Driven in part by a desire to never be hoodwinked again, America now keeps a much closer eye on the chief executive's corporeal being, with the concern we usually reserve for our own children.
Is he sleeping enough? Getting enough exercise? Is his temperature normal? Please describe, in detail, the president's bowels.
Last week, a strange news conference featuring White House physician Ronny Jackson highlighted this concern. After administering President Trump's annual physical, Jackson went to the press briefing room's podium and delivered something more like a love letter than a medical update.
"I told the president that if he had a healthier diet over the last 20 years, he might live to be 200 years old. He has incredible genes. . . . I mean, if I didn't watch what I ate, I wouldn't have the cardiac and overall health that he has," Jackson said. Trump had enviable "energy" and "stamina," Jackson reported, and all of it was "just the way God made him."
So effusive was the report that when "Saturday Night Live" lampooned it, the dialogue required only moderate modifications to get laughs.
Reporters seemed incredulous. Was it suspect that the notoriously sedentary president's weight was given as 239, precisely one pound short of qualifying for the "obese" category? His height was provided as 6-foot-3, but a FOIA'd New York driver's license placed it at 6-foot-2. Was it normal for a 71-year-old man to have a growth spurt?
There was no reason to believe that Jackson, a man hired into the job by Barack Obama, was offering false information — but then again, privacy laws meant that the amount of information he divulged was entirely Trump's decision.
The relationship between a president and his physician has historically been complicated. And it would hardly be the first time that we didn't know what we thought we knew about the American presidency — which has been, essentially, a 230-year parade of unwell men.
It was 1893, and the president was sick. Grover Cleveland woke up one morning with a lesion in his mouth and W.W. Keen, a celebrity surgeon of the time, decided that the president had cancer.
The country, meanwhile, was in a financial panic. While Cleveland supported the gold standard, his vice president supported the silver. The death of the president would have caused chaos as the business community tried to figure out which standard would rule. So, over the Fourth of July weekend, the president boarded a yacht in New York bound for Cape Cod, where a surgical team — in a procedure that would have been complicated even in a hospital — removed five teeth, parts of his jaw, and the upper left part of his palate, all while afloat.
The public, meanwhile, was told that president had a toothache.
It wasn't until 25 years later, well after Cleveland's death, that Keen published an essay in Saturday Evening Post detailing the procedure and the coverup: "The panic would have become a rout," he claimed, and might have upended the economy.
The economy had already been unaware, a decade prior, that President Chester Arthur suffered from Bright's disease, a kidney ailment that killed him a few years after he left office. The economy was also unaware that George Washington nearly died of influenza, and that a massive boil, excised by Samuel Bard, had been located not on his thigh, as the public heard, but on his butt. (The reason for the fib, Bard explained: "presidential dignity.")
Woodrow Wilson is perhaps the most famous U.S. president to benefit from a euphemistic doctor. When he collapsed due to a serious stroke, his physician, Cary Grayson, released a series of vague, optimistic statements: Wilson was suffering from "exhaustion," but it was "not alarming."
In fact, Grayson had emerged from his initial consult to exclaim, "My God, the president is paralyzed." He and the first lady, Edith, conspired to run the government for more than a year while the president remained largely bedridden.
"There were plenty of rumors," says Andrew Phillips, curator of the Wilson Presidential Museum and Library. "Wilson was dead. Wilson had gone insane and was running around the White House."
Nothing was confirmed. Nothing was ever confirmed. "It has been a big undertaking," Grayson wrote in a letter to his own wife, about hiding yet another Wilson malady. "No one knows anything about it. It is one secret that has been kept quiet."
Kept quiet because? Because of the country. Of course. Again and again, presidents and their physicians have lied about health because they convinced themselves that the lie was patriotic. The lie was noble. Wilson was the only thing keeping Europe from descending into communism, Grayson once implied in a letter to a friend after Wilson contracted the flu. "Some day perhaps I may be able to tell the world what a close call we had."
"Presidential physicians find themselves in a very difficult position," says historian and author H.W. Brands. "They have taken a vow, as physicians, to protect the privacy of their patients, and to ask a physician to break that bond would feel very strange."
Many White House doctors — a title that wasn't created officially until 1928 — were simply personal friends of the president until they acquired the most visible stethoscope in the land.
"If you think of the list of people who have seen a president in his underwear, it's pretty small," says Matthew Algeo, author of a biography of Cleveland. "And they probably don't want it to get any bigger. So they tend to choose people they already know."
Grayson won the role of Wilson's personal physician because he happened to treat the president's sister on Inauguration Day, when she fell and cut her head.
Warren Harding's personal physician was a family friend from Ohio — a homeopath who prescribed pills for their color rather than for their ingredients. He told the president that his chest pains were indigestion. It was heart disease. He said the president, who fell ill on a trip to Alaska, was suffering from food poisoning. It was a heart attack. Harding died two years into his presidency.
Ross McIntire had been the White House physician beginning with FDR's first inauguration. By 1944, it was clear the president was suffering from congestive heart failure. He looked haggard; members of his own party hinted that he shouldn't seek reelection. McIntire assured them that the president was in fine health. Roosevelt was reelected. Then he died three months into his fourth term.
'There's a huge gulf between how we look at medicine now and in, say, the 1950s," says William Hitchcock, a University of Virginia history professor and author of a forthcoming Eisenhower biography. "Then, when a doctor, a figure of authority, said the president's going to be all right, it was the end of discussion."
There was no Sanjay Gupta in the press briefing room, using his own medical knowledge to fact-check the White House physician's report. There was no phalanx of talking-head surgeons on CNN. The public would have assumed the president's health was ultimately a private matter, like extramarital affairs.
And if the public had known better, it's possible it would have viewed these health issues as merely a matter of course.
The history of the American presidency has been a history of older men, and for centuries, the expectation was that older men have health problems. For the first half of the 20th century, the life expectancy for American males hovered in the 50s and low 60s. The average age of American presidents is 55. Perhaps the country was more forgiving of ill health in the presidency when it was seen as something unavoidable, a byproduct of age, rather than something to be railed against and overcome.
The 25th Amendment — codifying protocols for when a president dies or is unable to serve — wasn't even ratified until 1967.
That was after Dwight D. Eisenhower had suffered a major heart attack, which left him recuperating in Denver for several weeks in 1955. (His press secretary first reported it as indigestion before coming clean). It was also after John F. Kennedy was assassinated, a sharp reminder of presidential mortality. In life, Kennedy presented an image of healthful vigor, but "his ailments were legion," says Barbara Perry of the University of Virginia's Miller Center, which studies the American presidency.
Among them: Addison's disease, crippling back pain, colitis — not to mention a physician nicknamed "Dr. Feelgood" who prescribed the president amphetamines.
Some historians posit that the public never would have demanded a detailed rundown of the president's health were it not for Richard Nixon and Watergate. The scandal was a light switch flipping in the American brain, a realization that the president might not necessarily be an honest man. That the president might be orchestrating break-ins, and the president might also be having major surgery, on a yacht, out to sea, and dismissing it as tooth pain.
Would we have elected these ailing men if their doctors had been honest? Would we have reelected them? And what about those doctors? Who are they really working for?
"Increasingly, we've gone toward the idea that the physician is actually working for the American people," Brands says. "But we're not there yet. I don't know if we'll ever get there, and I don't know if we should."
Presidents are not required to release their health records, just like they're not required to release their taxes. In the modern era, many have done so anyway, resulting in the 1992 revelation that Bill Clinton suffered from allergies, a mild hearing loss, and a left knee ligament strain.
When, 24 years later, Hillary Clinton was caught on camera stumbling, a doctor released a statement saying the cause had been pneumonia. The candidate had been prescribed Levaquin for treatment. She'd also had a recent sinus infection.
Was there more that doctors weren't telling us? Conspiracy theorists assumed there must have been, just like conspiracy theorists last week introduced the term "girther," to describe the belief that Donald Trump weighed more than Jackson said he did.
It seemed like things were getting a little weird. It seemed like things were no weirder than they've ever been.