Edith Wison, First Lady and [Acting President, October 1919 ~March 1921] ~High Blood Pressure and Stroke Incapacitates President Woodrow Wilson
This post is the third of a series building to my first-person history of medicine and surgery in The Twentieth Century. These early, historical, posts are necessary to set a platform for comparison to the dramatic revolution occurring in the last three percent of recorded history. The first two posts were:
Woodrow Wilson’s high blood pressure and stroke caused incapacitation from hemiparesis in October 1919, which allowed Edith Bolling Galt Wilson, a woman, to become, effectively the Acting President of The United State for seventeen months. Warren Harding was Inaugurated President March 1921.  
Edith Bolling Galt Wilso, Lived: Oct 15, 1872 – Dec 28, 1961 (age 89)
First Lady: December 18, 1915, March 4, 1921 [Effectivelt Acting President October 1919- March 1921]
“From the onset of her marriage to the President, Edith Wilson’s primary role as First Lady was as his companion, filter and later guardian. Since most of her tenure occurred during either a presidential campaign – when the couple was not living in the White House- a world war and then during the president’s illness, Edith Wilson hosted none of the [entertainment] at dinners and concerts held during the traditional social seasons in the fall and winter-early spring. That he largely conducted his work from a private office in the family quarters permitted Edith Wilson to remain steadfastly at his side; he soon gave her access to his private drawer and would eventually share a secret wartime code with her. ”
“When he worked from the Oval Office, however, she would often sit there listening silently as he conducted meetings with political leaders and foreign representatives. As pressures mounted on the President in the months leading up to U.S. entry in World War I, she began to screen his mail and limit his callers, soon alienating his most trusted advisor Edmund House and his loyal press secretary Joseph Tumulty. She was successful in eventually breaking the long friendship between Wilson and House, in November 1919.”
“After U.S. entry into the war in April 1917, Edith Wilson was made privy to classified information. Publicly, she led fundraising efforts by selling the wool sheared from sheep that grazed on the White House lawn, volunteered at the Red Cross canteen at Union Station where soldiers were departing for ports and eventually the war front, and released a public service statement warning soldiers against the dangers of venereal disease they might encounter in war-torn Europe. Leading by example, she also instituted certain days of the week when meat, wheat and gasoline were not used, to conserve these resources for the war effort. After the Armistice of November 1918 was signed, ending the war, Edith Wilson became the first First Lady to travel to Europe during her incumbency; she accompanied the President on two separate occasions, in 1918 and in 1919, to visit troops and sign the Treaty of Versailles. Her presence among the queens and other women royalty of Europe put the position of First Lady on an equilent standing, thus helping to define the uniquely American role in an international context.”
“One of the most dramatic chapters in presidential history unfolded in October of 1919 when [Presiden] Wilson suffered a debilitating stroke. [Edith] Wilson decided to somehow continue the [Wilson] Administration by conducting a disinformation campaign, misleading Congress and the public into believing that the President was only suffering from temporary exhaustion which required extensive rest. She became the sole conduit between the President and his Cabinet, requiring that they send to her all pressing matters, memos, correspondence, questions and requests.” 
After [Edith, virtually alone] deciding that [President] Wilson should not resign and that VicePresident Thomas Marshall should not assume even temporary responsibility, “she began what she termed her “stewardship.” Most crucially, she decided what she felt was important enough to trouble her husband about as he lay disabled in his sick room. The result was often a confused response for the Cabinet, accompanied by their original papers with often-indecipherable notes in Edith Wilson’s handwriting, which she claimed were verbatim notes she took of the President’s answer to their questions.”]2]
“When the Secretary of State Robert Lansing conducted a series of Cabinet meeting without the President, the first being in October 1919, Edith Wilson considered it an act of disloyalty and pushed for his replacement with the more acquiescent Bainbridge Colby. Wilson requested Lansing’s resignation in February 1920. As her husband began partially to recover, she also guarded access to him from advisors and other political figures. When Republican Senator Albert Fall was sent to investigate the President’s true condition, Edith Wilson helped arrange Wilson in bed to be presentable and sat through the brief meeting, taking verbatim notes.” 
“Edith Wilson refused to have the U.S. accept the credentials of British representative Edward Grey who had been sent by his government to aid in the push for ratification of Wilson’s League of Nations unless Grey dismissed one of his aides who was known to have made demeaning jokes at her expense. As the liaison between Wilson and the Democratic Senator Gilbert Hitchcock (who was fighting in the Senate to make the President’s case for passage of his League of Nations), Edith Wilson refused to press [President] Wilson to accept the reality that without permitting compromise of one plank the original version that it wouldn’t pass at all. Historians have speculated whether, if Edith Wilson advised otherwise, a partial version of Wilson;s League of Nations would have been attained. It was defeated in November 1919.” 
“[The President’s severe stroke] left him paralyzed on his left side, and with only partial vision in the right eye. He was confined to bed for weeks and sequestered from everyone except his wife and physician, Dr. Cary Grayson. For some months he used a wheelchair and later he required use of a cane. His wife and aide Joe Tumulty were said to have helped a journalist, Louis Seibold, present a false account of an interview with the President.He was insulated by his wife, who selected matters for his attention and delegated others to his cabinet. Wilson temporarily resumed a perfunctory attendance at cabinet meetings. By February 1920, the President’s true condition was public. Many expressed qualms about Wilson’s fitness for the presidency at a time when the League fight was reaching a climax, and domestic issues such as strikes, unemployment, inflation and the threat of Communism were ablaze. No one, including his wife, his physician, or personal assistant, was willing to take upon themselves responsibility for the certification, required by the Constitution, of his “inability to discharge the powers and duties of the said office”.
Because of Woodrow Wilson’s hypertension leading a severely paralysing cerebrovascular [presumed hemorhage], Edith Wilson was effectively the Acting President of The United States, for one and a half years until Warren Harding was inaugurated in March of 1921. This complex case became a motivation for passage of the 25th Amendment.
Charles Clanton Rogers, MD, FACR, emeritus professor, GWU February 4, 2016
American Heart Association Reprint on High Blood Pressure and Stroke [cerebro-vascular accident]. 
“The last few years have seen a considerable increase in the amount of information available concerning blood pressure (BP) and stroke associations. This article provides an overview of published reviews of the effects on stroke seen in trials of BP-lowering drugs and compares these with the results available from cohort studies.
Summary of Review— We present a review of major overviews of prospective cohort studies and an updated meta-analysis of >40 randomized controlled trials of BP lowering, which included >188 000 participants and approximately 6800 stroke events. Cohort studies now indicate that in the Asia Pacific region as well as in North America and Western Europe, each 10 mm Hg lower systolic BP is associated with a decrease in risk of approximately one third in subjects aged 60 to 79 years. The association is continuous down to levels of at least 115/75 mm Hg and is consistent across sexes, regions, and stroke subtypes and for fatal and nonfatal events. The proportional association is age dependent but is still a strong and positive association in those aged 80 years. Data from randomized controlled trials, in which mean age at event was approximately 70 years, indicate that a 10 mm Hg reduction in systolic BP is associated with a reduction in risk of stroke of approximately one third. Per mm Hg systolic BP reduction, the benefits for stroke appear similar between agents, by baseline BP levels, and whether or not individuals have a past history of cardiovascular disease. There is, however, evidence of greater benefit with a larger BP reduction.”
“Conclusions— The epidemiologically expected benefits of BP lowering for stroke risk reduction are broadly consistent across a range of different population subgroups. There are greater benefits from larger BP reductions, and initiating and maintaining BP reduction for stroke prevention is a more important issue than choice of initial
Addendum: The Twenty-fifth Amendment to The Constitution of The United States
Section 1. In case of the removal of the President from office or of his death or resignation, the Vice President shall become President.
Section 2. Whenever there is a vacancy in the office of the Vice President, the President shall nominate a Vice President who shall take office upon confirmation by a majority vote of both Houses of Congress.
Section 3. Whenever the President transmits to the President pro tempore of the Senate and the Speaker of the House of Representatives his written declaration that he is unable to discharge the powers and duties of his office, and until he transmits to them a written declaration to the contrary, such powers and duties shall be discharged by the Vice President as Acting President.
Section 4. Whenever the Vice President and a majority of either the principal officers of the executive departments or of such other body as Congress may by law provide, transmit to the President pro tempore of the Senate and the Speaker of the House of Representatives their written declaration that the President is unable to discharge the powers and duties of his office, the Vice President shall immediately assume the powers and duties of the office as Acting President.
Thereafter, when the President transmits to the President pro tempore of the Senate and the Speaker of the House of Representatives his written declaration that no inability exists, he shall resume the powers and duties of his office unless the Vice President and a majority of either the principal officers of the executive department or of such other body as Congress may by law provide, transmit within four days to the President pro tempore of the Senate and the Speaker of the House of Representatives their written declaration that the President is unable to discharge the powers and duties of his office. Thereupon Congress shall decide the issue, assembling within forty-eight hours for that purpose if not in session. If the Congress, within twenty-one days after receipt of the latter written declaration, or, if Congress is not in session, within twenty-one days after Congress is required to assemble, determines by two-thirds vote of both Houses that the President is unable to discharge the powers and duties of his office, the Vice President shall continue to discharge the same as Acting President; otherwise, the President shall resume the powers and duties of his office.
 Edith Wison, Wikipedia
 Twenty-fifth Amendment to The Constitution, Wikipedia