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This volume opens with Wilson's tour of the Middle West and West to generate popular support for the League of Nations and to force the Senate to consent to the ratification of the Versailles Treaty without any significant reservations to the League Covenant. After the first speech of the tour, in Columbus, Ohio, Wilson travels to Missouri and Minnesota, the Northwest, California, and into the central Rocky Mountain states. His already dangerous hypertension escalates due to his punishing schedule, and he suffers increasingly from headaches, difficulties in breathing, and periods of cardiac arrest. After a stroke warning on September 26, his doctor cancels the remaining speeches, and the presidential special train returns to Washington.

Wilson does suffer a stroke on October 2 and nearly dies from a urinary obstruction two weeks later. As he lies ill during October and early November, Tumulty and members of the cabinet carry on the domestic business of the country and deal with a nationwide coal strike. But Wilson will not permit Lansing to take any action on important foreign policy matters. The nation's state of affairs is parlous as the volume ends.