The Health of the First Ladies: Medical Histories from Martha Washington to Michelle Obama (9 page)

Sewall had commenced his medical practice in Massachusetts, but in 1818 he was convicted of digging up a corpse for the purpose of dissection.
The History of the Medical Society of the District of Columbia
elaborated: “Sewall … came to Washington under a cloud, having robbed the grave of a near relative in his devotion to the study of medicine. Hingham’s loss was Washington’s gain.”
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Fortunately for the physician, his attorney was Daniel Webster, then a Massachusetts congressman, a future U.S. senator and later the secretary of state for president John Tyler. Webster invited Dr. Sewall, his client, to the more forgiving milieu of Washington. Sewall accepted this invitation and his career prospered.
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Phrenology was the study of the relationship between a person’s character and the morphology of the skull. Its practitioners were convinced that an examination of the skull’s shape predicted the size and development of the brain beneath. Its popularity in England in the early 1800s led to its spread and use in the United States between 1830 and 1850.
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Sewall, in two lectures delivered to the students of the Columbian College in February 1837, debunked the “science” of phrenology, concluding, “Is it strange, then, when we are told that a science that has been discovered, by which the character and capabilities of the human mind can be ascertained; the secrets of the heart disclosed, and this, too, by a momentary examination of the exterior of the head, that we should find men who will study and advocate its doctrines?” The following year Sewall loaned former first lady Dolley Madison a book on phrenology for reasons unknown.
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Sewall was very active in the national and international temperance movement. His lecture to the Maryland State Temperance Society, “On the Pathology of Drunkenness,” was widely reported. The lecture used as props transparent paintings of the stomach in a state of health, the stomach of a confirmed alcoholic, and the stomach of an alcoholic who died from delirium tremens.
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As a famous physician in the still small city of Washington, his professional connection with other inhabitants of the White House in addition to Mrs. Tyler should not surprise one. Sewall was called in consultation to the deathbed of William Henry Harrison, Tyler’s predecessor. It has been a frequent practice of doctors, when confronted with an unhappy or complex outcome for a prominent patient, to spread the blame for any treatment failure among as many physicians as possible. Sewall was prestigious enough to have his name included with other doctors in the medical statement issued to the public and press upon Harrison’s demise.
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In early 1835, Richard Lawrence attempted to assassinate President Andrew Jackson. The attempt failed when Lawrence’s pistols failed to discharge. Sewall and a second physician were charged to determine “the state of mind” of the assailant. Their widely disseminated report was comprehensive and factual but devoid of conclusions. A clarification was asked of the examiners, who replied, “[W]e therefore do not hesitate to state, as our opinion, that this unfortunate man is laboring under extensive mental hallucination upon some subjects.”
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A third connection was with the flamboyant congressman Franklin Pierce in late February 1836, seventeen years before Pierce was inaugurated as the fourteenth president. The congressman, inebriated, was embroiled in a fight with two other representatives at a Washington theater. Subsequently Pierce was awakened at night with a fever and pleuritic pain: “Dr. Sewall visited Pierce and removed 16 oz. of blood from him. On the next visit, 24 hours later, the doctor removed 10–12 more ounces of blood by cupping. To this treatment was attributed his recovery…. During the second week of March, he was well enough to resume his work in Congress.” Whether Sewall repeated this treatment on the dying Letitia Tyler remains unknown.
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In the nineteenth century, medical understanding of “paralytic stroke” was limited. Physicians were able to recognize it as an abrupt change in cerebral function and in muscle motor control. By the 1840s, it was accepted that its cause was an obstruction of the blood vessels to the brain. The accepted treatment for paralysis could be calamitous. Mushet wrote that “much evidence might be collected in favor of bleeding in cases of sudden hemiplegia.” According to Taylor, remedial treatment included rapid venesection, which “should be early and extensively employed, a frequent repetition of the bleedings being indispensable in most instances.” He further proposed that the bleeding be initiated in the jugular vein of the neck to the point that the radial pulse weakened.
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Adjunctive treatment also could be deleterious and included hot brandy. cayenne pepper, the cathartic calomel, emetics and blistering. There is no record of the treatment received by Letitia Tyler either for the stroke in 1839 or for her terminal cerebrovascular accident.
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The burdens of being first lady did not affect Letitia Tyler’s health, since she was already disabled when she first took up residence in her White House quarters. She was unable to perform any of the required tasks, and as a consequence the question is moot. She was incapable of accomplishing any of a first lady’s requisite social and ceremonial tasks. Her prominent position gave her access to the best D.C. physicians available. Dr. Thomas may not have merited such prestigious consideration, but Dr. Sewall certainly did. Letitia died at an earlier age—just shy of fifty-two years—then the life expectancy of that of white American females in 1850. The very first mortality statistics for the United States appeared as part of the seventh census of the United States in 1850. In 1850, a white female at age 10 would be expected to live for 47.2 more years, i.e., until age 57.2.
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John Tyler was well during his presidency and his medical care in the White House was minimal or absent. Letitia’s illness drove him to work harder: “He buried himself in work. Rising with the sun, he stayed at his desk without a break until three-thirty in the afternoon, at which time the family dined together. After candlelight he interviewed visitors and performed miscellaneous social chores until bedtime at ten o’clock. Tyler worked arduous hours to avoid dealing with the approaching death of his wife.”
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His wife’s illness apparently did not effect the performance of his presidential duties.

Elizabeth Monroe, Anna Harrison, Margaret Taylor and Abigail Fillmore

[Elizabeth Monroe suffered from] an unidentified ailment that forced her to curtail her activities as First Lady.
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Elizabeth Monroe, the wife of James Monroe, the fifth United States president (1817–1825), succeeded the effervescent and extremely popular Dolley Madison as first lady. Mrs. Monroe suffered greatly in comparison to Mrs. Madison. During the eight years of the Monroe presidency Dolley’s tradition of returning courtesy calls was abandoned and the previous sparkle of White House ceremonial dinners, drawing room mixers, and social teas was dimmed. Mrs. Monroe was accused of snobbery for her French manners, and the grande dames of the capital initially boycotted her parties.
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The criticism of the capital’s social elite assailed the first lady’s plans for her daughter Maria’s White House wedding, and the invitation list was limited to forty-four guests. Maria’s March 1820 wedding was the first for a daughter of a sitting president in the White House.
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First lady Monroe frequently missed social events where her presence was either anticipated or expected, and there were periods when she was absent from public view. Additionally she had the hauteur of an aristocrat and projected the image of a grande dame. Carl Anthony may have surmised the thoughts of her contemporaries: “But though the words were unspoken, it was understood that America now had its first Queen Elizabeth.”
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Someone needed to stand in for the often absent president’s wife. The surrogate was the Monroe’s older daughter, Eliza Hay. Almost immediately after her husband’s inauguration, Elizabeth began to rely upon her daughter to fulfill social commitments. This dependency increased during Monroe’s second term, since the first lady was said to be increasingly troubled by illness. Eliza Hay’s personality complicated rather than alleviated the sensitive social situation. Eliza was both abrasive and snobbish. Her schooling in France contributed to her aloofness and condescending behavior. Louisa Adams, the wife of Monroe’s secretary of state, was also schooled in France. The opinionated but perceptive Louisa described Eliza as so “full of agreeables and disagreeables, so accomplished and ill bred, so proud and mean,” with such a “love of scandal that no reputation is safe in her hands.”
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Elizabeth Monroe eventually overcame the early criticisms of her management of White House’s social and ceremonial affairs. Her charm, beauty and sincerity won the admiration and esteem of all, including her most severe critics. “In spite of her poor health, Mrs. Monroe still looked younger than her years and her beauty was much admired.” Although she had been ill during much of the winter, the first lady presided at the White House dinner that honored the Marquis de Lafayette upon the fiftieth anniversary of his initial visit to America. She impressed all with her remarkable beauty in spite of her sixty years.
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Ammon summarized the role of the nation’s fourth first lady: “In public, her formal manners left an impression of coldness and reserve, but in private she was a devoted wife and a doting mother, possessing to the full the domestic virtues then so highly prized—a complete absorption in the affairs of her family and household and a total detachment from the world of politics and business.”
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The only public political action undertaken by Elizabeth Monroe during her husband’s forty plus years in government service was her role in the release from a Paris prison of Madame de Lafayette, the wife of the French hero of the American Revolution. James Monroe was twice the American ambassador to France, the first time being 1793 to 1796 during the French Revolution. The aristocratic Madame de Lafayette was imprisoned under the sentence of death; her mother and her sister had already been executed. Ambassador Monroe was diplomatically constrained from any personal action to free the prisoner. However, the ambassador’s wife, Elizabeth, not shackled by similar restraints, became a willing coconspirator in the plan to free this prisoner. Mrs. Monroe boldly drove to the prison in a very elegant and conspicuous carriage to meet with Madame de Lafayette. The meeting between the two women became public knowledge almost immediately. Consequently the French government, made aware of the significance of Madame Lafayette to its American ally, freed her shortly thereafter.
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The Monroe presidency concluded in March 1825. Monroe welcomed the release from the responsibilities of office. His principal concern was that Elizabeth would regain her health in the quiet of their Virginia home. She was in such poor health that she and her husband were compelled to remain in the White House for three weeks after the inauguration of his successor, John Quincy Adams.
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Chronic illness or illnesses, rather than social maladroitness or a pretentious personality, prevented Elizabeth Monroe from performing successfully as a first lady. Without doubt she was sick in the White House both before and after Monroe’s presidency. Illness was chronic and persistent, and more than a single disease likely was present. Primary sources are largely silent regarding her symptoms, diagnoses, treatments, and even the identity of her physicians. Almost everything written on this subject in biographies is either inference or speculation.

James Monroe, age twenty-seven, married Elizabeth Kortright, only seventeen, in New York City’s historic Trinity Episcopal Church on February 16, 1786. Their devoted marriage produced three children: Eliza, born December 5, 1787; James Spence, born 1799 (died from pertussis on September 28, 1800); and Maria Hester, born in Paris in 1803.
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During the Monroes’ early married life, Elizabeth was healthy. James Monroe’s letters, mainly to fellow Virginians Thomas Jefferson and James Madison between 1786 and 1794, contain few references to Elizabeth’s health. There is no reference to a chronic illness. His epistolary references to Elizabeth were then, and would be later, habitually succinct.
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Elizabeth Monroe likely was afflicted by three diseases: rheumatoid arthritis, epilepsy, and a gastrointestinal malady. The first of these is the most documented. Her health problems began during Monroe’s terms as governor of Virginia (1799–1803) when she developed “rheumatism.” Her symptoms intensified during a March 1803 transatlantic voyage to France, where her husband negotiated the Louisiana Purchase. Elizabeth was thirty-five when this journey commenced.
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The age of onset of her illness and her generalized symptoms, including fatigue, convict rheumatoid arthritis as the offender. Unfortunately the specific joints affected and a clinical description of their appearance are missing. Therefore one should conclude that all references to “rheumatism” in this patient’s medical history would in today’s parlance be rheumatoid arthritis. The first description of rheumatoid arthritis appeared in the dissertation of Augustin Jacob Landre Beauvais in 1800. However, it was not until 1890 that the diagnostic term “rheumatoid arthritis” was coined by the French physician Archibald Garrod.
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Immediately upon the conclusion of his mission to France, James Monroe was dispatched to London as American ambassador to the Court of St. James. London’s cold damp weather worsened Mrs. Monroe’s symptoms, as such weather characteristically affects patients with arthritis. The ambassador was forced to move his family to the English countryside to escape both the dampness and the city’s deleterious air quality.
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