The Health of the First Ladies: Medical Histories from Martha Washington to Michelle Obama

by Deppisch, Ludwig M. , M. D.

  Abigail’s sense of civic responsibility overcame her reluctance to serve as her husband’s first lady in Philadelphia. But the late summer journey home in 1798 was the most unpleasant of her several journeys. She was seriously ill when the Adamses reached their Quincy, Massachusetts, home. She “felt so close to death that she directed her relatives to assemble so she might take care of them properly.” This attack was the most serious she had ever experienced. Her physicians were perplexed by the disease but finally made the diagnosis of “bilious fever.” Her symptoms subsided and she revived to the extent that John Adams, in early November, returned by himself to the nation’s capital city. Abigail’s physicians during this episode are not identified.17

  Rheumatoid Arthritis

  Even more debilitating than malaria was near-crippling rheumatism, probably rheumatoid arthritis. In 1775, “the middle of Abigail’s right hand was so sore that she could not hold her pen for three weeks.” A significant handicap for this inveterate scribe! Her age (30 years) and the location (middle finger joint) are characteristic of rheumatoid arthritis. Her rheumatism prohibited her journeying to Philadelphia that year for the smallpox inoculation urged by her husband. The sea journey to England in August 1784, as John Adams became the first ambassador to Great Britain, aggravated her symptoms and produced headaches.18

  Her rheumatism—and it was always called this by Abigail—continued to affect her in Philadelphia. In autumn 1791, the rheumatism combined to lay her low. After six weeks in bed, she was still too feeble to go downstairs without being carried. It was during this episode that Dr. Rush came several times to bleed her.19 This visit would be Mrs. Adams’ last visit to the nation’s capital for five years: “Her body was worn with rheumatic pains and fevers that, at times, left her wrists lame and her eyes so sensitive that she could not read, write, or sew by candlelight, let alone leave her bed.”20 In a March 20, 1792, letter to her sister, she wrote: “Tis now the sixth week since I have been out of the door of this chamber…. I was taken six weeks ago very ill with an Inflammatory Rheumatism and tho it did not totally deprive me of the use of my limbs, it swelld and inflamed them to a high degree, and the distress I sufferd in my head was almost intolerable.”21

  The arthritis, like malaria, was a chronic problem. On a return to Philadelphia in 1798 she wrote her sister, referring to it: “I have it floting about, sometimes in my head, Breast, Stomack etc, but if I can keep of fever I can Parry it so not to be confined.” In an aside about her favorite physician, she continued: “Dr. Rush is for calling it gout, but I will not believe a word of all that, for Rheumatism I have had ever since I was a child.” Apparently her physician continued to be Dr. Rush and bleeding remained his primary treatment.22 Arthritis continued to oppress the first lady when she took up residence in the unfinished White House in the District of Columbia in November 1800: “When she arrived, she ‘suffered from feverish chills, rheumatism and depression.’”23 In retirement in Quincy, Massachusetts, she continued to suffer from rheumatism.24

  Smallpox Inoculation

  After the British army quit Boston in the spring of 1776, the mingling of colonists, both those exiting the city after being sequestered by the British and those returning to their Boston homes after having been expelled, led to a major smallpox epidemic by June. Abigail determined that smallpox inoculation was required for her, her sisters, and her four children. The process had changed little since John Adams’ inoculation more than a decade before. In preparation the Adams family isolated themselves for several weeks. Seven thousand people received the smallpox virus through inoculation in Boston during this period, many, like the Adams contingent, in smallpox hospitals. Their inoculation doctor, Thomas Bullfinch (a 1756 graduate of the University of Edinburgh), had modified the usual ten-day preparation period of self-induced vomiting and a strict debilitating diet. Instead he prescribed medicines that caused the children to “puke every morning.” “The practice in colonial Boston … was to insert into the patient’s bloodstream a small quantity of the smallpox virus itself. The only way to obtain immunity to the disease was to deliberately contract a minor case of it. About one in every one hundred cases of self-inflicted infection proved fatal. It was widely believed that inoculation patients could improve their odds by preparing themselves with a week of isolation, purgatives, and abstention from meat and dairy products. After a patient had been infected, he or she became a highly contagious carrier of the virus and therefore had to be quarantined for at least three weeks.” Boston was a reservoir of the disease, and since John Adams practiced law in the city he was previously inoculated, in 1764.25 After Dr. Bullfinch inoculated the Adams family, Abigail and two of her children broke out with smallpox pustules, a sign that the infection took and immunity was conferred. However, the inoculation did not take for daughter Nabby and son Charles. Both required a second inoculation that rendered Nabby very sick. Charles required a third inoculation. When he finally broke out with pustules, it was not the mild form usually associated with inoculation but in the “Natural way,” a contagion from a sickened individual. The whole experience lasted more than two months. Fortunately, this inconvenience did not deter Abigail from participating in Boston’s celebration of the Declaration of Independence.26

  Both Martha Washington and Abigail Adams, the future first and second first ladies, had the foresight and the courage to suffer the rigors of smallpox inoculation, not only to protect themselves and their families from an often fatal disease but also to fortify themselves in advance for the rigors of future national prominence.

  In 1796 English physician Edward Jenner inoculated an eight-year-old boy with the pus of a patient with active cowpox. He subsequently inoculated the lad with smallpox discharge with no reaction. In this fashion Jenner determined that injection with cowpox (vaccinia) virus would render a person immune to the smallpox virus. Vaccination rapidly replaced inoculation; by 1801, over a hundred thousand people had been vaccinated in Great Britain. Thomas Jefferson, then the third U.S. president, became a strong proponent of vaccination in the United States.27

  The Adamses: Separation and Influence

  Mrs. Adams was an absentee “Second Lady.” The vice president’s wife resided in Philadelphia for only fourteen of the seventy-seven months John served there as vice president. Her reasons were several, the most significant being her health28: “Given Abigail’s anxieties about the hazards of office, age, and her poor health, which was only accentuated by Philadelphia’s seasonal heat and disease, retirement to Braintree seemed more ‘eligible’ to her on the eve of the presidency.”29 Additionally, Abigail did not like Philadelphia, basing her judgment on her first visit as wife of the vice president. She observed that the city was filled with Jacobins, not perceiving any difference between urban Republicans and French revolutionaries. Also, despite Philadelphia’s reputation for religious diversity and tolerance, there was no church that fit her spiritual tastes.30 Perhaps a further reason for her absence was the unimportance of the vice presidency. In Adams’ own words, “My country in its wisdom contrived for me the most insignificant office that ever the invention of man contrived or his imagination conceived.”31

  Abigail Adams was also for the most part an absentee first lady, remaining in the capital cities of Philadelphia and Washington for less than half the time Adams was president (only 21 out of 48 months). On New Year’s Day 1797, John urged Abigail to join him in Philadelphia for his March 4 inauguration. She demurred and the new president was forced to plead for her presence once again. This time Mrs. Adams acquiesced and departed from Massachusetts at the end of April.32

  After fewer than three months in the capital, she accompanied John Adams home in July. In early October of 1797, both left Massachusetts for Philadelphia. Since yellow fever still raged in that city, as a precaution the Adamses tarried in New York until the end of month.33 Their return journey to Massachusetts at the end of July 1798 was a very arduous one for Mrs. Adams, and she became very ill, as detailed previousl
y. Her illness determined that the president return to Philadelphia alone. Therefore, he was without his most trusted advisor, alone in the nation’s capital for five months. Moreover, upon his return home in late March 1799, he remained for seven months, a far longer absence than his predecessor, George Washington, spent at Mount Vernon, and never during a political crisis.34

  John Adams left his home the last day of September 1799. However, he was unable to reach Philadelphia because the capital was again in the midst of a yellow fever epidemic. The cabinet had to meet in Trenton, New Jersey. It was December 1799 when Abigail departed for Philadelphia; she remained there only until spring 1800.35 Her final trip south as first lady was to the unfinished White House in the desolate and sparsely populated new capital city of Washington, D.C. She thus became the first first lady to reside in the White House. She remained only briefly from November 16, 1800, to February 15, 1801.36

  A salient question, in light of this historical examination, is whether Abigail’s illnesses deprived the president of her advice, analysis, and encouragement. Did his months of lonely isolation in Philadelphia lead to policies that might have been altered or thwarted by her presence? Her absence excluded her from “political disquisitions” regarding the initiation of an American peace mission to France’s Talleyrand. On February 19, 1799, Adams informed Congress that he had just authorized William Vans Murray, then American minister to The Netherlands, to reopen peace negotiations with France.37 Conflict between the two countries had approached open warfare. To counter a feared French invasion, Congress previously had authorized the formation of a Provisional Army, to be led by George Washington and Alexander Hamilton. In this context, Adams’ peace initiative shocked the country, especially the members of his own Federalist party. Many Federalists concluded that John Adams had gone soft and “they wisht the old woman had been there,” “she surely would have shot it down”; “Oh how they lament Mrs. Adams absence…. If she had been there, Murray would never have been named nor his Mission instituted.” In Massachusetts the first lady was amused by these laments. Although Abigail was more warlike than her husband regarding France, this time she agreed with John’s “ master stroke of policy.”38

  The Responsibilities, Problems and Rewards of a First Lady

  Abigail Adams’ service to the young American republic as its first “Second Lady” and as its second first lady came with a significant price. Her physical well-being was assailed by malarial infection and by debilitating rheumatoid arthritis. Previously in her American travels she had rarely left New England, but the responsibilities of a vice president’s wife placed her in New York City, where she became a target of the Anopheles mosquito. Late eighteenth-century carriage travel over America’s roads was slow, arduous and physically harmful. Her trips between Boston, Philadelphia, and Washington, D.C., exacerbated the injuries to her joints and muscles, already under the grip of chronic rheumatoid arthritis.

  With her prominence as a member of the new government’s elite came the availability of the best physicians. Whether the attention of Dr. Benjamin Rush was a benefit to her is subject to conjecture. Rush provided Mrs. Adams with quinine, the standard remedy at the time for malaria. However, his standard treatment for rheumatism—bleeding—was both therapeutically ineffective and pernicious to her well-being.

  Abigail Adams was her husband’s political soulmate. Their separations were lengthy during John Adams’ tenures as vice president and as president. The distance between them probably did not affect his decision making, but this issue remains unresolved.

  Sarah Polk

  Overview

  Robert Watson described Mrs. Polk’s role as first lady (1845–1849): “Sarah Polk was a full political and presidential partner…. She was his political partner and leading political advisor … edited her husband’s speeches, discussed politics with him, campaigned with him, was his constant traveling partner, and … even briefed him on current events. The Polk partnership was well known. Samuel L. Laughlin, a newspaper editor from Nashville, even referred to Sarah as ‘Membress of Congress.’”39

  Sarah Polk was described as having large brown eyes, long dark hair, and a rich olive complexion. She was vivacious and outgoing, and her formal education was far above the norm for women of her generation. There is a possibly apocryphal story that James Polk asked his mentor and fellow Tennessean Andrew Jackson what Polk should do to further his political career. After Jackson had advised the younger man to find a wife and settle down, Polk asked his mentor who Jackson had in mind. He responded, “The one who will never give you any trouble. Her wealthy family, education, health, and appearance are all superior. You know her well.”40 Sarah Childress, born September 4, 1803, married aspiring politician James Knox Polk, nearly eight years her senior, in 1824. Together they formed a successful and intimate social and political union that dissolved only with James’s death from cholera in 1849, twenty-five years later.41 The Polks’ political partnership was continuous and successful, he emerging from Tennessee state legislative office to the United States House of Representatives, 1825–1839, where he held the position of Speaker, then rising to the governorship of Tennessee in 1839, and culminating in his election as the eleventh president of the United States in 1840.42

  However, the Polks’ bond was an infertile one, speculatively the consequence of a ghastly surgical procedure performed upon young Polk just shy of his seventeenth birthday. James was frail and in chronic poor health as a teenager. Urinary bladder stones were deemed to be the cause of his physical problems. Sam Polk, his father, decided that a surgical cure was required to ensure a robust manhood for his son. The Polks commenced an eight-hundred-mile journey from Tennessee to Philadelphia where the eminent surgeon Philip Syng Physick would operate. This will not be this good doctor’s final appearance in this narrative. However, violent spasms of pain interrupted the Polks’ odyssey and James was urgently placed into the surgical hands of Dr. Ephraim McDowell of Danville, Kentucky. Using brandy as an anesthetic, the surgeon “made an incision behind the young man’s scrotum and forced a sharp, pointed instrument called a gorget through his prostate and into the bladder. The stone was removed with forceps.” It is no surprise, then, that the Polk union was without progeny.43

  Malaria

  Sarah Polk’s life prior to the White House was a healthy one. The single exception was a severe case of measles she suffered in the fall of 1828.44

  Bumgarner, in his biography of Sarah Polk, described the capital’s summer political hiatus when James Polk was a congressman: “In Polk’s time Washington was deserted by the politicians and the affluent during the warm season, when they fled to the mountains and the seashore to escape the heat. The south side of the president’s mansion overlooked the Potomac and a canal laden with malaria-carrying mosquitoes. Quinine was available, but there was a high incidence of malaria among those who stayed in the capital in the hot season and exposed themselves to infection.” Sarah and James Polk always took advantage of this interlude to return home to Tennessee.45 However, when they were president and first lady, the Polks never traveled far from the capital and spent their 1845–1848 summers vulnerable to the pestilence of the District of Columbia. Their dedication to their civic responsibilities was rewarded with episodes of malaria: In May and again in September–October 1847 in the case of Sarah, and in late September 1847 and June 1848 in the case of James.

  The diary of President Polk from April 30 to May 8, 1847, recorded a classical textbook description of an attack of tertian malaria (plasmodium vivax), the species endemic to the Washington swamp. His entry for April 30 read: “She [Sarah] had slight symptoms of a chill Friday last, which had not attracted much attention as she had casually mentioned it, but had not complained of much indisposition of it.” However, two days later, on May 2, his entry was more alarming: “When Mrs. Polk returned from Church she complained of being very cold, and it was manifest she had a chill, and a short time later a reaction took place and she had a fever.” Both
she and the president remained in bed for the rest of the day. Predictably the symptoms of periodic chills and fever resumed two days later on Tuesday, May 4. Polk recorded it in his diary: “I soon discovered she had a chill and threw more covering on the bed. Her chill continued for more than three hours. I have never seen her suffer or complain more than she did for several hours. After the chill subsided, the fever rose.” Again, characteristically, Sarah was much better the next day. However, on the succeeding day, Thursday, May 6, the chills and fever diagnostic of “intermittent fever,” which are now recognized as tertian malaria, returned. A violent chill shook her, leaving her sick all day. Two days later the anticipated symptoms did not appear. Sarah commented, “Well, I guess I am getting better because I did not have my usual chill this morning. This has certainly been a severe attack of intermittent fever.”46 Mrs. Polk underwent a second bout of malaria during late September to mid October 1847. Polk’s diary recounted “she had another chill and suffered much and rested badly during the night and day.” During this period one of the president’s malarial episodes coincided with his wife’s.47

  Sarah Polk’s position as first lady attracted the best medical care then available. Two of the most prestigious physicians in practice in Washington attended her during her illnesses. Doctors James Crowdhill Hall and Thomas Miller also treated her husband. Hall and Miller were “Pillars of the Profession,” two of an elite group of Washington physicians whose patients included presidents of the United States, among other notables. In Hall’s case, he cared for five presidents; Miller was the physician to three. Dr. Hall holds the ghoulish distinction of attending at the deathbed of three presidents: Harrison, Taylor and Lincoln. Although James Polk was successful in escaping becoming president number four on Hall’s mortality list, the former president died from cholera in Nashville three months after the conclusion of his presidency.48