Sotos JG.   Taft and Pickwick: Sleep Apnea in the White House.   Chest. 2003;124:1133-1142.   Chest website

Below, we present reasons why scholars may want to study Taft. We present open questions, and try to be provocative.

Why study Taft?

• Constitutional reasons:

  Data from Taft's case can be used to examine several holes in the Constitution related to Presidential disability.

  (a) Taft's illness fulfills the "nightmare scenario" of Presidential disability, in which the Chief Executive has a medical condition affecting his ability to think, but the condition is not properly appreciated by the people around him.

  Multiple anecdotes show that Taft's illness is obvious only in retrospect. Retrospective obviousness is completely typical of sleep apnea. Many other illnesses have this characteristic.

  (b) During the framing of the 25th Amendment to the Constitution in the 1960s, "it was generally assumed that presidential inability would be obvious to an observer" . Lyndon Johnson's former press secretary has explained how obvious the inability must be:

  No one is going to act to interfere with the presidential exercise of authority unless the president drools in public or announces on television that he is Alexander the Great. ... Where presidents are concerned, the tolerance level for irrationality extends almost to the point of gibbering idiocy or delusions of identity.

  Is this the proper threshold?

  (c) As Taft began his campaign for President in 1908, his weight was increasing. It is reasonable to conclude that the severity of his sleep apnea was increasing, too. In some sense, therefore, the 300+ lb. man inaugurated on March 4, 1913 may not have been the same man, mentally, the public elected four months earlier. Should this matter? When should a President-elect not become President? More data are needed on Taft's weight and symptoms during this period.

  (d) Most Presidential aides are steadfastly loyal. Major Archibald Butt was no exception. He kept secret a physician's grim prognosis for Taft (as well as the physician's diagnosis of gout). Should there be requirements to disclose information about the President's health?

  (e) The bibliography page has a short list of books related to Presidential health.

• Historical reasons:

  More research is needed to determine the effects of sleep apnea on Taft's conduct of his Presidency. How much of his unhappiness with the Presidency was due to his disease, and how much was due to his aversion to contentious interpersonal politics? How many of his political errors can be ascribed to the tiredness in his brain?

  The split between Taft and Roosevelt gave the election of 1912 to Woodrow Wilson. Had Taft been his genial self during his Presidency, would the rift with Roosevelt have happened? Would have Taft been elected to a second term?

  These questions may be impossible to answer, but they illuminate the importance of subtle factors in the course of history.

• Medical reasons:

  A book review in JAMA [1994;272:569] observed: "Teaching with the 'fascinating case' has a long tradition in medical education and has a popularity that extends beyond medical audiences. ... At their best, such stories serve more than a didactic purpose: they provide a glimpse of the diversity of human experience and the moral and aesthestic dimensions of illness."

  No evidence has yet surfaced that William Osler and William Taft had a doctor-patient relationship. However, the daybooks from Osler's practice are held at McGill University. It should be possible, therefore, to determine whether Taft ever saw Osler formally.

Contents of Scholars' Area

• The Typhoon

• Butt's Descriptions

• "I Need Rest"

• The New York Times on Taft's Weight-Loss

• Physicians in William Howard Taft's Life

• Bibliography