Elizabeth Monroe eventually overcame the early criticisms of her management of White House’s social and ceremonial affairs. Her charm, beauty and sincerity won the admiration and esteem of all, including her most severe critics. “In spite of her poor health, Mrs. Monroe still looked younger than her years and her beauty was much admired.” Although she had been ill during much of the winter, the first lady presided at the White House dinner that honored the Marquis de Lafayette upon the fiftieth anniversary of his initial visit to America. She impressed all with her remarkable beauty in spite of her sixty years.6 Ammon summarized the role of the nation’s fourth first lady: “In public, her formal manners left an impression of coldness and reserve, but in private she was a devoted wife and a doting mother, possessing to the full the domestic virtues then so highly prized—a complete absorption in the affairs of her family and household and a total detachment from the world of politics and business.”7
The only public political action undertaken by Elizabeth Monroe during her husband’s forty plus years in government service was her role in the release from a Paris prison of Madame de Lafayette, the wife of the French hero of the American Revolution. James Monroe was twice the American ambassador to France, the first time being 1793 to 1796 during the French Revolution. The aristocratic Madame de Lafayette was imprisoned under the sentence of death; her mother and her sister had already been executed. Ambassador Monroe was diplomatically constrained from any personal action to free the prisoner. However, the ambassador’s wife, Elizabeth, not shackled by similar restraints, became a willing coconspirator in the plan to free this prisoner. Mrs. Monroe boldly drove to the prison in a very elegant and conspicuous carriage to meet with Madame de Lafayette. The meeting between the two women became public knowledge almost immediately. Consequently the French government, made aware of the significance of Madame Lafayette to its American ally, freed her shortly thereafter.8
The Monroe presidency concluded in March 1825. Monroe welcomed the release from the responsibilities of office. His principal concern was that Elizabeth would regain her health in the quiet of their Virginia home. She was in such poor health that she and her husband were compelled to remain in the White House for three weeks after the inauguration of his successor, John Quincy Adams.9
Illnesses
Chronic illness or illnesses, rather than social maladroitness or a pretentious personality, prevented Elizabeth Monroe from performing successfully as a first lady. Without doubt she was sick in the White House both before and after Monroe’s presidency. Illness was chronic and persistent, and more than a single disease likely was present. Primary sources are largely silent regarding her symptoms, diagnoses, treatments, and even the identity of her physicians. Almost everything written on this subject in biographies is either inference or speculation.
James Monroe, age twenty-seven, married Elizabeth Kortright, only seventeen, in New York City’s historic Trinity Episcopal Church on February 16, 1786. Their devoted marriage produced three children: Eliza, born December 5, 1787; James Spence, born 1799 (died from pertussis on September 28, 1800); and Maria Hester, born in Paris in 1803.10 During the Monroes’ early married life, Elizabeth was healthy. James Monroe’s letters, mainly to fellow Virginians Thomas Jefferson and James Madison between 1786 and 1794, contain few references to Elizabeth’s health. There is no reference to a chronic illness. His epistolary references to Elizabeth were then, and would be later, habitually succinct.11
Rheumatoid Arthritis
Elizabeth Monroe likely was afflicted by three diseases: rheumatoid arthritis, epilepsy, and a gastrointestinal malady. The first of these is the most documented. Her health problems began during Monroe’s terms as governor of Virginia (1799–1803) when she developed “rheumatism.” Her symptoms intensified during a March 1803 transatlantic voyage to France, where her husband negotiated the Louisiana Purchase. Elizabeth was thirty-five when this journey commenced.12
The age of onset of her illness and her generalized symptoms, including fatigue, convict rheumatoid arthritis as the offender. Unfortunately the specific joints affected and a clinical description of their appearance are missing. Therefore one should conclude that all references to “rheumatism” in this patient’s medical history would in today’s parlance be rheumatoid arthritis. The first description of rheumatoid arthritis appeared in the dissertation of Augustin Jacob Landre Beauvais in 1800. However, it was not until 1890 that the diagnostic term “rheumatoid arthritis” was coined by the French physician Archibald Garrod.13
Immediately upon the conclusion of his mission to France, James Monroe was dispatched to London as American ambassador to the Court of St. James. London’s cold damp weather worsened Mrs. Monroe’s symptoms, as such weather characteristically affects patients with arthritis. The ambassador was forced to move his family to the English countryside to escape both the dampness and the city’s deleterious air quality.14
A legendary palliative for arthritic sufferers is bathing in hot springs and mineral waters. The ambassador took his wife and daughters to the fabled therapeutic waters of Bath, England in early 1806.15 A second visit to therapeutic waters is mentioned in an 1806 letter from Ambassador Monroe to his boss, secretary of state James Madison. The letter also reveals the chronicity and severity of Elizabeth’s arthritis:
The delicate state of my family’s health especially Mrs. Monroe’s who has been much affected by rheumatism, more than 13 months past … makes it necessary that she should be as little exposed as possible to moisture. It is owing to her indisposition and that of my daughter just before we left London (but who is now recovered) that we passed some time at Cheltenham, whose waters are composed of salts and steel…. These waters are a compound of sulphur and steel, and are said to be excellent in the rheumatic complaints.16
“Rheumatism” continued to vex the future first lady after the Monroes returned to America. James wrote to his Albemarle neighbor, Dr. Charles Everett, that Elizabeth Monroe is ill with rheumatism. Later, that March, the husband complained to his Albemarle County neighbor, Elizabeth Trist, that his wife was suffering from rheumatism.17
James Monroe served as a very successful secretary of state (1811–1817) during the Madison administration. Elizabeth, still in her forties, suffered constantly from rheumatoid arthritis. She often ignored the pain and was a good hostess. The wife of a secretary of state had the significant social responsibility of entertaining many of the foreign dignitaries who either resided in or visited Washington in an official capacity. Louisa Adams, Elizabeth’s successor as both the wife of secretary of state and president, was also a very good hostess. However, Louisa’s talents were similarly eclipsed as first lady, but for a different reason. When Mrs. Monroe’s pain was too great, their daughter Eliza would come from Richmond to substitute for her mother at dinners and receptions. A prominent newspaper editor of the time wrote that when Elizabeth was well, she had “an appearance of youth which would induce a stranger to suppose her age to be thirty.” In 1815, both Monroes visited the therapeutic mineral springs of Sweet Springs, White Sulfur Springs, and Warm Springs, all then in Virginia. They spent ten days at each spa and the prolonged rest proved beneficial.18
When Elizabeth was first lady, rheumatism is cited as a major factor in limiting the size of the 1818 New Year’s reception and her absence at her husband’s formal dinners during his second term.19 Controversy continues whether Elizabeth’s semiretirement as first lady was due to an illness other than rheumatoid arthritis. However, there is no disputing the fact that her disability worsened during Monroe’s second term. Her health deteriorated, leaving her infirm when Monroe began his last year in office.20
In late August 1824, an auditor in the treasury confirmed her dire condition: “Mrs. Monroe is very ill. I fear she will die. If she does, the President will not survive her long.”21
Epilepsy
Many biographers have speculated that epilepsy was a major reason for Elizabeth’s disability and inability to function as
a first lady.22 However, a strong inference and later a documentation of epilepsy are found in two letters, written by James Monroe, the first while still president, and the second in retirement. A letter dated September 1, 1824, to physician Charles Everett declared: “Since we have been in London, Mrs. Monroe has had a very serious attack of the kind to which she has been subject of late, in the head, but was recover’d from it, in a great measure, when I left her Saturday.”23
A December 29, 1826, letter to son-in-law Samuel Gourveneur is more diagnostic. It refers to a “fit,” a “convulsion” and implies that the episode was a recurrent event: “[She fell ill] shortly after I left home, of a fit, a convulsion, which was attended with the painful consequences. Occurred unattended in her room and burned herself severely by falling into the fireplace … and found her senseless, at some distance from the fire, incapable of motion. Burned herself very severely in many places. Three days before she could be restored to her senses. 250 drops of laudanum and some glasses of pure brandy, rubbed with spirit, and her feet immersed in hot spirit and water, with a portion of salt in it. She has since been rapidly recovering—her wounds are healing. She still takes fifty drops of laudanum every night.” Monroe elaborated that no physician was called but daughter Eliza, the aforementioned surrogate to the first lady, “is altogether ignorant of the disease of convulsive fits, and would wish to know how she is to act, before they come on … before, by great irritability of temper, or deep melancholy, and unhappiness of mind. Mrs. Hay thinks these fits occur once in three months.”24
Further evidence for epilepsy is theoretical and conjectural. Epilepsy is offered as an explanation as to why first lady Monroe was “alternatively in good, and then bad, condition, and sometimes unavailable for weeks at a time.”25 Biographies that suggest this diagnosis reference no other primary sources than the two letters cited above.26
A parallel conjecture argues that rheumatoid arthritis (rheumatism) by itself is insufficient to explain the secretive nature of Elizabeth’s disappearances and absences in the White House. Epilepsy, then called the “falling disease,” had emotional and mental connotations, and its diagnosis would bring both shame and embarrassment to the affected parties, especially if they were prominent. Therefore “it was natural that it was kept very private, particularly in a first Lady.”27
Medical Care of the First Lady
A third medical ailment, characterized by a congeries of digestive symptoms, was treated by Dr. Charles Everett. Dr. Charles Everett was James Monroe’s Virginia neighbor, friend, political confidante, and occasional physician. His medical care of the first couple during his two-term presidency seems to have been episodic. He was a 1795 graduate of the University of Pennsylvania School of Medicine,28 and his medical practice was based in and around Charlottesville (Albemarle County), Virginia. Proximity to Monticello and Ash Lawn-Highland exposed both Thomas Jefferson and James Monroe to Everett’s professional care. However, the doctor preferred to maintain his Virginia practice rather than move to the nation’s capital to tend to the medical needs of his famous patients.
The president and his first lady vacationed at their Albemarle County home during the summer of 1820, and on July 1 Monroe urgently requested the medical assistance of Doctor Everett, who was nearby. Elizabeth Monroe became seriously indisposed with “digestive disorders, particularly her problem with her bile…. So strong are the evidences of a disorder’d bilious affection, that we are induced if you do not forbid it, or we do not hear from you this evening, to give her 10 grains of calomel.” On July 9, Monroe wrote the doctor to thank him for bringing medicine. The identity of the medicinals and the nature of Everett’s treatment are undocumented.29
Curiously, Everett frequented the White House not in the role of a physician but as a political appointee. On December 2, 1822, the president invited Everett, then practicing in Richmond, to move to Washington to become his presidential secretary “in the station lately held by my brother, & after him, by Mr. Governeur.”30 The position paid six hundred dollars a year, and Monroe attempted to make his offer more appealing by offering a good room and other allowances. The president wished that the position were more attractive and concluded the invitation by mentioning their friendship. When Everett accepted his friend’s overture is unclear, but a letter to Everett dated November 13, 1823, encouraged the physician to return to the White House since Elizabeth “has been much indisposed.” At the time, there was no government payment for a civilian physician to serve as “White House Physician.” Perhaps the offered monies as a government employee might have eased this assignment.31
The same letter narrated the course of Mrs. Monroe’s illness, calling it a “debility of the stomach,” then “bile” and finally “erysipelas fixing on her stomach.” Weakness, frequent fevers and loss of appetite accompanied her illness. Dr. Henry Huntt, a prominent physician of the District, treated the first lady with stimulants, calomel in strong doses, quinine, tartar emetic plasters, Jennings steam bath and port wine. Most of Huntt’s prescriptions exacerbated Elizabeth’s illness and only later did the gentler remedies calm her symptoms. Monroe’s dispatch to his trusted friend can be interpreted as a plea to preserve his wife from the aggressive practices of an elite Washington doctor.32 Mrs. Monroe’s digestive complaints were chronic and episodic, but remain without a definitive diagnosis. In the nineteenth century, “bilious fever,” a bile disease with an elevated temperature, referred to intestinal disorders of any cause, malaria and typhus. What ailed this patient is highly speculative.33
After his presidency ended, Monroe’s letters frequently mentioned his wife’s illnesses, which seemed to be episodic but frequent. The only specificities, other than his 1826 letter to his son-in-law, were mentions of “influenza” and having a “fever.”34 Elizabeth Monroe died six years after leaving the White House, on September 23, 1830, likely from a pulmonary infection. She was sixty-two years old. James Monroe died in New York City less than a year later.35
Anna Harrison: The Absent First Lady
Anna Harrison, the wife of General William Henry Harrison, America’s ninth President (1841), was one of the antebellum first ladies whose tenure was inconsequential and unmemorable. In her case it was with good reason. She was an absent first lady who never visited Washington, D.C., or entered the White House. Anna Harrison was a first lady only in the literal sense, as the wife of a sitting president, but not in the geographic sense as she never resided in the executive mansion of the United States.
William Henry Harrison was elected president as the top half of the famous 1840 “Tippecanoe and Tyler Too” national ticket. At sixty-eight years of age, Harrison was the oldest incoming American president until Ronald Reagan in 1980. Harrison traveled from his North Bend, Ohio, home to Washington, and as a hardy and sturdy former military commander, proceeded to deliver a lengthy inauguration address in the outdoors and in the rain. Hatless and without an overcoat, he spoke before fifty thousand for one and a half hours. He relied on his physical well-being to shield him. It didn’t. He developed a respiratory infection that evolved into pneumonia. He died exactly one month after his inauguration, thus becoming the first president to die in office and the one with the shortest tenure.36
Anna Harrison previously had decided not to accompany her husband to Washington. She planned to travel there in May when the road conditions from North Bend to the East would be better. There is a single reference that she was too ill to accompany William’s coterie to the nation’s capital. This report may be erroneous, because she was in good health and was prepared to travel by stagecoach to Washington when news of her husband’s demise reached her. She remained at home to prepare for the president’s burial.
Anna Harrison was not enthusiastic over the prospect that William would be president and she first lady. She had opposed his running for the presidency both in 1836 and in 1840. In this she was persistent, saying, “I wish that my husband’s friends had left him where he is, happy and contented in retirement.
”37 However, disinterested as she was, Mrs. Harrison did contemplate her Washington future. She dispatched her daughter-in-law with her husband to serve as the official White House hostess until Anna’s later arrival. The daughter-in-law, Jane Irwin Harrison, was thirty-six years old and a widow.38
Anna Harrison was sixty-six in March 1841. She bore ten children, nine of whom survived to adulthood. This number of adult surviving children is a record for a first lady. (Louisa Johnson Adams was pregnant twelve times, but only four children were born alive.) It is unknown whether Mrs. Harrison suffered any miscarriages. She viewed her responsibilities as lying in—and achieved her satisfaction from—the traditional role of mother and wife and as a devoted member of her church. She lived with her children in North Bend, Ohio, when her husband was campaigning during the War of 1812; while he was In Washington serving as a United States representative and senator; and when he resided in Bogotá, Columbia, as U.S. minister.39
Anna Harrison, wife of William Henry Harrison and also the absent first lady (Library of Congress).
When Harrison was territorial governor of Indiana, Anna was a successful hostess at the territorial capital. Moreover, her health was robust enough to rear her many children and to manage her household. There is no documentation of any medical illness or any treating physician during her life. She lived until she was eighty-eight and died at North Bend. She outlived all but one of her children.
The Health of the First Ladies: Medical Histories from Martha Washington to Michelle Obama Page 7
