The Health of the First Ladies: Medical Histories from Martha Washington to Michelle Obama
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A final pre–White House medical reference was to a summer 1908 trip to Hot Springs, Virginia, to use its baths for her rheumatism.15
First Lady Helen Taft
William Howard Taft was elected the twenty-seventh president of the United States in November 1908. His first lady, previously goal-oriented towards the White House, ceased to be her husband’s constant political prod and concentrated her energies on entertaining and the management of the executive mansion.16
Her emergence as the lady in the White House was welcomed by social and official Washington with the following encomiums: “immensely capable,” “of exceptional learning, intelligence, and ambition,” “she is probably the best fitted woman who ever graced the position she now holds and enjoys,” “has brains and uses them,” “an intellectual woman and a woman of wonderful executive ability.” Her changes in White House custom, her ride in the inaugural parade, her civic and social reform efforts—all converged to make Mrs. Taft a presidential wife of more than the usual fascination in the national press.17 This changed dramatically the afternoon of May 17, 1909, a mere thirteen weeks into her tenure. She had a stroke that first ended and then permanently affected her ability to speak. Although a shock when it occurred, in retrospect her cerebrovascular accident (CVA) should not have been. Her personality, family history, and history of smoking are all recognized as significant predisposing factors.
Both her parents were stroke victims. Harriet Collins Herron experienced facial paralysis in late 1886. She recovered only to be struck again in 1901. Her father, John Williamson Herron, had a cerebrovascular accident in 1902. When Nellie was recovering from her second CVA in 1911, John Herron experienced his second and became delusional.18 A 2003 family history study demonstrated that patients suffering a stroke at 65 years of age or younger (Nellie was 48), were three times as likely to have a first degree relative with an early stroke or heart attack (Harriet Herron was 53).19
It is not difficult to characterize Nellie Taft as possessing a Type A personality. Her competitiveness and zeal for achievement fulfilled this designation; a consequence was chronic stress. Stressful activities during May 17, 1909, preceded the medical cataclysm of later in the day. A recent research study proved what was long surmised: Stressful habits and type A behavior are associated with a high risk of stroke.20
Diary entries during Helen Herron’s 1880 vacation in Newport, Rhode Island, recorded early experimentation with cigarette smoking. She started to smoke cigarettes to escape depression. She began to smoke at a time when genteel women did not, and smoking became a matter of course for her. Her habit consisted of an occasional cigarette and although she never smoked to excess, she never relinquished the habit.21 Today the dangers of cigarettes are widely acknowledged, and stroke is a recognized consequence for both men and women. The stroke risk increases with each additional cigarette. Any smoking increases the risk of a cerebral accident, 2.2 times for 1 to 10 cigarettes a day, 4.3 times for those smoking 21 to 39 a day, and 9.1 times greater for two or more packs a day.22
Nellie Taft, wife of William Howard Taft, was a determined first lady whose dour countenance reflected her inner drive (Library of Congress).
The First Stroke
During the afternoon of May 17, 1909, the new first lady was halfway through a more than usually stressful day. She spent the morning in a Washington hospital where Charlie, her younger son and favorite child, had undergone an especially bloody removal of his tonsils and adenoids. Continuing unease over her aging and fragile father and anxiety over her sixth congressional dinner scheduled at the White House that evening were inescapable. In an attempt at relaxation, still annoyed with her husband for his tardy arrival at the hospital, she decided upon an informal cruise on the Potomac to Mount Vernon. Aboard the presidential yacht, Nellie fainted. An aide attempted to revive her with the captain’s whiskey; the boat returned immediately to Washington.
Accounts of her condition and the course of it differed, partially the result of the president’s attempt to minimize the medical situation: “She made no motion and did not seem to be more than half conscious.” Upon the yacht’s return, military attaché Archie Butt carried the limp Helen Taft to her bedroom. For the next sixteen hours, the first lady was comatose and “utterly speechless.” The president admitted in a letter to their oldest son, Robert, that the first lady had lost muscular control of her right arm and leg, and that only after three days did she begin to make audible sounds, but not words.23
In the early decades of the twentieth century, home care was greatly preferred over hospital care for nonsurgical emergencies. Accordingly, Nellie Taft recuperated at the White House. Dr. Matthew A. DeLaney of the Army Medical Corps was the White House physician and accordingly took charge of his patient’s care. He administered stimulants, for her heart “was very weak,” and put her to bed. The president wrote Robert: “The doctor soon reassured us all, and her as well … that it was a mere attack of nervous hysteria.”24
Will Taft personally wrote the statement that was released to the press the following morning. Under the headline “Mrs. Taft’s Illness Due to Social Cares,” the New York Times reported: “Mrs. Taft’s sudden and severe illness on Monday when she succumbed to the excessive heat, is yielding to rest and care, promising an early and complete recovery.” The article continued: “In the ten weeks of her husband’s Administration, Mrs. Taft has done more for society than any former mistress of the White House has undertaken in as many months…. This with numerous official receptions and dinners within a short time, proved too much for her.” In another newspaper, it was alleged that Mrs. Taft suffered from a “slight nervous attack” and that she would be able to resume normal activities in a few days.25 However, when the previously very active first lady did not appear during the next few weeks at scheduled concerts and White House social events, the press realized that all was not well. But the public was shielded from the severity of her disease. Nellie’s sister, Eleanor Moore, served as temporary White House hostess.26
Within a short time, Nellie’s mental faculties recovered their usual acuteness and the motor control of her right arm and leg returned. During the summer, with slow care, she could write fairly legibly. The catastrophe for this forceful and energetic woman was an inability to speak at first, and later to talk only with difficulty. Mortified by her impediment, for the first two months Mrs. Taft came into a White House corridor only when assured she would not be seen by anyone.27
Sister Eleanor, daughter Helen, and even the president participated in the exceedingly slow process of speech therapy. This consisted of her repetition of what was spoken to her. Each morning Dr. DeLaney checked in and tried different therapies. In early June he experimented with a machine that applied electricity to the throat.28 Progress in restoring normal articulation was slow. Therefore Dr. Delaney sought the consultation of Dr. Lewellys F. Barker, William Osler’s successor as director of medicine and physician in chief of the Johns Hopkins Medical Institutions. Barker’s examination, conducted five months after the stroke, “found her practically normal except for the one trouble—articulation—and told her that that only required rest, time and the same treatment she has been receiving to restore her to health.”29
Nellie took comfort in the Baltimore specialist, who implied that her problem was not paralysis at all but something unusual that occasionally strikes people, and so she wanted to resume her public role. However, her doctors informed the president that if she did they would release themselves from any responsibility for her care as they feared a relapse.30 Dr. Barker again visited the White House in early 1910, and assured Taft “that she [had] made remarkable progress in the preceding two months.” When the president journeyed to Panama in October 2010, his wife no longer feared a relapse while he was gone. She was comfortable enough to speak once again with strangers. Moreover, she hosted the White House debutante party during the 1910 Christmas season.31
With hindsight and with the medical knowledge accumula
ted over one hundred years, the verbal disability of Mrs. Taft is classified as apraxia of speech. It defines a disorder involving difficulty of articulation despite having intact language skills and muscular function. It occurs in about 11 percent of stroke cases and is usually minor. In the most severe cases, as in this first lady’s, all linguistic motor function can be lost and must be relearned. Today’s recommended treatment involves frequent one-on-one therapy with a specialist, using repetition of words or phrases. That was the therapy of her doctors and her family a century ago, and it was successful.32
The Second Stroke
On May 13, 1911, President and Mrs. Taft were in New York City, where the president delivered a speech at the New York Academy of Political Sciences. Two years after her initial attack Mrs. Taft’s speech had improved to only a slight undetectable speech impediment. Nellie left the dinner early but collapsed at her husband’s brother’s home, where they were staying. Horace Taft immediately summoned his family physician, Dr. E.M. Evans. The doctor diagnosed a “nervous attack” that was mild in comparison to her earlier episode. Daughter Helen wrote: “She isn’t able to articulate clearly or find the words. The doctor seems to think that the attack is similar to the first one but much less severe.” The president continued to characterize it as a “nervous attack,” as did the contemporaneous New York Times report.33
Five days after her collapse, Nellie Taft was well enough to return by train to Washington, D.C. Once ensconced in the White House, her condition improved. The president offered Horace reassurance: “There is nothing except the tongue which interferes with distinct enunciation, but which is improving with use from week to week. We have induced Nellie to stay in bed, so that she does not come down stairs at all, and while she resents this treatment, I think she realizes the necessity for care.” The New York Times on May 20, 1911, under its headline “Mrs. Taft Will Rest,” related that the first lady had recovered well from her attack of nervous trouble, but daughter Miss Helen Taft will preside at the White House functions for the present.”34
The first lady sparkled at the Tafts’ excessively elegant June 19, 1911, silver anniversary party held before thousands on the White House lawn. She remained on the sidelines during her husband’s 1912 renomination battle, citing her physical condition as the reason. But her role on the public stage was not yet over; Mrs. Taft was the first first lady to appear at a national nominating convention of the opposing party. She attended the 1912 Democratic presidential convention in Baltimore. This gathering nominated Woodrow Wilson, who subsequently was victorious in a three-way race with William Taft and Theodore Roosevelt.35
Effects of Her Disability Upon President Taft
An incapacitating cerebrovascular accident, occurring so early in the Taft presidency, was a tragedy—tragic not only for the new first lady, whose determination to engrave her indelible mark upon the first lady narrative and upon the Washington social scene was thwarted, but also tragic for the president, whose closest political advisor was both stricken and unavailable for counsel and support. “During Nellie’s illness Taft was a somber and stricken man, ever attentive to her needs and desires. Nellie’s stroke left her very weak, with partial paralysis of some facial muscles and with a speech difficulty which took some time and considerable effort to overcome.” Her condition was not only a burden for her, but also for those around her, especially her husband. He could no longer count on his wife as he had formerly since he feared for her health.36
Taft was stressed and his focus distracted by Mrs. Taft’s condition. Gradually she took part in social situations where she could speak a formula of greeting. But dinners and socials where she had to talk were avoided.37 Helen, the Tafts’ daughter, recollected the following to a national magazine forty-five years after the fact: “Within two months of my father’s inauguration, my mother suffered a brain hemorrhage which rendered her unconscious for four or five days and from the effects of which she never fully recovered. For the next two years she had, most unwillingly, to accept the role of invalid. During the whole period of my father’s presidency I doubt whether she visited the executive offices half a dozen times.”38
One Taft biographer suggested that if Mrs. Taft’s health had remained good and she had been in a position to advise the president about the tariff and other matters, Taft’s record might have been altogether different.39 Another summed up: “Given four years of good health and sustained hard work, she might have reshaped the role of the first lady decades earlier than Eleanor Roosevelt or Lady Bird Johnson did.”40
Postpresidential Years
After his reelection defeat, the Tafts moved to New Haven, Connecticut, where William was a member of the Yale Law faculty for nearly ten years. In 1921 the ex-president achieved his own, but not his wife’s, professional goal when President Harding appointed Taft chief justice of the United States Supreme Court. After Taft’s death in 1930, his widow continued in live in Washington, but she also developed an annual pattern of travel. She visited Charleston, South Carolina, in mid-winter, made an overseas trip until early summer, then spent several months in Murray Bay, Canada, until October, and celebrated the holidays in Washington. She lived with a cook and a maid who were Irish immigrant sisters.41 The effects of the stroke on her articulation both lingered and persisted, but her speech generally improved after the presidency. Nellie had learned to let go of stress “that had provoked her earlier attacks, she was even calm when she fell ill.”42
Mrs. Taft was in excellent health during her three decades as a former first lady. In 1926 she had a gastrointestinal complaint for which she reached out to her former physician in the White House, Dr. DeLaney.43 In December 1935, she “Suffered a slight brain swelling with ‘distinct paralysis on the right side.’ Within twenty-four hours all such symptoms had vanished.” At the time, the event was dismissed as a minor matter and not a cerebrovascular accident. However in retrospect we realize it was a transient ischemic attack, a minor stroke, and her third such event. A year later, sufficiently recovered, she left for a seven-month overseas trip.44
In the summer of 1941 Mrs. Taft battled a lung illness and, in addition, she fractured her right arm at her summer home. A fourth CVA followed, which led to convulsions and a slight paralysis. She recovered. Mrs. Taft was ill during 1942 and into 1943; although bedridden she was lucid. She died with “a circulatory ailment” in Washington on May 22, 1943, just shy of her eighty-second birthday.45
Helen Herron Taft was buried at Arlington National Cemetery. Her interment there was preceded not only by that of her husband, William H. Taft, but also by her White House physician, General Matthew DeLaney, who died in November 1926. Always the trailblazer, Nellie in death became the first first lady to be laid to rest at the storied burial ground. She preceded the much publicized burial of Jacqueline Kennedy there by half a century.46
Pat Nixon: A Brave and Misunderstood First Lady
Richard Nixon reported to the Nixon family physician John C. Lungren: “[T]wo days before the stroke, Pat was reading The Final Days…. Pat was extremely upset over the sections where Woodward and Bernstein portrayed us as demented alcoholics and our marriage as loveless—pure, unadulterated lies.”47
Images: Private and Public
The public image of Mrs. Pat Nixon, first lady and wife of President Richard Nixon (1969–1974), was that of a stoic and ornamental supporter of her husband’s political aspirations. She was depicted as the perfect middle-class mother and housewife, supportive and silently admiring of her politician husband. Boller compiled a list of the most critical epithets directed towards Mrs. Nixon: “plastic Pat,” “antiseptic Pat,” “Pat the robot,” and “chatters, answers questions, smiles and smiles, all with a doll’s terrifying poise.”48
Retrospectives at the time of her death began to correct this portrayal. William Safire wrote in the New York Times: “She was politically savvy, an asset on the trail, and not just for patenting that rapt look listening to the same speech for the umpteenth time.”
Donnie Radcliffe, writing in a newspaper which, more than any other, was responsible for the demonization of her husband, explained: “[F]ar from a ‘plastic Pat,’ as some tried to portray her. She was a complicated woman, a savvy politician who was fiercely loyal to her husband.”49
Her two biographers, Julie Nixon Eisenhower and Mary C. Brennan, portray a woman far more substantial than the mainstream media’s caricature. Thelma Catherine Ryan was born on March 16, 1912, in the small mining town of Ely, Nevada, to an Irish immigrant father and a German immigrant mother. Her father insisted that she be called “Pat” and that her birth occurred on Saint Patrick’s Day and not a day earlier as documented on her birth certificate.
Pat’s early life was tough but she was brave, smart, and determined. Her parents were poor and when her mother died at an early age, Pat became the woman of the family, taking care of her father and brothers. The senior Ryan also passed away when Pat was young. Although an excellent student in high school, Pat gave up college in order to support her brother Tom’s university studies. Other formative experiences included a cross-country drive, two years of successful performance of many technical jobs at Seton Catholic Hospital in Manhattan, New York City, graduation from the University of Southern California after a delayed start, and recognition as a much admired teacher at Whittier High School in Southern California.50
Pat Nixon, the wife of Richard Nixon, was a smoker and a stroke victim (Library of Congress).
Medical History
Pat Nixon was a sturdy and healthy wife through her husband’s elective career. A single exception was a strained back in March 1958, suffered when she lifted her daughter Julie. The pain was severe and she was admitted to a hospital for the first time since her daughter’s birth ten years earlier.51
This first lady was a smoker, although to what extent remains undetermined. But the habit was of long duration. The Watergate crisis (1972–4) obviously took its physical and emotional toll. “She got thinner, and her face appeared more puffy and lined. Her smoking, which she tried to hide from the public, increased. In fact, on several occasions, she even smoked in public.” Previously she repeatedly told reporters that she did not smoke. In an interview at the time of her first cerebrovascular accident her last White House press secretary, Helen McCain Smith, recalled that Mrs. Nixon smoked cigarettes.52