The recent revelation that former President Joe Biden has advanced prostate cancer has raised questions among some about the quality of his medical care during his time in the White House. Historically, presidential physicians have mainly been beneficial, though some have caused harm and a few have been deceitful.
Presidents’ physicians hold responsibilities that extend far beyond those of an ordinary medical practitioner. Over time, the role and type of medical providers caring for commanders in chief have evolved significantly. In the early years, most presidential doctors were private practitioners. “They were compensated on a fee-for-service basis paid by the respective presidents,” Dr. Ludwig Deppisch says in his book “The White House Physician.”
Shortly after George Washington was inaugurated in New York City in April 1789, he developed a painful swelling in his left thigh. With his regular physician back in Virginia, a prominent local doctor, Samuel Bard, was called to attend to him. Bard — who would become the first presidential physician — and his son, also a doctor, diagnosed and successfully treated what was then called a “malignant carbuncle,” now known as a bacterial abscess. They billed Washington 84 pounds for their services.
Just over half a century later, in 1841, another president fell ill shortly after taking the oath of office. When William Henry Harrison developed a cold that progressively worsened, medical help was sought. Dr. Thomas Miller, a prominent Washington physician, was called to the Executive Mansion and enlisted a distinguished colleague, Dr. James Hall, as a consultant.
They became the first physicians to stay overnight at the White House while treating a sitting president. Unfortunately, their efforts were unsuccessful. Harrison became the first president to die in office. Following his death, the doctors helped establish a precedent by publishing a report detailing the medical care they had provided to the nation’s leader.
The death of President Abraham Lincoln marked the end of the fee-for-service era in presidential medical care. After the 16th president was shot, the first medical professional to reach him was a Union Army surgeon. From that point forward, with few exceptions, military physicians assumed responsibility for the health care of U.S. presidents for the next century.
Because surgeons general held the highest rank that military doctors could attain at the time, they often treated presidents directly. Civilian specialists were also consulted for specific medical issues affecting the president. During this period, occasional tensions arose between military and civilian medical personnel — one such conflict even led to unfortunate consequences.
On July 2, 1881, President James Garfield was shot at a Washington train station. Unfortunately, his personal physician, Army Col. Jedediah Baxter, was out of town at the time. In his absence, a controversial civilian doctor, Dr. D.W. Bliss, assumed the role of principal physician. When Baxter returned, Bliss barred him from treating the wounded president.
Bliss and other doctors repeatedly probed Garfield’s abdominal wound with unwashed hands in an attempt to locate the bullet. This practice accelerated the onset of infection and the formation of abscesses, which ultimately contributed to the president’s death. Bliss was later criticized for his unprofessional conduct and for disregarding basic aseptic techniques, which were becoming standard medical practice in the late 19th century. His actions gave grim relevance to the phrase, “ignorance is bliss.”
The 20th century brought major changes to the medical presence within the Executive Mansion, expanding beyond episodic emergency care to include routine, non-emergent medical services. The appointment of Navy officer Dr. Presley Rixey to care for presidents William McKinley and Theodore Roosevelt marked the beginning of this transformation. Rixey established the first medical office in the White House, ensuring that medical care was readily available to the president and his family at all times.
Two decades later, another Navy physician, Dr. Joel Boone, built upon the improvements made by Rixey. With President Herbert Hoover’s approval, Boone significantly enhanced the responsibilities, facilities and stature of the White House medical office. “Acts of Congress in 1928 and 1930 that codified the rank and perquisites of military physicians assigned to the White House provided its first official acknowledgment of the position of presidential doctor,” Deppisch writes.
Today, the White House Medical Unit is a modern, nonpartisan, military-staffed “mini urgent care center,” responsible for the health and well-being of the president, the vice president and their families.
Historically, presidential physicians have sometimes faced the difficult challenge of balancing their Hippocratic duty with the public’s right to know about the health of its leader. In several instances, this has led to deliberate deception.
- In 1882, the surgeon general secretly examined Chester A. Arthur. He diagnosed an untreatable chronic kidney disorder, Bright’s disease. The existence of the condition was not revealed to the public.
- In 1893, Grover Cleveland underwent a secret surgery to remove a tumor from his mouth. The public was never officially informed about the operation until after Cleveland’s death in 1917.
- After Woodrow Wilson suffered a stroke, the true extent of his condition was hidden by his physician. Similarly, Franklin D. Roosevelt’s high blood pressure and John F. Kennedy’s Addison’s disease were not disclosed while they were in office.
The 25th Amendment, adopted in 1967, added a critical responsibility for the president’s physician: assessing medical incapacity that could justify removing a sitting president from office. Dr. Lawrence Mohr called this “the most sensitive area that a White House doctor must deal with.” It was first applied when President George W. Bush temporarily transferred power to Vice President Dick Cheney during a routine colonoscopy.
The revelation of Biden’s advanced prostate cancer highlights longstanding tensions in presidential medical care. From early private practitioners to today’s medical unit within the White House, physicians have balanced patient loyalty with public transparency — sometimes failing. History shows evolving roles, ethical dilemmas and moments of secrecy surrounding presidential health.
Jonathan L. Stolz is a resident of James City County.
