The only credentialed physician, by modern standards, who treated Martha was James Craik of Alexandria, Virginia. Craik had been the first president’s personal doctor for many years before Washington’s presidency and was unwilling to forego his lucrative Virginia medical practice in order to become the first presidential physician—in either New York or Philadelphia.38 However, when the Washingtons returned to Mount Vernon after leaving office in 1797, Craik reassumed his role as George’s personal physician and eventually attended his death. On several occasions in 1799 the doctor was requested to treat Martha for probable malaria. He used the usual remedy, “the bark” (quinine).39 In 1802 he was present during Martha Washington’s final illness and death at 70 years. At the end of her life Martha Washington suffered from some sort of mental distress or possibly dementia.40
Dolley Madison’s Medical History
Dolley Madison, a robust and attractive woman, was notable not only for her extravagant sociability but also for her physical appearance. She stood five feet, six and one half inches tall and had blue eyes and black hair. The latter was usually adorned by her signature turban. Born Dorothea Payne, she was early on familiarly addressed as Dolley and the name stuck.
While providing sturdy physical and emotional support props for her second husband, James Madison, during his secretary of state, presidential and retirement years, Dolley had several illnesses. A major problem occurred midway during her service as President Jefferson’s social hostess. While at the Madison home in Virginia—Montpelier—“In the fourth year at Washington, Mrs. Madison succumbed to a physical ailment. She had an attack of rheumatism, the inflammatory kind. From Montpellier [sic], June 3, 1804, she tells her sister, Anna, of the painfulness of it; of the bleeding by Dr. Willis and the nursing by Mother Madison, and of her intended return to Washington the week later.” “Then Mrs. Madison was at Montpellier, held by rheumatism.” The lesion of her right knee was variously described as a “sore,” an “ulcer,” and a “tumor.” Its true nature remains unsettled; Ketcham described the lesion as “a complaint near her knee, which from a very slight tumor had ulcerated into a very obstinate sore.”41 Washington doctors were consulted: “Two doctors have applied caustic with the hope of getting me well, but heaven knows! I feel as if I should never walk again.” It is unsurprising that the fierceness of these remedies was directly proportional to the distress of the patient, since she was confined to her room in Washington with no clinical relief.42
Dr. Philip Syng Physick, prominent Philadelphia surgeon. He treated future first ladies Dolley Madison and Louisa Catherine Adams (courtesy National Library of Medicine).
After a month of unsuccessful treatment, James Madison accompanied his wife to Philadelphia for treatment by the famous and respected physician with the memorable last name—Dr. Philip Synge Physick. A benefit, then and now, generally reserved for the prominent, especially America’s first ladies, is access to the most famous and skilled practitioners of the day. Philadelphia native Physick had received his medical degree in 1792 from the prestigious University of Edinburgh.43 Returning home, he was shortly appointed surgeon to the Pennsylvania Hospital. Ten years later he became the first chair of surgery at the University of Pennsylvania School of Medicine.44 Physick returned to Philadelphia just in time to assist during the 1793 yellow fever epidemic which “afforded … his first opportunity for proving to his fellow citizens his entire devotion to his professional disputes, his utter disregard of his personal considerations … and the fearless intrepidity with which he exposed himself to danger, in order to contribute to the safety of others.”45 Physick autopsied yellow fever deaths, but, like all his contemporaries, erroneously ascribed its cause. He attributed its pathogenesis to gastritis.46 Physick was sickened with yellow fever during the 1798 Philadelphia epidemic but survived.47 (Dolley may have had a previous connection with Physick. As a student, Physick boarded in Philadelphia “with the family of the late Mr. John Todd, the father in law of the present venerable Mrs. Madison.”)48
The eminent Physick confined Dolley to a bed and treated her with splints that bound her knee. Although a noted surgeon, he did not operate. She wrote her sister: “I am on my bed.” At first she was afraid that she would never walk again. She remained under his care for four months. Then, cured, she returned to Washington in November 1805. A November 1, 1805, letter from Dolley in Philadelphia to James Madison in Washington states the following: “I have great pleasure, my beloved, in repeating to you what the doctor has just told me—that I may reasonably hope to leave this place in a fortnight.”49
Physick’s fame was such that he treated President Andrew Jackson and Louisa Johnson Adams in later years. On August 19, 1811, Mrs. Madison wrote Anna Custis advising her to consult Physick for her daughter’s foot problem: “…but your precious daughter—What shall we do? when you are able, come on, & stop with Dr. Physick—many, many, have been made perfect by [his] care, & why may we not hope that her dr. foot will be streighten’d with care—Yes, I am sure it will.”50
Dolley suffered one other illness before her husband’s inauguration that occurred after an arduous journey from Washington to the Madisons’ Montpelier estate. Her June 3, 1808, letter stated: “I have been quite ill since I wrote you last, with the Infamitory Rumatism [sic]—never had I more extreme sickness and pain—Doct Willis bled me and gave me medcin [sic].” (Dr. John Willis had married Nelly, Dolley’s niece, in 1804.)51
Wife of the President
“Queen Dolley” was nothing less than regal during James Madison’s eight-year, two-term presidential reign. Catherine Allgor characterized the tenure of this first lady: “Despite an eye ailment. rheumatism, ear trouble with temporary deafness, and several other bouts of ill health, Dolley Madison presented a healthy, energetic, robust appearance to the political world: “A confident, easy Dolley, cheeks ablaze, dominating the room, not only balanced James’s [Madison] lack of vigor, it allowed him to be himself.”52 “[U]nder Dolley’s presiding genius … the years of Madison’s presidency were a social triumph.” “The Madisons set entertaining standards that dominated Washington social life until the Civil War.”53 The first wedding in the White House was that of Dolley’s widowed sister Lucy to associate Supreme Court justice Thomas Todd.54
Her correspondence, however, disclosed several episodes of significant illness. Her June 1811 letters refer to “a dangerous and severe illness” and being “extremely ill,” an illness that confined her to her room for three weeks. A July 29, 1812, letter explained: “For the past 10 days I have been sick, so much so, that I could not write or do anything but nurse myself.” A February 1, 1816, letter by a Mrs. Crowninshield recounts the following: “Mrs. Madison has been sick since Sunday—bilious colic.” The nature of her sicknesses remains undetermined. In neither instance did she seek medical advice. At this time there was no official physician in attendance at the White House.55 However, one chronic medical problem was identified—an eye ailment. For this she was treated with brandy and water by Scottish physician Robert Honyman. She refused to take “physick” other than a cream of tartar, and magnesia now and then. Honyman practiced in Hanover County, Virginia, and was a friend of Dolley’s aunt and uncle and acquainted with the Madisons.56
After the presidency, the Madisons returned to their plantation at Montpelier, where James Madison died in 1836. The former president was chronically unhealthy; Dolley was in far better condition but continued to suffer from rheumatism, stress, and the recurrent eye ailment. Her “ophthalmia, so draining of her reading pleasure grew worse. With weakening painful eyes, she could be less useful in rearranging Madison’s papers.”57 In letters she wrote that “my eyes are troubling me,” “the continuing and very severe affection of my eyes, not permitting, but with much difficulty, even the signature of my name, has deferred … the acknowledgements due to your very kind and very acceptable letter.”58 In 1837 she journeyed to White Sulphur Springs for her eyes. Despite episodic improvements, there was a negative net
loss.59
After her husband’s death, Dolley Madison eventually returned to Washington, where she led an active social life and was revered both by presidents and by the social-political elite. She died from a stroke on July 12, 1849, at age seventy-seven.60
Chapter Two
Malaria in the White House
Abigail Adams, Sarah Polk and Lucretia Garfield
Abigail’s malaria and rheumatism had both acted up in Philadelphia, and she had been especially miserable the previous spring. The malaria “still hangs about me & prevents my intire recovery,” she reported to her sister Mary … in April, 1792.1
Malaria was a significant illness in colonial and nineteenth-century America. It affected at least three presidential wives: Abigail Adams (1797–1801), Sarah Polk (1845–1849) and Lucretia Garfield (1881). (Malaria still infects 225 million people worldwide each year and almost 800,000, mostly in Africa, die annually from this disease.)2
Prior to the discovery of its infectious agent and its mode of transmission during the late nineteenth and early twentieth centuries, malaria in North America was commonly known as the “ague,” “fever and ague,” “intermittent fever,” and, less frequently, “remittent fever” or “bilious fever.” Its symptoms—the cyclic occurrence every two days of sudden coolness followed by rigor, and then fever and sweating lasting four to six hours—were familiar to both the medical and lay population. Malaria’s intermittent character is related to the cyclic multiplication of its causative agent within the patient’s red blood cells. There was an early recognition that proximity to swamps or still water was a requirement for infection. Seasonality was connected to the appearance of the disease; symptoms would arise in the summer and disappear in the cold of winter. For centuries there was an erroneous association with the miasma, i.e., noxious air, arising from decomposing waste. Hence arises the derivation of its name: foul or bad (mal) air (aria).
It was not until 1880 that the Frenchman Charles Laveran discovered the protozoan parasite (plasmodium) in human blood as the agent that caused the disease. Furthermore, it was only at the dawn of the twentieth century that Ronald Ross proved that this protozoan was transmitted by mosquitoes.3
Abigail Adams
Malaria
The formidable wife of John Adams, much admired and a frequent subject of biographers, suffered from many physical ills, one of which was malaria. Readers may inquire how this hardy New Englander, who rarely spent the months of summer south of New England, was able to contract malaria, considered at present to be a neotropical disease. Her husband, John Adams, was inaugurated as the first vice president of the United States in 1789. He importuned Abigail to join him in New York City, the first capital; she acquiesced and joined him in June 1789.4 The Adamses remained in the city until the nation’s seat of government transferred to Philadelphia in late 1790. Mrs. Adams left for the new capital during mid-autumn of 1790.5 A biographer described New York City at the time as “steamy and unsanitary.” In the 1700s, the city neighborhood known as Five Points (now near city hall) was the site of a swampish lake, called the Collect, which was rimmed by slaughterhouses: “Due to the conditions, malaria was not uncommon.”6
Abigail Adams, wife of John Adams. She was the second first lady (Library of Congress).
The prospect of moving the household back to Massachusetts and back again to New York City and then to Philadelphia proved too daunting, and consequently Abigail remained eighteen months, including the summers of 1789 and 1790, in New York. This episode was one of the few times she spent these months south of New England.7
Dr. Benjamin Rush, physician to Abigail Adams in Philadelphia (courtesy National Library of Medicine).
On the evening of October 10, 1790, “she contracted an illness she called ‘intermitting Fever’ … Abigail ‘was taken with a shaking fit which held me 2 hours and was succeeded by a fever which lasted till near morning.’” Historians believe she had contracted malaria. It would periodically flare up throughout the rest of her life. The usually sturdy Mrs. Adams was diminished by her illness, becoming so weakened that any effort made her ill: “Despite her illness she managed to finish the packing, and in late October they moved to Philadelphia…. Her ill health had made the trip slow and tedious, she could stand to travel only about 20 miles a day, so it took them five days to go from New York to Philadelphia.”8 Her symptoms, the early autumn onset, her summer residence in a “steamy and unsanitary” port city, and her own description of the fever as “intermitting” convince one that the disease was malaria, a conclusion shared by her biographers. A feature of the type of malaria endemic to America is its chronic periodicity, with several annual flare-ups that produce morbidity but rarely mortality.9
After an uninterrupted year and a half in New York and Philadelphia (1790–1791), the Adamses decided never again to spend a summer in the nation’s capital. The restorative effects of a few months at home far outweighed the inconvenience of moving their household twice a year. The Adamses journeyed to their Massachusetts home to spend the 1791 summer and subsequently returned to Philadelphia for the congressional session that commenced in October. “For the remainder of his term as Vice President, the Adamses settled into a comfortable if hectic routine. From late fall when Congress convened until sometime in the spring when it adjourned, they lived in Philadelphia; the moment Congress completed its session they went home.”10 Abigail was miserable during her 1791–1792 stay in Philadelphia. Physical complaints from rheumatism and malaria increased to the point that she worried how she could manage the journey home when Congress adjourned. In a March 20, 1792, letter to her sister, Abigail explained: “It was necessary to quell the inflamitory disease first, & Bark could not be administered for that. I am now reduced low enough to drive away the Rhumatism but the old Enemy yet keeps possession. The Dr. promisses me the Bark in a few days.”11
The physician referred to in the letter was the famous Dr. Benjamin Rush; the bark was the material wherein quinine was administered at the time. Benjamin Rush was well known to both Adamses; he was a friend of John and both were signers of the Declaration of Independence. The doctor had previously treated their youngest son, Thomas, in Philadelphia in 1790. At that time, Abigail “found him a kind friend as well as Physician.” During her miserable 1791–2 interlude in Philadelphia, Rush visited several times to draw blood from her. She also consulted Rush regarding her niece’s tuberculosis. “The (future) first lady’s reliance upon Dr. Rush stemmed in part from her agreement … on the value of bleeding as an almost universal remedy. Emetics, bleeding, and the bark, in Abigail’s catechism of health, the holy trinity of treatment.” Abigail’s faith in Rush was enduring. In 1811 she wrote him in Philadelphia from her home in Massachusetts about the breast tumor that afflicted Nabby, the Adamses’ daughter. From afar, Rush diagnosed cancer. He urged a mastectomy—an exceedingly rare surgery at that time—upon the Adamses’ reluctant Boston doctors. The operation was performed and Nabby lived for three more years.12
John Adams’ political activity was the nexus connecting the most renowned Philadelphia physician of the period to Abigail and the Adams children. The courageous doctoring of Benjamin Rush during Philadelphia’s yellow fever plague of 1793 has already been noted. Rush, with fellow American graduates of the University of Edinburgh Medical School, founded the first medical college in North America. He was a charter member of the faculty of the Medical School of the College of Philadelphia. His long tenure there allowed him to become the most influential teacher of future American physicians during the late eighteenth and early nineteenth centuries. His “heroic” approach to a patient, which encompassed significant bloodletting and both adventuresome emetics and purgatives, may have endeared him to the future first lady but also corrupted medical therapeutics for decades to come.13
In the early 1600s, Jesuit missionaries noted that the bark of the cinchona tree was used by the northern Peru Indians as a cure for “shivering diseases.” Assuming that “Jesuit’s bark” or
the “bark,” would be equally effective for treating the shaking chills associated with “marsh fever,” as malaria was commonly called in Rome, the bark was exported to Italy. Later, quinine was identified as the active ingredient of the bark. It was introduced to colonial America by English physicians. Its use would temper the symptoms but not cure the disease.14
During the summer of 1792, “Abigail was sick through most of the summer with malaria, or ‘intermittent fever,’ as she called it…. Abigail was debilitated for several weeks with the disease. When it came time to return to Philadelphia in the fall, she had neither the strength nor enthusiasm for the journey.” She did not leave her Massachusetts home for the capital for five years, even missing her husband’s second vice presidential inaugural in 1793.15
Malaria sickened Abigail Adams periodically through 1798. It occurred annually, sometimes attacking her twice a year. Its symptoms seldom kept her bedridden for more than a few days. There is no record of medical attendance or type of treatment for these chronic attacks during the Massachusetts interval. Perhaps her uncle, Cotton Tufts, provided for her care. He was a Harvard undergraduate, studied medicine as an apprentice to his brother, and later received an honorary degree in medicine from Harvard. Tufts was a well-known physician and was an incorporator and later president of the Massachusetts Medical Society.16
The Health of the First Ladies: Medical Histories from Martha Washington to Michelle Obama Page 3