The Health of the First Ladies: Medical Histories from Martha Washington to Michelle Obama (2 page)

The First Ladies’ National Library, Canton, Ohio, the Saxton McKinley House, the family home of first lady Ida Saxton McKinley and longtime residence of President and Mrs. McKinley (courtesy National First Ladies’ Library).

Margaret Truman, the daughter of President Harry and first lady Bess Wallace Truman, scrutinized the lives of these women from an insider’s perspective. Her biographical work,
First Ladies
, was released by Random House in 1995.
⁸
Professor Robert P. Watson in his 2000 book,
The Presidents’ Wives: Reassessing the Office of First Lady
, analyzed the evolving social, ceremonial and political responsibilities of this unofficial position and has measured the success of each in fulfilling these responsibilities.
⁹

In 2001 Louis L. Gould edited and contributed to
America’s First Ladies: Their Lives and Their Legacy
. The book was a compendium of short biographies of all of the first ladies up to the publication date. Gould’s purpose for the work was stated in the introduction: “By the early 1990s the outlines of a distinct research area devoted to First Ladies had emerged where history, political science, and women’s studies intersected…. Despite these constructive achievements the new field lacked a reliable up to date reference work that included the essential facts about each First Lady in a brief biographical essay.” Therefore, he produced his book as an “effort to assess … place in the development of the institution of the First Lady.”
¹⁰

Both professors Robert Watson and Louis Gould have edited an ongoing series of concise biographies of individual first ladies.
The Presidential Wives
series is edited by Watson and published by Nova History of New York.
Modern First Ladies
is edited by Gould and published by the University of Kansas Press. Watson’s purpose is public enlightenment regarding the important office of first lady and the power and influence of its occupants.
¹¹
Gould’s foreword to his series’ biography of Grace Coolidge is more personal and specific: “[It] will leave readers … with the real sense of Grace Coolidge as a human being and a contributor to the historical legacy of presidential wives.”
¹²

My previous book,
The White House Physician: A History from George Washington to George W. Bush
, focused on the complex nexus of the health of American presidents, their medical care, their medical practitioners, and the evolution of medical practice in the United States. During my research, I discovered that presidential wives lived compelling and interesting histories. They were frequently ill; their health often suffered because of their husbands’ ambitions; some were crushed by the responsibilities of a first lady, while others thrived. The influence of their health on their spouses’ executive performance was both complicated and at times ambiguous. The subject of the health of the first ladies of the United States became too intriguing and enticing to abandon. Hence this book. The chapters that follow explore various aspects of the first ladies’ health. The histories are presented in a broadly chronological sequence. However, in a few instances, exceptions will occur when individual stories from different times will be conflated for purposes of interest and explanation.

The medical histories of the first ladies will be examined. Focus will be upon, but not restricted to, their years in the White House. Their medical care will be analyzed, with respect to both diagnostic and therapeutic standards of the times and the qualifications and competence of their physicians. With the passage of time, public and preventative health measures, refined medical skills and major scientific advances have influenced the types and severity of illness. Over two and a quarter centuries, America’s first ladies have battled in rough sequence: infections (yellow fever, malaria, tuberculosis); pregnancy-related disorders; mental problems; kidney ailments; vascular disease, including stroke; cancer
;
and, lastly, autoimmune disorders such as Barbara Bush’s bout with Graves’ disease.

Particular attention will be given to this question: Did health influence performance as first lady? The role of the first lady encompasses social, ceremonial, familial and political responsibilities in variable degrees. Did illness affect any first lady’s success in accomplishing her duties? Conversely, did these responsibilities affect the health of the first lady? Also, does marriage to a very ambitious man take a toll on the health of his wife? Admittedly this is a question that in many cases has no definitive answer.

Illness may plausibly affect the performance of a president who is confronted with the sickness of a loved one. However, any generalization is a Herculean task far beyond the scope of this book. The specific responses of two presidents, Franklin Pierce and William McKinley, when faced with this situation will be described.

The position of first lady accrues medical advantages that may be unavailable to other citizens, which gives rise to the following questions: What sort of medical attention did the first ladies receive and from whom? Was their care equivalent to that received by other women of that era? Therefore, the selection, training, and success or failure of the treatments by their physicians will be discussed. Moreover, it was possible that presidents were given different, and possibly better, medical care and attention than their wives. Over the years physicians to the first ladies were burdened with additional conflicts: patient confidentiality versus the public’s right to know; homeopathic care versus orthodox medicine; and when and whom to employ as medical consultants.

Lastly, consideration will be given to the use by the first lady of the “bully pulpit,” or, more appropriately, the “velvet voice,” to raise public awareness through a personal experience with a disease. This has occurred with increasing frequency since the mid-twentieth century and has become a significant point of political discourse.

The Constitution does not mention the title “First Lady.” Moreover there is neither a law nor a job description that authorizes the use of a specific title for the president’s spouse.
¹
Martha Washington was hailed with shouts of “Long live Lady Washington” as she was rowed across the Hudson River on the presidential barge after her husband’s 1789 inauguration in New York City. These shouts were accompanied by a thirteen-gun cannonade.
²

Inconsistent titles were applied to early and mid-nineteenth century presidential wives. Abigail Adams was called “Mrs. President” and “Her Majesty,” mainly by her husband’s political opponents. Dolley Madison, the wife of James Madison, the fourth chief executive of the United States, was called respectfully “Lady Presidentress.” Additionally, at her death in 1849, President Zachary in his eulogy referred to Dolley as “our First Lady for half a century.”
³

Historians and biographers generally agree that the title “First Lady” achieved acceptance and general usage during the presidency of Rutherford B. Hayes (1877–1881). Hayes’ wife, Lucy, was the first presidential wife to secure a college degree (from Cincinnati Wesleyan). Lucy Hayes was a prominent personage during the Hayes administration; additionally she accompanied her spouse on a transcontinental train trip. In 1877 reporter Mary Clemmer Ames, writing in the
Independent
, referred to Lucy Hayes as “First Lady of the Land.” Historian Stanley Pillsbury, writing in the
Dictionary of American History
, applied the title “First Lady” to Lucy Hayes in his narration describing her husband’s inauguration in 1877.
⁴

Caroli noticed that dictionaries gradually began to use “First Lady,” but only after the country’s political attention had been drawn to Washington, D.C., in the twentieth century. Beginning with Webster’s
New International Dictionary
in 1934, other dictionaries began adopting the title. Two plays solidified its usage by the general public: the 1911 production by Charles F. Nirdlinger about Dolley Madison,
The First Lady of the Land
, and a 1935 play by Katherine Dayton and George S. Kaufman, titled
First Lady
.
⁵

For clarification, “First Lady” as used in this book refers only to the wives of sitting presidents of the United States. The deceased wives of the four presidents who were widowers (Thomas Jefferson, Andrew Jackson, Martin Van Buren and Chester Arthur) are not included. Moreover, surrogates, either family members or others, who assisted disabled first ladies with their ceremonial and social responsibilities are neither considered nor analyzed.

The National First Ladies’ Library lists Harriet Lane as a first lady. Miss Lane was the orphaned niece of President James Buchanan (1857–1861). When his sister’s daughter was orphaned Buchanan adopted her, directed her schooling, and provided for her welfare. Over time Harriet Lane became not only her uncle’s political consort, but also his personal confidante. When Buchanan became president, his niece acted as his “First Lady.” Harriet was twenty-seven years of age at his inauguration and married only after her uncle’s death. She is not included in the profiles that follow.
⁶

Caroline Fillmore and Mary Harrison married presidents after the chief executive left the White House; neither were first ladies. Conversely, two sitting presidents, John Tyler and Woodrow Wilson, remarried shortly after the death of their wives. Both second wives, Julia Gardiner Tyler and Edith Bolling Gault Wilson, deservedly are listed as first ladies. Benjamin Harrison, a third president who was widowered in the executive mansion, married his deceased wife’s niece, but only after leaving the presidency. Three wives of presidents died in the White House, while a disproportionate eight presidents died or were killed in office.

The First First Lady and the First Mistress in the White House

It was my wish to have continued in Philadelphia longer, [George Washington wrote to his personal secretary, Tobias Lear] but Mrs. Washington was unwilling to leave me surrounded by the malignant fever wch. prevailed, I could not think of hazarding her … any longer by my continuing in the City the house in which we lived being, in a manner, blockaded by the disorder and was becoming every day more and more fatal.
¹

Martha Washington never lived in the White House; its construction was not completed until after George Washington’s death. Abigail Adams, the spouse of the second United States president, John Adams, occupied the still unfinished building for four brief months during the winter of 1800–1801.
²
The third American president, Thomas Jefferson, was a widower. Mrs. Dolley Madison, the wife of his secretary of state and successor as president, officiated as White House hostess for both Jefferson and James Madison, and thus may correctly be identified as its first mistress.

Both Mrs. Washington and Mrs. Madison were confronted by infectious diseases (yellow fever, smallpox), scourges of a bygone era, and both suffered from chronic maladies (gall bladder disease [Washington] and arthritis [Madison]), still prevalent in modern times. A physician was not officially assigned to either president during their husbands’ tenures, although both George Washington and James Madison were seriously ill while president. Neither Martha nor Dolley was significantly sick or the recipient of medical attention during her tenure as first lady. As a result, both were able to successfully fulfill the responsibilities of wife and first lady.

Martha Washington and Dolley Madison were Virginia born. Both experienced early widowhood upon the deaths of their first husbands. Both bore children during their first marriages but were unable to become pregnant during long second marriages. Children with both first husbands died at an early age. Both ladies outlived their presidential husbands, Dolley by many years. Martha and Dolley had auditioned for their roles as first lady. Washington was the wife of the Revolutionary War American commander in chief; Madison served as hostess for the widower Thomas Jefferson while her husband James was Jefferson’s secretary of state.