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Saturday, January 30, 2010
Thursday, January 28, 2010
Yet Another Stunning Report of Roosevelt's Seizures and Disability
This report comes from an oral history taken for the Herbert Hoover Presidential Library on December 1, 1969 of Walter S. Robertson, a senior offiical in the state department. The document is 28 pages in length. The following begins of page 24:
"I had been out in Australia for two years and I was coming home to go over to the State Department, and I went by to tell him (General Douglas MacArthur) goodby. I haven't seen this in print anywhere. The man who collected General MacArthur's papers probably doesn't know it ever existed. I'm telling you of a personal conversation I had with him on August 1, 1944. As I went in he greeted me and said. "You can't guess where I've been." He said, "I've just come back from a meeting with the President in Honolulu." It was a secret meeting, it later came out. He said: "He asked me to come to meet him there, and I hadn't seen Franklin Roosevelt for X-number of years" -- I forget how many -- he had been out in the Phillippines and then down to Australia. And he sais, "I was so shocked when I saw him. He's a doomed man." He said: "Before, he was this dominant personality that dominated every conference he was in." He said: He sat there, and his head bobbed up and down, and his mouth sort of hung open. Admiral Leahy was his aide, and we talked." However, I don't think I'll put on the record what he said. And he said "You can't guess what he wanted of me," and then he told me. But then he went on to say: "If he lives until November, he will be elected President of the United Sttaes, but whoever is elected the Vice President of the United States will serve his term. He's an ill man and don't you be surprised to hear of his death at any moment," But Roosevelt did go back, he went to his doctors and they said he was all right, and he ran. Then when they inaugurated him in January they propped him up -- the doctors saying he was all right. He was inaugurated in January and was dead in April. But Douglas MacArthur told me in his office in August '44 not to be surprised at his death at any moment. I'll tell you off the record -- I won't put in on tape -- what it was the President . . . (machine turned off)
This is but one of dozens of similar accounts, though perhaps one of the most graphic and one of the earliest, of the degree of medical problems FDR was experiencing. This is the first account I've seen of MacArthur's comments from his meeting with FDR in Honolulu.
To recount, other graphic reports of his seizures come from: Anna Roosevelt Halsted, Frances Perkins, Senator Frank Maloney, future NYT editor Turner Catledge, to mention only a few.
As stated in the book, these seizures most probably came from a stroke as a consequence of vascular disease. The visual deficit seen after January 1945 was more probably related to a brain metastasis from melanoma as was the fatal brain hemorrhage on April 12th 1945.
I will leave it to you to judge the impact of these astounding findings on the course of history.
"I had been out in Australia for two years and I was coming home to go over to the State Department, and I went by to tell him (General Douglas MacArthur) goodby. I haven't seen this in print anywhere. The man who collected General MacArthur's papers probably doesn't know it ever existed. I'm telling you of a personal conversation I had with him on August 1, 1944. As I went in he greeted me and said. "You can't guess where I've been." He said, "I've just come back from a meeting with the President in Honolulu." It was a secret meeting, it later came out. He said: "He asked me to come to meet him there, and I hadn't seen Franklin Roosevelt for X-number of years" -- I forget how many -- he had been out in the Phillippines and then down to Australia. And he sais, "I was so shocked when I saw him. He's a doomed man." He said: "Before, he was this dominant personality that dominated every conference he was in." He said: He sat there, and his head bobbed up and down, and his mouth sort of hung open. Admiral Leahy was his aide, and we talked." However, I don't think I'll put on the record what he said. And he said "You can't guess what he wanted of me," and then he told me. But then he went on to say: "If he lives until November, he will be elected President of the United Sttaes, but whoever is elected the Vice President of the United States will serve his term. He's an ill man and don't you be surprised to hear of his death at any moment," But Roosevelt did go back, he went to his doctors and they said he was all right, and he ran. Then when they inaugurated him in January they propped him up -- the doctors saying he was all right. He was inaugurated in January and was dead in April. But Douglas MacArthur told me in his office in August '44 not to be surprised at his death at any moment. I'll tell you off the record -- I won't put in on tape -- what it was the President . . . (machine turned off)
This is but one of dozens of similar accounts, though perhaps one of the most graphic and one of the earliest, of the degree of medical problems FDR was experiencing. This is the first account I've seen of MacArthur's comments from his meeting with FDR in Honolulu.
To recount, other graphic reports of his seizures come from: Anna Roosevelt Halsted, Frances Perkins, Senator Frank Maloney, future NYT editor Turner Catledge, to mention only a few.
As stated in the book, these seizures most probably came from a stroke as a consequence of vascular disease. The visual deficit seen after January 1945 was more probably related to a brain metastasis from melanoma as was the fatal brain hemorrhage on April 12th 1945.
I will leave it to you to judge the impact of these astounding findings on the course of history.
Saturday, January 23, 2010
When did they know? Connecting more dots.
I have previously posted a photograph from LIFE magazine, published in 1937, with a caption that stated FDR had been avoiding photographers for four days for a "sty" that in his eye that I subquently found to be his left eye, raising the question as to when they really knew of the malignant potential of the lesion. There is now some further evidence to report.
In my recent conversations with Dr. Pack's close confidante, Dr. Oropeza, he told me that Pack told him that they were following the lesion for "about ten years" and that it was a "Hutchinson's Freckle" that eventually turned malignant. As you can read in my paper with Dr. Ackerman, that was exactly the thinking in the 1930's.
Re-reading Dr. Harry Goldsmith's book, which is full of stories collected in the early 1980's akin to the ones I am getting now, he recounts on page 70-71 his conversation with Dr. Harry Ungerleider, a retired physician who had examined FDR in 1935 and found a "medical problem" during an insurance exam, after which, because he refused to release the information to government agents, he was hounded by the FBI and IRS to the point that he personally burned the file.
Are Doctors Oropeza and Goldsmith making this up? I think not.
Connecting Dr. Oropeza's story with that of Dr. Ungerleider, there is a suggestion that what the latter physician noted was the pigmented lesion above FDR's left eye.
This is all admittedly incredibly speculative and circumstantial but, if true, dates the problem prior to the second term, during the time when Cary Grayson was still alive (and probably calling the medical shots).
I could never assert with any reasonable probability that the lesion was diagnosed this early, but, knowing the case as I do, my gut feeling tells me that it was.
In my recent conversations with Dr. Pack's close confidante, Dr. Oropeza, he told me that Pack told him that they were following the lesion for "about ten years" and that it was a "Hutchinson's Freckle" that eventually turned malignant. As you can read in my paper with Dr. Ackerman, that was exactly the thinking in the 1930's.
Re-reading Dr. Harry Goldsmith's book, which is full of stories collected in the early 1980's akin to the ones I am getting now, he recounts on page 70-71 his conversation with Dr. Harry Ungerleider, a retired physician who had examined FDR in 1935 and found a "medical problem" during an insurance exam, after which, because he refused to release the information to government agents, he was hounded by the FBI and IRS to the point that he personally burned the file.
Are Doctors Oropeza and Goldsmith making this up? I think not.
Connecting Dr. Oropeza's story with that of Dr. Ungerleider, there is a suggestion that what the latter physician noted was the pigmented lesion above FDR's left eye.
This is all admittedly incredibly speculative and circumstantial but, if true, dates the problem prior to the second term, during the time when Cary Grayson was still alive (and probably calling the medical shots).
I could never assert with any reasonable probability that the lesion was diagnosed this early, but, knowing the case as I do, my gut feeling tells me that it was.
Knowing more about FDR’s Health. Why does it matter?
Since publication of our book, perhaps the most frequent question I am asked is “Even if we now know FDR died of cancer, what’s the difference? This sentiment even rose to the level of a bad joke in the opening monologue on a recent Jay Leno show.
If one is to believe the conventional wisdom as espoused by the editors of the Annals of Medicine in the accompanying editorial to Howard Bruenn’s 1970 paper “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”, then the findings in each and every historical treatise about Roosevelt and his policies since this time should be considered valid. In fact, the reality of FDR’s health and the consequences of it upon his behavior and decision making are a far different story.
It is quite evident, despite the protestations of Howard Bruenn to the contrary, that FDR was well aware of his diagnosis and prognosis prior to accepting the 1944 Democratic nomination for president (we believe he knew it prior to the third term). The Lahey memorandum makes it clear that the president was informed, in no uncertain terms, on July 7th 1944, that he would not survive a fourth term. This had to have had a tangible effect upon Roosevelt’s thought process going forward, especially in light of the fact that he had personally witnessed the decline of Woodrow Wilson and the consequential failure to establish a successful world peace organization due to his marked infirmity. Roosevelt had a close personal relationship with Wilson’s physician, Cary Grayson, and the very same person who administered daily physical therapy to the hemiplegic Wilson, George Fox, later became Roosevelt’s daily personal medical assistant as well.
The establishment of the United Nations dominated Roosevelt’s thinking in the last year of his life. It is easy to see how different his approach might have been with an unlimited amount of time as opposed to the reality of his knowing of his race against death. How much did he then appease Stalin, whom he considered essential to any success?
By 1945, Roosevelt was barely functioning. Was he unable to comprehend the legitimacy of a Japanese peace offer brought to him in January 1945 by MacArthur? If he pursued it more vigorously would we have been spared the loss of hundreds of thousands of lives at Iwo Jima and Okinawa? Would it have been necessary to use atomic weapons in Hiroshima and Nagasaki?
If Roosevelt was able to focus on the information brought to him in March 1945 by General Albert C. Wedemeyer (who wrote he was in “never-never land”) about the future of China, or if he heeded the warnings of Governor George H. Earle about Stalin (instead of exiling him to Samoa) would there have been a Korean war? Would there have been a war in Vietnam? Would there have been a cold war?
All of these questions must now be revisited, based on the enhanced knowledge we now have about the thinking process and mental capabilities of the man responsible for making the most important decisions.
The cadaverous images of the cachectic Roosevelt at Yalta and the dozens of reliable reports of his diminished ability to function in the last year of his life are largely attributable to diseases not at all addressed until now.
So does it matter? Yes Mr. Leno, it surely does.
If one is to believe the conventional wisdom as espoused by the editors of the Annals of Medicine in the accompanying editorial to Howard Bruenn’s 1970 paper “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”, then the findings in each and every historical treatise about Roosevelt and his policies since this time should be considered valid. In fact, the reality of FDR’s health and the consequences of it upon his behavior and decision making are a far different story.
It is quite evident, despite the protestations of Howard Bruenn to the contrary, that FDR was well aware of his diagnosis and prognosis prior to accepting the 1944 Democratic nomination for president (we believe he knew it prior to the third term). The Lahey memorandum makes it clear that the president was informed, in no uncertain terms, on July 7th 1944, that he would not survive a fourth term. This had to have had a tangible effect upon Roosevelt’s thought process going forward, especially in light of the fact that he had personally witnessed the decline of Woodrow Wilson and the consequential failure to establish a successful world peace organization due to his marked infirmity. Roosevelt had a close personal relationship with Wilson’s physician, Cary Grayson, and the very same person who administered daily physical therapy to the hemiplegic Wilson, George Fox, later became Roosevelt’s daily personal medical assistant as well.
The establishment of the United Nations dominated Roosevelt’s thinking in the last year of his life. It is easy to see how different his approach might have been with an unlimited amount of time as opposed to the reality of his knowing of his race against death. How much did he then appease Stalin, whom he considered essential to any success?
By 1945, Roosevelt was barely functioning. Was he unable to comprehend the legitimacy of a Japanese peace offer brought to him in January 1945 by MacArthur? If he pursued it more vigorously would we have been spared the loss of hundreds of thousands of lives at Iwo Jima and Okinawa? Would it have been necessary to use atomic weapons in Hiroshima and Nagasaki?
If Roosevelt was able to focus on the information brought to him in March 1945 by General Albert C. Wedemeyer (who wrote he was in “never-never land”) about the future of China, or if he heeded the warnings of Governor George H. Earle about Stalin (instead of exiling him to Samoa) would there have been a Korean war? Would there have been a war in Vietnam? Would there have been a cold war?
All of these questions must now be revisited, based on the enhanced knowledge we now have about the thinking process and mental capabilities of the man responsible for making the most important decisions.
The cadaverous images of the cachectic Roosevelt at Yalta and the dozens of reliable reports of his diminished ability to function in the last year of his life are largely attributable to diseases not at all addressed until now.
So does it matter? Yes Mr. Leno, it surely does.
Sunday, January 17, 2010
Our Letter to the Editor of the New York Times
In the extensive article devoted to our book “FDR’s Deadly Secret” (Science Times, January 5th), Lawrence K. Altman implies that we may not have adequately “fact-checked”. The case we have laid out is a result of four years of painstaking research. It is the consummation of the prevailing opinions of hundreds of highly trained physicians, across many disciplines, to whom we have presented our findings at many of America’s finest institutions of medicine including Harvard, Columbia, Mount Sinai, SUNY Albany and in the inaugural lecture of The Surgeon General’s Lecture Series at the Bethesda National Naval Medical Center.
As to melanoma, we consulted with the “legendary” Dr. A. Bernard Ackerman (as the Journal of The American Academy of Dermatology called him on the occasion of his 70th birthday) with whom I co-authored a paper in Archives of Dermatology after we examined many hundreds of photographs at the Franklin Delano Roosevelt Library at Hyde Park. In their abstract, the editors of this esteemed publication wrote “the lesion, when fully developed most closely resembled a melanoma with central regression”. This is reflective of the degree of care and high level of expertise utilized in all of the material presented.
Nor are all of our findings speculative. That Roosevelt suffered a near-fatal gastrointestinal bleed in 1941 requiring at least nine previously unreported transfusions over two months is an absolute certainty. That he suffered frequent and clinically evident seizures for over a year before his death goes well beyond any reasonable doubt and the evidence presented that presidential cardiologist Howard Bruenn’s 1970 paper is less than an unimpeachable or unbiased source is overwhelming.
As my colleagues in the top echelon of the various specialties that deal with the panoply of pathology that FDR manifested publicly weigh in, it will provide even more reinforcement that our findings are consistent with the highest levels of present-day medical reasoning.
Our book unequivocally states that we cannot prove our hypothesis with absolute certainty absent the presence of tissue or medical records. This does not, though, require that we continually qualify every observation and statement as we present it. We hope that those who offer future critique will do so only after thoroughly reading the entirety of what we have presented, in both the book and our blog www.fdrsdeadlysecret.blogspot.com, the latter containing a wealth of corroborative and supplementary photos, videos and documents that we were unable to include in our original thesis.
“FDR’s Deadly Secret” is, by any measure, the most comprehensive discussion of the health of our thirty-second president. The enhanced knowledge of the facts of FDR’s health that we provide will permit historians to more accurately assess this highly-important and often controversial American persona.
Steven Lomazow, M.D.
Eric Fettman
As to melanoma, we consulted with the “legendary” Dr. A. Bernard Ackerman (as the Journal of The American Academy of Dermatology called him on the occasion of his 70th birthday) with whom I co-authored a paper in Archives of Dermatology after we examined many hundreds of photographs at the Franklin Delano Roosevelt Library at Hyde Park. In their abstract, the editors of this esteemed publication wrote “the lesion, when fully developed most closely resembled a melanoma with central regression”. This is reflective of the degree of care and high level of expertise utilized in all of the material presented.
Nor are all of our findings speculative. That Roosevelt suffered a near-fatal gastrointestinal bleed in 1941 requiring at least nine previously unreported transfusions over two months is an absolute certainty. That he suffered frequent and clinically evident seizures for over a year before his death goes well beyond any reasonable doubt and the evidence presented that presidential cardiologist Howard Bruenn’s 1970 paper is less than an unimpeachable or unbiased source is overwhelming.
As my colleagues in the top echelon of the various specialties that deal with the panoply of pathology that FDR manifested publicly weigh in, it will provide even more reinforcement that our findings are consistent with the highest levels of present-day medical reasoning.
Our book unequivocally states that we cannot prove our hypothesis with absolute certainty absent the presence of tissue or medical records. This does not, though, require that we continually qualify every observation and statement as we present it. We hope that those who offer future critique will do so only after thoroughly reading the entirety of what we have presented, in both the book and our blog www.fdrsdeadlysecret.blogspot.com, the latter containing a wealth of corroborative and supplementary photos, videos and documents that we were unable to include in our original thesis.
“FDR’s Deadly Secret” is, by any measure, the most comprehensive discussion of the health of our thirty-second president. The enhanced knowledge of the facts of FDR’s health that we provide will permit historians to more accurately assess this highly-important and often controversial American persona.
Steven Lomazow, M.D.
Eric Fettman
Saturday, January 9, 2010
What Caused the 1941 GI Bleed?
In some measure, I am publishing this post to illustrate the degree of thought that went into "FDR's Deadly Secret" and to show that our conclusions are not made flippantly are as part of a loosely constructed "conspiracy theory". I also wanted to emphatically answer Dr. Altman's inference in Science Times that we may not have "fact checked".
Ever since the analysis of the laboratory reports in the Anna Halsted file at the FDRL revealed the details of this nearly catastrophic event, I have been trying to arrive at a reasonable answer as to its cause. This has led to study in the areas of gastroenterology, urology, radiation oncology and medical history that have been both instructive and fascinating to this neurologist. I have consulted with dozens of highly trained physicians in various disciplines and spent many hours of independent research in an effort to reach the most plausible conclusion.
This post may be too technical for the non-physician, but I think my colleagues in the medical profession will find it fascinating. We have a remarkably large amount of objective laboratory evidence from this incident to work with. Just why Ross McIntire chose to preserve this material and send it to Mrs Roosevelt in 1957 is not entirely clear, but one can hazard a guess.
1) Eleanor Roosevelt was already aware of the specific details (down to the actual lab numbers) of this episode. Whether it was FDR himself or Ross Mcintire that told her is unclear, but her letter to her daughter, as seen in Bernard Asbell's book (the original letter personally examined at the FDRL) is absolute and specific.
2) Perhaps McIntire kept them as a reminder that he almost lost his star patient at the time. As we say in the book, this is the only incident where poor medical follow-up can be documented. All the rest (missing obvious heart failure, the cardiac consult motivated only after the family insisted) are a part of Howard Bruenn's 1970 fairy tale.
While there are urinalyses seen from this time and the succeeding months, the next hemoglobin we have is 4.5 on March 5 1941, the day after he returned from Staunton Virginia. (I was just in Staunton to do research at the Wilson Library and the director told me that FDR was reported to look pretty bad on that day, understandable considering that he only about a third of his normal blood volume.
The indicies from the May 5th lab report show a chronic process. Since this number apparantly caught them by surprise, it is fair to surmise that the bleeding was slow and not noticed by FDR or his daily attendants- George Adam Fox, his "physical therapist" who was McIntire's right hand man and Arthur Prettyman, his valet, to whom most probably fell the task of helping FDR on and off the john and cleaning up after it.
Existing lab reports reveal the following-
1) normal upper and lower GI contrast studies. Dr. Behrens remarks that there may have been a silght abnormality in the area of the cecum (possibly due to FDR's 1915 appendectomy), but the study was interpreted as normal.
7) At least nine well-document sudden rises in hemoglobin between May and July 1941 for which there is no other reasonable explanation than transfusion.
Here is a compendium of all the lab work from this time.
http://www.scribd.com/doc/20430562/FDR-s-Weight-Chart-and-1941-Bloodwork
Our conclusions are based on sound medical reasoning backed by years of intensive research. As David Shribman so eloquently concluded in his review of our book in The Wall Street Journal, more information is better than less!
http://online.wsj.com/article/SB10001424052748703580904574638352930354872.html
http://online.wsj.com/article/SB10001424052748703580904574638352930354872.html
So what follows is probably more than you ever wanted to know about the secret medical life of FDR.
While our book devoted considerable space to FDR's May-July 1941 lower GI bleed (and reveals for the first time that there is unequivocal objective evidence for at least nine transfusions), a detailed discussion of the differential diagnosis was felt to be far too technical and speculative to discuss there. This blog is a better forum.
Ever since the analysis of the laboratory reports in the Anna Halsted file at the FDRL revealed the details of this nearly catastrophic event, I have been trying to arrive at a reasonable answer as to its cause. This has led to study in the areas of gastroenterology, urology, radiation oncology and medical history that have been both instructive and fascinating to this neurologist. I have consulted with dozens of highly trained physicians in various disciplines and spent many hours of independent research in an effort to reach the most plausible conclusion.
This post may be too technical for the non-physician, but I think my colleagues in the medical profession will find it fascinating. We have a remarkably large amount of objective laboratory evidence from this incident to work with. Just why Ross McIntire chose to preserve this material and send it to Mrs Roosevelt in 1957 is not entirely clear, but one can hazard a guess.
1) Eleanor Roosevelt was already aware of the specific details (down to the actual lab numbers) of this episode. Whether it was FDR himself or Ross Mcintire that told her is unclear, but her letter to her daughter, as seen in Bernard Asbell's book (the original letter personally examined at the FDRL) is absolute and specific.
2) Perhaps McIntire kept them as a reminder that he almost lost his star patient at the time. As we say in the book, this is the only incident where poor medical follow-up can be documented. All the rest (missing obvious heart failure, the cardiac consult motivated only after the family insisted) are a part of Howard Bruenn's 1970 fairy tale.
3) There is no link apparent link to the deadly secret that one can connect with these lab results. though, as you will see, there may be one indeed.
You will also see that volume and type of medical testing done suggests that the etiology of the problem was probably a mystery even to FDR's physicians at the time.
You will also see that volume and type of medical testing done suggests that the etiology of the problem was probably a mystery even to FDR's physicians at the time.
Now the facts:
FDR's hemoglobin was 13.5 in March 1940, shortly after returning from his second two-week "mystery cruise" aboard the USS Tuscaloosa. At the time, he was out of the public eye for at least two additional weeks, cancelling 3 or 4 press conferences, with a cover story as told by Steve Early to the press that he had "Swamp Fever".
The following 4 photos are from Steve Early's scrapbook at the FDRL. See for yourself!
While there are urinalyses seen from this time and the succeeding months, the next hemoglobin we have is 4.5 on March 5 1941, the day after he returned from Staunton Virginia. (I was just in Staunton to do research at the Wilson Library and the director told me that FDR was reported to look pretty bad on that day, understandable considering that he only about a third of his normal blood volume.
The indicies from the May 5th lab report show a chronic process. Since this number apparantly caught them by surprise, it is fair to surmise that the bleeding was slow and not noticed by FDR or his daily attendants- George Adam Fox, his "physical therapist" who was McIntire's right hand man and Arthur Prettyman, his valet, to whom most probably fell the task of helping FDR on and off the john and cleaning up after it.
Existing lab reports reveal the following-
1) normal upper and lower GI contrast studies. Dr. Behrens remarks that there may have been a silght abnormality in the area of the cecum (possibly due to FDR's 1915 appendectomy), but the study was interpreted as normal.
2) Entamoeba Coli, a benign one-celled parasite, reported in stool for ova and parasites.
3) Normal blood chemistries, other than a low chloride.
4)Persistent low-grade proteinuria.
5)Negative studies for hemolysis.
6)A grossly bloody stool (bright red in color) on two occasions in July.
3) Normal blood chemistries, other than a low chloride.
4)Persistent low-grade proteinuria.
5)Negative studies for hemolysis.
6)A grossly bloody stool (bright red in color) on two occasions in July.
7) At least nine well-document sudden rises in hemoglobin between May and July 1941 for which there is no other reasonable explanation than transfusion.
Here is a compendium of all the lab work from this time.
http://www.scribd.com/doc/20430562/FDR-s-Weight-Chart-and-1941-Bloodwork
All this comes together as a chronic lower GI bleed with a documented loss of 9 grams of hemoglobin in 14 months with ongoing blood loss for two months requiring at least nine transfusions until the patient was apparantly stabilized.
This is beginning to look very much like a classic New England Journal of Medicine CPC, I'll bet you didn't know that there was actually one done in that esteemed journal for the case of Eleanor Roosevelt, after her unexplained death (from undetected miliary tuberculosis). Unlike FDR, medical reports of ER's final illness and autopsy (FDR never had one, its easy to understand why) are completely transparent, authorized to be released by the family and contained, in graphic detail, at the FDRL.
Differential diagnosis:
The most common cause of lower GI bleeding fitting these criteria would be colon cancer. The negative contrast study and the four year survival speaks loudly against this probability, as it does for bowel metastases from melanoma (see 1943 for this one!). Probably next in order of common causes would be diverticuli. This would not be completely excluded with a negative lower GI study, but I am told that the bleeding in this instance is generally paroxysmal and would most probably have been noticed. Remember, the hemoglobin of 4.5, unlike FDR's fatal brain hemorrhage, really did come as a "bolt out of the blue", completely unnoticed until FDR basically collapsed.
One thing this wasn't was hemorrhoids, the cover story. I've yet to find a single physician who doesn't chuckle when presented with the facts and the wholly untenable diagnosis. Even small amounts of bleeding from hemorrhoids (or other rectal pathology such as fissures) is eminently noticable and easily correctable. To lose nine gram of hemoglobin (8 pints of blood) by this route in a little over a year, not to mention in the POTUS, is a virtual impossibility. How this never got challenged until this time is mind-boggling but, of course, how a cosmetically significant "brown blob" over FDR's left eye could disappear without mention in two years is equally remarkable.
There aren't really too many other common causes, so this takes us into the "zebras".
Here is my best (highly educated) guess: radiation bowel disease. This comes from studying the history of the treatment of prostate cancer as best summarized in a wonderful May 2002 article by Samuel R. Denmeade and John T. Isaacs in Nature Reviews. Cancer (also remember that FDR's radiologist, Charles F. Behrens, literally "wrote the book" on the effects of radiation on the body).
In 1941, Charles Huggins and Clarence Hodges published that prostatic cancer is influenced by androgenic (male hormonal) activity, using the level of an enzyme in the blood, acid phosphatase, as an objective measure. In the same year, Huggins’ classic paper described the effective use of surgical and/or chemical castration with the administration of oral estrogen. This was the first systematic approach to the treatment of Prostate cancer and earning Huggins a Nobel Prize in 1966.
Prior to Huggins’ seminal work, brachytherapy, the surgical implantation of radium into prostate through the perineum (the area between the base of the penis and rectum), bladder or rectum was the treatment of choice. It was uncomfortable and technically difficult and rapidly fell out of favor after hormonal therapy was introduced. Prostatectomy was used mostly as a palliative measure until its technique was improved by Terrence Millin in 1945.
Prior to Huggins’ seminal work, brachytherapy, the surgical implantation of radium into prostate through the perineum (the area between the base of the penis and rectum), bladder or rectum was the treatment of choice. It was uncomfortable and technically difficult and rapidly fell out of favor after hormonal therapy was introduced. Prostatectomy was used mostly as a palliative measure until its technique was improved by Terrence Millin in 1945.
Though obviously speculative, the timeline of the advances in medical and surgical treatment at the time of Roosevelt’s illness fits quite well. One of Roosevelt’s frequent prolonged absences from public view, such as the "mystery cruise" or the “swamp fever” that followed would have sufficed to perform and recover from the relatively minor surgical procedure of radium implantation. Likewise, the lower gastrointestinal bleed that resulted in a loss of two-thirds of FDR’s blood between March 1940 and May 1941 would be explained by the well-recognized complication of radiation bowel disease, as would the laboratory evidence consistent with a subsequent radiation nephritis.
This also explains the well-documented presence of urologist William Calhoun Stirling, who was on the scene according to Walter Trohan and Stirling’s soon-to-be estranged daughter, at least as early as 1942. Stirling would have overseen any hormonal therapy and the tentative surgical procedure referred to in Trohan’s important 1975 book “Political Animals”. The recommended procedure could easily have been an orchiectomy. (By the way, Trohan’s 1975 memoir has been been almost completely overlooked by scholars, probably since it is not indexed, to the point that even the incredibly comprehensive archive at the FDRL didn’t have a copy (they do now, courtesy of yours truly). It is an important resource and a unique and critical look into FDR like no other).
My co-author, a non-physician, cringed at the prospect of even mentioning the possiblity of removing FDR's testicles, but that's the stark reality of real medicine. If FDR thought that a cutting edge procedure would prolong his ability to remain in power, he probably would have done it. The whole prostate scenario also gives us some insight into FDR's ability to perform sexually. He was sexually active (probably exclusively with Missy until her stroke) and here is the evidence (note another of the thirty or so aliases)!
For the uninitiated, "motile organisms" are sperm.
In keeping with the highly confidential and sensitive nature of any treatment for prostatic disease, there is no laboratory evidence of acid phosphates levels but this surely would have been available to Mcintire’s board of consulting physicians. There is no reason whatsoever to believe that a competent urologist such as Stirling would not have employed the most advanced measures to treat the world’s most important patient. Even the anticipated operation allegedly described in 1945 by Eleanor to Veronica Lake correlates well with the onset of the newly described advances in surgical prostatectomy.
There's a lot to digest here, but I'm glad for the opportunity to get it into cyberspace. I remain intensely interested in communicating with any physician who might be able to offer additional insight into the etiology of this event, since, despite the educated speculation above, the actual reason for the problem has yet to be determined with reasonable medical certainty.
Thanks.
Thursday, January 7, 2010
The Gospel According to Bruenn.
Here is my article that recently ran on http://www.hnn.us/.
http://hnn.us/articles/120718.html
Some people think that this is a snipe at Dr. Bruenn and that I am trying to demean his reputation. Nothing could be farther from the truth.
Howard Gerald Bruenn was a doctor's doctor and, by all reports. a superb and cutting-edge cardiologist at the the time the specialty was in its infancy. It was for this reason that he came to the attention of Ross Mcintire, who entrusted him above all others with the health of the world's most important patient. I have previously publicly and vigorously defended Ross McIntire, who has been villified as a liar, an incompetent and even a "medical ignoramus" (by the highly regarded historian, Thomas Fleming) in an article I wrote for Navy Medicine.
http://www.scribd.com/doc/20281239/Navy-Med-Article
That Howard Bruenn fell under the spell of the most charismatic person of the 20th century is not surprising. He lived with the man for over a year and professed to Daisy Suckley on March 31st 1945, a mere two weeks prior to FDR's death:
“Miss Suckley, to begin with, you realize that like all people who work with this man – I love him. If he told me to jump out of the window, I would do it, without hesitation.”
Bruenn's role as keeper of FDR's deadly secret goes to the larger question that has been and will be debated in the future: the role of a presidential physician to balance the confidentiality of his patient and the welfare of his country. When Roosevelt was alive, it came straight from the top and after he died, both Mcintire and Bruenn's loyalty remained with FDR's wishes.
If I had cardiac disease, I could only hope to find a personal physician with the competence and ethics of Howard Bruenn. To expose the truth about FDR, and he surely could have done it, was against all that Howard Bruenn was about- the loyalty, competence and ethics of the medical profession that, quite frankly, only a well trained physician can fully appreciate.
I recently had lunch with an internist who practiced with Bruenn for many years, who told me his work was always scrupulously documented and meticulously comprehensive. Not at all surprising for one of America's best clinical cardiologists.
http://hnn.us/articles/120718.html
Some people think that this is a snipe at Dr. Bruenn and that I am trying to demean his reputation. Nothing could be farther from the truth.
Howard Gerald Bruenn was a doctor's doctor and, by all reports. a superb and cutting-edge cardiologist at the the time the specialty was in its infancy. It was for this reason that he came to the attention of Ross Mcintire, who entrusted him above all others with the health of the world's most important patient. I have previously publicly and vigorously defended Ross McIntire, who has been villified as a liar, an incompetent and even a "medical ignoramus" (by the highly regarded historian, Thomas Fleming) in an article I wrote for Navy Medicine.
http://www.scribd.com/doc/20281239/Navy-Med-Article
That Howard Bruenn fell under the spell of the most charismatic person of the 20th century is not surprising. He lived with the man for over a year and professed to Daisy Suckley on March 31st 1945, a mere two weeks prior to FDR's death:
“Miss Suckley, to begin with, you realize that like all people who work with this man – I love him. If he told me to jump out of the window, I would do it, without hesitation.”
Bruenn's role as keeper of FDR's deadly secret goes to the larger question that has been and will be debated in the future: the role of a presidential physician to balance the confidentiality of his patient and the welfare of his country. When Roosevelt was alive, it came straight from the top and after he died, both Mcintire and Bruenn's loyalty remained with FDR's wishes.
If I had cardiac disease, I could only hope to find a personal physician with the competence and ethics of Howard Bruenn. To expose the truth about FDR, and he surely could have done it, was against all that Howard Bruenn was about- the loyalty, competence and ethics of the medical profession that, quite frankly, only a well trained physician can fully appreciate.
I recently had lunch with an internist who practiced with Bruenn for many years, who told me his work was always scrupulously documented and meticulously comprehensive. Not at all surprising for one of America's best clinical cardiologists.
My paper on FDR in Journal of Medical Biography. Additional comments on FDR and Guillain Barre Syndrome (GBS).
Here is a pdf file of my paper "The Untold Neurological Disease of Franklin Delano Roosevelt" in the current issue of the well-respected British Journal of Medical Biography.
http://www.scribd.com/doc/24896077/jhm
The editor is a neurologist, Christopher Gardner-Thorpe. I chose to submit this work to JHM because it had previously published Armond Goldman's article on FDR in which he opined that Roosevelt's polio was actually Guillain-Barre Syndrome. That article garnered, and continues to garner, considerable attention. I have seen it referred to in a number of comments surrounding our book.
http://www.scribd.com/doc/25009888/fdr-gbs
To address that question:
I had the opportunity to get into the Robert Lovett papers at Harvard, which I, in turn, had sent in toto to the FDRL where they are now available on microfilm. In the file, there is a note from Lovett that reveals that FDR probably had a spinal tap at the outset of his 1921 illness (in fact, there is evidence that FDR later underwent a second spinal tap to donate his serum to other victims of Polio, since it was then believed that the spinal fluid of polios was therapeutic. Such was his dedication to curing the disease).
GBS was described in 1916 and Lovett (as many of FDR's later physicians) being the world's leading expert on Polio would surely have known how to differentiate the two. Unfortunately he died unexpectedly in 1924, leaving FDR to find another guru who eventually turned out to be Dr. McDonald. As I have stated at other times, the world's leading expert on polio in the late 1920's was none other than "Doctor" Franklin Delano Roosevelt, who, had he not chosen to re-enter public life, would have surely spent the remainder of his days at Warm Springs, promoting his rehabilitation center and treating fellow polios- so much for Howard Bruenn's 1970 myth that FDR did not care about his health!
The bottom line here, is that Lovett would surely have known that a spinal tap would unequivocally differentiate between the two diseases (polio has white cells, GBS high protein) and most probably knew the results (as undoubtedly did FDR himself). It can therefore safely be inferred that FDR's 1921 neurological illness was indeed polio.
Despite Goldman's sound academic treatise, based largely on a statistical analysis, he was not privy to the fact of the spinal tap (at least, he didn't cite it in his references). This, aside from the facts that the degree of atrophy, the muscle tenderness at the outset of the disease and the perfect timing for the incubation period between FDR's well known visit to the Boy Scout camp and onset of his illness are all most compatible with polio, all lead to the inevitable conclusion that FDR's 1921 illness was poliomyelitis.
http://www.scribd.com/doc/24896077/jhm
The editor is a neurologist, Christopher Gardner-Thorpe. I chose to submit this work to JHM because it had previously published Armond Goldman's article on FDR in which he opined that Roosevelt's polio was actually Guillain-Barre Syndrome. That article garnered, and continues to garner, considerable attention. I have seen it referred to in a number of comments surrounding our book.
http://www.scribd.com/doc/25009888/fdr-gbs
To address that question:
I had the opportunity to get into the Robert Lovett papers at Harvard, which I, in turn, had sent in toto to the FDRL where they are now available on microfilm. In the file, there is a note from Lovett that reveals that FDR probably had a spinal tap at the outset of his 1921 illness (in fact, there is evidence that FDR later underwent a second spinal tap to donate his serum to other victims of Polio, since it was then believed that the spinal fluid of polios was therapeutic. Such was his dedication to curing the disease).
GBS was described in 1916 and Lovett (as many of FDR's later physicians) being the world's leading expert on Polio would surely have known how to differentiate the two. Unfortunately he died unexpectedly in 1924, leaving FDR to find another guru who eventually turned out to be Dr. McDonald. As I have stated at other times, the world's leading expert on polio in the late 1920's was none other than "Doctor" Franklin Delano Roosevelt, who, had he not chosen to re-enter public life, would have surely spent the remainder of his days at Warm Springs, promoting his rehabilitation center and treating fellow polios- so much for Howard Bruenn's 1970 myth that FDR did not care about his health!
The bottom line here, is that Lovett would surely have known that a spinal tap would unequivocally differentiate between the two diseases (polio has white cells, GBS high protein) and most probably knew the results (as undoubtedly did FDR himself). It can therefore safely be inferred that FDR's 1921 neurological illness was indeed polio.
Despite Goldman's sound academic treatise, based largely on a statistical analysis, he was not privy to the fact of the spinal tap (at least, he didn't cite it in his references). This, aside from the facts that the degree of atrophy, the muscle tenderness at the outset of the disease and the perfect timing for the incubation period between FDR's well known visit to the Boy Scout camp and onset of his illness are all most compatible with polio, all lead to the inevitable conclusion that FDR's 1921 illness was poliomyelitis.
Wednesday, January 6, 2010
A New Find. An Authentic Specimen of FDR's Wen.
Comment number 41 of Larry Altman's article in tuesdays Science Times was indeed intriguing, claiming that the father-in-law of the commentor, David Greenspan of Madison, Wisconsin, had a slide of "Roosevelt's mole".
Of course this led to an immediate search to find "number 41". Within an hour I was on the phone with him, a very knowledgable and amiable medical scientist at the University of Wisconsin. He told me his ex-wife, a pediatrician living in Conneticut was in possession of the slide and gave me her phone number.
Shortly afterwards I was on the phone with the daughter of Dr. Richard Berlin, who had done a year in patholgy at Bethesda and gone on to a career as surgeon, dying in 1993. Prior to death, Dr. Berlin gifted his "prize possesion" to his daughter.
She initially told me it was from the lesion above Roosevelt's left eye and that it was not cancerous. She than said she'd call me in a few days when she located it. 5 minutes later she called back with the news that she had found it.
It was labeled "John Doe" and "Bethesda Naval Medical Center" and dated February 2, 1944. Dr Berlin had annotated it "Frank Delano Roosevelt, Epidermoid Cyst".
Thanks to the letter from William Webster, the primary surgeon for the procedure (removal of a cyst the size of a hen's egg fron the back of FDR's head), on page 82 of Harry Goldsmith's book, it became immediately evident that it was indeed an artifact of Franklin Delano Roosevelt, an authentic piece of the "wen" which Dr. Webster wrote was sent to the pathology lab, where the young Dr. Berlin was waiting. He took a specimen of the biopsy and, as they say, the rest is history!
To my knowledge this is the only authentic specimen of FDR known. Obviously, the holy grail would be a be a similarly documented piece of the the pigmented lesion (which I obviously believe will document malignancy). Since the "wen" became a public event, commented upon by FDR in a news conference shortly after the procedure and discussed quite openly in Daisy Suckley's diary, the level of security may have been a bit lax. I doubt that any biopsy of the melanoma would have had any similar opportunity to surface.
There are only two other stories of specimens. One, from Hugh L'Etang's second, less widely circulated book is that pathologist William Ober (of Teaneck New Jersey where Eric now lives,btw) saw a specimen and reported to L'Etang that it was a seborrheic keratosis, a benign lesion.
The other, more intriguing, report appears on the Dr. Zebra website, mentioning that Dr. Philip Kousoubris a radiologist at the Lahey Clinic was told by "an older physician" who was a pathology resident in the early 1940's that he was present when a slide of Roosevelt's pigmented lesion showed a malignancy and was immediately confiscated by the FBI and it is presently housed in a safe in a Newton Massachusetts law firm!
That physician is still alive and when Dr. Kousoubris approached him again, the senior pathologist told him that he would not discuss it any further and that was that! Phil has given me his name but it is probably best to let him continue to work privately to get the information.
Incidentally, Phil is my connection at Lahey. His efforts to get a CME program for me there has met with curious resistance (whether thus is related or not, the director if the Tufts University Foundation that runs the clinic is none other than James Roosevelt, Jr.).
I am personally convinced that FDR had a surreptitous surgery at Lahey in the winter of 1943-44 as exquisitely documented in Harry Goldsmith's book. Harry, who I speak with regularly, told me that his source is absolutely reliable, not to mention that Linda Strand, Lahey's "gumad" for lack of a better term, told Harry that she met FDR at Lahey Clinic while he was there under an assumed name and that she had made all the arrangements! This incident, which I have personally discussed at length with Harry, is an incredibly important piece information. perhaps the most important line in Harry's self-published book, A Conspiracy of Silence, available on Amazon and an indispensible source for anyone seriously interested in FDR's health (by the way, If anyone want's to talk to Harry, contact me and I will give you his contact information).
To add fuel to the fire, I just had a most amazing conversation with Dr. Ruben Oropeza, a close associate of Dr. George Pack, the greatest melanoma surgeon of the early part of the twentieth century, for eight years (1959-1967, Pack died in 1969). Dr Oropeza, whose credibility has been testified to me by an eminent NYC plastic surgeon, told me that Lahey assisted Pack himself in an operation on FDR's melanoma in Boston, at that the operation was performed at 5AM. Dr Oropeza has not read Dr Goldsmith's book and was unaware of the information in it, essentially an independent confirmation of something that probably occurred. Oropeza told me of many things, including news of a second operation involving another prominent surgeon and Pack, related to Oropeza by Pack himself. More on that later, we are in the process of trying to independently confirm this story from relatives and associates of the other surgeon, a very big name indeed.
If there is any chance to to find medical records of FDR's cancer, I believe the best chance is at Lahey, but, to this point, they have been absolutely stone silent. Oropeza also told me that Pack told him that "the records will not come out for 100 years". Should that be the case, I will be 96 years old. I really don't want to wait that long!
(my girlfriend reminded me after reading this that you might know what a "wen" is. It is a benign (non-cancerous) cyst which in this case was allegedly removed because it was bothering FDR when he wore a hat. sl
Of course this led to an immediate search to find "number 41". Within an hour I was on the phone with him, a very knowledgable and amiable medical scientist at the University of Wisconsin. He told me his ex-wife, a pediatrician living in Conneticut was in possession of the slide and gave me her phone number.
Shortly afterwards I was on the phone with the daughter of Dr. Richard Berlin, who had done a year in patholgy at Bethesda and gone on to a career as surgeon, dying in 1993. Prior to death, Dr. Berlin gifted his "prize possesion" to his daughter.
She initially told me it was from the lesion above Roosevelt's left eye and that it was not cancerous. She than said she'd call me in a few days when she located it. 5 minutes later she called back with the news that she had found it.
It was labeled "John Doe" and "Bethesda Naval Medical Center" and dated February 2, 1944. Dr Berlin had annotated it "Frank Delano Roosevelt, Epidermoid Cyst".
Thanks to the letter from William Webster, the primary surgeon for the procedure (removal of a cyst the size of a hen's egg fron the back of FDR's head), on page 82 of Harry Goldsmith's book, it became immediately evident that it was indeed an artifact of Franklin Delano Roosevelt, an authentic piece of the "wen" which Dr. Webster wrote was sent to the pathology lab, where the young Dr. Berlin was waiting. He took a specimen of the biopsy and, as they say, the rest is history!
To my knowledge this is the only authentic specimen of FDR known. Obviously, the holy grail would be a be a similarly documented piece of the the pigmented lesion (which I obviously believe will document malignancy). Since the "wen" became a public event, commented upon by FDR in a news conference shortly after the procedure and discussed quite openly in Daisy Suckley's diary, the level of security may have been a bit lax. I doubt that any biopsy of the melanoma would have had any similar opportunity to surface.
There are only two other stories of specimens. One, from Hugh L'Etang's second, less widely circulated book is that pathologist William Ober (of Teaneck New Jersey where Eric now lives,btw) saw a specimen and reported to L'Etang that it was a seborrheic keratosis, a benign lesion.
The other, more intriguing, report appears on the Dr. Zebra website, mentioning that Dr. Philip Kousoubris a radiologist at the Lahey Clinic was told by "an older physician" who was a pathology resident in the early 1940's that he was present when a slide of Roosevelt's pigmented lesion showed a malignancy and was immediately confiscated by the FBI and it is presently housed in a safe in a Newton Massachusetts law firm!
That physician is still alive and when Dr. Kousoubris approached him again, the senior pathologist told him that he would not discuss it any further and that was that! Phil has given me his name but it is probably best to let him continue to work privately to get the information.
Incidentally, Phil is my connection at Lahey. His efforts to get a CME program for me there has met with curious resistance (whether thus is related or not, the director if the Tufts University Foundation that runs the clinic is none other than James Roosevelt, Jr.).
I am personally convinced that FDR had a surreptitous surgery at Lahey in the winter of 1943-44 as exquisitely documented in Harry Goldsmith's book. Harry, who I speak with regularly, told me that his source is absolutely reliable, not to mention that Linda Strand, Lahey's "gumad" for lack of a better term, told Harry that she met FDR at Lahey Clinic while he was there under an assumed name and that she had made all the arrangements! This incident, which I have personally discussed at length with Harry, is an incredibly important piece information. perhaps the most important line in Harry's self-published book, A Conspiracy of Silence, available on Amazon and an indispensible source for anyone seriously interested in FDR's health (by the way, If anyone want's to talk to Harry, contact me and I will give you his contact information).
To add fuel to the fire, I just had a most amazing conversation with Dr. Ruben Oropeza, a close associate of Dr. George Pack, the greatest melanoma surgeon of the early part of the twentieth century, for eight years (1959-1967, Pack died in 1969). Dr Oropeza, whose credibility has been testified to me by an eminent NYC plastic surgeon, told me that Lahey assisted Pack himself in an operation on FDR's melanoma in Boston, at that the operation was performed at 5AM. Dr Oropeza has not read Dr Goldsmith's book and was unaware of the information in it, essentially an independent confirmation of something that probably occurred. Oropeza told me of many things, including news of a second operation involving another prominent surgeon and Pack, related to Oropeza by Pack himself. More on that later, we are in the process of trying to independently confirm this story from relatives and associates of the other surgeon, a very big name indeed.
If there is any chance to to find medical records of FDR's cancer, I believe the best chance is at Lahey, but, to this point, they have been absolutely stone silent. Oropeza also told me that Pack told him that "the records will not come out for 100 years". Should that be the case, I will be 96 years old. I really don't want to wait that long!
(my girlfriend reminded me after reading this that you might know what a "wen" is. It is a benign (non-cancerous) cyst which in this case was allegedly removed because it was bothering FDR when he wore a hat. sl
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