The Health of the First Ladies: Medical Histories from Martha Washington to Michelle Obama (5 page)

Abigail Adams, wife of John Adams. She was the second first lady (Library of Congress).

The prospect of moving the household back to Massachusetts and back again to New York City and then to Philadelphia proved too daunting, and consequently Abigail remained eighteen months, including the summers of 1789 and 1790, in New York. This episode was one of the few times she spent these months south of New England.
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Dr. Benjamin Rush, physician to Abigail Adams in Philadelphia (courtesy National Library of Medicine).

On the evening of October 10, 1790, “she contracted an illness she called ‘intermitting Fever’ … Abigail ‘was taken with a shaking fit which held me 2 hours and was succeeded by a fever which lasted till near morning.’” Historians believe she had contracted malaria. It would periodically flare up throughout the rest of her life. The usually sturdy Mrs. Adams was diminished by her illness, becoming so weakened that any effort made her ill: “Despite her illness she managed to finish the packing, and in late October they moved to Philadelphia…. Her ill health had made the trip slow and tedious, she could stand to travel only about 20 miles a day, so it took them five days to go from New York to Philadelphia.”
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Her symptoms, the early autumn onset, her summer residence in a “steamy and unsanitary” port city, and her own description of the fever as “intermitting” convince one that the disease was malaria, a conclusion shared by her biographers. A feature of the type of malaria endemic to America is its chronic periodicity, with several annual flare-ups that produce morbidity but rarely mortality.
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After an uninterrupted year and a half in New York and Philadelphia (1790–1791), the Adamses decided never again to spend a summer in the nation’s capital. The restorative effects of a few months at home far outweighed the inconvenience of moving their household twice a year. The Adamses journeyed to their Massachusetts home to spend the 1791 summer and subsequently returned to Philadelphia for the congressional session that commenced in October. “For the remainder of his term as Vice President, the Adamses settled into a comfortable if hectic routine. From late fall when Congress convened until sometime in the spring when it adjourned, they lived in Philadelphia; the moment Congress completed its session they went home.”
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Abigail was miserable during her 1791–1792 stay in Philadelphia. Physical complaints from rheumatism and malaria increased to the point that she worried how she could manage the journey home when Congress adjourned. In a March 20, 1792, letter to her sister, Abigail explained: “It was necessary to quell the inflamitory disease first, & Bark could not be administered for that. I am now reduced low enough to drive away the Rhumatism but the old Enemy yet keeps possession. The Dr. promisses me the Bark in a few days.”
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The physician referred to in the letter was the famous Dr. Benjamin Rush; the bark was the material wherein quinine was administered at the time. Benjamin Rush was well known to both Adamses; he was a friend of John and both were signers of the Declaration of Independence. The doctor had previously treated their youngest son, Thomas, in Philadelphia in 1790. At that time, Abigail “found him a kind friend as well as Physician.” During her miserable 1791–2 interlude in Philadelphia, Rush visited several times to draw blood from her. She also consulted Rush regarding her niece’s tuberculosis. “The (future) first lady’s reliance upon Dr. Rush stemmed in part from her agreement … on the value of bleeding as an almost universal remedy. Emetics, bleeding, and the bark, in Abigail’s catechism of health, the holy trinity of treatment.” Abigail’s faith in Rush was enduring. In 1811 she wrote him in Philadelphia from her home in Massachusetts about the breast tumor that afflicted Nabby, the Adamses’ daughter. From afar, Rush diagnosed cancer. He urged a mastectomy—an exceedingly rare surgery at that time—upon the Adamses’ reluctant Boston doctors. The operation was performed and Nabby lived for three more years.
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John Adams’ political activity was the nexus connecting the most renowned Philadelphia physician of the period to Abigail and the Adams children. The courageous doctoring of Benjamin Rush during Philadelphia’s yellow fever plague of 1793 has already been noted. Rush, with fellow American graduates of the University of Edinburgh Medical School, founded the first medical college in North America. He was a charter member of the faculty of the Medical School of the College of Philadelphia. His long tenure there allowed him to become the most influential teacher of future American physicians during the late eighteenth and early nineteenth centuries. His “heroic” approach to a patient, which encompassed significant blood-letting and both adventuresome emetics and purgatives, may have endeared him to the future first lady but also corrupted medical therapeutics for decades to come.
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In the early 1600s, Jesuit missionaries noted that the bark of the cinchona tree was used by the northern Peru Indians as a cure for “shivering diseases.” Assuming that “Jesuit’s bark” or the “bark,” would be equally effective for treating the shaking chills associated with “marsh fever,” as malaria was commonly called in Rome, the bark was exported to Italy. Later, quinine was identified as the active ingredient of the bark. It was introduced to colonial America by English physicians. Its use would temper the symptoms but not cure the disease.
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During the summer of 1792, “Abigail was sick through most of the summer with malaria, or ‘intermittent fever,’ as she called it…. Abigail was debilitated for several weeks with the disease. When it came time to return to Philadelphia in the fall, she had neither the strength nor enthusiasm for the journey.” She did not leave her Massachusetts home for the capital for five years, even missing her husband’s second vice presidential inaugural in 1793.
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Malaria sickened Abigail Adams periodically through 1798. It occurred annually, sometimes attacking her twice a year. Its symptoms seldom kept her bedridden for more than a few days. There is no record of medical attendance or type of treatment for these chronic attacks during the Massachusetts interval. Perhaps her uncle, Cotton Tufts, provided for her care. He was a Harvard undergraduate, studied medicine as an apprentice to his brother, and later received an honorary degree in medicine from Harvard. Tufts was a well-known physician and was an incorporator and later president of the Massachusetts Medical Society.
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Abigail’s sense of civic responsibility overcame her reluctance to serve as her husband’s first lady in Philadelphia. But the late summer journey home in 1798 was the most unpleasant of her several journeys. She was seriously ill when the Adamses reached their Quincy, Massachusetts, home. She “felt so close to death that she directed her relatives to assemble so she might take care of them properly.” This attack was the most serious she had ever experienced. Her physicians were perplexed by the disease but finally made the diagnosis of “bilious fever.” Her symptoms subsided and she revived to the extent that John Adams, in early November, returned by himself to the nation’s capital city. Abigail’s physicians during this episode are not identified.
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Even more debilitating than malaria was near-crippling rheumatism, probably rheumatoid arthritis. In 1775, “the middle of Abigail’s right hand was so sore that she could not hold her pen for three weeks.” A significant handicap for this inveterate scribe! Her age (30 years) and the location (middle finger joint) are characteristic of rheumatoid arthritis. Her rheumatism prohibited her journeying to Philadelphia that year for the smallpox inoculation urged by her husband. The sea journey to England in August 1784, as John Adams became the first ambassador to Great Britain, aggravated her symptoms and produced headaches.
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Her rheumatism—and it was always called this by Abigail—continued to affect her in Philadelphia. In autumn 1791, the rheumatism combined to lay her low. After six weeks in bed, she was still too feeble to go downstairs without being carried. It was during this episode that Dr. Rush came several times to bleed her.
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This visit would be Mrs. Adams’ last visit to the nation’s capital for five years: “Her body was worn with rheumatic pains and fevers that, at times, left her wrists lame and her eyes so sensitive that she could not read, write, or sew by candlelight, let alone leave her bed.”
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In a March 20, 1792, letter to her sister, she wrote: “Tis now the sixth week since I have been out of the door of this chamber…. I was taken six weeks ago very ill with an Inflammatory Rheumatism and tho it did not totally deprive me of the use of my limbs, it swelld and inflamed them to a high degree, and the distress I sufferd in my head was almost intolerable.”
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The arthritis, like malaria, was a chronic problem. On a return to Philadelphia in 1798 she wrote her sister, referring to it: “I have it floting about, sometimes in my head, Breast, Stomack etc, but if I can keep of fever I can Parry it so not to be confined.” In an aside about her favorite physician, she continued: “Dr. Rush is for calling it gout, but I will not believe a word of all that, for Rheumatism I have had ever since I was a child.” Apparently her physician continued to be Dr. Rush and bleeding remained his primary treatment.
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Arthritis continued to oppress the first lady when she took up residence in the unfinished White House in the District of Columbia in November 1800: “When she arrived, she ‘suffered from feverish chills, rheumatism and depression.’”
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In retirement in Quincy, Massachusetts, she continued to suffer from rheumatism.
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After the British army quit Boston in the spring of 1776, the mingling of colonists, both those exiting the city after being sequestered by the British and those returning to their Boston homes after having been expelled, led to a major smallpox epidemic by June. Abigail determined that smallpox inoculation was required for her, her sisters, and her four children. The process had changed little since John Adams’ inoculation more than a decade before. In preparation the Adams family isolated themselves for several weeks. Seven thousand people received the smallpox virus through inoculation in Boston during this period, many, like the Adams contingent, in smallpox hospitals. Their inoculation doctor, Thomas Bullfinch (a 1756 graduate of the University of Edinburgh), had modified the usual ten-day preparation period of self-induced vomiting and a strict debilitating diet. Instead he prescribed medicines that caused the children to “puke every morning.” “The practice in colonial Boston … was to insert into the patient’s bloodstream a small quantity of the smallpox virus itself. The only way to obtain immunity to the disease was to deliberately contract a minor case of it. About one in every one hundred cases of self-inflicted infection proved fatal. It was widely believed that inoculation patients could improve their odds by preparing themselves with a week of isolation, purgatives, and abstention from meat and dairy products. After a patient had been infected, he or she became a highly contagious carrier of the virus and therefore had to be quarantined for at least three weeks.” Boston was a reservoir of the disease, and since John Adams practiced law in the city he was previously inoculated, in 1764.
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After Dr. Bullfinch inoculated the Adams family, Abigail and two of her children broke out with smallpox pustules, a sign that the infection took and immunity was conferred. However, the inoculation did not take for daughter Nabby and son Charles. Both required a second inoculation that rendered Nabby very sick. Charles required a third inoculation. When he finally broke out with pustules, it was not the mild form usually associated with inoculation but in the “Natural way,” a contagion from a sickened individual. The whole experience lasted more than two months. Fortunately, this inconvenience did not deter Abigail from participating in Boston’s celebration of the Declaration of Independence.
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