“PRESIDENT RAPIDLY IMPROVING”, ran the headline of the San Francisco Chronicle on August 1, 1923, referring to President Warren Harding, ill and bedded down in the Palace Hotel in San Francisco.
But the next day readers were astounded by, “HARDING DEAD. BELOVED PRESIDENT SUCCUMBS SUDDENLY IN EARLY EVENING”.
What happened? What was the illness that brought Harding to the Palace Hotel? And who took care of him?
Warren Harding was elected president in 1920, and was felt by some even then to not look well. He smoked a lot and his blood pressure had been high for some time, usually around 180. In January of 1923 he was laid up with “the flu”, with poorly defined chest complaints, after which he often had to sit up at night to
breathe comfortably. On the golf course he was panting, unable to finish the course. Close associates feared for his health.
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| Warren Harding (Wikipedia) |
A trip to Alaska, to settle some political problems but mainly as a rest, should help restore him, and Harding’s doctor, Charles Sawyer, agreed. On the way he felt better but on the return trip, in Vancouver, he weakened, with abdominal pain followed by shortness of breath and intermittent chest pains. Sawyer incriminated recently consumed bad crabmeat. In Seattle Harding almost collapsed during a speech. His staff was alarmed and arranged to bypass an Oregon stop and rush him directly to a suite on the eighth floor in the Palace Hotel in San Francisco (visible at http://thepalacehotel.org ), arriving on July 29.
The President’s physician, Dr. Sawyer, was a homeopathic physician and a family friend, but with rudimentary training. He had treated Mrs. Harding for a kidney problem and on her
insistence was brought to the White House. (And Harding’s father was a homeopathic physician.) A better-trained naval physician Dr. Joel T. Boone was also hired, mainly to be physician on the presidential yacht. He had graduated from the Hahnemann Medical College, and the U.S. Navy Medical School.
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| Dr. Charles Sawyer (Wikipedia) |
On the way to San Francisco Dr. Boone examined the President and, realizing that crabmeat was not the problem, alerted Herbert Hoover, Secretary of Commerce and part of the entourage, who in turn spoke to Hubert Work, Secretary of the Interior and a former doctor (trained at the U. of Pennsylvania). Work examined Harding and found his blood pressure low, his heart grossly enlarged, the sounds muffled, and his pulse regular but rapid. Hoover wanted consultation and telegraphed an old friend, Lyman Wilbur, president of Stanford University and formerly dean of the Stanford Medical School. Wilbur, on vacation in the Sierra Mountains,
rushed down, bringing Charles M. Cooper, a Stanford internist, with him to the Palace Hotel.
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| Dr. Lyman Wilbur (Wikipedia) |
They agreed with the findings and noted tenderness over the gallbladder. Fever ensued, with pneumonia in the right lung seen on X-ray. Digitalis was administered with some improvement, but on August 2, as his wife was reading to him, she noticed her husband suddenly bathed in sweat. Moments later he stiffened, then slumped, without breath or pulse. An autopsy was refused. Wilbur and Cooper suspected a stroke as the immediate cause of death.
The official statement, authored by all the physicians, was “apoplexy or the rupture of a blood vessel in the axis of the brain near the respiratory center”. Wilbur and Cooper added a further note that he had cardiac enlargement, probably with thickened blood vessels, angina, nocturnal dyspnea, and Cheyne-Stokes respiration. Gall bladder disease was suspected. Sawyer’s misdiagnoses were not mentioned.
What was known about blood pressure and heart disease at the time, and might other measures have been taken? The auscultatory method of blood pressure measurement was invented by the
Russian Nicolai Korotkoff, first reported in1905, a method that was easy, allowed diastolic measurement, and rapidly replaced previous more cumbersome methods. After just a few years it became apparent that high blood pressure predisposed to cardiovascular problems, and by 1911 about two thirds of U.S. life insurance companies had made it part of their physical examination. Alas, there was no treatment until after WWII.
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| Nicolai Korotkoff (Wikipedia) |
Anginal pain, which Harding almost certainly had, was known to relate to coronary vessel disease, the case of John Hunter being a prime example. Myocardial infarction had been thought to be rapidly fatal and to have made this diagnosis in Vancouver, or instead of “the flu” in January, would have been unlikely (though occasional reports had described longer survivors). As late as 1919 James Herrick published the first case of myocardial infarction diagnosed by EKG findings, inverted T waves in this case, that were identical to those seen in dogs with ligated coronary arteries. Other features, such as Q waves, were still unrecognized and until then the EKG was used only for rhythm disturbances. No EKG is mentioned in Harding’s case. The only cardiac drug in use was digitalis and the only diuretics available were caffeine and theophylline, not very potent.
In short, cardiac knowledge, especially of diagnostic tools, was still in its infancy. And aside from digitalis, little of medicinal use was available. Though earlier diagnosis of heart disease would have led to more rest and earlier use of digitalis, the tools for more sophisticated management were not at hand.
Sources
Ferrell, R H. The Strange Deaths of President Harding. 1996
Starling, E W and Sugrue, T. Starling of the White House, 1946.
Robinson, E E and Edwards, P C. The Memoirs of Ray Wyman
Wilbur. 1960
Herrick, J. “Thrombosis of the Coronary Arteries. JAMA 1919.
72(6): 387-90.
“President Harding’s Last Illness: official bulletins of attending
physicians”. JAMA 1923. 81(7), p603.
Lewis, WH. The Evolution of Clinical Sphygmomanometry. Bull
N Y Acad Med 1941. November, p 971.
