Public Disclosure of Presidential Illnesses: The Discouraging History

Marine One hovers near a flag with the presidential seal. (Official White House Photo by Shealah Craighead) In the time since the president announced his COVID-19 diagnosis in the early morning of Oct. 1, the public has received little news concerning his condition. First, the press reported that President Trump had “mild symptoms”; then, the White House released a letter from the president’s doctor stating that Trump was suffering from a fever and cough. By late afternoon on Oct. 1, Trump was flown to Walter Reed Medical Center, where he is expected to remain for several days, in what the White House described as a “ precautionary measure .” Timely and thorough information about Trump’s condition will help inform the public, the Congress, and others in the administration about what to prepare for and how to address second- and third-order effects to both the country and the ongoing presidential campaign. Yet history provides plenty of reason to believe that the public will not receive such updates about the president’s health. The Trump White House has never been forthright about the president’s medical information—but previous administrations, even those more inclined to be truthful with the American people, have routinely and often blatantly withheld crucial medical diagnoses and data from public view. As a review of the history shows, candor about presidential ailments has been more the exception than the rule. It started early. In 1813, about halfway through his time in office, James Madison arranged to have an urgent letter sent to members of Congress with whom he’d intended to meet, informing them that neither could he see them “nor can he at present fix a day when it will be in his power.” Left out of the letter were details about the intestinal ailment and fever that knocked Madison down and kept him there for the greater part of a month. Madison’s illness became so severe that he couldn’t even read congressional resolutions that a representative had brought to him. He eventually recovered, and his initial lack of candor about the severity of his sickness had no consequences. Likewise, Abraham Lincoln faced temporary disabilities during his time in office. First, his 11-year-old son Willie caught a serious fever and died in February 1862, spurring presidential grief so intense that Lincoln stopped attending to government business and spent his days crying over the loss. Second, he suffered from numerous ailments, including a dangerous bout with smallpox in 1863. The exigencies of leading the nation during the Civil War, along with the norms of the time, provided an excuse to not share timely updates to the public about his condition. In 1881, less than a year after ascending to the presidency following the assassination of James Garfield, Chester Arthur found out that he had Bright’s disease—a fatal kidney condition. He chose to keep news of his diagnosis within a tight circle of family and close friends. The White House vigorously denied an Associated Press report that accurately identified the story. He failed to win the nomination for a term of his own and died from the disease less than two years after leaving office. A much more robust effort to mislead the public developed in 1893 when Grover Cleveland—ironically regarded as a generally honest and forthcoming president—learned that a growth on the roof of his mouth was malignant. Doctors urged quick attention, and Cleveland assented. But to avoid public knowledge of the cancer and the attempt to remove it, Cleveland approved a clever but risky plan . No hospital visit could be kept private, so the cabal decided to perform the necessary surgery below deck on a yacht owned by a friend of the president, with the bare minimum of secrecy-sworn doctors, while Cleveland was en route to vacation in the Northeast. An oversized chair, to which the rotund president would be strapped, was tethered to one of the ship’s two masts. The plan meant that the president’s life, already at risk from cancer, would be exposed to new dangers : the administration of anesthesia under less than ideal conditions, waves that would make a delicate surgery even more challenging, and the inability of the small surgical staff to deal with any major complications. Thankfully, the waters remained calm, allowing the doctors to remove not only the tumor but also Cleveland’s entire left upper jaw and part of his soft palate, after discovering that the tumor had actually grown through it. The truth was kept to a very small circle; the captain and minimal crew heard that the president needed two badly ulcerated teeth removed. After five long days, the ship finally docked at the western edge of Cape Cod. Reporters, from a healthy distance, were allowed to see Cleveland walk off under his own power. Over the next couple of days, the doctors and the president’s private secretary would lie to cover their tracks and excuse his unwillingness to entertain visitors. “He is suffering from rheumatism,” they said. “No operation has been performed, except that a bad tooth was extracted,” they said. “The thing that had occasioned the prolonged journey on Mr. Benedict’s yacht was only a bad case of dentistry,” they said. The press remained skeptical, especially after a dentist who had participated in the operation let it slip that something more dramatic may have taken place on the boat. By the time the president returned to the nation’s capital in August, however, he’d adjusted to his prosthetic jaw and could talk without most anyone seeing or hearing differences. The president’s men maintained the deception, vilifying the one bold journalist who correctly reported the bulk of the story—who would receive vindication in the new century, after Cleveland had died of a heart attack. Cleveland’s lies affected few major matters of state, but 30 years later, the deception surrounded Woodrow Wilson’s stroke and subsequent disability certainly did. Heading into a public event on Sept. 25, 1919 in Pueblo, Colorado, Wilson stumbled on the single step from the car to the entrance. Once inside, he mumbled during his speech and failed to project as well as usual. A Secret Service agent noticed later that night that the president seemed to be walking oddly. After experiencing a crushing headache overnight, Wilson awoke the next morning with the left side of his face fallen and motionless, slurring his words and with trouble moving his left arm and leg. His wife Edith and his personal physician, Cary Grayson, agreed to head back to Washington immediately—and to mislead the public. Despite the incident the night before and the president’s dramatic symptoms, Grayson told the press that Wilson’s simple “nervous exhaustion” demanded the change of plans. Train stops along the way for passengers and supplies brought onlookers to the tracks to try to get a glimpse at the sick president, so Edith pulled down the shades to keep his hidden from view. A week later, the president collapsed unconscious in a White House bathroom, awakening to find he couldn’t move his left side or communicate clearly. A massive stroke had left him “helpless,” the White House usher recalled . It took more than a month until the president could be carried from his bed to a chair nearby, and the usher later said that even then Wilson remained “a shadow of his former self.” A doctor’s bulletin called the president “a very sick man” and declared “absolute rest is essential for some time,” but withheld all details. The information-starved public and members of Congress wanted more, as did Wilson’s own cabinet, which lacked guidance on an ever-growing stack of executive actions. Even the vice president was kept in the dark. Without consulting with the vice president, the cabinet, or Congress, Grayson and Edith Wilson decided the president’s progress depended on him remaining in office, so he would have motivation to improve, but forgoing any engagement on official business.For months, the two severely restricted access to the president to themselves, a handful of doctors and nurses, essential White House staff members, and Wilson’s daughters from his first marriage. Outside that circle, only a trusted few—including the president’s private secretary, the secretary of state, and a handful of others—even heard the truth about his paralysis and disability in those early weeks. Most of the cabinet, everyone in Congress, and the general public could only guess his actual condition. Key papers requiring presidential action went through Dr. Grayson to Edith Wilson, who took it upon herself to decide which ones her husband needed to hear about. Most of them never received replies; a few decisions did come down from the residence in the president’s name, but nobody could be sure if the decisions or the signatures on them were truly his or Edith’s. Available evidence strongly suggests that the first lady took great liberties with her new role. Secret Service agent Edmund Starling admitted that Grayson and Edit
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