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This persuasive re-examination of Roosevelt’s last years reveals a more profoundly disabled president than the nation knew, and asks whether Roosevelt should be criticized or celebrated for shouldering the weight of a wartime presidency in his compromised state.
For Isabelle Faye Lomazow and Grace Maya Lomazow,
whose lives are just beginning,
and to the memory of
Sadie Feldman Fettmann (1920-1971)
and Morton Fettmann (1921-1978),
who grew up in the FDR years
whose lives are just beginning,
and to the memory of
Sadie Feldman Fettmann (1920-1971)
and Morton Fettmann (1921-1978),
who grew up in the FDR years
This story begins in 1979, with the publication of Dr. Harry Goldsmith’s landmark paper, “Unanswered Mysteries in the Death of Franklin D. Roosevelt,” by the medical journal Surgery, Gynecology & Obstetrics, the first peer-reviewed examination that challenged the traditional account of FDR’s final illness. This paper by a well-respected surgeon, which garnered national attention, raised the possibility that a pigmented lesion over the thirty-second president’s left eye—quite visible, but rarely commented on during his lifetime—may have been malignant.
If true, this would suggest the need for a whole new evaluation of Roosevelt’s final years and the precise nature of the ill health that progressively overtook him. And it raises questions, long debated by historians, as to whether FDR was fully capable of functioning as chief executive and commander in chief during the global conflict of World War II.
In reaction to Goldsmith’s article, Roosevelt’s lone surviving primary physician, Howard Bruenn, emphatically denied that FDR ever had cancer, effectively quashing further speculation and investigation. But the 1991 death of Margaret “Daisy” Suckley, Roosevelt’s cousin and frequent companion, led to a surprising discovery: Daisy had kept a secret diary that documented her relationship with FDR, along with many of his previously unknown letters to her. And, to the surprise of Roosevelt biographers, who had dismissed her as a historical footnote, it turns out that FDR had confided things to Daisy he didn’t dare divulge to anyone else (save, perhaps, his onetime mistress, Lucy Mercer Rutherfurd), knowing she would protect his secrets.
Like Goldsmith’s paper, the startling revelations in Daisy’s diary, published in 1995, often directly contradicted many of the claims made years earlier by FDR’s physicians, including what historians long had accepted as the definitive account of Franklin Roosevelt’s medical history.
Working with these disclosures, and expanding on them with intensive research, we have produced what essentially is a medical biography of Franklin D. Roosevelt. It presents a strong circumstantial case, backed by surviving medical records and analysis, that Roosevelt did indeed have cancer—melanoma, to be exact, originating in the pigmented lesion above his eye—that eventually spread to his brain and his abdomen. In other words, the cerebral hemorrhage that struck him down less than a month before V-E Day was not a “bolt out of the blue,” as his doctors contended, but the inevitable result of a deadly illness, compounded by catastrophic heart problems.
We did not intend this to be a political book, although it is impossible to avoid politics entirely when considering the effect that cancer had on Roosevelt’s performance as president. Others can read into this information what they will: Some will see confirmation that FDR was indeed the “sick man of Yalta,” incapable of negotiating skillfully with the determined Soviet dictator, Joseph Stalin. Others will see a determined champion, tirelessly guiding America through the global conflagration while contending with the ravages of the diseases that threatened his own life.
In fact, even as soldiers were fighting the enemy on the battlefields of Europe, Africa, and Asia, a parallel struggle was under way in the White House to preserve the president himself against the considerable medical challenges—polio, heart disease, and cancer—that surrounded him. Roosevelt himself was at the center of this battle—not as a disengaged and uninterested spectator, as historians have long believed, but as a chief executive who ultimately determined the course of his own medical struggle, just as he did in the fight against the Axis powers.
With the help of his doctors, Roosevelt was determined not only to stay alive for the time needed to accomplish his goals, but also to convince the nation—and the world at large—that he was always functioning at full capacity. Yet he knew that his was a desperate race against time. In this respect, Franklin Roosevelt took one of the greatest gambles in world history—and won.
An Orator Stumbles
Over the course of his unprecedented twelve years as president of the United States, Franklin Delano Roosevelt had—whether standing before Congress, addressing a huge political rally, or simply sitting before a microphone while delivering one of his intimate Fireside Chats—enthralled his listeners with self-assured oratory that was simple, yet stirring. But on March 1, 1945, as FDR prepared to tell Congress and a national radio audience about his recent summit at the Crimean city of Yalta with British Prime Minister Winston Churchill and Soviet leader Joseph Stalin, at which they had planned nothing less than the political shape of the postwar world, something about his delivery was very different—and radically wrong.
For one thing, the president was sitting down, something he’d never before done while delivering a major address before Congress. And he’d been wheeled into the chamber, where previously the chief executive had “walked,” heavy steel braces tightly supporting his withered legs, while tightly grasping an aide’s arm. Indeed, in his opening remarks, FDR surprisingly would refer publicly, for the first and only time as president, to the paralysis that had crippled him more than two decades earlier. “I hope that you will pardon me for the unusual posture of sitting down during the presentation of what I want to say,” Roosevelt told his astonished listeners. “But I know that you will realize that it makes it a lot easier for me in not having to carry around ten pounds of steel around the bottom of my legs.” This in itself was startling: After all, Roosevelt had waged a determined—and successful—quarter-century-long campaign to keep the American people from fully understanding that he was physically unable to stand without his braces, or to walk unaided.
In his first appearance before Congress in twenty-six months, the president was a weary and exhausted man, both physically and emotionally drained. Just the day before, in a downpour of rain and sleet, he had attended the burial of Gen. Edwin “Pa” Watson, his trusted military aide and one of his closest friends and advisers. Watson’s unexpected death of a stroke aboard the USS Quincy while returning from Yalta had been a crushing blow to the president, who, in an unusual display of emotion, spent the rest of the transatlantic voyage in an obvious state of depression. Physically, Roosevelt was a shell of the powerful and commanding figure he’d once presented: Over the past year, he’d lost at least forty pounds. He looked gaunt and emaciated, and dark shadows circled his eyes. Even some of FDR’s closest aides, like his confidential secretary, William Hassett, were speculating privately that the president was “slipping away.”1
But in front of Congress, Roosevelt had a more immediate and perilous problem. As he began to read from a loose-leaf binder containing thirty-one double-spaced typewritten sheets, the president came to a horrifying realization: He could not fully see all of the words on the page.
For at least six weeks, and possibly longer, FDR had been aware that he had a problem. Progressively, he had lost his ability to read—specifically, he could no longer see the words in the left side of his field of vision; they had either become incomplete or simply were no longer visible at all. To compensate, he’d developed a technique, first noticeable a few weeks earlier when he sat for newsreel cameras reading short excerpts from his upcoming State of the Union message, which he did not deliver live to Congress, as was traditional. Roosevelt used his hands as a stylus to mark his place, even crossing them over each other to keep track of his position on the page;2 it was a procedure he’d never before employed while speaking publicly.
But the speech he was delivering this day was one he’d determined could not simply be sent to Congress in written form. The nation needed to hear him speak. In many ways, this was the most critical speech Roosevelt had ever given; one that, likely knowing his days were numbered, he meant to cement his postwar legacy. For beyond simply reporting on the events at Yalta, the president had a burning desire to convince both Congress and the American people of the need for a postwar global peacekeeping organization. As Margaret “Daisy” Suckley, the adoring distant cousin who, it was later revealed, had been Roosevelt’s intimate confidante, confided to her diary: “FDR’s one really great wish is to get this international organization for peace started. Nothing else counts, next to that.”3a
Roosevelt’s mentor, Woodrow Wilson, had envisioned a similar framework for global peacekeeping after World War I, but Congress, after a bitter and rancorous partisan debate, rejected his dream of U.S. participation in the League of Nations. Roosevelt knew all too well what that political defeat had done to Wilson, destroying him both politically and physically. And, as he’d been heard muttering during a screening of the 1944 film Wilson, as he watched the enfeebled leader being portrayed by Alexander Knox: “By God, that will never happen to me.”4
But, with Congress and the country hanging on his words, Roosevelt could not deliver the clarion call to postwar solidarity that he’d envisioned. The greatest political orator of the twentieth century—the man who twelve years earlier had inspired a nation in the throes of a great depression by declaring that “the only thing we have to fear is fear itself”—failed to enthrall his listeners. Time after time he stumbled over the text, making mistakes that sometimes were simple and at other times were substantial. Over and over, he appeared to lose his place and tried to compensate by ad-libbing, buying time in order to find the right spot on the page or simply to rest from the intense mental gymnastics it must have taken to keep restructuring into intelligible form sentences whose words he could not fully see. Time magazine calculated that he’d departed from his text forty-nine times, adding a total of seven hundred words.5
“I was dismayed at the halting, ineffective manner of delivery,” noted his aghast speechwriter, Judge Samuel Rosenman, who had worked with Roosevelt through seven drafts of the address. “Some of his extemporaneous remarks were wholly irrelevant and some of them almost bordered on the ridiculous.”6 Grace Tully, FDR’s personal secretary, added: “Sam and I were sick [over it]; he wasn’t himself at all.”7 Even his White House physician, Admiral Ross McIntire—who until his death contended that Roosevelt had never been in ill health before the attack that killed him—later wrote that “now and then he passed his hand over his eyes as if to clear his sight.”8 And Howard Bruenn, the Navy cardiologist who had assumed day-today responsibility as the president’s attending physician, wrote a quarter-century later that “his speech at times was hesitant and . . . 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 from memory and ‘off the record’ and that he then had slight difficulty in finding the proper place when returning to read the printed word of his address.”9
Senator Bourke B. Hickenlooper, an Iowa Republican, sitting only a few feet from Roosevelt on March 1, noticed something unusual as the president spoke to Congress: “Watch his hands,” he told a colleague. FDR’s right hand, Hickenlooper said, didn’t seem to be working, and he was having trouble turning the pages of his loose-leaf binder with his left hand.10 In fact, as he’d done in January for the newsreel cameras, Roosevelt’s right hand was busy marking his place in the text.
Newspaper reporters, both friendly and unfriendly, commented widely on the president’s unusually weak performance. The New York Times headlined its front-page report, “President Put Many Interpolations in Text,” and wrote that FDR had taken “his carefully prepared congressional speech for a buggy ride.”11 The paper also noted that while stenographers from the Congressional Record had taken down Roosevelt’s words, “they did not transcribe their notes immediately, because their instructions from the White House were to use the prepared text.”12 (Press Secretary Jonathan Daniels said it was nearly impossible later on to construct a comprehensible official text from the actual transcript.)13 The Times’s Capitol Hill correspondent, Allen Drury,b wrote in his private journal that “it was a long, rambling, rather lifeless affair, delivered in a rambling and rather lifeless fashion.14 Drury added that FDR’s own vice president, Harry Truman, when asked afterward for his reaction to the speech, called it “one of the greatest ever given,” then “burst into hearty laughter in which we all joined.”15 The notoriously anti-Roosevelt Chicago Tribune was far less circumspect: “FDR Rambles in Talk,” the paper’s lead headline read. Its story, by longtime Roosevelt bête noire Walter Trohan, noted that the speech’s “delivery was sometimes marked by hesitancy as the president obviously lost his place several times after diverging from the typewritten text placed before him.”16
Some of the mistakes Roosevelt made were in individual words, reading “conclusions” instead of “decisions,” or “arrangements” instead of “agreements.” Sometimes FDR’s vision problem led him to repeat words in awkward construction: For example, his original notation of the period between the Teheran and Yalta summits “without conferences of civilian representatives” of the three major powers became “without conferences of representatives of civilian representatives.” And many of the ad libs, which ranged from a few words to entire paragraphs, were rambling and often disjointed, as if Roosevelt had embarked upon a rhetorical path from which he could not always easily find his way back.c
Today, listening to recordings of FDR’s speech and watching the short film excerpts that survive feels like an intrusion into a moment of private weakness because the speaker, a man of magnificent intellect and rhetorical skills, an unmatched orator who had flawlessly delivered hundreds of speeches and enthralled audiences, is so audibly struggling to read the words on the page in front of him. Yet FDR was by no means mentally impaired. On the contrary: His superb mental acuity demonstrated a remarkable ability to cover his visual deficit.
What exactly was Roosevelt’s problem? The answer can be found in a close examination of the actual reading text from which the president delivered his speech, for it reveals that the mistakes FDR made were by no means random. The overwhelming majority stemmed from his visual inability to find the left margin of each page or to see the left side of the individual words—forcing him to reconstruct sentences on the fly.
President Roosevelt, seated—for the first and only time—in the well of the House of Representatives, reports to Congress and the nation on the summit at Yalta. FDR’s listeners, including his top aides, were horrified by his rambling, tentative, and confused delivery. (Bettmann/CORBIS)
However, the problem was not with the president’s eyes but with his brain. He was suffering from a neurological condition called left hemianopia, characteristic of a specific focal dysfunction in the right posterior portion of the brain. The errors Roosevelt made present the strongest evidence that a large pigmented lesion over his left eyebrow, which had grown and darkened over a period of nearly two decades, was not a harmless sunspot, but rather a deadly melanoma, or skin cancer. And that—just as the medical literature of the day predicted—in the four to five years since it had become malignant, the cancer had now metastasized to his brain, causing the growing tumor that would take Roosevelt’s life a mere six weeks later. Even with all the advances in today’s state of medical knowledge, the presence of symptomatic brain metastases from melanoma, from which FDR was suffering, is the inevitable harbinger of an inexorable and rapid demise.
Although hemianopia is most commonly seen in strokes, it can also be a consequence of a host of neurological diseases, including tumors involving the areas of the brain that affect vision.d
Roosevelt died two and a half hours after suffering a sudden catastrophic brain hemorrhage at Warm Springs, Georgia, on April 12, 1945. The notes taken by Bruenn, one of two doctors at FDR’s bedside as his life ebbed, document physical findings that a neurologist easily would recognize as emanating from the posterior aspect of the right cerebral hemisphere—precisely the area of the brain that would produce the left-sided visual deficit Roosevelt exhibited for three months prior to his death. Coupled with the knowledge that melanoma is notorious for its rate of brain metastases, and that hemorrhages from them are the second most common cause of death among melanoma victims, the implications are obvious.
More evidence of Roosevelt’s hemianopia comes from an incident that occurred on January 14, 1945, while the president was at his Hyde Park residence. Daisy Suckley records that FDR phoned her at her nearby home, Wilderstein, “at 5 minutes to 2—He had mistaken the time on his clock & had just come down for his lunch.”17 An inability to clearly see the left side of his clock might easily have led the president to mistake 2 p.m. for noon. Having a patient draw a clock face is a routine part of present-day neurological examinations to assess the integrity of the right cerebral hemisphere.
Yet even if Roosevelt’s doctors had known about hemianopia, there was precious little they could have done about it. While the medical literature of FDR’s day asserted that melanoma invariably was fatal and that it fairly consistently metastasized to the brain and the abdomen, as did Roosevelt’s, it’s not at all clear that his doctors fully understood the nature of this neurological problem, though they certainly knew that the president’s lesion was malignant and had metastasized. All Roosevelt and his doctors knew on March 1, 1945, was that he could not easily read the pages in front of him. And those listening to the distressed president were aware only that, as Sam Rosenman put it, “the great fighting eloquence and oratory that distinguished him in his [re-election] campaign only four months before were lacking.”18e
When the frail, coughing sixty-three-year-old president was wheeled out of the House chamber at the end of his speech, many of those in the audience instinctively felt that they were seeing Franklin Delano Roosevelt for the last time.
They were right.
It is unlikely we will ever know with absolute certainty what killed the thirty-second president of the United States. No autopsy was performed (though none of those present could ever agree why), and, save for a few lab slips that turned up in 1957, the whereabouts of Roosevelt’s medical file, maintained by Ross McIntire, has been unknown since his death.
For the first quarter-century, the official line on FDR’s passing was the one given by his doctors on April 12, 1945, at the Little White House in Warm Springs, where he died: An otherwise healthy Roosevelt had been brought down by a sudden and unforeseeable massive cerebral hemorrhage—“a bolt out of the blue,” they called it—with arteriosclerosis as a contributing cause.19 The president’s gaunt appearance and his shocking weight loss and startling performance in his recent speech to Congress were not signs of ill health, they maintained, but sheer physical exhaustion, brought on by overwork and the strain of being a wartime chief executive. Americans accepted this explanation, though there had long been whispers in Washington circles that all was not right with the president’s health.
Those whispers were vindicated in 1970, when Bruenn—a cardiologist who, virtually unknown to the outside world, had been at Roosevelt’s side daily since April 1944—wrote a paper in a medical journal disclosing that the president had indeed been terribly ill, physically compromised during the last year of his life by severe cardiac illness and uncontrollable high blood pressure. Bruenn’s paper was widely hailed at the time as a revelation and the irrefutable last word on Franklin Roosevelt’s final illness.
That Roosevelt had critical heart problems—Bruenn’s diagnosis of acute cardiac failure in March 1944—is undeniable. Dr. Wayne C. Levy, a cardiologist at the University of Washington who in 2006 developed a comprehensive model for predicting the short-term survival rates for patients with heart failure, has analyzed FDR’s data and suggested that his estimated mortality at the time of Bruenn’s diagnosis was 23 percent at one year and 78 percent at five years. This, he said, “is about the average mortality of a ninety-year-old male in the current era.”20
But Bruenn’s paper was not the final word on FDR’s illness. It contains numerous discrepancies and significant omissions that have been contradicted by other available evidence. His insistence that the president was wholly unconcerned about the state of his health is utterly refuted by the 1995 publication of Daisy Suckley’s diary. The diary, previously unknown and discovered only after her death in 1991, makes undeniably clear that Roosevelt was all too aware of the specific details of his fatally compromised health.
The present book goes even further—presenting a strong case that, far from being a submissive patient who just sat back and followed his doctors’ orders, Roosevelt was in control of his own medical situation; indeed, that whatever actions McIntire ultimately undertook came only at the president’s specific direction. Roosevelt knew his condition as well, perhaps better, than many of the doctors who treated him. He gambled that he was, despite all the medical evidence, fit for the highest office at the most critical time: as America joined, fought, and won the Second World War, and then negotiated the shape of the postwar world.
Additionally, this book presents an alternate account of Roosevelt’s final illness that not only explains the circumstances of the president’s death better than any of his doctors offered at the time, but also raises anew the question of his competence in the last years of his life. Cancer of the brain has very different consequences than the heart condition that Roosevelt’s doctors finally, and reluctantly, acknowledged. They said he was fatigued; we assert that the president was diagnosed with a highly malignant skin cancer, melanoma, which later metastasized to his abdomen and to his brain, producing a hemorrhage that was the most probable immediate cause of his death. And that he may also have suffered from prostate cancer, whose treatment ultimately was compromised by a multitude of serious health problems. Cancer, over many years, was Roosevelt’s deadly secret.
Rumors that Roosevelt had prostate cancer circulated widely even while he was still alive. And the specific notion that a lesion over his eye was malignant first was raised as early as 1948; in particular, the groundbreaking work by Dr. Harry S. Goldsmith, who has spent forty years investigating FDR’s health and whose 1979 paper in a leading medical journal provided the inspiration for this work, moved this theory forward. But none of the earlier researchers could offer anything more than the visual appearance of Roosevelt’s lesion; this work provides a more solid basis for the scenario, based on medical evidence of the effect of the melanoma.
We cannot be incontrovertibly certain in our diagnosis, of course—absent an autopsy or objective confirmation from Roosevelt’s still-missing contemporary medical records. Both McIntire and Bruenn repeatedly denied that the president ever had cancer. Moreover, his severe cardiovascular problems were sufficient to kill him, and likely would have done so before the end of his fourth term. And the many documented spells of unconsciousness, most consistent with seizures, that Roosevelt exhibited in the final year of his life, and that have gone largely undiscussed by most historians, most probably are attributable to the effects of his malignant hypertension.
But a very strong, albeit circumstantial case—based on surviving records, independent medical evidence, and reliable eyewitness reports of his condition—supports the notion that Roosevelt died of cancer. Moreover, there are the numerous reports, long after his death, quoting other doctors involved in his case—some of whose connections previously were known, such as Frank Lahey, and others not, such as William Calhoun Stirling—that Roosevelt did indeed have widespread malignancy.
If true, this presents a profound historical revelation. Conventional wisdom has it that Roosevelt took ill in early 1944, ran for a fourth term knowing he was ill, and then suffered a rapid physical breakdown only in the last few weeks before his death, retaining his mental powers to the end. But if the melanoma scenario is correct, it means that Roosevelt, while still in his second term, knew he was almost certainly doomed to die of cancer within five years. And that, even with this knowledge, he and his doctors covered it up—even as they are known to have kept from the public an honest understanding of the president’s disability from polio—and forged ahead, believing in his tremendous force of will, combined with a firm conviction that his continued presence in the Oval Office was necessary to bring the country into and through the growing war against Germany and Japan.
- On Sale
- Jan 4, 2011
- Page Count
- 304 pages