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Presidential Stroke: United States Presidents and Cerebrovascular Disease


Jeffrey M. Jones, MD, FAAN, and Joni L. Jones, PhD, RN


Needs Assessment:

 

A study of the United States presidents suffering from stokes underlines the fact that vascular disease is important. Furthermore, strokes occurring to presidents have had a significant influence on the nation and world. And finally, discussions about strokes and presidents emphasize the importance of understanding this disorder.

 

 

Learning Objectives:

 
• Explain the medical importance of studying stroke in prominent individuals.
• Examine some effects of strokes on the conduct of the presidency.
• Discuss some effects cerebrovascular disease has had on governmental and public policy.

Target Audience: Neurologists and psychiatrists

 

 
 
CME Accreditation Statement: The Mount Sinai School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide Continuing Medical Education for physicians.
 
The Mount Sinai School of Medicine designates this educational activity for a maximum of 3 AMA PRA Category 1 Credit(s)TM.  Physicians should only claim credit commensurate with the extent of their participation in the activity.

It is the policy of Mount Sinai School of Medicine to ensure objectivity, balance, independence, transparency, and scientific rigor in all CME-sponsored educational activities. 

Faculty Disclosure Policy Statement: All faculty participating in the planning or implementation of a sponsored activity are expected to disclose to the audience any relevant financial relationships and to assist in resolving any conflict of interest that may arise from the relationship.  Presenters must also make a meaningful disclosure to the audience of their discussions of unlabeled or unapproved drugs or devices. This information will be available as part of the course material. 

This activity has been peer-reviewed and approved by Eric Hollander, MD, professor of psychiatry, Mount Sinai School of Medicine. Review Date: July 11, 2006.

To Receive Credit for This Activity: Read this article, and the two CME-designated accompanying articles, reflect on the information presented, and then complete the CME quiz. To obtain credits, you should score 70% or better. Termination date: September 30, 2008. The estimated time to complete this activity is 3 hours.



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CNS Spectr. 2006;11(9)674-678

 

Dr. J.M. Jones is in private practice with Neurology of Battle Creek in Battle Creek, Michigan. Dr. J.L. Jones is a faculty specialist in the the nursing department at the College of Health and Human Services at Western Michigan University in Kalamazoo.

Disclosures: Drs. J.M. Jones and J.L. Jones do not have an affiliation with or financial interest in any organization that might pose a conflict of interest.

Submitted for publication: January 23, 2006; Accepted for publication: June 16, 2006.

Please direct all correspondence to: Jeffrey M. Jones, MD, Neurology of Battle Creek, 70 W. Michigan Avenue, Suite 250, Battle Creek, MI 49017; Tel: 269-969-6177, Fax: 269-969-8776; E-mail: jmjones@voyager.net.


 

Abstract

In the United States, more individuals suffer disability from stroke than from any other disease, and as many as 11 of the 43 presidents have been affected. In this article, the authors review the cases of the United States presidents who have had strokes, some of which have occurred while the president was in office, having a direct effect on the country.

Introduction

Cerebrovascular disease is an important disorder causing more disability in the United States than any other illness.1 Even individuals in the nation’s highest political office are not immune, with as many as 11 past presidents having suffered strokes.

There are several substantial reasons to discuss presidents with stroke. First, it underlines the importance of vascular disease. All but three of the 17 presidents who served in the 20th century died of cerebrovascular or cardiovascular disease.2 Ronald W. Reagan died with Alzheimer’s disease, John F. Kennedy was assassinated, and Herbert C. Hoover died of colon cancer. Occurrences of stroke in presidents in office have had a significant influence on the nation and world. Such discussions emphasize the advances that have been made in the understanding of cerebrovascular disease.

In the 1993 film Dave, the President of the US, William Harrison Mitchell, has a stroke and becomes comatose during an illicit affair.3 His life is preserved by a ventilator in the basement of the White House, and a look-alike, Dave, is recruited to stand-in for him.

One would think that presidents having strokes, illicit affairs, and other people running the country with no one knowing about it could never happen. This review of presidential strokes suggests otherwise.

The First Presidential Stroke

John Quincy Adams

John Quincy Adams, the sixth president of the US, was the first president to have a stroke. He was, until George W. Bush, the only son of a previous president to reach that office, and he is still the only president to have served in the US House of Representatives. In November 1846, Adams collapsed while touring Harvard Medical School in Boston, Massachusetts.4 He was helped to his son’s house, where the family doctor diagnosed the former president as having suffered a stroke. After a prolonged recovery, Adams returned to his seat in Congress that had been given to a young representative from Tennessee, Andrew Johnson, who quickly gave up his seat to Adams. Ironically, Johnson later also became president and eventually died from cerebrovascular disease. In February 1848, Adams suffered another stroke while addressing Congress. He died 2 days later, perhaps the only legislator to suffer a fatal stroke on the floor of Congress.

First Vice Presidents Inheriting the Presidency

There have been nine presidents who did not complete their term in office—William H. Harrison, Zachary Taylor, Abraham Lincoln, James A. Garfield, William McKinley, Warren G. Harding, Franklin D. Roosevelt, John F. Kennedy, and Richard M. Nixon. The first four vice presidents who inherited the presidency eventually died of strokes.

John Tyler

John Tyler became the 10th president when William Henry Harrison died 1 month after his inauguration. Tyler’s wife, the mother of eight children, suffered a major stroke while moving into the White House. A year and a half later, she died of a second stroke. President Tyler remarried while in office, eventually having seven more children. He was the first vice president to become president upon his predecessor’s death, the first president widowed in office, the first president to marry during his term, and the most prolific president, with 15 children.5

After leaving office, Tyler joined his state, Virginia, in secession and agreed to serve as a member of the Congress of the Confederacy. Before he could attend, however, he suffered what likely was a brainstem stroke and died 3 days later.

Millard Fillmore

Millard Fillmore, the 13th president, was the second vice president to become president on the death of his predecessor, Zachary Taylor. He alienated his political base by signing the Fugitive Slave Act, failed to win the renomination of his party, and was humiliated as a candidate of the American or Know-Nothing Party. His wife caught pneumonia at the inauguration of his successor and subsequently died. He later married a wealthy widow. Fillmore did not smoke or drink and ate simple foods, but ate too much and was considered obese. At 74 years of age, he developed a dense left hemiparesis while shaving. He improved a little but subsequently died 3 weeks later.5

Andrew Johnson

Andrew Johnson was the 17th president and the third vice president to inherit the presidency after the untimely death of his predecessor, Abraham Lincoln. Johnson was the first president to be impeached, but prevailed and successfully finished his term. He returned to Washington, DC, in 1874 as a senator from Tennessee, to become the only former president to serve in the US Senate. In July of 1875, he developed left hemiparesis. He initially refused to call a physician, but did seek medical help the following day when he extended his stroke. He died 2 days later.5

Chester A. Arthur

Chester A. Arthur inherited the 21st presidency after the assassination of James R. Garfield. Garfield lived for 80 days after the assassination attempt in a debilitated state. Since there was no mechanism for transfer of power if the president was debilitated, the US was without a chief executive officer during that time. Arthur became the first president to lie about his health. Within 1 year of taking office, he developed kidney failure and, in spite of frequently requiring bed rest in the last 2 years of his term, he repeatedly insisted he was in “tiptop shape.” He was, however, too sick to stand for re-election and continued to deteriorate after his term ended. One year later, his nurse found him unconscious. He died the following morning of a probable massive cerebral hemorrhage.5

Presidents Suffering Strokes While In Office

The next four presidents who experienced strokes suffered them during their terms. This further raised issues regarding transfer of power in the event of a disabled president as well as the ethics of hiding president’s medical condition or outright lying to the public.

Woodrow Wilson

Woodrow Wilson was the 28th president. He was one of the more intellectual presidents and the only one with a doctorate degree. He was also quite neurotic as depicted by Freud and Bullitt6 in their devastatingly unsympathetic book about his psychology. It was not published until 1978, 30 years after Freud’s death.

What was not psychological was an episode in 1906 when Wilson became blind in his left eye. It was eventually diagnosed as thrombosis of the ophthalmic artery and he later recovered some vision.5

Because of his pacifist policies leading up to the eventual US involvement in World War I, the European allies rejected most of Wilson’s proposals. Wilson’s League of Nations idea was the most acceptable, but he encountered much resistance upon his return to the US. During a speaking campaign in Colorado, in September of 1919, he was trying to generate public support when he developed a headache and slurred speech. Although improved the next day, his trip was cancelled and he returned home by train. On return to Washington, DC, his health improved, but the following morning he collapsed with a dense left hemiparesis.4

For the remaining 16 months of Wilson’s presidency, his wife, Edith, essentially ran the country. She kept his condition secret and hidden from the general public, refusing to let anyone other than the president’s personal physician have any contact with the president. It is unclear as to how much Edith affected presidential business, but she undoubtedly influenced US policy. Certainly Wilson’s stroke truncated his efforts to gain senate approval of his idea for a League of Nations.

For the presidential election of 1920, Wilson wanted to run for a third term. This placed the Democratic Party in the difficult position of discrediting its incumbent, virtually guaranteeing the Republican nominee a victory. The frontrunner coming into the Republican National Convention was Major General Leonard Wood. He was a Harvard-trained physician, a Congressional Medal of Honor winner for his participation in the capture of Geronimo, a successful military leader who commanded Theodore Roosevelt and his Rough Riders in the Spanish American War, and a former governor of two countries, Cuba and the Philippines.7

Unfortunately, the Republican Party bosses were very fearful of Wood because they felt they could not control him. He was a very strong candidate, however, and Wood’s only weakness involved his medical history. Earlier in 1910, Harvey Cushing8 had removed a parasagittal meningioma from Wood, and using the fact that he had had brain surgery, Wood was discredited. An obscure junior senator from Ohio, Warren Harding, was nominated and subsequently became president. Harding was the next president who reportedly suffered a stroke in office.

Warren G. Harding

Warren G. Harding, the 29th president, is considered9 one of the worst presidents in US history. His tenure was marred by scandals. Even though Prohibition was in effect, there was a speakeasy in the White House and, across the street, a house of prostitution called the “Green House.” Harding held poker parties in the White House and speculated in the stock market, losing >$100,000. He carried on an illicit affair with the wife of a close friend and fathered at least one child in 1919 with Nan Britton, a girl 30 years his junior, continuing an affair with her while in the White House.

The biggest scandal, rivaling the Watergate Affair, concerned the Secretary of the Interior Albert Fall, who, in exchange for money, allowed drilling of the Teapot Dome, governmental oil reserves in Wyoming.

In July of 1923, with scandals breaking all around him, Harding left Washington, DC, and became the first president to tour Alaska. On his return voyage, he became ill and was taken to a hotel in San Francisco, California. His personal physician, homeopath Charles Sawyer, thought the president was suffering from crabmeat poisoning.10 Other physicians, however, noted Harding had not eaten any crabmeat and was probably experiencing a heart attack. Four days later, just hours after Sawyer pronounced Harding as completely recovered, the president died. Sawyer suggested Harding had died of a stroke from a cardiac embolus, but other physicians believed he had died of a ruptured cardiac aneurysm. The public rejected both theories, suspecting that Harding’s ambitious wife, Florence, had become distressed over his extramarital affairs and poisoned her husband. She refused an autopsy, so the final scandal of Harding’s administration revolved around the public feud about his death. Officially, stroke is identified as the cause of death.5

Franklin D. Roosevelt

Franklin D. Roosevelt, the 32nd president, was president during one of the nation’s most perilous times, with an economic depression and a world war with which to contend. FDR informed the public that he was paralyzed from polio, but failed to reveal that he had not recovered any function of his legs. He went to great lengths to hide his handicap. Also kept from the public, or at least under appreciated, was his malignant hypertension. As early as 1931, the newly elected president’s blood pressure was recorded at 140/103, and his continued smoking and heavy drinking as well as the stresses of the office further deteriorated his health. In 1944, with blood pressures ranging from 170/80 to 240/130, Roosevelt’s daughter demanded more attention to her father’s condition. Even so, his blood pressure remained difficult to manage and his health further deteriorated, leading some to think it interfered with his ability to deal with Stalin at the Yalta Conference in February of 1945.4

In April of 1945, while sitting for a portrait, FDR suddenly developed a severe headache and lapsed into a coma, dying several hours later. Although an autopsy was not performed, his attending physician was convinced the President had suffered a massive cerebral hemorrhage. The somewhat controversial death of Harding notwithstanding, Roosevelt was probably the only president to die of a stroke while in office.

Dwight D. Eisenhower

Dwight D. Eisenhower was the 34th president and is considered by many to be the most popular president.9 He smoked >3 packs of cigarettes/day, suffered from hypertension, and in September of 1955, suffered a massive heart attack. He recovered well, but was left with a large ventricular aneurysm and intermittent arrhythmias.4

In November of 1957, more than 2 years later, President Eisenhower suffered a stroke, probably due to a cardiac embolus, that left him aphasic with a mild right facial droop. He recovered quickly and never had another stroke, but his acute debilitation, in absence of any mechanism for the vice president to assume power, led to the 25th Constitutional Amendment, adopted in 1967, that specifies such procedures.

Recent Presidents With Strokes

Richard M. Nixon

Richard M. Nixon was the 37th president and, to avoid impeachment, the only president to resign from office. He had several risk factors for stroke, including atrial fibrillation and several bouts of thrombophlebitis. In 1994, he suffered a massive stroke that left him hemiplegic. He had given an advanced directive for no heroic efforts and died 4 days later.11

Gerald R. Ford

Gerald R. Ford was the 38th president. Despite media coverage to the contrary, he was probably the most physically coordinated and best athlete of the presidents. After a successful career playing football for the University of Michigan in Ann Arbor, he received offers to play professional football. He was also the fifth vice president to inherit the presidency and later suffer a stroke.

In August 2000, at 87 years of age, Ford began to slur his speech while interviewing with television reporters during the Republican National Convention in Philadelphia, Pennsylvania. The following day, he experienced further symptoms of dizziness, slurred speech, and arm weakness. Magnetic resonance imaging revealed he had had suffered two small brainstem infarcts. Fortunately, he made an uneventful recovery.12

Conclusion

The office of the presidency is extremely important to our nation, and cerebrovascular disease has had an impact on a number of presidencies. Of the 43 chief executives, 11 have had strokes with four having attacks while in office. These attacks ultimately caused the US government to realize the importance of developing mechanisms for transferring presidential powers and the dangers of hiding the president’s medical conditions from the public.

Many improvements have been made in the prevention, diagnosis, and treatment of cerebrovascular disease since John Quincy Adams suffered his fatal stroke on the floor of the US Congress in 1848, but much more needs to be done. A review of strokes occurring among prominent individuals in our society helps to increase public awareness of this debilitating disease.  CNS

References

1. Stroke: Hope Through Research. National Institutes of Health: National Institute of Neurological Disorders and Stroke. Available at: http://www.ninds.nih.gov/disorders/stroke/detail_stroke.htm. Accessed December 15, 2004.
2. Fields W, Lemak N. Well-known persons who have suffered strokes. In: A History of Stroke: Its Recognition and Treatment . New York, NY: Oxford University Press; 1989:199.
3. Dave [videotape]. Warner Home Video; 1993.   
4. Bumgarner JR. The Health of the Presidents: The 41 United States Presidents Through 1993 from a Physician’s Point of View. Jefferson, NC: McFarland & Company, Inc; 1994.
5. Marx R. The Health of the Presidents. New York, NY: GP Putnam’s Sons; 1960.
6. Freud S, Bullitt W. Thomas Woodrow Wilson, Twenty-Eighth President of the United States: A Psychological Study. Boston, Mass: Houghton Mifflin; 1967.
7. Rolak LA, Rolak B. Leonard Wood: the physician who was almost President of the United States. J Med Biogr. 1998;6:35-38.
8. Fulton J. Harvey Cushing: A Biography. Springfield, Ill: Charles C. Thomas; 1946.
9. Taranto J, Leo L.  Presidential Leadership. New York, NY: Free Press; 2004.
10. Deppisch L. Homeopathic medicine and presidential health: Homeopathic influences upon two Ohio presidents. Pharos Alpha Omega Alpha Honor Med Soc. 1997;5-10.
11. Meschia J, Safirstein BE, Biller J. Stroke and the American presidency–US presidents who have had strokes. Saturday Evening Post. January 2001;273:40-43.
12. Meschia J, Safirstein BE, Biller J. Stroke and the American presidency–US presidents who have had strokes. Saturday Evening Post. January 2001;273:43.
 



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