THE SURGEON GENERAL’S SPEAKER SERIES

Unanswered Mysteries
in the Health of
Franklin Delano Roosevelt

Steven Lomazow, M.D.

National Naval Medical Center
Bethesda, Maryland
November 9, 2007
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 ?
Vice Admiral Ross T. McIntire Admiral Cary T. Grayson
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 Boettinger
May 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 transfused 2 units 50 34
• 5-17-41 7.5 4.6 56 34
• 5-21-41 8.75 6.1 57 34 GI Series normal
• 5-24-41 10.5 5.6 57 30 Entamoeba Coli
• 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 4+ Albuminuria
Elevated Uric Acid*
 Every Tuesday

Barbara Lint sees FDR at Bethesda

for “swim therapy”.
1900 (Age 18) 1913 (Age 31) 1920 (Age 38)
 1933

1932
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
Melanoma Treatment
in 1932
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.”
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

 Archives of
Dermatology
2008
Ackerman, A. & Lomazow, S.

An Inquiry into the Nature of

the Pigmented Lesion above
the Left Eyebrow of Franklin
Delano Roosevelt

“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.

 New Physician Consultants 1944

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

Navy Medicine

Howard G. Bruenn, M.D.

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.
Cousin
DAISY SUCKLEY
(diary entry)

September 30th 1943

Washington

“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!”
Interpreter
CHARLES BOHLEN
Witness 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.”
200

FDR’s Weight in 1944-1945

Baseline- (188)
190

180

170

160

Death
(150?)
150

140

130
Mar Apr May Ju Jul Aug Sept Oct Nov Dec Jan Feb Mar Apr
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

A New View
of Presidential
Health and History
Thank You!

Steven Lomazow, M.D.

lomazow@comcast.net
and Eric Fettmann ef200@verizon.net