Neurological Ailments of U.S. Presidents

Friday, March 16th, 2018

Follow this link to watch Dr. Silvestri’s Presentation on YouTube

The TR Site’s ongoing Speaker Nite series recently featured Nicholas Silvestri MD FAAN, Associate Professor of Neurology at the University at Buffalo Jacobs School of Medicine & Biomedical Science and longtime history buff. His presentation, “Neurological Ailments of U.S. Presidents”, briefly covered the health and medical issues of a few former presidents before focusing specifically on the neurological conditions of Woodrow Wilson and Franklin D. Roosevelt.   

Dr. Silvestri began by pointing out the only two requirements of the presidency: age and U.S. citizenship.  While one might think generally good health is implied in the job description, it turns out our presidents have suffered from a wide range of medical conditions. Some of which were intentionally kept from the public, while others may have actually impacted their presidency. Presidential causes of death are also fairly telling. Of the presidents who have passed away, 12 died of heart disease, 9 of infection, 8 of stroke, 4 from assassination, 2 from respiratory failure, 2 of G.I. bleed, 1 from asthma, and 1 from cancer. While four were killed by assassins, more were the targets of assassination attempts. And, while this is not often thought of as a medical condition, the treatment the presidents received made all the difference. Occasionally, the doctors unintentionally finished what the assassin had started. However, that was not always the case. Dr. Silvestri made a point of mentioning the 1912 attempt on Theodore Roosevelt’s life in Milwaukee when the would-be assassin was thwarted more by TR’s long-windedness, than by his doctors’ prowess. His 50-page speech, steel eyeglass case, and heavy overcoat slowed the bullet enough to prevent it from reaching his heart. While Dr. Silvestri found this and other examples of presidential medical history fascinating, as a neurologist, his focus was on the ailments that plagued Woodrow Wilson and Franklin Roosevelt.

Woodrow Wilson’s medical history is particularly complex. He suffered from dyslexia, high blood pressure, frequent migraines, recurrent stomach aches (dyspepsia), and a left retinal hemorrhage which left him partially blind in that eye--and that’s just to name a few. His history of neurological ailments, in particular, dates back to roughly 1896 when nerve pain in his right arm forced him to begin writing and golfing left-handed.  However, in September of 1919, severe headaches and muscle weakness not only forced the president to cancel his ‘Tour to Join the League’, but also led to a stroke on October 2nd. The stroke caused serious weakness on the left side of the body (left hemiparesis) and anosagnosia. Anosagnosia is a neurological condition that causes patients to minimize their symptoms or even to deny there are any. This was particularly problematic in Wilson’s case because despite having suffered a serious stroke and being under intensive medical care in isolation, he still felt he could run for a third term of office. Interestingly, the public was not even notified of the president’s condition until February of 1920, a full five months later and cabinet meetings were put off even further. With the president in isolation from the cabinet and the people, who was running the country?

In Wilson’s place, his wife (Edith Bolling Galt Wilson) was effectively running the show. Wilson’s Vice President (Thomas Marshall) had been selected more to balance the ticket than for his abilities. Many of Wilson’s cabinet and even Wilson himself did not think highly of Marshall. Instead, it was Mrs. Wilson who was able to set the agenda, make decisions, and determine what was brought to the president and what was not. The implications of this arrangement had lasting effects. In 1967, the 25th Amendment was passed which contained a section specifically outlining the protocol for a Vice Presidential succession should the president be unable to discharge the duties of his office. It prevents the First Lady or First Gentleman or any other unelected person from assuming some or all of the powers of the presidency.

Wilson did not run for re-election in 1920. Instead, against the Republican Harding/Coolidge ticket, the Democrats ran James M. Cox with Franklin Roosevelt as his vice president. While unsuccessful, it was the following year that 39-year-old FDR was diagnosed with polio. Roosevelt’s struggle with polio is now considered common knowledge and one of the best known presidential ailments. However, Dr. Silvestri began his discussion of FDR by challenging the idea that he even had the disease. After careful review of his symptoms and the documentation of his treatments and progress, Dr. Silvestri suggested that Guillain- Barre Syndrome more closely matches the symptoms FDR experienced. While the evidence is quite compelling, Dr. Silvestri was quick to point out that, in this particular case, the diagnosis is not terribly important. In 1921, neither polio nor Guillain-Barre were curable. Instead, the focused shifted to other aspects of FDR’s health and the neurological ailments he suffered from.

In addition to high blood pressure, FDR may have also contracted melanoma, a type of skin cancer that often spreads to the brain. Either of those conditions could have led to seizures, which interestingly, the evidence suggests was the case. People close to the president repeatedly described occasions when FDR seemed to abruptly lose his train of thought and sit staring blankly in silence. This behavior could be described as a complex partial seizure, which simply meant he was unaware of his surroundings or even briefly unconscious. Additionally, FDR suffered from extremely high blood pressure (malignant hypertension) especially in the final years of his life. Blood pressure readings graphed against significant historical events showed just how serious this problem was. On D-Day and after the Yalta Conference his readings were roughly 225/125, which was double a normal blood pressure reading. On the day of his death, his pressure was 300/190, which Dr. Silvestri described as, “incompatible with life.” FDR’s death in April of 1945 meant he was unable to complete his fourth term of office, but more importantly was unable to guide the U.S. through the final months of the Second World War.

Dr. Silvestri finished his talk by making the interesting point that all men and women who wish to serve in the military are required to take a physical, yet as Commander-in-Chief of that army, the President is not required to undergo any type of medical evaluation. His presentation demonstrated the impact of presidential health on history and left the audience pondering the significance of the health of elected officials.

- Lindsey Evans, Public Programming Assistant

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Speaker Nite is part of the TR Site’s regular Tuesday evening programming, which is made possible with generous support from M&T Bank, as well as the New York State Council on the Arts (NYSCA), with the support of Governor Andrew Cuomo and the New York State Legislature.

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