The Health of the First Ladies: Medical Histories from Martha Washington to Michelle Obama
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Introduction
“First Lady” Usage and Acceptance
The Constitution does not mention the title “First Lady.” Moreover there is neither a law nor a job description that authorizes the use of a specific title for the president’s spouse.1 Martha Washington was hailed with shouts of “Long live Lady Washington” as she was rowed across the Hudson River on the presidential barge after her husband’s 1789 inauguration in New York City. These shouts were accompanied by a thirteen-gun cannonade.2
Inconsistent titles were applied to early and mid-nineteenth century presidential wives. Abigail Adams was called “Mrs. President” and “Her Majesty,” mainly by her husband’s political opponents. Dolley Madison, the wife of James Madison, the fourth chief executive of the United States, was called respectfully “Lady Presidentress.” Additionally, at her death in 1849, President Zachary in his eulogy referred to Dolley as “our First Lady for half a century.”3
Historians and biographers generally agree that the title “First Lady” achieved acceptance and general usage during the presidency of Rutherford B. Hayes (1877–1881). Hayes’ wife, Lucy, was the first presidential wife to secure a college degree (from Cincinnati Wesleyan). Lucy Hayes was a prominent personage during the Hayes administration; additionally she accompanied her spouse on a transcontinental train trip. In 1877 reporter Mary Clemmer Ames, writing in the Independent, referred to Lucy Hayes as “First Lady of the Land.” Historian Stanley Pillsbury, writing in the Dictionary of American History, applied the title “First Lady” to Lucy Hayes in his narration describing her husband’s inauguration in 1877.4
Caroli noticed that dictionaries gradually began to use “First Lady,” but only after the country’s political attention had been drawn to Washington, D.C., in the twentieth century. Beginning with Webster’s New International Dictionary in 1934, other dictionaries began adopting the title. Two plays solidified its usage by the general public: the 1911 production by Charles F. Nirdlinger about Dolley Madison, The First Lady of the Land, and a 1935 play by Katherine Dayton and George S. Kaufman, titled First Lady.5
For clarification, “First Lady” as used in this book refers only to the wives of sitting presidents of the United States. The deceased wives of the four presidents who were widowers (Thomas Jefferson, Andrew Jackson, Martin Van Buren and Chester Arthur) are not included. Moreover, surrogates, either family members or others, who assisted disabled first ladies with their ceremonial and social responsibilities are neither considered nor analyzed.
The National First Ladies’ Library lists Harriet Lane as a first lady. Miss Lane was the orphaned niece of President James Buchanan (1857–1861). When his sister’s daughter was orphaned Buchanan adopted her, directed her schooling, and provided for her welfare. Over time Harriet Lane became not only her uncle’s political consort, but also his personal confidante. When Buchanan became president, his niece acted as his “First Lady.” Harriet was twenty-seven years of age at his inauguration and married only after her uncle’s death. She is not included in the profiles that follow.6
Caroline Fillmore and Mary Harrison married presidents after the chief executive left the White House; neither were first ladies. Conversely, two sitting presidents, John Tyler and Woodrow Wilson, remarried shortly after the death of their wives. Both second wives, Julia Gardiner Tyler and Edith Bolling Gault Wilson, deservedly are listed as first ladies. Benjamin Harrison, a third president who was widowered in the executive mansion, married his deceased wife’s niece, but only after leaving the presidency. Three wives of presidents died in the White House, while a disproportionate eight presidents died or were killed in office.
Part I: Before the Advent of Modern Medicine
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Chapter One
Martha Washington and Dolley Madison
The First First Lady and the First Mistress in the White House
It was my wish to have continued in Philadelphia longer, [George Washington wrote to his personal secretary, Tobias Lear] but Mrs. Washington was unwilling to leave me surrounded by the malignant fever wch. prevailed, I could not think of hazarding her … any longer by my continuing in the City the house in which we lived being, in a manner, blockaded by the disorder and was becoming every day more and more fatal.1
Martha Washington never lived in the White House; its construction was not completed until after George Washington’s death. Abigail Adams, the spouse of the second United States president, John Adams, occupied the still unfinished building for four brief months during the winter of 1800–1801.2 The third American president, Thomas Jefferson, was a widower. Mrs. Dolley Madison, the wife of his secretary of state and successor as president, officiated as White House hostess for both Jefferson and James Madison, and thus may correctly be identified as its first mistress.
Both Mrs. Washington and Mrs. Madison were confronted by infectious diseases (yellow fever, smallpox), scourges of a bygone era, and both suffered from chronic maladies (gall bladder disease [Washington] and arthritis [Madison]), still prevalent in modern times. A physician was not officially assigned to either president during their husbands’ tenures, although both George Washington and James Madison were seriously ill while president. Neither Martha nor Dolley was significantly sick or the recipient of medical attention during her tenure as first lady. As a result, both were able to successfully fulfill the responsibilities of wife and first lady.
Martha Washington and Dolley Madison were Virginia born. Both experienced early widowhood upon the deaths of their first husbands. Both bore children during their first marriages but were unable to become pregnant during long second marriages. Children with both first husbands died at an early age. Both ladies outlived their presidential husbands, Dolley by many years. Martha and Dolley had auditioned for their roles as first lady. Washington was the wife of the Revolutionary War American commander in chief; Madison served as hostess for the widower Thomas Jefferson while her husband James was Jefferson’s secretary of state.
Martha Washington was often addressed as Lady Washington.3 While serving as Jefferson’s hostess, Dolley Madison acquired the unofficial title of Presidentress. During her husband’s administration she received the nicknames of “Lady Presidentress” and “Queen Dolley.”4
Martha Washington, the first first lady (Library of Congress).
Yellow Fever
In 1793, Philadelphia, Pennsylvania, was the largest city in North America, with a population of nearly 51,000.5 It was also the capital of the infant American republic, the United States of America. The seat of national government officially moved from New York City to Philadelphia on December 6, 1790. The city would remain the nation’s capital until 1800, when the next and permanent center of government would be established in Washington, D.C.6
Dolley Madison, the first mistress of the White House. Yellow fever killed her first husband and her infant son (Library of Congress).
In mid–August a familiar yet mysterious pestilence affected the city. Yellow fever disrupted not only the personal lives of its inhabitants but also the institutions of federal and state governments. Yellow fever killed five thousand, or 10 percent, of Philadelphia’s population, sickened thousands, impelled twenty thousand into exile, and cast two of the city’s residents, Martha Washington and the future Dolley Madison, into decisive roles. Lady Washington was the country’s first first lady when the epidemic struck. Her principal goal was to assure the medical safety of her husband by removing him from Philadelphia’s pestilence. The future Queen Dolley was the young wife of John Todd, a local attorney, with a newborn child and fearful of any ill consequences for her family.
On Sunday, August 3, 1793, “a young French sailor rooming at Richard Denny’s boarding house, over on North Water Street, was desperately ill with a fever…. All we know is that his fever worsened and was accompanied by violent seizures, and that a few days later he died.”7 Thereafter the numbers of deaths increased by geometric progression. The usual course of the disease began with chills and a high fever, h
eadache, and generalized muscle aches. This state would persist for approximately three days until the fever broke, with an apparent recovery. However, fever returned almost immediately accompanied by jaundice of the eyes and skin. Hence the diagnosis “yellow fever.” Subsequently the nose, gums and intestines would experience spontaneous bleeding, with the vomitus of black blood. Neurological symptoms of depression, confusion and delirium climaxed in death.8
The leading practitioner of medicine in Philadelphia at the time was Dr. Benjamin Rush. On August 19, Rush, recalling the signs and symptoms of a 1762 epidemic that ravaged the city, was quick to make the diagnosis of yellow fever. He worked tirelessly to serve the victims of the “American plague” while many of his professional colleagues fled and others sickened and died. Rush was twice infected, on September 12 and on October 20, 1793.9 An August 28 newspaper article authored by a committee of the Philadelphia College of Physicians panicked the city’s population rather than reassuring it. Its inhabitants fled and private business was abandoned. The term of the U.S. Supreme Court was interrupted, and the Pennsylvania General Assembly adjourned on September 5 after only eight days in session.10
Yellow fever brushed close to, but did not infect, Martha Washington. Her close companion was Polly Lear, the wife of the president’s secretary, Tobias Lear. The Lears lived in the presidential mansion with the Washingtons. Polly Lear was one of the first fatalities of the epidemic.11 Then, Alexander Hamilton, the country’s treasury secretary and Washington’s closest friend in the cabinet, came down with the illness. Other members of the cabinet were absent: attorney general Edmund Randolph was away negotiating an Indian treaty and secretary of state Thomas Jefferson had resigned and remained at Monticello, his country retreat. Almost all the clerks in the Treasury Department and the Post Office became ill, leaving the people’s business at a standstill. Washington was very reluctant to depart from the city. He worried about Hamilton’s well-being. He was also dismayed by the floundering functioning of the government, complaining that nearly everyone had “matters of private concernment which required them to be absent.”12
There was great anxiety among Washington’s friends for his physical well-being as the epidemic raged through August into September. Deaths from the epidemic reached one hundred per day. The president had great anxiety for Martha; he urged her to retreat to the safety of their Mount Vernon, Virginia, home. Martha refused to leave her husband and insisted that she would remain with him in Philadelphia. Finally, Washington acquiesced and left the nation’s capital for his Virginia home.13
First lady-to-be Dolley Madison, then Dolley Todd, had lived in Philadelphia for some years. Dolley married attorney John Todd in January 1790, and bore him a son, John Payne, in February 1792, and a second son, William Temple, in the summer of 1793.14 Dolley Todd. her husband, her two sons, her mother, her two sisters and a brother, were among the thousands who fled the epidemic. They reached Gray’s Ferry, a resort fourteen miles away. Dolley, still weak after her recent pregnancy, required a litter to reach their hoped-for refuge. John Todd returned to Philadelphia to be with his parents and to tend to his infected law student. After the deaths of all three from yellow fever, he departed for Gray’s Ferry, where he became chilled and succumbed to the disease on October 14.15 Their infant son, William, died the same day, despite departing Philadelphia with his mother and older brother two months earlier. “Mr. Todd on his return bore with him the dread disease. At the threshold, he said to Dolley’s mother: ‘I feel the fever in my veins, but I must see her once more.’ In a few hours he was dead—‘a martyr to professional duty.’ In the embrace was contamination. The younger child died and Dolley recovered. Mr. Todd died October 24, 1793.”16
Katherine Anthony suggests that Dolley had contracted yellow fever, which in her case was prolonged and severe. In late autumn Dolley returned to the city, recovered from her own illness: “[W]hether she contracted yellow fever is unclear; certainly a woman weakened from childbirth must have been susceptible.”17 “And even though she had removed herself and her two-year-old son to a farm at Gray’s Ferry, they had both become infected and been close to death themselves.” She returned to the city in November 1793 to set up a boardinghouse.18 It is intriguing to speculate whether the future first lady developed yellow fever. However, she probably did not. Yellow fever is infectious from a mosquito bite, not contagious from another infected individual. Dolley had been absent from the epidemic’s epicenter for two months prior to her farewell embrace with her husband. His return to Philadelphia from the haven at Gray’s Ferry, although heroic, was deadly.
When yellow fever returned to Philadelphia in the summer of 1794, George Washington wasted no time in removing Martha, himself, and the rest of his household along with his official papers to Germantown, Pennsylvania, over seven miles from the seat of government.
President and Mrs. John Adams’ arrival in Philadelphia from their summer residence in Quincy, Massachusetts, was delayed in 1797: “Yellow fever raged again in Philadelphia, as they learned en route, and so it was necessary to stop and wait in East Chester…. Adams was kept apprised by daily reports. Two thirds of the population of Philadelphia had fled the city.” During the summer of 1799 John Adams’ administration evacuated to Trenton, New Jersey, to avoid another outbreak of the disease.19
In 1793 both the medical community and the lay population were ignorant of the cause and the treatment of yellow fever. The miasma of summer was widely considered to be the culprit. It was only in 1900 that Dr. Jesse Lazear of the U.S. Army Yellow Fever Commission conclusively demonstrated that a mosquito was the vector of yellow fever.20 That same year, Lazear’s superior, Dr. Walter Reed, publicly announced that mosquitoes transmitted the disease and identified the female Aedes aegypti mosquito as the carrier.21 Since many French refugees fled Haiti’s revolution in 1793 to reach Philadelphia, it is possible that some previously infected with the yellow fever virus might have provided the necessary viral reservoir for summer-abundant mosquitoes to transmit the infection to Philadelphia’s unsuspecting denizens.22
The aforementioned Benjamin Rush claimed that only heroic, aggressive measures could cure the disease. These included toxic doses of mercury and jalap to purge the gastrointestinal system through vomiting and explosive diarrhea. Copious bloodletting completed his heroic regimen.23 The Philadelphia epidemic waned and then disappeared with the onset of cold weather, which destroyed the adult mosquito population. Today yellow fever is controlled by isolation, destruction of a breeding mosquito population by swamp clearage and insecticides, and vaccination against the yellow fever virus.24 Fortunately for the widow Todd, geographic distance spared her from Rush’s heroic ministrations.
Smallpox
Smallpox was widespread in America during the 1700s. Vaccination using cowpox virus did not become accepted until later. During Revolutionary times, protection against the smallpox virus was by inoculation with fluid from a skin pustule of a patient with active smallpox. The inoculant would often develop significant but nonfatal smallpox symptoms.
Martha Washington was well aware of the ravages of active smallpox; her husband was stricken in Barbados as a young man, and his face was permanently marked with scars of the disease.25 Martha underwent inoculation in May 1776. The procedure was performed by Dr. John Morgan, a graduate of the Medical College of Edinburgh and a professor and founder of the first American medical school in Philadelphia.26 The procedure went well. Martha received a June 9, 1776, letter from her son John Parke Custis: “My dear Momma … [I] hear You were in so fair a Way of getting favorably through the Smalpox … which I doubt less should have felt on the inoculation of so dear a Mother.”27
Martha Washington’s Medical History
During her first marriage, to Daniel Parke Custis, Martha gave birth to four children, two of whom died in childhood.28 Her second marriage, to George Washington, was childless, but it was generally blessed with good health.29
Although Washington during his two-term
presidency (1789–1797) was beset by serious medical afflictions for which he was cared for by the elite of the New York and Philadelphia medical establishments, there is no record that the first lady sought any doctor’s care during her husband’s presidential tenure.30 Her singular complaint was gallbladder disease. In May 1781, she came down with abdominal pain, “biliousness” and jaundice that lasted five weeks.31 In an April 1792 letter to Fanny Bassett Washington she complained: “I have been unwell for some weeks with chollick complaints.”32 Elizabeth Willing Powel wrote to the first lady on December 7, 1796: “[Y]ou mentioned that you had taken Noyan as a Medicine to cure the Colick, but that you did not think it was as pure as that you then tasted, knowing that the true Martinique Noyan is not to be purchased as this time, I have taken the liberty to send you a Bottle, tho I hope you will not have occasion to use it as a Remedy for any complaint half so distressing as the Colick.”33 Martha’s physique was that of a gallstone victim: “At 5 feet tall, Martha put on weight easily. She no longer rode horseback and frequently indulged her fondness for candy and desserts. The pleasing plumpness of her middle age had become grandmotherly stoutness, complete with double chin. She often suffered from colic and severe stomach pains.”34
Reports of the physicians who assisted Martha during her life are few. In June and July 1757, Dr. James Carter of Williamsburg treated the Custis family, first by dispatching drugs. When there was no improvement, he traveled the twenty-five miles to the Custis farm with a vast array of medicines. Not only did he unsuccessfully treat Martha’s husband, Daniel Custis, who died at age 45, he also stayed for five days and in August returned to treat Martha for an undisclosed illness.35 The Custis estate received the following bills from Dr. Carter for services rendered: 132 British pounds (November 28, 1757), 27 pounds, eight shillings, nine pence (December 1, 1758, to November 16, 1759). Carter set up an apothecary shop and practiced medicine and surgery at the Unicorn’s Horn in Williamsburg as early as 1751. He served in the Virginia militia during the Revolutionary War and continued practice until his death about 1800.36 In January 1760, Martha’s second husband, George Washington, used the services of the Rev. Charles Green, a local clergyman with medical training, when Martha contacted measles. In April 1760, Martha was ill once more and Washington contacted another physician, who showed up drunk. Nevertheless the doctor spent the night at Mount Vernon and bled Martha in the morning.37