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

by Deppisch, Ludwig M. , M. D.

  Van Valzah was a demonstrator in clinical medicine at Jefferson Medical College. He unfortunately became embroiled in the conflict raging between homeopathic and allopathic practitioners in the 1880s. A few years after graduation, he was hospitalized at Jefferson with “dyspepsia.” Van Valzah’s doctors, the orthodox luminaries of the medical faculty, finally concluded that he was “more the victim of a delusion than an actual sufferer.” In other words, his complaints were psychosomatic. After a relapse the physician-patient sought an alternate opinion; he was treated by a homeopathic physician. After receiving knowledge of Van Valzah’s choice of a physician, the medical staff of Jefferson demanded his resignation for crossing the philosophical orthodox/homeopath Rubicon. Dr. Samuel Gross, who was immortalized by painter Thomas Eakins in 1875, announced, “I know nothing of the particulars of the case except that he went over to homeopathy and we got rid of him. When a man goes over to homeopathy and we have no further use of him. You can’t mix oil and water together. They won’t unite.” As a result, Van Valzah suspended his practice in Philadelphia and relocated to New York City.26

  Dr. Wikoff is identified as the Wilson family physician during their years in Princeton. None of his professional information can be located, which casts doubt upon his medical pedigree and certification. Eleanor Wilson described him unfavorably: “He was a gloomy old soul with fierce bristling eyebrows and I shuddered every time I saw him.” Wikoff’s care for the future first lady is also unrecorded. It appears that he too was unable to make the diagnosis of chronic kidney disease.27

  Ellen’s health did recover for a while, leading one biographer to exclaim, “Health-wise she never felt better.” However, several years later, in 1905, she was described as “pale and thin.” For a period of four months the following year, Ellen was afflicted by a mysterious painful stiffness in her back and limbs. She curtailed her ordinary activities and required constant massages for any respite. Weinstein, noting that she was depressed at this time, ascribed her symptoms to a psychosomatic origin, rather than another episode of kidney disease.28

  Unfortunately, her illness reappeared with significant and troubling symptoms. The effects of chronic renal failure, especially anemia, became apparent during the presidential election year of 1912. Her daughters Jesse and Eleanor noticed that their mother was less animated. She remained home during her husband’s successful campaign for the presidency; her family and close friends became alarmed “that something was very wrong with Ellen.” On inauguration day, Eleanor was shocked that the small figure “walking slowly and wearily” ahead of her was her mother.29

  Preeclampsia (the common form of toxemia of pregnancy) increases the risk of end-stage renal disease (Bright’s disease) three-to fivefold. Among women who were pregnant three or more times, preeclampsia during one pregnancy was associated with a relative risk of end-stage kidney disease of 6.3, and preeclampsia during two or three pregnancies was associated with a relative risk of 15.5. Although the absolute risk for chronic renal disease in those who have had preeclampsia is low, preeclampsia is a marker for an increased risk. The reason for the first lady’s physical decline continued to be unsuspected. Colonel Edward House, Wilson’s friend and political confidante, attributed her symptoms to the effects of overwork. Wilson cancelled the traditional inaugural ball, in all likelihood out of concern for his wife’s health.30

  Did Ellen Wilson’s Disease Affect Her Performance as First Lady?

  Chronic kidney disease, although indolent, is a sinister sickness, insidious, enervating and progressive. Despite this, Ellen Wilson for many months until her terminal decline fulfilled most of the responsibilities of a presidential wife: “Until her health began to decline, Ellen pursued the role of an active, involved First Lady.”31 Her decade-long experience as the wife of the president of Princeton University prepared her for social success in the White House.32 Official entertaining, whether cabinet luncheons, diplomatic receptions, teas or dinners, were handled with grace and efficiency.33 Eleanor, the Wilsons’ youngest daughter, raved about her mother’s skills as a hostess: “Mother carried out the usual program of dinners, receptions and musicals at the White House, gave two or three tea parties a week, and received callers almost every afternoon…. [T]here were never less than fifty people at the smallest dinner party, and often a hundred or more attended her informal teas…. She managed, however, to make even the huge receptions more homely and gracious.”34

  Doctor Cary Grayson and Mrs. Wilson’s Final Illness

  The Wilsons’ change of residence required the selection of a new family physician. Navy doctor Lieutenant (later Admiral) Cary Grayson became their White House physician. He filled the role of the Wilson family doctor and then some, becoming confidante, advisor and intimate friend. Grayson attended William and Mary College in Williamsburg, Virginia, and received his medical degree from the University of the South in Sewanee, Tennessee. After an internship at Columbia Hospital for Women in Washington, D.C., he was commissioned an acting assistant surgeon in the United States Navy. A few years later, in 1910, he received the coveted assignment of medical officer of the presidential yacht, Mayflower. This billet, where Dr. Grayson got to know both Presidents Theodore Roosevelt and William Howard Taft, may have served as an audition for his prestigious appointment as White House physician and personal physician to the Wilsons.

  The young navy lieutenant’s career was undoubtedly abetted by the interest and friendship of a significant mentor, White House physician to Presidents Roosevelt and Taft, Admiral Presley Rixey. Rixey shared a Virginia birth and skilled horsemanship with his protégé. Moreover they were kinsmen; Grayson’s half sister was married to Rixey’s youngest brother. The admiral reflected upon their relationship: “I had known Dr. Grayson for many years prior to his entry in the Navy and advised him how to proceed with his medical education so as to become a naval surgeon, and in the service made good in every assignment I gave him.”35

  The circumstances leading to the installation of this thirty-four-year-old naval officer as the president’s personal physician, then as his personal and political confidante, and finally as Woodrow Wilson’s surrogate son, seem to be the following: The Wilsons first met Grayson on March 3, 1913, the day prior to the incoming president’s inauguration. They were guests of the departing Tafts at a White House tea where they were informed that Woodrow’s sister, Annie Howe, had slipped on a marble staircase and cut her forehead. Grayson, by virtue of his role as medical doctor to the presidential yacht, was both available and prepared with his doctor’s bag. He sewed up Annie Howe’s wound and attended her for a few days thereafter. The doctor ascribed this meeting to providence; a skeptic might attribute it to foresight and ambition.

  Serendipitously, the Wilsons, in a new venue and without a family doctor, needed a new physician. Ellen Wilson probably had a significant role in Grayson’s selection: “Thinking of her husband’s health, she sent for Lieutenant Grayson, who had patched up Aunt Annie with such efficiency, and asked him if he would not look after the President.” The doctor was informed of his appointment a few days later in a meeting with President Wilson and navy secretary Josephus Daniels. It is unknown, but quite likely, that President Taft and Admiral Rixey supported Grayson’s professional promotion. As first lady, Ellen Wilson was under the care of Dr. Grayson. On rare occasions, when he finally concluded that her care exceeded his professional acumen, he sought the consultation of experts.36

  As spring 1913 progressed, “it escaped no one’s notice … that Ellen was taxing her strength to the limit.” Daughter Eleanor described her mother as “warm and white.” A decision was forced. On June 20, 1913, the White House released the following statement: “Upon the advice of her physician, Mrs. Wilson has decided to abandon active participation in the philanthropic movements which have commanded much of her attention since she came to Washington. Mrs. Wilson is not seriously ill, but will remain quietly in the White House until she goes to Cornish, N.H.”37 The first lady recuperated in N
ew England, resting, painting, and socializing with friends and other artists. Her physical strength had been restored by the time she returned to Washington on October 17, after an absence of almost four months. Wilson made only a rare visit to his wife in New Hampshire, and Ellen, whose first priority was always her husband’s well-being, made one trip to Washington.38

  Jesse was the first of the Wilson daughters to marry. Upon her return from Cornish, Ellen actively assumed the traditional responsibility of the mother of the bride, the planning of the wedding. The White House marriage of Jesse Wilson to attorney Francis Sayre on November 25, 1913, was a splendid event. In the meantime, Ellen made frequent references to being tired and the necessity of rest breaks. The president’s family spent Christmas vacation in Pass Christian, Mississippi, but upon their return to the White House, the first lady began to lose weight and “the lovely color in her cheeks disappeared.”39

  On March 1, 1914, the physically failing Ellen fainted in her room. She remained confined to her room for several weeks and “she remained weak, lethargic, and anorectic, a triad of symptoms typical of chronic nephritis.”40 Finally, on March 10, Dr. Grayson realized that he needed help. He summoned Dr. Edward Parker Davis of Philadelphia to the White House to examine his patient. Davis was named for several reasons: He was a Princeton classmate of President Wilson and the two had maintained a long-term friendship, marked by frequent correspondence. He may even have treated the Wilsons when they resided in Princeton. In addition, Grayson and Davis previously had established a respectful professional relationship. Finally, the consultant’s medical expertise—obstetrics and gynecology—was relevant to the ailing Mrs. Wilson’s condition.41

  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.42

  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.”43

  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.44 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.45

  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.46 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.47

  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.48

  The Death of a First Lady and a Critique

  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.49

  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 1914.50

  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.”51

  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.”52

  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.

  Dr. Grayson’s Responsibility to His Other Patient, President Wilson

  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 effec
ts of her illness upon the President.”53

  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.54 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.”55