Conversations and debates surrounding health and disease have been bought to the forefront of public discussion in recent years. Topics that had previously only been of interest to clinicians, scientists and researchers are now commonplace in newspapers, social media and even advertisements as a result of the COVID-19 pandemic.

The undeniable disruption caused by the onset of the pandemic has seen the public rely heavily on the guidance delivered by politicians to limit the spread of the virus. Throughout the course of the pandemic, it became clear that the virus does not discriminate between the public and their government, with numerous US Senators testing positive for the disease. In July 2022, President Biden also tested positive for COVID-19, though fortunately was reported to be “doing just fine” according to White House officials. In light of this, AMI President Brendan Gilmore takes a look back at how the health of those that would be President has always been a political issue.

Infectious diseases in particular have dictated the length, timbre or trajectory of the terms of many past Presidents of the United States of America, perhaps more so than any scandal, war or assassin’s bullet. Deadly, embarrassing (George Bush Snr famously vomited on the Japanese Prime minister at a formal dinner), devastating and tragic; here’s a few of the most notable examples:

George Washington (1789-97)

The first US president, George Washington might well be remembered as the president who had everything, quite literally. Washington was witness to (and survived) more epidemics than any other president and led a life plagued by deadly infections. As a youth of 15, Washington contracted diphtheria, and by 17, malaria. Taking a voyage with his tuberculosis-stricken half-brother to Barbados in 1751, the 19-year-old Washington not only contracted TB himself, but also smallpox, but made a full recovery (his half-brother died the next year). He would later accuse the British, in 1776, of deliberately infecting Bostonians with the disease in an act of bioterrorism and advocated variolation to promote immunity for his soldiers and the general population during the Revolutionary War. He endured recurrent bouts of dysentery, tonsillitis (quinsy), epiglottitis (Haemophilus influenzae infection) and pneumonia. By the time he was inaugurated president, he had lost all but one of his teeth to infection and decay. He was one of 20,000 who fled the 1793 Philadelphia yellow fever epidemic, managing to dodge the most severe epidemic in American history, which claimed the lives of at least 5,000 Philadelphians. In 1799, two years after leaving office, having refused a third term to enjoy his retirement, Washington died aged 67 of upper airways obstruction due to acute laryngitis or acute bacterial epiglottitis, most likely a streptococcal infection. Although his junior physician suggested a tracheotomy, which would most likely have saved him, his older physician considered the procedure, still in its infancy, too risky to perform on a man of such stature.

Thomas Jefferson (1801-1809)

The founding father, principal author of the 1776 Declaration of Independence and third President of the US had, by the time he took office, endured a litany of diseases and injuries which by made him certain, in 1797, that death was near. Despite this, during his term of office he suffered only one bout of dysentery (1802) and a severe jaw infection (1806). Unfortunately, things got a little worse towards the end of his life when in 1818 he contracted a severe infection (boils) on his buttocks, which possibly led to septicaemia. He was plagued by urinary retention due to prostatic hypertrophy, which was relieved by the use of “bougies”, early urinary catheters which, being unsterile introduced bacteria to the bladder and led to urinary tract infections and pyelitis. Following bouts of recurrent diarrhea, Jefferson died on 4 July 1826, just a few hours before John Adams.

However, Jefferson is notable for being the first president to champion Edward Jenner’s approach of using cowpox inoculation to prevent smallpox (John Adams had been approached in 1800 but did not respond, perhaps put off by his own experiences of variolation which was by all accounts, horrendous). In a letter to Jenner in 1806, Jefferson wrote “having been among the early converts, in this part of the globe, to its efficiency, I took an early part in recommending it to my countrymen,” Jefferson had himself and his family inoculated against smallpox.

William Henry Harrison (1841-1841)

The first US President to die in office, Harrison didn’t get to stride the corridors of power for long. He gave his two-hour inauguration speech on a wet, freezing and windy March 4 morning. He caught a cold and had, by March 27, developed right lower lobe pneumonia. He died one month to the day of his inauguration, on April 4. Pneumonia would also claim the life of his grandson, President Benjamin Harrison (1889-1893) in 1901.

Zachary Taylor (1849-1850)

Infection was once again destined to claim the life of a serving president. Taylor had endured three bouts of malaria before becoming president and while on a presidential tour in 1849 fell ill with a suspected case of cholera, leaving his health in a precarious state. On 4 July 1850, Taylor attended a number of Independence Day celebrations in Washington DC, including the dedication of the Washington Monument, became overheated and later developed abdominal cramps. Initially blamed on his consumption of iced milk and cherries, his conditioned worsened; diarrhoea, fever, vomiting and bloody motions led to a diagnosis of ‘cholera morbus’ (an antiquated term for gastroenteritis) which eventually led to his death on 9 July. The exact cause of death is unclear, but cholera or typhoid fever (Salmonella typhi) contracted from the cherries consumed on 4 July have been proposed.

Abraham Lincoln (1861-1865)

Honest Abe, the most famous and beloved of US presidents, contracted malaria on at least two occasions and is suspected to have caught scarlet fever in 1860 from his son, Willie (who died in 1862 from typhoid fever). Lincoln traveled with his personal valet, William H. Johnson, to the dedication of the Soldiers’ National Cemetery, Gettysburg, Pennsylvania where he delivered the now infamous Gettysburg Address on 19 November 1863. On the return journey to Washington DC, Lincoln developed a severe headache, weakness and fever, eventually diagnosed as smallpox. By December Lincoln had recovered, however, William H. Johnson who had also contracted the disease at the same time, died on 28 January. Abraham Lincoln was assassinated by John Wilkes Booth on 15 April,1865.

James A Garfield (1881-1881)

President James Garfield, the twentieth US Commander-in-Chief, was shot en route to his first presidential family vacation (his wife Lucretia was convalescing after contracting malaria), by assassin Charlie Guiteau, at a railway depot in Washington DC on 2 July 1881. Two bullets hit Garfield, the first grazing his shoulder, the second entering via the right posterior thorax, lodged beneath the pancreas. The physicians attending Garfield were unable to locate the second bullet, and the wound was probed regularly by multiple physicians. In response to the shooting, Alexander Graham Bell invented the ‘induction balance’ (an early metal detector) to help locate the bullet, but to no avail - the president’s bedsprings interfered with the signal to such an extent that the detector (which would have worked otherwise) was useless. Although Lister’s theories of antiseptic surgery, published in 1867, would have been well known at the time of Garfield’s shooting, his physicians in probing for the bullet with unsanitised hands and instruments undoubtedly led to the president’s death 80 days later on 19 September 1881. Garfield’s original wound was 3.5 inches in length, by the time of death it was over 20 inches in length and copiously purulent. One of his physicians, Dr D.W. Bliss, later died of septicaemia contracted when he cut himself dressing the president’s wound.

Woodrow Wilson (1913-1921)

Wilson’s presidency coincided with the First World War and the ‘Great Pandemic’ (Spanish Influenza), which resulted in the deaths of tens of thousands of US soldiers. While attending the Paris Peace Conference to negotiate the Treaty of Versailles in January 1919, Wilson developed severe coughing spasms, diarrhoea and fever, later diagnosed as Spanish influenza. Although he recovered, he was unable to participate in some of the key negotiations, the outcomes of the peace conference were therefore significantly different to those Wilson envisaged.

Calvin Coolidge (1923-1929)

The presidency of Calvin Coolidge gives us a stark and tragic reminder of the horrors of the pre-antibiotic era. In 1924, his 16-year-old son, Calvin, developed a blister on his foot after a game of tennis. The abrasion became infected and Calvin Jr. died a few days later from septicaemia. Many agree that the tone of his presidency changed entirely after the death of his son. The remainder of Coolidge’s time in office was marked by severe episodes of depression. Once described as the “Great Refrainer” Coolidge’s laissez-faire attitude led many to blame him for the Wall Street Crash of 1929. Fleming’s discovery of penicillin in 1928 was the dawn of the antibiotic era.

Franklin Delano Roosevelt (1933-1945)

Four term president Franklin D. Roosevelt contracted Polio, aged 39, during a family visit to Canada in 1921. As a result, Roosevelt was paralysed in both legs and had to use a wheelchair for the remainder of his life. Roosevelt is famous for extensively funding polio research, and was the founder of the ‘March of Dimes’, a grass-roots initiative whereby people, including millions of children, across the US sent dimes to the president to fund research into a vaccine, an initiative that led to Jonas Salk’s polio vaccine in 1954 and Sabin’s oral vaccine in 1962.