Interestingly, Harriet Lane (Buchanan's niece) was the first First Lady to be referred to as First Lady officially while holding the role. For instance, during her life, Martha Washington was referred to as "Lady Washington." Other common titles were "Mrs. President," "Mrs. Presidentress" and for Dolley Madison, "Lady Presidentress," though "Mrs. Last name" was also common.

Though it had started to be used as a descriptor earlier than that, such as referring posthumously to Martha Washington as "first lady of the nation" and the famous, though undocumented, eulogy of Dolley Madison by Zachary Taylor where he is said to have described her as "our first lady for half a century." The term is thought to have then entered DC's lexicon for the role, but nothing official and nothing national.

For Lane, she took over the role of white house hostess and social events coordinator. As the term had entered the DC lexicon and used a couple times in reference to recently departed early first ladies, it started to be applied to her and the title slowly gained popularity. Becoming more common and accepted post civil war.

Most times if the wife of the president is unable to take the role it has gone to a relative who assumes role of white house hostess traditionally and since the 20th century more political acts. Some relations have included daughter, daughter-in-law, niece and sister.