Medical mystery: The U.S. president who died in a San Francisco hotel

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July 1923: Warren Gamaliel Harding (1865 - 1923), the 29th American President, smiling.

President Warren Harding, his wife, Florence, and his staff spent the summer of 1923 on an ambitious “Voyage of Understanding,” a cross-country rail adventure that would get them out of Washington during the steamiest months.  And the president would get to win support for his upcoming reelection bid.

The couple traveled across the continent, viewing Yellowstone and Zion National Parks, and even paid a special visit to Alaska, making Harding the first U.S. president to visit the then-territory.

In June and July, Harding gave, on average, more than a speech a day.  Charles “Doc” Sawyer, a homeopathic physician and family friend of Mrs. Harding's, urged the president to climb stairs to stay in shape.

Harding visited Ketchikan, Mendenhall Glacier, and Mount McKinley; spoke at the Alaska Railroad; and hammered in a ceremonial rail spike. After speaking at the Alaska Agricultural College, he seemed fatigued, so his wife filled in for him, speaking with reporters about the territory's statehood prospects.

As the presidential entourage left Alaska, its ship headed for Seattle's harbor, where the president reviewed the U.S. Navy fleet and then led a huge group of Boy Scouts in the Pledge of Allegiance.

The president  developed gastrointestinal distress, attributed to crabs brought him by local fishermen. While he rested in the train, the first lady gave speeches from the caboose, and then urged the engineer to rush to San Francisco.

A worried secretary of commerce, Herbert Hoover, contacted Ray Lyman Wilbur, president of Stanford University and the American Medical Association, by telegram, asking him to set out for San Francisco to consult on the president’s illness. 

On arriving in San Francisco on July 29, Harding was exhausted and had trouble breathing. Doc Sawyer thought he had pneumonia. 

By the evening of Aug. 2, Harding was sitting up in bed, listening to his wife read a flattering article about him from the Saturday Evening Post, “A Calm Review of a Calm Man.”  

"That's good. Go on," he told her. 

Suddenly the president’s body twisted and convulsed, and he passed out.

Mrs. Harding called for the doctors. There were five in the entourage, but Doc Sawyer took the lead and attempted to revive the president with a purgative.

Harding was declared dead at 7:35 p.m. in the presidential suite of the San Francisco Palace Hotel. Sawyer suspected apoplexy, or stroke. Was he right?


Solution:

The untimely death of the 57-year-old president sparked much speculation. It was reported that "within an hour of his death, he was embalmed, rouged, powdered, dressed, and in his casket. By morning, he was on a train, headed back to Washington, D.C."  Mrs. Harding refused to allow an autopsy. Was Doc Sawyer covering up?

Though Harding now is often most remembered for the scandals of his administration, at the time of his death he was popular with the public, which clamored for answers.

The rumor mill ran into overdrive. Five times between 1889 and 1901, Harding had been sent to the Battle Creek Sanitarium for "fatigue, overstrain, nervous illnesses,” sparking speculation that political scandals during his term, including the Tea Pot Dome oil fiasco, might have caused him to take his own life. 

Others pointed to his reputation for womanizing, including fathering a child outside of marriage. Should jealousy and murder by poisoning be  added to the list of possibilities?  A former Justice Department employee, Gaston Means, fanned these flames in a book he wrote, but it was quickly discredited.   

Naval physician Joel Boone, a graduate of Hahnemann Medical College and a Medal of Honor recipient, was assistant White House physician under Sawyer, and was along for the cross-country trip. Alarmed by the president's enlarged heart, especially given the rigors of the Alaska trip, Boone recognized symptoms of congestive heart failure and started digitalis for cardiac therapy as the presidential party rushed to San Francisco. 

But why the president went to a hotel, rather than San Francisco General Hospital, was never explained.

Wilbur, the AMA president, interviewed  all the presidential party and doctors. He later wrote in his diary that President Harding died of heart disease. Others have indicated a heart attack.

Another potential culprit: Doc Sawyer's ministrations. For centuries, doctors who didn't know what else to do used purgatives, or laxatives, for all kinds of ailments on the theory that "cleaning out" the patient might help. But with Harding's weakened heart, a laxative may actually have hastened his death.

Allan B. Schwartz, M.D., is a professor of medicine in the division of nephrology and hypertension at Drexel University College of Medicine.