Woodrow Wilson Stroke

Title

Woodrow Wilson Stroke

Creator

Grayson, Cary T. (Cary Travers), 1878-1938

Identifier

WWP16061

Date

1919 October

Source

Cary T. Grayson Papers, Woodrow Wilson Presidential Library, Staunton, Virginia

Language

English

Text

I noticed in the morning a little saliva on the President’s pillow. I examined his face and it seemed to me to be slightly flattened and drooping on the left side but the change was so slight that I could not be certain about it, and later when I re-examined him it had disappeared. However, notwithstanding, I insisted upon his giving up the trip and immediately returning to Washington. This he strenuously resisted, saying that it was a matter of conscience with him to do his duty. He was exceedingly prostrated and for some time previously had shown considerable nervous exhaustion. However, he rested continuously in bed on the train until we reached Washington. By this time he had in a measure recovered his strength.

After his return to the White House his gain in strength continued and he was able to take an occasional automobile ride and a short walk. He was insistent upon this. I thought it wise, however, to communicate with Dr. FX Dercum of Philadelphia and arrange for a consultation. The time was fixed for Friday morning, October 3rd. On Thursday morning, October 2nd, the President complained of some numbness and weakness in his left side. This symptom seemed to become somewhat more marked during the day and I at once consulted my friends Dr. Sterling Ruffin and Admiral Stitt and also phoned to Dr. Dercum to come by the first train. In the meantime the weakness in the left leg became more pronounced and also made its appearance in the left arm. A drooping of the lower half of the left side of the face also became evident.

Dr. Dercum arrived at the White House and made an examination about 4.30 pm By that time a well marked loss of power had made its appearance in the left leg, left arm and lower half of the left side of the face. It was also noted that the President had lost sensation in the affected limbs and also in the left side of the trunk and left side of the head, face and neck. In other words a hemiplegia, both motor and sensory, had become established. The palsy was flaccid in character. The knee jerk, however, could still be elicited upon both sides, that upon the left side was less marked than upon the right. There was no ankle clonus. A well marked Babinski sign was also present upon the left side. It was noted that both eyes were directed to the right, i.E. there was conjugate deviation of both globes to the right. There was also an impairment of both visual fields, suggesting a left lateral hemianopsia. However, the fields could not be well outlined. The pupils were somewhat unequal, the left pupil was distinctly larger than the right. Both pupils, however, responded to light. There was no involvement of the sphincters. There was no rise of temperature, pulse and respiration revealed nothing abnormal.

During the examination the President was fully conscious and cooperated with Dr. Dercum during the examination; protruded his tongue, his lips, showing his teeth, opening and closing his eyes and performing other gestures in response to various requests and directions.

The President was in full command of all of his faculties. He spoke clearly without hesitation and with an unimpaired enunciation.

On Saturday, October 4th, the President was visited by Dr. Dercum and Dr. de Schweinitz and examined about 11.30 am Dr. Dercum made another examination confirming the symptoms previously noted. Dr. de Schweinitz reported that no true hemianopsic fields now existed so that this symptom if present had receded.

The dilatation of the left pupil was also a little less marked than at the previous examination. While the eyes when at rest still deviated to the right, the President was able to deviate them to the left though he did not perform conjugate deviation to the left as well as to the right. Speech and mental faculties as before.

On October 11th, Dr. Dercum again examined the President shortly after 11 am It was now noted that the hemianæsthesia had lessened so as to have been replaced by a moderate degree of hypæsthesia. The President was able to recognize light impressions with the touch of cotton wool upon the affected side though he did not recognize them it as readily or as promptly as upon the right side. This improvement in sensation appeared to be diffuse and was noted over all parts of the affected side.

The pupils were as at the previous examination. There was a less marked conjugate deviation to the right and about the same improvement in the ability to rotate the eyes to the left, as at the previous examination. There was no involvement of the sphincters. There were no rise of temperature, and no peculiarities of pulse or respiration.

There was still a marked flaccid palsy of both the arm and the leg. The left knee jerk was possibly a little more active than at the previous examination. There was no ankle clonus. A well marked typical Babinski sign was present. The tendon reflexes in the left arm could not be elicited. It was stated by Mrs. Wilson the nurse & Miss Powderly—assistant nurse that the President had at various times moved his left arm, carrying it to his face and also that he had at various times moved his left leg. Upon my requesting the President to move the affected members, he was unable to comply. At the time of Doctor Stitt’s making a puncture of the left hand for a leucocyte count the President jerked his hand away Speech and mental faculties as before.

The marked subsidence of the hemianæsthesia and the improvement in some of the associated symptoms justified the inference that these had been distance symptoms and had not been directly due to the lesion.

Besides having Dr Dercum in consultation as to the neurological condition and Dr. de Schweinitz as to the ocular manifestations, I have consulted daily with Dr Sterling Ruffin—a practitioner general practitioner of this city & professor of medicine in Geo. Wash. Univ—and Admiral Stitt the head of the Naval Medicine School as to his general condition and from day to day.

THE DIAGNOSIS made October 2nd and confirmed at the subsequent examinations was that of a thrombosis involving the internal capsule of the right cerebral hemisphere.

In view of the fact that the first manifestation of weakness of the left side of the face noted Sept. had cleared up so rapidly, it was hoped that the same improvement in the involvement of the left face, leg and arm, which occurred on the 2nd of October, might have a similar termination. Doctor Dercum’s second examination on Oct. 4th made it apparent that such a course could not be expected.

It was then desired by all the consultants on the case to make a full statement of the President’s condition to the public but in view of the wishes of _____ this was deferred.

At the time of the first consultation, the diagnosis was at once communicated to Mrs. Wilson and Miss Margaret Wilson and without any reservations. For various reasons it was thought that the hemiplegia might possibly prove transitory in nature; and in spite of the President’s rather good mental condition—though he was slightly somnolent—hemiplegia of other origin could not be absolutely excluded. It was thought wise therefore to make only a general statement regarding the President’s illness. The subsequent course of the case revealed the hemiplegia to be persistent. Notwithstanding, because of the undoubted improvement noted at various times, I (Dr. Grayson) thought it wise to issue general statements only. Further, Mrs. Wilson, the President’s wife was absolutely opposed to any other course. Use Admiral Stitt’s statement for the General Statement—add Dr. Dercum’s technical statement of the neurological examination under some such title as “Dr. Dercum’s detailed statement of his neurological examination is as follows:”

Files

http://resources.presidentwilson.org/wp-content/uploads/2017/02/D00017.pdf

Citation

Grayson, Cary T. (Cary Travers), 1878-1938, “Woodrow Wilson Stroke,” 1919 October, WWP16061, Cary T. Grayson Papers, Woodrow Wilson Presidential Library & Museum, Staunton, Virginia.