F.D.R., Dr. Bruenn, Etc.

Sherwyn E. Warren

“I hope you will pardon me for the unusual posture of sitting down during the presentation of what I wish to say, but I know you realize it makes it a lot easier for me.” President Franklin Delano Roosevelt said this on March 1, 1945 when addressing the American people and Congress from the well of the House of Representatives, reporting on the Yalta Summit conference. He added, “I have just completed a fourteen-thousand mile trip.”

As Allied victory seemed assured in World War II, Roosevelt, Winston Churchill of Great Britain and Joseph Stalin of the Soviet Union agreed on the need for face to face summit meetings to set long term strategy. Because Stalin refused to travel outside the Soviet orbit, the first conference was late November, 1943, in the northern Iranian city of Tehran. The second, in February, 1945, was in the Crimean Black Sea resort city of Yalta. For F.D.R. both trips involved long sea journeys by U.S. naval cruisers and flights in unpressurized, C54 propeller aircraft, some of which were over high mountains. From my experience as an Air Force flight surgeon I realize such flights are uncomfortable, tedious and stressful.

In February, 1944, after the President returned from Iran, daughter Anna Roosevelt Boettiger moved into the White House. She acted as the President’s unofficial social secretary and substitute hostess for her mother who was frequently away. She observed F.D.R.’s persistent cough and failing strength. By the middle of March she was alarmed and discussed the situation with Eleanor, who either did not notice the symptoms (Anna said, “She simply was not interested in physiology”) or did not consider them significant.

Anna saw how her father dealt with the challenges from his polio. White house and secret service were always available with a wheel chair or whatever physical assistance he needed. George Fox, a navy physical therapist was assigned to him full time. He used the 50-foot swimming pool in the basement many afternoons. Post-polio syndrome had not yet been defined. She felt this was different and confronted White House physician, Dr. Ross McIntire for an explanation. He told her that it was the residual of the flu and bronchitis. Knowing that McIntire was an eye, ear, nose and throat specialist, not a generalist, Anna persisted quite strenuously. She cajoled him into arranging a general physical examination. This was conducted at Bethesda Naval Hospital on March 28, 1944.

Assigned to examine the President was the 39 year-old head of cardiology, Lieutenant-commander Howard Bruenn. Born in Youngstown, Ohio, graduate of Columbia University and Johns Hopkins medical school he served his medical residency at New York’s Columbia-Presbyterian medical center. Shortly after the attack on Pearl Harbor he enlisted in the Naval Medical Corps. I came across the report of Dr. Bruenn’s evaluation and subsequent care of F.D.R. in a 1970 article in the “Annals of Internal Medicine” with the unusual title, “Clinical Notes on the Illness and Death of President Franklin D. Roosevelt.” Why the modifier “Clinical Notes”? That will become clear shortly.

Bruenn diagnosed “Hypertension, hypertensive heart disease, cardiac failure (left ventricular) and acute bronchitis.” These findings and their interpretation were conveyed to Admiral McIntire to whom they had been completely unsuspected. A memorandum of recommendations was requested. Bruenn recommended bed rest for one to two weeks, digitalis, light diet low in salt, codeine for cough, sedation for sleep and weight reduction. This memorandum was rejected because of the “exigencies and demands on the President.” The President was placed on modified bed rest and given a cough syrup.

McIntire convened a meeting with Bruenn; Capt. John Harper, commander of the Naval Hospital; Capt. Robert Duncan, executive officer of the Naval Hospital; Capt. Charles Behrens, head of radiology and an internist, Dr. Paul Dickens. At this meeting it was suggested to limit the President’s activity, cigarettes, caloric intake and “irritations and tensions of office.” The next day McIntire called a meeting with Harper, Behrens, Duncan, Bruenn and two Navy medical consultants who examined the President, Dr. Frank Lahey, an abdominal surgeon and head of the Lahey Clinic in Boston and Dr. James Paullin of Atlanta, an internist and president of the American Medical Association. The meeting was long and contentious. Dr. Paullin agreed with the findings and Bruenn was assigned to duty as the President’s personal physician. McIntire ordered Bruenn not to discuss the President’s medical situation with anyone except himself and other involved physicians, citing the Hippocratic Oath, his rank as admiral and his positions as commanding officer and Surgeon General of the Navy. He was also to be the conduit of all medical information for the family. In subsequent interviews Bruenn said F.D.R. never inquired about his physical condition or medications and was a compliant patient.

Bruenn waited twenty-five years to publish his paper as he felt that was sufficient time to make it of objective historical interest. The scrupulous doctor obtained permission—in fact encouragement—from the President’s daughter. He examined F.D.R. almost daily, recording blood pressures in the range of 220/110. His final sentence states, “As a result of this unforgettable experience and as a practicing physician, I have often wondered what turn the subsequent course of history might have taken if the modern methods for the control of hypertension had been available.”

An editorial in the New England Journal of Medicine 25 years later stated: “Today, 50 years later, a powerful therapeutic arsenal to treat all forms of hypertension is at the physician’s disposal. As a result, malignant hypertension, as observed in FDR, has become rare.”

These reports struck a personal chord. I had acute polio as a young adult. My own blood pressure was elevated and I ignored my physician’s directions to accept treatment because of the medication’s annoying side effects. I had graduated medical school in 1956. What was the treatment of hypertension in 1944? I located a 1943 edition of “A Textbook of Medicine by American Authors 6^th Edition”, R.L. Cecil, editor. I perused the chapters on Diseases of the Cardiovascular System and Hypertension. Hypertension was defined as blood pressure consistently over 160/90. Unless an underlying cause was found it was considered essential hypertension. Roosevelt certainly fulfilled these criteria.

Regarding treatment Cecil said, “Drugs which are prescribed specifically for blood pressure reduction are of little value.” Weight control, reduction of nervous tension, adequate rest and relaxation and possibly sedatives such as Phenobarbital were recommended. When heart failure intervenes, physical and mental rest must be imposed, usually requiring a period of bed rest. The diet should be simple and low salt. Sedatives or hypnotics are of help, especially for cough or respiratory problems. Digitalis should be used. There are no contraindications to its use. Finally, diuretics may be used.

However. F.D.R. had blood pressure readings higher than 200/120. This put him, even by the criteria of 1944, into the category of malignant essential hypertension, where “the clinical course is telescoped into a period of months or a year or two.” Parenthetically, when I read this my own blood pressure was threatening to reach such levels.

I believe Dr. Bruenn conscientiously prescribed the treatment then available and recommended. He tried to fulfill the admonition of the text’s summary that “it requires the meticulous guidance of all the patient’s activities, including both physical and mental activity, diet, fluid and salt restriction, rest and sleep. Digitalization should be continued and diuretics used as required. Treatment will usually do much to enhance the patient’s comfort and prolong his life, but one should always remember that it is the patient who is being treated—not the disease.” Under his care Roosevelt was able to campaign successfully for his fourth Presidential term and attend the Yalta conference.

F.D.R.’s daughter, Anna was not the only woman close to the President who tried to improve his health. Margaret Suckley was Franklin’s sixth cousin, Hyde Park neighbor and ten years younger. In spring 1922, after having been stricken with paralytic polio the previous summer, he went to Springwood, his mother’s New York estate to recuperate and rehabilitate. Sara, watching her son’s lonely struggling to regain his strength, invited the pleasant, retiring, intelligent young woman to keep him company. In 1933 Roosevelt invited her to his inauguration as president. As years went by their friendship evolved.

Franklin’s relationship with wife, Eleanor changed precipitously in 1918 after she discovered his affair with her social secretary, Lucy Mercer. Sara Roosevelt insisted they not divorce, since that might damage her son’s political career. Eleanor agreed to continue the marriage but refused to share bedrooms; she told her daughter sex was “an ordeal to be borne.” He found warm, intelligent, feminine companionship with Margaret (Missy) Le Hand, whom he hired as his secretary while governor of New York and took to the White House. In June, 1941 Missy suffered an incapacitating stroke. Her successor, Grace Tully, did not completely fill her role and Franklin reestablished closer relationships with cousin Margaret Suckley, known as Daisy, and his flamboyant, glamorous, old maid fifth cousin, Laura Delano, known as Polly. He also established a close friendship with the charming and beautiful Crown Princess Martha of Norway, who was living with her children in the United States during the Nazi occupation of her country.

Daisy was hired as librarian at the Roosevelt Library in Hyde Park and began spending increasing time, some perhaps quite intimately—you may have seen the recent movie “White House on the Hudson”—with Franklin in the White House, on his travels and in New York. Her diaries and letters, discovered in 1991, after her death at age 100, provide a fly-on-the-wall description of Roosevelt’s world and her role in it. They were edited by historian Geoffrey Ward and published in 1995.

Sensitive Daisy also noticed Roosevelt’s physical decline after Tehran. Her approach was to convince the President in the spring of 1944 to take curative salts from a French “healer,” Mlle Grace Gassette. Analyzed by chemists at Bethesda Naval hospital they were proclaimed harmless and useless. In the fall of that year she convinced him to be treated by “Healer Lenny,” Harry Setato, a former professional boxer and trainer from Philadelphia. On December 27, Lenny gave his first massage treatment to F.D.R. Daisy describes, “Lenny sat at the end of the sofa, working on the Pres’ feet, carrying on an easy conversation, the Pres relaxed. Two complete contrasts: Lenny, simple, childlike, uneducated, the Pres, product of the best education, man of the world. These two could talk together, understand each other.”

Before F.D.R. left for Yalta on January 23, 1945 Lenny gave him five more treatments. This caused hostility towards Daisy among the President’s staff. His secretary Dorothy Brady recalled. “We all turned against her when she got that strange fellow into the scene. We were scared of him, messing with the President’s treatment like that.”

For his entire presidency, Roosevelt’s personal doctor was Ross T. McIntire. Born 1889 in Salem, Oregon, McIntire went to Willamette University and medical school, graduating in 1912. He began private practice in his home town, but in 1917 he joined the Naval Medical Corps.

When he was elected president, Roosevelt asked Cary Grayson, personal physician to Woodrow Wilson, the most recent Democratic president, to recommend a personal physician. Incidentally, Wilson suffered a series of strokes nineteen months before the end of his term, leaving him severely incapacitated, paralyzed on the left side of his body and unable to speak coherently. His widow Edith and Grayson hid the seriousness of his condition, limited access of others to him, helped decide on the information he received and assumed the role of his spokespersons. Until the 25^th amendment to the United States constitution in 1967 there was no mechanism for removal of an incapacitated President.

Grayson recommended Dr. McIntire to Roosevelt. When informed, McIntire asked, “What could an eye, ear, nose and throat man offer a victim of infantile paralysis?” Cary told him to quit worrying. “The President is as strong as a horse with the exception of a chronic sinus condition. That’s where you come in.”

McIntire wrote, “It is the habit of presidents to select either an Army or Navy doctor when the time comes to choose the medico who will look after their well being. These men are officers as well as physicians and being subject to the iron discipline of the armed services, they can be counted on to keep a close [sic] mouth about what they see and hear.” Regarding his examinations he came to the White House every morning at 8:30 “and went to the President’s bedroom for a look-see. Neither the thermometer nor stethoscope was produced, there was no request for a look at the tongue or a feel of the pulse. A close but casual watch told all I wanted to know.”

These frequent and congenial interactions resulted in a close personal as well as doctor-patient relationship. McIntire was a frequent fishing and travel companion. He also showed administrative ability and F.D.R. appointed him Surgeon General of the Navy. In 1947 President Truman appointed him chairman of President’s Committee for the Employment of the Handicapped. He subsequently established the American Red Cross blood program. His final position was in Chicago in 1955 as executive director of the International College of Surgeons. When he died on December 8, 1959, Eleanor Roosevelt wrote the College, “I am saddened by the death of Dr. Ross T. McIntire. He was a devoted friend and a kind doctor to my husband and he commanded the respect and admiration of all of us.”

Admiral McIntire was admired for his eagerness and energy but not for his candor or clinical judgment. He is frequently recorded as giving F.D.R. treatments for his sinuses. Although their specifics are uncertain, the usual treatments at the time were solutions of epinephrine or cocaine, both of which significantly raise blood pressure. When Anna asked him accusingly if he ever took her father’s blood pressure he answered stiffly only when it was indicated.

In June, 1944, three months after Dr. Bruenn first saw Roosevelt, Life magazine formally questioned McIntire about the President’s health and prospect of completing a fourth term. He responded, “Considering his age his physical exam is equally as good as the one made on him twelve years ago.” In his memoir, McIntire stated that Roosevelt was considered to be in good health and likely to survive a fourth term as President by all the doctors and consultants who had seen him. Consultant Dr. Frank Lahey of Boston wrote that he had “informed Admiral McIntire July 8, 1944 that I did not believe, if Mr. Roosevelt were elected President again, he had the physical capacity to complete a term.” Bruenn, in later interviews, was asked whether he had considered it likely that Roosevelt would finish a fourth term. He answered that he did not think so but no one asked him at the time. He did believe that the President was always mentally competent and had never suffered small strokes, as had been rumored.

In any event Roosevelt’s medical records are not available for review. They were kept in the commanding officer’s safe at the Bethesda Naval hospital. Only three people had access, one of whom was McIntire. It is generally agreed that McIntire removed and destroyed all of Roosevelt’s medical records after his death. This explains the unusual title addition of “Clinical Notes” on Dr. Bruenn’s paper 25 years later. I find it difficult to characterize and understand McIntire’s personality, motivations and values.

A month after F.D.R.’s Yalta speech on March first, he apparently was in and out of congestive heart failure. He spent a long weekend at Hyde Park without improvement and plans were made for a two week rest in the more salubrious climate of the Little White House in Warm Springs, Georgia. Daughter Anna planned to go but changed her plans when her son was hospitalized at Walter Reed Army hospital. She did arrange for her father’s old love, Lucy Mercer Rutherfurd to be a guest at the compound’s gate house during the second week.

In 1920 Lucy Mercer married an older widower, Winthrop Rutherfurd. After more than two decades of marriage Winthrop died, leaving Lucy a wealthy widow with an estate in Aiken, South Carolina. From 1943, Lucy visited F.D.R. at the White House and the two went for drives together when Eleanor was away. Anna sometimes joined her father and saw how much he enjoyed these visits and how relaxed he became in Lucy’s presence.

The President left Washington by train on March 29. 1945. Eleanor did not enjoy Warm Springs and stayed behind. With F.D.R. were Dr. Bruenn, secretaries William Hassett, Grace Tully and Dorothy Brady and the feminine companionship of cousins, glamorous, garrulous, gossipy Polly (Laura Delano) and quiet, sensitive, comforting Daisy (Margaret Suckley). The first week was relaxed and low-key. Bruenn enforced an early bedtime and adequate rest. He noted that Roosevelt’s strength, color and stamina improved and F.D.R. became more engaged and animated.

Lucy was scheduled to drive down from Aiken on Monday, April 9. She was accompanied by a friend, Elizabeth Shoumatoff, a Russian artist, who was to paint a portrait of the President as a graduation present for her daughter Barbara Rutherfurd. F.D.R. phoned Lucy and arranged to meet her car in Macon, Georgia, at 4: P.M. He set out in early afternoon in an open car with Daisy and his dog, Fala. The meeting was delayed, the evening became cold and Daisy noted they were all chilled by the time they returned to The Little White House in the open car. The following two days were relaxing and he reveled in the company of four admiring women, while keeping to a modest schedule of official duties. F.D.R. was soon in excellent spirits and began to plan a weekend involving a barbecue and minstrel show.

On Thursday, April 12, Dr. Bruenn saw him at 9:20, shortly after he awakened. His guests commented on how well he looked. Shortly after 1 P.M. he was sitting in the parlor, posing for the portrait by Mme. Shoumatoff and signing official papers when he leaned forward, put his left hand to the back of his head and said, “I have a terrific pain in the back of my head.” He slumped forward and was carried to his bed by his valet and butler. Daisy immediately phoned for Dr. Bruenn, who arrived within 15 minutes and found the President in bed, unconscious, with a dilated right pupil, blood pressure of 300+/190, and having mild, convulsive movements. He diagnosed a massive cerebral hemorrhage and immediately phoned Dr. McIntire in Washington.

McIntire put in an emergency call to Dr. James Paullin in Atlanta to rush to Warm Springs. He contacted Eleanor and told her that the President had fainted. She asked if she should cancel her four o’clock speaking engagement that afternoon. No, McIntire replied, it would cause great commotion, but she should prepare to go to Warm Springs that night. At 4 P.M. she gave a short talk at the Sulgrave Club and sat at the head table to listen to a piano recital. In the middle of the piece she was told she had an urgent phone call. Excusing herself quietly, she took the call from Press Secretary Steve Early, who told her to come home at once. Although she sensed something terrible had happened, she felt amenities had to be observed, went back to the party, joined the applause after the piece had been completed, then excused herself and received a standing ovation.

In Warm Springs, Bruenn stayed with the President, kept him warm and gave him papavarine and amylnitrite to relieve vasospasm. Roosevelt’s blood pressure came down. He was breathing spontaneously, but remained profoundly unconscious. Just after 3:30 his breathing stopped, Dr. Paullin arrived from Atlanta and injected Adrenalin into the heart, but the President was pronounced dead at 3:35. While all this was happening Lucy and Mme. Shoumatoff rushed to their rooms, packed, got their car and immediately drove off.

Eleanor and McIntire flew down and arrived after 11 P.M. Eleanor sat down with Grace Tully, Daisy and Polly and asked them to describe what had happened. Grace and Daisy gave quiet descriptions of their experiences. Polly volunteered that Lucy Mercer Rutherfurd was also present. Eleanor seemed devastated by this information but Polly justified herself by saying that she would have found out anyway. Despite an official request by Joseph Stalin that an autopsy be conducted to rule out poisoning, Eleanor, with McIntire’s support, refused to permit a post mortem examination.

The next morning, at the little Warm Springs railroad station, the bronze coffin was lifted into the rear car of the President’s train and placed upon a special cradle, raised so it could be seen through the windows. Eleanor and the contingent that had made the journey down occupied the rest of the train on a slow, day and night journey, past grieving throngs lining the right of way, back to Washington. The funeral service was held in the East Room of the White House. Per F.D.R’s request, burial was in the green-hedged, rose garden of his Hyde Park home. He had expressed the hope that, “My dear wife will on her death be buried there also.” When Eleanor died seventeen years later, on November 7, 1962, she was laid to rest at his side, under a common marble headstone. An autopsy was performed on her.

Perhaps this story, with its historical and medical aspects and its gossip, intrigues me because of the parallels in the life of Franklin Roosevelt and of myself: adult onset polio, hypertension and post-polio syndrome. I am the beneficiary of medical progress over the past 68 years. He died as a result of hypertension at age 63. I’m still around at 83. I have had a much more mundane life. I also don’t believe I’ve had as interesting gossip associated with me. Nevertheless I hope this meld of medicine, world history and gossip might be interesting enough for me to sit down and relate to you.

BIBLIOGRAPHY

Bishop, Jim. FDR’s Last Year. New York: William Morrow, 1974

Bruenn, Howard. “Clinical Notes on the Illness and Death of President Franklin D. Roosevelt.” Annals of Internal Medicine, 72:579-591, 1970 See also later interviews in Bishop, Goodwin, Ward.

Cecil, R.L. A Textbook of Medicine by American Authors, 6^th Edition. Philadelphia: W.B.Saunders, 1943

Goodwin, Doris Kearns. No Ordinary Time, New York: Simon & Schuster, 1994

“Journal International College of Surgeons,” Chicago : 32: 6, p6

Ibid: 33: 1, p 12

Lerner, B.H. “Revisiting the Death of Eleanor Roosevelt; Was the Diagnosis of Tuberculosis Missed?” Int J Tuberc Lung Dis.: 5:1080-1085, 2001

McIntire, Ross. White House Physician. New York: Putnam, 1946

Meacham, Jim. “A Roosevelt Mystery”, “Newsweek Magazine”: p. 8, April 18, 2005

Messerli, F.H. “This Day 50 Years Ago” New England Journal of Medicine 1995:332:1038-1039

Ward, Geoffrey, Closest Companion. The Unknown Story of the Intimate Friendship between Franklin Roosevelt and Margaret Suckley. New York: Mifflin, 1995