The Health of the First Ladies: Medical Histories from Martha Washington to Michelle Obama (21 page)

On May 25 the patient had recovered sufficiently to start back to the White House. Rixey was careful to assure future historians of his diligence: “I had left nothing undone to make the trip safe, a special train, two trained nurses, everything that could be needed in an emergency—even a tank of oxygen was put on board. The train was to run slow or fast or be sidetracked as the patient’s condition demanded.” He added the following: “Her condition on arriving at the White House was as good or better than when she started.”
³⁴
Rixey’s optimistic recollection is contradicted by his urgent request for expert consultation upon the McKinleys’ return to Washington. Drs. William Sternberg, Walter Reed, and William Johnson were called in to advise on the case. Sternberg, after listening to Ida’s heart and obtaining the results of blood cultures, made the diagnosis of acute bacterial endocarditis. An anonymous White House visitor pessimistically reported “Mrs. McKinley was in a very grave condition. There was hope of the outcome … but it was a very slender hope.”
³⁵

The White House physician remained silent regarding Mrs. McKinley’s symptoms, her diagnosis and the recommendations of the medical consultants whose expertise he had requested. Rixey’s medical reputation did not suffer. “In spite of his errors in diagnosis, he remained the beloved physician and the ultimate authority on Mrs. McKinley’s health.” In early June, McKinley decided that he would take his wife to their Canton, Ohio, home to recover. A newspaper reporter noted both the pallor of her face and unmistakable evidence of her recent severe illness as she boarded the train to Canton.
³⁶

During her protracted serious illness, the first lady was the beneficiary of medical care unavailable to her peers in the public. She received VIP care both in San Francisco and in Washington, D.C. Six influential physicians, three in San Francisco and three in Washington, assisted the White House physician with her treatment. In California Rixey might have initially diagnosed Mrs. McKinley’s problem as gynecological. This may account for the consultations of Drs. Henry Gibbons and Clinton Cushing, both professors of obstetrics and gynecology at area medical schools.
³⁷
The third consultant, Dr. Joseph Hirschfelder, educated in Germany, was a specialist in infectious disease.
³⁸

In Washington, Presley Rixey apparently had a better grasp of his patient’s condition. His consultants were principally infectious disease experts, not gynecologists. Doctor George M. Sternberg was America’s pioneer bacteriologist. Major Walter Reed was a preeminent specialist in the field of infectious disease. He graduated from the University of Virginia School of Medicine at the precocious age of 17 and subsequently studied infectious disease at Johns Hopkins School of Medicine under Dr. William Welch, the preeminent American scientist of the age. Reed was head of the Yellow Fever Commission, which had just proved conclusively that yellow fever was transmitted by a mosquito vector. Dr. William Johnston was a busy and well-respected Washington medical practitioner, and a longtime professor of medicine at the District’s Columbian University.
³⁹

The first lady recovered just before President McKinley’s assassination and death in Buffalo, New York, in September 1901. Presley Rixey consoled and protected Ida McKinley during a prolonged aftermath. The now former first lady was heavily sedated but was able to undergo the trials of the McKinley funeral services in Buffalo, the funeral train to Washington, the public services there, and the trip to Canton, Ohio, and his public burial.
⁴⁰

Not only did the White House physician accompany Mrs. McKinley to her Canton home, he remained there until her emotional and physical condition stabilized. Moreover Rixey, who remained the White House physician under McKinley’s successor, Theodore Roosevelt, visited her occasionally by order of President Roosevelt. The visits to Canton continued until her last illness: “I was constantly in communication with her family physicians in Canton, Ohio, Dr. Phillips and Dr. Portman, and with her nurses, Miss A. Moses, and Miss Maud Healy.”
⁴¹
Dr. Rixey was present at the deathbed in Canton when Ida died on May 27, 1907.
⁴²

First lady Ida McKinley reaped the benefits of her prominent position: The constant attendance of Dr. Rixey; VIP care both in San Francisco and Washington D.C.; and the oversight of the presidential physician during her widowhood. Such advantages were far beyond the imagination of her fellow citizens.

The “other ailments” ascribed to Mrs. McKinley by Dr. Rixey
⁴³
referred to significant, often dramatic, fits and spells that exceeded both in duration and in intensity her stereotypical petit mal epileptic attacks (absence seizures). These episodes were atypical for grand mal epilepsy and most likely had no organic cause. “It is not clear whether her condition was entirely one resulting from a mild case of epilepsy or was psychologically induced, or a combination of both.”
⁴⁴

Ida’s dependency upon William McKinley and his reciprocal care, tenderness and constant vigilance were well known. Her dependency was brewed with a strong dose of jealousy. In the White House the first lady created logistical problems because she refused to have women companions in attendance,
⁴⁵
Leech’s biography related an episode from years earlier: William McKinley mentioned a good-looking woman that he had seen at the funeral of President James Garfield. His statement provoked in Ida a fit of hysterics that culminated in a severe “epileptic” attack.
⁴⁶
Another episode occurred at the McKinley home in Canton in 1898. Congress was in session, which prevented the president from accompanying his wife to Ohio. She developed such violent convulsions that the doctors in attendance feared for her life. McKinley rushed to his wife’s bedside to find her unconscious. William sat with her, rubbing her hands and caressing her forehead. Sometime later Ida opened her eyes, grasped his hands, and remarked, “I knew you would come.” She recovered.
⁴⁷

After President McKinley’s death from an assassin’s bullet, Ida, interestingly enough, never again experienced the epileptic seizures that disabled her throughout her marital life. She lived for almost six years after her husband’s demise. During her widowhood there was no documentation of seizures or fainting episodes. This suggested to one author “that they may have largely been emotionally and psychologically induced.”
⁴⁸
Her atypical fits were dramatic and usually occurred when distanced from her husband, either by geography or by transient inattention while talking to someone else, especially another woman. Mrs. McKinley’s behavior is reminiscent of that of a previous first lady, Louisa Adams, who employed “hysteria” and physical outbursts to gain attention.
⁴⁹

Hysteria is no longer a recognized diagnosis. Many other diagnostic terms instead have been applied. These include hysterical epilepsy, hysteroepilepsy, nonepileptic seizure, pseudoseizure and psychogenic seizure.
⁵⁰
The most applicable diagnosis, currently in use, for Ida McKinley’s behavior, is “conversion disorder.” It is defined as “clinically significant symptoms affecting voluntary motor or sensory function in which psychological factors are associated. The latter initiates or exacerbates the symptoms. The symptoms are medically inexplicable.”
⁵¹
Moreover, conversion behavior can be superimposed upon epilepsy so that a confusing pattern results. A sustaining element for a conversion disorder is having a partner “who believes in the patient’s illness and constantly supports it…. So after President McKinley died that would explain the disappearance of Ida’s ‘hysteria.’ You’d expect there to be some secondary gain from the symptom.”
⁵²

Mrs. McKinley insisted on playing the role of first lady, attending dinners, meeting with visiting dignitaries and even accompanying the president on trips outside the White House, including travel by train across the country. Her hostess activities were augmented by the helpful presence of the vice president’s wife, Jennie Hobart, or one of the visiting Saxton or McKinley nieces.
⁵³

Previously, as the wife of the governor of Ohio, it was widely acknowledged that Ida McKinley was an invalid who was unable to discharge the ceremonial and social duties of a governor’s wife. She lived in semiretirement and made only perfunctory appearances at the governor’s official receptions. She spent her quiet hours crocheting.
⁵⁴
The incoming first lady was unable to manage the 1897 inaugural ball. She fainted, and her husband picked her up and took her home. There was little White House entertaining in 1897. In preparation for her husband’s 1901 inaugural ball Ida was heavily sedated. She was observed sitting propped up in a chair overlooking the crowd.
⁵⁵

Occasionally special visitors were permitted to call on her in her private quarters in the White House, where she sat in a wooden chair. She spent her time compulsively crocheting bedroom slippers, several thousand over a lifetime. She gave them away, mainly to charity. Another hobby was cleaning her jewelry.
⁵⁶
Major adjustments to White House protocol were made to accommodate the first lady. Tradition required the president to escort the guest of honor to the dinner table at formal dinners with the first lady to sit opposite. Instead Ida sat next to William so that, if a petit mal episode occurred, the president could cover her face with a handkerchief and continue his conversation until the attack passed. Moreover, if a significant seizure took place, the president could unobtrusively escort her out of the room. Additionally, instead of standing at official receptions, she greeted people while seated.
⁵⁷

Historians have rated Ida McKinley’s performance as first lady a seriously flawed one. Recent surveys listed her 32 of 36 and 32 of 38 rated wives.
⁵⁸
Watson classified her as a Behind the Scenes Partner. This type of first lady is active and supportive of her spouse’s political activities but is not a public participant in political or presidential affairs. Such a first lady’s partnership is private and personal in nature, and, away from the public, she is a powerful, influential force in the White House.
⁵⁹

Ida McKinley’s health problems had no adverse effects upon her husband’s political career. The public was kept unaware of her diagnosis. Contemporary newspapers and magazines were silent about Ida’s epilepsy. The McKinleys kept her medical problems a private matter and the nature of her problems was never publicly exposed. The only descriptions of her malady were incidental observations of visitors. The country at large knew only that her health was “delicate.”
⁶⁰

On the other hand, the president’s devotion to his wife enhanced the public’s appreciation of his character. His solicitude for her well-being became well known and met with widespread approval. “He spent his free hours sitting in stuffy rooms and driving in closed carriages because she avoided fresh air. Her headaches often required him to pass the evening in the dark. McKinley learned how to support his wife’s weight on his arm, timing his quick step to her faltering pace, and how to hold her head, when her temples throbbed with the pressure of an oncoming attack.”
⁶¹

Little is known about any policy advice Mrs. McKinley may have confided to her husband, other than that General Leonard Wood should be selected to lead the military forces of the United States in Cuba and that the Philippines should be retained at the conclusion of the Spanish-American War. In both cases, he accepted his wife’s advice.
⁶²

Nellie Taft and Pat Nixon

Two first ladies, Nellie Taft and Pat Nixon, who entered the White House sixty years apart, were dissimilar in ambition, family background, and political engagement. Mrs. Taft coveted the presidency for her politically unambitious husband, William Taft. However, it was Mrs. Nixon’s husband, Richard, who strove inexorably towards the presidency while his wife occupied a supportive, but not a leadership, role in his political ascendancy. Nellie came from wealth; Pat’s family was, at best, lower middle class. Future first lady Taft was conspicuous in political maneuvering; Pat Nixon remained in the background.

Two similarities pair first ladies Taft and Nixon in this chapter. Both suffered disabling strokes, one as she commenced her White House responsibilities, the other soon after her husband resigned the presidency in disgrace and she was attempting to reestablish her personal life. Both smoked cigarettes at a time when this habit was unfashionable for women. They were not the only first ladies to do so, but they were the ones to suffer the medical consequences of this habit.

“Given four years of good health and sustained hard work, she might have reshaped the role of the first lady decades earlier than Eleanor Roosevelt or Lady Bird Johnson did.”
¹

Helen Herron, born July 2, 1861, was the third of eight surviving children of the upper-middle class Herron family of Cincinnati, Ohio. Called “Nellie” almost from the start, she grew into a formidable, focused and free-spirited woman who was a determined feminist, well before that designation was birthed.
²

Her father, although not a politician, enjoyed important political friendships. The Herron family were White House guests of President and Mrs. Rutherford Hayes during Christmas 1877. Both tradition and her biographies recount that the sixteen-year-old Nellie determined that the next time she resided in the White House, it would be as first lady.
³
She focused her quest for marriage upon finding a mate whose qualifications matched her ambition. Her focus and talent enabled her to found and successfully manage the Cincinnati Symphony Orchestra, to become a well-loved wife of the governor of the Philippine Islands, to beautify the District of Columbia with thousands of Japanese cherry trees, and to be the first first lady to publish her memoirs.