Sawyer's reliance on dated medical practices resulted in the misdiagnosis of the President's coronary condition that led to the President's death in San Francisco in 1923. Joel Boone, M.D., the Vice Admiral in the United States Naval Medical Corps, had diagnosed the condition while Harding was on tour in Alaska. Sawyer deferred to the attending physician; however, Harding insisted on finishing the trip. It has even been speculated that Sawyer's use of harsh purgatives was the cause of Harding's fatal heart attack. The nursing notes from President Harding's medical records do not support this contention. Harding died of congestive heart failure and suffered a fatal heart attack. Harding's medical records from the western trip (the six-week trip during which he died) exist, and they show a man suffering from high blood pressure, chest pains, respiratory discomfort, indigestion, etc. Cardiac medicine was in its infancy, and these very recognizable symptoms to us were not automatic signals then for an impending catastrophic event. At Sawyer's recommendation, Mrs. Harding did not have an autopsy performed.