Unanswered Mysteries

in the Health of

Franklin Delano Roosevelt

Steven Lomazow, M.D.

National Naval Medical Center

Bethesda, Maryland

November 9, 2007

THE SURGEON GENERAL’S SPEAKER SERIES

First visit to Warm Springs, Georgia 1924

March 19, 1926

“I am down here on a

small boat & the legs

are greatly improved-

I get around now with

no brace on right knee

& hope to get rid of the

other this summer”

FDR’s Medical Records ?

Admiral Cary T. GraysonVice Admiral Ross T. McIntire

Dr. Bruenn’s Explanation

(Bruenn) There was also a history (in the chart) of the development of

a severe iron deficiency anemia in May 1941, with a hemoglobin of

4.5 g/100ml. This was evidently due to bleeding hemorrhoids, and the

anemia responded quickly to ferrous sulfate therapy.

Eleanor Roosevelt to

Anna BoettingerMay 15, 1941

“I found Pa had really been quite ill & Dr.

McIntire was worried because his red cells

which should be up to 5,000,000 dropped

suddenly to 2,800,000. He has had 2

transfusions & his tummy is cleared up & his

color seems good, his blood is back to

4,000,000… no temperature for the last 4 days.

Ross McIntire (interview for 1951 article in US News and

World Report)

Q. Does that mean in all the years he was in the

White House he didn’t have a really serious

illness? Is that right?

A. I would say he didn’t have a serious illness,

but we had one time that gave us a little concern.

He developed a mild anemia… It was the day we

went down to Staunton… I thought he didn’t

look too good and he told me he didn’t feel very

well. He said “It’s strange, I just don’t feel very

well– I feel that I’ve lost some pep.” So when we

got back to Washington we proceeded to get a

blood picture, and sure enough, his blood had

dropped down, so we immediately got busy to

see what had happened. This was over a short

period– We found that he had an ordinary thing

that lots of people have- he had a bleeding

hemorrhoid that he hadn’t noticed, and blood

had been dripping from this thing for quite a

little time and brought him down some. But he

picked up in no time flat. – in fact, no one ever

noticed that- it was just that easy.

• Date Hgb WBC Neut Lymph additional

• 5-19-39 13.5 7.2 48 40

• 6-1-39 13.5 6.5 81 12

• 3-21-40 14 13.9 59 24

• 3-23-40 13.5 9.2 71 16

• 3-27-40 13.5 9.2 68 20

• 5-5-41 4.5 8.4 45 45

• rbc’s show considerable poikilocytosis and moderate anisocytosis with tendency to microcytosis. There is marked hypochromia and some polychromatophilia. Wbc’s are mature in type with some increase in lymphocytes and eosinophils. Indices are all low indicating chronic iron loss. Platelets appear increased.

• 5-6-41 5.25 6.5 71 20

• 5-7-41 5.25 5.2 79 10 retics 2.5%

• 5-8-41 5.5 6.7 80 16

• 5-9-41 5.25 7.4 83 6 retics 3.2%

• 5-12-41 5.5 5.1 65 23

• 5-13-41 5.75 5.0 51 35

• 5-15-41 8 3.8 50 34

• 5-17-41 7.5 4.6 56 34

• 5-21-41 8.75 6.1 57 34

• 5-24-41 10.5 5.6 57 30

• 6-4-41 12 8.0 60 31

• 6-13-41 11 5.2 65 29

• 6-20-41 12.5 7.2 48 38

• 7-5-41 14 10.2 25 73

• 7-16-41 11.5 8.0 37 58

• 7-30-41 11.5 7.6 45 45

• 8-29-41 13.5 5.7 51 43

• 10-23-41 13.5 7.2 47 48 “normal” morphology 1-3-42 10.5 6.1 66 32

• 3-9-42 11.5 7.6 57 39

• 8-14-42 13.5 8.1 66 30

• 10-13-42 12.5 7.1 61 37

• 10-23-43 13.5 6.2 74 15

• 3-9-44 14 4.9 55 33

GI Series normal

Entamoeba Coli

4+ Albuminuria

Elevated Uric Acid*

transfused 2 units

Barbara Lint sees FDR at Bethesda

for “swim therapy”.

Every Tuesday

1900 (Age 18) 1913 (Age 31) 1920 (Age 38)

1932

1933

Late 1933

1935 1936

1937 1938

August 4, 1938

January 17, 1939

January 30, 1939

November 22, 1939 January 9, 1940

1935 Prognosis of Melanotic Sarcoma

Farrell, H.J. (Mayo Clinic)

Cutaneous Melanomas with Special

Reference to Prognosis

Arch Derm Syph 1932; 26: 110-24

“…the prognosis in cases of melanoma

is more unfavorable than that of any

other type of malignant neoplasm.”

“…the outlook in late cases of

melanoma is very poor in any event,

and rather than subject the patient to

radical surgical procedures it would

probably be better to give intensive

roentgenologic treatment as a

palliative measure.”

Melanoma Treatment

in 1932

Ten Day Cruise at Sea

“in Air of Mystery”

February 1940

Image Control

April 9, 1940

July 1940

August 1940

October 28,1940

December 27, 1940

September 11, 1941

1942

March 4, 1942

1933 January 1939 July 1940 August 1940

October 1940 December 1940 1942

Ackerman, A. & Lomazow, S.

An Inquiry into the Nature of

the Pigmented Lesion above

the Left Eyebrow of Franklin

Delano Roosevelt

Archives of

Dermatology

2008

“When fully formed, it

resembled most closely

a melanoma associated

with central regression.”

1943

The “Wen” Operation

February 2, 1944

George V. Webster, M.D. Winchell M. Craig, M.D.

Howard G. Bruenn, M.D.

Photo courtesy Navy Medicine

Frank H. Lahey, M.D.James E. Paullin, M.D.

New Physician Consultants 1944

GASTROINTESTINAL ATTACKS

Melanoma and the GI Tract

• Most common tumor to metastasize to the GI tract

• The incidence of gastrointestinal metastasis from

melanoma found in various studies has been around

68% liver, 58% small bowel, 22% colon, 20%

stomach, 12% duodenum, 5% rectum

• Metastatic melanoma in the gastrointestinal tract

should be suspected in patients with history of

melanoma of the skin and acute gastrointestinal

symptoms.

“At 9.45, I called up the P. to remind

him about telling the Dr. about a pain in

his side. He sounded very cheerful –

said the pain had moved & the Dr. had

left!...So much for that. He will go on a

diet!”

Cousin

DAISY SUCKLEY (diary entry)

September 30th 1943

Washington

Interpreter

CHARLES BOHLENWitness to History, p.143-144

November/December 1943

Teheran

“Roosevelt was about to say something when suddenly, in the flick of an eye, he turned green and great drops of sweat began to bead off his face; he put a shaky hand to his forehead. We were all caught by surprise. The President made no complaint, and none of us detected any sign of discomfort. Hopkins had the President wheeled to his room, where the White House doctor, Rear Admiral Ross T. McIntire, made a quick examination…The President retired for the evening without returning to the dining room. The next morning, Hopkins told me he had been quite concerned about Roosevelt- as had I – until the doctor diagnosed the attack as indigestion.”

Secretary of the Interior HAROLD ICKES (diary entry)

May 20, 1944 Washington

“It seems that he had some trouble with his colon, which at first he thought might be a growth. Then it suddenly it moved to his left side under his heart. It was very painful. Then, without notice, it moved clear over to his right side, where it again caused him pain. At any rate, this had the effect of persuading him that it could not be a growth. Then suddenly it disappeared and he had no pain. He is going to the Naval Hospital soon to have a complete checkup.”

Son

JAMES ROOSEVELT Affectionately F.D.R p.351

August 1944

San Diego

“Father turned suddenly white, his face took on an agonized look, and he said to me: “Jimmy, I don’t know if I can make it- I have horrible pains!”

It was a struggle for him to get the words out… Both of us thought he was suffering from some sort of acute digestive upset- Father himself was positive it had nothing to do with his heart… so for perhaps ten minutes.. father lay on the floor of the railroad car, his eyes closed, his face drawn, his powerful torso occasionally convulsed as the waves of pain stabbed him… then he opened his eyes, exhaled deeply and said “Help me up now Jimmy.” I did so…and the Commander-in Chief went out to review the exercises.”

130

140

150

160

170

180

190

200

Mar Apr May Ju Jul Aug Sept Oct Nov Dec Jan Feb Mar Apr

FDR’s Weight in 1944-1945

Death

(150?)

Baseline- (188)

Yalta Warm

Springs

1945

The “Flat Tummy”

Margaret Suckley

June 27th 1944(diary entry)

The P. was weighed today & has gone down to 174 ¾ - He wants to go up a lb or two, to not be less than 175, & not more than 180. He feels better thin, however, and walked much more easily in the water than a month ago.

Howard Bruenn

August 1944 (from 1970 paper)

“Despite the best efforts

of the cook, liberalization

of calories and much

persuasion, he obstinately

kept himself on his

restricted diet”

NEUROLOGICAL DYSFUNCTION

TURNER CATLEDGE (reporter and future editor of the New York Times)

July, 1944

“when I entered the president’s office. I had my first glimpse of him in several months. I was shocked and horrified- so much of my impulse was to turn around and leave. I felt I was seeing something I shouldn’t see. He had lost a great deal of weight. His shirt collar hung so loose around his neck that you could have put your hand inside it. He was sitting there with a vague glassy-eyed expression on his face and his mouth hanging open.Reluctantly, I sat down and we started talking. I expected him to ask me about the political situation, but he never did. He would start talking about something, then in mid-sentence he would stop and his mouth would drop open and he’d sit staring at me in silence. I knew he was a terribly sick man…. And my talk lasted more than an hour with him….Repeatedly he would lose his train of thought, stop, and stare blankly at me. It was an agonizing experience for me. Finally a waiter brought his lunch, and (Pa) Watson said his luncheon guest was waiting, and I was able to make my escape.”

JOHN T. FLYNN (Related to him by a “high-ranking officer”)

August, 1944

For the first time we hear of his conversation falling into intervals of irrelevance. Here at a dinner he sat reading a short speech.

Suddenly he faltered and paused, his eyes became glassy, consciousness drifted from him. The man at his side nudged him, shook him a little, pointed to the place in the manuscript at which he broke off and said: "Here, Mr. President, is your place." With an effort he resumed. As he was wheeled from his quarters, officers noticed his head drooping forward, his jaw hanging loosely.

(Senator) FRANK MALONEY January 1945

“Maloney went in and sat down. Roosevelt looked up but said nothing, his eyes fixed in a strange stare. After a few moments of silence, Maloney realized that Roosevelt had absolutely no idea who his visitor was. A pious Catholic, Maloney crossed himself and ran to get Pa Watson, fearing the president had suffered a stroke.

“Don’t worry.” Watson said. “He’ll come out of it. He always does.”By the time Maloney returned to the oval office, Roosevelt had pulled himself together. Smiling broadly, he greeted Maloney warmly and launched into a spirited conversation.”

Melanoma and Brain Metastases

• Clinically evident in 70% of cases

• 85% incidence at autopsy

• Terminal event in 25–50% of cases is

intracerebral hemorrhage

April 12,1945

• On the morning of April 12th, the president complained of a mild occipital headache and a stiff neck, relieved by massage by Bruenn and a hot water bottle. After signing some papers he began sitting for a portrait by Elizabeth Shoumatoff.

• 1:15 PM “F seemed to be looking for something; his head forward, his hands fumbling- I (Daisy) went forward & looked into his face. “Have you dropped your cigarette?”

He looked at me with his forehead furrowed in pain and tried to smile. He put his left hand up to the back of his head & said (in a low but distinct voice) “I have a terrific pain in the back of my head”. FDR slumped backwards and was carried to his bedroom and laid in bed on five pillows, fully clothed. (Later, his other cousin, Laura “Polly” Delano stated that he said “be careful” while being carried to the bedroom)

• 1:20 PM “Two or three times he rolled his head from side to side, opened his eyes. Polly thinks that he looked at us all in turn. He may have, I could see no signs of real recognition in those eyes- twice he drew up the left side of his face, as if in pain- But it was only a question of three or four minutes, for he became unconscious as far as one could see.

• 1:30 PM: Dr. Bruenn (who had been in the swimming pool) arrives:

Pale, cold and sweating profusely. Totally unconscious with fairly frequent tetanic contractions of a mild degree. Pupils at first equal, but in a few minutes, the right pupil becomes widely dilated.

BP greater than 300/190. Incontinent of urine. Papaverine, 1 mg. IM. Amyl Nitrate administered. Lower extremity DTR’s unobtainable (understandable in view of FDR’s polio -SL). Right elbow 3+.

• 2:45 PM: Breathing irregular and deep. BP 240/120. pulse 90.

• 3:15 PM: BP 210/110, pulse 96; Right pupil still widely dilated. But the left pupil, from moderate constriction, becomes moderately dilated. Occasional spasm of rigidity with marked slowing of respiration. Cyanotic.

• 3:30 PM: Pupils equal, breathing irregular. Dr. Paullin arrives.

• 3:31 PM: Respiratory arrest, agonal gasps. Absent pulse. Intracardiac Epinephrine administered by Dr. Paullin.

• 3:35 PM. Pronounced dead.

HOWARD BRUENN

re: March 1, 1945 address

(1970 paper)

“It was noticed on the radio by

many that he occasionally

appeared to be at a loss for

words. When queried about this

later, he laughingly reported that

while giving the speech he had

spoken at intervals from memory

and “off the record” and that he

had then had slight difficulty in

finding the proper place when

returning to read the printed

words of his address.”

Editorial: “Medicine in History”The speculation in a recently published book (based on the showing of an

unlabelled slide from Walter Reed Hospital) that the President was suffering

from a metastatic melanoma in the brain, is laid to rest by Dr. Bruenn;

there was no clinical evidence for such a lesion, and no autopsy was

performed. We are given, by Dr. Bruenn, the picture of a great and gallant

man, fatigued by the burdens of his office and by his hypertension and

reduced cardiac reserve, yet quite able to exercise his judgment and to use

the fruits of his unique knowledge and experience in guiding the war effort.”

from McCune et al 1949

The

Melanoma

Hypothesis

• Josephson 1948

• Massie 1961

• L’Etang 1970

• Goldsmith 1979

OTHER THEORIES

• Hypertension

• Encephalopathy

• Cardiac Cachexia

• Prostate Cancer

Metastatic Melanoma

FDR’s Deadly Secret

Steven Lomazow, M.D.and Eric Fettmann

lomazow@comcast.netef200@verizon.net

A New View of Presidential Health and History

Thank You!