The president’s statements seemed outlandish. Aides suggested his mood had changed. Secret sources revealed to the press that the illness was worse than had been publicly recognized.

This did not happen last week. It took place in October 1919, when President Woodrow Wilson suffered a debilitating stroke and people around him attempted to conceal the severity of the illness. His wife, Edith, operated as gatekeeper, carefully deciding what details would be publicly released and what would be protected.

While there are enormous differences and 101 years between 1919 and 2020, historical precedents make one thing crystal clear: public presidential illnesses can be a turning point that shape the public’s view of the president. This is especially important during an election year, when a debilitating illness may reflect poorly on the president’s ability to achieve his ends — even if it prompts a substantial upwelling of sympathy, thoughts and prayers.

President Trump’s illness with covid-19, the disease caused by the novel coronavirus, served as a reminder that the health of the nation’s president matters — not only for the individual, but for shaping public opinion and for the efficiency of policymaking. Wilson’s 1919 stroke revealed the significant role health plays in one’s ability to lead and maintain public trust.

Since President Trump’s positive coronavirus test was reported on Oct. 2, the White House has refused to say when he last tested negative for the virus. (The Washington Post)

Other than in 1881, when President James Garfield hung on to life for 2 ½ months after an assassination attempt, Wilson became the most severely ill president to continue to hold the office. He did so for almost a year and a half after his stroke. Like Trump, his illness came amid a deadly viral pandemic.

Indeed, historians believe but cannot prove definitively that Wilson’s negotiations after World War I at the Paris Peace Conference in April 1919 were interrupted by a case of the flu, or symptoms closely approximating it, that required him to stay in bed and cease most work for several days. If what he suffered was the flu, or pneumonia and an infection, as some speculate based on doctor’s notes and contemporary accounts, Wilson’s stroke in the fall of 1919 may well have been precipitated by this illness earlier in the year.

Records make clear the president’s mind was jumbled. He was paranoid in Paris. He often worried about being surrounded by spies. The president’s doctor, Rear Adm. Cary Grayson, seemed clear in private letters that Wilson was “sick with the influenza” in Paris and he lamented that this bout came just as “the whole of civilization seemed to be in the balance.”

Back in the United States, Wilson embarked on an ambitious multistate speaking tour in the fall of 1919 to promote U.S. entry into the League of Nations. On Sept. 25 in Pueblo, Colo., he made the final extended speech of his career. There he invoked the horrors of the Great War and the sacrifices made for peace. Wilson finished by warning that America would need to militarize if it did not help lead “the world out into the pastures of quietness and peace such as the world has never dreamed before.”

That night, the president reported a “unbearable” headache. His facial muscles twitched. His mouth drooped. The left side of his body began to “drag.” Edith Wilson called it “the longest and most heartbreaking [night] of her life.” The speaking tour was canceled. Wilson and entourage rushed back to Washington.

On top of the stroke, back at the White House, Wilson had an unrelated prolonged prostate gland infection with a high fever, putting his life in jeopardy. This ordeal further weakened an already exhausted, ill president. These events were the culmination of decades of cardiovascular issues that the public knew little about.

As his condition stabilized in late October after three weeks of recovery, Wilson was deluded enough to think he had the vigor to continue in office. The president held occasional Cabinet meetings in which his attention and stamina were clearly in short supply. For quite some time, Wilson never met with anyone outside his inside circle. His daily routine eventually involved light work in the morning, being wheeled into the garden, movies, lunch and a car ride. All of which Grayson, his friend as well as his physician, saw as progress. Wilson was not engaged with most domestic policy issues and largely still had strong views only about the League of Nations.

Some reports suggest Wilson seized far more on petty topics than he ever had previously. He brought in a new, less qualified secretary of state. He became obsessed with the cutting down of trees in Rock Creek Park. And he took stronger stands on some issues than one might expect — such as dictating a note to strongly support a U.S. mandate over the Armenians, against the genocidal efforts of the Turkish, a measure which subsequently was voted down by Republicans in Congress.

The few observers with whom he met or who had a firm sense of his actions ranged in assessments from being surprised by his “bright and cheerful” demeanor to calling him “unreasonable” on some points and “unresponsive” on others. Historians disagree about how to interpret these commitments and oscillations; however, there is one undeniable fact: Cumulatively, Wilson’s powerful intellect and capacities were never the same after the April illness and the October stroke. For the remainder of his term, the United States was, at best, operating with a part-time president whose faculties waxed and waned erratically, with Cabinet officials acting largely on their own.

Wilson’s enablers created a sham presidency for almost a year and a half. Information was channeled through Edith Wilson and Grayson while Wilson ever-so-gradually regained only the most modest capacity to govern. Vice President Thomas Marshall spurned several attempts by members of Congress to discuss taking over for Wilson. Marshall had no intention of replacing the “great man” if he could do the job and was reported to have said he would take action only if Edith and Grayson agreed and Congress passed legislation that said the presidency was vacant. The Cabinet was stymied by misinformation, bolstered by upbeat reports from Grayson and kept in general order by occasional meetings with the president at which he evidenced solid (but rare) energy and capacities.

The president’s illness and his keepers’ decision to suppress the truth about his condition had an impact on the course of history. For Wilson, both the Paris peace negotiations and the barnstorming tour across the nation to promote U.S. entry into the League of Nations pivoted on his heroic personal efforts at persuasion, as if only he could help to “make the world safe for democracy.”

The stroke may well have prevented Wilson from achieving his goal. It coincided with the hardening of his stance on the Senate ratification of the League of Nations treaty without reservations. Simultaneously, however, it sapped Wilson of his capacity to campaign, argue or make his case for the treaty, reducing his leverage in negotiations with senators. Had Wilson been able to campaign, or been more open to compromise, Republicans and Democrats might well have found a path to ratify the treaty and formally enter the League.

Instead, a coterie of enablers, virtually all of whom were unelected, made possible a quasi-regency presidency. One, at least partial, consequence was that Wilson’s dream of the League and a hard-won treaty were rejected by the Senate. The United States never joined the League. It is impossible to know what might have happened if it had.

Presidential illness and disability have historically functioned as a turning point from which presidents never fully recover even if their bodies and minds do. They cast in sharp relief collective assumptions about ability and disability as well as about a masculinist heroic narrative that is draped around the office of the president.