The Health of the First Ladies: Medical Histories from Martha Washington to Michelle Obama (41 page)

Profound grief assailed several first ladies. The office of the president triggered the assassinations of four of its occupants, Lincoln, Garfield, McKinley, and Kennedy. Mary Lincoln and Jacqueline Kennedy were first-person witnesses to their husbands’ murders. Nancy Reagan was permanently rattled by John Hinckley’s near-fatal attempt on President Reagan’s life.

Some first ladies experienced the loneliness of a spouse of an ambitious public figure. John Quincy Adams’ personality and political ambition took precedence over any intellectual or emotional intimacy with Louisa Catherine Adams. However, physical intimacy was not eschewed; Louisa’s twelve pregnancies were the proof, but loneliness and depression were her rewards. Mrs. Betty Ford acknowledged marital isolation from Gerald Ford both before and after the White House. Paradoxically, her abbreviated White House residence was somewhat beneficial. However, the cumulative years of loneliness resulted in depression and alcoholism. Barbara Bush, the epitome of assurance and composure while a president’s spouse, became lonely and depressed when George Bush previously was director of the CIA.
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A president’s career can sometimes place the first lady in a place or a situation disadvantageous to her health. Geography may have been instrumental in the malaria of Abigail Adams (New York City swamps), Sarah Polk and Lucretia Garfield (the District’s stagnant waterways), and possibly for Caroline Harrison’s tuberculosis (long hours in the dank basement of the executive mansion as she catalogued its furniture and furnishings). Last, why would Abigail Fillmore attend Franklin Pierce’s inauguration in Washington’s dismal March weather other than as the departing first lady? Pneumonia and death were her compensation.

As a public figure, the privacy of their medical history is subject to challenge. Only Florence Harding, Betty Ford, and to a lesser extent, Nancy Reagan, were transparent. Many, like Laura Bush, resented the intrusion.

Both tradition and contemporary medical ethics believe that confidentiality is the best way to protect the well-being of a patient. The principle that the physician-patient relationship is sacrosanct, requiring that all patient medical information must remain private, is both respected and followed. Medical confidentiality has its basis in the Hippocratic oath, which states, “What I may see or hear in the course of the treatment or even outside of the treatment in regard to the life of men, which on no account one must spread abroad, I will keep to myself holding such things shameful to be spoken of.”
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White House physicians have adhered strictly to complete confidentiality of a first lady’s medical information. Burt Lee, President George Bush’s personal physician, directed Dr. Connie Mariano upon her selection as a White House physician: “The health of the First Lady is off limits completely to the press.”
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Tony Snow, then President George W. Bush’s press secretary, defended first lady Laura Bush’s nondisclosure of a skin cancer. He posited that she was not an elected official, and as a result, had the same right to medical privacy as an ordinary citizen.
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An analyst agreed, admitting that, although the first lady is a public figure, she has no policy role and the removal of the skin lesion had no bearing on the commonweal.
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However, modern society acknowledges several exceptions to complete medical privacy. These include a personal waiver by the patient; specific diseases, injuries or treatments; threats of self-harm including suicide; and danger to third parties.
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This author proposes that the practice of strict confidentiality afforded to a first lady’s health be reexamined. The first lady is usually the president’s closest confidante and intimate. History has demonstrated that her illness may affect the performance of her husband. Examples include the following: (1) the depression of Jane Pierce damaged the effectiveness of antebellum president Franklin Pierce during the country’s drift to civil war; (2) Caroline Harrison’s fatal disease severely limited Benjamin Harrison’s campaign for reelection, which he lost; (3) Ellen Wilson’s terminal disease, her death, and its aftermath led to President Wilson’s apathy and delayed decision-making during early World War I. Is it not possible that a wife’s illness may present a danger to a third party, i.e., the citizens of the United States?

Moreover, a first lady cannot candidly be considered a “private citizen,” as claimed.
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She is housed, fed, transported, and protected at public expense. Moreover, she is provided constant and continuous medical care by the many members of the White House Medical Unit. A president’s wife occasionally intrudes into policy-making. The most striking example was Hillary Clinton’s attempt in the early 1990s to rearrange America’s health care system. As a result, on June 22, 1993, the United States Court of Appeals for the District of Columbia ruled that Hillary Rodham Clinton was a full-time government official.
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In addition, the revelation of a first lady’s illness may benefit the public. The publicity attached to Mrs. Ford’s and Mrs. Reagan’s breast cancers encouraged their peers in the public to arrange for early breast screenings.
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Unfortunately twenty-first century practices by the United States government,
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as well as widespread abuse and mishandling of Internet-obtained personal information,
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have made the confidentiality of personal information, including medical, nearly obsolete.

In this atmosphere there is little reason why the spouse of the leader of the American government should be exempt from such scrutiny. Such specialized treatment is unfair while at the same time average citizens going about their daily business are subjected to all sorts of intrusive surveillance against their will. After all, the decision to strive for the position of first lady was voluntary.

In my opinion, the first lady should waive the confidentiality of her medical record. It would be an affirmative gesture on her part, since in almost any case the public will find out about any medical problems sooner or later—probably sooner than later, given the vastly expanded and intrusive media outlets.

1.
John B. Roberts II,
Rating the First Ladies
(New York: Citadel, 2003).

2.
Jonah Goldberg, “The Irony of Michelle Obama’s Water Campaign,”
Los Angeles Times
, October 1, 2013.

3.
Carl Sferrazza Anthony, ed.,
This Elevated Position: A Catalogue and Guide to the National First Ladies’ Library
(Canton, OH: National First Ladies’ Library, 2003).

4.
Hillary Clinton,
Living History
(New York: Scribner, 2003). The former first lady’s autobiography sat near the top of nonfiction sales charts for many months in 2003; Sylvia Jukes Morris,
Edith Kermit Roosevelt: Portrait of a First Lady
(New York: Coward, McCann and Geoghegan, 1980). This biography of Theodore Roosevelt’s second wife, Edith Carow, was very favorably reviewed when published.

5.
Laura C. Holloway,
The Ladies of the White House; or, In the Home of the Presidents; Being a Complete History of the Social and Domestic Lives of the Presidents from Washington to the Present Time, 1789–1881
(Philadelphia: Bradley, 1881).

6.
Betty Boyd Caroli,
First Ladies
(New York: Oxford University Press, 1987), xxii.

7.
Carl Sferrazza Anthony,
First Ladies: The Saga of the Presidents’ Wives and Their Power, 1789–1961
, vols. 1 and 2 (New York: William Morrow, 1990).

8.
Margaret Truman,
First Ladies
(New York: Random House, 1995).

9.
Robert P. Watson,
The Presidents’ Wives: Reassessing the Office of the First Lad
y (Boulder, CO: Lynne Rienner, 2000).

10.
Lewis L. Gould,
American First Ladies: Their Lives and Legacy
, 2d ed. (New York: Routledge, 2001).

11.
Cynthia D. Bittinger,
Grace Coolidge: Sudden Star
(New York: Nova History, 2005), viii.

12.
Robert H. Ferrell,
Grace Coolidge: The People’s Lady in Silent Cal’s White House
(Lawrence: University Press of Kansas, 2008), viii.

1.
Robert P. Watson,
The Presidents’ Wives: Reassessing the Office of the First Lady
(Boulder, CO: Lynne Rienner, 2000), 16n.

2.
Margaret Truman,
First Ladies
(New York: Random House, 1995), 17–18; Betty Boyd Caroli,
First Ladies
(New York: Oxford University Press, 1987), xv.

3.
Watson,
The Presidents’ Wives
, 10–11.

4.
Ibid.; Caroli, xv.

5.
Caroli, xv; Watson:
The Presidents’ Wives
, 10.

6.
Harriet Lane, Biography, National First Ladies’ Library, http://www.firstladies.org/biographies/firstladies.aspx?biography=16 (accessed February 3, 2014).

1.
 Jim Murphy,
An American Plague: The True and Terrifying Story of the Yellow Fever Epidemic of 1793
(New York: Clarion, 2003), 43.

2.
Abigail Adams, Biography, National First Ladies’ Library, http://www.firstladies.org/biographies/firstladies.aspx?biography=2 (accessed October 10, 2013).

3.
Robert P. Watson,
First Ladies of the United States: A Biographical Dictionary
(Boulder, CO: Lynne Rienner, 2001), 16–7.

4.
Catherine Allgor,
A Perfect Union: Dolley Madison and the Creation of the American Nation
(New York: Henry Holt, 2006), 6, 247; Watson, 33; Dolley Madison, Biography, National First Ladies’ Library, http://www.firstladies.or/biographies/firstladies.apx?biography=4 (accessed February 8, 2010; Allen C. Clark,
Life and Letters of Dolly Madison
(Washington: W.F. Roberts, 1914), 93, 190.

5.
Murphy, 3.

6.
http://millercenter.org/president/events/12_06.

7.
Murphy, 9.

8.
Ibid., 12–14.

9.
Ibid., 15–16, 57, 85.

10.
Douglas Southall Freeman,
Washington
(New York: Simon & Schuster, 1992), 638–9.

11.
Helen Bryan,
Martha Washington: First Lady of Liberty
(New York: John Wiley, 2002), 325; Stephen Decatur and Tobias Lear,
Private Affairs of George Washington, from the Records and Accounts of Tobias Lear, Esquire, His Secretary
(New York: Da Capo, 1969 [1933]), 181, 194, 205.

12.
Murphy, 42.

13.
Anne Hollingsworth Wharton,
Martha Washington
(New York: Scribner’s, 1899), 245; Bryan, 327; Joseph E. Fields, ed.,
“Worthy Partner”: The Papers of Martha Washington
(Westport, CT: Greenwood, 1994), 252n; Murphy, 42; Freeman, 638–9.

14.
Allgor, 22–3.

15.
Paul Zall,
Dolley Madison
(Huntington, NY: Nova History, 2001), 9–10; Allgor, 25; Catharine Anthony,
Dolly Madison: Her Life and Times
(Garden City, NY: Doubleday, 1949), 49–50; Lewis L. Gould,
American First Ladies: Their Lives and Legacy
, 2d ed. (New York: Routledge, 2001), 22.

16.
Gould, 22; Clark, 18–9.

17.
Anthony, 49–50, the author’s definite diagnosis of yellow fever; Allgor, 25: “whether she contacted yellow fever is unclear.”

18.
Murphy, 104; Allgor, 25.

19.
Murphy, 108, removal of government to Germantown; David McCullough,
John Adams
(New York: Simon & Schuster, 2001), 491–2, Adams to Eastchester in 1797; Gould, Trenton in 1799.

20.
Murphy, 131

21.
Ibid., 132.

22.
“Yellow Fever Epidemic of 1793,” Wikipedia, http://en.wikipedia.org/wiki/Yellow_Fever_Epidemic_of_1793 (accessed October 9, 2011).

23.
Ibid.

24.
Ibid.; Mary T. Busowki, Burke A. Cunha, et al.: “Yellow Fever,” http://emedicine.medscape.com/article/232244 (accessed October 20, 2011).

25.
Ludwig M. Deppisch, M.D.:
The White House Physician: A History from Washington to George W. Bush
(Jefferson, NC: McFarland, 2007), 9.

26.
Ibid., 11; Wharton, 105–6; Bryan, 205–6.

27.
Fields, 168–9.

28.
Martha Washington Biography, National First Ladies’ Museum.

29.
Freeman, 710; Wharton, 148–9; Bryan, 139–141; Fields, 186.

30.
Deppisch, 7–9, 14–17.

31.
Fields, 186.

32.
Ibid., 237.

33.
Ibid., 23.

34.
Patricia Brady,
Martha Washington: An American Life
, Google Books, http://books.google.com/books?id=vqCIBnJOwsC&pg=PT170&lpg (accessed October 11, 2011).

35.
Bryan, 72–4.

36.
Fields, 15–16, 123–4.

37.
Bryan, 139–40.

38.
Deppisch, 7–10, 12.

39.
Freeman, 740; Bryan, 365–6.

40.
Bryan, 377, 379.

41.
Gould, 23; Anthony, 165–7; Allgor, 108–110; Zall, 39–40: various names applied to Mrs. Madison’s knee abnormality; Clark, 72–3: attempts to cure malady at Montpelier; Ralph Ketcham,
James Madison
(Charlottesville: University Press of Virginia, 1990), 442–5: “a complaint near her knee, which from a very slight tumor had ulcerated into a very obstinate sore.”

42.
Anthony, 165–7; Allgor, 108–110; Zall, 39–40.

43.
Deppisch, 12.

44.
Ira M. Rutkow, “Philip Syng Physick,”
Archives of Surgery
136, no. 8 (August 2001), 968.

45.
J. Randolph,
Life and Character of Philip Syng Physick
(Philadelphia: T.K. and P.G. Collins, 1839), 33.

46.
 Ibid., 37.