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

by Deppisch, Ludwig M. , M. D.

  The First Stroke

  For the first time in her life Pat Nixon was confronted by her own major medical problem. On July 7, 1976, at the Nixons’ retirement home in San Clemente, California, she was felled by a significant stroke.

  Richard Nixon resigned the presidency in August 1974, and the Nixons moved to their California seaside retreat. But they could not escape the fallout from the Watergate political scandal. Washington Post news reporters Bob Woodward and Carl Bernstein, perhaps wishing to embellish a fame-enhancing narrative, wrote a follow-up Watergate tell-all, titled The Final Days. The book, employing no documented sources and surmising “what might have been” conversations and internal thoughts, finally appeared in print in the early summer of 1976 after several months of a prepublication advertising blitz. The book portrayed the former first lady as an alcoholic and the Nixon marriage as loveless and close to collapse.53

  On the morning of July 7, 1976, against her husband’s wishes, Pat Nixon read part of the book, which had been borrowed from one of Nixon’s secretaries. Adding to her stress, Nixon had just informed his wife that New York State was about to disbar him from the practice of law. An afternoon of housecleaning added to her exhaustion. After a swim with her husband, son-in-law David and daughter Julie, Mrs. Nixon fell asleep without undressing and woke up fatigued. She recalled that she could hardly walk. At breakfast the following morning, the ex-president noted that his wife had developed left hand paresis and weakness of the left side of her mouth. Nixon immediately called Jack Lungren, the family physician, who arranged for the chief of medicine of nearly Camp Pendleton to examine Mrs. Nixon at their home. The physician diagnosed a “tiny stroke” and dispatched her by ambulance to Long Beach Memorial Hospital, fifty-four miles away.54 Dr. Lungren admitted Mrs. Nixon with a diagnosis of cerebral hemorrhage secondary to vascular hypertension. Her blood pressure was elevated to 175/100. The physical findings were generalized weakness of the left arm and leg and slurring of speech. The brain hemorrhage was localized to the brain’s right cerebral cortex.55

  Lungren quickly reduced the blood pressure to normal and promptly asked neurologist Doctor John Mosier to monitor her recovery. Physical exercises commenced first at the bedside and later in the hospital’s rehabilitation unit. Dr. Bernard J. Michela, the hospital’s director of rehabilitation medicine, placed Pat on a twice-daily physical treatment consisting primarily of walking and standing exercises. Julie Eisenhower underscored her mother’s stoicism during her illness: “She wanted no sympathy and no witnesses to the struggle.” Pat Nixon walked six days after the stroke and was discharged after two weeks in the hospital. An around-the-clock private nurse was hired for her first weeks at home. However, in October, three and one-half months later, Mrs. Nixon became dismayed by her slow progress.56

  At the time of the CVA, Mrs. Nixon was apparently in good health and was not taking any prescribed therapy. There was no past history of hypertension. However, “Dr. Lungren indicated today that Mrs. Nixon, by nature, had sought very little medical attention and had not had a physical checkup in the nearly two years since the Nixons left the White House. Since her examination for hypertension came at the beginning of this period, the possibility that she developed some form of the condition in recent months could not be completely ruled out.”57

  Lt. Colonel John Brennan, the ex-president’s aide, speculated in an interview that “Mrs. Pat Nixon was reading Woodward and Bernstein’s The Final Days, with its negative depiction of her character, on the June day when she suffered a stroke…. After Watergate she was in great health—she believed in her husband…. But on the day of her stroke her blood pressure was incredibly high…. I don’t know if this was the cause, but she had been reading the book.”58 When Mrs. Nixon was hospitalized, a newspaper editorial sympathized: “No one knows how much such efforts [fulfilling the difficult role of wife to a public official] have cost her emotionally, although her physician has said that pressures in her life ‘certainly could have been a contributing factor’ in the stroke.”59

  In a hospital conversation with Lungren Richard Nixon left no doubt about whom to blame: “[T]wo days before the stroke, Pat was reading The Final Days … Pat was extremely upset over the sections where Woodward and Bernstein portrayed us as demented alcoholics and our marriage as loveless—pure, unadulterated lies.”60

  Second Stroke and Death

  After her first stroke, Pat Nixon’s health was good. Her husband elaborated in a 1982 interview: “She doesn’t quite have the stamina she used to have and she doesn’t like to go on faraway trips. But other than a slight, almost unnoticeable problem with her left arm, she’s fine.” But she suffered a second stroke in 1983, which was reported only upon her return to the Nixons’ Saddle River, New Jersey, home. Her stroke was mild and she was released from New York Hospital after only five days. There was neither paralysis nor difficulty in speaking.61

  Pulmonary problems, probably cigarette-related, troubled Pat Nixon during her last decade of life—pneumonia, bronchitis, emphysema, and, finally, cancer of the lung. She died in June 1993, at age eighty-one.62

  In Summation

  Two first ladies smoked and suffered its consequences. Both first ladies were struck by significant cerebrovascular accidents. Nellie was incapacitated just two and a half months into her husband’s term. Her resulting motor disability disappeared rapidly, but she was also struck with apraxia, an inability to speak. She slowly improved but her grand plans for serving as the hostess in the executive mansion dissipated. A second, similar but milder, cerebral accident occurred two years later. She also recovered from this event. She died in her eighty-second year.

  Pat Nixon had a right cerebral hemorrhage in 1976 that weakened the left side of her body. She recovered only with persistence and prolonged physical therapy. A second stroke occurred in 1983. This was followed by emphysema and lung cancer, and she died from the latter in 1993 at eighty-one.

  Chapter Ten

  Ellen and Edith

  Woodrow Wilson’s Two Wives

  Ellen Wilson made a deathbed request to Cary Grayson, the White House physician: “Doctor, if I go away, promise me that you will take good care of my husband.”1

  Introduction

  Ellen Axson Wilson was the third and, up to the present, the last first lady to perish in the White House. Chronic kidney disease afflicted her during her brief seventeen months as the wife of a president. She was the first of two wives of President Woodrow Wilson. Wilson’s second wife, Edith Bolling Gault Wilson, would become a very controversial political actor who would expand the authority and power of the first lady beyond anything experienced either before or since.

  Ellen Wilson organized the late November 1913 wedding of Jesse, the middle Wilson daughter. It was an extravagant formal affair that took place in the East Room of the White House. The Marine band played and the entire diplomatic corps, many members of Congress, together with Wilson friends and family attended. The guest list totaled five hundred.2 However, Ellen’s disease was never absent. Out of concern for his wife’s health president Wilson cancelled the 1913 inaugural ball. Moreover, plans for the White House wedding of Eleanor, their youngest daughter, were left indefinite. Eleanor eventually married secretary of the treasury William McAdoo in a more restrained ceremony in May 1914.3

  Ellen Wilson was one of the first first ladies to adopt a significant philanthropic project. Her cause was the improvement of the terrible living conditions in the Washington slums, called the Alleys. Initially she was tireless, frequently visiting the Alleys, “often taking groups of Congressman with her. She talked to the people, helped them with food and money, held numerous conferences, and insisted with her own peculiar gentle firmness that something had to be done at once.” However, her illness intervened and she was forced to abandon her crusade. Congress passed the Alley Clearing Act to end these slums the same day that Mrs. Wilson passed away: “No one doubted that it was she who had brought it about.”4

  Robert Watso
n classified Ellen Wilson as a partial partner, i.e., a wife who is somewhat active in politics and is both interested in and supportive of her husband’s political activities, A partial partner may assist with the president’s speeches and appointments, and may be a public force. Such a first lady actively directs the White House social activities. Watson ranked Ellen Wilson number 10 on his list of successful first ladies.5 Other historians ranked her somewhat lower (#16–#21).6

  Ellen Wilson

  There is no doubt that the first Mrs. Wilson suffered from chronic kidney disease and perished from its consequences. Contemporary medical textbooks and the language of the times called this condition Bright’s disease. Underlying causes for chronic renal failure are multiple, but in the case of Ellen Wilson it is possible that toxemia of pregnancy was its etiology. Therefore, a close inspection of her three pregnancies is merited. Woodrow and Ellen Wilson married at the end of June 1885. Daughter Margaret was born on April 16, 1886; her sibling Jesse entered the world on August 28, 1887; Eleanor, the third daughter and last child, was born on October 5, 1889.7

  The first pregnancy was difficult. The Wilsons were forced to hire a cook-housekeeper, as the expectant mother became miserably nauseated for the first four months. Letters from her cousin and aunt commiserated with Ellen’s nausea.8 A biographer explained: “Severe morning sickness, lasting all day, left Ellen feeling a wreck all winter long.”9 Margaret Wilson was born in Aunt Louisa Brown’s home in Gainesville, Georgia, and not in Bryn Mawr, Pennsylvania, where the Wilsons resided. Ellen wanted to spare her husband the expense of a northern doctor and nurse. Ever the protective spouse, she determined to shield the anxiety-prone Woodrow from any worry that he would surely experience if he was present during her labor and delivery. Her aunt had a big house and servants; the family doctor would deliver the baby for practically nothing.10

  Margaret was born prematurely, by two or three weeks. Naively expecting that her first pregnancy would conclude on the predicted due date, Mrs. Wilson reserved a passenger seat on the Washington to Georgia train timed to arrive well before her labor began. However, contractions commenced just as she arrived at her aunt’s Georgia home.11 Aunt Louisa’s family doctor and Ellen Wilson’s accoucheur fortunately turned out to be a much respected physician. Dr. George Wray Bailey had graduated 26 years earlier from the Atlanta Medical College, the predecessor of the prestigious Emory University School of Medicine. He later served as a surgeon in the Confederate army. From his rural southern practice Dr. Bailey became president of the Georgia State Board of Medical Examiners, and in 1888 the vice president of the national American Medical Association.12

  The labor and delivery were uneventful, as reported by Aunt Louisa to the new father, distant in Pennsylvania.13 The unfortunate absence of a birth weight in Aunt Louisa’s letters to Wilson does not clarify the degree of Margaret’s prematurity. Eleanor McAdoo dramatized her mother’s postpartum experience: “Childbirth in the South, in those days, was considered a very dangerous undertaking. It was said that a mother, if she was fortunate enough to survive, was apt to be an invalid for the rest of her life.” Aunt Louisa insisted that her niece remain to be cared for in her Gainesville house for a month postdelivery and Ellen complied. The new mother was bravely stoic throughout the entire affair, although the postpartum death of her own mother surely was not far from her thoughts.14

  One clinical sign of toxemia of pregnancy is swelling (edema) of the eyelids. Suggestive evidence is discovered in a letter from Dr. George Howe, Jr. to Ellen: “[I] hasten to send you a prescription for your eyes. No. 1 is to be used for the lids if they are swollen at the edges…. If the lids are swollen inflamed inside, then use No. 2.” Dr. Howe was Woodrow Wilson’s brother-in-law, the husband of his sister. His medical pedigree is uncertain since his name does not appear on any roster of accredited physicians.15

  In 1887, Ellen was again pregnant. This time caution made her travel earlier to Aunt Louise’s home in Gainesville, leaving Bryn Mawr in mid–June well in advance of an August expected date of confinement. This arrangement was repeated “because she feared that Woodrow would become upset by her condition and she did not want to interrupt his work.” Her second pregnancy was once again marked by severe nausea: “Her second pregnancy had made her more ill than the first and even she referred to it as a sickness.” Her delivery and postpartum period were uncomplicated. Although undocumented, it is very likely that Dr. Bailey was again present for the delivery. Aunt Louisa once again controlled her niece’s postpartum care and effected a long restful recovery.16

  In February 1889, in Middletown, Connecticut, Ellen discovered that she was pregnant for the third time. In the interim between his wife’s pregnancies, the ambitious Professor Wilson had relocated his growing family from Bryn Mawr to the Connecticut campus of Wesleyan University. Wilson had ascended the academic ladder to the rung labeled professor of history and political science.17 For Ellen there was a repeat of the persistent nausea, and she, recalling her two previous pregnancies, became increasingly nervous.18

  The expectant mother, “overwhelmed by the intensity of her symptoms,” sought a physician’s care. This time, the medical contact was earlier and the doctor was local. Ellen selected Dr. Mary-Florence Taft, a woman who was homeopathically trained, as her obstetrician. The basis for her choice can only be conjectured; perhaps the empathy of a female and the reputed gentleness of homeopathic doctors were the traits desired for Ellen’s third and final pregnancy. Woodrow, expressing a widely held bias, was perturbed that a female physician would attend his wife.19 During her seventh month of pregnancy, symptoms of toxemia alarmed the Wilsons. Headaches, unspecified eye trouble and dizziness combined with continued nausea compelled a visit to an unidentified New York specialist. Protein, another indicator of toxemia, was detected in her urine.20

  Ellen Axson Wilson, the first wife of Woodrow Wilson (Library of Congress).

  Professor Wilson, his prejudice about the quality of female physician care unabated, wrote his brother-in-law, the aforementioned George Howe, for an opinion on women doctors. The uncredentialed Howe responded that female practitioners possessed a significant impediment, a nervousness occurring concurrently with menstruation, which rendered them unfit for some medical emergencies that arose during that period. But otherwise, he wrote, they were competent. Wilson was reassured by his relative’s comments.21

  Mrs. Wilson was comfortable with Dr. Taft’s care. Although the pills prescribed by her were ineffective, her psychological support assisted Ellen through her third pregnancy. Dr. Mary Florence Taft was a recent medical school graduate. She received her degree from the homeopathic medical school of Boston University just three short years before she delivered the Wilson’s third daughter. The doctor possessed an eminent political surname: future president and, later, an opponent of Woodrow Wilson’s White House bid in 1912, William Howard Taft was her cousin. Several years later, Dr. Taft became a professor of gynecology at Hering College of Homeopathic Medicine in Chicago. Her academic research led to the publication of several articles on gynecologic practice. One, published in 1895, was entitled “Puerperal Eclampsia,” which indicated that Taft was familiar with at least the most severe variant of toxemia. The specifics of Taft’s care for Mrs. Wilson are not recorded.22

  Toxemia of pregnancy is marked by the onset of hypertension and a group of associated findings including edema, protein (albumin) in the urine, headache, visual disturbances, and epigastric pain. Two forms have been identified—eclampsia and the far more common preeclampsia. The convulsions of eclampsia differentiate it from preeclampsia. Eclampsia is derived from a Greek word meaning a shining forth, in reference to the sudden appearance of convulsions, as in epilepsy. Methods of measuring blood pressure were not generally available in the late nineteenth century and therefore Ellen Wilson’s blood pressure metrics are unknown.23

  The Wilsons moved to Princeton, New Jersey, in 1890, where Woodrow received a professorship at the noted university. Six years a
fter Ellen’s final pregnancy, over a period of three and one half years (autumn 1895 to early winter 1899), the future first lady was often ill with episodic nausea and vomiting, accompanied by fever and abdominal pain. The pain was localized mainly to the area of the appendix. Ellen’s enthusiasm and vitality waned, her appetite periodically vanished, and easy fatigability appeared. These symptoms occasionally forced her to her bed for days. Her medical contacts were with Dr. William Van Valzah of New York City (twice), a Dr. Wikoff, who practiced in Princeton, a Philadelphia masseuse, and possibly Dr. Edward P. Davis of Philadelphia, who was Woodrow Wilson’s Princeton University classmate.

  Dr. Van Valzah could find nothing organically wrong with the patient. He decided after several examinations that her symptoms were caused by the then diagnostic wastebasket for disorders of women—nervousness. He initially treated her abdominal symptoms with calomel for four nights and four mornings, but this toxic drug only increased her nausea. Finally, the doctor admitted that her “stomach and liver [were] misbehaving a little.”24

  William Van Valzah’s practice in New York City emphasized diseases of the gastrointestinal tract; it was for this specialized expertise that both Professor and Mrs. Wilson sought his opinion. Woodrow consulted Van Valzah in 1898 for his own chronic digestive complaints; the professor frequently used a stomach pump as an extreme measure to treat his symptoms. Dr. Van Valzah’s diagnosis and treatment were a success. He was probably the first physician who understood that Wilson’s symptoms were both psychosomatic and dietary. He removed the stomach pump and regulated the patient’s diet. The physician’s diagnosis and treatments of Mrs. Wilson were far less successful. He was correct that her gastrointestinal complaints were not a result of pathology in either her stomach or intestinal tract. His prescription of calomel was harmful, rather than beneficial. However, Van Valzah, the coauthor of the textbook Diseases of the Stomach (W.B. Saunders, 1898), was unable to relate his patient’s nausea, vomiting, abdominal pain and tiredness to kidney disease, a difficult correlation at the time. There is no record that he obtained a urinalysis.25