The Health of the First Ladies: Medical Histories from Martha Washington to Michelle Obama

by Deppisch, Ludwig M. , M. D.

  The new Tyler daughter-in-law, Priscilla Cooper Tyler, wrote about her mother-in-law’s partial recovery in a letter to her sisters: “[She reads] her bible and her prayer-book—with her knitting usually in her hands…. Notwithstanding her very delicate health, mother attends to and regulates all household duties…. All the clothes for the children, and for the servants, are cut out under her immediate eye, and all the sewing is personally superintended by her.” “She must have been very beautiful in her youth, for she is still beautiful in her declining years and wretched health.” Unfortunately Mrs. Tyler remained in her bedchamber after this illness.13

  Motherhood in the Old South was both difficult and demanding. Women approached their due date in fear of pain and death for either themselves or their infants. Southern mothers emerged from their repeated pregnancies with physical ailments, infections, and debilitating illnesses. Southern families, as in the case of the Tylers, were large, thereby increasing a woman’s physical risks. “Malaria was another danger for Southern women during and after childbirth. For the most part it did its harm by causing debilitation and a susceptibility to other diseases.”14

  Letitia Tyler’s debility was no doubt in part a result of physical exhaustion from her repeated pregnancies. However, hypertension may be linked to grand multiparity; additionally a salient symptom in this patient was recurrent, frequently severe, headaches, another linkage with hypertension. The rudimentary medicine of the era could not document her blood pressure or laboratory values. However, one may speculate strongly that an elevated blood pressure would explain her medical problems, at least in part.15

  First Lady

  John Tyler, after his election (November 1840) as William Henry Harrison’s vice president, planned to continue living in his Williamsburg home. He decided that the ailing Letitia would be more comfortable there than in Washington. Such an arrangement was possible since the vice presidency continued to remain a nonessential office.16 This plan dramatically changed with President Harrison’s death one month after his inauguration. Tyler became the first vice president to succeed to the presidency upon the death of a president. Daniel Webster’s son, Fletcher, chief clerk in the State Department, and Mr. Beall, an officer of the Senate, interrupted the Tylers’ rustic peaceful existence with the shocking news. It was then decided that Letitia would move to the White House, but it was apparent that she was unequal to the role of first lady. Her daughter-in-law Priscilla, a former actress, became the social mistress of the executive mansion, the second of the surrogate first ladies. Fortunately, an old and successful hand was available for guidance, as we shall see.17

  As President Tyler had the social intuition to select as his official White House hostess one who could match his easy informality, he accordingly asked his daughter-in-law Priscilla to perform this responsibility and took her consent for granted as his wife was an invalid; his two older daughters were married; and his two younger daughters were either inexperienced or too young. Priscilla’s responsibilities included presiding at biweekly receptions, triweekly dinners, monthly public levees, and the entertainment of callers who every night crowded the White House Green Room. Occasionally one or several of the Tyler daughters would assist, but from April 1841 to March 1844 the responsibility was chiefly that of Priscilla Cooper Tyler.18

  When in doubt, she had that most experienced of White House hostesses available for advice. Dolley Madison had returned to Washington and subsequently assisted Priscilla in her social duties. The widow Madison, “turbaned, painted, powdered, and dipping snuff was in and out of the White House like a good neighbor.” Mrs. Madison, who had frequently served as the hostess for the widower Thomas Jefferson, was the first surrogate first lady19: “After a short time she became more accustomed to her stellar role and pleased the President and amazed herself by performing her duties with what seemed easy grace.”20

  Priscilla continued in this role until her husband accepted a government job in Philadelphia. The Tylers’ second daughter, Letitia Semple, briefly acted as hostess until the president’s young wife, Julia Gardiner, took on the role after her wedding in June 1844. John Tyler’s new bride was thirty-one years his junior. The ex-president went on to sire seven more children with his much younger wife.21

  Elizabeth Tyler, the third Tyler daughter, married William Waller in a White House ceremony on January 31, 1842. The wedding and the reception afterwards were the only public occasions at which Letitia Tyler appeared. She generally remained in her room, an invalid who avoided excitement of any kind. However, on the night of the wedding, she emerged, beautifully dressed, to celebrate with the bride and groom.22

  Mrs. Tyler’s death was both unexpected and sudden. Daughter Letitia wrote her brother: “From the time she had been first stricken with paralysis, her health had been frail, but none of us anticipated an immediate, or even an early renewal of an attack, and far less, a sudden dissolution of her system.”23

  On the morning of Friday, September 9, 1842, Dr. Thomas, the family physician, noted a significant change in the first lady and became alarmed that a recurrent stroke was imminent. He immediately called for the consultation of Dr. Sewall. The methods used by these practitioners to prevent a cerebrovascular accident are unrecorded. Whatever treatments that were employed were unsuccessful. Mrs. Tyler declined rapidly and expired at 8:00 p.m. on Saturday, September 10, 1842.24

  Medical Care in the Tyler White House

  President John Tyler, by all accounts, was healthy during his White House tenure (1841–1845). There is no record either of illness or of professional medical care during his presidency. However, his term in office was not tranquil. Tyler was confronted by contentious foreign issues, domestic policy disputes, political disappointments, and the illness and demise of his wife. After he departed from the White House, he devoted himself to his much younger second wife, a growing family, and his Virginia farm. He occasionally involved himself in politics, the most notable example his election to the Confederate House of Representatives in 1862. He died in Richmond, the capital city of the confederacy, seventeen years after leaving the presidency.25

  John Moylan Thomas and Thomas Sewall were the two District physicians who attended the first lady at the end of her life. Moreover Dr. Thomas had made “almost daily visits” to the failing first lady for many months prior to her demise. Thomas was also the doctor to President Tyler, although any medical care for the president is undocumented.26 Thomas was well trained, receiving his medical degree from the University of Maryland. He started a medical practice in Washington, D.C., and also became involved in the profession’s organizational and academic activities. He was active in the District of Columbia Medical Society and represented the society at the 1848 inaugural meeting of the American Medical Association in Baltimore. He later became a professor at Washington’s Columbian Medical College.27

  However, Dr. Samuel Busey, a contemporaneous practitioner in the District, was very critical of Thomas’ personal character. He recollected that Tyler “came leisurely, after time, to his lectures on physiology (at the Columbian College), which were brief, polished, and unsatisfactory. He was always neatly dressed in the latest style, dignified, polite, but very reserved. At that time he had a very large business among the better class of citizens, and lived sumptuously.” A later citation by Busey even suggested an addiction to alcohol: “Some years later I parted with him in front of John Foy’s saloon about one hour before he wrote a prescription, it was alleged, killed a porter at Fuller’s Hotel, and the last time I saw him he was struggling, with assistance, to respond to a summons to see Mrs. Adams.”28

  Dr. Busey was more complimentary of Dr. Thomas Sewall, the second physician present at Mrs. Tyler’s deathbed: “In 1825 Thomas Sewall, a native of Massachusetts and a graduate of Harvard University, delivered the first lecture in the Medical Department of Columbian University. From that date until his death in 1845, at the age of fifty-nine years, Sewall was one of the most conspicuous and popular physicians of the
city.” Sewall’s professional career in Washington was both prominent and successful: Charter professor of Anatomy and Physiology at Columbian University, the predecessor of the George Washington School of Medicine; astute promoter of William Beaumont’s groundbreaking experiments on gastric physiology; and assistant surgeon in the 1839 removal of a seven-and-a-half pound tumor of the jaw of a prisoner at the Washington almshouse.29 Sewall’s civic accomplishments were also numerous. He had been known to President Tyler since the chief executive appointed him as one of the three medical inspectors of the federal penitentiary in the District and reappointed him in 1844.30

  During his career, Sewall was involved with some of the more colorful aspects of nineteenth-century medicine in America: grave robbing (body snatching), phrenology, and temperance. The unavailability of bodies for medical teaching purposes was decidedly an impediment to eighteenth-and nineteenth-century physicians in England and the United States. The number of legally available cadavers was greatly inadequate for the development of anatomical familiarity and surgical skill. The only lawful sources of bodies were executed criminals and bodies bequeathed to medical schools for study. As a consequence there was an enormous imbalance between what numbers were available and the numbers required. It was estimated that in 1878 in the United States, at least half of the cadavers studied in medical schools were illegally acquired: “A body will sell for five dollars anywhere, and in Ohio and other states thirty dollars is the usual price.”31

  Sewall had commenced his medical practice in Massachusetts, but in 1818 he was convicted of digging up a corpse for the purpose of dissection. The History of the Medical Society of the District of Columbia elaborated: “Sewall … came to Washington under a cloud, having robbed the grave of a near relative in his devotion to the study of medicine. Hingham’s loss was Washington’s gain.”32 Fortunately for the physician, his attorney was Daniel Webster, then a Massachusetts congressman, a future U.S. senator and later the secretary of state for president John Tyler. Webster invited Dr. Sewall, his client, to the more forgiving milieu of Washington. Sewall accepted this invitation and his career prospered.33

  Phrenology was the study of the relationship between a person’s character and the morphology of the skull. Its practitioners were convinced that an examination of the skull’s shape predicted the size and development of the brain beneath. Its popularity in England in the early 1800s led to its spread and use in the United States between 1830 and 1850.34 Sewall, in two lectures delivered to the students of the Columbian College in February 1837, debunked the “science” of phrenology, concluding, “Is it strange, then, when we are told that a science that has been discovered, by which the character and capabilities of the human mind can be ascertained; the secrets of the heart disclosed, and this, too, by a momentary examination of the exterior of the head, that we should find men who will study and advocate its doctrines?” The following year Sewall loaned former first lady Dolley Madison a book on phrenology for reasons unknown.35

  Sewall was very active in the national and international temperance movement. His lecture to the Maryland State Temperance Society, “On the Pathology of Drunkenness,” was widely reported. The lecture used as props transparent paintings of the stomach in a state of health, the stomach of a confirmed alcoholic, and the stomach of an alcoholic who died from delirium tremens.36

  As a famous physician in the still small city of Washington, his professional connection with other inhabitants of the White House in addition to Mrs. Tyler should not surprise one. Sewall was called in consultation to the deathbed of William Henry Harrison, Tyler’s predecessor. It has been a frequent practice of doctors, when confronted with an unhappy or complex outcome for a prominent patient, to spread the blame for any treatment failure among as many physicians as possible. Sewall was prestigious enough to have his name included with other doctors in the medical statement issued to the public and press upon Harrison’s demise.37

  In early 1835, Richard Lawrence attempted to assassinate President Andrew Jackson. The attempt failed when Lawrence’s pistols failed to discharge. Sewall and a second physician were charged to determine “the state of mind” of the assailant. Their widely disseminated report was comprehensive and factual but devoid of conclusions. A clarification was asked of the examiners, who replied, “[W]e therefore do not hesitate to state, as our opinion, that this unfortunate man is laboring under extensive mental hallucination upon some subjects.”38

  A third connection was with the flamboyant congressman Franklin Pierce in late February 1836, seventeen years before Pierce was inaugurated as the fourteenth president. The congressman, inebriated, was embroiled in a fight with two other representatives at a Washington theater. Subsequently Pierce was awakened at night with a fever and pleuritic pain: “Dr. Sewall visited Pierce and removed 16 oz. of blood from him. On the next visit, 24 hours later, the doctor removed 10–12 more ounces of blood by cupping. To this treatment was attributed his recovery…. During the second week of March, he was well enough to resume his work in Congress.” Whether Sewall repeated this treatment on the dying Letitia Tyler remains unknown.39

  Diagnosis and Treatment of Stroke in the Nineteenth Century

  In the nineteenth century, medical understanding of “paralytic stroke” was limited. Physicians were able to recognize it as an abrupt change in cerebral function and in muscle motor control. By the 1840s, it was accepted that its cause was an obstruction of the blood vessels to the brain. The accepted treatment for paralysis could be calamitous. Mushet wrote that “much evidence might be collected in favor of bleeding in cases of sudden hemiplegia.” According to Taylor, remedial treatment included rapid venesection, which “should be early and extensively employed, a frequent repetition of the bleedings being indispensable in most instances.” He further proposed that the bleeding be initiated in the jugular vein of the neck to the point that the radial pulse weakened.40 Adjunctive treatment also could be deleterious and included hot brandy. cayenne pepper, the cathartic calomel, emetics and blistering. There is no record of the treatment received by Letitia Tyler either for the stroke in 1839 or for her terminal cerebrovascular accident.41

  Outcome

  The burdens of being first lady did not affect Letitia Tyler’s health, since she was already disabled when she first took up residence in her White House quarters. She was unable to perform any of the required tasks, and as a consequence the question is moot. She was incapable of accomplishing any of a first lady’s requisite social and ceremonial tasks. Her prominent position gave her access to the best D.C. physicians available. Dr. Thomas may not have merited such prestigious consideration, but Dr. Sewall certainly did. Letitia died at an earlier age—just shy of fifty-two years—then the life expectancy of that of white American females in 1850. The very first mortality statistics for the United States appeared as part of the seventh census of the United States in 1850. In 1850, a white female at age 10 would be expected to live for 47.2 more years, i.e., until age 57.2.42

  John Tyler was well during his presidency and his medical care in the White House was minimal or absent. Letitia’s illness drove him to work harder: “He buried himself in work. Rising with the sun, he stayed at his desk without a break until three-thirty in the afternoon, at which time the family dined together. After candlelight he interviewed visitors and performed miscellaneous social chores until bedtime at ten o’clock. Tyler worked arduous hours to avoid dealing with the approaching death of his wife.”43 His wife’s illness apparently did not effect the performance of his presidential duties.

  Chapter Four

  Retiring and Sickly First Ladies in Antebellum Washington

  Elizabeth Monroe, Anna Harrison, Margaret Taylor and Abigail Fillmore

  Elizabeth Monroe, the Sickly First Lady

  [Elizabeth Monroe suffered from] an unidentified ailment that forced her to curtail her activities as First Lady.1

  Social Challenges

  Elizabeth Monroe, the wife of James Monroe, the fifth
United States president (1817–1825), succeeded the effervescent and extremely popular Dolley Madison as first lady. Mrs. Monroe suffered greatly in comparison to Mrs. Madison. During the eight years of the Monroe presidency Dolley’s tradition of returning courtesy calls was abandoned and the previous sparkle of White House ceremonial dinners, drawing room mixers, and social teas was dimmed. Mrs. Monroe was accused of snobbery for her French manners, and the grande dames of the capital initially boycotted her parties.2 The criticism of the capital’s social elite assailed the first lady’s plans for her daughter Maria’s White House wedding, and the invitation list was limited to forty-four guests. Maria’s March 1820 wedding was the first for a daughter of a sitting president in the White House.3

  First lady Monroe frequently missed social events where her presence was either anticipated or expected, and there were periods when she was absent from public view. Additionally she had the hauteur of an aristocrat and projected the image of a grande dame. Carl Anthony may have surmised the thoughts of her contemporaries: “But though the words were unspoken, it was understood that America now had its first Queen Elizabeth.”4

  Someone needed to stand in for the often absent president’s wife. The surrogate was the Monroe’s older daughter, Eliza Hay. Almost immediately after her husband’s inauguration, Elizabeth began to rely upon her daughter to fulfill social commitments. This dependency increased during Monroe’s second term, since the first lady was said to be increasingly troubled by illness. Eliza Hay’s personality complicated rather than alleviated the sensitive social situation. Eliza was both abrasive and snobbish. Her schooling in France contributed to her aloofness and condescending behavior. Louisa Adams, the wife of Monroe’s secretary of state, was also schooled in France. The opinionated but perceptive Louisa described Eliza as so “full of agreeables and disagreeables, so accomplished and ill bred, so proud and mean,” with such a “love of scandal that no reputation is safe in her hands.”5