As President, he "pursued a lavish social life, entertaining ... friends smoking, drinking, and conversing. It was said that no human being could withstand the stress produced by such socializing combined with the extreme pressures of his official office" 1a.

Despite his appetites and his being a widower President, "his personal life was impeccable" 2a.

There are references to "nervous indigestion" toward the end of his life 1d.

New York specialists examined the President, but all they could do was advise rest and relaxation 1a.

A cover-up began. When the New York Herald reported the story, an Arthur spokesman specifically denied the President had Bright's disease or any kidney complaints. The spokesman claimed the President had a mild form of malaria 1c (then endemic in Washington DC).

In the winter of 1883-1884, "his associates noted that late at night while socializing his face was lined, his eyes dulled, and his mind much less acute than it had been" 1a.

His last months were miserable. He was recognized as having cardiac problems in early 1886. The symptoms were those of heart failure: dyspnea, orthopnea, edema, cachexia. He needed opiates to sleep. In June 1886 Arthur tried relocating from New York to the cooler climate of Connecticut, but found no relief. He returned to New York and told a friend "After all, life is not worth living. I might as well give up the struggle for it now as at any other time and submit to the inevitable" 1d.

Comment: His terminal symptoms are also consistent with end-stage renal disease. It would be interesting to know more about his mental status during these final months.