FDR Watch: Health and Final Illness
Historians know a lot about the personal lives of twentieth-century presidents—their friends, their drinking habits, their recreations, their relations with wives and children, their extra-curricular female companions—but one area is usually murky, their medical histories. It took forty years for Robert Dallek to pry loose the records on John F. Kennedy’s physical problems, treatment, and medications. At least, however, the documentation was there. It was twenty-five years before Dr. Howard Bruenn felt free to reveal the particulars of Franklin D. Roosevelt’s serious cardiovascular problems, and it seems likely even then that Bruenn softened the truth about FDR’s capabilities in the last months of his life. No comprehensive medical records remain for Roosevelt, inviting speculation and efforts to recover whatever information one can. Dr. Harry A. Goldsmith’s “A Conspiracy of Silence: The Health and Death of Franklin D. Roosevelt” (New York: iUniverse, Inc., 2007) is the latest of several books that deal with the problem.
Dr. Goldsmith, an eminent surgeon and amateur historian, relates his trials and adventures in attempting over a period of years to discover more about Roosevelt’s final years. Goldsmith pursues two issues: (1) Did FDR suffer from cancer in addition to his well-established heart and arterial problems? (2) Was he treated by physicians other than Bruenn, a cardiologist, and Dr. Ross McIntire, Roosevelt’s White House physician?
The issue of cancer has been raised for many years by numerous authors who have noted that photos of FDR in the 1930s and into 1940 consistently show a dark spot over his left eye. It seems to grow a bit over the years, then disappears. Some photos taken afterwards suggest either a surgical incision or a much fainter spot. [The online accessible photo archive at the Franklin D. Roosevelt Library clearly documents this progression.] Was the spot a melanoma that metastasized to other areas and left him with a serious malignancy? The author in addition pulled together numerous stories that Roosevelt in the final years of his life suffered from terminal prostate cancer.
The outside physician who seemed most likely to have been consulted on cancer was Dr. Frank Leahy, founder of Boston’s Leahy Clinic and a renowned surgeon. Leahy had a friendly relationship with Dr. McIntire, was an honorary surgical consultant to the Navy department, and had been appointed to a government commission with the duty of mobilizing medical professionals for the war effort. Leahy died in 1953; Dr. Goldsmith, just beginning his career ten years later, first heard that Leahy had examined FDR in 1944 and had warned that if the president ran for and was elected to a fourth term, he would not survive it. A casual interest in Roosevelt’s health would become over the next quarter-century an avocation pursued around the author’s successful medical career.
“A Conspiracy of Silence” deals with some of the consequences of FDR’s failing health—notably the choice of Harry Truman for vice-president in 1944—but its major focus and interest is the health issue. Dr. Goldsmith’s Holy Grail was documentary evidence of the Roosevelt-Leahy relationship. Much of his book details his pursuit.
He discovers quickly that Roosevelt’s medical chart—his full medical history—is nowhere to be found and presumably has been destroyed. He also encounters among some physicians who might have been helpful a rather extreme interpretation of the ethic of confidentiality. They feel that neither the death of a subject nor his historical importance warrant the disclosure of secrets. He searches for various functionaries reputed to have some knowledge of Roosevelt’s medical relationships—secretaries, office managers, federal agents, a naval aide who acted as FDR’s masseur and valet—many of them vanished into the quicksand of time.
Finally, he establishes contact with Mrs. Linda Strand, Leahy’s former business manager and executor of his estate. Mrs. Strand is supposed to have control over a document written by Leahy after examining Roosevelt. Actually the missive is in a sealed envelope in the hands of the clinic’s law firm. After Mrs. Strand agrees to ask a court to order the envelope returned to her, a long legal battle ensues. The Massachusetts Supreme Court finally decides in her favor.
What Mrs. Strand and Dr. Goldsmith find inside the envelope is a memorandum for the record, primarily written to be released if Leahy’s medical connection with Roosevelt was ever criticized. It is reproduced in full and is an important historical document. It affirms that Leahy examined Roosevelt on July 8, 1944, just before the Democratic convention, apparently did not speak frankly to him about the dire state of his health, but conveyed to Dr. McIntire a conviction that the president could not survive another term. It was McIntire’s duty, he declared, to tell Roosevelt that his days were numbered. The question of cancer is not addressed. But if Roosevelt suffered only from cardiovascular problems that could not in those days be addressed by surgery, why was he being examined by a surgeon?
This book raises some important questions. Was Roosevelt’s decision to run for a fourth term responsible? Did McIntire ever tell him to his face that he could not survive another four years in the White House? Are medical ethics as commonly understood by physicians reconcilable with the public’s need for information about national leaders? Do historians have a claim on the medical details of important persons?
Roosevelt’s death seems most likely a textbook case of clogged arteries, hypertension, and a consequent stroke. His father had died of similar problems forty-four years earlier. But what was that spot above the left eye? Were there contributory health problems?
We will never have Roosevelt’s medical records. No autopsy was performed at the time of his death. It is safe to assume that more books will address his medical condition and none will fully resolve the issues.
Partly as a result of FDR’s experience, presidents and presidential aspirants have found it increasingly necessary to make public their periodic medical examinations and other details about their physical health. Works such as Dr. Goldsmith’s have done a lot to cast some light into this critical area of the lives of the people we elect to lead us.
[This is the first in a series of occasional columns on the issues an FDR biographer faces.]
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Nancy REYES - 1/15/2008
Roosevelt had end term malignant hypertension, a disease few doctors under the age of 65 have ever seen, thanks to modern medicines.
This resulted in renal deterioration, congestive heart failure, and probably many "mini strokes" and maybe even low grade vascular dementia.
So no, he should not have run again in 1944, because the prognosis for him living for five years was dim...and could have resulted in a repeat of Wilson's last year in office, where a demented and incapacitated Wilson remained in office unable to work after a stroke.
Most cancers of the face are squamous cell cancers...and are rarely fatal. Ditto for Basal Cell cancers.
As for Melanoma, this is much rarer skin cancer. It is also a more aggressive tumor, and presumably his deterioration would have been much faster than that detected by photos.
In Medicine the maxim is when you hear hoofbeats, think horses not zebras.
Malignant hypertension fits the deteroriation of Roosevelt much closer than that of melanoma, and was and still is much more common.
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