When German Chancellor Angela Merkel was filmed shaking at an official ceremony in early June, her office brushed it off as an episode of dehydration. Then it happened again. And again.

On Thursday, she opted to sit through national anthems during an official visit with Danish Prime Minister Mette Frederiksen. After the event, she told journalists that she is fine but “will have to live with it for a while.”

“I am very well, and you don’t need to worry about me,” she said. “Just like how it has come, one day it will go away, too."

The episodes have left questions swirling in Germany, where for more than a decade she has earned respect among Germans for her stamina. She was credited for regularly negotiating with her counterparts from around the world until deep into the night, often pushing them to the brink of exhaustion. Merkel herself usually appeared to be wide-awake the next morning.

Many Germans were taken aback by the recent shaking episodes because the images they saw were so inherently different from the way the chancellor had presented herself since she was first elected in 2005. The conservative German weekly Focus wrote that the incidents revealed the “weakness of a strong woman,” and they resurfaced the question of who will eventually succeed her. Merkel has said she will not run for chancellor again when her term ends in 2021.

After a weak performance in the 2017 elections, Merkel found herself under mounting pressure to step aside. Among voters, Merkel remains Germany’s most popular politician. But critics have seized upon these recent shaking incidents — and her office’s choice not to expand on her medical details — as a new opportunity to lash out at a leader whom they have previously accused of failing to be forthright about her politics and biography.

It remains unclear how medically serious Merkel’s shaking incidents have been. But globally, her office is far from the first to keep details of a leader’s medical history private, often to avoid rumors they are unfit for office or perceptions they are too weak or vulnerable for their positions.

A number of American leaders and high-profile politicians have chosen to keep their medical conditions out of the public eye. On the campaign trail in 2016, Democratic candidate Hillary Clinton fell ill at an event honoring 9/11 victims and had to depart earlier than planned. An onlooker captured video that appeared to show her legs buckling as Secret Service agents helped her into her van. The campaign said she was dehydrated and later expanded the explanation to clarify she had recently been diagnosed with pneumonia after a long allergy-related cough. Her somewhat mild illness came after months of accusations from her Republican competition that she was suffering from an undisclosed condition.

As The Washington Post reported at the time, her initial instinct to keep her pneumonia diagnosis secret “set in motion perhaps the most damaging cascade of events for her in the general-election campaign — giving fresh ammunition to Republican nominee Donald Trump, who lags in the polls, and spoiling a two-week offensive she had plotted before the first debate.”

She later told CNN she kept the diagnosis private and tried to power through because she “just didn’t think it was going to be that big a deal.”

Other leaders have hidden far more serious medical conditions from the public — often for years at a time.

Decades after President John F. Kennedy was assassinated, medical files revealed that he was taking a wide range of medications previously unknown to the public, including hormones and painkillers. It was common knowledge that Kennedy had back pain, but these files showed he had also been diagnosed with Addison’s disease, a disorder in which one’s adrenal glands do not produce enough hormones, the files revealed.

The disease is often developed after a bout of tuberculosis, so when there was public speculation he was afflicted by the condition while he was alive, his aides carefully released a statement denying he had tuberculosis-induced Addison’s disease. Technically, that did not rule out he had developed Addison’s through different means.

Shortly after former French president François Mitterrand died of prostate cancer in 1996, eight months after he left office, his personal doctor Claude Gubler claimed the French leader had successfully hidden his illness from the public for years.

The revelations sparked outrage in France among those who saw Gubler’s publication of personal medical details as a violation of strict privacy laws. But the claims were especially dramatic because Mitterrand had pledged to publicize honest medical updates every six months, to avoid surprises like when French President Georges Pompidou died in office in 1974, having never revealed he was suffering from late-stage cancer.

Since then, other French leaders have kept their illnesses private. In 2013, President François Hollande acknowledged he underwent prostate surgery in 2011, shortly before he announced his run for the presidency. He did not publicize his medical condition, described as benign prostate swelling, until after he was elected.

More recently, health issues emerged as a campaign issue in Nigeria, where President Muhammadu Buhari was perceived to be in poor health ahead of 2019 elections. Throughout his first term, he spent long stints seeking medical care in Britain, but Nigerian officials never disclosed what type of treatment he needed or why. As of early May 2018, he had spent at least 170 days in London on medical leave since taking office in 2015. The saga inspired conspiracy theorists in Nigeria, who claimed he had a body double in the capital of Abuja. He won reelection anyway.

Noack reported from Berlin.

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