Medical historians debate what exactly happened to President Woodrow Wilson in April 1919. What we do know is that he wasn’t the same afterward.
Wilson was in Paris leading post-World War I peace talks and overseeing European relief and reconstruction. The first American president ever to leave the country while in office, he stayed abroad for seven months between December 1918 and July 1919, save for a three-week break in late February and early March, when he sailed to America to sign legislation, meet with senators, and deliver three speeches. In Paris, he was clocking in 15-hour days, desperate to forge a new international organization—the League of Nations—to prevent future world wars.
That the president himself was handling direct diplomacy was unusual. Before the December voyage, the French and British prime ministers indicated his presence in Paris should be limited. Secretary of State Robert Lansing told Wilson that attending the peace conference “was unwise and would be a mistake” because he could better “dictate the terms of peace if he held aloof.” His unofficial foreign policy adviser, Edward House (known as “Colonel”), relayed to Wilson that the views of others with “opinions of high value” thought going to Paris “would involve a loss of dignity and your commanding position.”
Wilson viewed these cautions as self-serving. The French and British wanted to dominate the talks. House wanted to be the lead negotiator. Lansing didn’t believe in a League of Nations. Mostly, Wilson viewed himself as indispensable.
In his memoir, Cary Grayson, Wilson’s physician and close friend, wrote that the president “knew that the only way to secure a real and vital compact of nations was to interknit it with the treaty of peace. Such was his faith, and he was fully aware that he himself must be the chief apostle of that faith and the chief champion of that cause…so it became to him a matter of conscience to head in person the American Peace Commission. He must go.”
But Wilson had a checkered medical history. Dr. Grayson wrote he “dreaded the added strain of his attendance upon the Peace Conference.”
According to Edwin Weinstein, a neuropsychiatrist who wrote Woodrow Wilson: A Medical and Psychological Biography, Wilson had a minor stroke at the age of 39 in May 1896, which deprived him of the ability to write correctly with his right hand for about a year. Doctors at the time were unable to make a diagnosis.
Ten years later, Wilson awoke and found himself blind in his left eye. An ophthalmologist diagnosed this as a stroke caused by a blood clot and told him to give up “active work.” Weeks later, an internist said he had a “general condition” of “arterial trouble” but could return to work after three months of rest. (Wilson’s wife further elaborated in a letter that he had “hardening of the arteries, due to prolonged blood pressure on brain and nerves.”) After a summer in England, he returned to his demanding post as president of Princeton University. He later regained partial vision.
As captured by the editors of The Papers of Woodrow Wilson (see Wilson’s Neurologic Illness at Paris in Volume 58), medical historians debate these episodes. For example, the blindness incident may have been caused by an “eye stroke,” different from a cerebral stroke. But there is a consensus that “untreated hypertension” underlaid Wilson’s afflictions, and he was “long the victim of a dangerous cerebrovascular disease.”
In an essay for The Papers, Bert Park, a neurologist, argued that the disease had life-altering consequences for Wilson and geopolitical implications for the world’s nations. Wilson, in the months before his Paris expedition, was showing signs of early-stage dementia.
When driven by hypertension and small “lacunar” strokes, dementia progresses gradually, so “certain behavioral changes may only be recognized in retrospect as nascent manifestations of the disease that later becomes obvious in time.”
One of several examples Park points to is August 1918, when Wilson told House he couldn’t remember details of a recent meeting because his mind had become “leaky.” He also cites uncharacteristically poor political decisions. Wilson foolishly urged voters to vote Democratic in the 1918 midterms, as the war neared its end, to show “undivided support to the government,” only to see Democrats lose control of the House and Senate. Wilson refused to include any senators in his delegation to Paris, even though he eventually would need Senate support to ratify his treaty and include America in a League of Nations. Wilson’s overall “manner” had become “increasingly secretive, suspicious, and defensive.”
Then, in early April 1919, Wilson came down with a 103-degree fever. Some medical historians argue Wilson contracted influenza; others a gastrointestinal infection. Either way, the illness appears to have accelerated Wilson’s neurological condition.
Herbert Hoover, Wilson’s point man on European reconstruction, wrote in his memoirs: “When [Wilson] returned [from his illness] he was drawn, exhausted, and haggard. He sometimes groped for ideas. His mind constantly strove for previous decisions and precedents in even minor matters. He clung to them. Prior to that time in all matters with which I had to deal, he was incisive, quick to grasp essentials, unhesitating in conclusions, and most willing to take advice. After the time I mention…we had to push against an unwilling mind.”
Park explained the fever appears to have caused temporary delirium, which is not the same as dementia. But “transient delirium may augment an underlying chronic brain disorder by inducing increased demands on cerebral metabolic rate… this may lead to stable cognitive and emotional impairment thereafter.”
In another essay for The Papers, James Toole, a neurologist, points to an account from a neuropsychologist who visited Wilson in late April after the fever abated and found “his hand was so shaky he could not shave himself.” Toole concluded, “It is not a question of whether Wilson had a stroke in Paris, but only of what kind of stroke it was.” John Milton Cooper, Jr., in his book Woodrow Wilson: A Biography, noted that when Wilson presented the League of Nations Covenant to the peace conference on April 28, he gave a “drab recital” with an “abrupt delivery” and “some factual slips” that may have been indicative of a minor stroke.
Upon returning to America in July 1919, with a hard-fought treaty establishing a League of Nations, Wilson turned to lobbying the Senate for ratification. But the leader of the Republican-controlled Senate, Henry Cabot Lodge, was determined to kill it. Lodge identified the most significant vulnerability as Article X, which read, “The Members of the League undertake to respect and preserve as against external aggression the territorial integrity and existing political independence of all Members of the League.” This raised sovereignty questions. Would Congress no longer have the power to declare war? Would America be obligated to defend a League member from attack militarily?
Lodge had proposed incorporating “reservations” that would limit America’s commitments. He was not interested in compromise with his bitter enemy Wilson; he told a reporter, “I mean to kill Article X or kill the treaty.” However, other senators were in the “mild reservationist” camp and were trying to find a middle ground. Secretary of State Lansing urged Wilson to deal, but the president refused, worrying about a slippery slope. Cooper concluded, “This was another significant missed opportunity; and the likeliest explanation lay once again in the effects of fatigue and nervous strain.”
Another Wilson biographer, A. Scott Berg, drew a sharper conclusion: “Wilson was, in fact, experiencing a mental decline, which was discernable to others. On several occasions in late July and early August, he responded to queries about the Treaty with incorrect information—instances of recent actions and events that he could not recall. His once photographic memory began to blur.”
Still, Wilson was not wholly without his faculties and rhetorical skills. Historian Patricia O’Toole, in The Moralist: Woodrow Wilson and the World He Made, noted that while his judgment was impaired, he was “not mentally incompetent … his mind was still capable of complex thought. If his memory had holes, it was still prodigious. He remained commanding onstage.”
With the treaty fight at an impasse, Wilson’s Senate allies wanted him on the stump. He obliged with a punishing month-long, 8,000-mile, 29-city train tour, much west of the Mississippi, including six days up and down California.
Close advisers urged him not to go for the sake of his health. Wilson acknowledged the concerns but told his secretary, Joseph Tumulty (serving in a position we would now refer to as Chief of Staff), “I know that I am at the end of my tether [but] I am willing to make whatever personal sacrifice is required.” Dr. Grayson made a last-minute appeal, but Wilson was unmovable: “The League of Nations is now in its crisis, and if it fails, I hate to think what will happen to the world.”
Wilson departed on September 3. According to Cooper, his performances on the tour “varied with his level of fatigue” and “a few ranked among the finest Wilson ever gave.”
However, traveling through the Rockies at high altitudes restricted his oxygen, and he suffered frequent headaches and coughing fits. By the third week, saliva was collecting at the corner of a trembling mouth. Late on September 25, while traveling from Pueblo, Colorado, to Wichita, Kansas, his face twitched. He was short of breath. His left side was numb, and he felt the train walls were closing in on him. Dr. Grayson canceled the tour’s remaining five stops. “I don’t seem to realize it, but I seem to have gone to pieces,” lamented Wilson. The train returned to Washington on September 28. On October 2, despite a few days of improvement, Wilson fell unconscious. His left arm and leg were paralyzed, and the left side of his face drooped.
The stroke was not revealed to the public. On October 3, Dr. Francis Dercum, a neurologist summoned to the White House from Philadelphia, said Wilson was “profoundly exhausted and very weak” and “in need of rest” but “very cheerful and takes an interest in what is going on.”
Resigning the office amid the League of Nations fight was apparently never considered. In her memoir, Edith Wilson, the president’s second wife of only four years, says she suggested resignation but was told by Dr. Dercum that “he has staked his life and made his promise to the world to do all in his power to get the treaty ratified and make the League of Nations complete. If he resigns, the greatest incentive to recovery is gone. And his mind is as clear as crystal [and] he can still do more with even a maimed body than anyone else.” Instead, he told her, “Have everything come to you” and try to “solve [matters] without the guidance of your husband.”
Historians doubt this self-serving account, as it attempts to justify Edith’s clandestine role in managing White House affairs during the president’s convalescence. In Edith and Woodrow, Phyllis Lee Levin notes that Dercum’s clinical papers, which had been hidden for 70 years in Grayson’s private files, indicated Wilson would never fully recover. In turn, “it is hardly likely that he would have advised Edith that her husband could do more for the country with a maimed body than any other man in full health.”
Lansing suggested to Tumulty and Grayson that Vice President Thomas Marshall serve as acting president under the constitutional provision that “Inability to discharge the Powers and Duties” of the presidency is cause for the “the Same [to] devolve on the Vice President.” But Tumulty and Grayson wouldn’t hear of it. Months later, Wilson provoked Lansing’s resignation.
Marshall was nominally acting president while Wilson was in Paris but only as a figurehead. A lightweight in an era when vice presidents were rarely intentionally groomed for succession, Marshall was never in the loop.
He was mainly known for his quips, such as “What this country needs is a good five-cent cigar.” In discussing his lack of interest in pursuing succession, Marshall told a reporter, “No politician ever exposes himself to the hatred of a woman, particularly if she’s the wife of the President of the United States.”
To Levin, Wilson’s failing to abdicate for Marshall was a tragic mistake: “An able, self-deprecating man who presided over the Senate with discretion, and a strong advocate for the League of Nations, Marshall might well have accepted a modified Senate version of the Treaty of Versailles, and the United States would then have participated in the League.”
Wilson would recover somewhat, taking steps in December and writing in his own hand in March. But he was forever weakened. Per Cooper, “his delusions and mood swings grew worse.” He was so delusional that he greenlit a plan from Lansing’s successor to snag a third nomination at the 1920 Democratic National Convention during a stalemate. Party leaders pushed back, and his name was not offered. Wilson “took the news hard.”
The Democratic convention winner, Ohio Governor James Cox, lost in a landslide to Republican Warren G. Harding as the unpopular League of Nations became a central issue in the campaign. An enfeebled Wilson would die in 1924. Amazingly, he outlasted Harding by several months. But Wilsonian progressive domestic and internationalist foreign policy would be sidetracked until the Great Depression catapulted Franklin D. Roosevelt, a former Wilson administration official and Cox’s running mate, into the White House.
Joe Biden’s neurological history is not Woodrow Wilson’s. I am not a doctor, let alone a neurologist. But it’s not untoward to see possible parallels between the two.
As Dr. Sanjay Gupta, the CNN medical correspondent, and neurologist, reported last week: “Biden’s medical team has previously disclosed that he had two separate brain operations for aneurysms, including one that ruptured on the left side of his brain, in 1988, and there is some evidence that this type of hemorrhage may increase the risk of delayed cognitive problems later in life.” In other words, like Wilson, Biden had previous neurological issues.
After Biden’s disastrous debate, he pointed to his recent travels to France, Italy, and California—spanning June 4 to 16 with a three-day break in the middle—and a subsequent “bad cold” as the reasons he was off his game. Wilson’s months-long stay in Paris and month-long speaking tour were more intense sojourns. Wilson’s feverish episode in Paris may have been a more significant illness than Biden’s cold, but we don’t know all the details.
Biden does seem different since he left for France on June 4, right after the trial of his son, Hunter Biden, began. You can watch Biden sit for unscripted interviews with Howard Stern in April and CNN’s Erin Burnett in May, in which he is more focused and coherent than in the debate and the following interview with ABC’s George Stephanopoulos (though his voice is raspy in the CNN interview.) Recent first-hand accounts from a June 10 Juneteenth event at the White House and a June 15 California fundraiser depict a declining president.
Between the travel, the trial, and the sickness, could this have been a particularly physically and emotionally stressful time that exacerbated an underlying neurological condition? I can’t know, but as Dr. Gupta concluded after consulting fellow neurologists, we can see enough troubling signs to warrant Biden undergoing “detailed cognitive and movement disorder testing.” Pointing to his neurological checkup in February, which Biden has been doing, doesn’t address whether something happened since February.
Biden’s July 11 NATO press conference showed the president in better shape than in the CNN debate and other recent appearances. But recall that Wilson had starkly varying qualities of performances throughout 1919, including on his fateful speaking tour that culminated with a devastating stroke. Instances of improvement do not obviate a slow-moving neurological condition. They do not negate the benefit of a medical assessment if for no other reason than the president’s health.
Another parallel between Wilson and Biden was their outsized sense of individual indispensability when the fate of democracy and global stability appeared tenuous. “I think the United States and the world is [sic] at an inflection point when the things that happen in the next several years are gonna determine what the next six, seven decades are gonna be like,” Biden told Stephanopoulos, “And who’s gonna be able to hold NATO together like me?”
Wilson could not fathom Marshall getting the League of Nations over the finish line. Perhaps that’s understandable because they had no working relationship. But Wilson had a diminished capacity to be flexible. Dr. Park wrote, “Chronic elevations of blood pressure arguably accounted in part for much of [Wilson’s] intransigence and character transformation that occurred from 1918 onward.” Marshall would not have had that problem.
Today’s Vice President Kamala Harris is far more enmeshed in the president’s administration than Marshall. She has embarked on at least 17 foreign trips in the past three and a half years, including three Munich Security Conferences and a Ukraine peace conference last month. Donald Trump won’t hold NATO together like Biden, but Harris would.
A damaged Wilson made poor strategic choices that not only doomed his prized initiative but also led to a landslide defeat for his party, a public repudiation of his record, and a long sidelining of his policy agenda.
Biden should not make Wilson’s mistake and presume only he can protect the world. He should resign and allow his vice president to protect our alliances and Constitution. That’s why we have vice presidents.
