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

by Deppisch, Ludwig M. , M. D.

  As first lady, she wrote about the demeaning role of women in America. In her experience the then accepted role of women was akin to servitude because women functioned as sexual and domestic slaves of their husbands, who subordinated women out of their own self interest. She dissuaded her niece, who wanted to marry her son John, by writing that marriage had brought her to look forward to death “where sorrow and treachery are no more.” She also escaped by eating chocolate: “She spent a lot of time in her room gorging herself on chocolate.”67 During the winters she remained in her White House bedroom for days at a time. Louisa once confined herself for eight days and then again for five days without leaving her room. She preferred to spend the summers in Washington and refused to accompany the president, who summered in Quincy. In 1827, when John Quincy visited Massachusetts, Louisa chose to remain in the White House and rarely exchanged letters with her husband. Later she roamed the Hudson Valley and New Hampshire without him.68

  In summer 1828, Louisa finally broke under the strain and became alarmingly ill. Her symptoms were mysterious but frightening enough to bring “John Quincy and her sons rushing back to Washington from … Quincy … recovering almost as quickly once she captured the attention of her husband and family.” Louisa continued, bored, isolated, and angry, in the White House. Her husband and sons dismissed her as a hypochondriac.69

  Erysipelas erupted again in the White House. In February 1828, Louisa became quite unwell and took to her room. Dr. Henry Huntt, the family physician, gave her an emetic and bled her three times. When his treatments were ineffective, surprisingly he returned to make three house calls. Presumably he continued his regimen of bloodletting. Henry Huntt was one of Washington’s most prestigious medical practitioners and later, exhibiting no political predilection, he attended President Andrew Jackson in the White House.70

  The Adamses’ political prominence led to many perquisites that were unavailable to their fellow citizens. An important one was the availability of the best physicians of the times. Louisa was attended by Drs. Benjamin Rush, Philip Synge Physick, and, in the White House, Henry Huntt.

  The effects of the presidency upon this first lady were near ruinous. She was depressed, isolated, and suffered from many physical ailments. Did her state of being affect her husband’s presidency (which has been judged only modestly successful)? Probably not, as he didn’t communicate with her and disparaged the opinions of women.

  After the White House

  Adams was soundly defeated by Andrew Jackson in the 1828 presidential election. The Adamses’ oldest son, George Washington Adams, summoned to Washington to assist his parents’ return to Massachusetts, committed suicide instead. In August 1829, on the trip north, Louisa’s sorrow over her son’s death overcame her. In her distress, she reenacted one of her successful behaviors: midway in the journey “one of those violent attacks which she is subject to with all the family and servants up and trying to assist her in her distress. She complained of coldness about the breast.” The Adams party returned to Washington. Next morning she was fully recuperated.71

  In 1835, after son John’s death, “she again, as she had in 1825–8, worried about her sanity.” “Louisa was so troubled by life and questioning that she rode into Boston and saw Dr. Harriot Kezla Hunt. Little is known of Dr. Hunt’s impact upon Louisa, but we do know that this radical woman physician was ‘a zealous little creature’ and ‘a very peculiar individual’ who treated neurasthenic women.” Dr. Hunt was trained only by apprenticeship with an English physician. She twice was refused admittance to Harvard Medical School. She opposed heroic treatments, and instead recommended diet, exercise, and regular bathing. In addition to medicine, her passions included women’s rights and abolition.72

  Louisa Catherine Johnson Adams, then a widow, died in the District of Columbia at age seventy-seven on May 15, 1852. A stroke in April 1849 affected her ability to walk and made useless her right hand. She learned to use her left. Subsequently she suffered additional strokes and heart failure. Heavy doses of opiate made Louisa comfortable.73

  Mary Todd Lincoln

  “I owe altogether about twenty-seven thousand dollars…. I must dress in costly materials. The people scrutinize every article that I wear with critical curiosity. The very fact of having grown up in the West, subjects me to more searching observation. To keep up appearances, I must have money … no alternative but to run in debt.”74

  There exist numerous books about Mary Todd Lincoln, and innumerable biographies of Abraham Lincoln, the 16th president of the United States. A thorough review of the Lincolns’ marital relationship is far beyond the scope of this essay; instead it will focus narrowly on Mrs. Lincoln’s mental illness, its development, progression, and effect both upon her behavior as first lady and upon the performance of Mr. Lincoln as president.

  Although the severity and the time of onset of Mary Lincoln’s mental illness may be in dispute, there is no disagreement that her life was buffeted by tragedy—the premature deaths of three of her four sons; the assassination of her beloved husband; the undeserved social and political scorn aimed at her as first lady; and the alienation from her Confederate step-family that paradoxically led to suspicion that she was disloyal to the Union.

  Physical complaints and illnesses were unusual until later in her life, after the death of President Lincoln. The only previous significant complaint until then was headaches, described as migraine. Robert K. Stone, M.D., was the family physician to the first family, but any medical treatment is unrecorded. From her early twenties on, Mary Lincoln was plagued by headaches. These were occasionally debilitating; they persisted in the White House, and continued until her death. During the early afternoon of that fateful Good Friday in 1865, “despite her fear of an oncoming headache earlier in the afternoon, Mary decided to accompany her husband.”75 Eventually, in 1875, a Chicago jury declared that Mary Lincoln was insane and committed her to a sanatorium. With the author’s apologies, this episode will be examined only briefly since excellent detailed analyses of the affair have appeared in book form.76

  Mary Todd was born in Lexington, Kentucky, on December 13, 1818. Her mother died when Mary was six and a half years old and her father remarried. She was raised in a blended family of many birth and stepbrothers and a step-sister. Mary’s birth mother and step-sister died in childbirth. Mrs. Lincoln herself had four successful pregnancies, the last of which produced future gynecological problems.77

  A major traumatic event was the death of the Lincoln’s second son, Eddie, in February 1849. Eddie struggled with tuberculosis for fifty-two days before he succumbed just shy of his fourth birthday. Mary Lincoln was “consumed by her grief—and suffered severe spells of weeping and a lack of appetite.” The sorrow prostrated her and was accompanied by a refusal of water and food. Abraham Lincoln’s concern over his wife’s depression caused him to seek help. He chose Dr. James Smith, a cleric, not a physician. Smith proved to be an effective counselor and steered Mary Lincoln through a difficult period.78

  For most of the Lincolns’ years in Springfield, Illinois, Mary provided excellent political counsel to Abraham: “She kept Mr. Lincoln from making several mistakes that would have been fatal politically.” He trusted her opinion, realizing that she was an excellent judge of people, a better reader of men’s motives than himself. However, even then she was unpredictable, possessed an acerbic tongue, and exhibited unexpected rage. Gossip had it that on one occasion she chased her husband down a street with a butcher knife in her hand.79

  As First Lady

  Mary Lincoln decided on her husband’s inauguration day that she would make the White House, then dismal and in disrepair, a home befitting its role as the residence of the country’s chief executive.80 She immediately accepted the social and ceremonial responsibilities of first lady and held her first White House reception within a week of the inauguration. She presided over weekly levees on Tuesday evenings. In August 1861 she hosted four thousand guests at a reception for Prince Bonaparte, the
cousin of the emperor of France. Her role as hostess delighted her and made a favorable impression on most visitors. Early in the Lincoln presidency, Mrs. Lincoln functioned as a political partner, advising her husband, particularly on appointments.81

  But her patina of prestige quickly faded, for reasons both her fault and not. Mary Lincoln was “brutalized by her husband’s critics, the press, and Washington society on both personal and political levels unprecedented in U.S. politics. Her attire, hosting, family life, and friendships were all open to condemnation. The South criticized her for being pro–Union, and the North never truly trusted this former belle from a prominent Southern family. She was simultaneously accused of being pro–Union and pro–South, uncouth and too fancy. She was even accused of treason by the North and received a considerable amount of hate mail and death threats from the South.” It did not take long for the first lady to unloosen her vitriolic tongue.82

  Her political judgment, excellent in the past, became flawed and eccentric. She inserted herself into disputes over postmaster and West Point appointments. In addition, she wrongly advised the president regarding his cabinet selections. Regarding secretary of state William Seward, she opined, “I wish you had nothing to do with the man. He cannot be trusted.” Her negative, eccentric, and personal judgments about politicians and others often became public.83

  Shopping Mania and Debt

  Abraham Lincoln’s presidential salary of $25,000, more than five times his previous annual income, became prey in Mary Lincoln’s quest to gown herself with extravagance to match her new station. In the latter part of January 1861, Mrs. Lincoln went to New York City to shop. In what was an early manifestation of her erratic judgment, she bought expensive dress goods, silks, ornaments, necklaces and earrings. These purchases, together with the inexplicable acquisition of lace curtains for the White House, “used [her] newly acquired credit to the breaking point.” In addition, during the first six months of 1861, her seamstress and friend, freed slave Elizabeth Keckley, fashioned fifteen or sixteen new dresses for her.84

  After her son Willie died, Mary Lincoln engaged in a more destructive pattern of spending. Her shopping sprees were hidden from the president, and for four years, she continued to run up debts: “She bought the most expensive goods on credit, and, in 1864, enormous unpaid bills stared her in the face.” As a result, she counseled Lincoln to run for a second term. (In 1863, she owed $27,000, and at the time of the president’s death two years later, $70,000.) Relieved after her husband’s reelection, she continued her shopping addiction. For the second inaugural ball, she purchased a gown for $2,000 and pearl, amethyst and diamond jewelry from Washington’s Galt Brothers Jewelers for almost $3,000.85 These were enormous sums for the era.

  The Death of Willie Lincoln

  According to Emerson, the inflection point in Mary Lincoln’s mental devolution was the death of the Lincolns’ favorite son, eleven-year-old Willie. Mary, incapacitated by sorrow, remained confined to her room for weeks. The president asked Elizabeth Edwards to remain to comfort her sister. Lincoln bent over his wife and pointed to Saint Elizabeth’s mental hospital seen in the distance: “Mother, do you see that large white building on the hill yonder? Try and control your grief, or it will drive you mad, and we may have to send you there.”86

  Willie became ill in February 1862. When his illness persisted, the family physician, Doctor Robert Stone, was summoned to the White House. He proclaimed that Willie was better, that he was “in no immediate danger,” and that there was every reason for a full recovery. The diagnosis was “bilious fever,” most likely malaria. Stone’s treatment was Peruvian bark, calomel, and jalap every thirty minutes when the patient was awake. In addition, gentle blackberry cordials were provided.87 The physician’s optimism was in error—neither the first nor the last time that a presidential physician’s eminence exceeded his diagnostic or prognostic accuracy. Willie’s condition deteriorated, his breathing became labored, and he died. The cause of death was probably typhoid fever. Mary Lincoln was paralyzed: she retreated to her bed. Elizabeth Edwards, her sister, finally persuaded the distraught parent to get out of bed, dress, and attend church services.88

  In December 1863, Mary’s Southern half-sister Emilie visited the White House. Emilie “was alarmed by … wide and shining eyes during rapturous descriptions of visitations from the dead…. [She] longed to communicate with her dead son Willie—not just in spirit circles, but when he came to her chamber at bedtime.”89 Emilie reported that Mary experienced hallucinations: “[Willie] comes to me every night and stands at the foot of my bed with the same sweet, adorable smile he always had; he does not always come alone; little Eddie is sometimes with him.”90 These hallucinations were probably Mary Lincoln’s first truly psychotic symptoms.91

  In the summer after Willie’s death, Mary Lincoln sought the comfort of spiritualism, the belief that one can communicate with the spirits of the dead, especially through mediums. She visited mediums in Georgetown and invited them to the White House to conduct séances. Lincoln was skeptical, but in deference to his wife, he attended a few meetings. Mary claimed communication with her son during these sessions. A constellation of spiritualist stars of the nineteenth century became associated with Mrs. Lincoln. These included the Fox sisters, Charles J. Colchester, Nettie Colburn, Mrs. Laurie of Georgetown, and William H. Mumler of Boston. After the Lincoln assassination, Mrs. Lincoln continued to visit mediums and returned to their ministrations after her son Tad’s death in 1871.92

  Effect on the President

  After Willie’s death, Mrs. Lincoln became truly eccentric. That was a near universal assessment, by her family, by the White House staff, by official Washington, and by the country. The accepted presumption was that her presence in the president’s life placed an additional burden upon him. Her inveterate bluntness and rudeness already had earned her legions of Washington enemies and detractors. After Willie’s death President Lincoln no longer received much emotional support from his wife. She lost interest in receptions and refurbishing the White House. Her behavior became increasingly erratic: One day she seemed fine, the following day she would be angry for no apparent reason.93

  A bizarre incident occurred in late March 1865, soon after the fall of Richmond to the Union army. The first couple journeyed to Union army headquarters aboard the River Queen. Amid a military celebration, Mary Lincoln became unhinged; she gave uncontrolled vent to her emotional insecurity and overreacted to any woman’s affection for her husband. She became enraged upon learning that Mary Ord, the beautiful wife of the local commander, General Ord, rode alone with her husband. Mary, in a carriage with General Grant’s wife, demanded that the carriage stop to let her out so she could upbraid the woman. When the driver refused, the first lady grabbed his arms and physically tried to force a stop. The next day Mary’s jealous rage was unabated; in a frenzy of excitement she insulted Mrs. Ord, called her vile names, and stormed at her until Mrs. Ord began to cry. The same night before guests at dinner aboard the River Queen, Mary Lincoln “repeatedly attacked her husband for flirting with Mrs. Ord and demanded that General Ord be removed from command.”94

  In contrast to her mental health, her physical health was good while in the White House. There was a single exception. On July 2, 1863, she fell from a carriage that was transporting her from the Soldiers’ Home, their summer Washington retreat, to the White House. The driver’s seat detached from the front of the vehicle, throwing the driver to the ground. The frightened horses began a frantic gallop. The first lady leaped from the carriage to avoid disaster. A traumatic head injury was the result. Mary was “stunned, bruised and battered, but no bones were broken, and her injuries, which were immediately attended to by surgeons from the nearby hospital, did not appear serious.”95 Her head wound was stitched. Unfortunately, the wound did not heal properly and it suppurated. Her “injuries were now seen to be unambiguously grave, the blow to her head and the shock of the fall much worse than first believed.” A physician was
forced to reopen the wound and drain the pus. It took three weeks for the wound to heal.96 The accident was not without untoward side effects. Mary’s chronic migraine headaches worsened in intensity and in frequency. Fears for her sanity appeared after this episode. Her son Robert retrospectively suggested that the fall had caused mental impairment and an increasing detachment from reality.97

  On Good Friday, April 1865, a cataclysm befell Mary Lincoln. As she sat next to her husband at Ford’s Theater, a .44 caliber bullet from John Wilkes Booth’s single-shot flintlock Derringer destroyed Abraham Lincoln’s brain and subsequently extinguished his life. Mary was inconsolable, but cruel protocol compelled her to endure the funeral exercises in Washington and the fifty-four-hour journey of a funeral train from Washington to Springfield, Illinois. Otherwise she remained sequestered in her rooms in the White House for a month, a generosity extended by the incoming President Andrew Johnson. Her only companions were her two surviving sons, Robert and Tad, Elizabeth Keckley, the family physician, Dr. Robert King Stone, and a longtime friend from Springfield and Abraham Lincoln’s former physician, Dr. Anson Henry. For the remainder of April, Mary Lincoln could manage to function only minimally, with the constant assistance of Elizabeth Keckley.98

  Evaluation of Mrs. Lincoln’s Performance as First Lady

  Davidson and Connor contrasted the effects of bereavement (loss of a child) upon the presidencies of Franklin Pierce and Calvin Coolidge with that of Abraham Lincoln: “Despite Lincoln’s own history of depression, his wife’s psychiatric instability, attributable perhaps to bipolar disorder, and the fact that he was leading a country at war, Lincoln’s overall effectiveness as president was undiminished in his grief.”99

  Mrs. Lincoln’s performance as first lady has been judged harshly, albeit accurately, by historians. Watson concluded that she became a liability for President Lincoln as a result of her vanity, insecurity, impulsiveness and public outbursts of jealousy. He highlighted the Ord affair as a glaring example of the disruptions that diverted the president’s focus from important matters.100 In the ranking of first ladies, Mrs. Lincoln sits at or near the bottom. In the 1997 Watson poll, she ranked next to last, barely surpassing Anna Harrison, whose husband was in office but a month before he died. Mrs. Lincoln ranked last in the 1993 Siena Research Institute poll and at only 36 of 38 first ladies in its 2003 poll. Numbers 37 and 38 were Florence Harding and Jane Pierce respectively.101