Presidents have long lied about their health. There is only one solution.

In 1893, President Grover Cleveland kept a secret from the public: mouth cancer. In a clandestine operation on a yacht in the East River in New York, surgeons removed the president’s left upper jaw to prevent the cancer from spreading, and replaced it with a prosthesis to hide the surgical excision. Cleveland’s brush with cancer didn’t become known until 1917, when one of his physicians published an article in the popular Saturday Evening Post. Cleveland hid his ailment out of a belief that admitting any sort of presidential incapacity would create a crisis of confidence in the country, undermining the economy and encouraging foreign adversaries to try to take advantage of the United States.

Cleveland’s deception was relatively minor compared to the liberties taken by Woodrow Wilson between 1912 and 1920. Wilson arrived in the White House in 1913 with a history of minor strokes: They had temporarily incapacitated him and blinded him in his left eye. But none of this was part of his public history as president of Princeton University and governor of New Jersey.

In 1913, before Wilson’s inauguration, a prominent Philadelphia neurologist who examined him told Dr. Cary T. Grayson, the new president’s personal physician, that Wilson was unlikely to live out his first term. Unconvinced that his 56-year-old patient was in such immediate peril, and believing that a proper diet, regular exercise and limited stress could preserve Wilson’s health, Grayson kept the neurologist’s assessment to himself.

Wilson defied this prediction, lasting through his first term with no overt evidence of a health crisis. But after winning a second term in 1916 and attending a peace conference in Paris in 1919 at the end of World War I, his health failed him. While at the conference he contracted the 1918 flu, the virus that took so many lives that year.

In September 1919, during a train tour of the country campaigning for Senate ratification of the Versailles Treaty, Wilson exhibited symptoms that foretold a major stroke that then occurred in October. His doctor suggested resigning because he lacked the physical capacity to handle the burdens of the office. Wilson ignored this advice and finished the last roughly 17 months of his term. While the White House hid Wilson’s incapacity from the public, the stroke rendered him unable to manage either the physical or intellectual demands of the political fight for the treaty, effectively ending his presidency.

Wilson’s medical history was a prelude of sorts to Franklin Roosevelt’s successful campaigns for New York governor in 1928 and 1930. In 1923, polio had left him paralyzed from the waist down. Though he could not hide his disability, he encouraged the false belief that he had largely recovered from the paralysis. Speeches at the Democratic conventions in 1924 and 1928 created the false impression of a vigorous man capable of serving in executive positions.

Successful terms as governor, in turn, opened the way to the Democratic presidential nomination in 1932. With the country in an unprecedented economic collapse and the ineffective Herbert Hoover in the White House, Roosevelt’s disability actually boosted his political ambitions. As a political leader who was seen to have largely recovered from a health crisis and been an effective governor of the country’s largest state, Roosevelt situated himself as the ideal political figure to lead the country out of the depression and restore America’s economic health.

Urging the country to become “prophets of a new order,” Roosevelt’s New Deal, with a host of groundbreaking laws that made America a more humane society, made him the most popular president since his cousin Theodore and gave him a landslide reelection victory in 1936. Although his second term fell short of his initial achievements, the onset of World War II, with Nazi Germany in control of Western Europe, gave Roosevelt a fresh surge of appeal and an unprecedented third term. Despite his disability, his years in office and legislative accomplishments made him seem like the right leader to steer the country through the international crisis.

The Japanese attack on Pearl Harbor in December 1941 made questions about his polio and broader fitness to do the job all but disappear.

But by 1944, the 62-year-old president was in declining health and his weight loss and frailty made it impossible to hide. Yet with Americans hoping their leaders could help craft a new more peaceful world order, they turned to Roosevelt’s leadership once again, making an unprecedented fourth term a reality. The president had become a White House fixture that few wanted to remove during such a pressing time.

At the Yalta conference in February and March 1945, Roosevelt’s health problems shocked Winston Churchill and Joseph Stalin. In the United States, there was no discussion of having Roosevelt turn the presidency over to Vice President Harry Truman. (An issue that wouldn’t be addressed until the 25th Amendment to the Constitution in 1967.) Yet, it was not surprising when on April 12, less than four months into his fourth term, a cerebral hemorrhage brought Roosevelt’s life to an end.

It is doubtful that Donald Trump knows much, if anything, about this history. Someone who demonstrated ignorance of the events at Pearl Harbor that brought the United States into World War II seems unlikely to be informed about prior presidential health issues. And even if he were up to speed on health issues surrounding Presidents Cleveland, Wilson and Roosevelt, it is doubtful that he would see them as a precedent for his behavior.

But what these examples, combined with his behavior, suggest is that presidents of all stripes will continue to be less than forthcoming about their health, even when it influences their capacity to govern. Especially, therefore, as Americans grow more comfortable with older presidential candidates — either the 74-year-old Trump and or his opponent, Joe Biden, age 77, will be the oldest president ever inaugurated — only a law requiring some sort of independent assessment of presidents’ health, or full transparency regarding their ailments, will give the public the necessary information to know that their commander in chief is fit to do the job.

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