'The President Is Ill': How Health Has Impacted the U.S. Presidency
President Lyndon B. Johnson recovers from gall bladder surgery in 1965. Photo courtesy of the LBJ Presidential Library.
Two endorsements you probably missed this political season might be among the most important in the years ahead: President Barack Obama and GOP challenger Mitt Romney have both received clear bills of health from their doctors.
It's not always been the case for those seeking to fill the Oval Office -- and it's certainly not guaranteed to last.
Just ask Woodrow Wilson, who likely never predicted that a severe bout of influenza would strike as he was attempting to wind down the first World War. Or Lyndon B. Johnson, whose efforts to show he was in "tip-top shape" were followed by abdominal pain and surgery to remove his gall bladder. William Henry Harrison might have put on a coat during his inauguration if he would have known that two-hour speech in the cold would lead to pneumonia and death. (More on all of that below.)
"Everyone gets sick," said Dr. Howard Markel, a physician in Ann Arbor, Mich., who also heads up the Center for the History of Medicine at the University of Michigan, "but when the disease exists in a world leader, such as the President of the United States, or even one of his family members, it has the power to change the course of lives and human events."
Markel walks us through some of the lesser-known moments of health crisis within America's first family (in no particular order):
Woodrow Wilson and the Great Influenza of 1918-1919
Woodrow Wilson with his wife Edith at the Versailles Peace Conference.
Markel: While spending significant time in Paris at the close of World War I to settle the war accounts and develop his utopian League of Nations, President Woodrow Wilson contracted the raging and novel influenza that traversed the world and killed millions in 1918-19. True influenza, unlike a common cold, is no trip to the beach. Raging fevers, muscle aches, mental depression and often worse strike the victim. And even after the case is no longer contagious, there can be weeks to months of recovery.
Wilson not only was severely stricken with flu, he also had a difficult time negotiating the Versailles Treaty. When he returned home to Washington, he went on a grueling campaign trip to push the League of Nations. And before that trip ended, he suffered a major stroke [which can be a complication of severe influenza]. As an example of just how much illness can shape world events, his wife, Edith Galt, basically ran the nation for many months, until the end of his presidency in 1920.
John F. Kennedy and the death of his premature son, Patrick, 1962
Posthumous official presidential portrait of U.S. President John F. Kennedy, painted by Aaron Shikler.
Markel: John F. Kennedy's back condition -- an erosion of the spine caused by injuries incurred while saving his PT-109 shipmates during the Second World War -- and the long effects of steroid use as a result of his Addison's disease, is well-known. He was in constant pain and required the use of a back brace and relied upon a number of mind-altering medications, including cortisone and amphetamines.
Less well known was the birth of his and Jacqueline Kennedy's premature infant, Patrick. In the late summer of 1962, Mrs. Kennedy went into premature labor and delivered a 34-week baby. The child suffered from poorly developed lungs and respiratory distress syndrome and later died at Boston Children's Hospital. If Patrick had been born today, modern neonatal intensive care would have easily saved him.
JFK Signing the Limited Nuclear Test Ban Treaty.
As Jackie Kennedy was transported from the Cape Cod Hospital to the Boston Children's Hospital, JFK was negotiating the Nuclear Test Ban Treaty -- a critical agreement in those heated days of the Cold War. One can only wonder how his jetting around the Eastern seaboard, from Washington to Boston and back, while dealing with this personal tragedy, affected his duties as president.
FDR's Polio, 1921-1945
Markel: The story told is that FDR was stricken with polio after a long day of swimming and sailing in the waters of the Roosevelt summer retreat at Campobello Island, off the coast of Maine, in the summer of 1921. Recent historical research has suggested that FDR may have contracted the virus -- known as poliomyelitis, or as it was once called, infantile paralysis -- while visiting a Boy Scout camp in upstate New York a few weeks earlier. Several of the boys there contracted polio at around the same time and the lake that they all used was contaminated with raw sewage (poliovirus is a gastrointestinal virus before it strikes the nervous system and is shed in the feces).
A rare shot of President Franklin D. Roosevelt in his wheelchair.
The polio, and the resulting paralysis from the waist down, famously confined him to using either heavy iron leg braces or a wheelchair to move. At the time of FDR's presidency, however, few Americans acknowledged or worried about this disability. Reporters and photographers tacitly agreed to not cover this aspect of FDR's life.
Almost a century later, it is important to note the marked change in how we accommodate and value people with disabilities. But in 1933, FDR was making history when he became the first leader in Western civilization to actually lead from a wheelchair.
His health challenges plagued him until the end. Many years later, at the close of WWII, while negotiating at the Yalta conference, FDR was being treated for a condition called malignant hypertension.
Prime Minister Winston Churchill, President Franklin D. Roosevelt, and Marshal Joseph Stalin at the palace in Yalta, where the "Big Three" met.
In an attempt to get his raging blood pressure down, the president's doctors prescribed high doses of phenobarbital, a barbiturate drug that makes one quite sleepy.
Photographs of the conference depict a haggard and visibly ill Roosevelt. Some hypothesize that the negotiations were severely hampered by FDR's illness. A few months later, FDR died of a cerebral hemorrhage and his vice president, Harry Truman, was left to close the second World War, including making the decision to drop two atomic bombs on Japan in 1945.
Markel: The historian Joshua Wolf Shenk, who authored a study on Abraham Lincoln's clinical depression, tells an intriguing story about Lincoln's attendance at the 1860 Illinois state Republican convention in Decatur. As the tall, lean politician approached the lectern to begin his speech, the crowd roared and cheered, many of them throwing their hats in the air as they expressed their approval for their candidate.
It was a wave of approval that would take him all the way to becoming the national presidential candidate for the GOP and, ultimately, the presidency. But Lincoln felt no joy at his political triumph. He neither laughed nor smiled. Indeed, one eyewitness noted, "I then thought him one of the most diffident and worst-plagued men I ever saw."
Although a retrospective diagnosis, it appears that Abraham Lincoln may have suffered from depression, or as it was known during the 19th century -- melancholia -- for most of his adult life. As a young man, he even contemplated suicide but held off on doing anything about it when he decided that he was meant for greater things in life, according to Shenk. In the eyes of some historians, this mental health issue may have inspired Lincoln to greater heights and depths of understanding rather than spelling out his political ruin.
Lincoln often used his periods of sadness and depression to think a great deal about his strengths and weaknesses as well as to empathically understand the men and women he interacted with and, at times, battled against. It is difficult to ascertain, at this late date, that clinical depression was responsible for Lincoln's greatness and powers of rational thought. The physician in me bristles at such a simplistic formula. Nevertheless, depression was part of his personality and, undoubtedly, had an effect on his presidency.
He experienced personal tragedies such as the death of his son in 1862 and a difficult married life to Mary Todd Lincoln, who suffered from migraine headaches. What may have been a bipolar disorder and an altogether unpleasing personality could not have made his home life any easier.
Eisenhower's Heart Attacks, 1955-56
President Dwight D. Eisenhower in a wheelchair at a Denver hospital as he is recovering from a heart attack in 1955.
Markel: In September of 1955, Dwight Eisenhower suffered a severe heart attack (his second). From that point until the election the following November, Ike worried about his abilities to lead, let alone run for re-election, and may have suffered elements of depression, a not uncommon sequel to a serious heart attack.
This crisis, as well as a serious bout of intestinal blockage in 1956 could have easily killed Ike and they certainly hindered his abilities to govern during his second term. For much of the year 1955 to 1956, Ike was considering simply stepping down from his high office.
Unlike today, the American public knew little about the extent of Ike's illnesses and the press reported little details as a courtesy to Eisenhower's desire for privacy. A half of century later, few journalists would be so hesitant to inform the public on these critical issues.
LBJ's "Poorly Functioning Gall Bladder"
President Johnson recovers from gall bladder surgery at Bethesda Naval Hospital.
Markel: One of the oddest, and certainly the most bombastic, episodes of presidential illness concerned Lyndon B. Johnson. Although Johnson had suffered a severe heart attack in 1955, while still the U.S. Senate majority leader, he engaged in strenuous efforts, both when running for the presidential nomination in 1960 and during his presidency, to demonstrate that he was in tip-top shape.
In September of 1965, LBJ began experiencing severe abdominal pain that led him to seek medical advice at the Mayo Clinic. The result was the removal of his gall bladder and one of the most striking presidential photos in American history: LBJ lifting up his shirt to show off the surgical scar and his robust recovery.
The White House released a full and complete statement of the extent and prognosis of his illness on Oct. 5, 1965, and the operation occurred on Oct. 8. More telling, it ushered in an era of far better presidential disclosure of illness and a breakdown of the wall between the President's personal health and his public life.
Richard Nixon and Watergate
Markel: Psychologists could have a field day analyzing the inner workings of Richard Nixon's psyche. The psychological wounds he incurred as a young boy growing up during the Great Depression, as a college student who felt less than equal to his wealthier classmates, and years of combat in the political wars of the second half of the 20th century, undoubtedly, had an impact on the way he thought and reacted to events.
Most intriguing was his excessive consumption of alcohol in the final days of his presidency combined with a heavy reliance on a drug called Dilantin. Typically prescribed as an anti-seizure drug for those with epilepsy, in the mid-1970s some physicians recommended the drug as a tranquilizer.
Regardless, the combination of alcohol and Dilantin is hardly a healthy one and their joint consumption is both mind-altering and intellectually debilitating. How his penchant for inebriation and self-medication affected his thought process during the final days of his presidency is the stuff of Hollywood films.
The Assassination Attempt on Ronald Reagan
President Reagan waves to the crowd outside the Washington Hilton moments before being shot.
Markel: On March 30, 1981, John Hinckley shot off a .22 caliber bullet aimed at President Ronald Reagan.
James Brady and police officer Thomas Delahanty lie wounded on the ground after the shooting.
One of the bullets ricocheted off the President's limousine and entered Reagan's chest, just under the left arm. Other bullets struck his press secretary James Brady. Despite being a bullet designed to explode in the body, the one that entered Reagan's chest remained intact, lodged in the left lung just 1 inch from the president's heart. The main threats to the president's life resulted from a collapsed lung and severe blood loss.
Experts say that Reagan did not fully recuperate from this attack until seven months after the shooting -- an extended period of presidential time that most definitely changed the course of Ronald Reagan's presidency in innumerable ways. (Editor's Note: For more information on the assassination attempt, read NewsHour senior correspondent Judy Woodruff's first-hand account of her experience covering that day and watch her discussion with Dr. Joseph Giorando, who led the George Washington University Hospital trauma team that treated the president.)
William Henry Harrison's Deadly Inauguration
William Henry Harrison, the ninth president of the United States.
Markel: Born on Feb. 9, 1773, William Henry Harrison became the oldest president to take office (until Ronald Reagan in 1981) when he took the presidential oath on a frigidly cold and wet March 4, 1841. He was 68 years and 23 days old. Ever the politician, Harrison gave the longest inaugural address in American history -- a whopping two hours of verbiage even after his friend Daniel Webster edited and shortened an earlier draft.
Desiring to deny his advancing years and to look vigorous and powerful, Harrison refused to wear a winter coat, let alone a hat, during his speech. He followed this exercise in oratory by walking in a long and weather-hampered inaugural parade. Alas, the president contracted a bad cold that advanced into a severe case of pneumonia. Harrison died only 32 days after being sworn in -- the shortest term of presidential office in the history of the United States.
A rendering of the inauguration of William Henry Harrison in Washington on the March 4, 1841
Although his vice-president, John Tyler (who until that time was best known by Harrison's campaign slogan, "Tippecanoe and Tyler, too") quickly assumed the office of president, Harrison's death set off a brief constitutional crisis over presidential succession that eventually led to the 25th amendment of the U.S. Constitution. Ratified in 1967, this amendment more clearly spells out issues related to presidential succession in the event of death or disability. Nevertheless, many presidential scholars insist that even this amendment requires better clarification in an age of medicine that can prolong life in ways that even our leaders of the 1960s could not imagine.
Dr. Howard Markel continues this series by looking ahead rather than back -- considering what it might mean for the first family if Ann Romney, who suffers from multiple sclerosis, became the first lady of the United States. Read that story here.
Photo credits: Wilson photo by Hulton Archive/Getty Images. JFK portrait: Wikimedia Commons; photo: Library of Congress. FDR top photo: WIkimedia Commons; bottom FDR photo: Library of Congress. Lincoln stamp: Wikimedia Commons. Eisenhower photo Photo by Rolls Press/Popperfoto/Getty Images. Lyndon Johnson photos courtesy of LBJ Presidential Library. Nixon newspaper photo by NY Daily News Archive via Getty Images. Ronald Reagan photos courtesy of Ronald Reagan Presidential Library. William Henry Harrison photos: Library of Congress.