The Health of the First Ladies: Medical Histories from Martha Washington to Michelle Obama (18 page)

In contrast to the previous White House decedent, Letitia Tyler, who was an absentee mistress of the executive mansion, Mrs. Harrison prominently and effectively fulfilled the social and White House managerial responsibilities of a first lady. She imaginatively enhanced the decor and the ambience of the White House; moreover, she represented the first lady as a person of significance in public, community, and charitable affairs. Indeed, according to Watson, “Caroline Harrison may be the most underrated first lady of all time.”
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The questions of why, when, where, and from whom the first lady contracted the infection remain unanswered. One frequent risk factor, a positive family history, was present. Franklin Gardner, the first lady’s physician, confirmed “the Scott family, of which Mrs. Harrison is a member, has a consumptive vein running through its otherwise sturdy stock…. A number have succumbed, however, to the latent consumptive characteristic of the family.” Both Mary Scott, Caroline’s younger sister, and Capt. Henry M. Scott, a younger brother, died with tuberculosis (then frequently called consumption).
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No other infectious contacts have been identified. However, Mrs. Harrison was active at the Garfield Hospital in Washington until 1887 while her husband was a United States senator. Consequently the possibility of exposure to a tuberculous patient cannot be excluded.

Mrs. Harrison’s health was rarely robust. Her physical well-being was a frequent concern of her husband. Consequently, Benjamin Harrison accelerated the plans for their 1853 wedding: “If I marry Carrie now … the relief it would bring to her bodily health … would restore her health.”
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Increased anxiety over her health during the Civil War almost forced General Harrison to request a leave. Significant periods of illness persisted during his term as senator (1881–1887). However, there is no record of her symptoms, diagnosis or treatment.
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The medical record became clearer during her White House years. She suffered from respiratory ailments, especially in 1891. During that summer, the president informed a political confidante that he did not wish to run again, “being naturally influenced by an ailing Mrs. Harrison.” Dr. Gardner was quoted in the
Indianapolis News
obituary of the first lady that the final illness began in the winter of 1891 with a cough that was assumed to be an attack of the grippe. Mary Dimmick’s diary entry for December 29, 1891, was precise: “Mrs. Harrison sick with cold and too ill to go downstairs.”
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Mrs. Harrison was well enough to preside at formal White House dinners on February 16 and April 6, 1892. The development of “catarrhal pneumonia” with pulmonary hemorrhage forced her absence from all March social events. Her presence at the April 6 dinner was marked by a frequent cough and noticeable pallor. It was the last White House social event that the first lady was able to attend.
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The Dimmick diary entries, although neither astute nor medically informed, are the best source of Caroline’s physical deterioration. Immediately following the April 6 dinner, Mary Dimmick began her constant attendance upon her seriously ill aunt. Diary entries and a letter recorded Caroline’s mental state: “suffers much from depression, the effects of malarial fever,” “still very depressed and nervous,” and “very nervous and ill all day.” In a letter to a relative, Dimmick wrote, “She is in a state of melancholia.”
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Caroline Harrison, wife of Benjamin Harrison, was the second first lady to die in the White House. Tuberculosis was the cause (Library of Congress).

Dr. Gardner was a homeopathic physician by training and practice. When Mrs. Harrison’s lung infection worsened, Gardner requested an urgent consultation on May 1 from fellow homeopath Doctor Francis E. Doughty of New York City. Doughty was considered to be an expert in the treatment of the unlikely combination of pulmonary and nervous disorders. At the time, he was serving as professor of surgical gynecology at the New York Homeopathic Medical College and Hospital.
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There was intermittent improvement in Mrs. Harrison. But when there was a relapse of Caroline’s “bronchial trouble” both Drs. Gardner and Doughty were urgently summoned to her bedside. Despite his illustrious professional pedigree, Doughty’s diagnostic and prognostic skills were missing from this case. He “made a thorough examination and left at noon. He says he finds no organic trouble. We all feel much relieved.”
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Untreated tuberculous may be both intermittent and progressive. Caroline’s condition characteristically improved over the next several weeks although she spent most of her time in bed. Finally more appropriate therapy was introduced: A special train carried the presidential party to the fresh air and peaceful rural surroundings of Loon Lake in New York State’s Adirondack Mountains. Mary Dimmick continued as the first lady’s constant companion. The president, Dr. Gardner, and a nurse were often present. Initially this change of scenery was salutary and her temperature, fever and cough all improved.
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Inevitably, the disease progressed. Pleurisy struck in early September. On September 14, a suction pump under cocaine anesthesia drained fluid from the right pleural cavity. Caroline Harrison’s prominence assured high-level medical consultations even in the remoteness of the Adirondacks. Dr. Gardner was joined once again by Dr. Doughty and this time by the highly regarded tuberculosis expert, Dr. Edward Trudeau, from his nearby Saranac Lake sanitarium. It was Dr. Trudeau who finally made the diagnosis of pulmonary tuberculosis. It was nine months after Caroline’s initial symptoms and five months after its serious nature became apparent. In addition, Trudeau declared her prognosis to be dire and any further treatment to be hopeless. For the first time the Harrison family became alarmed. The diagnosis of tuberculosis was announced to the public. President Harrison had previously censored all medical reports of his wife’s illness.
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“Unaware of her true condition, Mrs. Harrison often remarked that ‘if they would only take her back to Washington’ she would get better.”
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A special train returned Mrs. Harrison to the White House on September 20. Upon her arrival, Gardner’s examination determined that her right lung was completely consolidated; later the left lung also became diseased. Her final five weeks were marked by a continuous cough, a high temperature, a rapid heart rate, and a distressed respiratory rate of 50–60/minute. Gardner was in constant attendance at the patient’s bedside and issued “progress” reports several times daily. Prior to Mrs. Harrison’s demise, Gardner stated defensively, “We did all that could be done, faced with the certain knowledge that will cure consumption.” Caroline Harrison died in the White House on October 25, 1892, just three years after becoming first lady.
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During the late nineteenth century tuberculosis was a public health emergency in the United States. Called “The White Plague,” “The White Death,” and “Captain of Death,” in 1900 it was the second leading cause of death, trailing only deaths caused by pneumonia and influenza. Its annual death rate was 200 individuals per about 100,000 population. A U.S. public health estimate for the 1880s indicted the White Plague as the eventual killer of one-seventh of the total population and one-fourth of the adult population. One medical historian predicted that nearly one-half of the adult population in large American cities would contract tuberculosis at some time in their lives.
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Before the introduction of antibiotic therapy in the twentieth century, the only accepted and useful treatment was confinement of the patient to a sanitarium, away from society, where a combination of fresh air, a good diet and rest would be salutary. The most famous and respected U.S. sanitarium was Dr. Edward Trudeau’s Adirondack Cottage Sanitarium at Saranac Lake, New York, started in 1884. Trudeau, the son of a prominent and wealthy family, personally cared for his beloved older brother Francis, who was terminally ill with tuberculosis. Trudeau decided upon a medical career, graduated from Columbia’s College of Physicians and Surgeons, and became a junior partner in a fashionable New York City medical practice. He was diagnosed with pulmonary tuberculosis in 1873, and “realizing that I had only a short time to live, I yearned for the wilderness I loved.” Trudeau secluded himself in the Adirondack mountains of northern New York State. He discovered that resting, fishing and hunting brought a remission, and the following year he returned there with his family.
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Around 1880, Trudeau began to have patients referred to him at Saranac Lake by an eminent New York physician who had previously treated him. Subsequently Trudeau began to build his treatment cottages and set up a research laboratory. His fame grew. Trudeau’s aim was to cure tuberculosis by diagnosing it at an early stage: “I realized that if I was to try to obtain curative results I must confine the admission of patients to incipient and favorable cases as much as possible, and refuse to take the acute and far-advanced cases.”
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Therefore Trudeau decided that any treatment for first lady Caroline Harrison would be hopeless and destined to fail. President Harrison likely understood this decision. In a March 22, 1899, letter to Trudeau, he requested that a former servant, a widow of modest means, suffering with “incipient tuberculosis” be admitted to the Saranac Lake sanitarium. The ex-president wrote: “She has not the means to seek her health unless she can exchange her services for treatment and a salubrious climate.”
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Why Caroline Harrison selected thirty-three-year-old homeopathic doctor Franklin Gardner, a native of Massachusetts, as the physician to treat her pulmonary disease is unknown. The only previous physician to be associated with her care was Dr. Thomas Addis Emmet, but Emmet practiced in New York City and his expertise was gynecologic surgery. President Harrison was in good health during his presidency. His nominal physician was army colonel Jedediah Baxter, who had taken care of him when Harrison was a senator.
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Most likely, the onset of Mrs. Harrison’s pulmonary disease in early 1892 initiated a search for a family physician. Caroline may have preferred the gentler, patient-oriented treatment philosophy of homeopathy over the rigorous therapies of allopathy; perhaps the first lady had met Dr. Gardner socially and liked him; perhaps it was a decision by the president.

Franklin Gardner graduated from the Homeopathic Medical College of New York in 1882 at age 24 and shortly thereafter moved to Washington, D.C. His medical practice was successful, “his patrons including many persons prominent in official and social life.” His professional reputation was a good one, and Gardner was identified as “the best known homeopathic physician of Washington.” His reputation gained invitations for the doctor and his wife to several formal social events at the White House, a dinner on March 18, 1892, and a reception for Indiana poet James Whitcomb Riley on April 1, 1892. The first lady became seriously ill shortly thereafter.
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Despite his inability to either diagnose or treat the tuberculosis of Caroline, Gardner remained on good professional and personal terms with the president. The physician was summoned to the White House two months after Caroline’s death to treat Harrison’s granddaughter for a mild case of scarlet fever. Moreover, during 1898 and 1899 Gardner and ex–President Harrison exchanged several friendly social letters. The gracious ex-president also retained a high regard for the inept Dr. Francis Doughty. When Harrison, his second wife, and their infant daughter developed upper respiratory infections on a visit to New York City in 1897, Doughty’s medical care was requested. On this occasion, the doctor was successful. The family recovered. In 1896 the widower married Mary Dimmick, his wife’s companion and niece. She presented the sixty-four-year-old Harrison with a daughter, Elizabeth, a year later.
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The homeopath-allopath conflict was an incendiary matter that inflamed the Washington medical community during the latter decades of the nineteenth century and beyond. Gardner attempted to escape the controversy, and his cooperation with the eminent orthodox physician Edward Trudeau on Caroline Harrison’s case may have been an indication. However, acrimonious contention was unavoidable. Editorials in the
Medical Mirror
, an orthodox medical journal, criticized both President Harrison and Edward Trudeau, an active member of the New York State Medical Association, for hiring, and consulting with, a member of an irregular medical sect: “I regret … that the case … could not have been under the care of members of the regular profession whose attainments were of such order as to command a national reputation, instead of irregulars, as irregular in this day and age is another name for mediocrity.”
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