In our modern era of the wide and vast dissemination of information it is expected that anything pertaining to the President should be considered public knowledge. That includes any medical or health condition information. Should we also expect that the health of our First Ladies be made public?
In this article, written originally as a response to a public inquiry, National First Ladies Library Historian Carl Anthony sheds his thoughts on the answer to this question, and expands it with several examples of how different presidential Administrations have handled the issue of health matters of First Ladies.
Since the incumbency of Pat Nixon as First Lady in the 1970s, matters of health care, preventative health measures, public awareness about early warning signs of specific illnesses and those physical problems which particularly affect American women have become among primary issues First Ladies since then have sought to address in various forums.
Since the beginning of the presidency, however, there has been fair consideration of the question regarding the degree to which the public might expect full disclosure on elements of the private lives of presidential spouses.
Even after the 1994 judicial designation of Hillary Clinton being a “public official” by her marriage to the incumbent President of the United States, there is good sense making the arguments both that the public has a right to particularly know the details about the First Lady’s health or that is has no right to know but rather than disclosure of such sensitive matters is a prerogative of the individual in question.
I think that a balanced guideline might be drawn from several factors.
One is whether the First Lady in question is seeking medical care at the expense of public funds: in almost all instances this is the case, presidential family members being given such care by army and navy surgeons and physicians of high rank and skill.
The other factor is answered more elusively and a matter of subjective judgment: how is the President’s ability to fulfill his constitutionally-mandated duty being impeded by matters involving the health condition of a spouse?
We know now, for example, that the kidney disease which ultimately killed Ellen Wilson just a year and a half into her tenure as First Lady, deeply distracted President Wilson just as war was breaking out in Europe.
Following her August 1914 death in the White House, Wilson sunk into such a severe depression that his physician even feared he might become suicidal. Yet not until days before Mrs. Wilson died did the media and thus the public first learn the full story on her terminal condition.
Outside of this one can find no greater example of the dramatically positive affect of full disclosure regarding a First Lady’s health than the 1974 breast cancer and mastectomy of Betty Ford. Previous to this incident, discomfort in the discussion of breast cancer prevention and detection had kept the matter one that remained largely verboten in the general public discussion and news media.
Quite literally overnight, that societal norm shifted because of Mrs. Ford’s conscious decision to permit full public disclosure; as a result untold hundreds of thousands of lives were likely saved as not only American but non-American women sought out the necessary medical procedures ensuring early detection.
In 1989, Barbara Bush followed the model of Betty Ford by permitting full public disclosure of her diagnosis of a thyroid condition, following her detection that her eyesight was changing and that her eyes appeared to bulge. Her doing so helped raise public awareness of this condition which can often go undetected and lead to other complications.
Modernity, interestingly, is not a factor in how fully a First Lady might chose to publicly disclose her health issues.
Nearly twenty years after Barbara Bush chose to disclose her thyroid condition, her daughter-in-law Laura Bush did not permit the news that she had a squamous cell carcinoma tumor, commonly known as “skin cancer,” removed from her right shin in November 2006 until five weeks after the surgery.
“It’s no big deal,” she said, explaining her decision, “and we knew it was no big deal at the time.”
Yet even before the radical change in news transmission brought by the Internet, or even the invention of television or the widespread use of the radio, this uneven pattern was in place.
In the Jazz Age, Florence Harding wanted the public to be provided with the full details about the kidney dysfunction that nearly killed her in September of 1922.
For several days, as the First Lady’s life hung in the balance, the entire country was able to follow her condition with the release of detailed medical bulletins, which included explicit physical descriptions.
Almost forty years later, however, the Eisenhower Administration would only tell the press that First Lady Mamie Eisenhower had been to Walter Reed Hospital to treat a “woman’s problem,” a vague description which veiled the fact that it was a hysterectomy.
One also finds that the evolving nature of public response to various types of health issues is also a factor.
For example, in May of 1901 the McKinley Administration permitted full disclosure by the release of daily medical bulletins about the developing health crisis faced by Ida McKinley during a presidential tour to the Pacific Coast.
By the time a finger infection which was first detected in Los Angeles developed into high fever, blood poisoning and near-death upon their reaching the Monterey Peninsula, a sudden change in the President’s public schedule (permitting him to remain with her) necessitated public disclosure of the reason.
Determining that the First Lady’s grave condition could best be treated in the nearby city of San Francisco, the traveling White House moved with her to that nearby city, issuing two bulletins a day to keep the nation informed of her condition.
A month later, government medical consultants who conducted further blood tests and physical examinations on her provided the media with the startling speculation that her heart function may have been affected; the White House made no effort to deny or censor this.
And yet, pre-dating and simultaneous to all this was the McKinley White House policy of refusing to acknowledge, clarify or elaborate the repeated news reports of her vaguely described “nervous illness,” with symptoms of “fainting.” We know now that this was because the nervous system dysfunction in question was epilepsy.
During the McKinley Administration there were great strides in the expanding professional field of neurology which established seizure disorder to be a brain and nervous system condition and not the result of a mood disorder.
The general public, however, still held fast to the primitive belief that epilepsy was a form of insanity. Fearing the political repercussion of such association with the First Lady, the President was iron-clad in refusing to even acknowledge her seizures when they were occurring.
Might the public understanding of epilepsy have advanced more rapidly had the McKinley Administration disclosed the truth about the First Lady’s condition? Most likely.
Was it the responsibility of the McKinleys to do so? I believe that, despite their public roles and care by federally-salaried physicians they preserved their right to make a personal choice on how much they chose to disclose on the matter.
Sometimes, a halfway measure has also been employed. In 1909, for example, following her suffering of a stroke, First Lady Nellie Taft lost the ability to speak and thus cancelled all her public appearances. For months she struggled to learn again how to speak, her sisters and daughter aiding in social duties.
By her absence, the press and the public knew something was wrong. The White House released a degree of what was truthful facts about her condition, but did not make all of it publicly-known, including the fact that she had lost but was regaining her power of speech.
Rather than use the word “stroke” in more abstractly, yet honestly, referred to it as a “nervous condition.”
This sort of policy when it comes to First Ladies and their health might not be the full truth, but it is better than no truth at all.