In the realm of confidentiality, hardly anything exceeds the patient / physician relationship. The physician's code of ethics is one of the most sacred trusts in our society. Yet, even that almost inviolable trust has its limits. When the doctor's patient is the president of the United States, there can be times when confidentiality and national security collide head-on. Such a situation existed in 1919 when President Woodrow Wilson collapsed with a stroke in Pueblo, Colo., on Sept. 25, 1919. He'd been campaigning for ratification of the controversial 1919 Peace Treaty. During the period of his convalescence presidential physician, Dr. Cary T. Grayson, withheld all details of the president's illness from Congress, cabinet, and the vice-president. Together with the first lady and presidential aide, Joe Tumulty, Grayson made political decisions for the stricken head of state. Wilson's friend, Herbert Hoover, was also in on the secret.

Thomas Woodrow Wilson, known to his Princeton classmates as Tommy, earned a law degree and a Ph.D. in American government before he was 30 years old - so he knew by heart Section II, Article 1 of the Constitution. Among other things, Article I of Section II deals with what happens upon the incapacitation of a president. "In Case of the Removal of the President from Office, or of his Death, Resignation, or Inability to discharge the Powers and Duties of the said Office, the same shall devolve on the Vice President." As a former American government professor at Bryn Mawr, Johns Hopkins and Princeton, Wilson had quoted lengthy sections of the Constitution verbatim. Therefore, it was not a befuddled mind of Wilson, but rather, a desperate effort on the part of Wilson's wife and doctor to preserve the Wilson Peace Initiative - the peace for the "war to end all wars."

Dr. Cary Grayson displayed extraordinary resourcefulness in second-guessing the commander-in-chief's mind, but he was afoul of the Constitution and could have been subject to court-martial if the truth had leaked to the press.

Even 93 years later it is difficult to piece together what the president knowingly approved and what he did not approve in the period between October 1919 and February 1920. By all accounts, the president was incoherent, paralyzed on the left side of his body and unable to recall much at all of what had been going on prior to his series of strokes.

Wilson may have been one of our smartest presidents, but he was never a crafty politician. His was an embattled presidency as he was a Democrat and both Houses of Congress were in the hands of Republicans. The leading Republican was Senator Henry Cabot Lodge, and he and Wilson were barely on speaking terms. At the behest of Colonel Edward M. House, a close advisor to Wilson on international affairs, no Republican senator was invited to attend the 1919 Peace Conference in Paris. No Democrat senators were invited either, and that is very odd, because the Constitution mandates that the Senate ratify or reject all treaty proposals.

Wilson's Peace Initiative was the most radical departure ever from traditional diplomacy. In Wilson's mind he was establishing a Monroe Doctrine type of arrangement for Europe. It was as if the old schoolmaster was the only one to comprehend the "grand fix" that would insure world peace, and that was his 14 Point Peace Plan that brought into being the arbitration body known as the League of Nations. And he was desperate to see his plan through.

Wife Edith Bolling Galt Wilson and Cary Grayson, M.D., carried out the sick man's commands and interpreted his wishes when he was not in touch with reality. Fortunately, neither Edith Wilson nor Dr. Grayson was a sinister character bent upon carrying on his own agenda.

The pair of furtive operatives kept the president secluded and incommunicado with the rest of the government - much to the consternation of Congress. Even more amazing is the fact that the two protectors denied access to Colonel Edward House - the architect of the 14 Point Peace Plan - the man who had maneuvered Woodrow Wilson into complete acceptance of both the League of Nations idea and the Federal Reserve central bank concept. The anti-Wilson faction rejoiced at the decline of House's influence.

What the first lady and the president's physician did over the months of October, November and December of 1919, and January and February of 1920, became a part of the rationale for the 25th Amendment (1967) that says in part that if two-thirds of Congress deems that the president is incapacitated and unfit to serve, then Congress may appoint the vice-president to assume the duties of the chief executive until such time as the president may be able to resume his duties. Why it took Congress 47 years to amend the Constitution on this issue remains a mystery. This Amendment was in place by 1981 for the attempted Reagan assassination and it quickly clarified the confusing statement made by Secretary of State Haig of "I'm in charge." Reagan's physician, Dr. Daniel Ruge did not occupy himself with any other matters than his patient's recovery.

Cary Grayson's career thus far had been a physician's dream. He had grown up on the old family plantation outside Culpepper, Va., just 60 miles from where Woodrow Wilson had been born two decades earlier in Staunton. The Graysons were direct descendants of Founding Father George Mason, one of the leading theorists of the U.S. Constitution. Grayson's father was a country doctor who tended to the needs of the rural folk and even some of the livestock within a 10 mile radius of Culpepper in the latter part of the 19th century. Grayson graduated Phi Beta Kappa from William and Mary and pursued the study of medicine and pharmacy simultaneously at the Medical College of Richmond and then at the University of the South at Sewanee. He was awarded both degrees and after what we would call a residency at Columbia Women's Hospital in Washington, Grayson did a second medical degree at the Medical College of Richmond, thus making him one of the most learned physicians of his time.

Eager to serve his country, Grayson volunteered for active duty in the Navy and served as surgeon aboard the heavy cruiser U.S.S. Maryland. Following that tour he applied for and received the appointment of crew physician for the presidential yacht Mayflower moored on the Potomac. The young doctor had occasion to treat presidents Theodore Roosevelt and Howard Taft for minor illnesses. Being a dapper fellow and cutting a fine image in his naval uniform, the popular doctor was a frequent guest at White House parties, and it was in that capacity that he had the opportunity to do a medical favor for the sister of newly elected Woodrow Wilson in 1913 following a fall the lady had at the White House.

Wilson took an instant liking to Grayson. Both men were Virginians of old stock, and both were Phi Beta Kappa scholars and shared common political ideals. The president bestowed rank on the young Grayson, advancing the 36-year-old lieutenant to the rank of rear admiral - by-passing the usual progression. Grayson had spent time at the Bureau of Naval Medicine and had had a good rapport with his seniors, but "feathers were ruffled" at the abrupt, unprecedented jump in rank.

Again, this promotion reflected poorly on Wilson's political judgment among insiders in both the Navy and the politicians in the Capital.

When the Great War was won and Germany signed the Wilson Armistice, Dr. Grayson was at Wilson's side, and sometimes this annoyed Colonel House, the foreign affairs advisor - and it certainly annoyed Secretary of State Robert Lansing, who was all but shut out of the serious negotiations in Paris. Wilson's refusal to bring Senate Majority Leader Henry Cabot Lodge into the loop of the deliberations has been ranked as one of the greatest political blunders ever committed by a sitting president.

Scholars today still wonder at how a president could have been so learned in matters of government and history and yet, so inept in the art of governing. Wilson's learning and his idealism have made him a byword for the faction that distrusts academicians in politics.

Cary Grayson did a serious surgical procedure on Wilson in early 1920 when he removed several polyps from inside the president's nose. No other attending physician was called in. The press was told that Wilson needed seclusion and quiet. Edith Wilson despised Wilson's vice-president, Thomas R. Marshall, and forbade him access to any part of the White House. Marshall had opposed both our entry into the War and the 14 Point Peace Plan. Twice Marshall made inroads to have Congress install him as acting president, but Henry Cabot Lodge blocked these moves. It was to the Republican Party's advantage to have a stricken president as they organized the Senate's rejection of Wilson's grand Paris Peace scheme.

They wanted no part of entangling alliances.

Grayson placed President Wilson in the back seat of his [Grayson's] personal automobile and sneaked him out of the White House to see an eye surgeon in Philadelphia. For a year and a half this bizarre episode dragged on, and Wilson's second term came to an end. Grayson eventually became the head of the American Red Cross.

Wilson died in 1924, less than three years after leaving office. Dr. Grayson's personal papers have just recently been made available to historians.

(Dr. Thomas B. Horton is a history teacher at Porter-Gaud School. He lives in the Old Village of Mount Pleasant). See more columns online at www.moultrienews.com. Visit his Web site at www.historyslostmoments.com.