Woodrow Wilson suffers a stroke

Woodrow Wilson suffers a stroke

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President Woodrow Wilson, who had just cut short a tour of the country to promote the formation of the League of Nations, suffers a stroke on October 2, 1919.

The tour’s intense schedule–8,000 miles in 22 days–cost Wilson his health. He suffered constant headaches during the tour, finally collapsing from exhaustion in Pueblo, Colorado, in late September. He managed to return to Washington, only to suffer a near-fatal stroke on October 2.

Wilson’s wife Edith blamed Republican opponents in Congress for her husband’s stroke, as their vehement opposition to the League of Nations often took the form of character assassination. Edith, who was even suspicious of the political motives of Vice President Thomas Marshall, closely guarded access to her husband. She kept the true extent of Wilson’s incapacitation from the press and his opponents. While Wilson lay in bed, unable to speak or move, Edith purportedly insisted that she screen all of Wilson’s paperwork, in some cases signing Wilson’s name to documents without consulting the convalescing president. Edith, however, denied usurping her husband’s position during his recovery and in her memoirs insisted she acted only as a “steward.”

Wilson slowly regained his health, but the lasting effects of the stroke—he remained partially paralyzed on one side–limited his ability to continue to campaign in favor of the League. In 1921, Republican Warren Harding’s election to the presidency effectively ended efforts by the League’s supporters to get it ratified. Wilson died in 1924.

The Surprising Evidence that Woodrow Wilson Was Suffering from a Brain Malfunction Before the Stroke that Crippled Him

This is part three of a three-part series distilling the thesis of Richard Striner’s new book, Woodrow Wilson and World War One: A Burden Too Great to Bear, published by Rowman & Littlefield in April 2014. (Click here for Part 1 and here for Part 2.) Mr. Striner is a professor of history at Washington College. His other books include Father Abraham: Lincoln’s Relentless Struggle to End Slavery and Lincoln’s Way: How Six Great Presidents Created American Power.

Almost everyone who knows anything about Woodrow Wilson agrees he was a tragic figure. But the admirers and detractors of Wilson have differed sharply down the years as to whether Wilson’s tragedy was essentially his own fault. One critical fact about the tragedy was obviously not his fault: the stroke that he suffered on October 2, 1919. And due to the underlying condition of arteriosclerosis (diagnosed as early as 1906), distinguished medical observers have theorized that Wilson suffered from a progressive cerebro-vascular deterioration resulting in episodic dementia as early as 1917.

As one studies the historical record in detail — a record set forth in magnificent abundance by the editorial team led by the late Arthur S. Link that produced the 69-volume Papers of Woodrow Wilson — there is much to support the belief that he was hampered by his medical condition.

Wilson’s judgment seemed grossly impaired by the war years. He was extraordinarily petulant and irrational by 1918, and contemporaneous observers who were in a position to know commented often on his strange and quirky ways.

In 1919, Wilson’s pre-existing medical and mental conditions arguably led to a breakdown months before his paralytic stroke, which occurred on October 2. The nature of this breakdown could be seen as early as February, in a series of words and actions that prefigured his behavior of November and December, at which point he was clearly out of his mind.

When Wilson sailed to Europe aboard the USS George Washington, he had — typically — no substantive strategy for preventing the kind of vindictive peace that he had warned against in his 1917 “Peace Without Victory” speech. One of the advisers recruited for the U.S. peace delegation, Yale historian Charles Seymour, recalled that Wilson turned to him during the voyage and asked, “What means, Mr. Seymour, can be utilized to bring pressure upon these people in the interest of justice?” It was very late indeed for Wilson to be thinking in these terms, especially after the many missed opportunities in 1917 and 1918 to build the political pre-conditions for “peace without victory.”

John Maynard Keynes, at that time serving as an adviser to David Lloyd George, argued in his best-selling book The Economic Consequences of the Peace that Wilson could have come to Europe with a formidable basis for pressuring the allies. Keynes wrote that “Europe was in complete dependence on the food supplies of the United States and financially she was even more absolutely at their mercy. Europe not only already owed the United States more than she could pay but only a large measure of further assistance could save her from starvation and bankruptcy.” Referring to Wilson, Keynes wrote that “never had a philosopher held such weapons wherewith to bind the princes of this world.”

If Wilson had explored the possibility of offering a debt moratorium to the allies, the reparations that the British and the French would inflict upon the Germans might have been far less severe. But Wilson never seriously considered that option in 1918 or 1919, as the historical record demonstrates.

The negotiations over reparations and territorial settlements were grueling, but Wilson consoled himself with the fact that the League of Nations won general approval at the Paris Peace Conference in January, though the task of hammering out the details of its overall plan and structure was difficult. Wilson returned briefly to the United States in late February to sign legislation that the lame-duck Congress had passed in its final session. Here was an opportunity to test and adjust the domestic politics regarding both the League and the overall treaty.

Wilson’s behavior in February and early March shows clearly that a mental breakdown was beginning. Some of his behavior, to be sure, was quintessentially Wilsonian: his proclamations, for instance, that pure idealism had won the war and that power politics had nothing to do with the outcome were symptomatic of the escapism that was intermittently a factor in his thinking. In Boston, he delivered the following incantation: “In the name of the people of the United States I have uttered as the objects of this great war ideals, and nothing but ideals, and the war has been won by that inspiration.” He had engaged in this sort of hyperbole many times and it had rendered him largely incapable of strategic thinking since the war began. But some other episodes during this visit showed a new and shocking deterioration.

At the suggestion of Col. House, he sponsored a dinner at the White House to explain the preliminary terms of the League covenant to select members of Congress. The results of this meeting showed clearly that the League was in trouble on Capitol Hill. Several worried Democrats suggested that Republican feedback should supply the basis for revisions that Wilson could bring with him when he returned to Paris. But Wilson refused to consider this.

Two days later, Henry Cabot Lodge made a powerful and persuasive speech on the floor of the Senate denouncing the preliminary structure of the League. Wilson’s response was appallingly simple: he threw a public temper tantrum. In remarks at a meeting of the Democratic National Committee, he proclaimed that all who opposed the preliminary plans for the League were imbeciles. Listen to him: “Of all the blind and little provincial people, they are the littlest and most contemptible . . . . They have not even got good working imitations of minds. They remind me of a man with a head that is not a head but is just a knot providentially put there to keep him from raveling out . . . . They are going to have the most conspicuously contemptible names in history. The gibbets that they are going to be erected on by future historians will scrape the heavens, they will be so high.”

Just before Wilson returned to Paris, Lodge circulated in the Senate a document in which the signatories declared that they would under no circumstances vote for the League in its existing form. Lodge obtained more than enough signatures to show Wilson he was beaten unless he made revisions to the League.

Wilson did so when he returned to Paris, and these new deliberations were as grueling as the earlier ones had been. But Wilson refused to have any contact with Lodge and his supporters, which meant that all of his work was a waste of time, for Lodge was engaging in a simple game of payback, an exercise for the fun of it to make Wilson humble himself and give Republicans a “piece of the action.” Surely at some level Wilson sensed what was going on, but his vanity, his stubbornness, and his indignation were becoming more severe.

Wilson's signature in 1913

His health began to give way in recurrent bouts of illness. But something drastic seemed to happen to him on April 28 — something that did not come to light until many years later, when historian Arthur S. Link was editing the Wilson documents from 1919. Let Link and his editorial colleagues tell the story: “It became obvious to us while going through the documents from late April to about mid-May 1919 that Wilson was undergoing some kind of a crisis in his health . . . . Whatever happened to Wilson seems to have occurred when he was signing letters in the morning of April 28” when his handwriting changed and became almost bizarre.

Wilson's signature in spring 1919

The editors continue: “Wilson’s handwriting continued to deteriorate even further. It grew increasingly awkward, was more and more heavily inked, and became almost grotesque.” Link summoned some medical specialists who told him that in their own opinion there was simply no doubt about it: Wilson had suffered a stroke on the morning of April 28.

And then he threw away yet another opportunity to strike a blow for “peace without victory.” When the terms of the Versailles treaty were made public there was widespread outrage regarding their severity. David Lloyd George, the British prime minister, was stricken, and he called the British delegation together on June 1. Their decision was unanimous: the terms of the treaty should be softened.

But when Wilson was approached, he declared that the severe terms were perfectly appropriate. According to one account, he proclaimed that “if the Germans won’t sign the treaty as we have written it, then we must renew the war.”

When he returned to the United States, his mental decline proceeded rapidly. He seemed to be more and more convinced that a religious drama was being enacted, a drama that he could understand more than others. When he presented the treaty to the Senate on July 10, he declared that “the stage is set, the destiny disclosed. It has come about by no plan of our conceiving, but by the hand of God who led us into this way. We cannot turn back. We can only go forward, with lifted eyes and freshened spirit, to follow the vision.” A Democrat, Senator Henry Fountain Ashurst, reacted to the speech as follows: “Wilson’s speech was as if the head of a great Corporation, after committing his company to enormous undertakings, when called upon to render a statement as to the meanings and extent of the obligations he had incurred, should arise before the Board of Directors and tonefully read Longfellow’s Psalm of Life.” Republican responses to the speech were even less charitable.

In August Wilson came to his senses and began to engage in discussions with congressional opponents, including some Republicans known as “mild reservationists” who supported the treaty but insisted on some clarifications to the League covenant, especially in regard to the issue of military force. But on August 11, his mood changed abruptly, and he made his fateful decision to appeal to the American people on a speaking tour that would take him to the West Coast and back.

Before he left, however, he made a significant (if private) concession: he gave his preliminary assent to some secret text for a possible “reservation” to the League covenant that was drafted by Democratic Senator Gilbert Hitchcock.

The speaking tour broke his health permanently, and after falling ill in Pueblo, Colorado, he returned to Washington, where the paralytic stroke occurred on October 2. After a medical team diagnosed the stroke, Wilson’s wife made the very bad decision to conceal the diagnosis from the public. Wilson could and should have been relieved of his presidential duties. As an invalid who had suffered a severe brain injury, he became more irrational and petulant than ever before.

The preliminary showdown in Congress over the Versailles treaty and its League covenant happened in November. Lodge had drafted a series of reservations, the most important of which concerned Article 10, which pertained to collective security and the use of military force under League auspices. Lodge’s text was negative and grudging: it declared that the United States would never participate in collective security actions as recommended by the League unless Congress approved through its constitutional prerogative to declare war. As Arthur Link noted years ago, the Lodge reservation was essentially the same as the Hitchcock reservation that Wilson had secretly approved, though the tone of Lodge's reservation was of course nasty and negative. But both of them said essentially the same thing: the United States could never be drawn into war against the opposition of the people’s elected representatives.

Wilson, however, was convinced that the Lodge reservation “cuts the very heart out of the treaty.” A caucus of Democratic senators had voted to obey the president’s wishes, so bipartisan discussions with Republican “mild reservationists” were called off. The treaty went down to defeat on November 19.

The reaction was one of bipartisan shock, especially with Republicans such as former President William Howard Taft, who supported the League and who declared that the Lodge reservation “does not modify the original article nearly so much as a good many people have supposed it did.”

So bipartisan discussions resumed in January 1920. Success was approaching as more and more Democrats rebelled against Wilson’s delusional position. Wilson ranted that he would never tolerate “disloyalty,” and he did his best to use party discipline to force recalcitrant Democrats into line. When the treaty was considered again on March 19, twenty-two Democrats broke with Wilson and voted for the treaty with the Lodge reservations attached. But that was seven votes shy of the necessary two-thirds majority. The treaty of Versailles was rejected once and for all on that spring day in 1920. And the blame must be placed where it belongs: at the bedside of Woodrow Wilson.

In the opinion of John Milton Cooper, Jr., one of Wilson’s greatest admirers among academic historians, “in the first three months of 1920” Wilson seemed to be in the grip of “mental instability, if not insanity . . . . He should not have remained in office.”

As this series has attempted to argue — and as my book Woodrow Wilson and World War I: A Burden Too Great to Bear seeks to demonstrate at length — the catastrophe of Wilson’s wartime leadership started long before his madness. For a long time, qualified medical observers have theorized that Wilson suffered from a cerebro-vascular condition that warped his judgment for several years before the stroke. To the extent that these theories are justified, Wilson was not to blame for the blunders and follies that characterized his behavior during World War I. On the other hand, if his mistakes — especially his earlier mistakes when his mind was more lucid, the mistakes that resulted from aversion to strategic thinking — sprang from character flaws that can afflict any one of us, the judgment of history must be severe.

But one thing seems certain to me after studying the record in detail: Woodrow Wilson was not the right leader for the United States during World War I.

Woodrow Wilson suffers debilitating stroke, Oct. 2, 1919

On this day in 1919, Woodrow Wilson, the nation’s 28th president, suffered a debilitating, near fatal stroke. While Wilson continued to live until 1924, he never fully recovered his faculties before his death in Washington at age 67.

Edith Wilson, the first lady, found her husband sprawled on the bathroom floor. When Rear Adm. Cary Grayson, the president’s personal physician, saw him, he exclaimed, “My God, the president is dead!” The stroke left Wilson paralyzed on his left side, unable to speak, blind in his left eye and with only partial vision in his right eye.

He was confined to bed for the next few weeks and kept away from everyone save Edith and Grayson. For some months thereafter, Wilson, having partially recovered, remained confined to a wheelchair later, he began to walk again with the use of a cane. Until Wilson left office in March 1921, his condition remained hidden from the public and much of official Washington.

(The probable cause of Wilson’s incapacity was the physical strain he suffered during a cross-country public speaking tour that he undertook in support of ratification of the Treaty of Versailles. After he had collapsed in Pueblo, Colo., on Sept. 25, his special train raced back to Washington.)

For a time, it was one of greatest cover-ups in the annals of the American presidency. (Many more years would pass before ratification of the 25th Amendment in 1967, which specifies the procedures to be followed in the event of a presidential disability.) Edith would regularly review pending legislation and executive documents — becoming, according to some historians, the de facto acting president.

Scenes from Jeff Flake's Supreme Court rebellion

Edith and Wilson’s aide, Joe Tumulty, helped a journalist, Louis Seibold of the New York World, write a false account of a purported interview with the president. (Seibold won the 1921 Pulitzer Prize for national reporting for his fabricated account of the interview.)

She selected important matters — such as strikes, unemployment, inflation and the threat of communism — that she thought deserved her husband’s attention and fobbed off all the others onto members of his Cabinet. Wilson temporarily resumed a perfunctory attendance at Cabinet meetings. Despite her efforts at masking the president’s health, by February 1920, his condition had become the subject of widespread gossip.

After her husband’s death, Edith stayed in their home for 37 years, dying there at age 89 on Dec. 28, 1961, which was Woodrow's birthday and the day she was to be the guest of honor at the opening of the Woodrow Wilson Bridge across the Potomac River.

She left the home and much of the contents to the National Trust for Historic Preservation to be made into a museum honoring her husband. The Woodrow Wilson House opened to the public in 1963, was designated a National Historic Landmark in 1964, and was listed on the National Register of Historic Places in 1966.

1919: Woodrow Wilson suffers from the Spanish flu and a stroke

Woodrow Wilson was in Paris to negotiate the treaty that would end World War I when he came down sick with the Spanish flu on the evening of April 3, 1919. Wilson had clashed with French Prime Minister Georges Clemenceau over the terms of the treaty: Clemenceau wanted Germany to pay for its role as aggressor in the war, while Wilson sought to create a more peaceful world order and de-escalate tensions. But, as the New Yorker writes, the exhausted president gave up most of his demands after contracting the flu—resulting in an infamously harsh treaty that ultimately led to the rise of Adolf Hitler and World War II. (Discover the swift, deadly history of the Spanish flu pandemic.)

Six months later, while traveling across the U.S. to shore up support for the treaty, Wilson fell ill once again. On the morning of October 2, 1919, he woke up partially paralyzed and was later diagnosed with a stroke. Seeking to protect her husband, Edith Wilson stepped in to hide the extent of his illness. Although the White House Historical Association notes that she didn’t initiate any programs or make major decisions, Edith controlled access to him and took over many of the routine duties of the presidency until his term ended in March 1921.

When a secret president ran the country

Woodrow Wilson may have been one of our hardest-working chief executives and by the fall of 1919, he looked it.

For most of the six months between late Dec. 1918 and June 1919, our 28th president was in Europe negotiating the Treaty of Versailles and planning for the nascent League of Nations, efforts for which he was awarded the 1919 Nobel Peace Prize (an award he did not officially receive until 1920). Back home, however, the ratification of the treaty met with mixed public support and strong opposition from Republican senators, led by Henry Cabot Lodge (R-Mass.), as well as Irish Catholic Democrats. As the summer progressed, President Wilson worried that defeat was in the air.

Bone-tired but determined to wage peace, on Sept. 3, 1919, Woodrow Wilson embarked on a national speaking tour across the United States so that he could make his case directly to the American people. For the next three and a half weeks, the president, his wife Edith Bolling Galt Wilson, assorted aides, servants, cooks, Secret Service men and members of the press rode the rails. The presidential train car, quaintly named the Mayflower, served as a rolling White House. Also joining the party was the president’s personal physician, Cary T. Grayson, who had grave concerns over his patient’s health.

Not that Woodrow Wilson was the picture of health before beginning this grueling crusade.

When Wilson took office, the famed physician and part-time novelist Silas Weir Mitchell ominously predicted that the president would never complete his first term. Dr. Weir was wrong on that prognosis even though Dr. Grayson did fret aloud and often about the Wilson’s tendency to overwork.

For example, while negotiating with European leaders on arriving at an equitable peace to end “the Great War,” Wilson worked incessantly, eliminating all the exercise, entertainment and relaxation sessions from his schedule. And like tens of millions of other people during the worst pandemic in human history, the American president succumbed to a terrible case of influenza in early April of 1919.

All during September of 1919, as the presidential train traveled across the Midwest, into the Great Plains states, over the Rockies into the Pacific Northwest and then down the West Coast before turning back East, the president became thinner, paler and ever more frail. He lost his appetite, his asthma grew worse and he complained of unrelenting headaches.

Unfortunately, Woodrow Wilson refused to listen to his body.

He had too much important work to do. Combining his considerable skills as a professor, scholar of history, political science and government, orator and politician, he threw himself into the task of convincing the skeptics and preaching to the choir on the importance of ratifying the treaty and joining the League of Nations. At many of the “whistle stops,” vociferous critics heckled and shouted down his proposals. In the Senate, his political opponents criticized Wilson’s diplomacy, complained that the treaty reduced the Congress’s power to declare war, and ultimately voted the treaty down.

Late on the evening of Sept. 25, 1919, after speaking in Pueblo, Colorado, Edith discovered Woodrow in a profound state of illness his facial muscles were twitching uncontrollably and he was experiencing severe nausea. Earlier in the day, he complained of a splitting headache.

Six weeks after the event, Dr. Grayson told a journalist that he had noted a “curious drag or looseness at the left side of [Wilson’s] mouth — a sign of danger that could no longer be obscured.” In retrospect, this event may have been a transient ischemic attack (TIA), the medical term for a brief loss of blood flow to the brain, or “mini-stroke,” which can be a harbinger for a much worse cerebrovascular event to follow — in other words, a full-fledged stroke.

On Sept. 26, the president’s private secretary, Joseph Tumulty, announced that the rest of the speaking tour had been canceled because the president was suffering from “a nervous reaction in his digestive organs.” The Mayflower sped directly back to Washington’s Union Station. Upon arrival, on Sept. 28, the president appeared ill but was able to walk on his own accord through the station. He tipped his hat to awaiting crowd, shook the hands of a few of the people along the track’s platform, and was whisked away to the White House for an enforced period of rest and examination by a battery of doctors.

Everything changed on the morning of Oct. 2, 1919. According to some accounts, the president awoke to find his left hand numb to sensation before falling into unconsciousness. In other versions, Wilson had his stroke on the way to the bathroom and fell to the floor with Edith dragging him back into bed. However those events transpired, immediately after the president’s collapse, Mrs. Wilson discretely phoned down to the White House chief usher, Ike Hoover and told him to “please get Dr. Grayson, the president is very sick.”

Grayson quickly arrived. Ten minutes later, he emerged from the presidential bedroom and the doctor’s diagnosis was terrible: “My God, the president is paralyzed,” Grayson declared.

President Woodrow Wilson, seated at desk with his wife, Edith Bolling Galt, standing at his side. First posed picture after Mr. Wilson’s illness, White House, June 1920. Courtesy the Library of Congress

Protective of both her husband’s reputation and power, Edith shielded Woodrow from interlopers and embarked on a bedside government that essentially excluded Wilson’s staff, the Cabinet and the Congress. During a perfunctory meeting the president held with Sen. Gilbert Hitchcock (D-Neb.) and Albert Fall (R-N.M.) on Dec. 5, he and Edith even tried to hide the extent of his paralysis by keeping his left side covered with a blanket. Sen. Fall, who was one of the president’s most formidable political foes told Wilson, “I hope you will consider me sincere. I have been praying for you, Sir.” Edith later recalled that Woodrow was, at least, well enough to jest, “Which way, Senator?” A great story, perhaps, but Wilson’s biographer, John Milton Cooper, Jr. doubts its veracity and notes that neither Edith nor Dr. Grayson recorded such a clever rejoinder in their written memoranda from that day.

By February of 1920, news of the president’s stroke began to be reported in the press. Nevertheless, the full details of Woodrow Wilson’s disability, and his wife’s management of his affairs, were not entirely understood by the American public at the time.

What remained problematic was that in 1919 there did not yet exist clear constitutional guidelines of what to do, in terms of the transfer of presidential power, when severe illness struck the chief executive. What the U.S. Constitution’s Article II, Section 1, Clause 6 on presidential succession does state is as follows:

In Case of the Removal of the President from Office, or of his Death, Resignation, or Inability to discharge the Powers and Duties of the said Office, the Same shall devolve on the Vice President, and the Congress may by Law provide for the Case of Removal, Death, Resignation or Inability, both of the President and Vice President, declaring what Officer shall then act as President, and such Officer shall act accordingly, until the Disability be removed, or a President shall be elected.

But Wilson, of course, was not dead and not willing to resign because of inability. As a result, Vice President Thomas Marshall refused to assume the presidency unless the Congress passed a resolution that the office was, in fact, vacant, and only after Mrs. Wilson and Dr. Grayson certified in writing, using the language spelled out by the Constitution, of the president’s “inability to discharge the powers and duties of the said office.” Such resolutions never came.

In fact, it was not until 1967 that the 25th Amendment to the Constitution was ratified, which provides a more specific means of transfer of power when a president dies or is disabled. Parenthetically, many presidential health scholars continue to argue that even the 25th Amendment is not clear enough in terms of presidential succession and needs revision, especially in the face of 21st century medicine and the increased chances of surviving major illnesses with severe and impairing disabilities.

For the remainder of her life, Edith Wilson steadfastly insisted that her husband performed all of his presidential duties after his stroke. As she later declared in her 1938 autobiography, “My Memoir”:

So began my stewardship, I studied every paper, sent from the different Secretaries or Senators, and tried to digest and present in tabloid form the things that, despite my vigilance, had to go to the President. I, myself, never made a single decision regarding the disposition of public affairs. The only decision that was mine was what was important and what was not, and the very important decision of when to present matters to my husband.

Over the last century, historians have continued to dig into the proceedings of the Wilson administration and it has become clear that Edith Wilson acted as much more than a mere “steward.” She was, essentially, the nation’s chief executive until her husband’s second term concluded in March of 1921. Nearly three years later, Woodrow Wilson died in his Washington, D.C., home, at 2340 S Street, NW, at 11:15 AM on Sunday, Feb. 3, 1924.

According to the Feb. 4 issue of The New York Times, the former president uttered his last sentence on Friday, Feb. 1: “I am a broken piece of machinery. When the machinery is broken — I am ready.” And on Saturday, Feb. 2, he spoke his last word: Edith.

As we look forward to the presidential campaign of 2016, it seems appropriate to recall that Oct. 2, 1919, may well mark the first time in American history a woman became de-facto president of the United States, even if Edith Wilson never officially held the post. Indeed, the prolonged blockage of blood flow to his brain changed more than the course of Woodrow Wilson’s life it changed the course of history.

Left: As we look forward to the presidential campaign of 2016, it seems appropriate to recall that Oct. 2, 1919, may well mark the first time in American history a woman became de-facto president of the United States. Painting by Frank Graham Cootes, via Wikimedia Commons

Woodrow Wilson Suffers Stroke, 1919

When World War I ended, President Woodrow Wilson attended the Paris Peace Conference, where the Allied nations met to write the Treaty of Versailles. In September 1919, President Woodrow Wilson embarked on a speaking tour of US cities to gain support for the treaty and the League of Nations, which Americans were reluctant to join.

Traveling with the President was Dr. Cary Grayson, Wilson’s personal physician and friend. Grayson kept a diary of the trip and included notes on Wilson’s health. On September 26, on a train bound for Wichita, Kansas, Grayson was woken up to attend to Wilson:

Grayson attributed this health breakdown to the immense mental and physical strain of the trip and urged Wilson to cancel the remaining tour stops.

Wilson returned to Washington, DC, on September 28, and Grayson commenced a regimen of rest and seclusion for the President, insisting that "he should be not bothered with any matters of an official character, and especially that no question of controversy should be brought to his attention." On October 2, Wilson experienced numbness on his left side and collapsed at the White House. Neurologist Dr. Dercum evaluated Wilson:

Following his stroke, Wilson remained in seclusion with his wife, Edith, as the gatekeeper.

Although the United States did not join the League of Nations, Wilson was awarded the Nobel Peace Prize for his role in its founding. Wilson left office in 1921 and died in Washington, DC, three years later.


PRINCETON, N.J., NOV. 25 -- President Woodrow Wilson's behavior was affected by decreased blood flow to the brain during his oft-criticized and ultimately futile campaign to have the United States join the League of Nations, a historian says.

Records never made public show that Wilson was disabled by illness even before his 1919 stroke, during the critical period in U.S. history after World War I, said Princeton University history professor Arthur Link, editor of a series of volumes of Wilson's papers.

"It is one of the great tragedies of the 20th century," Link said in a recent interview. "The man who was most responsible for building support for the idea of a League of Nations was struck down just as his leadership was most needed. And he was struck down by events over which he had no control."

The 64th volume in the series, to be published in February, will reveal for the first time detailed medical records kept by Cary T. Grayson, Wilson's personal physician. Grayson's sons allowed Link to review the 70-year-old papers in May.

A Democrat, Wilson was president from 1913 to 1921. He suffered a devastating stroke in 1919 and died in 1924. He won the 1919 Nobel Peace Prize for his peacemaking efforts involving the League of Nations after World War I, but he failed to win U.S. support for the League, which fell apart before World War II.

Link said U.S. entry into the League of Nations could have altered history. "In a world with the United States playing a responsible, active role, the possibilities of preventing the rise of Hitler were limitless," Link said.

Wilson failed to get the Senate to ratify U.S. membership in the League because of what Link said was an uncharacteristic refusal to compromise. The Senate wanted guarantees that the United States would not be subordinate to the votes of other nations in case of war.

"In his normal, healthy state, Wilson would have found compromise with the large group of moderate Republicans," said Link. Instead, Wilson was robbed of "his ability at leadership, of his normal shrewdness and deftness, of his marvelous management skills. . . . He would lose his train of thought, and get confused. He would contradict himself, and eventually, blow his cool."

Against medical advice, Wilson, then 63, took his message directly to the people with a speaking tour of Western states in September 1919. The decision to go over the Senate's head angered the very lawmakers Wilson needed to court.

"The decision . . . was not only irrational but in the circumstances was bound to be futile," Link writes in the forthcoming book.

James F. Toole, director of the Stroke Center of the Bowman Gray School of Medicine in Winston-Salem, N.C., and Bert E. Park, a Springfield, Mo., neurosurgeon, analyzed the medical records for Link's book.

Toole wrote that the records indicate Wilson suffered from a disease of the carotid arteries in the neck, which hindered blood flow to the brain, and hypertension, which worsened his condition.

Park wrote that Wilson likely continued to suffer episodes of internal bleeding following a 1906 stroke. This could cause injury leading "in time to recognizable behavioral disturbances that typified Wilson from late 1919 onward," Park wrote.

Link said the records should lay to rest the theories that Wilson's problems were psychological.

"His failure in leadership instead derived from the ravages of disease," Link said. "History has judged Wilson as if he were a well man during this period."

In addition, the widespread belief that Wilson's wife ran the government after her husband's stroke is "pure nonsense," Link said. "It is a popular belief, but it has gotten more into the realm of legend than scholarship."

Grayson's journals show that Edith Bolling Galt Wilson served as a liaison between Wilson and his advisers, but that the government was run by his department heads, Link said.

Edith Wilson did make two crucial decisions following Wilson's stroke, Link said. She covered up the extent of Wilson's illness and thwarted suggestions that he resign. But Link said she long denied being an acting president and once told him she was "never interested in politics."

The Anosognosic’s Dilemma: Something’s Wrong but You’ll Never Know What It Is (Part 3)

The Ushers’ Room at the White House, circa 1915.

Oct. 2, 1919, 8:50 a.m.[35] A telephone rang in the Ushers’ Room at the White House.  There were two telephones perched on a roll-top desk in a corner of the room. One went through the White House switchboard the other was a private line directly to the president. Ike Hoover, the Chief Usher, answered the call on the private line.  It was the First Lady, who told Hoover, “Please get Dr. Grayson, the president is very sick.”

Hoover’s account is graphic and shocking.

. . . I waited up there until Doctor Grayson came, which was but a few minutes at most.  A little after nine, I should say, Doctor Grayson attempted to walk right in, but the door was locked.  He knocked quietly and, upon the door being opened, he entered.  I continued to wait in the outer hall. In about ten minutes Doctor Grayson came out and with raised arms said, “My God, the President is paralyzed!”

. . . The second doctor and nurse arrived and were shown to the room. The employees about the place began to get wise to the fact that the President was very ill, but they could find out nothing more.  Other doctors were sent for during the day, and the best that could be learned was that the President was resting quietly.  Doctor Davis of Philadelphia and Doctor Ruffin, Mrs. Wilson’s personal physician, were among those summoned.  There were doctors everywhere.

. . . The President lay stretched out on the large Lincoln bed. He looked as if he were dead. There was not a sign of life. His face had a long cut about the temple from which the signs of blood were still evident. His nose also bore a long cut lengthwise.  This too looked red and raw.  There was no bandage.

The Lincoln Bedroom, the White House, circa 1915.

. . . Soon after, I made confidential inquiry as to how and when it all happened. I was told — and know it to be right — that he had gone to the bathroom upon arising in the morning and was sitting on the stool when the affliction overcame him that he tumbled to the floor, striking his head on the sharp plumbing of the bathtub in his fall that Mrs. Wilson, hearing groans from the bathroom, went in and found him in an unconscious condition. She dragged him to the bed in the room adjoining and came out into the hall to call over the telephone for the doctor, as I have related.

. . . For the next three or four days the White House was like a hospital. There were all kinds of medical apparatus and more doctors and more nurses. Day and night this went on. All the while the only answer one could get from an inquiry as to his condition was that it “showed signs of improvement.” No details, no explanations. This situation seemed to go on indefinitely. It was perhaps three weeks or more before any change came over things. I had been in and out of the room many times during this period and I saw very little progress in the President’s condition. He just lay helpless. True, he had been taking nourishment, but the work the doctors had been doing on him had just about sapped his remaining vitality.  All his natural functions had to be artificially assisted and he appeared just as helpless as one could possibly be and live.[36]

Wilson’s personal physician, Admiral Cary T.  Grayson, took elaborate notes and kept a day-to-day log of the president’s condition.  Grayson’s papers are now housed at the Woodrow Wilson Presidential Library in Staunton, Va. [37]

Here are Grayson’s notes from the week following the president’s stroke:

Courtesy of the Woodrow Wilson Presidential Library and Museum, Staunton, Virginia Graphic by Steven Hathaway Excerpts of Grayson’s notes following Wilson’s stroke of Oct. 2, 1919.

On October 11th the President was extremely ill and weak and even to speak was an exertion.  He had difficulty in swallowing.  He was being given liquid nourishment and it frequently took a great deal of persuasion to get him to take even this simple diet.  On the day in question Mrs. Wilson and I were begging him to take this nourishment, and, after taking a couple of mouthfuls given to him by Mrs. Wilson with a spoon, he held up one finger and motioned me to come nearer.  He said to me in a whisper:

𠇊 wonderful bird is the pelican,
His bill will hold more than his bellican,
He can take in his beak, enough food for a week,
I wonder how in the hell-he-can.”

The notes, written on yellow foolscap, contain an assortment of limericks and anecdotes, drifting into seeming nonsense.

On one occasion Secretary Tumulty came in to see the President, and as he was leaving, the President said: “Why leave now?” Mr. Tumulty said: “I must go to see the King of Belgium.”  The President said: “You are wrong you should say “‘The King of the Belgians.’” Mr. Tumulty said: “I accept the interpretation.”  The President said: “It is not an interpretation but a reservation.”[38]

Albert I of Belgium.

Wilson was obsessed with limericks prior to his stroke, but what about the post-stroke limericks?  As Grayson leaned in to hear the soft, indistinct voice of the president, was the president trying to reassure him?  Were the limericks examples of light-hearted humor in the face of unblinking adversity? Or manifestations of limitless dementia? [39]

Courtesy of the Woodrow Wilson Presidential Library and Museum, Staunton, Virginia Wilson and Grayson, 1920.

In the 1970s, Edwin Weinstein, a neuropsychiatrist, was asked by Arthur Link, the editor of the Wilson papers, to survey Wilson’s medical history.

The symptoms indicate that Wilson suffered an occlusion of the right middle cerebral artery, which resulted in a complete paralysis of the left-side of the body, and a left homonymous hemianopia — a loss of vision in the left half fields of both eyes. Because he had already lost vision in his left eye from his stroke in 1906, he had clear vision only in the temporal (outer) half field of his right eye.  The weakness of the muscles of the left side of his face, tongue, jaw and pharynx accounted for his difficulty in swallowing and the impairment of his speech.  His voice was weak and dysarthric . . . [40]

Following his stroke, the outstanding feature of the President’s behavior was his denial of his incapacity.  Denial of illness, or anosognosia, literally lack of knowledge of disease, is a common sequel of the type of brain injury received by Wilson.  In this condition, the patient denies or appears unaware of such deficits as paralysis or blindness . . . To casual observers, anosognosiac patients may appear quite normal and even bright and witty.  When not on the subject of their disability, they are quite rational and tests of their intelligence may show no deficit.[41] [42]

Wilson described himself as “lame” and referred to his cane as his “third leg,”[43] but otherwise he considered himself perfectly fit to be president.  There was even talk of a third term. Yet his close associates noticed a change in his personality.  He became increasingly suspicious, even paranoid, without having the dimmest awareness of the fact that he was perhaps becoming a different person from what he once was.  Stockton Axson, his brother-in-law from his first marriage, wrote that “[Wilson] would be seized with what, to a normal person, would seem to be inexplicable outbursts of emotion.”[44] He was furious at anyone who suggested that he had physical and mental problems, and the last months of his presidency became a graveyard of fired associates.  Edith Bolling Wilson, his second wife, had already deposed many of the president’s closest and most effective associates, including Colonel Edward M. House, who had played a major role at the Paris peace talks.  Wilson also forced the resignation of Robert Lansing, his secretary of state, who had dared to call a cabinet meeting to discuss the president’s illness.

It was John Maynard Keynes who asked a central question:  “Was Hamlet mad or feigning was the president sick or cunning?”[45] Babinski and subsequent writers had stressed that anosognosia leaves most “intellectual and affective” faculties intact.  But was this true?  Or were they focused on the paralysis and the denial of paralysis, and paid scant attention to anything else?  Were they anodiaphoric with respect to the anosognosia?

It is interesting to speculate about the total effect that Wilson’s illnesses had on the president’s behavior.  The Oct. 2 stroke was not Wilson’s first cerebral episode.  In his books and articles, Weinstein chronicles Wilson’s long history of stroke, neuritis, numbness, visual impairments and an assortment of vascular pathologies.  The catastrophic Oct. 2 stroke was preceded by a stroke on Sept. 25 that left the president temporarily paralyzed on the left side, and by a severe attack of influenza in April 1909 that “suggested that he may have had another stroke.”

Woodrow Wilson: A Medical and Psychological Biography, Edwin A. Weinstein Diagram of carotid circulation indicating sites of vessel narrowing and occlusion.

With such massive impairments, was Wilson still “there?” Grayson tells us that Wilson knew that King Albert was “King of the Belgians,” but how comforting is that?

The subsequent role played by the president’s doctors, his family and political friends was complex.  But it is clear that they were involved in a coverup.  Since the president was actually impaired — at least physically — what do you tell the Washington news corps?  Or do you deny it to yourself and others?  A determined group of gatekeepers intervened: Ike Hoover, Dr. Grayson and Edith Bolling Wilson, Wilson’s second wife, who became the de facto president of the United States.

Their actions leave open the further question: when does out-and-out prevarication shade off into self-deception and denial?  Did the president’s immediate advisers convince themselves that Wilson was in possession of all his faculties despite evidence to the contrary?  Did Edith Wilson cynically decide to grab power was she in denial or did she become anosognosic, as well, truly believing that there was nothing wrong with her husband?

I had read a number of books about the last years of the Wilson presidency — both first-hand accounts (Hoover, Edith Wilson and Grayson) and secondary sources — but there was a pair of books which stood out from the others: Edith Bolling Wilson’s autobiographical account of her marriage to Woodrow Wilson, “My Memoir,” and Phyllis Lee Levin’s �ith and Woodrow” — two books that paint incompatible pictures of what was happening in the White House.

In Edith Wilson’s account of Oct. 2, she takes great pains to discredit Ike Hoover’s account.

Then came a knock at the door.  It was locked the President and I always locked our doors leading into the hall . . .  The knock was Grayson’s.  We lifted the President into his bed.  He had suffered a stroke paralyzing the left side of his body.  An arm and one leg were useless, but, thank God, the brain was clear and untouched . . .

So far as was possible I checked my recollections with the data of Dr. Grayson, before his lamented death in 1938.  I did this because of a rather remarkable account of the events which appears in the posthumously published 𠇍iary” of Mr. I.H. Hoover, the White House head usher.  For example, the late Mr. Hoover is represented as seeing a long cut on the President’s temple, which late that afternoon, still showed signs of blood also a cut lengthwise on the nose.  Dr. Grayson and I did not see such things. [46]

Mr. Hoover is “represented as seeing . . .” But who is doing the representing?  It’s Hoover’s first person account that includes the observation, “The whole truth, of course, can be told by only one person in all the world, Mrs. Woodrow Wilson . . . [And] I doubt that she will ever tell the world just what happened.”[47]

Edith Bolling Wilson has been dead for nearly 50 years, but Phyllis Lee Levin, formerly a columnist and reporter for The New York Times and a feature writer and editor at Harper’s Bazaar, Mademoiselle and Vogue, is very much alive and living in Manhattan.  In addition to her book on Wilson’s second marriage, she has also written an outstanding biography of Abigail Adams, the wife of John Adams, and now, at almost 90, she is working on a biography of John Quincy Adams.

It is now nearly a decade since the publication of �ith and Woodrow.”  I was surprised by her anger, and her conviction that the coverup of Wilson’s mental impairment that started in the White House continues to the present day.

PHYLLIS LEE LEVIN: I had no idea what I was getting into.  My daughter gave me a copy.  She was at camp, and there was a copy of Mrs. Wilson’s memoir.  And so, I read it.  I just found it so unbelievable that they would have toyed with the fate of this country, the welfare of this country, these two irresponsible people, certainly this lady was.  Perhaps, we could excuse Mr. Wilson a little bit, that he really had no idea of how sick he was.  The doctor came out and said that he was irreversibly damaged.  And then that was dismissed.  There’s such denial.  I’m just being very, very honest with you.  And there’s such denial at Princeton.  They’re quite silly on this subject.  The editor of the Wilson Papers [Arthur Link], when I first called to see him said, “There is nothing in Dr. Grayson’s letters.  Nothing.”  I finally got up enough courage to say, “Well, that should be for me to decide.”  It took me a lot of courage to say that to this nice man.   The papers were hidden.  I went to see Dr. Grayson’s son, who lived in Virginia.  And he is the one who gave the papers over.  I dare say there were more there.  I was quite shocked by the whole affair.  When they said Woodrow Wilson wrote something to Tumulty [Wilson’s secretary, essentially his chief of staff], there𠆝 be a little tiny asterisk.  And then, at the bottom, you would find, in the tiniest possible print, “in the hand of Edith Wilson.”

Library of Congress President Woodrow Wilson with his wife, Edith Bolling Galt Wilson, in June 1920.

ERROL MORRIS: Did you feel, from the very outset, that there was something inherently dishonorable about what they did?  That they should have been completely transparent or forthcoming about the extent of his illness?  The idea that perhaps they were preserving his policies, a chance for world peace, that it was critical to —

PHYLLIS LEE LEVIN: But, they weren’t doing anything.  They weren’t executing anything at all.

ERROL MORRIS: So it was just a grab for power, power for its own sake, by Mrs. Wilson?

PHYLLIS LEE LEVIN: She was probably a very limited woman, intellectually. I’m being very kind.  She wasn’t a very educated woman.  And she was a very vain woman.  She honestly felt that her husband was the only one in the world entitled to be president, even in the shape he was in.

ERROL MORRIS: But who was in control?  Was it Wilson?  Was it Edith?

PHYLLIS LEE LEVIN: It was a conglomerate of people.  Republicans are always blamed for the failure of the peace pact.  When the vote came there had to be compromises.  But Wilson’s mind was so damaged by his illness that he had to have peace on his terms or not at all.  So we didn’t have the peace pact because of him.  Henry Cabot Lodge [the leader of Wilson’s Republican opposition] has been made the villain of all time for this.  Whereas, he had offered a compromise.  What the Wilsons did was just desperately terrible.  It was really the grandest deception in the world.   It’s really a very shocking story.

And then Phyllis Lee Levin asked me if I had seen the movie.

ERROL MORRIS: I didn’t know there was a movie.

PHYLLIS LEE LEVIN:  “Wilson.”  You ought to find it. It appears every now and then on television.  Oh, you𠆝 be so interested because it’s absolutely out of whole cloth.

“Wilson” is a curious document.  Clearly a work of hagiography, it was released in 1944, was a Times Critic’s Pick, was nominated for 10 Academy Awards, and won 5 Oscars, including an Oscar for best original screenplay. [48] (In the midst of World War II, why not have a movie that celebrates a man, who through his intransigence, may have helped bring it about?)  It contains yet one more sanitized version of Wilson’s stroke and anosognosia.

Dr. Grayson: His whole left side is paralyzed, but his mind is perfectly clear and untouched.

Edith: Will he recover?

Dr. Grayson: He’ll improve with time.  For the present, he needs rest and quiet.  Release from every disturbing problem.

Joseph Tumulty: But how’s that possible?  Everything that comes to the president is a problem.

Edith: Would it be better if he resigned and let Mr. Marshall succeed him?

Dr. Grayson: No, no, no, Edith!  He staked his life on getting the league ratified. If he resigns now this great incentive to recovery will be gone.

George Felton:[49] Besides his resignation would have a very bad effect on the country . . . for that matter the whole world.

Dr. Grayson: Our thought is to have everything of an official nature come to you.  You can weigh the importance of each matter and in consultation with the heads of the various departments decide what he must see and what can be left to others.  In this way, Edith, you can be of great service to him.

Edith: No, I can’t do it.  It’s too great a responsibility.

George Felton: Even though his life may depend upon it?

Edith: In that case, there’s only one answer, I’ll try.

A recovering Woodrow Wilson in a wheelchair on the porch of the White House.

Wilson (to Edith): Well, Mrs. President…

Edith: Woodrow!

Wilson:  What’s on tap for today?

Edith: Don’t you dare to call me that!  You know very well I never even made one decision without your knowledge and consent!

Wilson: You know it, I know it, but do our enemies know it?

Edith: I’m not concerned with what our enemies know.


Wilson was a fervent believer in collective world democracy as a necessary prerequisite for world peace. This belief fueled his actions and life’s work. It was the recalcitrant attitude of the American public in regard to international affairs and his own failure to persuade the US to join the League of Nations that led to his ultimate political and possibly his physical demise: “… but the League of Nations is now in its crisis, and if it fails, I hate to think what will happen to the world … I cannot put my personal safety, my health, in the balance against my duty-I must go.” -Woodrow Wilson, 1919. 11

Wilson suffered a catastrophic stroke in 1919 and died in 1924 without ever seeing the US join the League of Nations. His ideas, however, lived on. Regardless of the secrecy surrounding his stroke, his ideas propagated and found fertile ground in future generations, setting the foundation for the formation of the United Nations and the role of the US as a world leader.

25th Amendment: Establishing the Rules for Presidential Incapacity

A president’s health decline while in office was not a novel event isolated to Wilson. Four of the eight presidents who died while in office did so from disease and disability. However, no other president’s health had such grave foreign policy implications as Wilson’s. The only truly prolonged illness was that of James A. Garfield, who survived 81 days following an assassination attempt before succumbing to infection, blood poisoning, and pneumonia. 7 Prior to passage of the 25th Amendment no president sought to voluntarily formally transition complete power to their vice president during a period of illness (Table 2).

History of known presidential incapacity *

CHF = congestive heart failure MI = myocardial infarction VP = vice president.