In September, 1919, Wilson suffered a paralytic stroke which limited his future activity. After the presidency, he lived on in retirement in Washington, dying February 3, 1924. — Information Please Almanac.
(Most history books are equally uninformative about Wilson’s illness.)
The Twenty-fifth Amendment, dealing with Presidential disability, becomes part of the U.S. Constitution. It provides that the Vice-President becomes Acting President if the President declares himself disabled, or if the Vice-President and a majority of the Cabinet so declare. — Adopted February 10, 1967 , largely without discussion of President Wilson’s serious problems in 1919.
Author’s note: I wrote this in the early 1980s, but the history hasn’t changed.
Diseases need heroes: men or women who have triumphed despite the disease. For the child with polio, one could always point to Franklin Delano Roosevelt, who campaigned on leg braces to become governor of New York and then president of the United States. For epilepsy, there is always Joan of Arc or Napoleon. The blind and deaf have Helen Keller. Woodrow Wilson provides a similarly inspiring story for both dyslexia and stroke victims — but the story of his last two years in office provides a troubling example of how brain damage can affect judgment and even block insight into one’s own disabilities.
Wilson had dyslexia in childhood. Imagine not learning your letters until age 9, not reading until age 12, being a slow reader all your life. Rather than being a prescription for a life as a nonintellectual ditchdigger, this was part of the background of a man who became a professor at Princeton University and the author of a popularly acclaimed book on George Washington.
When Professor Wilson was 39, he suffered a minor stroke that left him with weakness of the right arm and hand, sensory disturbances in the tips of several fingers, and an inability to write in his usual right-handed manner. As often happens following minor strokes, there was recovery: his right-handed writing ability returned within a year.
Was his career impeded? No, in 1902 he became the president of Princeton. But the problem recurred in 1904. In 1906 it happened again, this time with blindness in the left eye (also supplied by the left internal carotid artery, which is probably where clots were originating which plugged up various small arteries in the left eye and left brain). While the right arm weakness went away, Wilson had enough damage to his left eye that he could never read with it again. Some think that his judgment was impaired in the following years — his attempts to reform Princeton academia were often impractical. By 1910 he was essentially being forced out of his presidency by the trustees.
But no matter — in 1910 Wilson was elected the governor of New Jersey. Being a university president is not the usual route to such an office (from being a zoology professor at the University of Washington, Dixie Lee Ray went on to become governor — but her stepping stones were positions as Nixon’s chairman of the Atomic Energy Commission and Assistant Secretary of State, not the presidency of the university!). From the governorship, Wilson began his successful campaign for president of the United States. He won the Democratic nomination after a protracted contest, on the forty-sixth ballot.
During the campaign in 1912, Governor Wilson again suffered from mild and temporary neurological problems (now called Transient Ischemic Attacks, or TIAs, they are minor strokes without detectable lasting effects). And, a month after his inauguration, President Wilson had an episode where his left arm and hand were weak. All of the previous right-sided troubles had implicated the left side of the brain. Now it appeared that the right brain was also being damaged by cerebral vascular disease. But he once again recovered, an inspiration to the 2.5 million stroke victims in the U.S. who must cope with their assorted disabilities.
During his first term, President Wilson suffered from serious headaches accompanied by high blood pressure. The headaches became particularly bad at the time of the Lusitania sinking by a German U-boat in 1915. Were they just tension headaches, or perhaps neurological symptoms? He was re-elected to a second term in 1916, but suffered a number of TIAs during the next two years as American involvement grew in “the” world war.
Edwin A. Weinstein, the neurology professor who wrote the authoritative Woodrow Wilson: A Medical and Psychological Biography, also notes that President Wilson “grew more suspicious, secretive, and egocentric.” An occupational hazard of the presidency — or a change in personality resulting from brain damage? The U.S. Constitution has since been amended to provide for presidential disability in office, but what neurologist would be brave enough to declare a president disabled from such a history?
If Woodrow Wilson’s brain had suffered no further damage, the history of the following decades could have been very different. For Wilson in 1916 wanted Germany defeated but not crushed; he wanted Germany to be a viable member of the proposed League of Nations. He was convinced that a dictated peace would be accepted in humiliation, under duress, at an intolerable sacrifice, and that would leave a sting, a resentment, a bitter memory upon which the terms of peace would rest, not permanently, but only as upon quicksand.” The overthrow of the Kaiser in 1918 and his replacement by a democratic government raised Wilson’s hopes for rehabilitating Germany. At the 1919 peace conference in Paris, he argued against French efforts to try the ex-Kaiser and to exact punitive reparations.
But then President Wilson suddenly took ill during the conference: he had vomiting, high fever, and the other signs of having caught the influenza which was sweeping Europe and later much of the world. It turned out that the virus had affected his respiratory system, heart, brain, and prostate. Indeed, judging from some of the mental symptoms (his top aide noted that, just overnight, Wilson’s personality changed), Wilson may have suffered another stroke at this time or, as Dr. Weinstein suggests, have also caught the frequently associated virus of encephalitis lethargica (this is the virus whose victims often developed Parkinson’s disease years later, Oliver Sacks wrote about them in Awakenings).
Even before the influenza attack, his obsession with secrecy was pronounced: none of the other American peace commissioners were privy to President Wilson’s thinking. Bedridden, Wilson became obsessed with being overheard, with guarding his papers. In addition to the paranoia, he became euphoric and almost manic at times following the bedridden phase of the illness. He even became socially outgoing in ways quite uncharacteristic of the normally reticent Wilson.
But most striking was Wilson’s change in attitude toward the Germans: now he himself proposed that the former Emperor be tried. Whereas he had previously insisted that the German delegates be granted full diplomatic privileges at the conference, now he was contemptuous of them. Herbert Hoover, who was there, noted the change in Wilson’s behavior: before the influenza, Wilson was willing to listen to advice, was incisive, quick to grasp essentials and unhesitating in his conclusions. Afterward, he had lapses in memory, he groped for ideas, he was obsessed with “precedents.”
To ask our Twenty-fifth Amendment question again, it seems likely that modern physicians would be able to diagnose the brain damage leading to such a personality change. They would probably recommend to their patient that he voluntarily step down. But on such evidence, would they have been able to persuade the Vice President and a majority of the Cabinet to force the President to step aside? One can imagine the discussion in the Cabinet as the neurologists tried to educate them on how brain damage can modify and affect judgment. Those not acquainted with neurologically induced personality changes would be more likely to focus on interwoven issues that they understood better — political issues such as the proper attitude toward the Germans, for example, or the allowances that must be made for people under stress.
It is hard to appreciate personality changes due to brain damage until you’ve seen such a patient, before and after. The first one I ever saw was a man whose head had been injured in a car accident the day before; one temporal lobe (at least) was swollen as a result of the concussion. On the door to the patient’s room, the nurses had posted a sign: “Do not give this patient matches!” It wasn’t that smoking was prohibited — he was mischievously lighting matches and throwing them around the room. There was nothing lethargic about this man: he was bright-eyed, aggressive with the doctors, teasing the nurses, and generally acting like a sailor in port looking for a good time. Could he have walked, it would surely have been with a swagger. Perhaps fortunately, he also had a large plaster cast on one leg; otherwise, it might have been difficult to persuade him to remain in the hospital where his brain swelling could be controlled.
One week later when again stopping in to examine all the patients on the neurosurgical service, I saw a man with an identical brain injury. This man was meek, most hesitant in his dealings with the staff, a quiet unobtrusive soul who usually averted his eyes when talking with anyone. After we left the room, I commented that the neurosurgeons’ fame must have spread, that they were certainly being sent one temporal-lobe contusion patient after another. No, the attending neurosurgeon said with a smile, that man was the same patient that I had seen the previous week. I was too astonished to mind that I had fallen into a neatly laid trap which had probably been sprung upon a half-dozen insufficiently-observant medical students and residents already that week. But which was his real personality? The present meek one. His family had, of course, been perplexed by the change and had told the physicians what his real personality was like. So now they knew that their patient was getting back to normal. And, mirabile dictu, he could also walk again — there was no longer a cast on the leg! But most cases of personality change are not this dramatic, nor can most be treated with a leg cast and diuretics. President Wilson’s is a more typical case — though, because of his position, having wider ramifications.
President Wilson returned home with a treaty establishing the League of Nations. His attempts to get the U.S. Senate to ratify it were clumsy and authoritarian, not the actions of a skilled politician used to dealing with the Congress. Frustrated after five months, he decided to take his case directly to the people. Within a few days after embarking upon a speaking tour of the West in September 1919, he had developed double vision (this usually isn’t either left or right hemisphere but suggests trouble in the brain stem). Wilson insisted on continuing on the speaking tour, and several weeks later, he became paralyzed on his left side: an unmistakable sign of right-hemisphere malfunction. Another week later, after returning to the White House, he suffered a massive right-hemisphere stroke. He lost vision in the left visual field which, because of the previous trouble with the left eye, left him with vision from only one-half of one eye (this is one of those unusual sets of facts which we inflict upon medical students in a neuroanatomy quiz, to see if they can figure out that there must have been two separate problems rather than the usual one). Wilson could feel nothing on the left side of his body, besides not being able to move it voluntarily. Indeed he totally neglected the left side of his body.
Though the language functions of Wilson’s left hemisphere were not affected by the right-hemisphere stroke, his voice never regained the emotional inflections and resonance of his earlier years; this aspect of speech (called prosody) is now known to be controlled predominantly by the right hemisphere.
His right-hemisphere stroke also produced a curious effect: Wilson denied he had suffered a stroke. If you have not previously encountered the denial-of-illness syndrome, you may find this incredible. How could someone whose left body was paralyzed deny that something had happened? He indeed considered himself perfectly fit to be President (he fired his secretary of state, who had dared to call a Cabinet meeting to discuss the illness with the President’s physician).
This denial-of-illness syndrome is characteristic of right parietal-lobe damage; some patients will even deny that their left arm and leg are part of their own body. Wilson merely referred to himself as “lame.” His spatial sense was disturbed: when the Secret Service took him out for a drive around town, Wilson insisted they drive very slowly and then demanded that the Secret Service chase and arrest a driver who passed them — for speeding!
Had the Constitutional amendment on Presidential disability been in effect in September 1919, Wilson’s doctors should have been able to declare Wilson unfit to carry out presidential duties. But would they have done so? Like others, they could have been drawn into an elaborate cover-up to preserve presidential authority. The history of Wilson’s illness gives us no comforting reassurance about how either the White House insiders or the doctors would have performed. The President’s physician, Cary T. Grayson, was asked by Secretary of State Lansing to sign a certificate of disability four days after the massive stroke, but he refused. In February 1920, when the White House was issuing glowing reports on the President’s health and abilities, a distinguished surgeon, Hugh H. Young, reported to the press. He said that the President had suffered only a slight impairment of his left arm and leg and that “the extreme vigor and lucidity of his mental processes had not abated in the slightest degree . . . he is in better shape than before the illness.” Dr. Young summarized by saying that “you can say that the President is able-minded and able-bodied, and that he is giving splendid attention to the affairs of state.”
Dr. Weinstein’s excellent biography notes that at the time of Dr. Young’s statement, President Wilson’s left arm was useless, he could barely walk, he could not hold himself upright so as to work at a desk, he could not read more than a few lines at a time, he was subject to outbursts of temper and tears, and his periods of alertness alternated with periods of lethargy and withdrawal. And that President Wilson still insisted that he was merely lame.
Who ran the government? Gene Smith, in his book When the Cheering Stopped, says that the President’s wife and doctors did — and that chaos and secrecy reigned. Remember, this is not a science fiction story, nor a make-believe White House thriller: this is the story of Woodrow Wilson’s last two years in the White House. It not only happened, but it has only recently made it into the history books: nearly all the books on Wilson mention none of this medical history, either from an ignorance of neurology (it was just “flu” followed by a “paralytic stroke”) or from the lasting effects of the cover-up conducted by Wilson’s White House insiders. If the history books omit such a significant event so that we cannot learn from it, how can we avoid repeating such history?
The treaty joining the U.S. to the League of Nations was defeated in the Senate, crippling the League. Dr. Weinstein’s opinion is that Wilson’s stroke is what made the difference: “It is almost certain that had Wilson not been so afflicted, his political skills and his facility with language would have bridged the gap” between the two opposing sides in the Senate, much as he had done on other occasions preceding the Paris trip.
President Wilson persisted in his effort to win re-nomination for a third term. Pictures appeared before the 1920 Democratic convention showing Wilson in right profile (the left side of his face was paralyzed) seated at a desk holding a pen. But Wilson had no support. The Democratic party leaders prevented his name from being placed in nomination; James M. Cox and Franklin Delano Roosevelt were nominated for president and vice president. The Republican nominee, Warren Gamaliel Harding, won the election with the biggest landslide vote in recorded history. He has been described in retrospect as a “handsome and genial man, undiscriminating in his associates, lacking in political ideas or fortitude . . . totally unfitted for the presidency.” American historians, when polled on who was the worst president in history, regularly select Harding.
Many feel that some consequences of Wilson’s illness outlived his presidency (he completed his term of office and lived until 1924, surviving Harding) and were to be seen in the events of the following decades — in the disastrous German inflation of the 1920s during the reparations exacted by the Allies, in the ensuing reaction to social disorder which led to the rise of the genocidal Nazis, and in a second world war. All had multiple causes, but the pre-influenza Wilson anticipated many. Woodrow Wilson was a great liberal and reformer, the first world leader to fire the masses with a vision of world peace, and a courageous person who repeatedly conquered the afflictions of his chronic cerebral vascular disease. At a critical juncture in history, his brain failed him — but not obviously enough to remove him from office and let others take up the reins. During the last two years of his term following the Paris illness, Woodrow Wilson was unfit to lead the United States. He no longer had the same judgment and personality as the man whom the voters had elected.
Just as a lawyer tries to cover all the unlikely inheritance possibilities when drawing up a will, so lawmakers must try to provide for an orderly succession when the holder of a critical office is disabled — which can happen in a number of ways. Would the Twenty-fifth Amendment, which seems so inadequate to deal with Wilson’s earlier problems, have covered the final Wilson tragedy?
Even if neurologists could diagnose a serious change in perceptual abilities or in personality, could they convince the President to voluntarily step aside? What happens when a strongwilled President’s judgment, like Wilson’s, is clouded by his illness? Judging from the difficulty that physicians have in persuading ordinary patients with right-parietal-lobe damage that they are ill, the physicians would probably have been rebuffed. Could they then convince the Vice President and a majority of the Cabinet to notify Congress that the President was disabled? The Twenty-fifth Amendment seems to assume that either a President will be rational enough to declare disability personally, or that the President will be in coma, unable to interfere in the Cabinet’s decision. Suppose that, like Wilson, a President were to fire the questioning Cabinet members first? The Twenty-fifth Amendment would seem not to cover the most serious and most prolonged Presidential disability yet encountered in more than two centuries and forty Presidents. It remains to be seen if the Constitution’s disability provisions function any better than those of the Divine Right of Kings (which allowed George III — the bete noire of the American colonists — to rule England for many decades while insane on and off, even confined to a straightjacket at times).
Neurology was established as a medical specialty in the nineteenth century by a series of great physician-investigators, but the recognition of subtle intellectual deficits in stroke patients was only beginning in Wilson’s time. Because such “higher functions” cannot be studied easily in experimental animals, progress has been slow in comparison to other areas of brain research. In 1920 a remarkable era began, during which the individual nerve cells have been explored, the reflexes extensively studied, great inroads made into understanding the functions of sensory and motor systems, and many specialized cortical areas identified. We now know more about developmental dyslexia, from which Wilson initially suffered, and about recovery of function after strokes, which permitted Wilson to recover from his many earlier strokes so successfully. We now have diagnostic techniques such as computerized tomographic (CT) scans and magnetic resonance imaging (MRI) which would have detected much of Wilson’s brain damage. We have therapeutic techniques such as vascular surgery which, if performed at age 39 after Wilson’s first stroke, might have cleaned out the arterial lining problems in the carotids which probably formed the clots.
Yet we still lack a body of reliable physiological and anatomical facts with which to understand personality change and denial of illness. One must rely more on the art of the experienced physician in such cases, not on the hard facts of science dispensed by machines. But it is not clear whether even the most expert of modern physicians would be able to protect the world from the consequences of a similar brain malfunction in a modern president.
The Throwing Madonna: Essays on the Brain (McGraw-Hill 1983, Bantam 1991) is a group of 17 essays: The Throwing Madonna; The Lovable Cat: Mimicry Strikes Again; Woman the Toolmaker? Did Throwing Stones Lead to Bigger Brains? The Ratchets of Social Evolution; The Computer as Metaphor in Neurobiology; Last Year in Jerusalem; Computing Without Nerve Impulses; Aplysia, the Hare of the Ocean; Left Brain, Right Brain: Science or the New Phrenology? What to Do About Tic Douloureux; The Woodrow Wilson Story; Thinking Clearly About Schizophrenia; Of Cancer Pain, Magic Bullets, and Humor; Linguistics and the Brain’s Buffer; Probing Language Cortex: The Second Wave; and The Creation Myth, Updated: A Scenario for Humankind. Note that my throwing theory for language origins (last 3 essays) has nothing to do with the title essay: THE THROWING MADONNA is a parody (involving maternal heartbeat sounds!) on the typically-male theories of handedness.