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

by Deppisch, Ludwig M. , M. D.

  Louisa Catherine Johnson Adams

  “There is something in this great, unsocial house which depresses my spirits beyond expression.”29

  Louisa Catherine Johnson, the second of seven daughters (there was one son) of a prominent American expatriate family, married John Quincy Adams, the son of a sitting American president. The wedding was at London’s All Hallows Barking parish church on July 26, 1797. Louisa was twenty-two and had lived mostly in England and briefly in France. She was to set foot for the first time on United States soil in 1801 at age twenty-six. She is the only American first lady born abroad.30

  Louisa Catherine Adams, wife of John Quincy Adams. Her White House years were marked by alienation from her husband (Library of Congress).

  Louisa Adams suffered severely from mental disease, characterized as dysthymia, chronic depression, and even hysteria. As one psychiatrist wrote after an analysis of her background: “While I am always hesitant to apply modern diagnostic terminology to historical data, I expect she would today be classified as one of the mood disorder categories, either dysthymic disorder or recurrent major depressive disorder.”31

  Family Matters

  The naïve and sheltered Louisa married into the renowned, ambitious, but morose and troubled Adams family of New England. Her father-in-law, President Adams, was bipolar. Her driven, ambitious husband, future president John Quincy Adams, suffered from chronic depression.32 Two of three sons of both the imperious Abigail Adams and the unhappy Louisa died with mental illness. John Quincy’s brother Charles died at thirty with alcoholism and chronic depression. The third brother, Thomas, was both an alcoholic and a gambling addict. Louisa’s two older sons, George Washington Adams and John Adams, died at early ages. George, at 28, was a suicide, and John, at 31, was a chronically depressed alcoholic. It should be noted on Louisa’s behalf that sons George and John Adams were taken from Louisa in 1809 when she went to Russia. For more than six of their formative years both were under the care of her mother-in-law, Abigail, and Abigail’s sister, Mary Cranch.33

  Many years later, reflecting upon her marriage in Adventures of a Nobody, Louisa wrote with regret: “I was two and twenty, accustomed to live in luxury without display, and too much beloved by my family for my good.” She rebuked herself: “The faults of my character have never been corrected. owing to a happy, but also visionary education: which have made the disgusting realities of a heartless political life, a source of perpetual disappointment.” As John Quincy Adams’ wife, her nervous system often in turmoil, she blamed herself for the consequent emotional distress that ensnared both Louisa and her husband. She concluded that John Quincy would have been happier had he “not harnessed himself with a Wife altogether so unsuited to his peculiar character.” These quotes hint at her physical reaction to stress, considered to be “hysterical” or psychosomatic. It also captures her feeling of inferiority to her husband.34 Joan Ridder Challinor’s doctoral dissertation, “Louise Catherine Johnson Adams,” probed Louisa’s ambivalent feelings: “The great affection and gratitude she felt because her husband had married her, and her appreciation for his great probity and high-mindedness, constantly warred with the tremendous anger he roused in her by his remote and distant personality.” Louisa complained about her husband’s self-centeredness and misogyny, opining how utterly tangential were women in his scheme of things: “Mr. Adams has always accustomed me to believe that Women had nothing to do with politics.”35

  The marriage of Louisa Catherine Johnson to John Quincy Adams, although it endured for more than fifty years until his death in 1848, was extremely painful for Louisa. It was a marriage of two dissimilar persons and was dysfunctional more often than functional. Mr. Adams’ frequent calls to duty by his country were not matched by more mundane calls to be a devoted husband and an understanding father. A very difficult and insensitive man,36 aloof from his wife, he either ignored or didn’t ask her opinion regarding his major career moves. His acceptance in 1809 of the ambassadorship to the court of the Russian czar was a shock to his wife. Later, Adams’ postpresidential election to the House of Representatives in 1830 appalled both Louisa and their surviving son, Charles.37

  Foreign Affairs

  Subsequent to their London marriage, the Adamses relocated almost immediately to the unfamiliarity of Berlin, where he served as ambassador to Prussia for four years. The succeeding nine years, spent in America, were chaotic, with many trips between Philadelphia, Washington, and Massachusetts as John Quincy pursued opportunities in the practice of the law and in the United States Senate.38 “Louisa was … small and quite attractive. Dark-haired, bright-eyed and vivacious, she proved to be an outstanding hostess,” not only in the Monroe administration, but also as an ambassador’s wife in Berlin, Saint Petersburg, and London.39 During John’s tenure as President James Monroe’s secretary of state, “John and Louisa were being applauded as hosts of some of the most successful social events in the town’s memory…. The couple’s victory was due mainly to Louisa’s skill in planning entertainment.”40 She took great pleasure in reading and writing and loved to add spice through storytelling. Moreover, she played both the piano and the harp and was an excellent singer.41

  In 1809, Louisa accompanied her husband to Saint Petersburg on another European assignment. John Quincy was appointed American minister to the court of the Russian czar, in Saint Petersburg. Mrs. Adams was pressured to leave her two older sons to be educated in America, and was allowed to take her only remaining child, two-year-old Charles Francis, with her.42 She vividly recollected her departure in Adventures of a Nobody: “The day the news arrived of Mr. Adams’ appointment … I had been so grossly deceived, every apprehension lulled—and now to come on me with such a shock! … Every preparation was made without the slightest consultation with me and even the disposal of my Children and my Sister was fixed without my knowledge until it was too late to change…. I having been taken to Quincy to see my two boys and not being permitted to speak to the old gentleman alone lest I should excite his pity and he allow me to take my two boys with me—In this agony of agonies! can ambition repay such sacrifice never!! and from that hour to the end of time life to me…. Adieu to America.”43

  During her nearly six years in Russia, the future first lady was depressed and self-accusatory and entertained suicidal thoughts, especially after their baby daughter, her namesake, Louisa Catherine, barely thirteen months old, died. Louisa “at times wished obsessively and overwhelmingly to die and be buried next to her child.”44 Louisa’s Russian interlude ended in triumph with a forty-day, several-thousand-mile coach journey to Paris in the winter of 1815. Louisa had been summoned to rejoin John Quincy in Paris where he had successfully concluded the treaty that ended the War of 1812. Michael O’ Brien’s Mrs. Adams in Winter vividly chronicles her adventure. She was accompanied only by Charles Francis, just seven, a French-speaking maid, and two men, one a prisoner of war who was being repatriated to his native France, the second a servant. On the way, her expert French was instrumental in protecting her party from a boisterous group of French veterans who were on their way to Paris to welcome Napoleon’s return from exile.45

  John Quincy Adams served successfully as ambassador to Great Britain before his recall to the United States to become secretary of state in President James Monroe’s cabinet. The two years in London (1815–1817) may have been the happiest of Louisa’s marriage. A transatlantic journey had reunited Louisa’s two older sons with her in 1815. From her arrival in Philadelphia (1801) to her departure from Saint Petersburg (1815)—almost 14 years—Mrs. Adams lived as a family with her husband and children for little more than a third of the time. She was with her husband but not all of her children for nearly half the time, and with her children but not her husband a tenth of the time. For three months she was alone, with neither children nor husband with her.46

  As the American ambassador’s wife in her native London (1815–1817), Louisa was “in better health than at any point in her life.” Her happine
ss ended upon her return to the United States. She correctly feared that her husband would again immerse himself in his duties, this time as secretary of state. The marital change resulted in what the family called “fainting fits”—protestations of illness and weakness with concomitant crying: “These neurotic indispositions became Louisa’s refuge…. After 1817 began a twelve-year period during which she held little importance in her husband’s life and had few ways of helping him.”47

  Pregnancy and Illness

  In her first thirteen years of marriage Louisa was pregnant eleven times. Her twelfth and final pregnancy occurred in 1817 when she was 42 years old. It terminated in a traumatic miscarriage in the middle of the Atlantic Ocean as the Adamses returned to the United States. In the aptly titled Cannibals of the Heart—Jack Shepherd’s examination of this marriage—Shepherd concluded: “[T]welve pregnancies created tension between her and John Quincy, and explain her chronic difficulties and pain.”48 In the early 1800s, the possibility of obstetrical death was significant, a fact surely known by Louisa. Perhaps her mother’s successful eight pregnancies provided some comfort. However, her knowledge of English history would recall that King Henry VIII’s mother and two of his wives, Jane Seymour and Catherine Parr, died very soon after childbirth.49

  In the spring of 1817, she was pregnant for the twelfth and last time. This pregnancy was both difficult and painful. Her London physician applied the remedies of the time—bleeding and leeches (see Jane Pierce), and warned that she would die if she undertook an ocean voyage. Nevertheless, she decided to accompany her husband and her three sons to America. The voyage was nearly catastrophic; her habitual seasickness contributed to yet another miscarriage. Louisa became so ill postpartum that she feared she was dying. Louisa was fortunate that Dr. Tillary, an eminent New York physician, was a fellow passenger. He bled her and prescribed laudanum.50

  Six years earlier, in March 1811, Louisa was pregnant. John Quincy Adams had been unanimously confirmed by the Senate as an associate justice of the Supreme Court. His parents urged acceptance. But this time, Adams avoided a hazardous ocean journey for his wife and declined the appointment.51 Louisa’s pregnancies were always problematical, beginning with her first miscarriage in Berlin: “My husband’s time was entirely occupied by his publick avocation. My nurse and one of my Physicians did not speak a word that I could understand, but I was fortunate in having the attendance of Dr. Brown, an Englishman and the then Queens Physician, who bestowed fatherly care and restored me to life.” The expectant father was frequently absent during her deliveries. After Louisa suffered four miscarriages, a Berlin midwife was employed to support the birth of George Washington Adams in 1801. The midwife, however, was drunk; her physical technique was so rough that Louisa almost died. For five weeks her left leg was paralyzed and she could walk only with assistance.52

  Louisa discovered in her childhood that illness brought her the attention she craved, a technique she employed throughout her adult life. During her marriage, migraine headaches and fainting spells were frequent.53 While in Massachusetts during the interval between her husband’s diplomatic missions abroad, she suffered from hysterics, with violent cramps, fainting spells, headaches, and crippling pain in her hands. The latter was treated with laudanum poultices. She also ingested laudanum to compose her nerves both during this period and when she lived in Russia.54

  On a November 1801 trip from Washington to Massachusetts, Mrs. Adams was afflicted with a severe cough and baby George with acute diarrhea. An impatient John Quincy had to make stops in Philadelphia and New York so the patients could be treated. In Philadelphia, Dr. Benjamin Rush examined Louisa and accurately concluded: “She is under great apprehensions and still more depressed in her spirits than really ill.”55

  Laudanum—discovered by the Swiss-German alchemist Paracelsus in the sixteenth century and popularized by the eminent English physician Thomas Sydenham in the late seventeenth century—was an alcoholic herbal preparation containing approximately 10 percent powdered opium by weight. Synonymous with “tincture of opium,” laudanum was used widely in England and in the United States until the twentieth century. Its original uses were as a cough suppressant, a diarrhea cure, and a pain reliever. Eventually its medical indications widened and laudanum was issued principally to produce sleep and to allay anxiety. Mrs. Adams imbibed laudanum for the latter reasons. Although the principal complications of chronic usage are drug tolerance or addiction, there is no evidence for either in Louisa’s case. (However, speculation abounds that Mary Todd Lincoln, a chronic and persistent user of the drug both during and after the White House, may have become addicted.)56

  Commencing in April 1810 and continuing through her years in the White House, Louisa Adams contracted erysipelas, a definitive organic (and not a suspect psychological) disease. Its symptoms were ear pain, deafness, fever, lassitude, and headaches. A painful, very red, and warm swelling affected the face, especially the cheeks and bridge of the nose. It may produce disfigurement. The characteristic appearance of the disease has been recognized since ancient times. Her treatment was brutal—the application of blisters to her head. During the summer of 1824, in the midst of John Quincy Adams’ campaign for the presidency, Louisa fled Washington for the mineral waters near Bedford, Pennsylvania. It is not clear whether her month-long stay trying this all-purpose curative was successful. Streptococcus infection is now recognized as the cause of erysipelas and penicillin is its treatment. Unfortunately for Louisa, she was born a hundred years too early.57

  In the 1821–2 winter the unlucky Louisa was miserable with another condition—painful hemorrhoids. Coincidentally her brother Thomas Johnson suffered from the same condition. He traveled to Washington to seek Louisa’s advice since she and John Quincy knew some of the best doctors in America. That June Louisa and Thomas visited Philip Syng Physick in Philadelphia. Physick, like his mentor Benjamin Rush, makes several appearances in this story. “America’s most respected and eccentric surgeon. Physick assured Louisa that he had never killed a patient in such an operation.”58

  Physick eventually operated—and then reoperated—on Thomas. Later Physick performed Louisa’s hemorrhoidectomy at Mrs. Pardon’s rooming house dressed, “as he always did for surgery, in his dark blue coat with bright metal buttons, white vest … and light gray pantaloons.” A graphic description of the operation may be read in Shepherd’s Cannibals of the Heart. The results of these operations, despite their occurrence in the preantiseptic and preanesthetic era, were successful. Louisa wrote in January 23, 1823: “My health is uncommonly good.”59 Mrs. Adams was also appreciative of the doctor who advised “her that sleeping with a husband who insisted on keeping the windows open was what caused most of her illnesses.”60

  When her husband was secretary of state (1817–1824), “Louisa’s drawing room became a central area that notables utilized. Louisa loved beautiful music.” The Adamses’ residence was a “social center when John Quincy was Secretary of State … wonderful hostess reputation … music recitals and theater parties.” Louisa’s success as a hostess was not only social, but also, of more consequence, political: “John Quincy could never have become president without Louisa Catherine’s efforts as campaign manager. Louisa Catherine launched what she called ‘my campaign’ with the political savvy she had developed during a twenty-year career in European courts.”61

  As First Lady

  Louisa Adams was a depressed first lady. The contrast between her social involvement as wife of the secretary of state and that of the president was stark and harmful. She was sidelined. As the wife of the secretary of state, Louisa frequently charmed guests with her song and her accompaniment on the piano or harp. After becoming first lady, John Quincy Adams asked her to stop performing. She complied and practiced alone in the evenings, composing music and playing her harp.62

  The absence of her children, public suspicion of her foreign birth, and limitations upon her previous social contributions made Louisa more miserable and increasi
ngly reclusive.63 John Quincy was neither completely obtuse nor totally untroubled by his wife’s persistent unhappiness. In 1813, he suggested that she read Benjamin Rush’s Diseases of the Mind. The result was the opposite of his intention. In Louisa’s words, “I have read it through although I confess it produced a very powerful effect upon my feelings and occasion’d sensations of a very painful kind. Since the loss of my darling babe I am sensible of a great change in my character and I often involuntarily question myself as to the perfect sanity of my mind in this state of spirits a person is apt to fancy himself afflicted with every particular symptom described … cast a heavy gloom over me which I much fear nothing will ever correct. In vain I struggle against it. Life has become so barren.”64

  Over a decade later Adams tried again. He consulted an unnamed (presumably his wife’s) physician. The doctor, fortunately for him still anonymous, employed with assurance a stereotypically gendered diagnosis. Louisa was a woman who suffered from the “peculiarities of the female anatomy.” It was not a dangerous condition, but it resulted in “an excited state from time to time.” He implied that his patient suffered from hysteria, a now-discredited diagnosis applied exclusively to women. (“Hysteria” is derived from the Greek “hysteros” referring to the uterus.)65

  The first family lived quietly in the White House and seldom went out. The first lady declined invitations to outside events and limited her entertaining. But Louisa did not entirely shun her ceremonial and social duties. During the season she gave dinners once a week, fortnightly levees, and an occasional ball, plus the traditional New Year’s Ball.66 Deprived of substantial ceremonial, and even of an insubstantial, political, role, how did she bide her time?