The epilepsy of Franklin Delano Roosevelt

Steven Lomazow, MD In the 4 years since beginning research for a book on the health1 of our 32nd president, the diagnosis ofFranklin Delano Roosevelt’s seizures evolved from a suspicion to a virtual certainty. Even more importantly, itis clear that they had a major impact upon his mental acuity and decision-making during one of the mostcritical periods in American history.

There are dozens of independent reports of behavior consistent with complex partial seizures that occurredwith considerable frequency for over a year prior to his death from a cerebral hemorrhage at Warm Springs,GA, on April 12, 1945, none of which were recognized as such by the observers. The true nature of Roos-evelt’s neurologic illness has been one of the most closely held secrets of the 20th century, abetted by the activeparticipation in a cover-up by his 2 most well-recognized physicians, ENT specialist Ross T. McIntire andcardiologist Howard G. Bruenn. It is ludicrous to assume that symptomatology so gross and so frequent wentunrecognized by those entrusted with the health of the most important and powerful man in the world. Thepieces of the puzzle are scattered in dozens of books, articles, oral histories, and a limited amount of survivingmedical records.

In the last year of Roosevelt’s life, the long list of observers who were aghast at his appearance, demeanor, andloss of mental acuity include Winston Churchill, Churchill’s physician, Lord Moran, and Generals DouglasMacArthur and Albert C. Wedemeyer, yet a number of others are particularly graphic and convincing.

In July 1944, prior to his nomination for an unprecedented fourth term, Turner Catledge, then a reporterand soon to be editor of The New York Times, met with FDR:

When I entered the president’s office … he was sitting there with a vague glassy-eyed expression on his face and hismouth hanging open. He would start talking about something, then in midsentence he would stop and his mouthwould drop open and he’d sit staring at me in silence … Repeatedly he would lose his train of thought, stop, andstare blankly at me. It was an agonizing experience for me. Finally a waiter brought his lunch, and (Chief of Staff,General Edwin “Pa”) Watson said his luncheon guest was waiting, and I was able to make my escape.2

Watson was Roosevelt’s chief of staff and close confidante since the earliest days of the New Deal, havingbeen brought into Roosevelt’s inner circle (as was Presidential physician McIntire) by Dr. Cary T. Grayson,the orchestrator of the medical cover-up of Woodrow Wilson’s devastating 1919 stroke.

In January 1945, Senator Frank Maloney of Connecticut, a long-time acquaintance of the President, metwith him over lunch.

Roosevelt looked up but said nothing, his eyes fixed in a strange stare. After a few moments of silence, Maloneyrealized that Roosevelt had absolutely no idea who his visitor was. A pious Catholic, Maloney crossed himself andran to get Pa Watson, fearing the president had suffered a stroke. “Don’t worry.” Watson said. “He’ll come out of it.He always does.” By the time Maloney returned to the oval office, Roosevelt had pulled himself together. Smilingbroadly, he greeted Maloney warmly and launched into a spirited conversation.3

Watson’s dismissive response to the event is strong testimony to both the frequency and the familiaritywith which FDR’s intimate associates dealt with the problem.

Frances Perkins, America’s first female cabinet member, gave the best description:

The change in appearance had to do with the oncoming of a kind of glassy eye, and an extremely drawn look aroundthe eyes and cheeks, and even a sort of dropping of the muscles of the jaw and mouth, as though they weren’tworking exactly. I think they were, but there was a great weakness in those muscles. Also, if you saw him close to, youwould see that his hands were weak … When he fainted, as he did occasionally—not for many years, but for severalyears—that was all accentuated. It would be momentary. It would be very brief, and he’d be back again.4

A January 5, 1948, memo from a Chicago Tribune reporter, Orville “Doc” Dwyer, to his colleague,Walter Trohan, best illustrates the historical importance and also reliably reports that Roosevelt’s daughter,Anna, who served as his hostess and aide for the last year of his life, was well aware of the problem, though she

From the Mount Sinai School of Medicine, West Orange, NJ.

Disclosure: Author disclosures are provided at the end of the article.

Address correspondence andreprint requests to Dr. StevenLomazow, Mount Sinai School ofMedicine, 8 McGuirk Lane, WestOrange, NJ 07052Lomazow@comcast.net

HISTORICALNEUROLOGY

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misinterpreted the seizures as TIAs. The source was aphysician “for years,” a close friend of Anna Roos-evelt Boettinger.

The doctor told me that from what Anna has out-lined to him Franklin D. Roosevelt was for a longtime before he died—and particularly when he wentto Yalta and Tehran (sic)—suffering from hemor-rhages of the brain. The doctor said he died “from abig hemorrhage” but for several years before his deathhad a lot of “little hemorrhages,” small blood vesselsbursting in his brain. When these burstings oc-curred—and they were frequent during his lastyears—he would be unconscious (completely out) al-though sitting up and apparently functioning for pe-riods of from a few seconds to several minutes. Dr.Schmidt said he has no doubt from his conversationswith Anna that these were occurring regularly at thetime he was meeting with Churchill and Stalin andholding other momentous conferences of the utmostimportance to the United States. He said the effectwould be that he would be cognizant of what was goingon, then suddenly lose the thread completely for any-where from a few seconds to 2 or 3 minutes—and thathe could not possibly have known what was going on inbetween.5

Considering the frequency, duration, stereotypicnature, and rapidity of change of this behavior, alter-native diagnoses other than complex partial seizuresare hard to surmise. Their etiology is most attribut-able to cerebrovascular disease, no surprise consider-ing Roosevelt’s severe uncontrolled hypertension and2-pack-a-day cigarette habit. Roosevelt was pre-scribed phenobarbital, between 60 and 90 mg/d, atleast from the beginning of April 1944, allegedly forhis soaring blood pressure. Amazingly, no referenceto lapses of consciousness or, indeed, any neurologicsymptomatology whatsoever (other than those asso-ciated with the fatal brain hemorrhage) is mentioned

in Bruenn’s allegedly definitive 1970 paper on Roos-evelt’s health.6 Bruenn was assigned exclusively toRoosevelt and saw him daily beginning on March 29,1944.

Present-day neurologists spend a good portion oftheir time diagnosing seizures and public educationin epilepsy continues to be a major focus of the spe-cialty. It is not surprising that Roosevelt’s seizureswent unrecognized by those outside his most innercircle of physicians and confidantes. With the intensemedia and greater disease awareness in the 21st cen-tury, it is unlikely that these dramatic events wouldtoday escape notice in such a high-profile persona.

DISCLOSUREDr. Lomazow receives royalties from the publication of FDR’s Deadly

Secret (Public Affairs 2010) and serves on speakers’ bureaus for Glaxo-

SmithKline and Pfizer Inc.

Received August 6, 2010. Accepted in final form October 4, 2010.

REFERENCES1. Lomazow S, Fettmann E. FDR’s Deadly Secret. New

York, NY: Public Affairs; 2010.2. Catledge T. My Life and Times. New York: Harper and

Row; 1971: 146.3. Goodwin DK. No Ordinary Time: Franklin & Eleanor

Roosevelt: The Home Front in World War II. New York,NY: Touchstone; 1995: 571. Goodwin identifies hersource as Eliot Janeway, the noted columnist.

4. Perkins F. Columbia Oral History Project, Part 8, Session12. 1955: 283–284.

5. Walter Trohan Papers, Herbert Hoover Presidential Li-brary, West Branch, IA. January 5, 1948.

6. Bruenn HG. Clinical notes on the illness and death ofPresident Franklin D. Roosevelt. Ann Intern Med 1970;72:579–591.

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