Public Disclosure of Presidential Illnesses: The Discouraging History

In the time since the president announced his COVID-19 diagnosis in the early morning of Oct. 2, 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, 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 recovered eventually, 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 not to share with the public timely updates 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 him 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 his 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 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 Edith Wilson “stood between the President and the rest of the world while he was ill. How much they kept from him will never be known.”

Wilson’s successor, Warren Harding, declared no concerns about his health during the 1920 campaign or early in his term. In fact, Harding proved lively enough to pursue not only a heavy work schedule but also plenty of wager-filled rounds of golf and cards and risky extramarital liaisons. But he suffered from high blood pressure and signs of a heart problem; exhaustion and chest pains troubled him by the end of his first year in office. A nasty case of the flu soon thereafter, possibly accompanied by a small heart attack, brought sleep dysfunction and difficulty breathing while lying down. Harding, who refused to kick his smoking habit, had increasingly complained to the Secret Service’s Starling about getting extremely tired, with heavy feet, while playing golf. The public still knew nothing.

When Harding and his wife, Florence, took a long trip in the summer of 1923 by train, car and boat to the western states and then the Alaska Territory, the president experienced upper abdominal pains and nausea. Two of the physicians who saw him assessed that Harding’s heart had malfunctioned. A couple of days later, in San Francisco, X-rays indicated pneumonia, and blood tests pointed to significant heart problems. His doctors kept the exhausted and weak president in bed for a few days, trying to prevent the damage from getting any worse, and the White House didn’t release details about his decline. On the evening of Aug. 2, he died of a heart attack.

A decade later, Franklin Roosevelt famously tried to hide from public view the effects of his paralysis. For example, the Secret Service kept quiet that it had installed canvas fire chutes at the White House—and brought similar chutes when the president traveled—to drop from the president’s window in case of a fire emergency so that he could escape without being carried down the stairs. Other medical conditions that beset him in the 1940s, and ultimately killed him, prompted similar deceptions. By early 1944, Roosevelt admitted to only a select few that he felt “rotten” or “like hell.” Examinations revealed a litany of conditions that had developed or grown worse over the years: high blood pressure, congestive heart failure, poor circulation, limited lung capacity, an enlarged heart, an intermittent slack jaw and blank stare, and reduced supply of oxygen to the brain.

The communication between doctors and their very important patient was poor—in both directions. A method lay behind this madness: It allowed FDR to answer the media’s questions about his condition more freely than if he had complete knowledge about his health. Citing the war effort, Roosevelt didn’t campaign much at all in 1944, while his doctors increasingly deceived the press about what they knew. “The President’s health is perfectly okay,” his lead physician wrote in an October statement to the media. “There are absolutely no organic difficulties at all.” Within a few days, when a reporter followed up, the doctor doubled down: “The stories that he is in bad health are understandable enough around election time, but they are not true.” But, of course, they were true, and Roosevelt died in April 1945 after a cerebral hemorrhage.

A few presidents have been open with the public. Dwight Eisenhower, for example, had a heart attack while playing golf in September 1955, which left him in an oxygen tent at a nearby army hospital. After initial speed bumps with the press, the president’s staff soon forthrightly released frank reports about Eisenhower’s progress. Two additional health scares spurred Eisenhower to make specific arrangements for his vice president, in the event of a severe presidential disability, to “decide upon the devolution of the powers and duties of the Office” and serve as acting president until the inability had ended. More to the point, the letter codifying this intention was made public the following month—and helped inform debates about the presidential disability provisions of the 25th Amendment, ratified in 1967.

Those around Ronald Reagan didn’t act as smoothly on March 30, 1981, when John Hinckley shot and nearly killed the president. Almost immediately after the attack, Reagan underwent surgery and remained largely unconscious for hours. The obvious thing to do would be to invoke Section 4 of the 25th Amendment, which had been added specifically to deal with situations when the president “is unable to discharge the powers and duties of his office” by letting the vice president and the majority of the executive departments’ principal officers transfer power, at least temporarily. But administration officials failed to push consideration of the provision, even as Reagan bounced back and forth between consciousness and unconsciousness into the evening. Eisenhower’s example did, however, help them to communicate more robustly and effectively about the president’s medical condition with the press, the media and congressional leaders than most previous presidents had done.

Four of Trump’s 43 predecessors ultimately died of natural causes while in office, and many more of them faced serious illnesses or other disabling conditions during at least part of their tenures. Uncertainty about this president’s health, however, remains higher than most, even after significant advances in press reporting on medical issues. Mystery, for example, still surrounds Trump’s unannounced trip to Walter Reed in November 2019.

Legitimate security concerns understandably would limit public disclosure of minute-by-minute developments in a deathbed situation, but the president’s health appears to remain far from that scenario. This rough start and the history of presidential ailments combine to suggest that Americans shouldn’t expect robust public disclosures. Depending on how Trump’s illness progresses, months, even years, could pass before the truth comes out.

Correction: A previous version of this piece incorrectly stated that Trump announced his diagnosis on the morning of Oct. 1. The diagnosis was announced on Oct. 2.