Over the years, there has been much speculation about the sudden death of the 32nd president Franklin Delano Roosevelt (FDR) in 1945. Now a new book, FDR's Deadly Secret (Public Affairs, January 2010), by neurologist Steven Lomazow, MD, and journalist, Eric Fettmann, provides a new look into FDR's somewhat guarded medical history. They claim to have uncovered a secret illness that they say contributed to Roosevelt's death.
Dr. Lomazow is assistant professor neurology at the Mount Sinai School of Medicine and president of the Neurologic Association of New Jersey. He also has a private practice in Belleville, NJ. Eric Fettmann is associate editorial-page editor for the New York Post, and has also written for New York Magazine, The Nation, National Review, and USA Today.
Neurology Today spoke to Dr. Lomazow and Mr. Fettmann about their new book and discussed the evidence for the claims.
WHAT INSPIRED YOUR INTEREST IN UNCOVERING FDR'S MEDICAL HISTORY?
Steven Lomazow (SL): I've always been interested in the medical history and diseases of the famous. Ever since reading Harry S. Goldsmith's 1979 article, “Unanswered Mysteries in the Death of Franklin D. Roosevelt” (Surgery, Gynecology & Obstetrics) – when I was doing my neuropathology rotation – I've had it in the back of mind that there was some possibility Roosevelt may have had melanoma.
WHAT LED YOU TO THAT CONCLUSION?
SL: I read the 1970 paper by the primary care doctor who treated Roosevelt in the last year of his life, Dr. Howard G. Bruenn. In the paper, Dr. Bruenn described neurological symptoms that Roosevelt experienced in the last two-and-a-half hours of his life, which are consistent with a transtentorial herniation that emanated from the right hemisphere of the brain.
Dr. Bruenn's 1970 paper established a new clinical history for the president. It stated that Roosevelt suffered from severe cardiovascular disease in the last year of his life, which ended in an unforeseen cerebrovascular event — a stroke — that killed him. From that point on, everybody has taken this as gospel — as the truth.
Now Eric Fettmann and I have uncovered absolute clear evidence to controvert many of things Howard Bruenn wrote in 1970.
WHAT WAS THE EVIDENCE FOR YOUR CLAIM THAT FDR HAD A MELANOMA, WHICH ORIGINATED IN THE PIGMENTED LESION ABOVE HIS EYE THAT EVENTUALLY SPREAD TO HIS BRAIN AND ABDOMEN, AND THAT THE CEREBRAL HEMORRHAGE WAS THE RESULT OF THE MELANOMA COMPOUNDED BY FDR'S CATASTROPHIC HEART PROBLEMS?
Eric Fettmann (EF): We were working off the basic thesis that Roosevelt had melanoma, which had been raised before, but without any real medical basis other than the observation of the pigmented lesion above his left eye. The lesion had characteristics of both a melanoma and benign spot. We enlisted the help of Dr. A. Bernard Ackerman, who was the world's leading dermatopathologist, and he examined the visual evidence we had collected — every photograph and video. He concluded that the lesion most likely, based on physical observation and various other characteristics, was malignant.
SL: Dr. Ackerman based his diagnosis on the “ABCDEs” criteria: asymmetry, border irregularity, color variability, diameter greater than 6 mm, and elevation. He found that Roosevelt's lesion fulfills those criteria.
HOW DID DR. ACKERMAN'S DIAGNOSIS INFLUENCE YOUR RESEARCH?
EF: Since melanoma typically metastasizes to the abdomen and brain, we searched for evidence representative of metastasis.
SL: Melanoma is the most common tumor to metastasize to the gastrointestinal tract; patients who have a history of melanoma and experience acute gastrointestinal symptoms should consider a possible metastasis to the GI tract.
There are several documented reports that suggest Roosevelt suffered from gastrointestinal pain. Roosevelt's son, James, recalled in his book, Affectionately F.D.R. (Harcourt, 1959) an extreme episode of his father's gastrointestinal pain:
“Father turned suddenly white, his face took on an agonized look, and he said to me: ‘Jimmy, I don't know if I can make it I have horrible pains!’ It was a struggle for him to get the words out Both of us thought he was suffering from some sort of acute digestive upset. Father himself was positive it had nothing to do with his heart ...so for perhaps ten minutes...father lay on the floor of the railroad car, his eyes closed, his face drawn, his powerful torso occasionally convulsed as the waves of pain stabbed him... then he opened his eyes, exhaled deeply and said ‘Help me up now Jimmy.’”
WHAT IS THE MOST COMPELLING EVIDENCE SUPPORTING YOUR MELANOMA HYPOTHESIS?
SL: Dr. Bruenn wrote Roosevelt died from a hemorrhage that originated in the right posterior portion of the brain — the area of the brain that controls vision — with arteriosclerosis as the only contributing cause on his death certificate. I asked myself what neurologic symptoms would be evident to indicate Roosevelt had a tumor in that area of his brain.
Six weeks prior to his death, Roosevelt gave a highly uncharacteristic speech to Congress about his summit at Yalta. Roosevelt was known to be a highly obsessive person: Everything he did was rehearsed — every word and gesture of a speech. However, during the Yalta speech, he made numerous word errors, ad-libbed, and rambled — he had never done this before.
EF: It was the worst performance of Roosevelt's career. We wanted to find out if it was the result of true exhaustion, of it was caused by something else.
SL: While analyzing the original reading copy of the speech, it became highly evident that Roosevelt gave the speech with hemianopia — a left-side visual field impairment. An overwhelming majority of the word-substitutions and word errors occurred on the left side of the text. Roosevelt made about a dozen word substitutions; most notably he replaced “decisions” with “conclusions”; “arrangements” with “agreements”; “here” as “are”; and “evidence” with “advance.” Just six weeks later Roosevelt died of a brain hemorrhage that emanated from the area of the brain that controls the left side of your vision. That was the epiphany moment, because that makes Roosevelt's death a lot more than a bolt of the blue, like Dr. Bruenn's version. This evidence suggests that Roosevelt had melanoma that metastasized to his brain. In fact, melanoma metastasizes to the brain more than any other non-primary CNS tumor, and hemorrhages from brain metastases are the second most common cause of death among melanoma victims.
I UNDERSTAND MANY OF FDR'S MEDICAL RECORDS WERE LOST OR COVERED UP. COULD YOU TELL US MORE ABOUT THAT — AND HOW YOU WERE ABLE TO TRACK DOWN THE INFORMATION?
SL: Roosevelt's medical records have been missing since his death. But the pieces of the puzzle are scattered all over. Many books have been written about Roosevelt's health, and each of them has a little bit of evidence that doesn't gel with Dr. Bruenn's account. Those most supportive of our theory include: Closest Companion (Geoffrey Ward, 2009); A Conspiracy of Silence (Harry Goldsmith, 2007); and Hidden Illness in the White House (Crispell & Gomez, 1988)
We have also located dozens of eyewitness reports — from Labor Secretary Frances Perkins, Sen. Frank Maloney, and The New York Times editor and reporter Turner Catledge to name a few — describing events that are undoubtedly complex partial seizures. Some of the reports are so convincing that any neurologist that reads them would agree they're complex partial seizures.
The most graphic of the reports comes from Roosevelt's longtime friend and cabinet member, Frances Perkins. In a 1955 oral history interview with Columbia University, Perkins recalled: 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.
WHY DO YOU THINK DR. BRUENN MIGHT HAVE COVERED UP FDR'S TRUE CAUSE OF DEATH?
SL: Based on the evidence we uncovered, it is clear Dr. Bruenn tried to protect Roosevelt's reputation because he was in fact a leader in wartime who was mentally impaired. Roosevelt's family became concerned that he would be remembered as the “sick man at Yalta” who had given away Poland and Eastern Europe and made concessions to Joseph Stalin he shouldn't, as the result of his poor health. Dr. Bruenn created this scenario in 1970 that Roosevelt had been diagnosed with only cardiovascular disease in an attempt to protect the legacy of the president, and most probably to respect Roosevelt's wishes that the true nature of his illness should never be known.
DO YOU THINK FDR MAY NOT HAVE BEEN FULLY CAPABLE — COGNITIVELY — TO FUNCTION AS CHIEF EXECUTIVE AND COMMANDER IN CHIEF DURING WORLD WAR II?
SL: My thinking about that has changed. Based on a solely cardiovascular etiology, without any mental impairment, the answer is no, he wouldn't have been impaired. Knowing what I know now — that he probably had a metastatic tumor in his brain and frequent complex partial seizures during the last year of his life — Roosevelt was not capable to function as chief executive and commander in chief during his fourth term. I don't think we want the leader of the free world and of a multinational war effort having active complex partial seizures. Heart disease is one thing, but brain tumors and complex partial seizures is something else altogether.
IN WHAT WAYS WOULD ROOSEVELT HAVE BEEN IMPAIRED?
SL: Someone with a heart condition would have an impaired reserve and would be tired and short of breath. If you're a cardiac cripple, getting around is difficult. But Roosevelt was wheelchair bound since 1921 because of his polio, so he could hide all of that. But, with complex partial seizures — as it has been described by many people — Roosevelt would be unconscious, non-cognizant. He would have periods of time, for seconds if not minutes, where he would stare into space and be unable to be communicated with, and then he would pop out of it. Roosevelt was limited to a four-hour work day — he was sleeping 14 hours a day.
PATIENT-PHYSICIAN CONFIDENTIALITY IS AN IMPORTANT TENET OF MEDICINE, AND THE LAW SUPPORTS PROTECTING PATIENTS FROM PUBLIC DISCLOSURE OF DISEASE. DO YOU THINK EXCEPTIONS SHOULD BE MADE FOR LEADERS WHO ARE RESPONSIBLE FOR POLITICAL DECISIONS?
SL: It's not the role of the president's physician to disclose anything. However, this has to be balanced, of course, with national security and the 25th Amendment, which focuses on the succession of power in the event of the death, removal, or resignation of the president. It's a very sticky issue. So patient-doctor confidentiality has to be balanced with this question: Can the president function?
WHAT ARE YOUR ECOMMENDATIONS TO ENSURE THAT A COVER UP, SUCH AS THE ONE SUGGESTED IN YOUR BOOK, DOESN'T HAPPEN AGAIN?
SL: Neurologists James Toole and Robert Joynt convened a blue ribbon panel in 1995, which included President Gerald Ford, to address specifically that question and published their results in a comprehensive book [Presidential Disability: Papers and Discussions on Inability and Disability among U. S. Presidents, Boydell & Brewer, Limited 2001]. These recommendations, to this point, have yet to be fully utilized. Personally, I believe there should be an independent agency of Congress that receives confidential reports from top-quality doctors. The panel should ultimately have the ability to invoke the 25th Amendment.