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
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
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
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
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.
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 25th amendment to the
United States constitution in 1967 there was no mechanism for removal of an
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
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.”
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
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.
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.
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.
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.
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
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.
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
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.
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.
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.
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.
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.
Last Year. New York: William Morrow, 1974
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,
R.L. A Textbook of Medicine by American
Authors, 6th Edition. Philadelphia: W.B.Saunders,
Doris Kearns. No Ordinary Time, New
York: Simon & Schuster, 1994
International College of Surgeons,” Chicago : 32: 6, p6
33: 1, p 12
B.H. “Revisiting the Death of Eleanor Roosevelt; Was the Diagnosis of
Tuberculosis Missed?” Int J Tuberc Lung
Dis.: 5:1080-1085, 2001
Ross. White House Physician. New York: Putnam,
Jim. “A Roosevelt Mystery”, “Newsweek
Magazine”: p. 8, April 18, 2005
F.H. “This Day 50 Years Ago” New England
Journal of Medicine 1995:332:1038-1039
Geoffrey, Closest Companion. The Unknown
Story of the Intimate Friendship between Franklin Roosevelt and Margaret Suckley. New
York: Mifflin, 1995