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

by Deppisch, Ludwig M. , M. D.

  Both physicians were well trained, unlike the vast majority of “doctors” at the time. Both had an apprenticeship before attending and completing medical school. In the mid-nineteenth century most physicians’ training ceased with the completion of an apprenticeship. Formal medical school education was obtained only by a minority. Miller and Hall were graduates of the University of Pennsylvania School of Medicine and both had previously graduated from college before medical school. Both served as presidents of the District of Columbia Medical Society. Miller was the president of the District’s board of health and established the practice of recording Washington births during his tenure. Moreover, he was active in the establishment of St. Elizabeth’s Asylum and was the physician to the District’s jail.49

  Drs. Hall and Miller prescribed medicine for Mrs. Polk’s malaria, undoubtedly quinine.50 One might ask why a congressman’s wife, whose husband had spent seven terms over fourteen years in Washington as a congressman, was not stricken earlier by malaria. At the time, congressional sessions commenced in late autumn or December and adjourned before summer’s heat enveloped the capital. A review of the Polks’ travels during his congressional tenure indicates that they escaped D.C. and spent their summers in Tennessee.51 There is no evidence that either episode of malaria affected Sarah’s partnership with, and her support of, the president.

  Mrs. Polk was one of the widows who long outlived their ex-president husbands. She never remarried. She died in her Nashville, Tennessee, home in her eighty-ninth year in late summer 1891, forty-two years after the death of James.52

  Lucretia Garfield

  Overview

  Lucretia Garfield was 48 years old when her husband, James, was inaugurated as the United States’ twentieth chief executive on March 4, 1881. Their twenty-two-year marriage resulted in ten pregnancies. Five children—only one a girl—survived into adulthood.53

  James Garfield served as a U.S. Representative from Ohio between 1863 and 1880. At that time it was still the practice for congressional families to flee Washington in the summer for cooler and healthier locations: “The Garfield family … was now settling into a yearly routine of life in Washington during the Congressional season and summer vacations in Ohio, or occasionally on the Jersey coast.”54

  Malaria

  Lucretia Garfield’s May 1881 episode with malaria distinguishes her illness in the following ways: The first huddling of doctors in the practice on “VIP Medicine”; the first female physician to treat a first lady; the first doctor of the homeopathic school to render care; and widespread newspaper coverage of a president’s wife’s illness.

  In early May 1881, Mrs. Garfield was seen huddled before “a rather unseasonable wood fire” and appeared “pale but animated.” Garfield’s diary entry for May 4, 1881, recorded: “Crete has been quite ill all day with something like chill fever. She has been too hard worked during the past two months.”55 The morning after huddling before the wood fire, the chill of the previous night “turned into malaria.” Her fever spiked to 104 degrees and her pulse raced to 100 beats per minute. “Her hair fell out in patches,” and ominously “for a time it seemed as if she could not possibly live.”56

  James Garfield, as president, had the capacity to summon as many physicians as he thought necessary to cure the first lady, in this instance at least four. Included in the professional huddle were prominent Washington physician Col. Jedediah Baxter, who was also James Garfield’s doctor; Dr. Gustavus Polk, who was trained as an allopathic doctor but who treated homeopathically; and two true homeopathic doctors, Susan Edson and Silas Boynton. Fortunately for Lucretia, Thomas Jefferson’s famous maxim about group medicine did not apply in her case: “That whenever he saw three physicians together, he looked upward to discover whether there was not a turkey buzzard in the neighborhood.”57

  Homeopath doctor Susan Edson was the first female physician to practice in Washington, D.C., and the first female doctor to tend to a first lady. Edson at some undetermined time had assumed the medical care of Lucretia Garfield. Edson was a favorite of the entire Garfield family, and son Abe Garfield addressed her as “Dr. Edson, full of Med’cin.” Edson made the diagnoses of malaria and nervous exhaustion and proclaimed her prognosis that the patient would recover. But President Garfield was dissatisfied with the slow pace of his wife’s improvement and summoned his cousin, prominent homeopath Silas Boynton, from his ranch near Wichita, Kansas. Eventually all the medical consultants agreed with Edson’s original diagnosis.58 Lucretia Garfield had a predilection for homeopathic doctors. These physicians, in contrast to the doctors of the predominant orthodox or allopathic school, were considered to be more patient-friendly and to employ gentler remedies, not the bleeding and purging in vogue among orthodox practitioners. Other first ladies in the future would also seek the assistance of homeopaths for their physical ills.

  Mrs. Garfield’s illness inserted itself into the public’s awareness. On May 11, one week after the onset of the illness, Washington’s newspapers began commenting on it: “Early reports stated … [she] had fallen victim to typhoid fever; later the diagnosis was changed to typhoid-malaria. Finally it was said she suffered from malaria and nervous exhaustion.” Later, “her illness was followed across the country in headlines and editorials.”59 By mid–May her condition had improved somewhat, and on June 12, Silas Boynton declared that she was past her illness. There was a long convalescence. On June 12, still weak and thin, Lucretia was carried downstairs to attend dinner with the family for the first time since she had become ill. On June 18, she left Washington by train for the Atlantic seaside cottage at Long Branch, New Jersey. At the time, future assassin Charles Guiteau, then stalking President Garfield, was at the Washington train depot with his pistol. Later he recalled that Mrs. Garfield “looked so thin and clung so tenderly to the president’s arm, my heart failed me to part them.” The first lady wrote her husband on June 30 that her recovery was complete.

  On July 2, 1881, she was well enough to plan to travel to New York City to meet her husband. Meanwhile the president arrived at Washington’s Baltimore and Potomac depot for his train to New York. This time Charles Guiteau did not hesitate and shot Garfield twice. Mrs. Garfield hastened to Washington to care for her husband. The president lingered in pain for many weeks. Despite the ministrations of multiple physicians he died on the eightieth day after the attack. Jefferson’s foreboding epigram proved correct in the case of President Garfield’s condition.60

  The Garfields and the Effects of Lucretia’s Malaria

  Lucretia’s illness and convalescence lasted six weeks, during which Garfield refused to see anyone, not even senators. The gates of the White House were closed to visitors.61 Instead, Garfield spent much of his time beside his wife’s bed or sleeping on a nearby daybed. “I sat up with Crete until 4 hours past midnight.”62 It is questionable whether the president’s distraction significantly interfered with the performance of his responsibilities. A principal function of many 19th-century presidencies was completing patronage appointments. In the opinion of one biographer, “the president could pay only fitful attention to the last critical stages of the struggle with Conkling. Instead he devoted all his energies to nursing his wife back to health.”63 Sen. Roscoe Conkling was the political boss of New York State and a leader of the Republican faction opposed to Garfield. During May 1881, Garfield all but recused himself from participating in the intra-party feud. On the month’s last day, Lucretia’s doctors pronounced her recovered; coincidentally this was same day that Conkling resigned from the Senate and doomed his political career.64

  The District of Columbia: No Place for the Squeamish

  It was recognized early that a proximity to stagnant water or swamps was a prerequisite for the existence of malaria. Only later was it understood that these venues provided the breeding grounds for the mosquitoes that functioned as the vectors for human transmission. Draining the swamps improved the health of those in their proximity.65 Malaria flourished for centuries in the A
merican South and in port cities like Boston and New York. Swamp drainage and residential spread gradually removed malaria from the North, but Walter Reed’s 1895 study of two army posts on the Virginia side of the Potomac River showed that “intermittent and remittent” fevers were constantly present from 1871 to 1895.66 Packard described late nineteenth-century Washington: “But more than just the weather gave the city its notable unpleasantness. Washington’s water supply was not only the dirty and the polluted but represented in all its permutations a mortal threat to the health of the capital’s inhabitants. The lowest parts of the city, which unfortunately included the White House and its precincts, rose mere inches above the sluggishly tidal Potomac River, some stretches of which were lined with swamps. As the stream coursed past the District, its most troubling habit was overflowing onto lower Pennsylvania Avenue.”67

  The city’s reputation was so negative that a committee of its medical society was formed to combat the widely held belief that Washington was a very unhealthy place. The committee reported that “there has been a gradual but decided diminution in the extent and intensity of diseases of a malarial nature, owing, no doubt, to improved drainage, better paved streets, the filling of low lands, and other improvements…. Malarial diseases are almost entirely confined to those portions of the city immediately bordering on the Potomac river and its tributaries, the Eastern Branch and Rock Creek.” The timing of the society’s attempt at marketing was unfortunate, since its 1881 report was issued the same year that the country’s first lady contracted malaria in the same city.68

  Two years earlier the New York Times had reported that President Hayes arranged to be absent from the District “in order to escape the malarial atmosphere which will necessarily arise and be carried by the southerly winds across the parking to the mansion [White House] as soon as the vegetation begins decaying.” He was determined to submit legislation to Congress to have the decaying and dangerous vegetation removed.69

  As was the case of first lady Sarah Polk, Lucretia Garfield’s commitment to the White House during Washington’s malarial season made her vulnerable to its disease-carrying mosquitoes. Both received the care of the best available physicians and both recovered to lead long lives. Lucretia Garfield died March 13, 1918, in her California home after a brief bout with pneumonia. She did not remarry; her widowhood lasted almost thirty-seven years.70

  Presidents Who Contracted Malaria

  At least nine presidents contracted malaria, most of them prior to their tenure in the White House but several during their presidency. George Washington was treated for malaria with quinine in August and September 1786. His physician, Dr. James Craik, gave him eight doses of “red bark” at a time.71 Presidents James Monroe72 and James Polk were infected in the executive mansion. James Garfield’s malaria preceded that of his wife’s by many years. The young Garfield drove horses that pulled barges along Ohio’s many canals. At age sixteen, he fell many times into the canals’ miasmic waters and caught the disease.73

  Andrew Jackson was no stranger to diseases, one of which was malaria,74 and in the summer of 1835 Abraham Lincoln had chills and fever on alternate days for over a month, for which he took “heroic doses of Peruvian bark.”75 John Kennedy contracted malaria during his navy service in the South Pacific, a fact that was prominently stated in his 1960 campaign literature.76

  In 1858 Ulysses Grant gave up his attempt at farming as his “health was not good. He had what he believed to be the ague.”77 Finally, Theodore Roosevelt, during his postpresidential African safari, developed malaria’s well-recognized symptoms: “He knows this is not African malaria, but the Cuban variety that has plagued him since Rough Rider days. Always the sudden convulsions, the cracking headache, then zero at the bone.”78

  Chapter Three

  Letitia Tyler

  A First Lady Dies in the White House

  [In September 1839, Robert Tyler, son of John and Letitia Tyler, married Priscilla Cooper:] Yet the happy occasion was marred by the absence of Mrs. Tyler, who shortly before the wedding had suffered a stroke that left her partially paralyzed.1

  Letitia Tyler

  Letitia Christian Tyler, a daughter of the antebellum plantation South, fulfilled all expectations assigned her as wife, as mother, and as mistress of the Tyler homestead. Unfortunately, her exemplary success in satisfying these roles, wearying and debilitating as they were, undoubtedly diminished her ability to perform the social role as first lady of the United States. Mrs. Tyler died in the White House on September 10, 1842, at age fifty-one years and ten months and after more than twenty-one years of marriage. Her husband, John Tyler, had become president seventeen months earlier upon the death of William Henry Harrison. Mrs. Tyler was the first of three first ladies whose deathbeds were located in the presidential mansion.

  In the previous two chapters, the focus was on infectious diseases prevalent in eighteenth-and nineteenth-century America. This chapter introduces consideration of a physical state unique to women that often led to severe consequences, especially in the nineteenth century. Pregnancy was a significant maternal health risk during a period when obstetrical care was primitive by twentieth-and twenty-first-century standards. First ladies were not spared, as exemplified by Letitia Tyler (probable pregnancy-related hypertension); Louisa Johnson Adams (postpartum depression); Ida McKinley (eclampsia with cerebrovascular accident); and Ellen Wilson (probable post-eclamptic chronic renal failure).

  A “paralytic stroke” in 1839 incapacitated Letitia Tyler, and she was significantly disabled during her husband’s presidency. To what extent did her illness affect her functioning as first lady? Conversely, did her position as first lady affect the course of her disease? Moreover, was her medical care as the president’s wife comparable to that received by her husband? Did her position privilege her in the care she received in contrast to the care expected by the average male and female American in the early 1840s. Finally, did her illness affect Tyler’s functioning as president? The following discussion attempts to answer these questions.

  Medical History

  Letitia Christian married John Tyler in 1813. By 1830 she had given birth to eight children.2 John Tyler was an absentee father, his political career being nearly continuous. He was gone much of the time during his service in the Virginia house of delegates (1811–1816), the United States House of Representatives (1816–1821), as a returnee to the Virginia house (1823–1825), as governor of Virginia (1825–1827), in the United States Senate (1827–1836), and back again to the Virginia house of delegates (1838–1840) before his selection as William H. Harrison’s vice president.3

  Unlike the growing number of wives who traveled to Washington with their husbands to participate in the congressional social season, Letitia chose to accompany her husband to the District only once. She rarely traveled to Richmond when Tyler served in the Virginia legislature. (Williamsburg, Virginia, was the Tylers’ home.)4 However, when John was Virginia governor, she “presided over the governor’s mansion with charm and set a high standard for social life” in Richmond. An interview with a Richmond woman of the time appeared in the Washington Globe, and the woman recalled she was “then in perfect health and adorned with beauty.”5

  Yet Letitia was plagued by ill health for most of her marriage to John. Tyler was very concerned about his wife’s physical condition but not to the extent that he abandoned his political career. Instead the husband relied on their oldest child, Mary, to look after her sickly mother. As time passed, Mary became her mother’s caretaker: “Letitia’s health worsened with each passing year; she was ever more prone to excruciating headaches and debilitating illness as she got older. After her husband’s election to the [United States] Senate in 1827, she never seemed well.”6

  Her symptoms, other than severe headaches and a nonspecific debility, were undefined. One biographer ascribed her condition to “difficult pregnancies and the demands of a large family.” Mrs. Tyler’s condition continued to cause Tyler a great deal of unease,
and he worried about her delicate health constantly. However, he hewed to his climb up the political ladder. “He relied on Mary to look after her mother when she suffered from headaches and to keep him apprised of her condition.” Tyler purchased a large bathtub for his wife and converted their farm’s dairy to a room where she could soak in salt water for some relief: “Mary enjoined a slave to fill the tub with salt water once or twice a week, whenever her mother appeared to need treatment.”7

  In a June 16, 1832, letter to his daughter, Tyler, then a United States senator wrote to her, somewhat condescendingly: “[I am] concerned to learn from your mother that she had suffered from a severe headache the day after…. This proceeds from over anxiety on her part, aided by a predisposition to disease. Tell her that Doctor Gaither says a free use of the pills I gave her would serve to keep off those attacks, and that she would derive great benefit by using the bath.”8 The Tylers employed another tactic to fortify Letitia’s declining health. On several occasions when her health required it, Mrs. Tyler sought a respite at the Greenbrier in the (then) Virginia mountains.9 Ironically Greenbrier became the site of President Tyler’s honeymoon with his second wife, less than two years after his first wife’s demise. (The Greenbrier resort in White Sulphur Springs, West Virginia, continues as a famous vacation destination today.10)

  Stroke (Cerebrovascular Accident, CVA)

  In 1839, shortly before the wedding of the Tylers’ oldest son, Letitia suffered a stroke in Williamsburg, Virginia. Its extent was “extremely severe.” She was partially paralyzed and lost her powers of speech: “She could not express her joy in words when she heard the news of the happy outcome of her son’s courtship.” It is unclear whether she regained her ability to speak, either partially or completely. Despite medical care, “her system remained greatly shattered and her health continued evermore precarious.” It is also unclear whether she overcame the partial paralysis, but it is unambiguous that Letitia Tyler was even more physically dependent after this medical emergency.11 The identities of the treating physicians are unrecorded, as was the nature of their treatments. John Tyler, at the time a delegate to the Virginia house, should have understood the gravity of his wife’s condition, since in April 1797, when Tyler was seven, his mother died of a paralytic stroke.12