The Health of the First Ladies: Medical Histories from Martha Washington to Michelle Obama (15 page)

Physick eventually operated—and then reoperated—on Thomas. Later Physick performed Louisa’s hemorrhoidectomy at Mrs. Pardon’s rooming house dressed, “as he always did for surgery, in his dark blue coat with bright metal buttons, white vest … and light gray pantaloons.” A graphic description of the operation may be read in Shepherd’s
Cannibals of the Heart
. The results of these operations, despite their occurrence in the preantiseptic and preanesthetic era, were successful. Louisa wrote in January 23, 1823: “My health is uncommonly good.”
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Mrs. Adams was also appreciative of the doctor who advised “her that sleeping with a husband who insisted on keeping the windows open was what caused most of her illnesses.”
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When her husband was secretary of state (1817–1824), “Louisa’s drawing room became a central area that notables utilized. Louisa loved beautiful music.” The Adamses’ residence was a “social center when John Quincy was Secretary of State … wonderful hostess reputation … music recitals and theater parties.” Louisa’s success as a hostess was not only social, but also, of more consequence, political: “John Quincy could never have become president without Louisa Catherine’s efforts as campaign manager. Louisa Catherine launched what she called ‘my campaign’ with the political savvy she had developed during a twenty-year career in European courts.”
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Louisa Adams was a depressed first lady. The contrast between her social involvement as wife of the secretary of state and that of the president was stark and harmful. She was sidelined. As the wife of the secretary of state, Louisa frequently charmed guests with her song and her accompaniment on the piano or harp. After becoming first lady, John Quincy Adams asked her to stop performing. She complied and practiced alone in the evenings, composing music and playing her harp.
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The absence of her children, public suspicion of her foreign birth, and limitations upon her previous social contributions made Louisa more miserable and increasingly reclusive.
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John Quincy was neither completely obtuse nor totally untroubled by his wife’s persistent unhappiness. In 1813, he suggested that she read Benjamin Rush’s
Diseases of the Mind
. The result was the opposite of his intention. In Louisa’s words, “I have read it through although I confess it produced a very powerful effect upon my feelings and occasion’d sensations of a very painful kind. Since the loss of my darling babe I am sensible of a great change in my character and I often involuntarily question myself as to the perfect sanity of my mind in this state of spirits a person is apt to fancy himself afflicted with every particular symptom described … cast a heavy gloom over me which I much fear nothing will ever correct. In vain I struggle against it. Life has become so barren.”
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Over a decade later Adams tried again. He consulted an unnamed (presumably his wife’s) physician. The doctor, fortunately for him still anonymous, employed with assurance a stereotypically gendered diagnosis. Louisa was a woman who suffered from the “peculiarities of the female anatomy.” It was not a dangerous condition, but it resulted in “an excited state from time to time.” He implied that his patient suffered from hysteria, a now-discredited diagnosis applied exclusively to women. (“Hysteria” is derived from the Greek “hysteros” referring to the uterus.)
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The first family lived quietly in the White House and seldom went out. The first lady declined invitations to outside events and limited her entertaining. But Louisa did not entirely shun her ceremonial and social duties. During the season she gave dinners once a week, fortnightly levees, and an occasional ball, plus the traditional New Year’s Ball.
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Deprived of substantial ceremonial, and even of an insubstantial, political, role, how did she bide her time?

As first lady, she wrote about the demeaning role of women in America. In her experience the then accepted role of women was akin to servitude because women functioned as sexual and domestic slaves of their husbands, who subordinated women out of their own self interest. She dissuaded her niece, who wanted to marry her son John, by writing that marriage had brought her to look forward to death “where sorrow and treachery are no more.” She also escaped by eating chocolate: “She spent a lot of time in her room gorging herself on chocolate.”
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During the winters she remained in her White House bedroom for days at a time. Louisa once confined herself for eight days and then again for five days without leaving her room. She preferred to spend the summers in Washington and refused to accompany the president, who summered in Quincy. In 1827, when John Quincy visited Massachusetts, Louisa chose to remain in the White House and rarely exchanged letters with her husband. Later she roamed the Hudson Valley and New Hampshire without him.
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In summer 1828, Louisa finally broke under the strain and became alarmingly ill. Her symptoms were mysterious but frightening enough to bring “John Quincy and her sons rushing back to Washington from … Quincy … recovering almost as quickly once she captured the attention of her husband and family.” Louisa continued, bored, isolated, and angry, in the White House. Her husband and sons dismissed her as a hypochondriac.
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Erysipelas erupted again in the White House. In February 1828, Louisa became quite unwell and took to her room. Dr. Henry Huntt, the family physician, gave her an emetic and bled her three times. When his treatments were ineffective, surprisingly he returned to make three house calls. Presumably he continued his regimen of blood-letting. Henry Huntt was one of Washington’s most prestigious medical practitioners and later, exhibiting no political predilection, he attended President Andrew Jackson in the White House.
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The Adamses’ political prominence led to many perquisites that were unavailable to their fellow citizens. An important one was the availability of the best physicians of the times. Louisa was attended by Drs. Benjamin Rush, Philip Synge Physick, and, in the White House, Henry Huntt.

The effects of the presidency upon this first lady were near ruinous. She was depressed, isolated, and suffered from many physical ailments. Did her state of being affect her husband’s presidency (which has been judged only modestly successful)? Probably not, as he didn’t communicate with her and disparaged the opinions of women.

Adams was soundly defeated by Andrew Jackson in the 1828 presidential election. The Adamses’ oldest son, George Washington Adams, summoned to Washington to assist his parents’ return to Massachusetts, committed suicide instead. In August 1829, on the trip north, Louisa’s sorrow over her son’s death overcame her. In her distress, she reenacted one of her successful behaviors: midway in the journey “one of those violent attacks which she is subject to with all the family and servants up and trying to assist her in her distress. She complained of coldness about the breast.” The Adams party returned to Washington. Next morning she was fully recuperated.
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In 1835, after son John’s death, “she again, as she had in 1825–8, worried about her sanity.” “Louisa was so troubled by life and questioning that she rode into Boston and saw Dr. Harriot Kezla Hunt. Little is known of Dr. Hunt’s impact upon Louisa, but we do know that this radical woman physician was ‘a zealous little creature’ and ‘a very peculiar individual’ who treated neurasthenic women.” Dr. Hunt was trained only by apprenticeship with an English physician. She twice was refused admittance to Harvard Medical School. She opposed heroic treatments, and instead recommended diet, exercise, and regular bathing. In addition to medicine, her passions included women’s rights and abolition.
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Louisa Catherine Johnson Adams, then a widow, died in the District of Columbia at age seventy-seven on May 15, 1852. A stroke in April 1849 affected her ability to walk and made useless her right hand. She learned to use her left. Subsequently she suffered additional strokes and heart failure. Heavy doses of opiate made Louisa comfortable.
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“I owe altogether about twenty-seven thousand dollars…. I must dress in costly materials. The people scrutinize every article that I wear with critical curiosity. The very fact of having grown up in the West, subjects me to more searching observation. To keep up appearances, I must have money … no alternative but to run in debt.”
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There exist numerous books about Mary Todd Lincoln, and innumerable biographies of Abraham Lincoln, the 16th president of the United States. A thorough review of the Lincolns’ marital relationship is far beyond the scope of this essay; instead it will focus narrowly on Mrs. Lincoln’s mental illness, its development, progression, and effect both upon her behavior as first lady and upon the performance of Mr. Lincoln as president.

Although the severity and the time of onset of Mary Lincoln’s mental illness may be in dispute, there is no disagreement that her life was buffeted by tragedy—the premature deaths of three of her four sons; the assassination of her beloved husband; the undeserved social and political scorn aimed at her as first lady; and the alienation from her Confederate step-family that paradoxically led to suspicion that she was disloyal to the Union.

Physical complaints and illnesses were unusual until later in her life, after the death of President Lincoln. The only previous significant complaint until then was headaches, described as migraine. Robert K. Stone, M.D., was the family physician to the first family, but any medical treatment is unrecorded. From her early twenties on, Mary Lincoln was plagued by headaches. These were occasionally debilitating; they persisted in the White House, and continued until her death. During the early afternoon of that fateful Good Friday in 1865, “despite her fear of an oncoming headache earlier in the afternoon, Mary decided to accompany her husband.”
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Eventually, in 1875, a Chicago jury declared that Mary Lincoln was insane and committed her to a sanatorium. With the author’s apologies, this episode will be examined only briefly since excellent detailed analyses of the affair have appeared in book form.
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Mary Todd was born in Lexington, Kentucky, on December 13, 1818. Her mother died when Mary was six and a half years old and her father remarried. She was raised in a blended family of many birth and stepbrothers and a step-sister. Mary’s birth mother and step-sister died in childbirth. Mrs. Lincoln herself had four successful pregnancies, the last of which produced future gynecological problems.
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A major traumatic event was the death of the Lincoln’s second son, Eddie, in February 1849. Eddie struggled with tuberculosis for fifty-two days before he succumbed just shy of his fourth birthday. Mary Lincoln was “consumed by her grief—and suffered severe spells of weeping and a lack of appetite.” The sorrow prostrated her and was accompanied by a refusal of water and food. Abraham Lincoln’s concern over his wife’s depression caused him to seek help. He chose Dr. James Smith, a cleric, not a physician. Smith proved to be an effective counselor and steered Mary Lincoln through a difficult period.
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For most of the Lincolns’ years in Springfield, Illinois, Mary provided excellent political counsel to Abraham: “She kept Mr. Lincoln from making several mistakes that would have been fatal politically.” He trusted her opinion, realizing that she was an excellent judge of people, a better reader of men’s motives than himself. However, even then she was unpredictable, possessed an acerbic tongue, and exhibited unexpected rage. Gossip had it that on one occasion she chased her husband down a street with a butcher knife in her hand.
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Mary Lincoln decided on her husband’s inauguration day that she would make the White House, then dismal and in disrepair, a home befitting its role as the residence of the country’s chief executive.
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She immediately accepted the social and ceremonial responsibilities of first lady and held her first White House reception within a week of the inauguration. She presided over weekly levees on Tuesday evenings. In August 1861 she hosted four thousand guests at a reception for Prince Bonaparte, the cousin of the emperor of France. Her role as hostess delighted her and made a favorable impression on most visitors. Early in the Lincoln presidency, Mrs. Lincoln functioned as a political partner, advising her husband, particularly on appointments.
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But her patina of prestige quickly faded, for reasons both her fault and not. Mary Lincoln was “brutalized by her husband’s critics, the press, and Washington society on both personal and political levels unprecedented in U.S. politics. Her attire, hosting, family life, and friendships were all open to condemnation. The South criticized her for being pro–Union, and the North never truly trusted this former belle from a prominent Southern family. She was simultaneously accused of being pro–Union and pro–South, uncouth and too fancy. She was even accused of treason by the North and received a considerable amount of hate mail and death threats from the South.” It did not take long for the first lady to unloosen her vitriolic tongue.
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Her political judgment, excellent in the past, became flawed and eccentric. She inserted herself into disputes over postmaster and West Point appointments. In addition, she wrongly advised the president regarding his cabinet selections. Regarding secretary of state William Seward, she opined, “I wish you had nothing to do with the man. He cannot be trusted.” Her negative, eccentric, and personal judgments about politicians and others often became public.
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Abraham Lincoln’s presidential salary of $25,000, more than five times his previous annual income, became prey in Mary Lincoln’s quest to gown herself with extravagance to match her new station. In the latter part of January 1861, Mrs. Lincoln went to New York City to shop. In what was an early manifestation of her erratic judgment, she bought expensive dress goods, silks, ornaments, necklaces and earrings. These purchases, together with the inexplicable acquisition of lace curtains for the White House, “used [her] newly acquired credit to the breaking point.” In addition, during the first six months of 1861, her seamstress and friend, freed slave Elizabeth Keckley, fashioned fifteen or sixteen new dresses for her.
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