A Death in the White House

John A. Kolmer, MDJohn A. Kolmer, MD (1886-1962), was a Philadelphia physician whose interests included infectious diseases and public health. He developed a test for syphilis – the Kolmer test – and he was involved in early tests of Salvarsan, the first effective treatment for the disease. He is also known for his disastrous 1934 trial of a live polio vaccine that caused deaths and paralysis in some recipients. After the vaccine trial, Kolmer abandoned polio studies and focused on teaching public health and preventive medicine at Temple Medical School.

In his book about the 1955 Cutter Incident, Paul A. Offit, MD, mentions that Kolmer had been called in to treat President Calvin Coolidge’s son Cal, when the boy became ill in 1926.

Kolmer was a Fellow here at the College. Last week I was going through Kolmer’s files in our Historical Medical Library for materials related to his polio vaccine. I had forgotten that he was involved in the Coolidge case until I found a short typescript memoir of the incident in our collection of Kolmer’s biographical materials. I’ve typed up the short piece below.

In an era when we are concerned with mounting drug resistance in bacteria, we can only hope that young Coolidge’s fate is not repeated with increasing frequency.

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Dr. John A. Kolmer and Calvin Coolidge, Jr.

(Written by Dr. Kolmer on April 10, 1942.)

During the summer of 1926 (I believe early in July) Calvin Coolidge, the younger son of the President and Mrs. Coolidge, sustained a minor superficial abrasion on the top of a toe of the right foot resulting from playing tennis on the White House Courts one Sunday afternoon. The following day he complained of feeling ill but the White House physician could find no cause since young Coolidge made no complaint referable to the injured toe.

On Tuesday he had some fever and complained of pain in the lower right quadrant of the abdomen. Dr. John B. Deaver was called in consultation because of a suspicion of appendicitis. Upon examination he was able to exclude this diagnosis and found slight enlargement and tenderness of the right inguinal lymphatic glands. Suspecting a local infection, the abrasion of the toe was found upon examination.

On that same day a blood culture was made and subsequently reported by the laboratory of the Walter Reed Hospital as being positive for Staphylococcus albus*, showing as many as about 300 colonies per cc. of blood. A sharp leukocytosis was also discovered.

With these developments, I was called in consultation on Thursday. Upon examination the boy was already in a stuporous state with all of the cardinal signs and symptoms of a septicemia. The abrasion of the toe, however, showed remarkably little evidences of local infection but it was concluded that this was the primary focus of infection and especially since deep tenderness was elicited over the right tibia, suggesting a possible osteomyelitis.

Blood transfusions were given at once. At that time the medical profession was interested in the possible therapeutic efficacy of mercurochrome-soluble and dentian [sic] violet by intravenous injection. Both of these were administered in maximum dosage.

In the meantime the patient was transferred to the Walter Reed Hospital where Dr. Deaver explored the right tibia but without finding clinical evidences of infection although a culture of the marrow showed the presence of Staphylococcus albus.*

The patient continued to progress from bad to worse in spite of repeated transfusion and the administration of anti-staphylococcus serum, mercurochrome-soluble and gentian violet. On Saturday he passed into coma which continued until death on Monday at 10:20 P.M. – just one week after initial symptoms developed.

About two hours before death it was decided to administer oxygen. The wrong valves were opened with the result that a glass container exploded. A fragment of glass struck the President at the bedside on the forehead but fortunately with slight injury. A very large fragment just missed my hand.

During the last two hours of life the patient was attended by me, alone, in the presence of President and Mrs. Coolidge and a nurse. From time to time I examined the heart and was astounded by the President requesting that he be permitted to listen to the heart sounds. At about 10 P.M. I announced that the boy was rapidly dying. The President sprang from his chair and took his dying boy in his arms, shouting hysterically into his ears that he would soon join him in the Great Beyond and requesting that young Calvin so inform his Grandmother (the mother of the President). A medallion of the Grandmother was also placed in the hands of the dying boy. Mrs. Coolidge joined with the President in this hour of terrible grief. The boy died at 10:20 P.M. (to the best of my recollection).

It is commonly stated that President Coolidge was “cold as ice” but I had the opportunity of seeing him in this hour of grief and know quite otherwise. Indeed, it was the most touching and heart-rending experience of my whole professional career.

Upon death, the nurse and I withdrew from the room and left the President and Mrs. Coolidge with the body of their beloved son. About fifteen minutes later, in a collected manner, the President opened the door and received his secretary. He and Mrs. Coolidge thanked all of the physicians for their services to their boy. He urged me to come with them to the White House for the night but in view of the terrible experience and profound fatigue from loss of rest and sleep during the previous four days, I decided to take a midnight train back to Philadelphia.

Subsequently President and Mrs. Coolidge sent me a photostatic copy of the last letter written by their boy to one of his classmates at school. This letter went on to say that because his father was President of the United States it did not mean that he was above the average and that this would have to be proven by his own character and work. The President and Mrs. Coolidge, who graciously autographed this letter, valued it most highly in view of the lofty sentiments so nobly expressed by their boy.

*Now known as Staphylococcus epidermidis. Our advisor, Thomas Fekete, MD, FCCP, wonders if this might have been misidentified. He notes that Staphylococcus epidermidis is an unlikely culprit for systemic infection in a healthy person.