Thursday, December 31, 2009

BOOK REVIEW: Presidential Medical Secrets: The Most Disturbing of All?

While gossip mavens love to write about or read about the sexual and other private peccadillos of presidents of the United States, there is another aspect of presidential private lives that is much more pertinent in consideration of executive performance in our political history. That is the question of the medical (including the psychological) condition of the chief executive/commander-in-chief of the national armed forces, and the historical occurrence of secrecy and cover-up when a president is seriously or grievously ill.

Most of the time, the secrets come to light only after the term, or after the death, of a president.

The first presidential medical crisis was not a secret, nor a cover-up, but a case of colossal misjudgment. On inauguration day, March 4, 1841, newly-elected President William Henry Harrison (nicknamed “Tippecanoe” after the famous battle he had won as a general) decided to deliver his very long inaugural address on a bitterly cold Washington, DC day without an overcoat. He subsequently caught pneumonia, and a month later, died. (One might say it was the antithesis of a cover-up.) In any event, the Harrison campaign slogan “Tippecanoe and Tyler, Too!” was unexpectedly fulfilled when John Tyler became the first vice president in U.S. history to succeed prematurely, albeit constitutionally, to the presidency.

Numerous secret medical crises have confronted U.S. presidents since, including a possible undiagnosed case of Marfan’s Disease for Abraham Lincoln, the severe alcoholism of Andrew Johnson, the cover-up of Grover Cleveland’s secret surgery for cancer of the jaw on a naval battleship, Woodrow Wilson’s incapacitating stroke which made his wife the de facto president for almost two years, the circumstances in the sudden and premature death of Warren Harding, cover-ups of medical conditions and surgeries of Dwight Eisenhower and Lyndon Johnson, and the complete suppression of the facts by John F. Kennedy when he took office with then-fatal Addison’s Disease that had also made him, in effect, a drug addict.

But the latest revelation of presidential medical cover-ups may be the most serious of all of in historical risks and consequences for the nation.

“FDR Deadly Secret” by Steven Lomazow, M.D. and Eric Fettman (Public Affairs, 2010) is an extraordinary medical detective story that will force some re-evaluation of the nation’s longest-serving president. Roosevelt was sworn in for this fourth term on January 20, 1945. Less than two months later, the generally beloved “war president” (age only 63) died of a cerebral hemorrhage in his retreat at Warm Springs, Georgia, and Vice President Harry Truman took his place. Roosevelt’s physicians, including his primary caregiver, Rear Admiral Ross McIntyre, cited hypertension as the cause of death. Although Roosevelt’s physical condition had dramatically deteriorated since 1943, McIntyre and Roosevelt himself had repeatedly reassured the public that his health was good.

In fact, as authors Lomazow and Fettman conclusively demonstrate in their book, the president was grievously ill from 1940 on, and almost certainly knew most of the extent of his condition, as did the physicians taking care of him. Roosevelt’s immediate cause of death was the cerebral hemorrhage, and he did have severe (“uncontrolled” his physician admitted in 1970) hypertension, but Roosevelt’s underlying conditions of metastatic skin cancer (melanoma) and congestive heart failure were kept from public view for at least five years.

(Technically, although Lomazow is a distinguished neurologist and Fettman a very credible historical journalist, their contentions are theoretical, and they say so, because all pertinent medical records were destroyed or suppressed. Nevertheless, the first-hand testimony of so many involved, and the brilliant medical detective work of the authors makes their scenario accurate, in my opinion, beyond a reasonable doubt.)

In fact, on the day before (in 1944) when he informed the Democratic National Committee that he would run for the unprecedented fourth term, the book’s authors point out that Roosevelt had been told unambiguously and forcefully by his doctors that he could not survive a new term. Records of this do exist.

The precedent for the cover-up of his desperate medical condition, of course, had been set at the outset of his presidency when Roosevelt, his entourage, and the entire national media participated in the total cover-up of his paralysis following a bout with poliomyelitis in 1923. Hard as it may seem to believe today, most of the nation was unaware that the president of the United States was crippled. My father, a general practitioner and lifelong admirer of Roosevelt, first noticed this in October, 1932 when (New York) Governor Roosevelt passed through his home city of Erie, Pennsylvania on a campaign stop. Having succeeded in the most amazing (and for the media, willing) medical cover up in presidential history to that point, Roosevelt no doubt felt that he could succeed in a much more serious cover-up a decade later.

The authors of “FDR’s Deadly Secret” are telling a medical story, and as admirers of Roosevelt the politician, but they cannot avoid the conclusion that the president’s fourth term bid was a fraud from its outset, and a terrible risk for a nation still at war. They also point out that, contrary to popular opinion, Roosevelt wanted to keep Vice President Henry Wallace (a far leftist and a mystic) on the ticket in 1944. Roosevelt only agreed to name Truman after he was informed that the Democratic convention would likely refuse to renominate Wallace, or at the least, it would split the Democratic Party. His choice of Truman, the evidence suggests, was not because Roosevelt foresaw Truman as the excellent president he became, but because Truman would be the most acceptable to the convention and likely to hold the party together.

The book suggests that Roosevelt was informed that he had a malignant melanoma inlate circa 1940. A large mole on his forehead had appeared in the 1920’a, but had
undergone acute changes circa 1939. Photographs in the book show the changing mole and its disappearance (by surgery) over the next two years. Although there was no autopsy of the president in 1945, and no records of a melanoma diagnosis survive, the book plausibly shows that this deadly skin cancer had probably spread to the president’s brain and stomach prior to the 1944 election.

Furthermore, the authors conclusively prove that Roosevelt had been diagnosed with never-publicly disclosed congestive heart disease in this same period, and that he had a series of undisclosed heart “events”, also prior to 1944. This book also reveals that the president spent much of his last year and a half in office sleeping up to 12-18 hours a day, and only occasionally fully engaged in his duties. His physicians, staff, colleagues and family all participated in a massive concealment of Roosevelt’s condition although only the president himself and three or four physicians caring for him knew the whole extent of his illnesses.

As is well-known, Roosevelt only met with Truman privately once after January 20, 1945, and that the vice president was mostly in the dark about many issues facing the nation at war after his nomination, including most notoriously, the existence of the top-secret Manhattan Project developing the first atomic bomb. A few months after taking office and learning about the secret bomb project, Truman had to make the momentous decision of whether to drop two atomic bombs on Japan.

In recent years, a number of biographies of Roosevelt and other histories of his era, most notably Doris Kearns Goodwin’s excellent “No Ordinary Time” (1994), have increasingly mentioned in passing Roosevelt’s medical “secrets” and a few of them have cited reports of a possible melanoma, noting the disappearance of the mole over FDR’s left eyebrow. Some of these books have also analyzed the impact of the heart disease on Roosevelt’s executive performance, particularly at Yalta. Lomazow and Fettman’s book, however, is the first to concentrate on the medical facts, and to trace the evidence to a “beyond a reasonable doubt” conclusion of the skin cancer metastasis as both the principle cause of FDR’s dramatic physical decline and death. That new material, plus the exhaustive demonstration of a
massive cover up that has continued to the present day, is what makes this book so valuable.

By today’s standards, all of this cover-up is unthinkable, and with the frequent appearances of a president live and on camera, close to impossible. In 1945, my father who, as I previously noted, had met Roosevelt briefly in 1932, had become commandant of the base army hospital (Arlington Hall) at General Marshall’s headquarters in Virginia. Although he treated Marshall and his wife on occasion, my father did not treat the president, nor did he see him up close in person. But he did see him in newsreels, and he remarked then to my mother and later to me that he knew Roosevelt was very ill. And so did intuitively virtually all who met with him from 1943-44 on, especially those who had known Roosevelt before the war. Nevertheless, Roosevelt’s own insistence, and that of his personal physicians, convinced most to accept that his ghastly appearance was simply the result of fatigue and the stresses of the war and his duties as president.

Franklin Delano Roosevelt was a major president in American history. He developed an unprecedented bond with a majority of voters while in office as a result of his efforts during the Depression of the 1930’s. He skillfully guided the nation into its role as the defender of democracy and Western civilization before and after December 7, 1941. A case can be made that he was the indispensable man to be president for a third term in 1941 when the rest of the world was at war. In late, 1944, however, with the war clearly coming to an end, he was no longer indispensable, and his inability function daily as president put the nation and our war effort at huge risk. His performance at the Yalta Conference in 1944 has been virtually universally criticized. The failure of this Conference, many contend, prolonged the ensuing Cold War (which ended finally in 1991). The current constitutional limit of two terms was instituted following FDR’s terms.

As the case of President Franklin Roosevelt and this book show, anyone in the most powerful executive position in the free world too long is likely to lose his or her good judgment.

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