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President Dwight D. Eisenhower wheels onto the sun deck of the Fitzsimmons Army Hospital for the first photos after his heart attack in September 1955. It was the first of many serious medical incidents during his two-term presidency.

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How past U.S. presidents have battled illness in office

A hidden stroke. A heart attack that was presented as indigestion. The American presidency’s history of incapacity and sickness.

The announcement by President Trump that he has tested positive for COVID-19 makes him the latest in a long line of presidents who have battled serious illness in office. According to the New York Times, Trump has a fever, congestion, and a cough, and will undergo tests at Walter Reed National Military Medical Center, where he will stay for a few days.

Four presidents died from natural causes while in office—and, for some, the cause of death remains in dispute. (Another four were assassinated.) Presidents have suffered strokes, heart attacks, and severe gastrointestinal diseases. Woodrow Wilson was stricken with the Spanish flu, the last great pandemic, before suffering a stroke six months later.

For much of history, though, it has been unclear what exactly should happen when a president falls seriously ill. The Constitution was vague on the details, only providing that the president’s duties would “devolve” on the vice president. The country didn’t clear things up until the mid-20th century, following Dwight D. Eisenhower’s lengthy health battles in the 1950s and the assassination of John F. Kennedy in 1963. In 1967, the states ratified the 25th Amendment, which asserts that the vice president becomes the president when a president dies—and becomes acting president if the president is “unable to discharge the powers and duties of his office.”

Whether they were unwilling to relinquish their power or didn’t want to be perceived as vulnerable, several presidents covered up their illnesses. Wilson even relied on his wife, Edith, to take on some presidential duties after his stroke. Here’s a look at some of the presidents who have battled serious illnesses while in office.

1841: William Henry Harrison dies from pneumonia—or typhoid fever

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Though historians long believed President William Henry Harrison died of pneumonia, some modern researchers believe his cause of death may have been typhoid fever—caused by contamination in the White House water supply.

William Henry Harrison was only 32 days into his term as the ninth president of the United States when he became the first president to die in office. Historians have long believed that Harrison fell sick after delivering a nearly two-hour-long inaugural address without wearing a coat or hat on the bitterly cold morning of March 4, 1841. His health rapidly deteriorated in the weeks that followed and he died of pneumonia on April 4.

In 2014, however, that account was called into question by a study of Harrison’s medical records that was published in the journal Clinical Infectious Diseases. Although Harrison’s physician Thomas Miller did declare pneumonia to be the cause of death, researchers Jane McHugh and Philip A. Mackowiak argue that typhoid fever was a more likely culprit as it would have been consistent with Harrison’s symptoms, which included abdominal pain, diarrhea, constipation, chills, muscle pain, and respiratory symptoms.

1850: Zachary Taylor dies from cholera

Zachary Taylor died just 16 months after being sworn in as the 12th president of the United States. On July 4, 1950, Taylor had attended Fourth of July festivities on a scorching day in Washington, D.C., then returned to the White House where he ate cherries and drank iced milk and water. That night, he fell ill with stomach cramps that were diagnosed as cholera. He died days later on July 9, and Millard Fillmore was sworn in as the 13th president the following day.

But Taylor’s death, too, has been disputed in modern times. In the 1990s, more than 140 years after his death, a conspiracy theory emerged that Taylor had been assassinated because of his opposition to expanding slavery westward. On June 17, 1991, Taylor’s body was exhumed for a medical examination to test that theory. It was in vain, however: Kentucky Medical Examiner George Nichols concluded that Taylor likely died “of one of a myriad of natural diseases which would have produced the symptoms of gastroenteritis.” (Learn about more surreal cases of bodies exhumed for science.)

1919: Woodrow Wilson suffers from the Spanish flu and a stroke

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In 1919, then-President Woodrow Wilson was stricken by the Spanish flu followed by a stroke six months later. Wilson was incapacitated for the rest of his term in office—but was able to cover up the extent of his illness with the help of his wife, Edith, who took on many of his routine duties.

Woodrow Wilson was in Paris to negotiate the treaty that would end World War I when he came down sick with the Spanish flu on the evening of April 3, 1919. Wilson had clashed with French Prime Minister Georges Clemenceau over the terms of the treaty: Clemenceau wanted Germany to pay for its role as aggressor in the war, while Wilson sought to create a more peaceful world order and de-escalate tensions. But, as the New Yorker writes, the exhausted president gave up most of his demands after contracting the flu—resulting in an infamously harsh treaty that ultimately led to the rise of Adolf Hitler and World War II. (Discover the swift, deadly history of the Spanish flu pandemic.)

Six months later, while traveling across the U.S. to shore up support for the treaty, Wilson fell ill once again. On the morning of October 2, 1919, he woke up partially paralyzed and was later diagnosed with a stroke. Seeking to protect her husband, Edith Wilson stepped in to hide the extent of his illness. Although the White House Historical Association notes that she didn’t initiate any programs or make major decisions, Edith controlled access to him and took over many of the routine duties of the presidency until his term ended in March 1921.

1923: Warren G. Harding dies of heart attack

It seemed like the world was crumbling in on Harding in 1923. Scandals involving the popular president’s administration were heating up when he unexpectedly died in a San Francisco hotel room. His wife, Florence, rejected an autopsy and had the body embalmed an hour after his death.

Doctors told the public he had suffered a stroke. Nearly a century later, after examining the papers from Harding and associates, most historians have concluded he died from a heart attack brought on by cardiac problems.

Harding, who had an enlarged heart, had been on a grueling West Coast tour ahead of a probable re-election effort. After possible food poisoning, his train was diverted to San Francisco. He walked from the train to a limo, which took him to the hotel where he suddenly died on the evening of August 2.

1945: Franklin Delano Roosevelt dies of a stroke

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Throughout Franklin D. Roosevelt's presidency, there were few photographs taken of him in his wheelchair. Roosevelt had suffered from polio for more than a decade before ascending to the presidency in 1933. In 1945, during his fourth term, his health deteriorated and Roosevelt died of a stroke.

From his first days in the White House, America’s longest-serving president had hidden from the public his inability to walk unaided. The acquiescence of journalists and acquaintances to keep private the fact that he needed a wheelchair was exacerbated in FDR’s final year, when the president’s health was markedly deteriorating.

“Physically, he’s just going to pieces,” his running mate, Harry S. Truman, told an aide upon seeing the president. Months later, a stroke killed FDR, and Truman became president.

1955: Dwight D. Eisenhower suffers a heart attack

A digestive upset.” That was the term the White House used to tell the public of Eisenhower’s heart attack in September 1955, the first of several serious medical incidents during his presidency. A cardiologist urged him not to run for re-election in 1956—advice he ignored. Nine months after the heart attack, he underwent emergency surgery for a bowel obstruction that led to a diagnosis of Crohn’s Disease.

His lengthy recuperation spurred consideration of what would become, after John F. Kennedy’s assassination in 1967, the 25th Amendment, which provides for temporary replacement of a president who is incapacitated. Eisenhower had still more medical issues in office. In 1957, he suffered a stroke, but managed to complete his term.

1981: Ronald Reagan survives assassination attempt

The Trump announcement has been called the most serious threat to a serving president’s life since Ronald Reagan survived an assassin’s bullet in 1981. Reagan also made it through three minor skin cancer operations and was dogged by accusations of mental impairment. His son, Ron Reagan, said he saw early signs of Alzheimer’s during his dad’s presidency, but the elder Reagan was not diagnosed with Alzheimer’s until 1994, five years after leaving office.

A 2015 analysis detected subtle changes in Reagan’s speech patterns during his second term, including a reduced vocabulary. But the researchers said their findings did not prove dementia that could have impaired his decision-making or judgment in office.

The most audacious move

Presidents, for various reasons, have not gone public with their medical conditions, according to Matthew Algeo, author of The President Is a Sick Man. But perhaps none were as audacious as President Grover Cleveland.

In 1893, the public was told that Cleveland had gone on a fishing trip. Actually, he was having a cancerous tumor removed on a yacht in Long Island Sound.

The world did not know the truth for 24 years, Algeo told PBS Newshour. “It’s probably one of the most successful coverups in American political history,” he said.