Woodrow Wilson’s Hidden Stroke of 1919: The Impact of Patient-physician Confidentiality on United States
Foreign Policy
By: Richard P. Menger, MD; Christopher J. Storey, MD, PhD; Bharat Guthikonda, MD; Symeon Missios, MD; Anil Nanda, MD,
PhD, MPH; John M. Cooper, PhD
The clinical sequel of ischemic stroke altered the outcome of U.S. foreign policy in the 20
th
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 7
th
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 18
th
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. Advance copies of some of the
materials for this year’s observance will be posted under the “Media” area on the 2016 AANS Annual Scientific Meeting
website.
Founded in 1931 as the Harvey Cushing Society, the American Association of Neurological Surgeons (AANS) is a
scientific and educational association with more than 10,000 members worldwide. The AANS is dedicated to advancing
the specialty of neurological surgery in order to provide the highest quality of neurosurgical care to the public. Fellows of
the AANS are board-certified by the American Board of Neurological Surgery, the Royal College of Physicians and
Surgeons of Canada or the Mexican Council of Neurological Surgery, A.C. Neurosurgery is the medical specialty
concerned with the prevention, diagnosis, treatment and rehabilitation of disorders that affect the spinal column, spinal
cord, brain, nervous system and peripheral nerves.
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