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

by Deppisch, Ludwig M. , M. D.

  Navy doctor Joel Boone treated first ladies Florence Harding and Grace Coolidge (courtesy Bureau of Medicine and Surgery Archives).

  Boone was the naval presence in the White House during three presidential administrations. He was the naval medical bridge between Admiral Cary Grayson, who served Woodrow Wilson, and Admiral Ross McIntire, who was Franklin Roosevelt’s personal physician. Dr. Boone was admitted directly into medical school after high school and graduated from the Homeopathic Hahnemann Medical College of Pennsylvania in 1913. In contrast to Sawyer, he completed a year of postgraduate training as an intern at Hahnemann. Thereupon he immediately enlisted in the U.S. Navy. After 1900, American homeopathic and orthodox physicians compromised on their differences; similarities in diagnosis, treatment and patterns of consultation emerged. As a result, Boone’s professional philosophy and practice were indistinguishable from that of a member in good standing of the American Medical Association.38

  Professional, Family and Early Medical History

  Grace Coolidge was a professional woman. At a time when it was unusual for a woman to even enter a university, whether because it was not the norm or affordable, she graduated from the University of Vermont in 1902. Furthermore she commenced upon a career of teaching the hearing impaired. After graduation she entered teacher training at Clarke School for the Deaf in Northampton, Massachusetts. She taught at Clarke for three years until her marriage to Calvin Coolidge. Her support for Clarke and the hearing impaired was lifelong and unwavering.39 Born Grace Anna Goodhue in Burlington, Vermont, on January 3, 1879, she was an only child. In adulthood Grace measured five feet four inches and had “masses of lustrous dark hair.” Her biographers credited her eyes as being her most remarkable feature, which were described as “gray-green … wide set and grave, even when her face was alight with laughter.” It was her habit to focus them with close attention on anyone she was addressing.40

  The future first lady possessed lifelong good health, with the exception of a clandestine kidney crisis while she was living in the White House and several obscure illnesses during her early years. She initially enrolled at the University of Vermont for the 1897 fall semester, but withdrew fewer than three months later because “she needed to improve her health,” and, in an opaque reference, “an oculist [eye physician] had recommended she take time off.” Biographer Isabel Ross noted that Grace “had trouble with her spine as a child but vigorous exercises had strengthened her.” Grace definitely liked long walks and made them a lifelong daily habit.41

  Marriage to Calvin Coolidge

  At age 24 Grace Goodhue married attorney and ambitious politician Calvin Coolidge in Burlington, Vermont. The groom was 32. It was a marriage notable more for its dedication to duty and responsibility than for its joy and happiness. Eleven months later John Coolidge was born; twenty months after that, Cal Jr. made his appearance.42

  Grace Coolidge’s autobiography, written many years later, contained this retrospective: “The wedding ceremony has seldom united two people of more vastly different temperaments and tastes than on the fourth of October 1905, when Mr. Coolidge and I made our marriage vows standing in the bay window in the parlor of my father’s home.”43 Coolidge biographers underscored the personality contrast: “They made an uncommon pair—the girl with the wide smile, fine eyes and friendly manner, and the spare, tight-lipped lawyer…. His mouth was his most forbidding feature—a thin slash sweeping down at the corners with a suggestion of perpetual gloom. He seemed aloof because of his remote and frosty manner, plus his declarative chopped-off statements, as sharp as exclamation points.” The groom was characterized as notable for his “shy disposition, somber demeanor, and conscientious devotion to duty.”44

  First Lady Grace Coolidge

  In 1920 Massachusetts governor Coolidge, whose political star was burnished by his successful handling of the Boston police strike, was selected as the vice presidential nominee for Warren G. Harding’s successful presidential candidacy. Coolidge was an inconspicuous vice president. Grace Coolidge gracefully bore both the traditional obscurity of her position and the hostility of first lady Florence Harding. Everything changed when Warren Harding died from a heart attack. In the early morning of August 3, 1923, Calvin Coolidge was sworn in as the nation’s 30th president by his father, a Vermont justice of the peace. The ceremony took place in John Coolidge’s remote farmhouse in Plymouth, Vermont. The quaint domicile was without a phone, central heating, electricity or indoor plumbing.45

  As first lady, Grace was underappreciated, especially by her husband, the president. The 45-year-old Mrs. Coolidge fulfilled the social, ceremonial and supportive roles of her position with great charm, poise and grace. Her personality was her strongest point; it brought spontaneity and joy to the White House. Grace had an eye for style; she became a fashion leader during the Coolidge presidency.46 One biographer summed up her White House tenure: “She was comforting and nurturing to her partner, her husband, the president. Yet she was not a presidential partner since she did not get involved in politics. In addition, her management of the White House menus and staff was often overruled by her husband. With a change in housekeepers in 1926, she had more control over the budget and her husband was pleased with the arrangements.”47 However, for a while the penurious and controlling Coolidge examined all household bills and personally initialed the payment checks.48

  Three events shaped Grace Coolidge’s experience as America’s first lady: Her near fatal kidney attack in 1928; the death of her younger son, Calvin Jr., in 1924; and the estrangement from her husband during most of his presidency.

  Kidney Disease While First Lady

  The first lady nearly perished from renal failure in early 1928. Her prominence elicited the medical services of six physicians: four consultants and the two White House physicians, Charles Coupal and Joel Boone. The professional relationship between the latter two was fractious. Although army doctor Coupal, as the President’s personal physician, was senior, navy lieutenant commander Joel Boone was a prolific and opinionated writer. His diary entries provide most of the historical narrative of this episode and form the core of the following discussion.

  On February 2, 1928, Grace Coolidge was fortified with both bromides and codeine to get her through an evening White House reception. When she left the social engagement, a physical examination revealed exhaustion and a weak but rapid pulse. The patient’s condition improved over the succeeding two days. However, on the second day Boone judiciously sought advice from two eminent private internists, Drs. Walter Bloedorn and Paul Dickens. They advised an emergency cystoscopy, a visualization of the lower urinary tract.49

  It was not until two days later, February 6, when both staff doctors, very anxious and dissatisfied with the first lady’s progress, actively considered their consultants’ previous advice. Coupal urged a referral to the prominent Johns Hopkins urologist Dr. Hugh Young. The following day, February 7, Boone traveled to Baltimore to discuss Mrs. Coolidge’s medical problem with Dr. Young. The possibility that tuberculosis was the cause of the disease was discussed. Boone brought tuberculosis to the president’s attention in a private conversation.50 Young and his assistant, Dr. W. Scott, also from Johns Hopkins, examined Grace Coolidge at the Washington Naval Hospital on February 8. Strict secrecy was the desire of Mrs. Coolidge. Therefore neither the examination nor its results were announced. Consequently Boone drove the patient to the hospital in his own car without the customary accompaniment of a Secret Service agent.51

  The president’s wife was three hours on the examination table. Young’s cystoscopic visualization and urinary tract X-rays disclosed an abnormal right kidney that was both enlarged and misplaced. Its drainage tube, the right ureter, was kinked. As a result of this blockage, the drainage system—closest to the kidney—of pelvis and calyces were swollen. As a result, the first lady was vulnerable to both uremic poisoning and a serious kidney infection. Both complications had occurred in the case of Florence Harding six years earlier. In con
trast, surgery was performed in this case: the passage of instruments with irrigation of the kidneys was a successful treatment. An X-ray of Mrs. Coolidge’s chest was negative for any disease, including tuberculosis.52

  Drs. Young and Scott subsequently retired to the secrecy of Coolidge’s private White House study, where they were joined by Boone and Coupal. Young informed the president that Mrs. Coolidge had a kidney infection. He also advised Boone to sleep at the White House in order to monitor Mrs. Coolidge’ condition. The patient’s symptoms worsened over the next two days as she suffered severe pain spasms from her diseased kidney. The frightened president became so distraught that he confided to a longtime friend, “Hillsey, I’m afraid Mammy will die.”53

  Dr. Coupal was worried about Mrs. Coolidge’s heart and urged the administration of digitalis, a heart stimulant. His colleague Boone disagreed and was supported by Walter Bloedorn (“No! Don’t let them stampede you. Use your own judgment.”) and by the president (“You know best”). An electrocardiogram performed two days later confirmed Boone’s opinion.54 As a result, President Coolidge increasingly relied upon Boone to manage his wife’s care. He judged that the navy physician’s abilities were superior to that of his titular superior, Charles Coupal, a conclusion shared by Boone, who disparaged Coupal’s ability, considering it to be that of a family physician of the sort that one might have discovered at that time in towns and small cities in the United States.55

  Almost two weeks after the disease’s onset, the patient continued to battle terrible pain. Coupal urged the administration of benzyl benzoate as a pain killer, then in use as an antispasmodic to halt intestinal, biliary and ureteral colic. Boone, continuing his intellectual feud with his colleague, administered it “ against my better judgment.” When there was no improvement, Boone decided that codeine was the appropriate remedy. In a peculiar display of professional one-upmanship, the doctor complained to Coolidge about Coupal’s therapy and phoned Dr. Young, who agreed “with my deductions and treatment of Mrs. C, congratulates me on my conduct of the case.”56

  Due to insufficient rest, and despite her adherence to Boone’s admonition to avoid walks, Grace Coolidge remained both weak and tired through the early part of the Coolidges’ 1928 summer vacation at Brule, Wisconsin. The kidney attacks finally subsided during the summer, and there was no recurrence thereafter. In this pre-antibiotic era, rest and supportive care were sufficient to overcome the infection.57

  Near-identical Kidney Disease in Two Successive First Ladies

  Several comparisons are appropriate with Mrs. Harding’s illness in the White House six years previously. The disease was the same, but Mrs. Coolidge’s recovery was permanent, while Mrs. Harding’s outcome was eventually fatal. Both received VIP medical care from many physicians, both military and civilian, who were among the most illustrious in their field. In both situations, Boone was involved, and in both professional disagreements arose. However, the complete secrecy in the Coolidge White House was in stark contrast with the transparency in the Harding’s executive mansion.

  Four years after the comprehensive media coverage of her son’s fatal illness (see below) all news of Grace Coolidge’s condition was suppressed. This may have been at the first lady’s request. Grace had complained earlier about her lack of privacy, especially after having endured the death of her younger son in the public eye.58 The society sections of contemporary newspapers noted Mrs. Coolidge’s absence at events where her presence was anticipated, but there was no significant clarifying comment.59

  Dr. Hugh Young abetted in placing a shroud over publicity by his semi-clandestine appearances at the Washington Naval Hospital and in Calvin Coolidge’s study. His respect for his patient’s confidentiality was reflected in his 1940 autobiography. Grace Coolidge was not listed in its subject index. (The urologist had previously treated the disabled Woodrow Wilson in the White House. Young wrote about this episode at length in the same volume.)60

  Fatal Illness and Death of Calvin Coolidge, Jr.

  The Coolidges were not the only presidential couple whose child died immediately before, during, or shortly after their term in the White House. The tragic deaths of young Benjamin Pierce and Willie Lincoln were discussed in a previous chapter and a more recent example, the demise of newborn Patrick Kennedy, is considered later.61

  During the first half of the twentieth century, White House physicians, with a very short list of patients to follow and only an occasional acute illness to treat, often interacted socially with members of the first family. Both Drs. Coupal and Boone connected with the Coolidge sons, John and his younger brother, sixteen-year-old Calvin Jr. They rode horseback, played tennis, shot pool, went sightseeing and had lunches aboard the Mayflower together. Boone acted almost as an older brother.62 A tennis foursome between the two Coolidge sons and the two physicians was the setting for the subsequent Coolidge family tragedy. Cal Jr., late and in a rush to join his companions already on the court, donned his tennis shoes without wearing protective socks. A blister appeared on his toe afterwards. The boy was reticent about the lesion, took a bath and applied iodine. Symptoms arose over the next few days; he became tired and listless; pains shot up his leg, which became stiff.

  On July 2, 1924, Cal was absent from a scheduled tennis foursome. Boone quickly sought out the president’s son to determine whether he was ill and located the boy in the Lincoln bedroom, lying down while the first lady played the piano. Boone’s examination noted a fever and swollen lymph glands in his groin. In addition, red streaks ascended his leg and a blister, darker and larger than usual, was located “on the third toe just behind the second joint on the anterior surface.”63 Boone, alarmed by signs of a significant systemic infection, called Coupal to the bedside. The two physicians operated in tandem during the entire tragic episode, in sharp contrast with their disagreements four years later during the illness of Grace Coolidge. Antiseptic dressings were applied and a blood culture was obtained. Boone personally took the specimen to a military laboratory for analysis. The physicians disclosed their apprehension to Grace Coolidge and the president. Mrs. Coolidge was calm, resourceful and an efficient asset throughout her son’s illness.

  The president’s son was sicker the following day, more febrile and very restless. Colonel William Keller, the chief of surgery at Walter Reed Army Hospital, and Charles W. Richardson, a noted Washington physician, came to the White House to consult.64 The military physicians thought it wise to enlarge the medical team with more civilian consultation. John B. Deaver, professor of surgery at Philadelphia’s German Hospital, arrived on the next train. He joined Keller in suspecting appendicitis as the cause of the illness but was insufficiently certain to operate immediately. However, Calvin’s condition continued to deteriorate and the blood culture from two days earlier disclosed a systemic infection due to staphylococcal aureus bacteria.

  Drs. Boone and Coupal were aware that the situation was grave and that some sort of notification to the public was necessary. “President’s Son Is Seriously Ill; Foot Is Poisoned” was the headline in the July 5 edition of the Atlanta Constitution. The bulletin was informal in nature and not signed by the doctors. It was explained that no formal bulletins would be issued, the White House taking the position that the patient was “not a public character, and should be treated with no more dignity than any other upstanding American boy.”65 A far lesser degree of transparency was practiced by these same doctors four years later.

  On July 5, Deaver returned, accompanied by a pathologist, Dr. Kolmar from the University of Pennsylvania School of Medicine. Deaver decided hospitalization was necessary; an operation was performed at Walter Reed Hospital. Assisted by Keller, Deaver made an incision over the left tibia and chiseled some of the bone for culture to determine whether the infection had traveled. It had. “It was their belief … that the poison in the system had centralized sufficiently to warrant an effort at draining it from the body before the youth’s strength was further wasted in fighting the infection.”66 Th
is was a peculiar notion since a prior culture of the blood had already disclosed a generalized infection.

  The patient’s decline was precipitous. Calvin Coolidge, Jr. died on July 7, 1924, from staphylococcal septicemia, only four days after the severity of his illness was recognized.67 Many prominent American newspapers remarked on Mrs. Coolidge’s courage and endurance during this ordeal.68

  Grace Coolidge: Estranged Wife and Widow

  In The Tormented President Gilbert analyzed Calvin Coolidge’s depression after his son’s death: “not believing that death had occurred, of missing his young son, of not being happy without him, of seeing him playing tennis on the WH courts every time he glanced out the window, and of soon joining his son in death.” The president’s behavior in office underwent a remarkable change: he became indifferent instead of engaged, listless instead of alert and in control, passive instead of actively engaging with his cabinet and Congress.69 Coolidge’s major depression resulted in a pronounced propensity to sleep. He slept eleven hours a night. His accustomed post-lunch naps lengthened to between two and four hours. His presidential work schedule was reduced to four and a half hours a day.70

  In sharp contrast, his first lady reacted with hope and acceptance. She spoke of her son’s smile, of his happiness in heaven, of her sense of nearness to him, and of allowing her to glimpse God’s faith and the glory of his grace. She handled the loss of a son far better than her predecessors, Jane Pierce and Mary Lincoln. Grace wore all white at that August’s Republican National Convention and throughout the summer. She immediately returned to entertaining and presented a cheerful demeanor in the White House.71 And she discovered that the “Summer Game” was a source of fun and enjoyment. Mrs. Coolidge regularly attended the Washington Senators’ baseball games. She became a rabid fan, sat by the Senators dugout, was known by all the players, and refused to leave the ballpark even when her dour husband left during the early innings. In later years, when she retired to Massachusetts, she became a loyal supporter of the Boston Red Sox.72