Shortly after 8:00 on October 2, 1919, President Woodrow Wilson suffered a major stroke. He lost consciousness and fell from the stool in the bathroom, striking his head on the bathtub and opening a laceration across the bridge of his nose. He laid bleeding on the floor for nearly thirty minutes before he was discovered by Edith at ten minutes to nine that morning. Knowing that the White House switchboard could not be trusted to keep the information confidential, Edith phoned White House Usher Ike Hoover on the private line and asked him to find Dr. Grayson. After sending a car for the doctor, Hoover rushed to the Wilson’s bedroom, but Edith would not admit him until Grayson arrived. Soon after nine Dr. Grayson spent about ten minutes with the President. When he emerged, he told Hoover, “My God, the President is paralyzed.”
The United States Constitution at the time said that the vice president could assume the duties of president in case of the president's "Inability to discharge the Powers and Duties of the said Office," but until the Twenty-fifth Amendment was adopted in 1967, the Constitution said absolutely nothing about how the vice president should assume the duties of the presidency. The question had actually been publicly debated months before, when Wilson left the country for an extended period of time during the negotiations over the Treaty of Versailles. Other presidents had been ill, but death usually came quickly and the nation never faced the prospect of a long period of presidential disability. The president’s closest advisors were strongly opposed to Marshall, and did everything they could to hide from the nation the extent of Wilson’s sickness. Official press releases sought to reassure the public, and talked about “nervous exhaustion” rather than a stroke.
Marshall was also kept in the dark. Several days after the stoke, however, it was felt that Wilson was just hours away from death. Wilson’s advisors believed that any type of communication from a White House official would trigger the constitutional mechanism for Marshall to assume the presidency, so they asked a trusted intermediary, a correspondent with the Baltimore Sun, to brief Marshall on the president's condition.
It was then, for the first time and several days after the stroke, that Marshall was informed that Wilson’s condition was so grave that he might die at any time. A stunned Marshall sat absolutely speechless. He later said, "It was the first great shock of my life.”