PATIENTS

The untold neurological disease of

Franklin Delano Roosevelt (1882 – 1945)

Steven Lomazow

Summary: Conventional wisdom suggests that Franklin Delano Roosevelt died on 12 April
1945 aged 63 from a massive cerebral haemorrhage attributable to uncontrolled hypertension
and atherosclerosis. Evidence from numerous reliable sources is presented, based largely on a
constellation of previously unrecognized neurological symptoms including seizures,
encephalopathy and hemianopia, supporting a scenario that, while indeed he suffered from
severe cardiovascular disease, Roosevelt died from melanoma with the terminal event
attributable to a metastatic lesion in the brain.

The final event Bruenn’s account of events

In the last two years of his life, Franklin Delano
Roosevelt manifested a constellation of neurological
symptoms that had a major influence on his ability to
function as President which are, in large part, the key
to diagnosing a previously unappreciated malignant
process that was responsible for his death on 12 April
1945. The evidence is scattered in thousands of first-
hand accounts, letters, newsreels, photographs and
documents. As early as 1923, a macular lesion above
Roosevelt’s left eye1 can be seen that darkened and
expanded over the next decade and, in the mid-to-late
30s, exhibited morphology compatible with melanoma,2
a highly malignant and vascular tumour notorious for
its propensity to metastasise and bleed in the brain.
At 13:10 on 12 April 1945 at Warm Springs, Georgia,
the 63-year-old President Roosevelt was stricken by a
catastrophic intracerebral haemorrhage that originated
in the right posterior cerebral hemisphere and rapidly
progressed in a classic transtentorial herniation fashion.
Eyewitnesses at the scene have described these events
in detail, namely the cardiologist and primary physi-
cian Howard G Bruenn3 and Roosevelt’s cousin,
Margaret ‘Daisy’ Suckley.4
In 1946 the presidential physician Admiral Ross T
McIntire wrote that Roosevelt’s fatal haemorrhage was
unsuspected5 and vigorously defended this contention
until his death in 1959. The present accepted view of
this event was laid out in detail by Bruenn, the
President’s primary physician from April 1944, in his
1970 paper3 published with the consent and partici-
pation of the family, alleging that Franklin Delano
Roosevelt (FDR) showed little concern for his health
and that his death was solely a consequence of severe
and longstanding hypertension and atherosclerosis.
Steven Lomazow MD, is a neurologist practising in New Jersey. He is
a 1976 graduate of the University of Health Sciences/Chicago
Medical School and did his neurological training at the University of
Minnesota. He was the president of the Neurological Association of
New Jersey and currently is a member of the New Jersey State Board
of Medical Examiners. Correspondence: Steven Lomazow, 8 McGuirk
Lane, West Orange, NJ 07052, USA (email: Lomazow@comcast.net)
Only recently has the veracity of Bruenn’s assertions
been challenged.6 Each of the dozens of major biogra-
phical works published since 1970, beginning with that
of James MacGregor Burns7 who collaborated directly
with Bruenn and the family, is based on Bruenn’s
account. Why should anyone doubt the first-hand
account of the man who essentially lived with the
President and treated him daily for the last year of
his life?
The principal reason is the diary of ‘Daisy’ Suckley
who, unbeknown to the President and his physicians,
preserved her correspondence with Roosevelt and kept
a detailed diary of her relationship with him. First pub-
lished in Geoffrey Ward’s 1995 book, Closest Companion,
no other document is more revealing of the true state
of Roosevelt’s health and psyche. The diary reveals a
story of progressive loss of vitality and the deep con-
cerns Roosevelt had about his health, directly and cred-
ibly controverting the scenario described by Bruenn.
More doubt is cast upon Bruenn’s account by under-
standing how Roosevelt dealt with his previous health
problems. After the fateful summer of 1921, Roosevelt
was never again able to stand without the use of
braces. While the nature of the illness that struck him is
still a matter of debate,8 his intense rehabilitative efforts
and contributions toward the understanding and cure
of polio, his unchallenged diagnosis during his life-
time, are well appreciated.
Doctor Roosevelt
FDR took an active role in his rehabilitation, devising
treatments and novel ways of objectively measuring
improvement.9 He sought out the most learned auth-
orities in the field and gave advice to other victims,
gaining him the title of ‘Doctor Roosevelt’ around
Warm Springs. He personally financed and developed
the medical centre there and founded a charity to raise
awareness of the disease. The ‘March of Dimes’ was
directly responsible for funding the scientific research
that eventually produced a successful vaccine for

Journal of Medical Biography 2009; 17: 235– 240. DOI: 10.1258/jmb.2009.009036

236 Journal of Medical Biography Volume 17 November 2009

poliomyelitis. In 1946 Roosevelt’s image was placed on

the dime to commemorate his immense contribution
towards conquering polio.
Roosevelt made extraordinary efforts to conceal the
degree of his own disability from the public, both
personally and through surrogates including his
political operative, Louis Howe10 and, later, presidential
physician McIntire who was recommended for his posi-
tion largely because of his ability to ‘keep a close
mouth’ by Admiral Cary T Grayson, a long-time friend
of Roosevelt and the mastermind of the cover-up of
Woodrow Wilson’s severe disability following a large
non-dominant hemisphere stroke in October 1919.
Roosevelt exercised strict personal control over every
decision that affected his health. Despite the fact that
he was wheelchair bound, none of the tens of thou-
sands of photos seen publicly during his lifetime
shows him in a physically compromised state. Even
after his death, McIntire and, later, Bruenn, intention-
ally and deceptively protected the privacy of his
medical history. Roosevelt’s penchant for secrecy and
intrigue is well recognized. His existing medical
records carry the names of at least 30 different aliases.
FDR was very prone to infectious disease. While he
was a governor and president, he was frequently laid
up for days or weeks with illnesses that the public was
informed were influenza, sinus trouble, grippe and
swamp fever.

The dread disease

A 2008 paper in Archives of Dermatology co-authored
with dermatopathologist A Bernard Ackerman2
describes the pigmented lesion above Roosevelt’s left
eye and presents a differential diagnosis of melanoma
and solar lentigo. The primary lesion underwent
marked changes throughout 1940 with essentially total
disappearance by the end of 1941. The natural history
of the two possible pathologies is incompatible with
the well-documented rapid change in morphology. The
overwhelming probability is that the lesion was
removed surgically. The highest degree of secrecy
needed to be enforced since any hint that the President
was being treated for a highly malignant condition, as
melanoma was known to be at the time,11,12 would
have been disastrous to his future aspirations. Other
than a letter from a Massachusetts gynaecologist
expressing concern about it,13 the lesion quietly
disappeared.
Roosevelt had mild, intermittent hypertension noted
as early as 1933 that accelerated rapidly in 1944 with
one transient episode of inability to write his name cor-
rectly in 193714 and a well-documented syncopal
episode in March 1940.15 In 1943 many new and per-
sistent problems began to show.
Tremor
Beginning in late 1943 a progressive intention tremor
was noted that ultimately had a profound effect upon
his handwriting (Figure 1). As early as June 1943 FDR
Figure 1 FDR’s handwriting to show the changes in his tremor (author’s
collection): (a) on 1 June 1944, (b) on 7 September 1944, (c) on his last
cheque dated 9 April 1945
asked his secretary to get him a larger coffee cup so as
not to spill the contents when he drank from it. Several
reliable observers reported an intention tremor of vari-
able intensity. While it worsened generally with time, it
waxed and waned from day to day. Some samples of
FDR’s handwriting early in 1945 are virtually unintelli-
gible yet some in March are much clearer. There were
never any overt signs of extrapyramidal disease or lab-
oratory evidence of significant hepatic disease. There
was moderate hypoxemia and an unknown degree of
renal disease. Severe congestive heart failure was
treated with digitalis from early April 1944. FDR’s
mother, two of his sons and a daughter had a tremor.
His alcohol use was moderate, he smoked two packets
of cigarettes a day and, beginning in May 1944, was
using phenobarbital, 30– 60 mg three times daily.
Observers described the tremor. Harry Truman (18
August 1944)16 noted ‘In pouring cream in his tea,
he got more cream in the saucer than he did in the cup.
His hands are shaking and he talks with considerable
difficulty’. Ambassador Joseph P Kennedy (October
1944)17 noted ‘his hands shake violently when he tries
to take a drink of water. About 10 percent of the time
he is talking, his words are not clearly enunciated’. The
Director of Public Relations at the White House, David
Noyes (20 March 1945)18 noted ‘the president was
trying to light a cigarette and put the cigarette in his
 S Lomazow Untold neurological disease of Franklin Delano Roosevelt (1882– 1945)
holder to light it in the usual way. Unable to connect
the match, his hand shaking badly, he opened the desk
drawer, placed his bent elbow inside, partly closed the
drawer and got a firm hold on his hand’. The Secretary
to the Treasury, Henry Morgenthau (11 April 1945)19
wrote ‘he was mixing cocktails. His hands shook so
that he started to knock the glasses over and I had to
hold each as he poured the cocktail ... I noticed that he
took the two cocktails and then seemed to feel a little
better’.
Obviously an intention tremor; the family history
and apparent response to alcohol are highly suggestive
of benign essential tremor. With progression mirroring
the worsening of Roosevelt’s associated medical
problems, enhancement by metabolic encephalopathy
and possibly neuropathy must also be considered
seriously.
The beginning of the end
The Teheran Conference, held from late November to
early December 1943, marked the turning point in
Roosevelt’s health after which there was an inexorable
downhill course. At this conference the first report of
severe paroxysmal abdominal pain is reported,20 likely
the first recorded episode of symptomatic metastatic
disease, a consequence of intussusception well known
to be associated with small bowel metastases from
melanoma. Two other well-documented major abdomi-
nal attacks occurred in May21 and August of 1944.22
Although cholelithiasis was advanced as the source
of FDR’s abdominal pain, his diet was more in keeping
with a patient with partial bowel obstruction, the likely
cause of a 40-pound weight loss in his last year. The
time frame for the appearance of metastatic disease in
late 1943 after removal of the primary lesion in 1940 is
consistent with the natural history of melanoma.
Lethargy and seizures
From late 1943 there are many reports of a persistent
and progressive lethargy and somnolence. From early
in 1944 Roosevelt’s level of alertness varied. He wor-
sened generally as the days progressed. As April 1945
neared, the periods of exhaustion and stupor worsened
and he had many more bad days than good.
On 27 March 1944 FDR was diagnosed with severe
congestive heart failure which likely was a major con-
tributor to his tiredness. Shortly afterwards he was
started on digitalis which brought about rapid remark-
able clinical improvement. Despite another month of
seclusion, an enforced four-hour workday and mid-day
naps, the lethargy progressed. Secretary Grace Tully
(1944)23 ‘worried when Mr Roosevelt suddenly dozed
over his mail. She had witnessed it several times. In
chats with political friends he frequently ‘drew a blank’
as they listened: abashed, he had to ask what he had
been talking about’. Assistant Secretary of State
Breckinridge Long (1 November 1944)24 noted ‘I am
not sure nowadays that things are properly and fully
237
presented to the President and in such a manner that
he can pass on these matters with a full understanding
of the consequences of decisions’. Long-time friend
and Secretary of Labor Francis Perkins (January 1945)25
noted ‘I had a sense of his enormous fatigue. He had
the pallor, the deep gray color of a man who had been
long ill. He supported his head with his hand as
though it were too much to hold up. His lips were
blue. His hands shook’.
Speechwriter John Gunther (February 1945)26 noted
‘His fatigue was crushing, and he had intermittent
periods of being virtually comatose. In fact his exhaus-
tion was so complete that, on occasion, he could not
answer simple questions and talked what was close to
nonsense’. Winston S Churchill (February 1945)27 noted
‘His captivating smile, his gay and charming manner
had not deserted him, but his face had a transparency,
an air of purification, and often there was a far-away
look in his eyes’. Churchill’s physician, Lord Moran (13
February 1945)28 wrote ‘he sat looking straight ahead
with his mouth open, as if he were not taking things
in ... He has all the symptoms of hardening of the
arteries of the brain in an advanced stage’ and ‘The
President vacillated between intellectual acumen and a
vacuous attitude which was impossible to penetrate
with ideas and conversation. These extremes presented
themselves within hours of each other’. Judge Marvin
Jones (17 March 1945)29 ‘remembered that Mrs
Roosevelt carried most of the conversation and the
President would sometimes brighten up for a moment
and then ... his head would drop down’.
At FDR’s last public appearance, at the White House
correspondents’ dinner on 21 March 1945, Allen Drury,
correspondent for the United Press, noted how old and
thin and scrawny-necked FDR looked when he was
wheeled in, how he stared out at the crowded tables as
though he did not see the people, how he failed to
respond to the blare of trumpets and to the applause.
Everyone watched the greatest performer of all – how
he steadily drank wine and smoked his uplifted ciga-
rette, how he leaned forward with his hand cupped
behind his ear to hear a joke repeated as laughter
welled up in the room, how his booming laughter rang
out. Then a few moments later observers noticed how
he simply sat at the table with an intent, vague
expression on his face, while his jaw dropped and his
mouth fell open.30
The Canadian Prime Minister McKenzie King (26
March 1945)31,32 wrote ‘Roosevelt repeated two long
stories ... that he had told King the night before, King
noticed that Mrs Roosevelt and Anna ‘seemed a little
embarrassed’. Speechwriter Robert Sherwood (March
1945)33 noted the president was ‘in much worse shape
than I have ever seen him ... he had seemed unnatu-
rally quiet, even querulous, never before had Sherwood
found himself in the position of having to carry on
most of the conversation without reply’. In March 1945
‘Roosevelt was an animated human being from nine in
the morning until an hour after midday. Each day at
lunchtime he appeared to shatter into helpless frag-
ments. The good nature seemed intact but the body
and the mind faded in function toward a smiling
helplessness’.34
238 Journal of Medical Biography Volume 17 November 2009
Disturbing as the above reports are, there are others
for which an explanation other than seizures is hard to
surmise. New York Times reporter and editor Turner
Catledge (early April 1944)35 wrote ‘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 some-
thing, then in mid-sentence he would stop and his
mouth would drop open and he’d sit staring at me in
silence. ... Repeatedly he would lose his train of
thought, stop, and stare blankly at me’. John T Flynn36
wrote of an August 1944 incident related to him by an
eyewitness high-ranking officer ‘[while] reading a short
speech suddenly (FDR) 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’. At a January 1945
meeting between Roosevelt and Senator Frank
Maloney,37 ‘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 (Chief of Staff) Pa Watson, fearing the presi-
dent 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 conver-
sation’. The clincher comes from Francis Perkins38 who
noted in an oral history ‘the change in appearance had
to do with the oncoming of a kind of glassy eye, and
an extremely drawn look around the eyes and cheeks,
and even a sort of dropping of the muscles of the jaw
and mouth, as though they weren’t working exactly.
I think they were, but there was a great weakness in
those muscles. Also, if you saw him close to, you
would see that his hands were weak ... When he
fainted, as he did occasionally – not for many years,
but for several years – that was all accentuated. It
would be momentary. It would be very brief, and he’d
be back again’.
Over his last two years Roosevelt manifested pro-
gressive global cerebral dysfunction with frequent
episodes highly suggestive of seizures. It is remarkable
that Doctor Bruenn never acknowledged this problem,
one that a careful and competent physician such as he
must have recognized.
There is also a report of ‘brain haemorrhage’ while at
his residence in Hyde Park, New York, on 25 March
194539 in which FDR was ‘unconscious for some time’
and ‘miraculously recovered’. Since he was seen shortly
afterwards in his usual state of health, it was more
probably a transient seizure, transient ischaemic attack
or a syncopal episode.
Neurosurgeon Bert Park40 blamed FDR’s lethargy on
encephalopathy secondary to hypoxemia. Most prob-
ably there was encephalopathy although it was multi-
factorial. There is evidence of renal compromise.
Hypoxemia is easily implicated by right heart failure, a
long history of heavy smoking and pulmonary metas-
tases. Hypertension in 1944 was severe and persistent
with diastolic pressures consistently between 105 and
120 and spikes as high as 150. When on the campaign
trail and during the delivery of his fourth inaugural
address, and while in considerable pain,41 the
President was not observed to have much difficulty
with his mental faculties. The vast majority of the
reports of problems are in a less stimulating setting,
entirely consistent with a low-grade encephalopathy.
While the degree of his hypertension was alarming,
and an element of vascular dementia must be con-
sidered, Roosevelt never manifested any of the dys-
arthia, dysphagia and emotional lability characteristic
of advanced hypertensive cerebrovascular disease.
Explaining the aetiology of the seizures is more pro-
blematic. His chief of staff ’s casual familiarity with
them and Francis Perkins’ oral history provide reliable
evidence that they were not infrequent. The events,
most akin to partial complex seizures, were likely due
to a combination of a silent temporal lobe infarct and
multi-factorial encephalopathy. It would be attractive
to invoke cerebral metastases but the reliable obser-
vation from May 1944 and Francis Perkins’ obser-
vation that they were occurring for ‘several years’
weigh heavily against this, considering the very short
survival time in patients with metastatic brain mela-
noma. The apparent lack of focal neurological findings
through to the end of 1944 also speaks against earlier
brain metastases.
What FDR’s doctors’ thought about the aetiology of
the seizures is not known. They did not evade concern.
There is a report that the Navy’s chief neurosurgeon,
Winchell M Craig, performed a pneumoencephalogram
on the president.42
While the specialty of epileptology was in its infancy
in the 1940s, effective treatment was known. Merritt
and Putnam had introduced Dilantin (phenytoin) in
1937 and FDR was given phenobarbital, 90– 180 mg per
day, starting in April 1944, allegedly for control of his
hypertension but more likely for his episodic lapses of
consciousness.
Admiral McIntire, Surgeon General of the Navy,
was a competent ENT physician and, contrary to
current historical thought, competently utilized the
expertise of the finest naval and civilian doctors
including surgeon Frank Lahey and internist James
Paullin. No man could have received more competent
attention to his health than FDR. It is absurd to
assume that any measure was spared in treating the
President of the United States. His neurological care
was delivered by the chief neurosurgeon of the Navy,
Winchell M Craig, who later enjoyed a distinguished
career at the Mayo Clinic.
 S Lomazow
New answers
On 6 January 1945 the President prepared a newsreel
video of excerpts of the State of the Union address that
he had delivered on the radio. By this time he was
physically incapable of standing for the period required
to deliver it before a joint session of Congress as had
been his custom. The video reveals a curious behaviour
not previously seen in videos Roosevelt had made as
late as November 1944. While speaking, he used his
hands, first the left and then the right, apparently to
keep his place on the printed page. More evidence of
visual – spatial problems is seen in a 14 January diary
entry of Margaret Suckley who wrote ‘FDR called up at
5 minutes of two – he had mistaken the time on his
clock and had just come downstairs for his lunch’.
Yalta
Much has been written about FDR’s less than optimal
performance at Yalta in February 1945. Some accounts
provide clues to the reason why: Lord Moran wrote43
‘Winston is puzzled and distressed. The President no
longer seems to the PM to take an intelligent interest
in the war; often he does not seem to read the papers the
PM gives him’. Adviser James Byrnes44 wrote ‘Not until
the day before we landed at Yalta did I learn that we
had on board a very complete file of studies and
recommendations prepared by the state department ...
I am sure the failure to study them while en route was due to
the President’s illness’.
Franklin Roosevelt’s last public address was on 1
March 1945, a report to Congress upon his return from
Yalta. It is best remembered as the first and only address
of this magnitude given in a sitting position and the
only address where he referred publicly to his disability.
The speech is also notable for frequent, uncharacteristic
deviations from the prepared text. Roosevelt was a
master orator and showman. Every public event was
carefully orchestrated and every speech painstakingly
prepared and rehearsed. Rarely did he deviate from his
prepared text. Despite mixed reviews from the press,
those closest to him were aghast.
His speechwriter John Gunther45 wrote ‘this speech
was the first indication to many that something may be
gravely wrong with the President ... he ad-libbed a
great deal. In fact never in his whole career had he
ad-libbed so much in an important speech; he departed
from his prepared text no fewer than forty-nine times.
This phenomenon too was disconcerting to those who
were worried about his condition’. Speechwriter
Samuel Rosenman46,47 wrote ‘The President made so
many corrections in the reading copy (of the fifth draft)
that it was retyped as a sixth draft ... I was dismayed at
the halting, ineffective manner of delivery. He ad-
libbed a great deal – as frequently as I had ever heard
him. Some of his extemporaneous remarks were wholly
irrelevant, and some of them almost bordered on the
ridiculous ... It was quite obvious that the great fighting
eloquence and oratory that distinguished him in his
campaign only four months before were lacking’.
Untold neurological disease of Franklin Delano Roosevelt (1882– 1945) 239
Gunther and Rosenman were unaware of the reason for
the poor performance. Bruenn’s 1970 paper offers an ‘offi-
cial’ explanation: ‘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’.48
A detailed analysis of the original reading copy of
the address of 1 March provides a startling and eerie
objective record of the cause of FDR’s poor perform-
ance. The errors made by Roosevelt are not random.
From the very first page of the prepared text there are
word omissions and errors consistent with a left visual
field deficit. There are about a dozen clear-cut word
substitutions with errors on the left side of the word,
reading decisions as conclusions, here as are, evidence for
advance, arrangements for agreements as well as dozens
of instances of inability to find words on the left-hand
margin and omissions of individual words throughout
the text. Virtually all of the deviations from the text are
explained by these errors and the speaker’s extempora-
neous corrections in order to form semantically correct
sentences. Some pages have relatively few errors but at
times he became hopelessly lost, could not correct
himself immediately and resorted to long ad-lib devi-
ations, often incorporating a few random words of the
prepared text within them. The ad-libs must have also
provided brief respites from the exhausting, intense
mental gymnastics required to present a coherent
address before a packed congressional chamber and a
national radio audience. Some of those present
observed a problem with Roosevelt’s right arm during
the address,49 not knowing that throughout the hour
he was using it is as a stylus while clumsily turning the
pages of the speech.
Only a few minutes of video of the speech still exist.
The audio recording is edited to remove a persistent
cough, as was a transcript of the delivered address to
make it more coherent, a task that press secretary
Jonathan Daniels later commented took quite a bit of
effort.50 That Roosevelt was able to complete the monu-
mental task of delivering an hour-long address with
such a visual deficit is testimony to his skill and experi-
ence as an orator, to his dogged determination and to
an amazing degree of mental acuity. During that hour,
FDR was not impaired by encephalopathy. This address
also provides additional insight into his ability to func-
tion as ‘the sick man at Yalta’ a few weeks earlier.
On 29 March 1945 press secretary Jonathan Daniels
and speechwriter Archibald MacLeish were preparing a
memo that needed Roosevelt’s approval: ‘With seeming
precision he made a slight change in the first paragraph
and pushed the paper back to me. We departed in haste
[only to find that] the change he had made turned into
confusion the rest of the statement [which] he obviously
had not bothered to read’. Sheepishly they returned to FDR
who corrected the error without objection.51
There is objective evidence for a highly supportable
scenario. A progressive right hemispheric deficit, first
seen on the January 1945 video, was the cause of
Roosevelt’s poor performance on 1 March. Six weeks
240 Journal of Medical Biography Volume 17 November 2009
later, on 12 April, the President succumbed to a
massive right-sided supratentorial haemorrhage.
Surely Roosevelt suffered from severe cardiovascular
disease and hypertension that easily could have pro-
duced a similar clinical picture on 12 April but, consid-
ering the removal of a pigmented lesion in 1940,
episodic severe abdominal pain beginning in 1943 and
a 40-pound weight loss from April 1944, a more likely
explanation for his death is melanoma, his terminal
event being a bleed emanating from a metastatic lesion,
a well-recognized and frequent consequence of the
disease? Despite the fact that nowhere within Howard
Bruenn’s 1970 paper, written with the surreptitious
participation of Roosevelt’s daughter Anna and her
physician husband, is there any consideration or dis-
cussion of malignancy; the motivation for writing it is
contained in the accompanying editorial:52
‘The speculation in a recently published book, that the
President was suffering from a metastatic melanoma in the
brain, is laid to rest by Dr Bruenn; there was no clinical evi-
dence 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’.
The ethics of presidential physicians is an ongoing
matter of debate and controversy. In this instance, the
role of Ross McIntire and Howard Bruenn to present a
candid appraisal of their patient’s condition was super-
seded by their respect, devotion and duty to their
commander-in-chief.53
References and notes
1 Time Magazine, 23 May 1923
2 Ackerman AB, Lomazow S. An inquiry into the nature of the
pigmented lesion above Franklin Delano Roosevelt’s left
eyebrow. Archives of Dermatology 2008;14:529– 32
3 Bruenn HG. Clinical notes on the illness and death of President
Franklin D Roosevelt. Annals of Internal Medicine 1970;72:579–91
4 Ward GC. Closest Companion. New York: Houghton Mifflin, 1995
5 McIntire RT. White House Physician. New York: G.P Putnam’s
Sons, 1946
6 Lerner BH. Crafting medical history: revisiting the ‘Definitive’
account of Franklin D Roosevelt’s terminal illness. Bulletin of the
History of Medicine 2007;81:386–406
7 Burns JM. Roosevelt: The Soldier of Freedom. New York: Harcourt
Brace Jovanovich, 1970
8 Goldman AS, Schmalsteig EJ, Freeman DH Jr, Goldman DA,
Schmalstied FC Jr. What was the cause of Franklin Delano
Roosevelt’s paralytic illness? Journal of Medical Biography 2003;11:
232– 40
9 Letter of FDR to William Eggleston, MD, 11 October 1924
10 Letter of Louis Howe to Clayton L Wheeler, 20 September 1921,
Joseph Plaud Collection (Heritage Auctions Sale 6010); in part:
‘Dear Mr Wheeler: As you have probably seen in the papers Mr
Roosevelt’s illness turned out to be an attack of infantile
paralysis which fortunately is very mild and from which the
doctors assure him he will suffer no permanent effects’
11 Handley S. Prognosis of simple moles and melanotic sarcoma.
Lancet 1935:1401 –3
12 Farrell HJ. Cutaneous melanonas with special reference to
prognosis. Archives of Dermatology and Syphilology 1932;26:110–24
13 Letter from Ross McIntire to Dr Reuben Peterson, 25 January
1940. FDR Library, Ross McIntire papers, Box 6; the letter was in
response to a letter written to FDR by Peterson. McIntire wrote
‘The pigmented area above the President’s eye is very superficial
and has never shown any sign of an inflammatory nature. You
can rest assured that it is under observation at all times’
14 Suckley Diary, 10 September 1944
15 Bullitt OH, ed. The Correspondence Between Franklin D Roosevelt
and William C Bullitt. London: Andre Deutsch Ltd, 1973:298–9
16 Ferrell RH. The Dying President, Franklin Roosevelt 1944–45.
Columbia and London: University of Missouri Press, 1998:89
17 Wills M. A Diminished President. FDR in 1944. Raleigh: Ivy House,
2003:82
18 Ferrell, op. cit. ref. 18: p. 111
19 Henry Morganthau, Jr. Diary, 11 April 1945
20 Bohlen C. Witness to History, 1929–69. New York: WW Norton &
Company, 1973
21 Bruenn, op. cit. ref. 3: p. 584
22 Roosevelt J, Shallett S. Affectionately FDR. New York: Harcourt
and Brace, 1959:351
23 Bishop J. FDR’s Last Year. April 1944–April 1945. New York:
William Morrow & Company, 1974:263
24 Bohlen, op. cit. ref. 22: pp. 206– 7
25 Crispell KR, Gomez CF. Hidden Illness in the White House.
Durham and London: Duke University Press, 1988:121
26 Gunther J. Roosevelt in Retrospect. New York: Harper & Brothers,
1950:360
27 Crispell and Gomez, op. cit. ref. 27: p. 125
28 Evans HE. The Hidden Campaign. FDR’s Health and the 1944
Election. Armonk, NY and London: M. Sharpe, 2002:128
29 Ibid., p. 110
30 Burns, op. cit. ref. 8: pp. 594– 5
31 Goodwin DK. No Ordinary Time. Franklin and Eleanor Roosevelt:
The Home Front in World War II. New York: Simon & Schuster,
1994:588
32 Ferrell, op. cit. ref. 18: p. 112
33 Bishop, op. cit. ref. 25: p. 518
34 Ibid, p. 534
35 Wills, op. cit. ref. 19: pp. 24– 5
36 Flynn JT. The Roosevelt Myth. Garden City: Garden City Press,
1948
37 Goodwin, op. cit. ref. 35: p. 571
38 Perkins F. Oral History given to Dean Albertson, 1955, Columbia
University Oral History Project, Part 3, Book 8: 280 –5
39 News Story Magazine, October 1945:8
40 Park BE. The Impact of Illness on World Leaders. Philadelphia:
University of Pennsylvania Press, 1986
41 Roosevelt and Shallett. op. cit. ref. 24: p. 354
42 Ferrell. op. cit. ref 18: p. 161, footnote 9
43 Wilson C. (Lord Moran). Churchill. Taken from the Diaries of Lord
Moran. New York and London: Houghton Mifflin, 1966:43
44 Byrnes JF. Speaking Frankly. New York: Harper & Brothers,
1947:23
45 Gunther, op. cit. ref. 28: pp. 363 –4
46 Rosenman SI. Working With Roosevelt. New York: Harper and
Brothers, 1952:527
47 Ibid., p. 455
48 Bruenn, op. cit. ref. 3: p. 591
49 Morgan T. FDR, A Biography. New York: Simon and Schuster,
1985:758
50 Daniels J. White House Witness. New York: Doubleday, 1975:255
51 Ibid. p. 277
52 Elkinton JR, Huth EJ. Medicine in history. Annals of Internal
Medicine 1970;72:593
53 Steven Lomazow and journalist Eric Fettmann will be
incorporating the information contained in this paper into a
comprehensive medical biography of Roosevelt entitled FDR’s
Deadly Secret, to be published by Public Affairs and released in
early 2010