described in retrospect as a “handsome and genial man, undiscriminating in his
associates, lacking in political ideas or fortitude . . . totally unfitted for the
presidency.” American historians, when polled on who was the worst president in
history, regularly select Harding.
Many feel that some consequences of Wilson’s illness outlived his presidency (he
completed his term of office and lived until 1924, surviving Harding) and were to be
seen in the events of the following decades–in the disastrous German inflation of the
1920s during the reparations exacted by the Allies, in the ensuing reaction to social
disorder which led to the rise of the genocidal Nazis, and in a second world war. All
had multiple causes, but the pre-influenza Wilson anticipated many. Woodrow
Wilson was a great liberal and reformer, the first world leader to fire the masses with
a vision of world peace, and a courageous person who repeatedly conquered the
afflictions of his chronic cerebral vascular disease. At a critical juncture in history, his
brain failed him–but not obviously enough to remove him from office and let others
take up the reins. During the last two years of his term following the Paris illness,
Woodrow Wilson was unfit to lead the United States. He no longer had the same
judgment and personality as the man whom the voters had elected.
Just as a lawyer tries to cover all the unlikely inheritance possibilities when
drawing up a will, so lawmakers must try to provide for an orderly succession when
the holder of a critical office is disabled– which can happen in a number of ways.
Would the Twenty-fifth Amendment, which seems so inadequate to deal with
Wilson’s earlier problems, have covered the final Wilson tragedy?
Even if neurologists could diagnose a serious change in perceptual abilities or in
personality, could they convince the President to voluntarily step aside? What
happens when a strongwilled President’s judgment, like Wilson’s, is clouded by his
illness? Judging from the difficulty that physicians have in persuading ordinary patients
with right-parietal-lobe damage that they are ill, the physicians would probably have
been rebuffed. Could they then convince the Vice President and a majority of the
Cabinet to notify Congress that the President was disabled? The Twenty-fifth
Amendment seems to assume that either a President will be rational enough to
declare disability personally, or that the President will be in coma, unable to interfere
in the Cabinet’s decision. Suppose that, like Wilson, a President were to fire the
questioning Cabinet members first? The Twenty-fifth Amendment would seem not to
cover the most serious and most prolonged Presidential disability yet encountered in
more than two centuries and forty Presidents. It remains to be seen if the
Constitution’s disability provisions function any better than those of the Divine Right
of Kings (which allowed George III–the bete noire of the American colonists–to
rule England for many decades while insane on and off, even confined to a
straightjacket at times).
Neurology was established as a medical specialty in the nineteenth century by a
series of great physician-investigators, but the recognition of subtle intellectual deficits
in stroke patients was only beginning in Wilson’s time. Because such “higher
functions” cannot be studied easily in experimental animals, progress has been slow in
comparison to other areas of brain research. In 1920 a remarkable era began, during
which the individual nerve cells have been explored, the reflexes extensively studied,
great inroads made into understanding the functions of sensory and motor systems,
and many specialized cortical areas identified. We now know more about
developmental dyslexia, from which Wilson initially suffered, and about recovery of
function after strokes, which permitted Wilson to recover from his many earlier
strokes so successfully. We now have diagnostic techniques such as computerized
tomographic (CT) scans and magnetic resonance imaging (MRI) which would have
detected much of Wilson’s brain damage. We have therapeutic techniques such as
vascular surgery which, if performed at age 39 after Wilson’s first stroke, might have
cleaned out the arterial lining problems in the carotids which probably formed the
clots.
Yet we still lack a body of reliable physiological and anatomical facts with which
to understand personality change and denial of illness. One must rely more on the art
of the experienced physician in such cases, not on the hard facts of science dispensed
by machines. But it is not clear whether even the most expert of modern physicians
would be able to protect the world from the consequences of a similar brain
malfunction in a modern president.