Woodrow Wilson - Strokes and denial
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In 1919, President Woodrow Wilson suffered a severe stroke that left him incapacitated until the end of his presidency in 1921, an event that became one of the great crises in presidential succession. However, historian Edwin A. Weinstein notes that Wilson had a history of cerebrovascular disorders going back to 1896, sixteen years before his was elected president.

Weinstein writes in his biography of Wilson that the young Woodrow was a slow learner and this could be a sign that he was dyslexic. He was always a high-strung person and subject to illnesses that were probably psychosomatic in nature. His letters often contain references to poor health and his rhetoric frequently used metaphors regarding the body.

Wilson was serving as an instructor at Princeton in 1896 when he suffered his first stroke. As Weinstein puts it:

Wilsonâs first known stroke, in 1896, manifested itself in a weakness and loss of dexterity of his right hand, a numbness in the tips of several fingers, and some pain in the right arm. Aside from the pain, which was transitory, the symptoms and manner of onset indicate he had suffered an occlusion of a central branch of the left middle cerebral artery. This vessel supplies the regions of the left cerebral hemisphere that control movement and sensation for the contralateral extremities. The subsequent course of the disease suggest that the branch was blocked by an embolus from the left internal carotid artery. (P. 141)

Wilson consulted with Dr. William Keen, who had treated Grover Cleveland several years earlier. Apparently, Keen did not consider the matter too serious as Wilson was allowed to go on a trip to England. Wilson was able to write with his left hand and would not regain use of his right until about four months after the stroke.

Wilsonâs psychosomatic disorders usually rose when he found himself under great stress and he was wont to complain about his condition. However, with the strokes, Wilson would deny there was a problem or at best downplay the matter. After the massive stroke of 1919, Wilson still thought he had the vigor to serve a third term.

His brother in law Stockton Axson thought there was a change in personality following the 1896 stroke. Wilson became a more driven man; less inclined to recreation and seemed more concerned with national affairs. Wilson was about to enter the national spotlight; he was elected the president of Princeton in 1902. Two years later, he suffered another period of inability to use his right hand, but suggested that he had simply been writing too much.

In 1906, he suffered another serious stroke, one that left him nearly blind in his left eye. Wilson consulted a Philadelphia ophthalmologist named George de Schweinitz as well as Dr. Keen. De Schweinitz urged Wilson to adopt a more sedentary life. However, Wilson sought the advice of another doctor, Alfred Stengal, an internist, who thought that all Wilson needed was a few months of rest. He made another trip to Europe and returned to his work at Princeton.

Wilson had a plan to reorganize Princeton into a series of residential colleges or quadrangles, similar to Oxford. The plan met with opposition, Wilson often made counterproductive moves and saw his proposal go down to defeat. Weinstein is certain that Wilsonâs 1906 stroke had an adverse affect on his abilities.

In 1910, Wilson was elected governor of New Jersey and in 1912, he was elected president. In his early months in the White House, he seemed vigorous. The presidentâs new physician was Cary Grayson, who had been serving on the White House medical staff under Wilsonâs predecessor, William Taft. The two men soon became close.

In 1913, Wilson suffered another stroke, only this time, it was his left arm that was affected. Weinstein writes:

The episode which affected Wilsonâs left arm was particularly ominous from a clinical standpoint. The most likely diagnosis is that he had developed an ulcerated plaque in his right carotid artery from which an embolus had broken off. This meant that the cerebral circulation has been impaired on the right, previously unaffected, side of the brain. This evidence of bilaterality of involvement not only increased the risk of future strokes, but also created the possibility that enduring changes of behavior, based on insufficient blood supply and impaired oxygenation of the brain, might eventually occur. (P.252)

Wilson, as had become his habit, denied that there was anything seriously wrong. However, his wife Ellen had taken to consulting doctors. One, a neurologist named Francis Dercum, suggested that Wilson just needed a few months rest. Another, Silas Mitchell, said that Wilson would not survive his term.

Dr. Grayson would be placed in a difficult situation in 1914, when Ellen Wilson died of a kidney ailment. Wilson could not believe that his wifeâs condition was that serious and Grayson did not want to upset the president and possibly cause another stroke. Weinstein wonders if this is why Grayson did not call in consultants until it was too late. Wilson soon named Grayson Surgeon General.

Wilson seemed ill in 1915 and De Schweinitz was called in again. The doctor found evidence of hypertension and a hardening of the arteries, warning signs that the presidentâs state of health was precarious. In all likelihood, he informed Grayson, but Wilson continued his state of denial.

In 1919, after World War I, Wilson was trying to convince Congress to approve United States entry into the League of Nations. Some in the Senate opposed the idea while others would be willing to go along if certain reservations were included in the treaty. Wilson went on a public speaking tour but suffered a collapse at Pueblo, Colorado. The presidential party returned to Washington, and soon after, the president suffered his most serious stroke.

At this point, a cover-up began, led by Dr. Grayson and the presidentâs second wife, Edith. They thought that it would be best if Wilson was not informed of just how serious his condition truly was. When Dr. Grayson briefed the Cabinet, the question of succession came up but he refused to sign any official notice of disability. He also discouraged letting the public know the extent of the presidentâs condition (Weinstein suggests this reflected Edith Wilsonâs opinion).

Wilson was able to urge his supporters to vote against any reservations regarding the League of Nations treaty. The treaty went down to defeat. Weinstein feels that but for the stroke, Wilson might have been more willing to negotiate and come to a settlement. In his current state, he was unable to do so.

The strongest candidate the Democrats could have put forward for the presidency in 1920 was probably William McAdoo, who had served six years as Treasury Secretary and had married one of Wilsonâs daughters. However, Wilson still hoped he could win a third term and McAdoo was unable to launch the all-out campaign he would have required to get the nomination. The party went with a compromise candidate who lost by a landslide. Wilson retired from the presidency in 1921 and died less than three years later.

Books used for this piece include:

Bagby, Wesley Marvin. The road to normalcy; the presidential campaign and election of 1920. Baltimore, Johns Hopkins Press, 1962.

Crispell, Kenneth R. and Carlos F. Gomez. Hidden illness in the White House Durham : Duke University Press, 1988.

Kunhardt, Jr., Phillip, Philip Kunhardt and Peter Kunhardt. The American President. New York : Riverhead Books, 1999.