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Nicholas J. Silvestri, MD, FAAN: What You May Be Surprised to Know About the Maladies of US Presidents

Article In Brief

Dr. Silvestri discusses his interest in the medical maladies and case studies of US presidents who have neurologic problems.

A would-be assassin tried to shoot former President Andrew Jackson on the steps of the Capitol, but the president fought off his attacker with his own walking stick. President Martin van Buren died of an asthma attack. President Dwight Eisenhower's migraines may have been aggravated by his smoking habit: four packs of unfiltered Camels per day. When President Grover Cleveland developed cancer of the mouth, he kept the news from the public by being taken out on a U.S. Navy ship where his upper palate was replaced by a piece of vulcanized rubber.

All this and more—from juicy tidbits to surprising insights—are covered in the presentation by Nicholas J. Silvestri, MD, FAAN, about the medical maladies of U.S. presidents. Dr. Silvestri, clinical associate professor of neurology and assistant dean for graduate medical education at the University at Buffalo Jacobs School of Medicine and Biomedical Sciences, first gave the talk to his neurology department colleagues in grand rounds in 2015.

Since then, he has presented it nearly two dozen times to medical and non-medical audiences alike. He covers a lot of territory—how President Theodore Roosevelt's multi-page speech and glasses case may have prevented a bullet from entering his heart and how the League of Nations came to be formed—but his main focus is the wide range of neurologic problems presidents have experienced.

Former President James Madison, attacked by spells of temporary paralysis, was diagnosed with epilepsy. At least five presidents—John Adams, Thomas Jefferson, Abraham Lincoln, Dwight Eisenhower and John Kennedy—suffered from migraine headaches. After he left office, Ronald Reagan was diagnosed with Alzheimer's disease. Franklin Roosevelt, diagnosed with polio, may instead have suffered from Guillain-Barré syndrome. Eight presidents died from strokes.

The presentation, “Neurological Ailments of the Presidents,” includes case studies that explore the symptoms, diagnosis (or misdiagnosis, as the case may be), treatment, and outcomes of two presidents—Woodrow Wilson and Franklin Delano Roosevelt—who had debilitating neurologic problems. The presentation is available on YouTube (https://youtu.be/3_EazZfoSPk).

How did you come to learn so much about presidential history?

I can remember quite clearly my grandmother giving me an old used history textbook, probably when I was in pre-kindergarten, and I started getting interested in military history and the history of the presidents of the United States. History or social studies was definitely the subject I did the best in in school and it's an interest that I've kept pretty much my entire life.

I enjoy military history because I'm very interested in strategy and tactics and also in how stressful situations really bring out the best and the worst of people, and I've really been able to learn that through reading both military history and political history.

What prompted your interest in the neurologic problems of U.S. presidents?

I was on a kick of reading presidential biographies several years ago, and I started realizing how many of our presidents suffered from medical illnesses in general. And, because I am a neurologist, I focused in on the neurological illnesses.

As I was reading these books, I started putting thoughts to paper; the talk took several years to develop. It was initially for my own department but it got such a good reception from the faculty that people started asking me to give it other places. One of the most amazing experiences I've had was giving this talk at the National Press Club a few years ago. And I've given it at the Buffalo Historical Society Museum and the Theodore Roosevelt Inaugural Site.

In your talk, you suggest that Woodrow Wilson's cause of death was probably a gastrointestinal bleed rather than late effects of a stroke, as his physician said. And you suggest that Franklin Roosevelt might have been misdiagnosed with polio. Are these new ideas?

It's public knowledge now, but it may not have been public knowledge when these folks were in office. One of the major points that I make is about Woodrow Wilson's stroke during the presidency, how it affected him, and how that was kept out of the public eye. The debate over whether FDR had polio or maybe he had Guillain-Barré syndrome has been discussed in the literature. The point I make in the talk is, regardless of what Roosevelt had, it wasn't treatable when he had it back in the 1920s. And I try to demonstrate how much he overcame, at a time when disability was so stigmatized, to become arguably the most powerful person in the world in his time.

How do you make time for this avocation?

I tie this back to wellness and well-being; in order to really thrive in life, you have to have interests outside of your job. I think you have to make the time for them. I have a young family and I have a lot of other hobbies that I like to take care of, but I'm able to read pretty much on a daily basis at some point.

One of the things I love about being a neurologist is that, no pun intended, we're very cerebral people. Most neurologists have outside interests and, what I've come to learn from speaking with many neurologists over the course of my career, is that history tends to be one of the things that many neurologists are interested in.