During his presidency, the Surgeon General told Arthur he had "Bright's disease," a classification no longer used because it covers a variety of kidney problems that have more precise designations now. He diagnosis might not have been exact by later standards, but Arthur and his doctors knew that the condition would eventually kill him, and it did.
Dr. Zebra notes: "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'.
"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."
Chester Arthur's New York Times obituary began: "Ex-President Chester Alan Arthur died at 5:10 o'clock yesterday morning at his residence, No. 123 Lexington-avenue. The immediate cause of his death was cerebral apoplexy, due to the rupture of a small artery within the brain during Tuesday night or early on Wednesday morning. From the time of the attack the ex-President did not speak. He did not become immediately unconscious, but power of speech failed him and consciousness rapidly dimmed, although almost to the last he showed signs of ability to appreciate, in an even fainter degree, what was going on about him. In the closing hour of his life he opened his eyes several times, and at the end turned his head on the pillow. Then all was over...
"Although from the beginning of his illness Gen. Arthur was not ignorant of its gravity, his feelings were characteristic of the disease, buoyant and depressed by turns. Upon his return from New-London, on Sept. 27, he felt so much benefited that he was sanguine of recovery. His appearance even after a Summer of rest and change was sadly unlike the robust picture familiar to the public eye. Any one who had seen him in his vigor might have passed him without recognition. The features still remained, but they were pallid and hollow and the full, straight figure still showed the emaciation that had alarmed the patient and his friends before he sought a change of surroundings. But he felt better. He was again in excellent spirits, and talked confidently of plans for business and pleasure. When the Presidency of the Arcade Railway Company was offered him, he accepted it, believing that he would be able to discharge its duties. A few days after his return he felt so well that he went out driving. The effort fatigued him excessively. He was not willing to believe the fatigue due to his enfeebled condition, but laid it to the rough streets. In speaking of the drive, he used to say, not wholly with jocose meaning, that one of the aims of his life, after he should resume outdoor activity, would be to secure at least one avenue over which people might drive to the Park without being jolted half to death...."