The Health of the Presidents. No. III

The Health of the Presidents. No. III

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

WWP16615

1927 July 1

Cary T. Grayson writes about his time as physician to the Presidents.

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

English

Surgeon of the President’s Yacht Mayflower During the Roosevelt and Taft Administrations and White House Physician During Both Terms of President Wilson

III

IN THE days of the earlier Presidents, physicians, in great measure, still confined their activities to attempts at curing disease. The science of preventive medicine was little known or understood. Many of the infectious and contagious diseases which at that time were a scourge, causing tremendous havoc and a high death rate, have now been brought under control through the application of principles which medical science has established. We must keep in mind that the germ theory of disease is not definitely established until Pasteur published the results of his brilliant work. It was during the early days of the administration of Mr. Buchanan in 1857 that Pasteur, in France, published his first papers on lactic acid and alcoholic fermentation and showed that fermentation was caused by living organisms. Pasteur continued his remarkable researches and in 1865 took up the study of silkworm disease which was creating such havoc with the silk industry of France. He soon brought this disease under control by his new methods of investigation. During General Grant’s first administration he devised the process which we now call Pasteurization.

THESE discoveries were of tremendous value to the brewing and wine-making industries of France, serving to prevent the deterioration of wines and beers and practically saving the wine-making industry for France. In order to prove the value of Pasteur’s discovery, a cask of wine was sealed and placed on a ship setting out on a long cruise. Upon the return of this ship several months later the cask was opened and the wine drunk, all agreeing that it had not suffered the slightest deterioration, but in fact had been improved by its travels. The science of bacteriology came into existence as a result of Pasteur’s work, and the laboratory became a prime factor in the study of disease. To the art of medicine was gradually being added the science of medicine, and modern methods of preventive medicine were being formulated. The first disease in which the etiologic relation of the germ to disease was definitely proved was in the case of anthrax. This work was done by Pasteur and Koch in 1876 during the closing days of General Grant’s administration, so that modern bacteriology is, after all, a fairly young science. While it has made tremendous strides in the past fifty years and has become a veritable giant, it has by no means attained its full growth, and we are still looking eagerly toward the laboratory for further insight into disease prevention and cure. Smallpox was a great scourge among the early settlers of New England, who regarded it as a most malignant evil when it spread among themselves. Nevertheless, when smallpox attacked the threatening Indian tribes with heavy mortality it was regarded as a friendly act of Providence. It was a common practice to hold fast days in Colonial times in order to seek deliverance from those epidemics of smallpox which swept through the province. Before Jenner’s discovery it had become a common practice among the colonists to inoculate for smallpox, which procedure had been used for a considerable time by the Turks. In April, 1721, Lady Montague returned to England from Turkey and described inoculation, which she had seen used with such beneficial results by the Turks. This method consisted in taking some of the infective material from an individual suffering from mild smallpox and inoculating the healthy individual much in the same way that vaccination is practiced today. This result was an attack of smallpox which was usually mild in character and conferred immunity upon the individual, although occasionally it resulted in a severe or even fatal attack of the disease. There was great objection to this procedure and resort was had to the courts to curtail its use. Benjamin Franklin became one of the strong advocates of inoculation. In his Autobiography he tells how in 1736 he lost his son, “a fine boy of four years old, by the smallpox, taken in the common way. I long regretted it, and still regret that I did not give it to him by inoculation. This, I mention for the sake of parents who omit that operation on the supposition that they should never forgive themselves if a child died under it, my example showing that the regret may be the same either way, and therefore that the safer should be chosen.”

HOSPITALS for smallpox inoculation were opened and patronized freely by the people. James Warren wrote to John Adams from Boston on July 17, 1776, in part, as follows: “...the rage for inoculation prevailing here has whorled me into its vortex and brought me with my other self into a crowd of patients with which this town is now filled.” A week later John Adams replied to Warren: “This, I suppose, will find you in Boston growing well with the smallpox. This distemper is the king of terrors to America this year. We shall suffer as much by it as we did last year by the scarcity of powder and therefore I could wish that the whole people were inoculated. It gives me great pleasure to learn that such numbers have removed to Boston, for the sake of going through it and that inoculation is permitted in each town. I rejoice at the spread of the smallpox on another account; having had the smallpox was the merit which originally recommended me to this lofty station. This merit is now likely to be common enough and I shall stand a chance to be relieved. Let some others come here and see the beauties and sublimities of a Continental Congress—I will stay no longer. A ride to Philadelphia, after the smallpox, will contribute prodigiously to the restoration of your health.” It would appear from this letter that John Adams had been a sufferer from the smallpox and that he also was a hearty advocate of inoculation for this disease. Inoculation, as practiced in the Colonial days, was a separate and distinct procedure from vaccination. Inoculation resulted in smallpox which, as a rule, was mild in character but, in a small percentage of cases, produced a severe attack and an occasional death. Vaccination, as practiced later and at the present time, produces a disease known as cowpox which practically never results in death. General Washington was a firm believer in inoculating his troops in order to prevent an epidemic of smallpox. At his insistance Mrs. Washington was inoculated while she was staying at Philadelphia in the spring of 1776, as he feared that she might contract smallpox on some of her visits to the Army camp. General Washington had a number of houses in the vicinity of Morristown, New Jersey, fitted up as inoculation hospitals, and ordered a general inoculation not only of his troops but also of people in the vicinity of the camp. It was not until 1796 that Edward Jenner’s discovery of vaccination revolutionized the ideas of the medical world regarding smallpox and made available one of the greatest prophylactic measures against disease which have ever been devised. THE profound impression which this discovery made on the layman was well as the medical man is illustrated in the following sentence from The Heart of Midlothian. When he described the meeting between Jeanie Deans and Queen Caroline, Sir Walter Scott says, “The lady who seemed the principal person had remarkably good features, though somewhat injured by the smallpox, that venomous scourge, which each village Esculapius—thanks to Jenner—can now tame as easily as their tutelary deity subdued the python.” It was during the closing days of John Adams’ Administration and the beginning of Mr. Jefferson’s term that Jenner’s method of vaccination against smallpox began to be practiced in this country and also in Canada.Thomas Jefferson was so deeply impressed by this discovery that he wrote Jenner as follows: “Medicine has never before produced any single improvement of such utility.” At least three of our Presidents suffered in their youth from violent attacks of smallpox which threatened for a time to cause their death. At the age of nineteen Washington, who then held the rank of major in the militia, was called to accompany his eldest half brother, Lawrence, to the West Indies, on a voyage for his brother’s health. He was absent from home for more than four months, and on this trip suffered a severe attack of smallpox, the marks of which he carried on his face the remainder of his life. Andrew Jackson also was a victim of smallpox. He and his brother had been taken prisoners by the British in 1781 and brought to Camden, where both suffered from this disease. Two of his brothers as well as his mother died of hardships sustained in the war, and his own sufferings were well-nigh terminated by the smallpox. Thanks to Jenner’s discovery, this disease can now be controlled if universal vaccination is practiced. However, we must admit that with all of our boasted superiority in public health, we still have a high incidence of smallpox which could, no doubt, be stamped out if vaccination were more generally practiced today. In 1925 there were over thirty-nine thousand cases of smallpox in the United States, which were more than occurred in any country furnishing statistics, except India. In Washington, District of Columbia, in 1925, there were fifty-nine cases with twenty deaths, and during the first quarter of 1926 there were in Los Angeles eight hundred and twelve cases with one hundred and thirty-six deaths. Even Soviet Russia, with its larger populations, had only half as many cases as the United States. It would seem that a return to the practice of universal vaccination could be urged with a material lowering in the occurrence of this disease.

THIS survey of smallpox among the early settlers, with the tremendous death rate, and the eagerness with which these hardy settlers seized on inoculation, which carried with it a possibility of death, is an example which we may well recall at this time. The introduction of vaccination in 1800, with practically no mortality and with complete control of the disease wherever it is intelligently used, leaves little excuse for the present high smallpox rate in this country. Thomas Jefferson would be amazed today if he could scan the death reports from smallpox in the United States. He would have great difficulty in understanding why his prediction, over one hundred and twenty-five years ago, that “future nations will know by history only that the loathsome smallpox has existed” has not been fulfilled. During the first year of Mr. Wilson’s administration a number of cases of smallpox developed in Washington. The health authorities of the District advised the people to be vaccinated, but there seemed to be some reluctance on the part of public in carrying out these recommendations. The situation was explained to the President and he immediately volunteered and was the first one in the White House to be vaccinated. After this example the entire White House personnel submitted to vaccination. The example of the President had a most stimulating and beneficial effect on the attitude of the public towards this procedure. Yellow fever also caused great hardship in Colonial days and resulted in the first quarantine regulations known to have been made in this country. At that time it was called the Barbadoes distemper, and ships coming from the West Indies were not allowed to land their passengers until danger from infection was believed to have passed. Charlestown, Philadelphia and New York all passed through severe epidemics of yellow fever, which was termed the American Plague. In New York, in 1702, the ravages of yellow fever became so alarming that the Assembly of New York met at Jamaica, Long Island, instead of the City of New York. DR. BENJAMIN RUSH described the epidemic which invaded Philadelphia in 1793. He attributed its source to a quantity of damaged coffee which had been thrown out on a wharf in the neighborhood of a house in which yellow fever developed. Drastic measures were put in force to control its spread, which frequently involved much hardship. Thomas Jefferson felt compelled to protest against some of these measures, although his protest does not seem to have been particularly effective. The people were so alarmed and frightened by the ravages of this dreadful disease that any measures which appeared to have merit in curtailing its spread found considerable support. Of course we know now that yellow fever is transmitted by the bite of a mosquito which has previously fed upon an infected individual, and that eradication of the mosquito or preventing it from becoming infected by feeding on a patient with yellow fever is sufficient to control the disease. In these early days, however, there appeared to be no suggestion of the mosquito having any connection with the spread of yellow fever and consequently the preventive measures adopted did not meet with any startling degree of success. Many citizens fled from Philadelphia in hopes of escaping the contagion, but had great difficulty in entering the surrounding towns and frequently were subjected to considerable hardship and compelled to wander about, as none would receive them if it was learned that they had come from Philadelphia, where the epidemic was raging. Dr. Rush took an active part in combating this scourge and has left us an account of the depressing atmosphere which pervaded the city. The treatment of yellow fever in those days varied with the individual physician, and the management of the sick gave rise to much dispute and acrid controversy among the members of the medical profession. In the light of present-day knowledge some of these older methods of treatment appear to have little virtue, while others appear amusing or even ludicrous. Nevertheless, some of our recognized forms of treatment at the present time may appear equally amusing fifty or a hundred years hence. Whenever there is an illness at the White House which involves the President or some member of his family, the unofficial mail contains much in the way of advice and suggestion for the relief of the sufferer. A great deal of this advice is purely unselfish and the sender no doubt has at heart the interest and welfare of the President and his family. The advice, however, is frequently based on insufficient knowledge of the actual condition of the patient or involves some hobby or personal belief on the part of the sender. Some of these communications are disinterested and many are highly amusing. The President receives much advice on every conceivable topic, from curing a cold and reducing a fever to the knottiest problems of government. During Mr. Wilson’s régime one of the members of the White House staff was suffering from a persistent attack of the hiccups which had continued for several days and which was particularly resistant to treatment. Hearing of this case, a well-meaning individual communicated to the White House physician that she knew of a case of hiccups of three weeks’ duration, which a young physician was called in who directed that the patient be given two teaspoonfuls of bird shot. She stated that after the first teaspoonful the patient was tilted to the right and after the second teaspoonful he was tilted to the left, and that following this heroic measure the hiccups promptly subsided, as “the bird shot held the lights of the liver down.” James Monroe took an active part in the affairs of the colonies and during the yellow-fever epidemic of 1793 held a seat in the Senate. Whether or not he suffered an attack of yellow fever appears doubtful, as he was particularly active during this period. As a youth he went to William and Mary College. At the outbreak of the Revolutionary War he joined the Army at General Washington’s Headquarters in New York as a lieutenant in the Third Virginia Regiment. He saw much active military service and took part in the battles of Brandywine, Germantown and Monmouth. He early formed the acquaintance of Governor Jefferson and his intimacy with Mr. Jefferson continued throughout his life and had much to do with his early advancement and success. Mr. Monroe served as a member of Congress and at the end of his term in 1786 retired to his home in Fredericksburg to practice law, but was soon again called into public life. TWO years later, in 1788, he went as a Virginia delegate to the Assembly to consider the ratification of the proposed Constitution of the United States. It is a curious fact that while James Madison, John Marshall and Edmund Randolph urged the ratification of the proposed Constitution, Patrick Henry, James Monroe, William Grayson and George Mason opposed ratification. Mr. Monroe, however, later assented to ratification. Under the new Constitution Virginia sent, as her first senators, Richard Henry Lee and William Grayson. Upon the death of William Grayson in office, Mr. Monroe was selected to fill the vacancy and served in the Senate from 1790 to 1794, at which time he went as our envoy to France. During Madison’s Administration Monroe served as Secretary of State and also for two years as Secretary of War. While he was serving in the Cabinet hostilities began between the United States and England. At the time of Mr. Monroe’s election to the presidency in 1816 at the age of fifty-eight years, he had held almost every important position to which a politician could aspire. He had been a member of the Virginia Legislature, of the Continental Congress, and of the Senate of the United States. He had served as a member of the convention that considered the ratification of the Constitution. He had been twice Governor of Virginia and had been Minister to France, England and Spain. Almost continuously from the time he left William and Mary College in 1776 to join Washington’s Army, to the fourth of March, 1825, when he retired from the presidency, he had been in his country’s service. Monroe was of excellent physique, stood six feet tall and proportionately broad, and his early outdoor training and strenuous life with the Continental Army no doubt had a most salutary effect on his physical well-being. It should be recalled that during the battle of Trenton, a Hessian bullet lodged in his shoulder which he carried with him the remainder of his life. It is a rather sad commentary on the generosity of republics that although Monroe served his country almost continuously for fifty years he retired form the presidency with practically no visible means of support. Following the death of his wife he disposed of his Virginia farm, Oak Hill, and journeyed to New York City to live with his son-in-law. Here he died on the fourth of July, 1831, being the third President of the United States to die on the birthday of his country. There is little data available as to the exact cause of his death. He was in his seventy-fourth year, and had led a most colorful and vigorous life, although his closing days were rendered somewhat sorrowful by the shadow of poverty. Finances have been constant source of worry to many of our Presidents. Thomas Jefferson, in his last days, became seriously involved financially. John Quincy Adams bought a billiard table for his son out of money appropriated for refitting the White House and was so severely criticized that he finally paid for it out of his own pocket. President Buchanan found it difficult to meet the expenses incident to the Prince of Wales’ visit with the parsimonious congressional appropriation, and had to draw on his private means. At Grant’s second inauguration the heating was so inadequate that everyone danced in wraps and overcoats and the liquid refreshment froze. Van Buren’s elegance and good taste, his fine glass, elegance and good taste, his fine glass, china and silverware—the best in the country—especially his gold spoons, made him a target for many biting comments. On the expiration of their terms of office, our Presidents have frequently had to look about for a means of livelihood. Benjamin Harrison practiced law. Grover Cleveland became consulting member of a law firm. What to do with our ex-Presidents is a problem often mentioned but seldom discussed seriously. Some of them have been returened to office, as John Quincy Adams, who became a member of Congress and served brilliantly in this position. Mr. Taft was appointed to the Supreme Court of the United States, for which office he was eminently fitted, and which position he ably and amply fills. On the other hand, many of our retiring Presidents have expressed a disinclination to engage actively in public affairs. Mr. Cleveland is reported to have said, when asked to stand for a third term, “No, there has been quite enough of victory and defeat.” Why not pension our retiring Presidents? Surely they have earned it; and such a procedure would be dignified and would remove for all time the spector of an impoverished old age which has not infrequently stalked many of our former chief executives. It would also relieve a retiring President from the necessity of entering into business or professional activity in order to provide a livelihood for himself and his family. The closing years of General Grant’s life were embittered by the failure of the firm of Grant and Ward in which he and one of his sons were partners. This failure ruined him financially, although it was clearly shown that he was entirely ignorant of the money transactions that led to the disaster. As a result of this failure he felt compelled to write his Memoirs, and it appears doubtful whether these writing would have been accomplished except for financial necessity. Congress, in 1884, proposed to pension General Grant, but when he heard of this move he firmly refused to accept such a pension. The following year Congress passed a bill placing General Grant on the retired list of the Army. This bill was signed by President Arthur a few minutes before his term of office expired, and the general accepted the position by telegraph on the same day. He was even then in the early days of his fatal illness. However, if the pensioning of ex-Presidents was an automatic affair, recognized and established by act of Congress, there would be no hesitancy in accepting it and there probably would have been no hesitancy on the part of General Grant.

EDITOR’S NOTE—The fourth article in this series by Rear Admiral Grayson will appear in an early issue.