By Henry Ehrlich
Did Rome fall because Romans drank out of pewter cups that contained lead? Was Mozart poisoned by a jealous, second-rate composer? Was Abraham Lincoln bipolar? J. Edgar Hoover—was he or wasn’t he? I enjoy stories that reexamine history through a contemporary lens. That’s why I was drawn to an article recently in JACI In Practice called “The Misunderstood Asthma of Theodore Roosevelt” by Dr. Carlos A. Camargo and Tweed Roosevelt, great grandson of the 26th President of the United States.
I learned in elementary school that Roosevelt was driven to overcome a sickly childhood and become a man of action—Rough Rider, explorer, and hunter, whose philosophy was embodied in the slogan, “Speak softly and carry a big stick.”
Theodore Roosevelt was born in 1858, two years before a paper was published by the British MD Henry Salter that is recognized as the first modern treatise on asthma. Dr. Camargo and Mr. Roosevelt went through the family archives to examine an idea that has preoccupied T.R. scholars for a century, that his asthma was psychosomatic. When I was a kid, we thought that psychosomatic meant “all in your head” like the headaches that used to strike us occasionally on Monday mornings. Now we understand it to mean physical ailments that can be triggered or aggravated by stress and conflict. David McCullough, Roosevelt biographer cited by Camargo and Roosevelt, has noted that young Teddy’s exacerbations fell on weekends, giving him a chance to spend more time with his parents and avoid going to church. I would have to read the book to find out how dismissive he really is of the reality of the disease.
Like ordinary families trying to cope with chronic disease today, the Roosevelts went to great lengths to manage young T.R.’s asthma; his father even took to driving him around in a carriage in the middle of the night when symptoms were worst to get more fresh air into his lungs. (Contemporary parents have been known to strap sleepless children in a car seat and drive them around, too.) Like wealthier families in every age, they had recourse to every remedy money could buy, and the list is fascinating: rhubarb pills, mustard plasters, cigar smoke, and strong black coffee were favorites.
Up until the age of 12, Roosevelt frequently stayed indoors and avoided strenuous activity like many modern asthmatic kids. Unlike modern kids with their screens, he amused himself with hobbies like taxidermy. The exposure to animal pelts and chemicals may have aggravated his problems. After that, upon the urging of his dad, he built himself up in the gym and threw himself into the frontier life that made him so famous as an explorer, naturalist, and hunter, but he continued to suffer from asthma. Having pored over the papers in detail, the article authors find ample evidence that Teddy was really sick, which counters McCullough’s argument. Stress did play a role in triggering exacerbations, as when he traveled a great distance to be at the bedside of his dying wife.
We have been saying on this website and in our book for a long time that asthma is a syndrome, a collection of symptoms, not a single disease. Reading about Roosevelt, he is a walking collection of phenotypes—observed differences of disease characteristics, some of which appear allergic, and some of which look like they were triggered by other irritants. Some may have involved the stress of growing up in a high-powered family. As Larry points out in our book, the field of family therapy grew out of a residential asthma treatment program where children who seemed non-symptomatic would start wheezing on parent visiting day. In an article a decade ago, Dr. Rosalind J. Wright elevated stress to the level of an environmental asthma trigger when she wrote: “Psychological stress should be conceptualized as a social pollutant that can be ‘breathed’ into the body and disrupt several physiological pathways, similar to how air pollutants and other physical toxicants may lead to increased risk for atopy.”
Looking back, we can see in Roosevelt’s response to his childhood illness the seeds of the progressive political agenda that shaped his career, and which still resonate today, These include the idea of universal health care and dramatic expansion of the national park system. As William Faulkner said, “The past isn’t dead. It isn’t even past.”
Thanks to Dr. Camargo and Mr. Roosevelt for giving us the past in a way that instructs the present.