Our Sickest Presidents: The First Finalist

The medical histories of the past fascinate me. By default, they tend to medical histories of the powerful and famous, because that's the information that people care to study and keep. There's something inspirational, though, in seeing that these people also had their share, and sometimes more than their share, of problems, including medical problems. Presidents, they're just like us!

In picking our finalists we looked at two factors--severity of illness and impact on the actual presidency.

Here is the amazing history of our first finalist, Franklin Delano Roosevelt.

Well, of course, the polio. The man was a paraplegic, but paradoxically, the unenlightened attitudes of the day helped him conceal the extent of his disability from the public. The press of the day would no more show his crew of helpers extracting the president from an automobile than today’s mainstream press would publish a picture of the current president on the toilet.

But that’s not what makes him a finalist. Aside from the paralysis he was actually pretty sturdy—until the end of the 1930s. But by 1941 his blood pressure was 188/105.

Time for an interesting discursion. We are so used to getting our blood pressure checked, being told we should keep it down and bring it down, that we forget that this focus is a very recent phenomenon as far as medical history goes. Blood pressure equipment that you could use on a person without having to do something like open as artery dates from the end of the 19th century and the modern way to interpret the sounds through a stethoscope from about 1905. By the 1920s research doctors were finding out that people with very high blood pressure (i.e. systolic in the 300s) usually died in a year and started talking about “malignant hypertension.” By the end of the 1930s smart, up-to-date doctors already knew even more indolent hypertension was deadly. They had learned this via insurance companies, which had a very great interest in determining how likely people were to die. The data they collected showed that mortality started a noticeable upward climb after 140/90.

Unfortunately FDR’s personal physician was neither smart nor up-to-date. He was basically a specialist in Neti pot deployment, as Roosevelt was a martyr to sinus trouble. But it really wouldn’t have mattered if he’d been a Nobel Prize winner, because there weren’t any good treatments for hypertension, which usually only got diagnosed back then when you reached the 200/110 range. Basically the usual prescription was to live a healthy lifestyle, loss some weight, avoid stress, take mild doses of sedatives and eat a very low salt diet, because less salt causes fluid volume reduction and thus reduces blood pressure at least for a while (This latter advice has confused many people into thinking salt “causes” high blood pressure, which it does not.) Although most of this was probably good advice in general, it actually has little if any effect on someone with advanced hypertensive disease. Doctors had tried to lower blood pressure with chemicals called thiocyanates but these were so toxic and had so many side effects, that many practitioners considered the treatment worse than the disease.  In 1931 someone collected and recorded FDR’s blood pressure at 140/100, and it was a complete non-issue. It’s strange to think how much medical practice as changed since a time when many people who are still alive today were around, or when our parents or grandparents were living!

The doctor, Admiral McIntyre, eventually did sneak FDR  in 1944 off to a subordinate at Bethesda for a real medical exam. Like many doctors to rulers he probably found himself in the uncomfortable position of both wanting to cover up his incompetence as much as possible (and loving his power), but also fearing the consequences if the great man died on his watch. The competent MD at the Naval hospital found FDR had left sided heart failure and hypertension (186/108) with dyspnea on the slightest exertion and rales in his lung bases. He recommended some changes and eventually Admiral McIntyre agreed to put on FDR on digoxin and the president did much better. For a little while. By 1944 FDR was in and out of the hospital (under a false name) and a Life magazine photo spread had to be highly edited prior to publication as most of the shots showed a dead man walking. His blood pressures by April 1944 were running around 210/110. Incidentally Roosevelt was running for reelection (and winning) around that time. In February 1945 he attended the famous Yalta conference, doing his best zombie president impression. Some historians think that Papa Joe Stalin wouldn’t have gotten nearly so much of Europe if Roosevelt had been anywhere near his normal game. And in March 1945 a dying Roosevelt was taken to his favorite Warm Springs retreat where he soon succumbed to the inevitable stroke.

So Roosevelt spent the last 5 or 6 years of his presidency (he was elected an incredible 4 times!) with fairly rapidly deteriorating functioning and health due to advanced hypertensive disease. Many think that the effect on his performance at the Yalta conference gave a large portion of Europe to the communist bloc.

Doc Contrarian