The Health of the First Ladies: Medical Histories from Martha Washington to Michelle Obama (19 page)

Caroline Harrison was pregnant three times. Her pregnancies in 1854 (son, Russell), and 1858 (daughter, Mary), although successful, with the delivery of two healthy children, were very demanding upon the mother. She was under close medical care during the latter pregnancy, requiring the borrowing of money to pay for medical expenses and a lengthy stay at the Harrison ancestral home in Ohio. Subsequent to Mary’s birth, Caroline’s father wrote her brother: “Your Ma has not yet returned, as Carrie has been dangerously ill. She is now nearly recovered.” A third pregnancy, in 1861, resulted in a stillborn daughter. There were no further pregnancies.
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Pregnancy was a significant medical matter for America’s early first ladies. Fortunately, for these women and for all their female constituents, obstetrical management and prenatal care improved markedly with time. However, even in the mid-twentieth century, Jackie Kennedy was beset with complications in four of her five pregnancies.

Twenty-two years after Caroline’s final delivery, the future first lady was hospitalized for three months in a New York City hospital where she underwent an operation to correct what was probably a vesico-vaginal fistula. A vesico-vaginal fistula is a traumatic forced connection between the urinary bladder and the vagina. Patients with this condition experience unremitting pain, urinary incontinence and may also exhibit constitutional symptoms.
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The evidence for this diagnosis is circumstantial but persuasive. Mrs. Harrison was under the care of Dr. Thomas Addis Emmet, the national expert, in the surgical correction of this problem. At that time, the principal cause of this malady was difficult or prolonged obstetrical labor. The pre- and postpartum care for both of Mrs. Harrison’s live deliveries were lengthy; by inference both were difficult.
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Dr. Thomas Addis Emmet, an 1850 graduate of Thomas Jefferson Medical College, Philadelphia, was considered the preeminent gynecological surgeon of the last quarter of the 19th century. He was surgeon in chief to many public hospitals in New York City, including the Woman’s Hospital, the first hospital in the world dedicated solely to gynecologic disorders. When he retired, Emmet estimated that he treated almost one hundred thousand women during his career.
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An appreciative Benjamin Harrison expressed his gratitude in a June 13, 1883, letter to Emmet: “I am glad to be able to say that my wife seems to be in better health than she has enjoyed for years.” The letter enclosed a draft for $415 as payment for services rendered to Caroline Harrison.
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“Caroline Harrison compensated for her dull, dour husband and charmed guests at the White House. She was intelligent, personable, and an active donor to charities. Mrs. Harrison left a legacy of accomplishments, including the redecoration of the White House, the initiation of the White House china collection, and the founding of the Daughters of the American Revolution.”
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The diplomatic community valued her courtesy and grace, and foreign visitors appreciated her dignity. Until her illness she was active in greeting visitors almost on a daily basis; she hosted state dinners and was present during the annual New Year’s receptions at the White House. Dancing was reintroduced at the Harrison White House and Caroline selected the music for the White House entertainments.
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This first lady was a gifted artist who lent her own design to the official state china collection. She built support for a renovation of the then decrepit White House by giving public tours of it herself and inviting members of Congress to examine the condition of the building. She was convinced that the old building was near collapse and immediately began researching architectural improvements. She set in motion plans for adding east and west wings that were implemented ten years later. Additionally, she introduced electricity to the mansion.
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In her zeal as mistress of the White House, Mrs. Harrison may have exposed herself to illness, and perhaps even to the tubercle bacillus. She personally examined, selected and supervised the restoration and preservation of valuable forgotten relics—furniture, silver, glass and china, many of which were stored in the unventilated basement. The kitchen in the basement was completely remodeled; plumbing was repaired and accumulated mold was removed; the attic was cleaned. The first lady personally supervised much of the refurbishment. The White House was so rat infested that ferrets were introduced to destroy the rats. “During her years in the White House, Mrs. Harrison frequently suffered from respiratory ailments that some outsiders attributed to her spending too much time in the clammy basement and dusty attic while she pursued her renovation efforts.” Moreover, she painted on textiles and tapestries, a process that involved using solvents; the fumes undoubtedly contributed to her pulmonary distress.
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Caroline Harrison was considered by many to be an asset to her husband’s political career. In 1888, Harrison received the Republican nomination for president. Thereupon he successfully challenged incumbent president Grover Cleveland and won the presidency with the majority of the electoral vote. (However, in the popular vote count he trailed Cleveland by over one hundred thousand.)
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In June 1892, at the Republican National Convention in Minneapolis, Harrison was renominated on the first ballot. Grover Cleveland was again his Democratic opponent. The 1892 presidential election was unique in which two presidents, former and serving, opposed each other: “Most voters seemed to agree that either candidate would fill the presidential chair with credit, as indeed each already had done.”
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Caroline Harrison was severely, and then fatally, ill with tuberculosis during the entire 1892 presidential campaign. She died in the White House on October 25, 1892, less than two weeks before the November election. Subsequently, Grover Cleveland defeated her husband with 46–43 percent of the popular vote, and with a substantial margin in the electoral college. From July 6 until September 20, 1892, Mrs. Harrison had been treated at Loon Lake in the Adirondacks. After that, she was bedridden in the White House until her death. President Harrison was extremely attentive to his moribund spouse, making many trips from Washington to Loon Lake and then attending at her White House bedside. In a close election, every doubtful state called for Harrison’s presence to make at least one speech; instead he remained at Caroline’s side.
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An important question is whether his wife’s illness significantly contributed to Harrison’s election defeat. Most commentators think it did not. His opponent, Grover Cleveland, graciously limited his own campaigning upon knowledge of Mrs. Harrison’s sickness. Instead, commentators ascribed Harrison’s defeat to widespread labor strife and his unpopular support of the McKinley Tariff. Andrew Carnegie, the steel magnate, summed up the election results: “I fear that Homestead did much to elect Cleveland.” After the election, Harrison commented, “Indeed after the heavy blow the death of my wife dealt me, I do not think I could have stood the strain a re-election would have brought.”
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Did Mrs. Harrison’s fatal illness affect her husband’s decision-making? Scholars hold divergent opinions regarding Mrs. Harrison’s influence in political matters and service as a presidential advisor. However, most, including this author, have classified her as the “Partner in Marriage.” That is a first lady who was inactive in politics. She was a personal, not a political, advisor whose influence was limited to social, personal and ceremonial affairs. Therefore the answer is that her illness did not affect her husband’s decision-making.
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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.
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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.”
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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.
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(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.)
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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 seizures
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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.
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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.”
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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,
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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.
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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.”
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Admiral Dr. Presley Rixey whom McKinley asked to provide constant care for his wife (courtesy Bureau of Medicine and Surgery Archives).