This was not his first sign of receding health. Less than a year earlier, while U.S. troops were still fighting in Europe, Wilson sought treatment for a breathing problem. White House doctor Cary T. Grayson, later recounted the incident to his wife, in which he wrote: "The patient is progressing most satisfactorily, so far, and I have good reasons to hope for a most beneficial result. It has been a big undertaking. No one knows anything about it except Miss E., Miss Harkins, and [White House Chief Usher Ike] Hoover. It is one secret that has been kept quiet, so far, and I think it is safe all right now."
Wilson returned home from the conference to cheering crowds. But his popularity was soon to wane as Republicans in Congress fought Wilson over American entry into the proposed League of Nations. Ratification of the treaty required a two-thirds vote from the Republican-controlled Senate and public opinion over the treaty and the League was mixed. Groups opposed to the terms of the treaty inclided most Republicans, Germans, and Irish Catholic Democrats. In numerous meetings with Senators, Wilson discovered opposition was firm, and Wilson was not of a mind to accept some of the compromises proposed despite his weak bargaining position. He decided that if he could not convince the senators directly, he would take his case to the people in an effort to have them pressure their senators to vote to ratify the treaty. Wilson scheduled 29 major speeches and many other short addresses to audiences across the nation in an effort to rally support for his position.
The tour never completed as planned. While on the tour he showed signs of physical strain. A special train left Washington on September 3 making stops all across the country. Wilson spoke from the rear platform of the train. He would deliver a speech to the gathered crowd, and then the train wood speed off to the next stop. It was a grueling schedule and it began to take its toll on Wilson's health. He began to suffer severe asthma attacks and splitting headaches, starting in Montana. In Colorado, his headaches almost blinded him and in Wichita, his doctor found Wilson in what Grayson described as close to a "complete breakdown." In Pueblo, Colorado, on September 25, 1919, Wilson collapsed before giving his speech. He never fully recovered and the trip was cut short. On September 26, 1919 the train headed back to Washington.
On the morning of October 2, first lady Edith Wilson found her husband unconscious on the bathroom floor of their private White House quarters bleeding from a cut on his head. It was later determined that Wilson had suffered a stroke. A massive attack left his left side paralyzed and impaired his vision. Mrs. Wilson immediately summoned Dr. Grayson.
Ike Hoover, who served as Wilson's Chief Usher and who was responsible for managing the everyday activities of the presidential mansion, had accompanied Wilson on his trip to the Paris Peace Conference where he first become alarmed at changes in the President's behavior and suspected his health was failing.
Hoover later wrote about what happened on the morning of October 2:
"At exactly ten minutes before nine o'clock on this memorable day (I noted the time in writing the same day), my telephone on the desk in the Usher's Room at the White House rang and Mrs. Wilson's voice said, 'Please get Doctor Grayson, the President is very sick.' The telephone used was a private one that did not go through the general telephone switchboard. Mrs. Wilson had come all the way out to the end of the upper hall to use this particular telephone instead of the regular one in their bedroom. I reasoned at the time that it was done to avoid publicity, for there had been talk about the operators of the switchboard listening in and distributing information they picked up. I immediately called Doctor Grayson at his home, repeated the message as Mrs. Wilson had given it to me, and ordered one of the White House automobiles to go for him with all haste. I then went upstairs to see if there was anything I could do. I waited up there until Doctor Grayson came, which was but a few minutes at most. A little after nine, I should say, Doctor Grayson attempted to walk right in, but the door was locked. He knocked quietly and, upon the door being opened, he entered. I continued to wait in the outer hall. In about ten minutes Doctor Grayson came out and with raised arms said, 'My God, the President is paralyzed! Send for Doctor Stitt and the nurse.'
"The second doctor and nurse arrived and were shown to the room. The employees about the place began to get wise to the fact that the President was very ill, but they could find out nothing more. Other doctors were sent for during the day, and the best that could be learned was that the President was resting quietly. Doctor Davis of Philadelphia and Doctor Ruffin, Mrs. Wilson's personal physician, were among those summoned. There were doctors everywhere. A consultation of them all together was held about four o'clock. An air of secrecy had come over things during the day. Those on the outside, including family and employees, could learn nothing. It was my privilege to go into the sick-room in the late afternoon. Some rearrangement of the furnishing had to be made and the domestic attendants on the floor were not allowed in. So Doctor Grayson, the nurse, and I did the job.
"The President lay stretched out on the large Lincoln bed. He looked as if he were dead. There was not a sign of life. His face had a long cut about the temple from which the signs of blood were still evident. His nose also bore a long cut lengthwise. This too looked red and raw. There was no bandage. Soon after, I made confidential inquiry as to how and when it all happened. I was told - and know it to be right - that he had gone to the bathroom upon arising in the morning and was sitting on the stool when the affliction overcame him; that he tumbled to the floor, striking his head on the sharp plumbing of the bathtub in his fall; that Mrs. Wilson, hearing groans from the bathroom, went in and found him in an unconscious condition. She dragged him to the bed in the room adjoining and came out into the hall to call over the telephone for the doctor, as I have related. For the next three or four days the White House was like a hospital. There were all kinds of medical apparatus and more doctors and more nurses. Day and night this went on. All the while the only answer one could get from an inquiry as to his condition was that it 'showed signs of improvement.' No details, no explanations. This situation seemed to go on indefinitely. It was perhaps three weeks or more before any change came over things. I had been in and out of the room many times during this period and I saw very little progress in the President's condition. He just lay helpless. True, he had been taking nourishment, but the work the doctors had been doing on him had just about sapped his remaining vitality. All his natural functions had to be artificially assisted and he appeared just as helpless as one could possibly be and live."
For seventeen months the incapacitated President lay in his bed, barely able to write his own name. But the full extent of the President's condition was kept a secret from the outside. All communication with the President went through his wife. She and Dr. Grayson agreed that they would shield Wilson from intrusion and would hide his condition from outsiders. For virtually the remainder of Wilson's second term, Mrs. Wilson would enter her husband's room with messages and emerge with what purported to be his verbal instructions or the scrawl of a signature on a piece of paper. Edith Wilson later called this period her "stewardship." Others later called her the first woman President.
While Wilson was bedridden, the Senate rejected the Treaty of Versailles with its provision for the League. Although Wilson's health improved, he never fully recovered. Over that period Wilson was essentially an invalid in the White House. His wife insulated him from negative news and downplayed for him the gravity of his condition. In mid-November 1919, Senator Henry Cabot Lodge of Massachusetts and other like-minded Republicans formed a coalition with pro-Treaty Democrats on a compromise. The group were close to a two-thirds majority for a Treaty with reservations. But Wilson rejected this compromise. At least two of Wilson's biographers suggest that Wilson's stroke in September had prevented him from negotiating effectively with Lodge.
By February 1920, the President's true condition became more well-known. Many Senators expressed qualms about Wilson's fitness for the presidency, but no one, including his wife or his physician, was willing to accept responsibility for the certification required by the Constitution, of Wilson's "inability to discharge the powers and duties of the said office".
Vice-President Thomas Marshall Marshall tried to meet with Wilson to personally determine his condition, he was prevented from doing so by Mrs. Wilson and Dr. Grayson. He relied on the updates he received from Grayson. A group of Congressional leaders considered taking steps to press the issue, but many of the senators opposed the League of Nations treaty and were concerned that, as president, Marshall would make several key concessions that would allow the treaty to win ratification. Wilson, in his present condition, was either unwilling or unable to make those concessions. In order to prevent the treaty's ratification, those Senators did not press the issue.
On December 4, Secretary of State Robert Lansing announced in a Senate committee hearing that no one in the cabinet had spoken with or seen Wilson in over sixty days. The senators requested that a committee be sent to check on Wilson's condition, hoping to gain evidence to support their cause. Dubbed the "smelling committee" by several newspapers, the group discovered Wilson was in very poor health, but seemed to have recovered enough of his faculties to make decisions.
At a Sunday church service in mid-December, a courier brought a bogus message informing him that Wilson had died. Marshall was shocked, and rose to announce the news to the congregation. The ministers held a prayer, the congregation began singing hymns, and many people wept. Marshall and his wife exited the building, and made a call to the White House to determine his next course of action, only to find that he had been the victim of a hoax, and that Wilson was still living.
Marshall performed a few ceremonial functions for the President, but it was First Lady Edith Wilson who reviewed all of Wilson's communications and decided what he would be presented with and what she would delegate to others.
Wilson began to recover by the end of 1919, but remained secluded for the remainder of his term, steadfast in his refusal or inability to accept changes to the treaty. Marshall was prevented from meeting with him to ascertain his true condition until his final day in office.
After the end of his second term in 1921, Wilson and his wife moved from the White House to a town house in the Embassy Row section of Washington, D.C. On November 10, 1923, Wilson made a short Armistice Day radio speech from the library of his home, his last national address. The following day he spoke briefly from the front steps to more than 20,000 well wishers gathered outside the house. On February 3, 1924, Wilson died at home of a stroke and other heart-related problems at age 67. He was interred in a sarcophagus in Washington National Cathedral, the only president interred in Washington, D.C.