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PATIENTS

The untold neurological disease of


Franklin Delano Roosevelt (1882 – 1945)

Steven Lomazow

Summary: Conventional wisdom suggests that Franklin Delano Roosevelt died on 12 April
1945 aged 63 from a massive cerebral haemorrhage attributable to uncontrolled hypertension
and atherosclerosis. Evidence from numerous reliable sources is presented, based largely on a
constellation of previously unrecognized neurological symptoms including seizures,
encephalopathy and hemianopia, supporting a scenario that, while indeed he suffered from
severe cardiovascular disease, Roosevelt died from melanoma with the terminal event
attributable to a metastatic lesion in the brain.

The final event Bruenn’s account of events


In the last two years of his life, Franklin Delano Only recently has the veracity of Bruenn’s assertions
Roosevelt manifested a constellation of neurological been challenged.6 Each of the dozens of major biogra-
symptoms that had a major influence on his ability to phical works published since 1970, beginning with that
function as President which are, in large part, the key of James MacGregor Burns7 who collaborated directly
to diagnosing a previously unappreciated malignant with Bruenn and the family, is based on Bruenn’s
process that was responsible for his death on 12 April account. Why should anyone doubt the first-hand
1945. The evidence is scattered in thousands of first- account of the man who essentially lived with the
hand accounts, letters, newsreels, photographs and President and treated him daily for the last year of
documents. As early as 1923, a macular lesion above his life?
Roosevelt’s left eye1 can be seen that darkened and The principal reason is the diary of ‘Daisy’ Suckley
expanded over the next decade and, in the mid-to-late who, unbeknown to the President and his physicians,
30s, exhibited morphology compatible with melanoma,2 preserved her correspondence with Roosevelt and kept
a highly malignant and vascular tumour notorious for a detailed diary of her relationship with him. First pub-
its propensity to metastasise and bleed in the brain. lished in Geoffrey Ward’s 1995 book, Closest Companion,
At 13:10 on 12 April 1945 at Warm Springs, Georgia, no other document is more revealing of the true state
the 63-year-old President Roosevelt was stricken by a of Roosevelt’s health and psyche. The diary reveals a
catastrophic intracerebral haemorrhage that originated story of progressive loss of vitality and the deep con-
in the right posterior cerebral hemisphere and rapidly cerns Roosevelt had about his health, directly and cred-
progressed in a classic transtentorial herniation fashion. ibly controverting the scenario described by Bruenn.
Eyewitnesses at the scene have described these events More doubt is cast upon Bruenn’s account by under-
in detail, namely the cardiologist and primary physi- standing how Roosevelt dealt with his previous health
cian Howard G Bruenn3 and Roosevelt’s cousin, problems. After the fateful summer of 1921, Roosevelt
Margaret ‘Daisy’ Suckley.4 was never again able to stand without the use of
In 1946 the presidential physician Admiral Ross T braces. While the nature of the illness that struck him is
McIntire wrote that Roosevelt’s fatal haemorrhage was still a matter of debate,8 his intense rehabilitative efforts
unsuspected5 and vigorously defended this contention and contributions toward the understanding and cure
until his death in 1959. The present accepted view of of polio, his unchallenged diagnosis during his life-
this event was laid out in detail by Bruenn, the time, are well appreciated.
President’s primary physician from April 1944, in his
1970 paper3 published with the consent and partici-
pation of the family, alleging that Franklin Delano Doctor Roosevelt
Roosevelt (FDR) showed little concern for his health
and that his death was solely a consequence of severe FDR took an active role in his rehabilitation, devising
and longstanding hypertension and atherosclerosis. treatments and novel ways of objectively measuring
improvement.9 He sought out the most learned auth-
orities in the field and gave advice to other victims,
Steven Lomazow MD, is a neurologist practising in New Jersey. He is gaining him the title of ‘Doctor Roosevelt’ around
a 1976 graduate of the University of Health Sciences/Chicago Warm Springs. He personally financed and developed
Medical School and did his neurological training at the University of the medical centre there and founded a charity to raise
Minnesota. He was the president of the Neurological Association of
New Jersey and currently is a member of the New Jersey State Board
awareness of the disease. The ‘March of Dimes’ was
of Medical Examiners. Correspondence: Steven Lomazow, 8 McGuirk directly responsible for funding the scientific research
Lane, West Orange, NJ 07052, USA (email: Lomazow@comcast.net) that eventually produced a successful vaccine for

Journal of Medical Biography 2009; 17: 235– 240. DOI: 10.1258/jmb.2009.009036


236 Journal of Medical Biography Volume 17 November 2009

poliomyelitis. In 1946 Roosevelt’s image was placed on


the dime to commemorate his immense contribution
towards conquering polio.
Roosevelt made extraordinary efforts to conceal the
degree of his own disability from the public, both
personally and through surrogates including his
political operative, Louis Howe10 and, later, presidential
physician McIntire who was recommended for his posi-
tion largely because of his ability to ‘keep a close
mouth’ by Admiral Cary T Grayson, a long-time friend
of Roosevelt and the mastermind of the cover-up of
Woodrow Wilson’s severe disability following a large
non-dominant hemisphere stroke in October 1919.
Roosevelt exercised strict personal control over every
decision that affected his health. Despite the fact that
he was wheelchair bound, none of the tens of thou-
sands of photos seen publicly during his lifetime
shows him in a physically compromised state. Even
after his death, McIntire and, later, Bruenn, intention-
ally and deceptively protected the privacy of his
medical history. Roosevelt’s penchant for secrecy and
intrigue is well recognized. His existing medical
records carry the names of at least 30 different aliases.
FDR was very prone to infectious disease. While he
was a governor and president, he was frequently laid
up for days or weeks with illnesses that the public was
informed were influenza, sinus trouble, grippe and
swamp fever.

The dread disease


Figure 1 FDR’s handwriting to show the changes in his tremor (author’s
A 2008 paper in Archives of Dermatology co-authored collection): (a) on 1 June 1944, (b) on 7 September 1944, (c) on his last
with dermatopathologist A Bernard Ackerman2 cheque dated 9 April 1945
describes the pigmented lesion above Roosevelt’s left
eye and presents a differential diagnosis of melanoma
and solar lentigo. The primary lesion underwent asked his secretary to get him a larger coffee cup so as
marked changes throughout 1940 with essentially total not to spill the contents when he drank from it. Several
disappearance by the end of 1941. The natural history reliable observers reported an intention tremor of vari-
of the two possible pathologies is incompatible with able intensity. While it worsened generally with time, it
the well-documented rapid change in morphology. The waxed and waned from day to day. Some samples of
overwhelming probability is that the lesion was FDR’s handwriting early in 1945 are virtually unintelli-
removed surgically. The highest degree of secrecy gible yet some in March are much clearer. There were
needed to be enforced since any hint that the President never any overt signs of extrapyramidal disease or lab-
was being treated for a highly malignant condition, as oratory evidence of significant hepatic disease. There
melanoma was known to be at the time,11,12 would was moderate hypoxemia and an unknown degree of
have been disastrous to his future aspirations. Other renal disease. Severe congestive heart failure was
than a letter from a Massachusetts gynaecologist treated with digitalis from early April 1944. FDR’s
expressing concern about it,13 the lesion quietly mother, two of his sons and a daughter had a tremor.
disappeared. His alcohol use was moderate, he smoked two packets
Roosevelt had mild, intermittent hypertension noted of cigarettes a day and, beginning in May 1944, was
as early as 1933 that accelerated rapidly in 1944 with using phenobarbital, 30– 60 mg three times daily.
one transient episode of inability to write his name cor- Observers described the tremor. Harry Truman (18
rectly in 193714 and a well-documented syncopal August 1944)16 noted ‘In pouring cream in his tea,
episode in March 1940.15 In 1943 many new and per- he got more cream in the saucer than he did in the cup.
sistent problems began to show. His hands are shaking and he talks with considerable
difficulty’. Ambassador Joseph P Kennedy (October
1944)17 noted ‘his hands shake violently when he tries
Tremor to take a drink of water. About 10 percent of the time
he is talking, his words are not clearly enunciated’. The
Beginning in late 1943 a progressive intention tremor Director of Public Relations at the White House, David
was noted that ultimately had a profound effect upon Noyes (20 March 1945)18 noted ‘the president was
his handwriting (Figure 1). As early as June 1943 FDR trying to light a cigarette and put the cigarette in his
S Lomazow Untold neurological disease of Franklin Delano Roosevelt (1882– 1945) 237

holder to light it in the usual way. Unable to connect presented to the President and in such a manner that
the match, his hand shaking badly, he opened the desk he can pass on these matters with a full understanding
drawer, placed his bent elbow inside, partly closed the of the consequences of decisions’. Long-time friend
drawer and got a firm hold on his hand’. The Secretary and Secretary of Labor Francis Perkins (January 1945)25
to the Treasury, Henry Morgenthau (11 April 1945)19 noted ‘I had a sense of his enormous fatigue. He had
wrote ‘he was mixing cocktails. His hands shook so the pallor, the deep gray color of a man who had been
that he started to knock the glasses over and I had to long ill. He supported his head with his hand as
hold each as he poured the cocktail ... I noticed that he though it were too much to hold up. His lips were
took the two cocktails and then seemed to feel a little blue. His hands shook’.
better’. Speechwriter John Gunther (February 1945)26 noted
Obviously an intention tremor; the family history ‘His fatigue was crushing, and he had intermittent
and apparent response to alcohol are highly suggestive periods of being virtually comatose. In fact his exhaus-
of benign essential tremor. With progression mirroring tion was so complete that, on occasion, he could not
the worsening of Roosevelt’s associated medical answer simple questions and talked what was close to
problems, enhancement by metabolic encephalopathy nonsense’. Winston S Churchill (February 1945)27 noted
and possibly neuropathy must also be considered ‘His captivating smile, his gay and charming manner
seriously. had not deserted him, but his face had a transparency,
an air of purification, and often there was a far-away
look in his eyes’. Churchill’s physician, Lord Moran (13
February 1945)28 wrote ‘he sat looking straight ahead
The beginning of the end with his mouth open, as if he were not taking things
in ... He has all the symptoms of hardening of the
The Teheran Conference, held from late November to
arteries of the brain in an advanced stage’ and ‘The
early December 1943, marked the turning point in
President vacillated between intellectual acumen and a
Roosevelt’s health after which there was an inexorable
vacuous attitude which was impossible to penetrate
downhill course. At this conference the first report of
with ideas and conversation. These extremes presented
severe paroxysmal abdominal pain is reported,20 likely
themselves within hours of each other’. Judge Marvin
the first recorded episode of symptomatic metastatic
Jones (17 March 1945)29 ‘remembered that Mrs
disease, a consequence of intussusception well known
Roosevelt carried most of the conversation and the
to be associated with small bowel metastases from
President would sometimes brighten up for a moment
melanoma. Two other well-documented major abdomi-
and then ... his head would drop down’.
nal attacks occurred in May21 and August of 1944.22
At FDR’s last public appearance, at the White House
Although cholelithiasis was advanced as the source
correspondents’ dinner on 21 March 1945, Allen Drury,
of FDR’s abdominal pain, his diet was more in keeping
correspondent for the United Press, noted how old and
with a patient with partial bowel obstruction, the likely
thin and scrawny-necked FDR looked when he was
cause of a 40-pound weight loss in his last year. The
wheeled in, how he stared out at the crowded tables as
time frame for the appearance of metastatic disease in
though he did not see the people, how he failed to
late 1943 after removal of the primary lesion in 1940 is
respond to the blare of trumpets and to the applause.
consistent with the natural history of melanoma.
Everyone watched the greatest performer of all – how
he steadily drank wine and smoked his uplifted ciga-
rette, how he leaned forward with his hand cupped
Lethargy and seizures behind his ear to hear a joke repeated as laughter
welled up in the room, how his booming laughter rang
From late 1943 there are many reports of a persistent out. Then a few moments later observers noticed how
and progressive lethargy and somnolence. From early he simply sat at the table with an intent, vague
in 1944 Roosevelt’s level of alertness varied. He wor- expression on his face, while his jaw dropped and his
sened generally as the days progressed. As April 1945 mouth fell open.30
neared, the periods of exhaustion and stupor worsened The Canadian Prime Minister McKenzie King (26
and he had many more bad days than good. March 1945)31,32 wrote ‘Roosevelt repeated two long
On 27 March 1944 FDR was diagnosed with severe stories ... that he had told King the night before, King
congestive heart failure which likely was a major con- noticed that Mrs Roosevelt and Anna ‘seemed a little
tributor to his tiredness. Shortly afterwards he was embarrassed’. Speechwriter Robert Sherwood (March
started on digitalis which brought about rapid remark- 1945)33 noted the president was ‘in much worse shape
able clinical improvement. Despite another month of than I have ever seen him ... he had seemed unnatu-
seclusion, an enforced four-hour workday and mid-day rally quiet, even querulous, never before had Sherwood
naps, the lethargy progressed. Secretary Grace Tully found himself in the position of having to carry on
(1944)23 ‘worried when Mr Roosevelt suddenly dozed most of the conversation without reply’. In March 1945
over his mail. She had witnessed it several times. In ‘Roosevelt was an animated human being from nine in
chats with political friends he frequently ‘drew a blank’ the morning until an hour after midday. Each day at
as they listened: abashed, he had to ask what he had lunchtime he appeared to shatter into helpless frag-
been talking about’. Assistant Secretary of State ments. The good nature seemed intact but the body
Breckinridge Long (1 November 1944)24 noted ‘I am and the mind faded in function toward a smiling
not sure nowadays that things are properly and fully helplessness’.34
238 Journal of Medical Biography Volume 17 November 2009

Disturbing as the above reports are, there are others and ‘miraculously recovered’. Since he was seen shortly
for which an explanation other than seizures is hard to afterwards in his usual state of health, it was more
surmise. New York Times reporter and editor Turner probably a transient seizure, transient ischaemic attack
Catledge (early April 1944)35 wrote ‘when I entered the or a syncopal episode.
president’s office I had my first glimpse of him in Neurosurgeon Bert Park40 blamed FDR’s lethargy on
several months. I was shocked and horrified – so much encephalopathy secondary to hypoxemia. Most prob-
of my impulse was to turn around and leave. I felt ably there was encephalopathy although it was multi-
I was seeing something I shouldn’t see. He had lost a factorial. There is evidence of renal compromise.
great deal of weight. His shirt collar hung so loose Hypoxemia is easily implicated by right heart failure, a
around his neck that you could have put your hand long history of heavy smoking and pulmonary metas-
inside it. He was sitting there with a vague glassy-eyed tases. Hypertension in 1944 was severe and persistent
expression on his face and his mouth hanging open’. with diastolic pressures consistently between 105 and
‘Reluctantly, I sat down and we started talking. 120 and spikes as high as 150. When on the campaign
I expected him to ask me about the political situation, trail and during the delivery of his fourth inaugural
but he never did. He would start talking about some- address, and while in considerable pain,41 the
thing, then in mid-sentence he would stop and his President was not observed to have much difficulty
mouth would drop open and he’d sit staring at me in with his mental faculties. The vast majority of the
silence. ... Repeatedly he would lose his train of reports of problems are in a less stimulating setting,
thought, stop, and stare blankly at me’. John T Flynn36 entirely consistent with a low-grade encephalopathy.
wrote of an August 1944 incident related to him by an While the degree of his hypertension was alarming,
eyewitness high-ranking officer ‘[while] reading a short and an element of vascular dementia must be con-
speech suddenly (FDR) faltered and paused, his eyes sidered, Roosevelt never manifested any of the dys-
became glassy, consciousness drifted from him. The arthia, dysphagia and emotional lability characteristic
man at his side nudged him, shook him a little, of advanced hypertensive cerebrovascular disease.
pointed to the place in the manuscript at which he Explaining the aetiology of the seizures is more pro-
broke off and said: ‘Here, Mr President, is your place’. blematic. His chief of staff ’s casual familiarity with
With an effort he resumed. As he was wheeled from them and Francis Perkins’ oral history provide reliable
his quarters, officers noticed his head drooping evidence that they were not infrequent. The events,
forward, his jaw hanging loosely’. At a January 1945 most akin to partial complex seizures, were likely due
meeting between Roosevelt and Senator Frank to a combination of a silent temporal lobe infarct and
Maloney,37 ‘Maloney went in and sat down. Roosevelt multi-factorial encephalopathy. It would be attractive
looked up but said nothing, his eyes fixed in a strange to invoke cerebral metastases but the reliable obser-
stare. After a few moments of silence, Maloney realized vation from May 1944 and Francis Perkins’ obser-
that Roosevelt had absolutely no idea who his visitor vation that they were occurring for ‘several years’
was. A pious Catholic, Maloney crossed himself and weigh heavily against this, considering the very short
ran to get (Chief of Staff) Pa Watson, fearing the presi- survival time in patients with metastatic brain mela-
dent had suffered a stroke. ‘Don’t worry’. Watson said. noma. The apparent lack of focal neurological findings
‘He’ll come out of it. He always does’. By the time through to the end of 1944 also speaks against earlier
Maloney returned to the oval office, Roosevelt had brain metastases.
pulled himself together. Smiling broadly, he greeted What FDR’s doctors’ thought about the aetiology of
Maloney warmly and launched into a spirited conver- the seizures is not known. They did not evade concern.
sation’. The clincher comes from Francis Perkins38 who There is a report that the Navy’s chief neurosurgeon,
noted in an oral history ‘the change in appearance had Winchell M Craig, performed a pneumoencephalogram
to do with the oncoming of a kind of glassy eye, and on the president.42
an extremely drawn look around the eyes and cheeks, While the specialty of epileptology was in its infancy
and even a sort of dropping of the muscles of the jaw in the 1940s, effective treatment was known. Merritt
and mouth, as though they weren’t working exactly. and Putnam had introduced Dilantin (phenytoin) in
I think they were, but there was a great weakness in 1937 and FDR was given phenobarbital, 90– 180 mg per
those muscles. Also, if you saw him close to, you day, starting in April 1944, allegedly for control of his
would see that his hands were weak ... When he hypertension but more likely for his episodic lapses of
fainted, as he did occasionally – not for many years, consciousness.
but for several years – that was all accentuated. It Admiral McIntire, Surgeon General of the Navy,
would be momentary. It would be very brief, and he’d was a competent ENT physician and, contrary to
be back again’. current historical thought, competently utilized the
Over his last two years Roosevelt manifested pro- expertise of the finest naval and civilian doctors
gressive global cerebral dysfunction with frequent including surgeon Frank Lahey and internist James
episodes highly suggestive of seizures. It is remarkable Paullin. No man could have received more competent
that Doctor Bruenn never acknowledged this problem, attention to his health than FDR. It is absurd to
one that a careful and competent physician such as he assume that any measure was spared in treating the
must have recognized. President of the United States. His neurological care
There is also a report of ‘brain haemorrhage’ while at was delivered by the chief neurosurgeon of the Navy,
his residence in Hyde Park, New York, on 25 March Winchell M Craig, who later enjoyed a distinguished
194539 in which FDR was ‘unconscious for some time’ career at the Mayo Clinic.
S Lomazow Untold neurological disease of Franklin Delano Roosevelt (1882– 1945) 239

New answers Gunther and Rosenman were unaware of the reason for
the poor performance. Bruenn’s 1970 paper offers an ‘offi-
On 6 January 1945 the President prepared a newsreel cial’ explanation: ‘It was noticed on the radio by many
video of excerpts of the State of the Union address that that he occasionally appeared to be at a loss for words.
he had delivered on the radio. By this time he was When queried about this later, he laughingly reported
physically incapable of standing for the period required that while giving the speech he had spoken at intervals
to deliver it before a joint session of Congress as had from memory and ‘off the record’ and that he had then
been his custom. The video reveals a curious behaviour had slight difficulty in finding the proper place when
not previously seen in videos Roosevelt had made as returning to read the printed words of his address’.48
late as November 1944. While speaking, he used his A detailed analysis of the original reading copy of
hands, first the left and then the right, apparently to the address of 1 March provides a startling and eerie
keep his place on the printed page. More evidence of objective record of the cause of FDR’s poor perform-
visual – spatial problems is seen in a 14 January diary ance. The errors made by Roosevelt are not random.
entry of Margaret Suckley who wrote ‘FDR called up at From the very first page of the prepared text there are
5 minutes of two – he had mistaken the time on his word omissions and errors consistent with a left visual
clock and had just come downstairs for his lunch’. field deficit. There are about a dozen clear-cut word
substitutions with errors on the left side of the word,
reading decisions as conclusions, here as are, evidence for
advance, arrangements for agreements as well as dozens
Yalta of instances of inability to find words on the left-hand
margin and omissions of individual words throughout
Much has been written about FDR’s less than optimal the text. Virtually all of the deviations from the text are
performance at Yalta in February 1945. Some accounts explained by these errors and the speaker’s extempora-
provide clues to the reason why: Lord Moran wrote43 neous corrections in order to form semantically correct
‘Winston is puzzled and distressed. The President no sentences. Some pages have relatively few errors but at
longer seems to the PM to take an intelligent interest times he became hopelessly lost, could not correct
in the war; often he does not seem to read the papers the himself immediately and resorted to long ad-lib devi-
PM gives him’. Adviser James Byrnes44 wrote ‘Not until ations, often incorporating a few random words of the
the day before we landed at Yalta did I learn that we prepared text within them. The ad-libs must have also
had on board a very complete file of studies and provided brief respites from the exhausting, intense
recommendations prepared by the state department ... mental gymnastics required to present a coherent
I am sure the failure to study them while en route was due to address before a packed congressional chamber and a
the President’s illness’. national radio audience. Some of those present
Franklin Roosevelt’s last public address was on 1 observed a problem with Roosevelt’s right arm during
March 1945, a report to Congress upon his return from the address,49 not knowing that throughout the hour
Yalta. It is best remembered as the first and only address he was using it is as a stylus while clumsily turning the
of this magnitude given in a sitting position and the pages of the speech.
only address where he referred publicly to his disability. Only a few minutes of video of the speech still exist.
The speech is also notable for frequent, uncharacteristic The audio recording is edited to remove a persistent
deviations from the prepared text. Roosevelt was a cough, as was a transcript of the delivered address to
master orator and showman. Every public event was make it more coherent, a task that press secretary
carefully orchestrated and every speech painstakingly Jonathan Daniels later commented took quite a bit of
prepared and rehearsed. Rarely did he deviate from his effort.50 That Roosevelt was able to complete the monu-
prepared text. Despite mixed reviews from the press, mental task of delivering an hour-long address with
those closest to him were aghast. such a visual deficit is testimony to his skill and experi-
His speechwriter John Gunther45 wrote ‘this speech ence as an orator, to his dogged determination and to
was the first indication to many that something may be an amazing degree of mental acuity. During that hour,
gravely wrong with the President ... he ad-libbed a FDR was not impaired by encephalopathy. This address
great deal. In fact never in his whole career had he also provides additional insight into his ability to func-
ad-libbed so much in an important speech; he departed tion as ‘the sick man at Yalta’ a few weeks earlier.
from his prepared text no fewer than forty-nine times. On 29 March 1945 press secretary Jonathan Daniels
This phenomenon too was disconcerting to those who and speechwriter Archibald MacLeish were preparing a
were worried about his condition’. Speechwriter memo that needed Roosevelt’s approval: ‘With seeming
Samuel Rosenman46,47 wrote ‘The President made so precision he made a slight change in the first paragraph
many corrections in the reading copy (of the fifth draft) and pushed the paper back to me. We departed in haste
that it was retyped as a sixth draft ... I was dismayed at [only to find that] the change he had made turned into
the halting, ineffective manner of delivery. He ad- confusion the rest of the statement [which] he obviously
libbed a great deal – as frequently as I had ever heard had not bothered to read’. Sheepishly they returned to FDR
him. Some of his extemporaneous remarks were wholly who corrected the error without objection.51
irrelevant, and some of them almost bordered on the There is objective evidence for a highly supportable
ridiculous ... It was quite obvious that the great fighting scenario. A progressive right hemispheric deficit, first
eloquence and oratory that distinguished him in his seen on the January 1945 video, was the cause of
campaign only four months before were lacking’. Roosevelt’s poor performance on 1 March. Six weeks
240 Journal of Medical Biography Volume 17 November 2009

later, on 12 April, the President succumbed to a 12 Farrell HJ. Cutaneous melanonas with special reference to
massive right-sided supratentorial haemorrhage. prognosis. Archives of Dermatology and Syphilology 1932;26:110–24
13 Letter from Ross McIntire to Dr Reuben Peterson, 25 January
Surely Roosevelt suffered from severe cardiovascular 1940. FDR Library, Ross McIntire papers, Box 6; the letter was in
disease and hypertension that easily could have pro- response to a letter written to FDR by Peterson. McIntire wrote
duced a similar clinical picture on 12 April but, consid- ‘The pigmented area above the President’s eye is very superficial
ering the removal of a pigmented lesion in 1940, and has never shown any sign of an inflammatory nature. You
can rest assured that it is under observation at all times’
episodic severe abdominal pain beginning in 1943 and 14 Suckley Diary, 10 September 1944
a 40-pound weight loss from April 1944, a more likely 15 Bullitt OH, ed. The Correspondence Between Franklin D Roosevelt
explanation for his death is melanoma, his terminal and William C Bullitt. London: Andre Deutsch Ltd, 1973:298–9
event being a bleed emanating from a metastatic lesion, 16 Ferrell RH. The Dying President, Franklin Roosevelt 1944–45.
a well-recognized and frequent consequence of the Columbia and London: University of Missouri Press, 1998:89
17 Wills M. A Diminished President. FDR in 1944. Raleigh: Ivy House,
disease? Despite the fact that nowhere within Howard 2003:82
Bruenn’s 1970 paper, written with the surreptitious 18 Ferrell, op. cit. ref. 18: p. 111
participation of Roosevelt’s daughter Anna and her 19 Henry Morganthau, Jr. Diary, 11 April 1945
physician husband, is there any consideration or dis- 20 Bohlen C. Witness to History, 1929–69. New York: WW Norton &
Company, 1973
cussion of malignancy; the motivation for writing it is 21 Bruenn, op. cit. ref. 3: p. 584
contained in the accompanying editorial:52 22 Roosevelt J, Shallett S. Affectionately FDR. New York: Harcourt
‘The speculation in a recently published book, that the and Brace, 1959:351
President was suffering from a metastatic melanoma in the 23 Bishop J. FDR’s Last Year. April 1944–April 1945. New York:
brain, is laid to rest by Dr Bruenn; there was no clinical evi- William Morrow & Company, 1974:263
24 Bohlen, op. cit. ref. 22: pp. 206– 7
dence for such a lesion and no autopsy was performed. We 25 Crispell KR, Gomez CF. Hidden Illness in the White House.
are given, by Dr Bruenn, the picture of a great and gallant Durham and London: Duke University Press, 1988:121
man, fatigued by the burdens of his office and by his 26 Gunther J. Roosevelt in Retrospect. New York: Harper & Brothers,
hypertension and reduced cardiac reserve, yet quite able to 1950:360
27 Crispell and Gomez, op. cit. ref. 27: p. 125
exercise his judgment and to use the fruits of his unique 28 Evans HE. The Hidden Campaign. FDR’s Health and the 1944
knowledge and experience in guiding the war effort’. Election. Armonk, NY and London: M. Sharpe, 2002:128
The ethics of presidential physicians is an ongoing 29 Ibid., p. 110
matter of debate and controversy. In this instance, the 30 Burns, op. cit. ref. 8: pp. 594– 5
role of Ross McIntire and Howard Bruenn to present a 31 Goodwin DK. No Ordinary Time. Franklin and Eleanor Roosevelt:
The Home Front in World War II. New York: Simon & Schuster,
candid appraisal of their patient’s condition was super- 1994:588
seded by their respect, devotion and duty to their 32 Ferrell, op. cit. ref. 18: p. 112
commander-in-chief.53 33 Bishop, op. cit. ref. 25: p. 518
34 Ibid, p. 534
35 Wills, op. cit. ref. 19: pp. 24– 5
36 Flynn JT. The Roosevelt Myth. Garden City: Garden City Press,
References and notes 1948
37 Goodwin, op. cit. ref. 35: p. 571
1 Time Magazine, 23 May 1923 38 Perkins F. Oral History given to Dean Albertson, 1955, Columbia
2 Ackerman AB, Lomazow S. An inquiry into the nature of the University Oral History Project, Part 3, Book 8: 280 –5
pigmented lesion above Franklin Delano Roosevelt’s left 39 News Story Magazine, October 1945:8
eyebrow. Archives of Dermatology 2008;14:529– 32 40 Park BE. The Impact of Illness on World Leaders. Philadelphia:
3 Bruenn HG. Clinical notes on the illness and death of President University of Pennsylvania Press, 1986
Franklin D Roosevelt. Annals of Internal Medicine 1970;72:579–91 41 Roosevelt and Shallett. op. cit. ref. 24: p. 354
4 Ward GC. Closest Companion. New York: Houghton Mifflin, 1995 42 Ferrell. op. cit. ref 18: p. 161, footnote 9
5 McIntire RT. White House Physician. New York: G.P Putnam’s 43 Wilson C. (Lord Moran). Churchill. Taken from the Diaries of Lord
Sons, 1946 Moran. New York and London: Houghton Mifflin, 1966:43
6 Lerner BH. Crafting medical history: revisiting the ‘Definitive’ 44 Byrnes JF. Speaking Frankly. New York: Harper & Brothers,
account of Franklin D Roosevelt’s terminal illness. Bulletin of the 1947:23
History of Medicine 2007;81:386–406 45 Gunther, op. cit. ref. 28: pp. 363 –4
7 Burns JM. Roosevelt: The Soldier of Freedom. New York: Harcourt 46 Rosenman SI. Working With Roosevelt. New York: Harper and
Brace Jovanovich, 1970 Brothers, 1952:527
8 Goldman AS, Schmalsteig EJ, Freeman DH Jr, Goldman DA, 47 Ibid., p. 455
Schmalstied FC Jr. What was the cause of Franklin Delano 48 Bruenn, op. cit. ref. 3: p. 591
Roosevelt’s paralytic illness? Journal of Medical Biography 2003;11: 49 Morgan T. FDR, A Biography. New York: Simon and Schuster,
232– 40 1985:758
9 Letter of FDR to William Eggleston, MD, 11 October 1924 50 Daniels J. White House Witness. New York: Doubleday, 1975:255
10 Letter of Louis Howe to Clayton L Wheeler, 20 September 1921, 51 Ibid. p. 277
Joseph Plaud Collection (Heritage Auctions Sale 6010); in part: 52 Elkinton JR, Huth EJ. Medicine in history. Annals of Internal
‘Dear Mr Wheeler: As you have probably seen in the papers Mr Medicine 1970;72:593
Roosevelt’s illness turned out to be an attack of infantile 53 Steven Lomazow and journalist Eric Fettmann will be
paralysis which fortunately is very mild and from which the incorporating the information contained in this paper into a
doctors assure him he will suffer no permanent effects’ comprehensive medical biography of Roosevelt entitled FDR’s
11 Handley S. Prognosis of simple moles and melanotic sarcoma. Deadly Secret, to be published by Public Affairs and released in
Lancet 1935:1401 –3 early 2010