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

by Deppisch, Ludwig M. , M. D.

  Tuberculosis and Other First Ladies

  The White Plague infected two other 19th-century first ladies, Jane Pierce and Eliza Johnson. Mrs. Pierce was chronically unwell and there were suggestions that tuberculosis was the underlying cause. A definite diagnosis was made only in 1857; the Pierces spent the last six years of her life in travel to balmy foreign destinations in a vain quest for a cure.38

  Eliza Johnson was the wife of Andrew Johnson, who succeeded to the presidency (1865–1869) upon the assassination of Abraham Lincoln. Mrs. Johnson, pregnant with their fifth child, “developed a condition known in those days as ‘consumption.’ Today we would call it tuberculosis…. Eliza probably first noticed that she was coughing a great deal and feeling more tired than usual. She sometimes had a slight fever.” She was forty-two years of age. A chronic persistent cough, sometimes with a bloody sputum, continued to weaken her. She tried to avoid Washington while her husband served there as a senator representing Tennessee, as “she believed that she was more likely to recover in the fresh mountain air of Tennessee.”39

  As first lady, the ill Eliza spent most of her time in her room, where she read, embroidered, sewed and knitted. She almost entirely relinquished her social and ceremonial responsibilities; her daughter, Martha Johnson, was the official White House hostess. Eliza’s illness continued after the Johnsons left the White House, and she died in January 1876 at age 65.40 (Almost a century later, in 1962, former first lady Eleanor Roosevelt developed a strange disease whose prominent features were severe anemia and a fever of unknown origin. Although suspected pre-mortem, it was only at autopsy that a diagnosis of “disseminated tuberculosis acutissima,” involving the lungs, liver, kidneys, brain, and bone marrow was made. Mrs. Roosevelt was seventy-eight years old.)41

  Part II: The Twentieth Century

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  Chapter Eight

  Ida McKinley and the Audition of the First White House Physician

  Her world was dimmed by bromides, a medicine prescribed to prevent the dreaded grand mal seizures, whose side effects left her with dulled wits, skin rashes, headaches and the ever-ready petit mal seizures1

  Navy Physician Presley Rixey Becomes the First White House Physician

  Navy Captain Dr. Presley Marion Rixey was assigned to the Washington, D.C., Naval Dispensary. Out of necessity, the doctor supplemented his meager pay as a military physician by active moonlighting among the capital’s civilian elite. Secretary of the navy John D. Long and his family were patients of Dr. Rixey. In autumn of 1898 Secretary Long and his daughter were scheduled to accompany President William McKinley and the first lady on a trip to Atlanta, Georgia. The young daughter of Secretary Long had recently been ill. Self-interest directed Long to ask the president whether a physician would accompany the presidential party: “Upon consideration, the President expressed himself as also of the opinion that it would be desirable for many reasons to identify a medical man with the party, and having no one in mind himself asked Mr. Long to suggest some doctor.” Long’s choice of Dr. Rixey was no surprise.2

  Shortly thereafter, during a chance meeting between President McKinley and Doctor Rixey, the president inquired why the doctor had not accompanied the McKinleys on a trip to New York City the previous week. When Rixey responded that he had not received the required travel orders, “the president informed the physician that he wanted him to be his attending physician and also take care of Mrs. McKinley who had been an invalid for many years.”3 President McKinley’s solicitude for his wife, Ida, was due to her long and unpredictable history of epilepsy.

  Thus the serendipity of a substandard navy salary was combined with a presidential wife’s need for frequent medical attention to establish the position of White House Physician. Previously the presence of a physician at the White House had been both irregular and transient except in cases of acute emergencies caused either by a dire infection or by an assassin’s bullet. In contrast Rixey made regularly scheduled visits to the White House and became a customary member of the presidential party on the first couple’s travels and vacations. Although this title had been conferred upon previous doctors who had attended the president,4 it was Dr. Rixey who first fulfilled the responsibilities of the position as we recognize it today. A result of Rixey’s regular attendance was his establishment of dedicated medical treatment space in the executive mansion.5 The doctor acknowledged that the medical care of the president and first lady was his primary professional responsibility: “As to the White House physician, he must always sink his own interests in that of the health of the President and of his personal and official families. In other words, his desires, pleasures, and all other duties must be subordinated and devoted to this special service.”6

  Admiral Dr. Presley Rixey whom McKinley asked to provide constant care for his wife (courtesy Bureau of Medicine and Surgery Archives).

  Rixey provided the following description of his daily responsibilities: “This duty was in addition to my already large practice quite a task and comprised all that was related to the health of the inmates of the Executive Mansion, in addition to my duties as Surgeon in charge of the Naval Dispensary. My special care was the President and Mrs. McKinley. By direction of the President I made at least two visits every day, the first at 10:00 a.m., and the second at 10:00 p.m. and as many more as required…. The evening call was always in evening dress, as I would find the other guests so attired … and I was expected to remain until Mrs. McKinley had retired with her maid.”7

  Ida McKinley was Rixey’s principal patient at the White House. Before McKinley’s assassination in 1901, the president was significantly ill only once. In early 1901, William McKinley developed a severe cold that evolved into influenza. McKinley was seriously ill and was confined to his bed for several days. It was another week before he was able to fully resume his work schedule. 8

  The Epilepsy of Ida McKinley

  Ida McKinley was an epileptic from the age of twenty-six. This major illness struck suddenly at the conclusion of her second pregnancy. Her difficult labor resulted in the birth of the second McKinley daughter. But, shortly after the successful parturition in 1873, a neurologic catastrophe felled the future first lady. She lost strength both in her right hand and in her right leg, the leg weakness impairing her ability to walk. The attack resulted in lifelong disability. Photographs of Mrs. McKinley from about this time invariably showed her right hand partially out of view. Concomitantly, seizures and severe headaches occurred, both of which increased in frequency and reappeared for many years. The convulsions were described as both large and small.9 Unidentified “nerve specialists” consulted at the time of onset made an outlandish diagnosis of “phlebitis,” i.e., an inflammation of the veins.

  Ida McKinley, wife of William McKinley. Epilepsy and a stroke at an early age made her extremely dependent upon her husband (Library of Congress).

  The tragedy was incomplete until five months later, when Ida, the infant daughter, died.10 Unfortunately, the McKinleys’ first born, their older daughter Katherine, died three years later at the age of five and a half. The McKinleys’ misfortune continued; Ida was never again pregnant.11 Ida McKinley had suffered a cerebrovascular accident (stroke) which caused irreversible damage of her left brain. The result was right-sided weakness, most noticeably of her right hand, and epilepsy. The epileptic attacks were frequent, occurred at irregular intervals, and of two different types. The most common form presented itself as a stiffening of the body, an alteration of consciousness, and a hissing sound. This clinical appearance is typical of petit mal epilepsy.12 In contemporary medical parlance petit mal seizures are now designated “absence seizures.” The characteristic clinical appearance is a vacant stare, the absence of motion without falling, and occasionally hand movements and small movements of both arms. The seizure lasts for only a few seconds and full recovery is almost instantaneous. Subsequent to the seizure, the patient exhibits no confusion but has no memory of the incident. Absence seizures are frequent and may occur o
ften in a single day.13

  Ida McKinley’s convulsions were not all characteristic of petit mal attacks. Some were described as “big” and “prolonged and violent,” but were neither specific nor diagnostic of grand mal epilepsy. Dr. Rixey elliptically referred to these as “other ailments.” This situation is analyzed later in this chapter.14

  DeToledo raised the possibility of toxemia of pregnancy as a significant precursor of her cerebrovascular accident. Studies have documented an increased incidence of stroke, especially hemorrhagic in type, in the six weeks after pregnancy. This corresponds with the time line of Mrs. McKinley’s attack. The predominant risk factors are severe preeclampsia and eclampsia (toxemia of pregnancy), in which the systolic blood pressure measures 160 mm mercury or above. One article insisted that these pregnant women deserved immediate and special attention, intensive care, and antihypertensive therapy to reduce the stroke risk. Unfortunately, during the 1870s, there were no methods to measure blood pressure, and even if there had been, both effective antihypertensive drugs and intensive care hospital units remained far in the future.15

  Thereafter, Ida’s health fluctuated greatly, consistent only in its inconsistency and uncertainty. “Although she was never well, she was sometimes better.” Five years after the death of her first child and her mother, Ida’s physical condition deteriorated rapidly. Her health was variable when her husband was congressman and then senator. However, she was healthy enough to care for the Hayeses’ younger children when Lucy and her husband were away from the White House. But shortly thereafter, she suffered a seizure so severe as to warrant a real fear for her life.16

  Future first lady Ida McKinley, in the public eye as the wife of U.S. representative (1877–1883, 1885–1891) and then Ohio governor (1892–1896) William McKinley, consumed large quantities of bromides to control her epilepsy.17 Sir Charles Locock in 1857 was the first to announce, at a meeting of the Royal Medical and Chirurgical Society in London, the anticonvulsant properties of potassium bromide. Incidentally, Locock was the obstetrician to Queen Victoria. In the latter half of the 19th century bromide was used on an enormous scale for the calming of convulsions and other cerebral disorders. Its use by a single hospital amounted to several tons a year.18

  During Ida’s years as first lady, bromides, barbiturates, lithium and other drugs were used to restrain her. She was difficult to control when in physical pain or experiencing a seizure. After sedation “she became milder, but her mind was duller. Apparently, she had to be sedated because of how much she insisted on appearing in public and how unsure they were of her behavior.”19 Bromide therapy had significant side effects: lethargy, somnolence, loss of appetite, clonic seizures, psychosis, acne and dermatitis. In 1912, phenobarbital was acknowledged as a better drug with which to treat epilepsy, and bromide is no longer approved by the Federal Drug Administration as an anti-epileptic.20

  Epilepsy: Not a “Politically Correct” Diagnosis

  McKinley’s diagnosis of epilepsy was not released to the public during her husband’s lifetime and newspapers avoided any hint of this diagnosis. An unctuous Los Angeles Times article was typical: “After the birth if their last child Mrs. McKinley was told that she might never be able to walk again. She was young then, and hope was buoyant, but the doctor’s prophecies were true. For over a quarter of a century Mrs. McKinley has never walked unsupported…. For an invalid she has always displayed a remarkable constitution and will power. She always traveled with the President, if it was only for a day’s journey. She has never allowed her illness to close the doors of her home to social life.”21

  William McKinley never gave a name to his wife’s illness. He was consistently taciturn about her health and responded to inquiries by politely by saying that she “was not so well,” or that she “was feeling better.” In his autobiography, Rixey mentions no specificity regarding the first lady’s chronic and acute fainting illness. It was many years later, after Ida’s death, that he revealed that she suffered from “a mild form of epilepsy.”22

  Many were the euphemisms employed by contemporaries and biographers: “a condition of semi-invalidism”; “invalidism due to an irremediable condition”; “periodic attacks”; “in danger of a collapse”; “invalid”; “delicate”; and “fainting spells.” Ida’s niece, Kate, did not suspect her to be an epileptic and was both horrified and then resentful when, in later life, she heard the diagnosis applied to her aunt. When she heard the allusion, Kate thought it a slander spread by the Democrats: “The words, epilepsy and fits were spoken only in whispers. The press, of course, could not touch the subject.”23

  Epilepsy, a disease well described in antiquity, presently afflicts an estimated 2.2 million individuals in the United States.24 For centuries, epileptics have been stigmatized as being possessed, usually by evil spirits or the devil. Epilepsy was linked to aggressive or criminal behavior, abnormal sexual history, hereditary degeneracy, and a specific “epileptic personality.” It is only in the past half-century that epileptics’ restrictions against marriage and employment have been removed. This explains the reticence about Mrs. McKinley’s diagnosis. The Monroe White House may have practiced a similar reticence.25 Rixey cooperated completely with the obfuscation: “[T]he White House Physician should clearly have it understood that he will give out nothing in regard to the health of the occupants of the White House except though the president’s secretary, and then only when it is of such importance as to demand bulletins signed by the official physician and consultants…. In this way the public, which has a right to the information, is kept advised in no uncertain way and nothing is given out that might unduly alarm or affect social or business life.”26

  Rixey’s Care for First Lady Ida McKinley

  In 1893 McKinley sent his wife to New York City for intensive medical treatment. There she was treated by Dr. J.N. Bishop, “with whose potions she was liberally dosed for years.” Bishop was an Ontario born allopathic physician who was first a teacher, then a Florida businessman, and eventually a medical student at the Long Island College of Medicine. It took him a year longer than the usual two required at that time to complete his degree since he traveled to Florida in the winters to look after his considerable business interests. His specialties were the curious combination of nervous diseases and female disorders—diseases of women.27 Bishop continued his treatment of Ida McKinley, mainly by correspondence. Her husband willingly paid his large bills because the medicine “agreed with” Ida. Bishop’s “potion” probably consisted mainly of bromide, the usual antidote for epilepsy at the time, together with various sedatives. A calm remoteness became characteristic of the first lady’s mood, but the petit mal attacks continued.28

  When Rixey assumed control of Mrs. McKinley’s care, he insisted on the formula for Bishop’s potion. It was compounded personally by the New York practitioner, who, unsurprisingly, wished to retain secrecy of its components. Rixey informed McKinley “he could not take any responsibility of a case which was being treated by administrations unknown to him.” Consequently, the desired information was obtained. The White House physician first restricted, and then ceased completely, the administration of Bishop’s compound, and Ida McKinley improved.29

  Presley Rixey quickly gained the respect and trust of the first family: “Mrs. McKinley always had a sweet smile for Dr. Rixey, and he noticed and appreciated it. The President, too, warmly approved of his treatment. For one important thing, Rixey had cut down on the bromides on which Mrs. McKinley had formerly been so dependent. He had made a special study of her case, and was tireless in his attendance. McKinley had the utmost respect in his professional judgment.”30

  Near-Catastrophic Illness in California

  After his 1900 reelection, McKinley planned a 10,581-mile transcontinental railroad tour, scheduled to begin on April 19, 1901, with a return two months later. Rixey was concerned about Mrs. McKinley’s ability to withstand such a journey, but he eventually acquiesced to the McKinleys’ wishes. All went well until the p
residential party reached the California coast, where an abscess on the first lady’s thumb led to a fever. The abscess was lanced, but dysentery followed, the fever recurred, and the patient’s condition weakened precipitously. President and Mrs. McKinley abruptly left Los Angeles by special train on May 12. Mrs. McKinley was brought to the comfortable San Francisco home of Mr. Henry Scott, who had traveled westward with the McKinleys. Her physician despaired: “I soon had my patient where we could make the best fight for her life. Her strength was going fast.”31

  The first lady’s condition deteriorated over the next three days. The distressed Rixey called to her bedside three of San Francisco’s elite physicians—Doctors Henry Gibbons, Clinton Cushing, and Joseph Hirschfelder: “More than once we almost considered our patient hopeless, but heroic efforts prevailed.” The White House physician initially released reassuring and bland statements to the press, but the consultants recognized that the first lady had developed sepsis (blood infection) from the thumb abscess. In the pre-antibiotic era, sepsis was a frightening, often fatal, diagnosis. In confirmation of the seriousness of this diagnosis, the patient’s “pulse failed and she sank into a stupor. Further medical consultation was hastily called, and heart stimulants were administered.” The president’s West Coast relatives were summoned and tentative plans for a funeral train to Washington were discussed.32 However, the patient rallied. Updates released through the Associated Press on May 17 were hopeful.33

  On May 25 the patient had recovered sufficiently to start back to the White House. Rixey was careful to assure future historians of his diligence: “I had left nothing undone to make the trip safe, a special train, two trained nurses, everything that could be needed in an emergency—even a tank of oxygen was put on board. The train was to run slow or fast or be sidetracked as the patient’s condition demanded.” He added the following: “Her condition on arriving at the White House was as good or better than when she started.”34 Rixey’s optimistic recollection is contradicted by his urgent request for expert consultation upon the McKinleys’ return to Washington. Drs. William Sternberg, Walter Reed, and William Johnson were called in to advise on the case. Sternberg, after listening to Ida’s heart and obtaining the results of blood cultures, made the diagnosis of acute bacterial endocarditis. An anonymous White House visitor pessimistically reported “Mrs. McKinley was in a very grave condition. There was hope of the outcome … but it was a very slender hope.”35