The Health of the First Ladies: Medical Histories from Martha Washington to Michelle Obama (26 page)

Admiral Dr. Cary Grayson, who shielded President Wilson from his first wife’s illness and later covered up the policy-making of his second wife (courtesy Bureau of Medicine and Surgery Archives).

After he received Grayson’s request Dr. Davis attended the first lady several times in the White House. He performed minor surgery on Mrs. Wilson; the details of the operation were never made public. One biographer speculated that it corrected a chronic gynecological problem that was aggravated when she fainted. However it is known that the gynecologist brought an anesthesiologist, Dr. Widdowson, with him from Philadelphia to assist during the surgical procedure.
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The president was compelled to cancel a conference appearance in New York City because his wife was “distressingly weak.” The Wilsons then embarked for the West Virginia resort town of White Sulphur Springs for an Easter respite. The concerned president hired a personal nurse to care for the first lady. Once again, Grayson sought the advice of Dr. Davis, this time regarding the availability of a capable local physician. Davis reassured the White House physician: “Dr. Kahlo, White Sulphur Springs, is a sensible and competent physician.”
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Eleanor Wilson was wed in a simple White House marriage ceremony on May 7, 1914. Her husband was fifty-year-old widower William McAdoo, President Wilson’s secretary of the treasury. Dr. Grayson, who by this time had become an intimate of the Wilson family, served as McAdoo’s best man.
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After the wedding, Mrs. Wilson’s decline was swift. Progressive weakness and chronic indigestion were the most noticeable symptoms. At the end of June Grayson finally persuaded Ellen Wilson to spend most of each day in bed.
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Between mid–March and early July, Grayson was the only physician to attend the dying first lady. However, when her condition worsened decidedly, Grayson quickly arranged for professional reinforcements. He urgently requested consultations from his Philadelphia colleague Dr. Davis, Dr. Francis X. Dercum, also from Philadelphia, and Dr. Thomas R. Brown, from nearby Baltimore.

Dercum was a renowned neurologist who served as clinical professor of mental and nervous disorders at Jefferson Medical College and had authored several textbooks in this field. Five years later he would be one of the specialists Grayson consulted after Woodrow Wilson was felled by a massive stroke. Ironically, several years earlier Mrs. Wilson had consulted Dercum regarding her husband’s neurological problems. She was afraid of the effects the presidency might have upon Wilson’s fragile nervous constitution.
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The involvement of Dercum, a neurologist, at this critical stage, probably derived from the lingering misdiagnosis by Ellen’s doctors, that “nerves” were the basis for her symptoms. The kidneys had not yet been implicated as the source of her troubles.

Grayson’s reasons for consulting Dr. Brown are speculative; undoubtedly his medical reputation and his availability, with Baltimore’s proximity to Washington, were factors. Thomas Brown was the first candidate to receive an M.D. degree from the prestigious Johns Hopkins School of Medicine. After serving an internship at the Johns Hopkins Hospital, Brown was promoted to its prestigious teaching staff. In 1912 he was selected to develop gastroenterology as a new and distinct specialty. Perhaps it was Brown’s expertise with Mrs. Wilson’s prominent symptoms—nausea, vomiting, lack of appetite and abdominal pain—that attracted Grayson’s attention. It was an unfortunate conclusion that focused upon the secondary symptoms in the intestinal tract rather than upon the culprit organ, her kidneys.
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Despite the ministrations of the medical reinforcements, Mrs. Wilson continued to fail, and an alarmed Dr. Grayson moved into the White House on July 23 to be available around the clock.
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Mrs. Wilson passed away in her room in the White House on August 6, 1914. Forewarned, the Wilson family had gathered about the dying patient. The cause of death was attributed to Bright’s disease with complications. Grayson signed the death certificate that certified chronic nephritis as the cause of death.
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Daughter Ellen Wilson McAdoo, without any proof, stated that the underlying disease was tuberculosis of the kidneys. Perhaps she was misdirected by her friend Grayson, who was quoted some years after the death: “She was suffering from tuberculosis of both kidneys as well as from Bright’s disease.” Instead, Weinstein, a medical doctor, indicted damage to her kidneys that occurred during Ellen’s third pregnancy. The presence of albumin in her urine indicated either an upper urinary tract infection or, more likely, toxemia of pregnancy with kidney damage: Chronic nephritis that became progressive in 1912 and lethal in August 1914.
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It is unknown when the correct diagnosis of fatal kidney disease finally was made, but it was not made long before her death, and it was not made by Grayson. The first mention of diseased kidneys appeared only on August 12, the date of death, in a letter from Woodrow Wilson to his younger brother, J.R. Wilson: “Ellen’s condition gives us a great deal of alarm but we have by no means lost hope and are fighting hard to bring her through. The trouble centers in the kidneys.”
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Who made the correct diagnosis and why it was so delayed are academic questions. Their answers likely would not have affected Ellen Wilson’s terminal disease. Antihypertensive medications, which in present day are essential in the treatment of kidney disease, were yet to be discovered. Dubovay’s biography provides this summation: “Medical malpractice or Grayson’s intimate connection to the family … a correct diagnosis would have done nothing to save Ellen’s life. Prolonged bed rest and drugs to dull the pain … would still have been advised.”
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The ethical responsibilities of physicians to their patients are perceived differently in the early twenty-first century than during Wilson’s presidency a century ago. Today’s concepts of full disclosure and patient autonomy were then unknown, and a doctor was granted wide discretion regarding what he might reveal to, and what he might conceal from, a patient. It is not known, and will remain forever unknown, what Dr. Cary Grayson revealed to his patient Ellen Wilson about her medical condition.

The health of his other patient was paramount to Grayson. Not only was Woodrow Wilson the president, he was also the navy lieutenant’s commander-in-chief. Grayson’s words reflect his professional conflict: “My own anxiety was double for her, the invalid, and for the effects of her illness upon the President.”
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Weinstein sympathized with Grayson’s very difficult position. His close friendship with all the members of the presidential family confounded his ability to act with professional detachment: “Grayson was probably aware that she was seriously ill, but he was a military medical officer, serving under, and primarily responsible, for the health of the President. With this duty in mind, he could not risk upsetting Wilson by trying to penetrate his denial system and possibly precipitate another stroke…. This attitude may have delayed the calling in of consultants until relatively late in the illness.” The White House physician became so emotionally distraught that at the end he was unable to inform the immediate family that Ellen Wilson was terminally ill. That responsibility was left to Dr. Davis.
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Dr. Grayson rationalized his behavior in a letter to a president’s advisor: “I felt it my duty to save the President from all worry, anxiety and distress as long as possible. This was an awful load to struggle under. He gradually realized the seriousness of the case and about a week before the end I told him that I thought the daughters should be here—he understood.”
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The president was certainly confused, probably as a result of Grayson’s misdirection and ignorance. His letters from late June to late July contain phrases such as the following: “…fear … is past and she is coming along slowly but surely”; “Ellen is making good progress”; “…at present to be making little progress, and yet it still seems certain that there is nothing wrong with her.”
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The course and fatal outcome of Mrs. Wilson’s kidney disease probably were not related to her responsibilities as first lady. She was ill prior to her husband’s election to the presidency. When her symptoms worsened in the late spring of 1913, she temporarily retired from the White House to spend a restful summer in New Hampshire. Upon her return to Washington, she exhausted herself during the planning and organization of daughter Jesse’s elaborate wedding. However, the above opinion is not unanimous. A prominent newspaper opined: that “Bright’s disease … was aggravated by a nervous breakdown attributed to the exertion of social duties and her active interest in philanthropy and betterment work.”
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The first lady was the recipient of the continual attention and care of the White House physician. She was one of his only two patients. Moreover, Grayson was able to command when necessary the consultations of eminent physicians, e.g., Doctors Davis, Brown and Dercum. But his commitment to Ellen was muted by his prioritization of Woodrow Wilson’s psychological well-being. Grayson successfully masked the seriousness of Ellen’s illness; the president’s connubial distractions were consequently limited, allowing him to focus on the affairs of state. Psychologically unprepared for his wife’s death, Wilson became emotionally devastated and went through a severe reactive depression that lasted four or five months.
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Woodrow Wilson’s lifelong emotional and psychological difficulties were so prominent that Sigmund Freud coauthored with William Bullitt a book that analyzed them. Regarding his wife’s death, Freud and Bullitt wrote the following: “She had been a perfect wife to Woodrow Wilson: an admirable mother representative, a ‘center of quiet’ for his life…. [T]he loss of Ellen Axson shook the foundations of his character. He could not pull himself out of the depression caused by her death. Again and again he expressed his grief and his hopelessness … his life was unbearably lonely and sad since … death and he could not help wishing someone would kill him.” In the wake of Ellen’s demise, the president experienced grief, hopelessness, inadequacy, extreme loneliness, and guilt. He blamed his political ambitions for his wife’s death. “He felt that his life was over, and, in the depths of his depression, he expressed the wish that someone would kill him.”
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Mrs. Wilson died on August 6, 1914, the same day that Austro-Hungary declared war on Russia, one of the many actions that embroiled Europe in World War I. Wilson’s doctor noted that his patient’s attention was not upon the war, and not even upon American politics, but upon his deceased wife. Instead of exercising international leadership, Wilson was distracted, confessing to his senior advisor, Colonel House, that he could “not think straight” and “had no heart in the things he was doing.”
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Edmund Morris, in the final volume of his three-volume biography of Theodore Roosevelt, concluded that Woodrow Wilson, during the late summer of 1914, was perhaps the only statesman who could influence the outcome of the war. But the immobilized and depressed Wilson “could concentrate only on the driest details of domestic policy…. When Wilson thought about foreign policy at all, he brooded over the still-unsettled situation in Mexico.” In a grotesque coincidence, both Woodrow Wilson and his archenemy, Theodore Roosevelt, lost their first wives to Bright’s disease.
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Grayson’s efforts to pierce his patient’s depression included golf, automobile drives, and trips on the presidential yacht,
Mayflower
. Any relief was only temporary. After Colonel House departed the executive mansion for a European fact-finding trip in January 1915, Wilson’s loneliness became so desperate that he approached “a nervous collapse.” Music and guests at the White House became additional parts of Wilson’s therapeutic regimen.
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Although stories differ, the ever-concerned personal physician and by this time an intimate friend, Cary Grayson, was in some ways behind the introduction of the lonely president to his second wife, Edith Bolling Galt, “an outgoing, buxom, forty three year old widow, the owner of a thriving jewelry store.” The wedding occurred ten months after they first met, and Wilson recovered from his inactivity and depression.
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A recurrent leitmotif in this book so far is the morbidity associated with pregnancy. This situation lasted until the first decade of the twentieth century. Louisa Catherine Adams, who experienced twelve pregnancies, may have suffered from postpartum depression. A cerebrovascular stroke felled Letitia Tyler, who experienced nine pregnancies during her reproductive years. It is not farfetched to speculate upon a nexus between her repeated deliveries, the onset of hypertension, and the hemorrhagic infarction in her brain. There is an unequivocal connection between Ida McKinley’s second pregnancy and her stroke and lifelong epilepsy. Caroline Harrison’s genital organs were damaged during a difficult delivery. The resultant vesicovaginal fistula required surgical repair and a long convalescence. Finally, it is probable that Ellen Wilson developed toxemia of pregnancy with chronic kidney disease.