, "I am not so much worried about them, but what about this dilatation of my heart?"
An interesting aspect of Harding's confinement, as compared with later presidential illnesses in which the question if not of succession then of temporary replacement of the chief executive by the vice president arose immediately, is that in the somnolent 1920s the issue never even arose. Not merely was Harding far away from Washington, almost as far as he could have been, short of journeying to Alaska or Hawaii, but Vice President Coolidge had ensconced himself in rural Vermont, in Plymouth Notch, across the road from his birthplace, in the house of his father, Col. John Coolidge. The homestead was not in the village of Plymouth, known to local people as Plymouth Union, but up a narrow road that ran through a gorge for a mile, to a plateau on which were three houses, a general store, a cheese factory, and a church. The Notch had no telephone. Coolidge seems never to have thought he should return to Washington and spent his days in farm tasks, not seriously, for he was photographed in a business suit, cutting away at a rotten place in a tree, piling hay into a wagon. He was a canny politician, and he may have been watching the scene in San Francisco with if not anticipation then deepest personal interest, but if he did so there was not the slightest outward sign. Presumably newspapers were brought up to the Notch each day, yet he made no serious comments. On Wednesday, the day before he became president, he was quoted as saying, "I have never had any doubt of his ultimate recovery." A reporter told him of a proposal to establish an "assistant to the president," and Coolidge said that would not work, there was only one president.
Everything came down to the fatal day and evening, Thursday, August 2, 1923. The first bulletin at 9:30 in the morning said the president had had several hours of restful sleep and expressed himself as feeling "easier," which must have meant better. And then a reassurance that was to bring criticism upon the physicians: "While recovery will inevitably take some little time, we are more confident than heretofore as to the outcome of his illness." At 4:30, close to the end, the doctors related that "The President has had the most satisfactory day since his illness began." Harding did feel better but told his sister Mrs. Remsberg that he was tired out: "It isn't anything I have eaten. I thought I could stand anything but I find I can't. I am worn out, can't stand the heavy responsibilities and physical work too." Two hours before his death he talked on the telephone with Jennings and was cheerful and said he felt "out of the woods" but repeated, "I am so tired, so tired."
There was a strange preliminary, during which Boone was present. Mrs. Harding was reading to her husband an article about Henry Ford in the Dearborn Independent. The president had been very quiet, thoroughly relaxed, but suddenly stiffened, a frightened expression came on his face, and he turned pale. He broke out in a profuse perspiration. Sawyer, sitting by the bed, took his pulse without moving. One of the nurses, Ruth Powderly, got up from her chair, as did Boone, and both moved over to the president. The nurse felt his pajamas, which were wringing wet. Harding said, "I don't know what happened to me, a very strange, sinking feeling that I have never experienced before." He started to become restive, and Boone told him to keep very, very quiet. "But I'm so damn wet!" Harding said. The nurse took a Turkish towel, removed his pajamas, dried him off, and put on another pair. After a little while he said, "Florence, please go on with your reading. I don't know what happened to me. It was a very strange experience. Came on unbeknownst to me, now I feel perfectly comfortable, as though I had never had such an experience. Absolutely, I feel perfectly comfortable. Please go ahead with your reading, Florence." His color came back, his pulse returned to what it had been. All seemed normal.
After this odd behavior by the patient, Boone thought he might be able to leave the sickroom and go out on the street, take a short walk, get some air. He asked Sawyer if it would be all right. Night and day he had been in the president's room and did not take a bath or change clothes until Thursday afternoon. Not a soul "spent as many moments, hours, and days with him as I did at San Francisco." He thought the president was better. He knew that someone, a physician or one of the two nurses, would be in the room all the time. Nurse Powderly said she was going to be there, and Harding said, "I want Florence to go on with reading."
Boone went out, observed Gen. John J. Pershing at the cigar stand looking over the newspapers, went out on the street, and came back.
Then came the crisis. Actually it had happened while Boone was out on the street. As he went up the elevator he thought he heard someone calling his name several times. As he got out, a newspaperman appeared from nowhere into the hallway, and someone said excitedly, "There is Doctor Boone, there's Doctor Boone!" With that he ran down the hall.
As he entered the room Mrs. Harding "grabbed me hysterically, shook me by the shoulders, looked me in the eye with a very startled expression, and said: `Doctor Boone, you can save him, you can save him! You can bring him back! Hurry, hurry, hurry!'"
Boone took a look at Harding and instinctively knew he was dead. To make Mrs. Harding feel better he raised the lids of the president's eyes, touched both corneas, then replaced the eyelids to the closed position. He stood erect and took Mrs. Harding in his arms. She looked stunned as he said, shaking his head, "No one can save him, no one can restore him to life. He is gone!"
He asked Sawyer and the nurse what had happened. Sawyer told him that just a few minutes after Boone had left, the president had a terrible seizure, shook the bed violently, his body quivered, the color left his face, all in the twinkling of an eye. The seizure departed just as fast as it came, and he was dead.