Presidential Illness: Give the People What They Want

Even presidents get sick. This should come as no surprise, given the circumstances.

First of all, despite the energetic arm waving and sweet campaign jams (whether endorsed by the artists or not) US presidents are− by and large− old. The average age of a president at election is nearly 55. That may not sound old, but bear in mind that’s the average from 1789 to 2008; for most of that period, life expectancy was well below 55. As recently as 1900, the overall (male and female) life expectancy was about 49.8 The current life expectancy for American men is around 76.4 (When we finally elect a female president, she’ll have until 81.4) Add the long hours, extended travel and stress of being Commander-in-Chief, and you have the perfect recipe for ailment.

Acute (sudden and severe) illness has cut several presidencies short; four presidents have died from sickness while in office. Many more have suffered in silence, laboring with the burden of chronic (long-lasting, non-infectious) disease. With one exception (I’m looking at you, Woodrow), illness did not affect the president’s cognitive or leadership abilities, but was concealed nonetheless. At times, extreme measures were taken to minimize the appearance of illness, sometimes covering it up entirely.

Calling in sick to the (oval) office

At least two presidents have had major medical procedures to treat chronic illness while in office: Grover Cleveland and Dwight D. Eisenhower.

In what has to be one of the most amazing medical maneuvers of all time, Grover Cleveland underwent a clandestine surgery to treat mouth cancer near the beginning of his second term in 1893. To pull it off, he arranged for his surgery to take place on a friend’s yacht in Long Island Sound, using the cover story of a month-long fishing trip. The surgery took place in the refurbished saloon of the boat, where he had several teeth and part of his jaw removed. To ensure there was no noticeable difference in either his appearance or speech, he was fitted with a prosthesis and continued to cultivate his trademark mustache. He never relapsed and the surgery was not officially acknowledged until 1917, nine years after Cleveland’s death.1,5

Dwight D. “Ike” Eisenhower had a massive heart attack in 1955, about midway through his first term. It was likely the result of chronic heart disease; it may not have been his first, or even his first as president. The public was informed, but the severity of his condition was substantially downplayed. In fact, efforts to keep Ike’s condition secret may have actually endangered his life: his doctor waited a full day to seek outside medical assistance, for fear of political repercussions. Ike also suffered chronic gastrointestinal issues throughout his military and political career. Intense intestinal pain brought Eisenhower back for a second surgery in 1956. The public was told that the results were normal, but that was far from true. The surgery revealed adhesions suggestive of Crohn’s or inflammatory bowel disease.3

Two of the most beloved (and boldly initialed) American presidents, FDR and JFK, also suffered from serious chronic illness that they attempted to conceal. JFK had a slew of troublesome medical conditions that he publically denied, including Addison’s disease, colitis, ulcers, and a degenerative back issue.2 Roosevelt contracted polio in 1921, and the disease left him paraplegic. He initially tried to hide his condition, but it was eventually leaked to the press. In response, the president underwent a medical exam to dispel fears about his health. Despite the fact that his condition had become public knowledge, FDR never allowed media photographers to take his picture while he was in his wheelchair. Instead, photo ops and public events were carefully planned so that he used a seat that was not reminiscent of his condition, like his iconic convertible7.

fdr disease
What. A. Boss.


Everybody gets sick, so why all the secrecy and subterfuge?

Well, it’s politics. Image is everything, and any display of vulnerability is an invitation for an attack. Illness− even when it is chronic and does not affect job performance− can be seen as weakness and weakness is fatal in politics. No president has wanted to be viewed, either at home or abroad, as a Patient-in-Chief− a sick old man past his prime.

But the shows of vigorous good health were not just for fellow politicians. In all of these cases, it was thought that admitting the complex reality of the President’s health would not only minimize the effectiveness of the president, but also destabilize the country. It was taken as given that the admission of chronic disease would inspire uncertainty in the public, that the people would also see illness as weakness and reject it.

We, the People

It’s reasonable to be concerned about an ill president’s capacity to perform the duties of the office. However, in the history of the American presidency only one president has been incapacitated by illness, Woodrow Wilson. Wilson had a major stroke that left him bedridden and unable to sign his own name, but neither Congress nor the American people were informed of his condition. For the next 17 months, until Wilson left office, essentially no one was allowed to see the president, and nearly all communication was relayed through his wife, Edith.6 Disconcerting, to say the least. But, in an era with TV and Twitter, repeating this maneuver would never work. (I know, never say never, but seriously: never). Not only that, there are now procedures in place for passing presidential duties on to the Vice President in such circumstances, thanks to the 25th Amendment (passed by Eisenhower, BTW).6

Instead, the evidence actually shows the opposite: chronic disease and disability do not make a person incapable of meeting the demands of the presidency. Collectively, the presidents mentioned here successfully led America through some of its most trying times: financial crises, WWI, the Great Depression, WWII, and the Cuban Missile Crisis. They were taken seriously by their peers, both nationally and internationally, and they handled some seriously challenging situations with nothing short of grace. Three (FDR, Eisenhower, and JFK) routinely rank in the top ten greatest presidents.

While it is certainly not commendable that these men concealed their health issues, it is understandable. They were combatting their own fears of disgrace and disgust by attempting (albeit misguidedly) to give the people what they (might have) wanted. They were striving to fit an unrealistic ideal of youthful experience. However, I’d like to think that their concerns too were unfounded. We will never know if honesty would have damaged or ended their careers, but I hope not. Maybe Americans would have seen the bravery and endurance these men evinced. And, when a candidate finally runs for office openly admitting a chronic condition, maybe they will see strength in his or her suffering and admire it, knowing that there is− as FDR famously said− nothing to fear but fear itself.


  1. Cashman, EC, & C. Timon. 2011. Otolaryngology and the American presidency: a medical legacy. ORL, 73:105-109.
  1. Dallack, R. The medical ordeals of JFK. The Atlantic, Special Issue. Web. 4 September 2015.
  1. Gilbert, RE. 2008. Eisenhower’s 1955 heart attack: medical treatment, political effects, and the “behind the scenes” leadership style. Politics and the Life Sciences, 27: 2-21.
  1. Life expectancy. Centers for Disease Control and Prevention. 20 January 2015. Web. 4 September 2015.
  1. Maloney, W. 2010. Surreptitious surgery on Long Island Sound: the oral cancer surgeries of President Grover Cleveland. New York State Dental Journal, 76:42-5.
  1. Menger, RP, CM Storey, B Guthikonda, S Missios, A Nanda, & JM Cooper. 2015. Woodrow Wilson’s hidden stroke of 1919: the impact of patient-physician confidentiality on United States foreign policy. Neurosurgical Focus, 39:E6.
  1. Meschia, J, BE Safirstein, & J Biller. 1997. Stroke and the American presidency. Journal of Stroke and Cerebrovascular Disease, 6: 141-143.
  1. Rosner, M. 2015. Life expectancy. Web. 4 September 2015.

Image source: Creative Commons,

Cholera: You Know Nothing, John Snow

Aliases: cholera

Cholera moves in lockstep with extreme poverty; the pathogen capitalizes on the frailty of poor infrastructure to spread. Tragically, that means it is incredibly common around the globe. Worldwide, there are an estimated 1.4-4.3 million cases and 28,000-142,000 deaths from the disease each year. Its short incubation period (the time between a person contracting the disease and being able to pass it to someone else) of 2 hours to 5 days means that it can appear to emerge out of nowhere in explosive epidemics. And its effects are devastatingly lethal; if left untreated, cholera can kill within hours.1

Despite how truly terrible it is, cholera has had some positive effects on society. The disease has become iconic in epidemiology, the study of the patterns, causes, and effects of disease, after inspiring the birth of the field. During a major cholera epidemic in London’s Soho neighborhood in 18542, Dr. John Snow (yes, really) painstakingly mapped deaths caused by the disease and documented the household water usage. He personally visited 658 homes to determine their water source3, systematically compiling evidence to support his theory that cholera was water-borne and combat the prevailing “miasma” theory, which suggested that cholera was spread by “bad air” containing particles of decomposed matter.2

Eventually the data became overwhelming (all the deaths had occurred within 250m of one street intersection), and indicated that the source of the cholera was the now infamous Broad Street pump. Snow succeeded in having the handle of the pump removed3, and the epidemic came to a halt. Yet despite the fantastic results, doubts lingered about Snow’s theory. As he himself admitted, without knowing the cause of the disease he couldn’t prove that the removal of the pump handle had stopped disease spread; the epidemic could have been waning anyway for any number of reasons.2 Snow’s work was unpopular with the medical community and his ideas were widely rejected.3 He was only vindicated posthumously, when Robert Koch identified Vibrio cholera (the bacteria that causes cholera) in 1885.2

Education saved John Snow’s groundbreaking work. It was lost to obscurity until the 20th century, when it was revived by WH Frost, the first professor of epidemiology at the Johns Hopkins University School of Hygiene and Public Health. Frost edited a reprint of Snow’s book on cholera in 1936 and proceeded to popularize it in his classes. He used Snow’s efforts to combat cholera as a classic case study of epidemiology in action, and this view spread throughout academic circles globally.4 Today John Snow is acknowledged as one of the fathers of epidemiology, and he and the Broad Street pump have become icons.2,4

Come at me, bro.

Cause: Cholera is caused by ingesting the bacteria Vibrio cholera in either contaminated food or water. It affects all age groups, afflicting adults and children. When it comes to cholera, humanity may be its own worst enemy; humans are a main reservoir for the disease and global warming (which is at minimum partially our fault) creates favorable environments for the bacteria. But it is our predilection for inequality that may be our greatest gift to the disease; it is especially common in areas of poverty or crisis, where there is generally poor infrastructure.1

Consequence: 80% of cases are asymptomatic. That means that 80% of people who contract cholera experience no ill effects, although they can still potentially infect others. Of those that develop symptoms, 80% have a mild to moderate course of the disease; only 20% are severe cases that can be fatal, experiencing acute watery diarrhea and severe dehydration.1

Cure: Finally some good news: cholera is amazingly responsive to treatment. Up to 80% of cases can be successfully treated simply with rehydration salts and with proper treatment the case fatality rate plummets below 1%. There are also two WHO pre-qualified oral vaccines. But although the disease is treatable, the best protection against cholera is prevention. Safe water and sanitation are critical to long-term control and prevention. That means piped water and treatment plants, water filtration and safe storage in homes, and safe sewage and waste disposal systems. Here’s the rub: this kind of systemic change demands economic development to offset the significant initial investment and high maintenance costs.1


  1. Cholera. World Health Organization. July 2015. Web. 17 September 2015.
  1. Kukaswadia, A. John Snow− the first epidemiologist. PLOS Blogs. 11 March 2013. Web. 17 September 2015.
  1. Paneth, N. 2004. Assessing the contributions of John Snow to epidemiology: 150 years after removal of the Broad Street pump handle. Epidemiology, 15: 514-516.
  1. Vandenbroucke, JP, HM Eelkman Rooda, & H Beukers. 1991. Who made John Snow a hero? American Journal of Epidemiology, 133: 967-973.

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