Newswise — By: Richard P. Menger, MD; Christopher J. Storey, MD, PhD; Bharat Guthikonda, MD; Symeon Missios, MD; Anil Nanda, MD, PhD, MPH; John M. Cooper, PhDThe clinical sequel of ischemic stroke altered the outcome of U.S. foreign policy in the 20th century. World War I had catapulted the U.S. from historical isolationism to international involvement in a major European conflict. Upon the close of the war, Woodrow Wilson's vision involved a permanent U.S. imprint on democracy in world affairs through participation in the League of Nations. Amidst these defining historical events, Woodrow Wilson suffered his fourth and most serious ischemic stroke on Oct. 2, 1919, leaving him incapacitated.
In 1919, Wilson was relentlessly travelling the country by rail to garner support for the U.S. into the League of Nations. Wilson collapsed in Pueblo, Colo. on Sept. 25, 1919. His primary symptom was headache, unrelated to position and unrelenting. He mildly recuperated after some rest, and reports state that on October 1, he was able to watch a film and read verses from the Bible (7). On October 2, he began to exhibit left-sided hand and leg paresis and was found slumped on the floor of the private quarters bathroom by his wife Edith Wilson. This progressed to left hand and leg plegia (17).
Wilson had suffered his most significant stroke; a stroke that would leave him disabled (10228). The care of White House physician, Dr. Cary Grayson, was sought immediately. Dr. Grayson, under enormous secrecy, served as the de facto head of an interdisciplinary healthcare team. On October 3, examination noted a central left 7th cranial nerve deficit and complete left upper and lower extremity plegia (7). Given the nature of the onset and the lack of significant mental status changes, the presumed diagnosis of an ischemic stroke without hemorrhagic convergence was made. Speech function, by nature of the right-sided stroke, remained intact.
Information to the public was extremely limited. Only general statements from the government were issued, and essentially no one was allowed to see the President (17). The severity of the stroke was kept secret from the President, his cabinet, Congress and the American people (21). Wilson struggled to sign his own name, was bedridden and needed assistance with activities of daily living including feeding (17). Nevertheless, Wilson did not consider resigning (7). Interestingly, Edith Wilson, thought resignation would be fatal to the President and noted, “If he resigns, the greatest incentive to recovery is gone (7).”
Upon briefing his cabinet, Dr. Grayson refused to acknowledge or sign the paper of disability, thereby terminating any talks of potential Presidential succession (21). A stunning debate occurred during a cabinet meeting on Oct. 6, 1919, where Secretary Lansing raised the issue of Article II, Section 1 of the Constitution, naming the Vice President to substitute for President if the President was “unable to discharge the powers and duties of his office.” Grayson responded potently:
“Secretary Lansing asked me the direct questions as what is the matter with the President, what is the exact nature of the President’s trouble, how long he would be sick and was his mind clear or not. My reply was the President’s mind is not only clear but very active, and that he clearly showed that he was very much annoyed when he found out that the Cabinet had been called and that he wanted to know by whose authority the meeting had been called and to what purpose (7).”
For a period of 17 months, nearly all communication to and from the President was maintained via his wife Edith (717). All messages were conferred to Wilson by his wife. Wilson then privately communicated to Edith Wilson who would then relay Wilson’s supposed responses (21). Therefore, Edith Wilson, even though not officially making presidential decisions, functioned as the “gatekeeper” of information to Wilson and voice of his responses. She alone decided what was appropriate for the President to review or not.
Years later, while under political pressure, she once stated almost poetically, “I, myself, never made a single decision regarding the disposition of public affairs (7).” However, at least one document is noted to have been prepared without Wilson’s consent. Wilson’s veto to the Volstead Act in 1918 was written by proxy on behalf of Edith Wilson’s urging. The President’s private secretary, Joseph Tumulty, with the help of Secretary of Agriculture David F. Houston, crafted a message aiming to veto the lawful enforcement of the 18th Amendment (Prohibition) (7). This was directly in line with Wilson’s known political ideology. It serves as no surprise that some historians refer to this period as the most vulnerable period in the history of the American Presidency (21), while others coin Edith Wilson as the first female President.
Dr. Grayson, who held tremendous personal and professional loyalty to Wilson, kept hidden the severity of the stroke from Congress, the American people and even the President himself. Patient-physician confidentiality superseded national security amidst the backdrop of friendship and political power on the eve of a pivotal juncture in the history U.S. foreign policy.
It was in part because of the absence of Wilson’s vocal and unwavering support that the U.S. did not join the League of Nations and distanced itself from the international stage. The League of Nations would later prove powerless, without American support, and unable to thwart the rise and advance of Adolf Hitler. Only after World War II did the U.S. assume its global leadership role, and Wilson’s visionary yet contentious groundwork for a Pax Americana was realized.
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 recalcitrance of the American public to international affairs and failure to convince the U.S. to join the League of Nations 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 (21).
*Adopted from Menger, RP., Storey, C, Guthikonda, B, Missios S., Nanda A., & Cooper, J. M. Woodrow Wilson’s hidden stroke of 1919: the impact of patient-physician confidentiality on United States foreign policy. Neurosurgical Focus, 39(1), 2015 E6.
Full references available upon request.
Neurosurgery Awareness Month: Observed each August, Neurosurgery Awareness Month brings focus to a variety of neurosurgical conditions and treatments, as well as on neurosurgeons themselves. Additional materials may be found on the AANS.org website, http://www.aans.org/Patient%20Information/Neurosurgery%20Outreach%20Month.aspx.
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