A severe attack of poliomyelitis in 1921 resulted in total paralysis of both legs to the hips. FDR was 39 years old in 1921 2 MORE. Eleanor Roosevelt thought FDR's polio was "a turning point" that "proved a blessing in disguise; for it gave him strength and courage he had not had before" 3a.

The White House seamstress, who used crutches because of polio she contracted at age 6 and whom FDR nicknamed "Little Girl," described an interaction with Roosevelt that started light-hearted, but then: "Before the President wheeled away from me ... he became very serious for a moment. `Little Girl, you know and I know that one can overcome anything`" 4a. She was the only person, besides Roosevelt, allowed to use the White House elevator 4b. She also reported that occasionally he would "revolt against his wheelchair, and the fates that had put him there; then he would complain and become irritable," but this was treatable with a rubdown to soothe his muscles 4c. His lack of mobility gave him a special fear of being trapped in a fire, unable to escape -- this at a time when inspectors from the Interior Department called the White House a fire trap -- prompting the Secret Service to install special chutes to get him rapidly from his window to the ground 4d.

Comment: FDR's polio led him to lavishly fund polio research which, in turn, led to the vaccine 5 and, some say, to modern molecular biology. [McKusick in Lincoln article]

As President, Roosevelt's train journeys were limited to 35 miles per hour to minimize his discomfort from the vibration of the car 6. (Perhaps his muscles were weak to the point they couldn't buffer the impact, or they were so wasted that he had no cushion.)

During his bout of scarlet fever in childhood, his mother, who was barred from his room, climbed a ladder outside his window to read to him 4e.

how much did he drink?

Reliability of this information is uncertain. 7 In light of his polio history, however, it would not be surprising.

FDR was diagnosed as having systolic hypertension in 1937. Diastolic hypertension was first diagnosed in 1941.

In May 1941, FDR had severe iron deficiency anemia. His hemoglobin level was 4.5g/100ml, apparently due to bleeding hemorrhoids. The anemia responded quickly to therapy with ferrous sulfate. Interestingly, there were no cardiac symptoms at the time. 2 The lab slip showing this result survives. MORE

Two independent lines of evidence suggest FDR had a malignant melanoma excised while in the White House 8:

1. Between 1920 and 1932 FDR developed an enlarging pigmented lesion above his left eye. This lesion vanished between 1940 and 1944, leaving a scar and a sparse lateral eyebrow.
   
2. During lectures in 1963 and 1965, Dr. George Pack stated that his friend, Dr. Frank Lahey of Boston, had seen FDR in consultation in 1944 and had informed the president that he had a metastatic tumor, and advised him not to run for a fourth term.

Interestingly, FDR's main health problem, starting around November 1944, was anorexia and weight loss. No confirmation of the melanoma theory is possible, however, FDR's medical record is missing. 9

Addendum: Dr. Philip Kousoubris reports (Nov. 2003) that an older surgeon, still living in the Boston area, claims to have seen the melanoma in the pathology department at Beth Israel-Deaconess Hospital while an intern. According to this surgeon "FBI men" sequestered the sample in the safe of a Boston-area company.

During the night of November 28, 1943 FDR had an "acute digestive attack." He was attending the Tehran conference at the time. It must have been a serious event, since there were ill-founded rumors he had been poisoned.

By January 1944 his doctors thought this had been an episode of the flu. (I have not read an account of the episode, but one wonders whether it could have been an attack of cholescystitis or an embolic event. FDR had left ventricular enlargement when first examined by a cardiologist in March 1944.)

One of FDR's close friends dates the president's physical decline from this event. 9

In January 1944 FDR began complaining of headaches in the evening. "He seemed strangely tired, even in the morning hours; he occasionally nodded off during a conversation; once, he blacked out half-way through signing his name to a letter, leaving a long scrawl" 9.

FDR was referred to Dr. Howard Bruenn, a cardiologist at Bethesda Naval Hospital who, on March 27, 1944 found him cyanotic, breathless, with an enlarged left ventricle and a blood pressure of 186/108. Bruenn diagnosed hypertensive heart disease and wanted to give digitalis, but was prohibited by Dr. Ross McIntire, the president's personal physician and then surgeon-general of the U.S. Navy.

The next day, FDR developed moist rales at the base of the right lung. During a press conference that day, FDR was asked about his physical condition and answered, "I got bronchitis." By March 30 crackles were present at the base of both lungs. Bruenn diagnosed congestive heart failure, but it was not until the next day, after FDR was examined by civilian consultants, that digitalis was begun. FDR would continue the digitalis for the rest of his life.

By April 3, FDR was better. His color was better, he could lie flat without dyspnea, and the crackles disappeared from both lungs. His blood pressure, however, was 210/110.

At a press conference on February 4, 1944, FDR said that he had had a sebaceous cyst excised from the back of his head at Bethesda Naval Hospital. 9 (Could this event have been related to the pigmented lesion above the left eye?)

Dr. McIntire claimed, in a press conference after FDR's death, that the president had undergone only one surgical procedure during the time he was in the White House: removal of an abscessed tooth. 9

Woke up with laryngitis the morning he was to give an address to the Teamsters' Union, but it resolved in time 4f.

"Was prone to colds that kept hanging on and on" 4g

A reader has raised the possibility that President and Mrs. Roosevelt had cosmetic surgery during Roosevelt's presidency. For now, this should be considered as a topic to be investigated, rather than an established fact. MORE Of possible relevance is the disappearance of the pigmented lesion above FDR's left eye in 1940-1944 (see above).

When troubled, FDR would go into his study and work on his stamp collection, leading the White House servants to joke that he was "stamping out a problem" 4h. Oliver Wendell Holmes famously described Roosevelt as "a second-class intellect, but a first-rate temperament" 10a.

While resting at the South Carolina retreat of Bernard Baruch, FDR developed severe abdominal pains on April 28, 1944, diagnosed as acute cholescyctitis. He was treated with parenteral codeine. The pain subsided by May 1, but recurred the next day. He was again treated with codeine, and after two days became asymptomatic.

FDR returned to Washington and had a cholecystogram on May 26. Dr. McIntire, an otolaryngologist, interpreted it as a normal study. Dr. Bruenn, a cardiologist, said it showed a well-functioning gallbladder, but had evidence of a group of cholesterol stones. Bruenn, therefore, put FDR on a low-fat diet. Oddly, no surgeon was asked to review the study. 9

In the summer of 1944 FDR had an episode of severe abdominal pain while with his son. "Suddenly [FDR] began to groan, his face took an expression of suffering. [FDR said:] `Jimmy, I don't know if I can make it; I have a horrible pain.'" The president refused to allow his son to notify the proper authorities, fearing it would create unnecessary alarm and jeopardize his chances for re-election. 9

FDR was initially pleased by the loss of weight that occurred on Bruenn's low fat diet. He was at his normal wieight, 188 lbs, in June 1944. By the November 1944 election he was underweight: 165 pounds. His low fat diet was stopped, and egg nog supplements begun. The digitalis was also stopped. FDR's anorexia persisted, however, so it was re-started. FDR lost a bit more weight, so the digitalis was again stopped temporarily in March 1945 to see if FDR's appetite would improve -- it did not. 9 (Other causes of wieght loss to consider are cardiac cachexia and malignancy, as discussed above.)

In November 1944 one of the White House staff noticed "for the first time how he had shrunk in size and how tired he looked. I longed to tell him to get some new shirts that would be tighter at the collar, so that his neck wouldn't look so bad in the newspaper pictures." 4i

While campaigning for his fourth term in August 1944, FDR gave a speech at the Puget Sound Naval Base in Bremerton, Washington. For about the previous year, he had delivered speeches from the sitting position because of his polio-weakened legs. On this occasion FDR decided to speak standing up, to dispel rumors of failing health.

Unfortunately, in the year since he had last used his leg braces, FDR had lost considerable weight. As a result, his braces no longer fitted him and gave him little or no support at the podium. FDR compensated by using his arms for support, but this required a tremendous amount of arm effort. By the time the 35-minute speech ended, FDR was having severe substernal pain, radiating to both shoulders.

It was feared the president had sustained a myocardial infarction. 9 An electrocardiogram and white blood cell count, made within an hour of the event, showed "No unusual abnormalities." 2 (Based on the timing of the event and the EKG, the possibility of an anginal attack cannot be eliminated. Of course, it could also have been purely musculoskeletal in origin. The account of the episode differs between Goldsmith 9 and Bruenn 2 -- Goldsmith's is more dramatic.)

There is a photograph in the Roosevelt library that was taken the day before FDR died. It clearly shows clubbing in the fingers of his right hand. The left hand is not well seen.

Comment: Clubbing refers to a particular shape of the fingernails and the most distal part of the finger itself. (Toes can also be clubbed.) Sometimes benign, clubbing is usually associated with a chronic disease, for example, cancer, lung disease, or liver disease. It can be seen in heart failure, but is more classically associated with cyanotic heart disease. Hippocrates describes clubbing in his writings (ca. 400 BC).

"I have a terrific pain in the back of my head."

The nation was stunned when FDR died unexpectedly on April 12, 1945 -- less than six months after being elected to a fourth term in office. The death was unexpected because the president's personal physician, VADM Ross McIntire, whenever asked, had proclaimed that FDR's health was excellent. McIntire, an otolaryngologist and then surgeon-general of the U.S. Navy, must have known FDR was gravely ill -- FDR's physical decay was plainly evident even to non-physicians in the final months 9. FDR must have known, too, MORE and the FBI was interested in who among the public knew about his condition at the time of the November 1944 election. MORE
   Given his ill health, why did FDR run for a fourth term? FDR told his son he felt compelled to run because he had "to maintain a continuity of command in a time of continuing crisis" 9. World War II was, after all, still raging in 1944. Was FDR justified in this decision? If McIntire was an accomplice in the deception, was he acting for a greater good?
   Today, no one can precisely say how much McIntire knew and when he knew it. FDR's medical record, which was kept in a safe at Bethesda Naval Hospital in Maryland, has been missing since the president's death. VADM McIntire was one of three people with access to the safe. 9

Roosevelt's arteries were so atherosclerotic that embalmers could not get a needle into them. 11