Presidential illness since the beginning has been a factor in the life of the nation. Nevertheless, the health of presidents until relatively recently was rarely spoken of; it was regarded as nobody's business but the president's. Moreover, even after the advent of modern medicine, the unspoken proscription against speaking about the body in Victorian America played a role in keeping off limits the details of the chief executives' physical condition. Consequently, facts are known today that contemporaries were unaware of. George Washington, for example, was barely in office in 1789 when he developed a painful carbuncle on his left thigh. He may have been near death from the staphylococcal infection and high fever that accompanied it. His intense suffering, which in the end included the surgery he had to endure without anesthetic, necessitated rebuilding the carriage he traveled in so that he could lie in it at full length. The following year he contracted a cold, which, it was said, then turned into influenza and pneumonia—bringing despair for his recovery. We may only speculate on how the national history might have been different if the Father of His Country had died on either occasion: the first when the government was being launched under his hand as the indispensable man, and the second when the critical struggle over the first Bank of the United States was being played out.
When Andrew Jackson came to office in 1829 heralded as formidable, indestructible Old Hickory, he was in truth a debilitated man. He was still feeling the effects of a pistol shot long before lodged in his left shoulder, and suffering perpetually from intestinal bleeding, possibly caused by the calomel he took for his recurrent dysentery. We can never know how his frailty affected his performance as Chief Executive.
Presidents Polk and Truman, even though they served a century apart, have sometimes been compared as unexpected presidents who showed themselves to be feisty leaders forced to take the country into war. Both had been sickly children. Polk suffered as a boy from a bladder stone, eventually removed by surgery, that robbed him of a normal childhood. He was proud that his career as president and war leader proved he was no longer, as he once called himself, "the meager boy, with pallid cheeks, oppressed and worn with disease."
Truman, too, endured a boyhood blighted by illness. At the age of eight, paralyzed by the effects of diphtheria, he had to be wheeled around in a baby carriage. Amply coddled, he became, simply stated, a sissy. Indeed, he liked to believe that he could arrange his sister's curls better than his mother could. But he was determined to be manly. Growing up he set his heart on winning an appointment at the Military Academy at West Point, but this ambition was frustrated by his "flat eyeballs" (his own designation). In World War I he showed his mettle as an officer in an artillery unit and this service in uniform had an abiding influence on his political life. As president he demonstrated enormous respect for military men, including especially Generals Mark Clark, George C. Marshall, and Dwight D. Eisenhower.
The question of how far the president's health ought to come officially and contemporaneously to the public's knowledge did not trouble the country in earlier days. When, for instance, word leaked out in the 1880s that President Chester A. Arthur was suffering from Bright's disease, a usually fatal kidney ailment, the White House silenced public speculation by denouncing the story as malicious gossip. A notable case occurred in 1893, shortly after Grover Cleveland's second inauguration. He had begun to suffer from a lesion in his mouth that was soon diagnosed as a cancer, requiring immediate attention. Apart from the president's personal stake, the political stakes were enormous. Cleveland was a committed defender of the gold standard; if he should die, his vice president, Adlai E. Stevenson of Illinois (a grandfather of the Adlai E. Stevenson who twice ran unsuccessfully for president against Dwight D. Eisenhower in the 1950s), who was a fervent advocate of the free silver policy would be president. Because it would be risking exposure to take Cleveland to a clinic or hospital, the work was done aboard a friend's yacht anchored in New York's East River near Bellevue Hospital. The medical staff was ordered to stay out of sight lest they be recognized by Bellevue's resident doctors. To keep the president steady during the procedure, as the boat sailed slowly up the river, his chair was lashed tight to the mast. To avoid doing external surgery, one of the doctors, William W. Keen, a Philadelphia man, who had served in the Civil War and had studied abroad, employed a cheek retractor he had brought home from Paris in 1866. Operated on a second time a few weeks later, the president was fitted with a prosthesis that did not show on his face. The public was none the wiser until 1917—almost a quarter of a century later—when Dr. Keen, in an article in the Saturday Evening Post, finally broke the embargo on the story.
Although one in four presidents has been disabled at some time during his term of office, the disability of a president was not dealt with appropriately even after Woodrow Wilson was stricken by a massive stroke in 1919 that severely affected his gait and speech. His wife, Edith Galt Wilson, screened his mail and the list of his visitors, and is sometimes referred to, therefore, as the "first woman president." Wilson's medical history, had it been known in 1912 when he ran for the White House the first time, would have raised a flag of caution. The public was unaware that he had been suffering strokes since 1898. Many Americans will always believe that although the nation as a whole was bent on being quit of Europe after the end of the World War I, the failure of the Senate to ratify the Treaty of Versailles was in some measure related to the personality deficits the president had undergone.
A generation later, Franklin D. Roosevelt, aided as Wilson had been by a White House doctor willing to cover up what he knew, was an ailing man even as he presented to the world his smiling, confident face. At the end of 1943 when the Allied landings in Normandy were being planned, the president was suffering acutely from hypertensive congestive heart disease, and hypertension that resisted efforts at reduction. The medical people in the president's entourage well knew that by D-Day in 1944, the president was barely able to concentrate on affairs of state. When he traveled to the Pacific to visit the American commanders and ostensibly to lay plans for the final assault on Japan later in the year, he was actually seeking surcease from the daily cares of his office.
Although there was much gossip in 1944 when FDR ran for a fourth term that he was mortally ill, the voters, ignorant of the truth, elected him handily. During the canvass, though, when the invasion of France was in its critical moments, the president at a private lunch with his running mate, Harry Truman, urged him for his own safety and for the good of the country, to avoid campaigning by airplane. "This time, we may need you," the president told him presciently. Still, talking to the press after this portentous meeting, Truman offered traditional words of reassurance, saying that he found the president well and hearty. Not until 1970 was a full account of FDR's medical condition made public—in an article in the Annals of Internal Medicine, a medical journal, by Dr. Howard Bruenn, the young naval aide who had been called in to treat the president.
After Eisenhower suffered a heart attack in 1955, he and Vice President Nixon came to an informal agreement that the vice president would take over the responsibilities of the presidency in a comparable emergency in the future. In the next years first when Eisenhower underwent bowel surgery and then after he suffered a "brain spasm" there was, he would say, "a gap when I could not carry out the duties of my office." The openness of the Eisenhower administration in reporting on the various ailments the general came down with while in the White House, was no example for the Kennedy administration. It followed the style of the Cleveland and Wilson administrations. President Kennedy suffered, beginning when he was thirty years old, from adrenal insufficiency, or Addison's disease, a fact confirmed by the autopsy performed after his assassination, but kept secret at the behest of the Kennedy family. When Kennedy underwent back surgery in 1954 because of his disease, he received the last rites of the Roman Catholic Church. Kennedy had kept fit by taking regular supplements of cortisone and similar drugs in replacement of the adrenal hormone. Still, victims of the disease taking cortisone and its ilk are subject to mood swings and stomach inflammation, including ulcers. Moreover, the face is sometimes made fuller by the medicines.
In his quest for the nomination in 1960, Kennedy had declared himself "the healthiest candidate for President in the country." This was a backhanded reference to his opponent, Senator Lyndon B. Johnson, who had suffered a severe heart attack in 1955. When the truth about JFK's medical condition was finally revealed in the Journal of the American Medical Association in 1967, many people declared that if it had been known in 1960, it is doubtful that he would have been nominated, let alone elected.
Johnson's heart condition was constantly on his mind. He liked to say that he had had "the worst heart attack you could have and still live." He confessed that every time he passed Wilson's portrait, he trembled at the thought of himself lying helpless in the White House. He saw to it that there was defibrillation equipment on every floor, and he carried with him a copy of his electrocardiogram for emergency reference. The frenetic way in which he managed the Great Society legislation led some people to conclude that he felt instinctively he had no time to lose. Johnson and House Speaker John McCormack, who was next in line of succession, came to an agreement similar to the Eisenhower-Nixon arrangement. When President Reagan underwent surgery for colon cancer in 1985, he temporarily transferred the powers of his office to Vice President George H. W. Bush.
At last the Twenty-fifth Amendment, ratified in 1967, aimed at dealing officially with the vexing matter of presidential and vice presidential succession and disability. It provided formally for the first time that when death or resignation removes a president, the vice president becomes president. When a vice president is similarly removed, the president will choose a successor who takes office at once upon confirmation by a majority vote of both houses of Congress. And when a president writes to the president pro tem of the Senate and to the Speaker of the House that he is unable to perform the duties of his office—and until he informs them otherwise—the vice president becomes acting president. Similarly, if a majority of the cabinet (or of any other body that Congress designates) declares that the president cannot discharge his duties, the vice president becomes acting president. When the president declares that he is able to resume his office, he must so inform the president pro tem of the Senate and the Speaker of the House. If there is disagreement as to whether he is so able, Congress under specific time restraints must respond appropriately. In recent elections it has been common for candidates to issue medical reports on their physical condition, but these are not always complete.