SEVERE MIALNUTRITION IN A PUBLIC SERVANT OFTHE WORLD WAR II ERA: THE MIEDICAL

HISTORY OF HARRY HOPI?KNS*

JAMES A. HALSTED, M.D.

Harry Hopkins occupied a unique place in the nation's history as adevoted friend and advisor of President Roosevelt. During World War IIhe wielded power and influence which, according to testimony by Secretaryof War Stimson and General George C. 1\Iarshall amoong many others, wasof great benefit to the war effort.

Since 1948 I have been interested in his serious illnesses occurring simul-taneously with his historic activities. Hopkins had had a gastrectomy forcancer of the stomach in 1937. About a year later he began to have recurrentbouts of devastating malnutrition and finally, he developed liver diseasefrom which he died on January 29, 1946. How could he accomplish theprodigious feats w-hich he did, living wNith three such near lethal diseases?His activities were those for a man of unusually good health plus an in-domitable will. He had the latter but rarely the former, except during partialremissions in the malnutrition problem which was never adequately diag-nosed.To investigate his illnesses I was able to obtain copies of the Mayo Clinic

and i\Iemorial Hospital Records, plus the autopsy report from Memorialxhere he died.Hopkins was born in Iowa in 1890, with a background which was deeply

religious. At 22 he graduated from Grinnell College, and later became asocial welfare worker in New York. During his years in New York he be-came Executive Director of the New York Tuberculosis Association, thepresident of which was James Alexander Miller. (Dr. M\1iller was a memberof the Climatological from 1905 to 1948 and its president in 1916). He haddemonstrated marked leadership ability and administrative qualities whichwere unusual but effective. The Association under Hopkins' executivedirectorship grew enormously in membership with a large increase in bothincome and expenditure.He believed in positive action when he had the power to take action and

worried about finding the money later, a characteristic which shaped hislater career as Administrator of Federal Relief and de facto Administratorof Lend-Lease during World War II. He felt that when money was available

* From the Clinical Nutrition Program, Division of Gastroenterology, Depart-ment of Medicine, Albany Medical College, Albany, New York.

Address for reprints: R.D. #2, Hillsdale, New York, N.Y., 12529.

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24 JAMES A. HALSTED

it should be spent wrhen there was compelling need. This philosophy appliednot only to his public but to his personal life. He loved a good time andrarely saved.When Roosevelt was Governor of New York from 1928-1932, Hopkins

was appointed Director of the Temporary Emergeney Relief Administra-tion. He was very effective in this job and w-hen F.D.R. became I'residenthe was made Director of Federal Relief CWA, and later, WPA-in May1933.

President Roosevelt trusted Hopkins and turned to him more and morefor advice, ideas and action. Nine billion dollars was spent on Relief andsixty-nine billion on Lend-Lease supplies to the Allies. This great sum waslargely under Hopkins' direction. He had become de facto Administratorof Lend-Lease in 1941. Despite outcries to the contrary he was told byF. D.R. to have no truck with politicians and Harry refused to look out for"deserving Democrats". These enormous funds offered juicy patronageplums and Hopkins' refusal to play ball was undoubtedly the source of manyof the personal attacks on him such as a lead story in the Chicago Tribunebefore the 1936 election headlined, "Throw the Rascals Out !" His integrityand honesty, doubtless eoupled with his ill health, probably contributed tothe hostility.

Hopkins' advisory activities were primarily related to tacties rather thanstrategy. He was not a man likely to suggest broad topics with philosophicalovertones but rather he was extremely effective in summing up a problemor a policy matter which had been proposed and discussed by others. Hehad a keen analytical mind and was extremely adept at defining the prob-lem at hand and the solution decided upon, then to get things done bysuccinct action. Churchill facetiously declared that he was going to proposehim for the House of Lords with the title of "Lord Root of the M\Iatter".

In October 1937 Hopkins' second wife died of cancer. He had had aduodenal ulcer in 1934, confirmed by x-ray, but because his father had diedof cancer of the stomach he suspected that he, too, had the same. On De-cember 17, 1937 he entered the Mayo Clinic because of a recurrence of ulcersymptoms plus vomiting. Two months previously x-ray had demonstrateda pre-pyloric ulcer with crater. Upon admission pyloric obstruction wassuspected, confirmed by gastric aspiration, and after three days he wasoperated upon. There was a mass 4 X 2 X 1 cm. in size, with firm omentalnodes. The liver was normal. A high, partial gastrectomy of anterior Polyatype wN-as carried out with an entero-enterostomy performed ten inchesbelow the anastomosis. The pathologic report was that of a large adeno-carcinoma of the greater curvature with involvement of adjacent lymphnodes. The cancer never recurred, surprisingly, because statistically thecure rate of such a large adenocareinoma is in the neighborhood of two orthree per cent.

MIEDICAL HISTORY OF HARRY HOPKINS 25

His recovery Nas uneventful with no digestive problems nor other signsof the post-gastrectomy syndrome. About a year after the operation Hop-kins was appointed Secretary of Commerce. At that time, early January1939, he had developed ambitions of being the Democratic nominee forPresident in 1940. Indeed, it appears that he was first on F.D.R.'s list ofpossible choices to succeed him in the White House.

This career pathway was soon obliterated because in M\Iarch 1939 he hadthe first of numerous long episodes of great weakness with collapse, diarrhea,edema of the extremities, poor vision and signs attributable to severalvitamin deficiencies. He had vomiting on and off for three weeks and lost18 pounds. With bedrest he improved somewhat but could only work half-time. He spent the summer of 1939, which was tense with the build-up towar, in a country house near Washington. One of his sons had writtenabout his condition as follows: "We were amazed at how sick he was. Hisletters never indicated this. He went fishing in the morning and took a napin the afternoon. Then he began having trouble with his legs and soon wastoo N-eak to step into a boat". Hospitalization became imperative and onAugust 23rd he re-entered the M\ayo Clinic where he stayed for three weeks,being discharged on September 14, 1939.

Hopkins' medical records are of special interest in the multiplicity of de-tailed and frequent progress notes by many physicians well known to mostof us. These notes constituted the best of medical observation and logic ex-pressed in a quality of English rarely seen today. Of course in those daysclinical laboratory tests were less sophisticated than at present.The significant features of the second Mayo Clinic admission were as

follows: he had lost weight but, importantly, had a good appetite. He hadedema of the legs, shiny scaly skin, sore shin bones, and burning of feet andankles with redness of the toes. There was glossitis, ataxia and weakness oflegs. He had poor vision and diarrhea.

Examination revealed no abdominal mass, hepatomegaly nor palpablelymph nodes. X-ray studies showed that the anastamoses functioned well.Barium enema did not reveal a gastro-colic fistula.The laboratory findings showed moderate anemia (Hemoglobin 10 gm.

per 100 ml.) and macrocytosis on blood smear. (This was reported severaltimes both at this admission and later ones, being emphasized by the labora-tory physician). Blood chemistry findings were: Calcium 7.7, cholesterol105, total protein 2.04 and 3.47. The prothrombin time was 20 seconds.Stool fat was 10.4 gm. in 24 hours.

These findings may be interpreted in light of present knowledge of in-testinal absorption as showing malabsorption of fat (steatorrhea and lowcholesterol), protein, calcium, vitamin K, vitamin A (poor vision), watersoluble B vitamins (the neurologic findings and glossitis), and probablyfolic acid (moderate anemia with macrocytosis).

26 JAMES A. HALSTED

He was treated with a low residue diet high in vitamins, parenteral vita-mins plus crude liver extract intramuscularly three times a week, threeblood transfusions and intravenous amigen in 10 % dextrose.He progressed well, the glossitis and edema disappearing with rise in

total protein to 5.4 gm/100 ml. He had written his brother Lewis Hopkins,a physician, while in the hospital that his problem was inability to absorbproteins and fat, that he was losing his vision, had lost 30 pounds, that therewas no evidence of recurrence of the cancer. He said that weakness andother signs of malnutrition had begun "about a year ago" after a throatinfection, with periods of improvement and relapse until July 4, 1939 whenhe had to take to his bed most of the time. He wrote that he had "a generalsense of well-being, excellent appetite, no nausea and no diarrhea. The bestI can tell you is that I have a very severe malnutrition".The entire picture was indicative of intestinal malabsorption. Interest-

ingly up to now his physicians had not mentioned sprue, nor the post-gastrectomy syndrome including "the dumping syndrome", nor attemptedto analyze or clearly define, other than to use the general term of malnutri-tion. Since the physicians involved included leading authorities on malnu-trition secondary to disease it is an indication of the paucity of knovWledge35 years ago of intestinal function in relation to nutrient absorption andthe nutritional effects of gastrectomy.

After leaving the Mayo Clinic he continued to improve very slowly butwas unable to leave his home for uninterrupted work for another eightmonths. Eventually, however, he became well enough to have six moreyears of memorable accomplishment, even though interspersed with remis-sions and relapses.On May 10, 1940, the day of the German attack on the Low Countries, he

went to dinner at the White House. He was feeling miserable and F.D.R.prevailed upon him to spend the night. He remained there for three and ahalf years, where he was easily available.On August 22, 1940 he resigned as Secretary of Commerce to become a

Special Assistant to the President.Although the ups and downs in the effects of his nutrition problem con-

tinued, when an emissary was needed to talk to Churchill, Hopkins askedF.D.R. to send him to London. He set off on January 5,1941. This was at atime of partial remission but Churchill wrote later: "There he sat, slim,frail, ill, but absolutely glowing with refined comprehension of the Cause(the defeat of Hitler)-to the exelusion of all other purposes, loyalties, oraims. "The British recognized his ability and relied increasingly on his counsel

and intuitive good sense.In July 1941 Hopkins was sent to 1\Ioscow from London where he was on

MEDICAL HISTORY OF HARRY HOPKINS 27

a second mission. Described as "gaunt and ailing" he made a long dangerousjourney by, flying boat north of Norway to Archangel where he had toattend a four hour banquet, have two hours sleep, then fly to M\1oscow fortalks with Stalin and others. Returning home he was heavily occupied withlend-lease matters and being instrumental in soluitioIn of many monumentalproblems. In April 1942 he was in London for a third mission and in Augustfor a fourth. In July 1942 he was remarried. He and his wife, Louise, stayedon at the White House for a year with Diana Hopkins, the daughter ofBarbara who had died of breast cancer in 1937, but in August 1943 theymoved to their owIn home.

In about October 1943 Dr. Rivers of the i\Mayo Clinic saw Hopkins inWashington. This was four years after he had been so desperately ill whenmalnutrition first manifested itself in 1939. Despite relapse and remissionhe had carried on the strenuous work involving Lend-Lease matters, withfive trips to London and MIoscow for conferences with Churchill and Stalin,and with participation in the Casablanca, Quebec, Cairo and Tehrai. con-ferences.

Dr. Rivers noted that he had edema and ascites, a serum protein of 5.0gm/100 ml. and red blood count of 3.5 million/cu.mm. He was started onplasma infusions to be given every three weeks. None of the measures wasof much benefit because all through the winter of 1943-1944 he was criti-cally ill, unable to work and re-entered the 1\1ayo Clinic on 1\larch 9, 1944where he stayed until May 7, 1944.The history at this time uncovered the very important fact that he had

begun to have attacks of mild diarrhea, often brought on by a large ingestionof fat, in 1931-6 years before his gastrectomy.

Other significant findings were as follows: Weight was stationary with agood appetite and fair strength. He had poor vision and impaired darkadaptation. There was absence of body hair. The laboiatory examinationsrevealed macrocytic anemia (R.B.C. 3.30 million, Hgb. 13.6 and macrocyteson blood smear). The serum protein was 5.4 gm/100 ml. Stool fat showed14.4 gm. and nitrogen 4.5 gm. per day. Serum carotene was "low". A newobservation was that he had noted brief jaundice before admission whichsubsided. Serum bilirubin on two occasions was 2.5 and 3.75 gm/100 ml.An exploratory operation was done to rule out cancer recurrence and to

revise the anastamoses, hoping to obtain better mixing and a larger jejunalabsorptive surface. The operation revealed no evidence of recurrence andthe liver was reported as being normal. A biopsy was taken but no record ofthis was available. The pancreas and small bowel appeared normal.Some opinions expressed were as follows:1. Malnutrition leading to hypopituitarism with adrenal cortical insuffi-

ciency.

2(S JAMES A. HALSTED

2. A fatty liver from malnutrition "with low-grade cirrhosis".3. "The fundamental difficulty stems from non-tropical sprue".The post-operative course was uneventful and he recovered to his previ-

ous degree of ill health. The therapy, as it had been throughout, was heavilyweighted to parenteral vitamins, diet and transfusions both of blood andplasma. After leaving the AMayo Clinic he spent a long convalescence atWhite Sulphur Springs. Back in Washington July 4, 1944 he was incapableof much work but continued in an advisory capacity to the President,participated very little in the 1944 presidential election but continued as aconduit between London and Washington at highest levels respecting N-arproblems. His astute intellect and negotiating ability, despite the fact thathe, was too ill to work more than 2 to 3 hours a day, made him a key personin planning the Yalta Conference which he attended in February 1945.At Yalta he was so sick that he had to spend much of the time in bed

but attenided all conferences. On the returni he became wN-orse and left theship at Algiers whence he flew home to go directly to the M\ayo Clinic forthe fourth admission,Februar 27 April 13, 1945..There were no new findings at this admission, laboratory tests being

about as they were a year before. One physician with long experience innutritional problems, especially steatorrhea, noted in the chart "As far asI am concerned this is non-tropical sprue".Hopkins left the Clinic considerably improved the day after F.D.R.

died. He determined to retire from government but negotiations in SanFrancisco at the Conference to establish the United Nations ran into diffi-culties essentially over misunderstandings with the Russians. PresidentTruman decided to send Hopkins to M\oscow for talks directly with Stalin.Hopkins was so highly regarded in Russia that the 4 days of meetings prob-ably saved the San Francisco Conference, according to Sherwood.1 He re-turned exhausted and retired after declining President Truman's request toattend the Potsdam Conference in July 1945.He gave up his Washington house and moved to New York, the city he

loved most. He was given an honorary degree from Oxford and planned togo there on October 25, but by that time another episode of collapse withdiarrhea and great weakness required hospitalization. He went to 1\IemorialHospital on November 1, 1945 where he remained until his death onJanuary 29, 1946.The MI\emorial Hospital admission revealed little new respecting the basic

nutritional problem. It Nas emphasized, however, that his attacks of greatweakness, with collapse, muscle cramps, parathesias, diarrhea and dis-turbed vision seemed to be recurrent and intermittent about every threemonths. Examination revealed cheilosis, papillary atrophy of tongue, bloodpressure of 102/70, liver and spleen not palpable. Laboratory findings of

MEDICAL HISTORY OF HARRY HOPKINS 29

significance were an elevated serum bilirubin which gradually rose to 9.6shortly before death, serum vitamin A low at 20 units/100 ml., stool fat35 gm. and stool nitrogen 10 gm. per day.

After some initial improvement, increasing jaundice, edema and ascitesappeared. Gastro-intestinal bleeding occurred toward the end, then comaand death, three months after admission. The autopsy revealed much bloodin stomach and bowel, esophageal varices with rupture, ascites, but noevidence of recurrent carcinoma. The liver was small, weighed 1350 grams,and had nodules which were irregular in size, some of which were large, withstreaks of broN- pigments. The pancreas was diminished in size and yel-lowish-brown. The autopsy diagnosis was hemochromatosis, pigment cir-rhosis, ruptured varices, atrophy, fibrosis and pigmentation of the pancreas.

In analyzing Hopkins' medical history three basic problems are involved.The first, a large adenocarcinomna of the stomach, was undoubted and con-firmed. This never recurred. One might speculate (perhaps wildly) that hissevere malnutrition might have played an inhibitory role in neoplasticyrosvth.The second problem was the etiology of his mlalnutrition. Two physicians

at the M\Jayo Clinic were convinced that the basic cause was non-tropicalsprue. The others both at the Mlayo Clinic and M\emorial used the term"malnutrition" without specifying an underlying cause or relating it to thegastrectomy. In view of the onset of diarrheal attacks six years before thegastrectomy, with important signs of piimary malabsorption characterizedby recurrences and relapses over a seven year period preceding his death,it seems reasonable to conclude that non-tropical sprue was indeed the bestexplanation for his malnutrition. There was no evidence for rarer causesof malabsorption such as Whipple's disease, regional enteritis, etc.The third problem was the pathogenesis of the cirrhosis from which he

died. Although hemochromatosis was diagnosed it is unlikely that this wasin fact correct. Recent examination of the slides show that the iron foundwas primarily in Kupffer cells, not in the hepatocytes as is characteristicof hemochromatosis, nor was there an excessive amount of iron in other tis-sues especially the pancreas and spleen. Alcoholic cirrhosis must always beconsidered but there was nothing to suggest that Hopkins was ever morethan a social drinker and during his periods of ill health he often took noalcohol for long periods of time.

Because he had had about 35 blood transfusions and innumerable in-fusions of pooled plasma he was exposed very heavily to hepatitis B virus.Thus it seems more plausible that he had post-necrotic cirrhosis secondaryto serum hepatitis. The post-mortem findings were not inconsistent withsuch a diagnosis.

Considering the course of events in Hopkins' health history, beginning

30 JAMES A. HALSTED

in 1931, and in light of all the available facts up to his death in 1946, itseems justifiable to speculate that he had non-tropical sprue or adult (eliacdisease (gluten enteropathy), and that post-necrotic cirrhosis developedas ail end result of hepatitis B infection, and occurring as a result of the treat-ment he received for malnutrition. However, since histologic proof is lack-ing for a diagnosis of sprue, the C.P.C. is incomplete! Had his life spanoccurred a few years later he might have enjoyed the benefits of the "wheat-free diet" which grew out of the observations of the Dutch pediatricians,Dicke and Wejers, who noted that during the Nazi occupation of Hollandwith starvation conditions, childhood celiac disease disappeared.Harry Hopkins' place in history may well be judged as more important

than many people now recognize. The judgments of Secretary of WarStimson, General George C. Marshall and several historians would bearthis out. His role in the war effort which led to the defeat of Hitler, despitehis extremely complex and debilitating illnesses, may be regarded as rank-ing close to the top in importance. Whether, a hundred or more years fromnow, that event the defeat of Hitler-will be considered one of the greatturning points in history, no one yet knows.

ACKNOWLEDGMENTS

I am indebted to Mr. Harry L. Hopkins' children, Mr. David Hopkins,Mrs. Diana Baxter, and Mr. Robert Hopkins for making it possible toobtain medical records from the Miayo Clinic and the Memorial Hospital,New York, which provided the basis for the medical history. I am also in-debted to those institutions for their cooperation. Dr. Patrick Fitzgerald,Chairman, Department of Pathology, Sloane Kettering Memorial CancerCenter, was enormously helpful in reviewing the pathologic material. Thestaff of the Franklin D. Roosevelt Library, Hyde Park, New York wasmost generous in making materials available on 1lIr. Hopkins' life, andproviding photographs and slides of the Roosevelt era.

REFERENCES

1. SHERWOOD, ROBERT E. ROOSEVELT AND HOPKINS: An intimate history. Harperand Brothers, New York. 1948.

2. BURNS, JAMES MACGREGOR. ROOSEVELT: The soldier of freedom. Harcourt Braceand Jovanovich, Inc., New York. 1970.

3. CHARLES, SEARLE. Minister of Relief. Harry Hopkins and the Depression. Syra-cuse University Press, Syracuse, N.Y. 1963.

DISCUSSION

DR. GEORGE E. SCHREINER (Washington): I find this very interesting. I startedmedical school at Georgetown in 1943 in the Spring and lived in a house on 34thStreet which was just two doors away from an old Georgetown house that had justbeen purchased by the Hopkins and one hot afternoon there was a knock on my door,

MEDICAL HISTORY OF HARRY HOPKINS 31

and I presume this was the second Mrs. Hopkins. She asked if she could see how wehad fixed up our room and furnished it because they were just in the process of be-ginning to refurnish the house, and we lived there with several other medical students.The following day she asked if she could bring Mr. Hopkins back to see what we haddone on redecorating the room, and he came in and I introduced him to my room-mates, and we noticed the sallow skin and slight edema and after he had left specu-ulated that he might have cirrhosis. I never really did know the outeome of the story.

DR. HALSTED: Thank you, Dr. Schreiner, for this interesting observation. I sus-pect that the sallow skin and slight edema which you noted in 1943 and speculatedmight be due to cirrhosis was more likely caused by hypoproteinemia and anemiaresulting from malabsorption at that time. But since he died three years later fromcomplications of cirrhosis you may have been partly right. However, the explora-tory laparotomy a year after you saw him revealed a normal liver grossly.

DR. J. EDWIN WOOD, III (Philadelphia): Editorial opinion expressed recentlysuggests that health records of public officials should become a matter of publicrecord. Do you hold any opinion on this issue?

DR. HALSTED: I recently discussed this question, in part, in a letter which I wroteto the New York Times Book Review Section and shall send you a copy. However,that was not really pertinent to this paper although the health record of publicservants is certainly a highly important matter. I would say, however, that as weall know even the most sophisticated and educated person who is not a cliniciancould not accurately interpret such public health records. To answer your questionspecifically I am not in favor of the suggestion, not that health data of this sortshould be hidden-although that of course is another question of ethics-but becausethey could not be fairly or accurately understood by the public.

DR. JOHN STAIGE DAVIS, IV (Charlottesville): I would like to add that one'sinterpretation of the role Harry Hopkins played depends a lot on one's politicalpoint of view. For example, one thing I gather from this is that our country was notonly being run by a President in extremely poor health but was advised by a manwho was also in extremely poor health. We might characterize the decisions madeat these conferences as not reallv so astute, but because of Mr. Hopkin's illness,extremely hasty.

DR. HALSTED: As a physician I am merely trying to relate Hopkins' serious healthproblems to the extraordinary physical and mental effort he was able to exert, per-haps because of an extreme degree of motivation and dedication. Both Secretary ofWar Stimsoni and General Marshall had the highest regard for Hopkins' ability andpositive accomplishments in the war effort, as dicl several respected historians. Thesame viewpoint respecting the President's ability to function in relation to his healthmight apply I think. The facts known about his health have been published by Dr.Howard Bruenn.* The rest is conjecture and speculation. As to the results of Con-ferences these muist be judged by historians. I was interested to read "Witness toHistory" by Charles Bohlen, who was present at Yalta as the President's interpre-ter. He believed that Roosevelt was mentally sharp and effective. The interpretationof policy juidgments as possibly affected by health matters is very subjective.

1)R. IRVING S. WRIGHT (New York): I wouild like to ask a question that was nottouc('hed UpoIn. I believe I may have some idea of the answer. What was the alcoholichistory of Harry Hopkiiis?

* Bruenn, Howard G. Clinical notes oni the illness and death of President Franik-lin D. Roosevelt. Annals of Internal Medicine. 72: 579-591, 1970.

32 JAMES A. HALSTED

DR. HALSTED: I was skipping a bit to finish on time but did have a note to mentionalcohol since this is the commonest cause of cirrhosis. Hopkins drank socially butnot excessively according to testimony of people who knew him and with whom Ihave talked. It is known that he went for long periods of time without any alcohol.I don't think he could have functioned as he did if he drank a great deal.

DR. DANIEL N. MOHLER (Charlottesville): What did the autopsy show in the smallbowel, in the histology of the small bowel?

DR. HALSTED: They took a biopsy of the jejunum at the second operation and Itried to get it but it was lost. The bowel at autopsy was not compatible with spruebut the material was fixed thirty years ago and autopsy material is not likely to givean accurate picture of intestinal epithelium. All one can say is that sprue canniot beruled in or out.

DR. JOHN H. KNOWLES (New York): I have two questions. The first is relatedto ethics. Even though Hopkins' children gave you permission to inspect his medicalrecords do you think it is ethical to publish them? The second questioni relates toyour reaction to another man's view of Roosevelt and to another question askedthis morning. These would imply to me that science isn't completely pure and de-pends on the ideological bias of the observer. One man's illness, in someone he likes,is interpreted by the friendly observer as leading to creativity. In another whomthe observer doesn't like, he could conclude that illness is what led him to make somany mistakes! To me the ethics of your work, and the substantial question aboutthe objectivity of observers when it comes to famous people and their medical his-tories would lead me to wonder how you personally feel about this.

DR. HALSTED: Regarding the ethics.-As I stated, this was discussed with Hop-kins' heirs-his three children-with their approval. Here is a man, occutpying anuindeniably important place in history, with a disabling health problem who has beendead for 30 years. This to my ethical sense demands as objective studv as possible andwith ptublication-for the sake of historical perspective and the work of future his-torians. A book about Churchill's health and its effect on his judgment, written by hispersonal physician, Lord Moran, has been widely criticized as an invasion of privacy,unfairly or not, depending on one's viewpoint. The book was published one yearafter Churchill's lifetime. Would you clarify your other question, John?

DR. KNOWLES: The other question is that in this day and age illness doesn't nec-essarily do anything to a man's judgment and it might even make it more creative.But in Hopkins' case the situation might lead you in certain paths of interpretation.

DR. HALSTED: Meaning your political bias?DR. KNOWLES: Yes.DR. HALSTED: Well, it certainly might! I can only say that I leaned over back-

ward in my own mind in trying to be as objective as possible.DR. KNOWLES: Great! Jim, thank you very much. It is of some comfort to me that

they lose biopsy reports at the Mayo Clinic as well as other places.DR. HALSTE-D: Not the M.G.H., John?