Trump Is Not the First President to Become Ill in Office

By David E. Hubler
Contributor, In Homeland Security

President Trump’s bout with COVID-19 and his hospitalization have sent many Americans back to their history books to learn what happens when the Chief Executive is too ill or indisposed to carry out his official duties.

The Constitution originally allowed for the Vice President to become acting president if the President died, resigned or became debilitated. But it didn’t state who had the power to declare the President unfit to serve or prevent the President from returning to office.

In effect, the office of Vice President was viewed as a placeholder whose official duties were undefined. It was James Nance Garner who encapsulated the powers of the office when he reluctantly accepted the VP nomination as Franklin Roosevelt’s running mate in 1932. He famously described the office he would soon assume as “not worth a bucket of warm spit.”

Ratification of the 25th Amendment to the Constitution in 1967, however, changed the contents of the bucket. It set down the legal authority and manner in which the President officially turns over the functioning of the presidency to the Vice President during an illness or other debilitating circumstances. Since 1967, the 25th Amendment has been called into play six times.

It is not generally well known but the first president to fall seriously ill while in office was also the nation’s first president, George Washington. Washington underwent surgery – without any anesthesia ­– for removal of a tumor on his buttocks two months into his first term, which required him to rest on his right side for six weeks.

Washington’s Death ‘Would Have Brought on Another Crisis in Our Affairs’

Eighteenth-century surgery was fraught with the danger of infection or death. As James Madison, often called the author of the Constitution, is “reported to have later said about the incident, ‘his death at this precise moment would have brought on another crisis in our affairs.’”

In his second year of office, Washington survived a bout of influenza that threatened his hearing and his sight, prompting him to write: “I have already had within less than a year, two severe attacks — the last worst [sic] than the first — a third more than probable will put me to sleep with my fathers; at what distance this may be I know not.”

Washington’s Vice President, John Adams, became the nation’s second president.

According to the official White House history, “Adams’ two terms as Vice President were frustrating experiences for a man of his vigor, intellect, and vanity. He complained to his wife Abigail, ‘My country has in its wisdom contrived for me the most insignificant office that ever the invention of man contrived or his imagination conceived.’” Adams had just one term as President before being succeeded by Thomas Jefferson.

William Henry Harrison became the shortest-serving president when he died just 34 days after taking office from pneumonia, which he contracted on a cold March Inauguration Day. Many believe that history’s lengthiest inaugural address of nearly two hours led directly to his death exactly one month later on April 4, 1841.

Harrison was the first president to die while in office, meaning Vice President John Tyler’s rise to power was unprecedented. As a result, he was dubbed “His Accidency” by his detractors.

John Tyler Moved into the White House and Had Himself Sworn in as President

Tyler moved into the White House and had himself sworn in as president, even giving an inaugural address. While Congress initially gave Tyler the title “Vice President Acting President,” he sought a more permanent job title.

After the election of Abraham Lincoln in 1860, Tyler led a failing compromise movement when the first southern states seceded in 1861. He then helped create the Southern Confederacy, but died a year later while a member of the Confederate House of Representatives.

Grover Cleveland Had Oral Surgery on a Friend’s Yacht to Avoid the Press

In 1893, Grover Cleveland needed surgery to remove a cancerous tumor in his mouth. To avoid the attention of the press, he had the surgery performed on his friend’s yacht in Long Island Sound. He had a quarter of his upper palate entirely removed, was fitted with an implant and went back to work. The public was none the wiser; his vice president, Thomas A. Hendricks, may have been among them.

Hendricks served as Cleveland’s vice president for the last eight months of his life. When Hendricks died on November 25, 1885, the vice presidency remained vacant until Levi P. Morton assumed office in 1889 as Benjamin Harrison’s running mate. Interestingly, the Harrison-Morton ticket lost the popular vote to incumbent Cleveland and Allen G. Thurman but, like the 2016 Trump-Pence presidential ticket, won the Electoral College and took office on March 4, 1889.

The Spanish Flu left President Woodrow Wilson Depleted Physically and Mentally

Woodrow Wilson nearly died of the 1918 flu pandemic, which killed 20 million people worldwide. During Wilson’s sensitive negotiations with world leaders at the Paris Peace Talks, his doctor lied, telling the press that Wilson had caught a cold from the rain in Paris. The flu left Wilson depleted physically and mentally, and his aides feared that the president’s ability to negotiate had been compromised.

Some historians, including Michael Beschloss, blame Wilson’s poor response to the so-called Spanish flu as a factor that abetted its spread. “[B]eyond a lack of empathy,” Beschloss noted, Wilson’s failure to lead “did not allow Americans to protect themselves in a way that he would have if he were to have said: ‘Here is the magnitude of the problem. This is what you can do to make sure your family is safe.’”

It wouldn’t be the last time a doctor lied about Wilson’s condition. In 1919, he suffered a series of strokes that prompted his cabinet to suggest that Vice President Thomas Marshall take over. First Lady Edith Wilson and the president’s doctor, Cary Grayson, refused.

Marshall was the first vice president in almost a century to serve two terms in office. His lasting fame stemmed from his oft-quoted remark, “What this country needs is a really good five-cent cigar.”

When FDR Died at the Start of His Fourth Term, VP Harry Truman Succeeded Him

America’s longest-serving president, Franklin Delano Roosevelt, died in office on April 12, 1945, at the start of his fourth term and as World War II was winding down. He was succeeded by his third vice president, former Senator Harry S. Truman.

A virtual unknown prior to assuming the presidency, Truman hastened Japan’s surrender to end the war by authorizing the use of atomic bomb attacks on Hiroshima and Nagasaki that killed an estimated 225,000 people. Truman had no knowledge of the bomb nor of the Manhattan Project before he entered the White House.

Truman served out Roosevelt’s term without a vice president. When he ran successfully for a term of his own in 1949, Truman chose Alben W. Barkley as his running mate. Barkley was especially fond of telling the story of a mother who had two sons. One went to sea, the other became vice president and neither was heard from again.

During Dwight D. Eisenhower’s eight years in office, he suffered a heart attack, was diagnosed with and underwent surgery for Crohn’s disease, and had a stroke. Concerned he wouldn’t recover from the stroke, Eisenhower wrote a confidential letter to his vice president, Richard M. Nixon, telling him what to do in the event he didn’t regain his faculties. Nixon took over the duties of president only momentarily, once in 1955 after the president’s heart attack and again during his 1956 surgery.

When President Reagan Was Shot, Chaos Ensued with No Real Protocol in Place

When President Ronald Reagan was severely wounded in an assassination attempt on March 30, 1981, “chaos ensued behind the scenes at the White House. With no real protocol in place yet for such a situation, everyone involved had to improvise and hope that everything would turn out right. In an attempt to keep everyone calm, Al Haig, Reagan’s Secretary of State, committed a PR faux pas — and showed a glaring lapse in basic knowledge of the Constitution.” Haig falsely told the anxious press corps, “I’m in control here.”

The 25th Amendment was formally invoked for the first time on July 13, 1985, when Reagan underwent surgery for colon cancer. Vice President George H.W. Bush became acting president when Reagan was administered general anesthesia. After just under eight hours, Reagan notified the Senate that he was ready to resume his presidential duties.

During his two-term presidency, George W. Bush used the 25th Amendment twice. On June 29, 2002, he invoked the 25th Amendment prior to going under anesthesia for a colonoscopy. That briefly made Vice President Dick Cheney the acting president. Bush did the same again when he had a second colonoscopy in 2007.

Most recently, President Trump spent a few days at Walter Reed Military Medical Center for treatment of COVID-19, the disease caused by the novel coronavirus. Vice President Mike Pence substituted for Trump at some Republican events but the 25th Amendment was not invoked.