The Health of the First Ladies: Medical Histories from Martha Washington to Michelle Obama (25 page)

Mrs. Wilson was comfortable with Dr. Taft’s care. Although the pills prescribed by her were ineffective, her psychological support assisted Ellen through her third pregnancy. Dr. Mary Florence Taft was a recent medical school graduate. She received her degree from the homeopathic medical school of Boston University just three short years before she delivered the Wilson’s third daughter. The doctor possessed an eminent political surname: future president and, later, an opponent of Woodrow Wilson’s White House bid in 1912, William Howard Taft was her cousin. Several years later, Dr. Taft became a professor of gynecology at Hering College of Homeopathic Medicine in Chicago. Her academic research led to the publication of several articles on gynecologic practice. One, published in 1895, was entitled “Puerperal Eclampsia,” which indicated that Taft was familiar with at least the most severe variant of toxemia. The specifics of Taft’s care for Mrs. Wilson are not recorded.
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Toxemia of pregnancy is marked by the onset of hypertension and a group of associated findings including edema, protein (albumin) in the urine, headache, visual disturbances, and epigastric pain. Two forms have been identified—eclampsia and the far more common preeclampsia. The convulsions of eclampsia differentiate it from preeclampsia. Eclampsia is derived from a Greek word meaning a shining forth, in reference to the sudden appearance of convulsions, as in epilepsy. Methods of measuring blood pressure were not generally available in the late nineteenth century and therefore Ellen Wilson’s blood pressure metrics are unknown.
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The Wilsons moved to Princeton, New Jersey, in 1890, where Woodrow received a professorship at the noted university. Six years after Ellen’s final pregnancy, over a period of three and one half years (autumn 1895 to early winter 1899), the future first lady was often ill with episodic nausea and vomiting, accompanied by fever and abdominal pain. The pain was localized mainly to the area of the appendix. Ellen’s enthusiasm and vitality waned, her appetite periodically vanished, and easy fatigability appeared. These symptoms occasionally forced her to her bed for days. Her medical contacts were with Dr. William Van Valzah of New York City (twice), a Dr. Wikoff, who practiced in Princeton, a Philadelphia masseuse, and possibly Dr. Edward P. Davis of Philadelphia, who was Woodrow Wilson’s Princeton University classmate.

Dr. Van Valzah could find nothing organically wrong with the patient. He decided after several examinations that her symptoms were caused by the then diagnostic wastebasket for disorders of women—nervousness. He initially treated her abdominal symptoms with calomel for four nights and four mornings, but this toxic drug only increased her nausea. Finally, the doctor admitted that her “stomach and liver [were] misbehaving a little.”
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William Van Valzah’s practice in New York City emphasized diseases of the gastrointestinal tract; it was for this specialized expertise that both Professor and Mrs. Wilson sought his opinion. Woodrow consulted Van Valzah in 1898 for his own chronic digestive complaints; the professor frequently used a stomach pump as an extreme measure to treat his symptoms. Dr. Van Valzah’s diagnosis and treatment were a success. He was probably the first physician who understood that Wilson’s symptoms were both psychosomatic and dietary. He removed the stomach pump and regulated the patient’s diet. The physician’s diagnosis and treatments of Mrs. Wilson were far less successful. He was correct that her gastrointestinal complaints were not a result of pathology in either her stomach or intestinal tract. His prescription of calomel was harmful, rather than beneficial. However, Van Valzah, the coauthor of the textbook
Diseases of the Stomach
(W.B. Saunders, 1898), was unable to relate his patient’s nausea, vomiting, abdominal pain and tiredness to kidney disease, a difficult correlation at the time. There is no record that he obtained a urinalysis.
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Van Valzah was a demonstrator in clinical medicine at Jefferson Medical College. He unfortunately became embroiled in the conflict raging between homeopathic and allopathic practitioners in the 1880s. A few years after graduation, he was hospitalized at Jefferson with “dyspepsia.” Van Valzah’s doctors, the orthodox luminaries of the medical faculty, finally concluded that he was “more the victim of a delusion than an actual sufferer.” In other words, his complaints were psychosomatic. After a relapse the physician-patient sought an alternate opinion; he was treated by a homeopathic physician. After receiving knowledge of Van Valzah’s choice of a physician, the medical staff of Jefferson demanded his resignation for crossing the philosophical orthodox/homeopath Rubicon. Dr. Samuel Gross, who was immortalized by painter Thomas Eakins in 1875, announced, “I know nothing of the particulars of the case except that he went over to homeopathy and we got rid of him. When a man goes over to homeopathy and we have no further use of him. You can’t mix oil and water together. They won’t unite.” As a result, Van Valzah suspended his practice in Philadelphia and relocated to New York City.
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Dr. Wikoff is identified as the Wilson family physician during their years in Princeton. None of his professional information can be located, which casts doubt upon his medical pedigree and certification. Eleanor Wilson described him unfavorably: “He was a gloomy old soul with fierce bristling eyebrows and I shuddered every time I saw him.” Wikoff’s care for the future first lady is also unrecorded. It appears that he too was unable to make the diagnosis of chronic kidney disease.
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Ellen’s health did recover for a while, leading one biographer to exclaim, “Health-wise she never felt better.” However, several years later, in 1905, she was described as “pale and thin.” For a period of four months the following year, Ellen was afflicted by a mysterious painful stiffness in her back and limbs. She curtailed her ordinary activities and required constant massages for any respite. Weinstein, noting that she was depressed at this time, ascribed her symptoms to a psychosomatic origin, rather than another episode of kidney disease.
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Unfortunately, her illness reappeared with significant and troubling symptoms. The effects of chronic renal failure, especially anemia, became apparent during the presidential election year of 1912. Her daughters Jesse and Eleanor noticed that their mother was less animated. She remained home during her husband’s successful campaign for the presidency; her family and close friends became alarmed “that something was very wrong with Ellen.” On inauguration day, Eleanor was shocked that the small figure “walking slowly and wearily” ahead of her was her mother.
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Preeclampsia (the common form of toxemia of pregnancy) increases the risk of end-stage renal disease (Bright’s disease) three- to fivefold. Among women who were pregnant three or more times, preeclampsia during one pregnancy was associated with a relative risk of end-stage kidney disease of 6.3, and preeclampsia during two or three pregnancies was associated with a relative risk of 15.5. Although the absolute risk for chronic renal disease in those who have had preeclampsia is low, preeclampsia is a marker for an increased risk. The reason for the first lady’s physical decline continued to be unsuspected. Colonel Edward House, Wilson’s friend and political confidante, attributed her symptoms to the effects of overwork. Wilson cancelled the traditional inaugural ball, in all likelihood out of concern for his wife’s health.
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Chronic kidney disease, although indolent, is a sinister sickness, insidious, enervating and progressive. Despite this, Ellen Wilson for many months until her terminal decline fulfilled most of the responsibilities of a presidential wife: “Until her health began to decline, Ellen pursued the role of an active, involved First Lady.”
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Her decade-long experience as the wife of the president of Princeton University prepared her for social success in the White House.
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Official entertaining, whether cabinet luncheons, diplomatic receptions, teas or dinners, were handled with grace and efficiency.
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Eleanor, the Wilsons’ youngest daughter, raved about her mother’s skills as a hostess: “Mother carried out the usual program of dinners, receptions and musicals at the White House, gave two or three tea parties a week, and received callers almost every afternoon…. [T]here were never less than fifty people at the smallest dinner party, and often a hundred or more attended her informal teas…. She managed, however, to make even the huge receptions more homely and gracious.”
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The Wilsons’ change of residence required the selection of a new family physician. Navy doctor Lieutenant (later Admiral) Cary Grayson became their White House physician. He filled the role of the Wilson family doctor and then some, becoming confidante, advisor and intimate friend. Grayson attended William and Mary College in Williamsburg, Virginia, and received his medical degree from the University of the South in Sewanee, Tennessee. After an internship at Columbia Hospital for Women in Washington, D.C., he was commissioned an acting assistant surgeon in the United States Navy. A few years later, in 1910, he received the coveted assignment of medical officer of the presidential yacht,
Mayflower
. This billet, where Dr. Grayson got to know both Presidents Theodore Roosevelt and William Howard Taft, may have served as an audition for his prestigious appointment as White House physician and personal physician to the Wilsons.

The young navy lieutenant’s career was undoubtedly abetted by the interest and friendship of a significant mentor, White House physician to Presidents Roosevelt and Taft, Admiral Presley Rixey. Rixey shared a Virginia birth and skilled horsemanship with his protégé. Moreover they were kinsmen; Grayson’s half sister was married to Rixey’s youngest brother. The admiral reflected upon their relationship: “I had known Dr. Grayson for many years prior to his entry in the Navy and advised him how to proceed with his medical education so as to become a naval surgeon, and in the service made good in every assignment I gave him.”
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The circumstances leading to the installation of this thirty-four-year-old naval officer as the president’s personal physician, then as his personal and political confidante, and finally as Woodrow Wilson’s surrogate son, seem to be the following: The Wilsons first met Grayson on March 3, 1913, the day prior to the incoming president’s inauguration. They were guests of the departing Tafts at a White House tea where they were informed that Woodrow’s sister, Annie Howe, had slipped on a marble staircase and cut her forehead. Grayson, by virtue of his role as medical doctor to the presidential yacht, was both available and prepared with his doctor’s bag. He sewed up Annie Howe’s wound and attended her for a few days thereafter. The doctor ascribed this meeting to providence; a skeptic might attribute it to foresight and ambition.

Serendipitously, the Wilsons, in a new venue and without a family doctor, needed a new physician. Ellen Wilson probably had a significant role in Grayson’s selection: “Thinking of her husband’s health, she sent for Lieutenant Grayson, who had patched up Aunt Annie with such efficiency, and asked him if he would not look after the President.” The doctor was informed of his appointment a few days later in a meeting with President Wilson and navy secretary Josephus Daniels. It is unknown, but quite likely, that President Taft and Admiral Rixey supported Grayson’s professional promotion. As first lady, Ellen Wilson was under the care of Dr. Grayson. On rare occasions, when he finally concluded that her care exceeded his professional acumen, he sought the consultation of experts.
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As spring 1913 progressed, “it escaped no one’s notice … that Ellen was taxing her strength to the limit.” Daughter Eleanor described her mother as “warm and white.” A decision was forced. On June 20, 1913, the White House released the following statement: “Upon the advice of her physician, Mrs. Wilson has decided to abandon active participation in the philanthropic movements which have commanded much of her attention since she came to Washington. Mrs. Wilson is not seriously ill, but will remain quietly in the White House until she goes to Cornish, N.H.”
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The first lady recuperated in New England, resting, painting, and socializing with friends and other artists. Her physical strength had been restored by the time she returned to Washington on October 17, after an absence of almost four months. Wilson made only a rare visit to his wife in New Hampshire, and Ellen, whose first priority was always her husband’s well-being, made one trip to Washington.
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Jesse was the first of the Wilson daughters to marry. Upon her return from Cornish, Ellen actively assumed the traditional responsibility of the mother of the bride, the planning of the wedding. The White House marriage of Jesse Wilson to attorney Francis Sayre on November 25, 1913, was a splendid event. In the meantime, Ellen made frequent references to being tired and the necessity of rest breaks. The president’s family spent Christmas vacation in Pass Christian, Mississippi, but upon their return to the White House, the first lady began to lose weight and “the lovely color in her cheeks disappeared.”
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On March 1, 1914, the physically failing Ellen fainted in her room. She remained confined to her room for several weeks and “she remained weak, lethargic, and anorectic, a triad of symptoms typical of chronic nephritis.”
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Finally, on March 10, Dr. Grayson realized that he needed help. He summoned Dr. Edward Parker Davis of Philadelphia to the White House to examine his patient. Davis was named for several reasons: He was a Princeton classmate of President Wilson and the two had maintained a long-term friendship, marked by frequent correspondence. He may even have treated the Wilsons when they resided in Princeton. In addition, Grayson and Davis previously had established a respectful professional relationship. Finally, the consultant’s medical expertise—obstetrics and gynecology—was relevant to the ailing Mrs. Wilson’s condition.
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