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Ronald Reagan Presidential Library
Digital Library Collections
This is a PDF of a folder from our textual collections.
Collection: Roberts, John G.: Files
Folder Title: JGR/President's Health
(1 of 5)
Box: 43
To see more digitized collections visit:
https://reaganlibrary.gov/archives/digital-library
To see all Ronald Reagan Presidential Library inventories visit:
https://reaganlibrary.gov/document-collection
Contact a reference archivist at: [email protected]
Citation Guidelines: https://reaganlibrary.gov/citing
National Archives Catalogue: https://catalog.archives.gov/
THE WHITE HOUSE
WASHINGTON
March 22, 1985
MEMORANDUM FOR FRED F. FIELDING
FROM:
JOHN G. ROBERTS DR
SUBJECT:
Presidential Health Reports
In response to your inquiry concerning Presidential health
reports, I examined the United States Code and Code of
Federal Regulations, the Public Papers of the Presidents
from the Eisenhower Administration to the present, and the
assorted volumes on the Presidency in the library. I also
conducted a media search and discussed the issue with
Professor Meador and, at Professor Meador's suggestion, Dr.
Kenneth Crispell of the University of Virginia Medical
School. What I was able to learn is best characterized as
diverting rather than illuminating.
I have found no law specifically concerning Presidential
health records. To the extent the records are White House
documents and retained in the White House, they would not be
subject to the Freedom of Information Act (FOIA). Kissinger
V. Reporters Committee for Freedom of the Press, 445 U.S.
136, 156 (1980). If the records cannot be characterized as
White House documents, the question of their disclosure in
response to a FOIA request would turn on the applicability
of 5 U.S.C. § 552 (b) (6). Exemption (b) (6) exempts from
disclosure "personnel and medical files and similar files
the disclosure of which would constitute a clearly unwarranted
invasion of personal privacy." Courts have interpreted the
exemption as requiring courts to balance the personal
privacy interest against the public interest in disclosure;
how a court would rule with respect to any particular
Presidential medical record would depend, of course, on the
particular circumstances.
Dr. Crispell has authored a soon-to-be-published book on the
health of Presidents. According to Crispell, secrecy has
been the rule with respect to an incumbent's medical state,
at lease until the Eisenhower Administration. In fact, some
White Houses pursued an active policy of disinformation, and
in some cases (e.g., Kennedy) the refusal to disclose
medical information persists long after the individual's
death. President Cleveland's physician baldly lied about
Cleveland's operation for cancer (which took place on a
yacht for added secrecy); an elaborate conspiracy kept the
details of Wilson's debilitating stroke from the public and
Congress. Crispell considers the most successful cover-up
to have been that of President Kennedy's Addison's disease.
- 2 -
Episodic medical reports of considerable detail were
prompted by Eisenhower's heart attack and Johnson's similar
attack and celebrated surgery. A student of Presidential
illness wrote (in 1977) that "probably no President's
illnesses were as fully and graphically described as those
of Dwight Eisenhower." Riccards, "The Presidency: In
Sickness and in Health," 7 Presidential Studies Quarterly
215, 227. After his coronary Eisenhower himself instructed
his aides to "Tell the truth, the whole truth; don't try to
conceal anything." Extensive and detailed information was
provided on Eisenhower's health problems, but only as the
problems arose -- not on a regular basis. Eisenhower's
medical reporting did not establish a precedent because it
was associated with specific medical crises. Indeed,
Eisenhower's successor actively concealed his Addison's
disease and his use of steroids.
All avowed Presidential and Vice Presidential candidates
released medical records in 1976, probably because of the
Eagleton imbroglio in 1972. President Ford was the first
incumbent to release all the details of his routine physical,
in January of 1976, despite the objection of long-time White
House physician Dr. William Lukash. According to U.S. News
& World Report, Lukash feared Ford's disclosure would harm
the confidential patient-physician relationship and create a
"bad precedent."
The issue is hotly debated, but it is still considered a
violation of medical ethics, according to the AMA Judicial
Council, for a physician to discuss the health of a public
figure patient with the press without the patient's consent.
The Council has urged public figures to release the details
of their health, however, and has stated that physicians
should encourage their public figure patients to do SO.
Several commentators have gone so far as to call for medical
disclosure laws similar to financial disclosure laws, and
even an independent board of medical examiners to provide an
"objective" assessment of the health of candidates and
officials.
In short, there is no law on the subject, and any "precedent"
in favor of detailed disclosure is of only recent origin.
Lukash's fear in 1976 was well-founded, however, and any
refusal to release the details of routine examinations would
now likely be interpreted as a "cover-up." The Eisenhower
and Johnson precedents also suggest the need for full
disclosue with respect to major medical episodes. The
precedent with respect to non-routine testing or more minor
problems is less clear, however, and I for one am not
certain what public interest was advanced, for example, by
the publicity surrounding President Carter's hemorrhoids.
bate-
Prey Health
- Pray Does
- books (library)
- stories
extent of release regioned
-predents?
- material available
IKE heart attach, Sent 20 1955
"Tell the truth, the whole tatl; and to to
consent anythi. " Anham, 272
FOIA?
bitl: seguestration 1 JFK results 128
LBJ: electrocalizion in mollet
169
sear
173 Siday: mobin atatement on mallet lealth
been doctor
soll atos: like, as well (why
Dead
1. eximinal telail
2. Oylata, Ford
3. this
4. commuting (decline, idgelet)
at have a
1
med Setool
Health of Hewer : Chienell:
ww
FOR
medical
Adbin I'me JPK
publics
Chandill
most not made public
(s.ct. care)
/. law : more
2. FOIA : exception; W.H. exerytion (6)(6)
3. POTVS statements
4. Presedent
- Crimell
- books
- Does
- within sent ( Car canther output)
- Emilines
- JFK sequestered Cartony sent)
- later
Crispell:
duty billetin
hush hund whit IKE
when IKE sich
)
Physics because politicyed
JFK biggest false statement me: Address discose
Calidates tell public about health
FOR 28 this posital
mothing in regular boirs, until LBJ; Nin for sure
Conter had it
L
no livense
patient physics infilatility
N.Y. TIMES: 10-11-84
Reagan's Health: How Issue Emerged
M400
By ALEX S. JONES A130
age and fitness to hold office.
news reports and, on NBC, John Chan-
Why did the issue of President Rea-
But not for want of effort by some
cellor touched upon it in a commen-
gan's fitness for office because of his
members of the Democratic campaign
tary. All mentioned the Wall Street
age and health vault into headlines this
staff, and especially by Mr. Coelho,
Journal story.
week?
who is chairman of the Democratic
On Wednesday morning, The Wash-
Mr. Reagan, at 73 years of age, is the
Congressional Campaign Committee.
ington Post, The Philadelphia Inquirer
oldest United States President, and his
After the debate, Mr. Coelho spoke
and USA Today carried front page sto-
age has been an issue
freely with reporters about the age
ries addressing the issue and The New
since before he took office.
issue. He continued to do so the next
York Times published a column on its
News
But only since his debate
morning on the Mondale campaign
Op-Ed page by James Reston on the
Analysys
with Walter F. Mondale
plane as it flew from Louisville, Ky.,
subject.
Sunday night has the issue
where the debate took place, to Wash-
Also on Wednesday, reporters for the
been dealt with at length
ington.
first time after the debate pressed Mr.
this year by newspapers and television
"Reagan showed his age," Mr.
Regan for comment on the age issue
reporters.
Coelho said. "The age issue is in the
and his debate performance, and Mr.
The questions led the Reagan cam-
campaign now and people like me can
Reagan responded by saying that Mr.
paign yesterday to release details of
talk about it, even if Mondale can't."
Mondale appeared younger because he
last spring's medical report that found
On the CBS News broadcast Monday
had been wearing more make-up.
Mr. Reagan to be in good health. One of
night, Bob Schieffer, a correspondent
According to James M. Perry, one of
the President's physicians said yester-
who was on the Mondale plane that
the reporters who wrote the Journal's
day, "Mr. Reagan is a mentally alert,
morning, described the Mondale staff
article, the issue was important before
robust man who appears younger than
as "tap dancing down the aisles" be-
the debate.
his stated age."
cause of the President's performance
Mr. Perry said that the article had
The President's performance in the
in the debate and mentioned that Mr.
been prepared for the most part before
debate, which even his aides described
Coelho was discussing the age issue at
the debate. He said that he had been as-
as "tentative," seems to have been the
length with reporters.
signed the piece about two months ago
catalyst for the emergence of the issue.
The Journal's lengthy article on the
as part of the Journal's package of
But an article in the Tuesday issue of
President's health and age and Mr.
campaign coverage, but that it was
10/9/84
The Wall Street Journal, as well as the
Broder's column appeared the next
only in the last two weeks that they had
aggressive efforts of some Democratic
morning.
worked on it. He added that the begin-
officeholders and members of the
On Tuesday morning, Mr. O'Neill,
ning of the article had been rewritten to
Democratic campaign staff, also seem
who is 15 months younger than Mr.
reflect the controversy created by the
to have played a large role.
Reagan, said that age had become a
President's debate performance.
factor in the campaign. Mr. O'Neill has
The story was not originally assigned
Importance of Journal Article
said he will retire following his next
because of any specific incident, Mr.
"The Journal article was an impor-
term if he is re-elected.
Perry said, but because Mr. Reagan is
tant element in making the age ele-
On Tuesday evening, all three net-
the oldest President. He described the
ment an issue," said John Chancellor,
works addressed the age issue on their
convergence of the story's preparation
senior commentator for NBC News,
evening news broadcasts. CBS and
and the President's debate perform-
but House Speaker Thomas P. O'Neill
ABC treated the President's fitness in
ance as "propitious."
Jr., Representative Tony Coelho of
California and other Democrats "were
already starting to push it before the
Journal article appeared."
The Journal devoted its main article
Tuesday to what it termed the "fitness
issue." The headline said, "Reagan
Debate Performance Invites Open
Speculation on His Ability to Serve."
The article examined the available
information regarding the President's
health and included a comment from a
specialist in aging as saying it was im-
portant to keep an eye out for signs of
senility in a man of Mr. Reagan's age.
In his column on the Op-Ed Page of
The Washington Post the same day,
David S. Broder said the President's
performance in the debate would "let
the age issue emerge as it had not done
in any of his previous campaigns," and
he referred to the difference in appear-
ance between Mr. Reagan and Mr.
Mondale as a "startling contrast."
Initial Link Is Not Made
After, Following the Sunday debate,
virtually all news organizations de-
voted time to a review of the perform-
ances of both the President and Mr.
Mondale, but the focus had been on who
had won and why. While the Presi-
dent's aides acknowledged that his per-
formance had been tentative, the link
had generally not been made publicly I
between the performance and the polit-
ically volatile issue of the President's
WALL ST.J. : 10-11-84
President's Age and Debate Performance
Dominate Campaign to Reagan's Dismay
M400
By JANE MAYER and ELLEN HUME
mental health. But yesterday his personal
Staff Reporters of THE WALL STREET JOURNAL
physician, Dr. Daniel Ruge, pronounced the
WARREN, Mich. Last Sunday's debate
president in "excellent health" and said
and the issue of Ronald Reagan's age con-
there was "no need for a mental test, his
tinue to dominate the presidential cam-
mental health is good.' Dr. Ruge conceded,
paign, to the dismay of President Reagan
however, that by the end of the debate "I
and his supporters and the delight of Walter
think he (Mr. Reagan) was tired. Every-
Mondale and the Democrats.
body was tired."
The White House, nettled by suggestions
Issue of Makeup
that the 73-year-old president seemed falter-
ing and unsure during the Louisville, Ky.,
Mr. Reagan himself said of the debate,
debate, made public a doctor's report on his
"I wasn't tired. And in regard to the age is-
health.
sue and everything, if I had as much
makeup on as he (Mr. Mondale) did, I'd
The two-page report was a more detailed
have looked younger too."
version of one the White House issued last
May 18, describing the president as "a men-
Mr. Mondale, who is 56, pounced on Mr.
tally alert, robust man who appears younger
Reagan's remark. At a rally in Pittsburgh's
than his stated age." It said he suffers some
Market Square, he told a crowd estimated at
loss of hearing in his right ear and a con-
8,000 that "This morning the president said
tracting tendon in his left hand, and men-
the problem in the debate was makeup.
tioned a benign polyp in his colon.
That's the same answer Nixon gave when he
debated Kennedy." Mr. Mondale added,
The report didn't address the president's
"This is a brand new race. From now on,
everything is wide open."
Mondale aides studiously avoid talking
about the age issue, preferring to let the me-
dia pursue it. While clearly delighted that
the issue has arisen, they say Mr. Mondale
has instructed them not to discuss it, even
off the record, for fear of appearing ungra-
cious.
Mr. Reagan tried to score political points
yesterday by exploiting what Mr. Mondale
says was a slip of the tongue during the
debate. Speaking at Macomb Community
College here, the president accused Mr.
Mondale of planning not one but two major
tax increases by favoring the "repeal" of
tax indexing.
"On Sunday night," Mr. Reagan said,
"my opponent admitted that once his first
huge tax hike was approved. he would go for
still more tax increases. Let me quote him.
He said, 'As soon as we get the economy on
sound ground as well, I would like to see the
total repeal of indexing.'
Mr. Mondale said yesterday, "I did not
speak accurately" when he mentioned re-
peal. "I did not use the right words." Under
the 1981 tax law, indexing to account for in-
flation is to go into effect next Jan. 1. Mr.
Mondale has proposed limiting indexing for
families with annual incomes of more than
$25,000.
Mondale Gains
Polls continue to show Mr. Mondale gain-
ing strength after the debate. CBS-TV re-
ported last night that Mr. Mondale had
picked up six points since the debate, al-
though he remains 20 points behind the pres-
ident.
Mr. Mondale also met yesterday in New
York with Israeli Prime Minister Shimon
Peres. At a news conference afterward, Mr.
Peres said the former vice president is "an
old and good friend" and Mr. Mondale
charged that the Reagan administration's
Middle East policies have made "no pro-
gress at all."
L.A. TIMES 10-11-84
Reagan Called 'Alert' in
May 18 Medical Report
White House Releases
failed to employ during the nation-
Details of Examination
Mondale on the foreign policy and
ally televised debate witnessed by
MYDD
defense issues that will dominate
an estimated two-thirds of the
the candidates' second debate Oct.
American electorate.
By GEORGE SKELTON,
Times Staff Writer
A130
21. And, to substantiate the Presi-
But a new campaign issue stem-
dent's charges, he read to reporters
ming from the debate-Reagan's
WARREN, Mich,-Striving to
a long list of votes against military
age and its potential effect on his
keep President Reagan's age from
spending that the Democratic nom-
stamina during a second term-
becoming a major campaign issue,
inee cast during the 12 years he
continued to dog him. The Presi-
White House officials Wednesday
served in the Senate.
dent accused his Democratic critics
released a medical report quoting
Reagan, during a brief press
of a "kind of desperate reaching for
an examining physician as saying
conference conducted as he left the
something" in questioning whether
that the 73-year-old President is
White House Wednesday morning,
he is too old for the job.
"mentally alert" and "robust."
told reporters that, "when Presi-
Despite what he and his aides
The report disclosed nothing
dent Carter in his last two years
have acknowledged to be a disap-
substantially new about Reagan's
felt that he should start redressing
pointing performance during the
health and was based on a physical
the military imbalance, (Vice Pres-
debate-his answers often were
examination conducted last May 18
ident) Mondale advised against it."
hesitant and sometimes he seemed
at Bethesda Naval Medical Center.
And, in his address to the
to lose his train of thought-Rea-
But the the sudden release of the
Ukrainian community, Reagan
gan insisted to reporters: "I wasn't
report is politically significant be-
said, "If my opponent had had his
tired."
cause it comes at a time when
way, there would never have been
He added: "If had as much
Democratic critics are questioning
a (space) shuttle program. He led
makeup on as he (Mondale) did, I'd
whether the President, based on
have looked younger too.
I
the fight against starting the shut-
his debate performance with Wal-
tle program. He would have spent
never did wear it. I didn't wear it
ter F. Mondale Sunday night, is too
the money beefing up the bureau-
when I was in pictures."
old to serve a second term.
cracy in Washington, D.C."
Used Makeup for TV
'Appears Younger'
Repeal of Indexing'
(Reagan did use makeup on
According to the medical report
television, according to veteran
The President also asserted in an
released by the White House, the
makeup artist Howard Smit, who
address to community college stu-
physician who supervised the ex-
worked with him on programs
dents here that his opponent dis-
amination, Capt. W.W. Karney,
including "General Electric The-
closed during their debate that he
stated that "Mr. Reagan is a men-
ater." Smit said it was basically an
has a "two-part tax plan: raise
tally alert, robust man who appears
issue of "balance" before the bright
taxes and raise 'em again."
younger than his stated age" and is
Reagan was referring to Mon-
lights of television.
in good physical health.
dale's comment that he favored
Frank Westmore, the head of the
A brief summary of the report
"total repeal of indexing" of the
makeup department for Warner
had been released when Reagan
income tax once the nation's econ-
Bros. during Reagan's years as a
underwent the examination. But
omy is sound. But Mondale told
contract player for the studio, died
what the White House described as
reporters Wednesday in New York
in 1970, but his brother, Percy, one
complete details were made public
that he had misstated his position
of seven makeup artists in the
Wednesday after journalists trav-
during the debate and meant to say
Westmore family, said that he
eling with the President requested
that he is in favor of full implemen-
worked with Reagan and Ginger
the information.
tation of indexing once the federal
Rogers on the 1951 film "Storm
Meanwhile, Reagan returned to
deficit is under control.
Warning" and that Reagan did not
the political offensive for the first
White House spokesman Larry
wear makeup then. Like many
time in several days, charging in a
Speakes said: "There's a long way
male stars of the era, he said,
speech at a Ukrainian cultural
between repeal and implementa-
Reagan would "sit out in the sun
center here that Mondale "has
tion. Mondale ought to know the
and work on his tan" during pro-
made a career out of weakening
difference."
duction to avoid the need for
America's armed forces."
Indexing, which prevents tax-
artificial skin toning.)
Campaign spokesman James H.
payers from being bumped into
The President's version of how
Lake said Reagan's strategists
higher brackets merely because
he felt Sunday night during the
have decided to begin attacking
they receive cost-of-living wage
100-minute debate was contradict-
increases, is scheduled to take
ed later by his personal physician,
effect Jan. 1. Under Mondale's tax
Dr. Daniel Ruge, who travels with
increase plan, indexing would be
him constantly. "I think he was
reduced for taxpayers earning
tired. Everybody was tired," Ruge
$30,000 to $60,000 and postponed
told reporters.
for those earning more than
Ruge, however, said Reagan's
$60,000.
health is "excellent." And, when
Reagan hammered Mondale on
journalists asked whether he would
the defense and tax issues at three
authorize release of the President's
Michigan campaign stops, using
full medical report, the physician
hard-hitting language that he
agreed.
N.Y. TIMES 10-11-84
Text of a Medical Statement
From Physician to President
Special to The New York Times
A130
WARREN, Mich., Oct. 10 - Following is the text of a statement issued to-
day by Dr. Daniel Ruge, physician to President Reagan, on a medical report of
May 18:
The President's physical examina-
EKG was unchanged from prior
tion was done at the Naval Medical
tracings and without abnormalities.
Center, National Region, on May 18,
The following laboratory studies
1984. During the prior two weeks
were either negative or normal at the
some laboratory studies were done,
levels noted:
and the results are included in this re-
Alkaline phosphatase
61
port.
Total protein
6.5
Capt. W.W. Karney, who super-
Albumin
4.4
vised the examination and did a por-
Globulin
2.1
tion of the examination, stated that,
Cholesterol
219
"Mr. Reagan is a mentally alert, ro-
Calcium
8.7
bust man who appears younger than
Potassium
4.1
his stated age." Auditory acuity of
LDH
168
the right ear was diminished. There
SGOT
19
was contraction of one of the flexor
SGPT
14
tendons of the left hand (Dupuy-
Uric acid
6.0
trens). The remainder of the general
Total bilirubin
0.9
physical examination was normal.
Creatinine
1.0
Ophthalmological examination
Phosphorous
3.3
confirms the myopia for which he
Blood urea nitrogen
14
wears contact lenses.
Chloride
105
An extensive urologic examination
Carbon dioxide
22.2
done on April 1, 1982, was within nor-
Sodium
142
mal range. A limited examination
Red blood count
5.01 million
performed on May 18, 1984, con-
Hemoglobin
15
firmed the previous studies.
Hematocrit
45.6
Sigmoidoscopic examination re-
Platelets
277,000
vealed diverticula noted in a prior
White blood count
8,200
physical exam and a four-millimeter
Bands
1
polyp. The final diagnosis on the
Segmented neutrophils
64
polyp was inflammatory fibroid
Lymphocytes
30
polyp, which requires no further
Eosinophil
1
treatment.
Monocytes
4
Three successive hemo-occult stud-
Urinalysis - Negative for glucose,
ies of feces were negative for occult
al-
blood.
bumin and blood.
Three successive urine cytology
Mean corpuscular volume
91.1
specimens were negative for malig-
Mean corpuscular hemoglobin
30.0
nant cells.
Mean corpuscular hemoglobin con-
Chest X-rays revealed old pleural
centration
32.9
scarring with evidence of resolution
The blood pressure was 140/80 and
since a previous study dated Oct. 29,
the pulse 72.
1981. This is a residual of the event of
His only medicines are multiple
March 30, 1981, and indicates contin-
vitamins, weekly hyposensitization
ued healing.
allergy shots and yearly flu vaccine.
Services of Mead Data Central
PAGE
2
3RD STORY of Level 1 printed in FULL format.
Copyright (c) 1980 The New York Times Company;
The New York Times
July 6, 1980, Sunday, Late City Final Edition
SECTION: Section 7; Page 11, Column 1; Book Review Desk
LENGTH: 878 words
HEADLINE: THE TROUBLE WITH PRESIDENTS
BODY:
Lawrence K. Altman, M.D. is a science correspondent for The New York Times.
PRESIDENTIAL COURAGE By John B. Moses, M.D. and Wilbur Cross. 249 PP. New
York: W.W. Norton & Co. $11.95.
By LAWRENCE K. ALTMAN
American Presidents are often thought of as an unusually healthy lot because
of the rigors endured in their job. But the thesis of ''Presidential Courage'
by John B. Moses, M.D. and Wilbur Cross is that the 38 individuals who
became our leaders have had more disease, dementia and disability than almost
any other known professional group, and that their one enduring shared quality
was courage in overcoming their handicaps.
This book is not the first on the health of the Presidents and should not be
the last. AS a Presidential election unfolds, voters should be as concerned
about the candidates' medical status as about other factors, since the accidents
of health and those of history have a great deal in common.
The authors do provide fascinating accounts of how Grover Cleveland's jaw
cancer was secretly removed on a ship in the East River; of how Woodrow Wilson,
paralyzed from a stroke, could barely sign official papers; of how Franklin
Pierce suffered from cirrhosis of the liver.
Unfortunately, on other counts, this book disappoints. A major contention is
that American Presidents ''rarely turned to the outstanding medical men of their
day for treatment and counsel. This seems true of a few Presidents. But the
authors repeatedly contradict their point by describing many Presidential
doctors and consultants as prominent, noted, top, outstanding, foremost
specialists and pioneers in their fields.
The authors contend that Presidents suffered ''unique'' diseases,
particularly from the demands of office. Sustained stress can take its toll on
any person. But the illnesses described are heart attacks, cancer, alcoholism,
cirrhosis of the liver, depression and nervous breakdowns - common problems in
any doctor's practice.
The authors also argue that a conspiracy among historians has suppressed all
but the vaguest information about the health and disabilities of those who have
held the nation's highest office. Yet diagnosing illnesses from historical
accounts is extraordinarily difficult because it must be based on clues, not on
direct examinations and details from medical and autopsy reports. It is also
sobering to realize how ailments that are considered relatively minor today were
devastating only a few decades ago. In a few cases, the authors do give a good
LEXIS NEXIS LEXIS NEXIS
Services of Mead Data Central
PAGE
3
(c) 1980 The New York Times, July 6, 1980
description of what was once standard medical practice, such as the succession
of 'eminent and respected physicians'' who poked their unwashed fingers into
the bullet wound in President Garfield's lower chest.
In other cases, perspective is lacking, and the level of analysis is
sometimes superficial. For example, the authors attribute Mary Lincoln's violent
eruptions, personality changes and mental illness to the late stages of
syphilis, without mentioning if President Lincoln suffered from this contagious
disease. The omission is important because a heart condition called aortic
insufficiency can be a devastating, life-threatening complication of syphilis.
The authors cite a report concluding that Mr. Lincoln had aortic insufficiency
due to a genetic disease called Marfan's syndrome, which they contend would have
made Mr. Lincoln a hopeless invalid in office had his term not been cut short by
a bullet. Perhaps 50. But they do not consider whether Mr. Lincoln's heart
condition could have been due to syphilis as well as to Marfan's syndrome.
In some places, the writing and editing are sloppy. The authors mention that
President Nixon suffered from phlebitis when he went to China in 1972. Actually,
he suffered from that leg ailment not in 1972, but during his visits to Egypt
and Russia in 1974. His hospitalization and surgery for complications of
phlebitis came shortly after his resignation.
Finally, the authors do not discuss the most important questions regarding
Presidential health. A constitutional amendment now specifies the order of
succession, yet the issue of when a President should relinquish power in a time
of disability or medical crisis is far from resolved. An urgent need exists to
discuss the complexities of the problem of disability and the health of the
Presidents.
A further question is whether someone should be disqualified from becoming
President just because of a chronic illness. How much detail about such a
condition should the public be given? And by whom? The President's personal
doctor? An independent panel? Should a doctor break confidentiality to tell the
public that a President is lying about his health?
Many more such questions need public discussion. Unfortunately, the authors
did not attempt to enlighten us about the answers.
TYPE: review
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4
1ST STORY of Level 1 printed in FULL format.
Copyright (c) 1980 The New York Times Company;
The New York Times
July 20, 1980, Sunday, Late City Final Edition
SECTION: Section 11; Westchester; Page 17, Column 1; Weschester Weekly Desk
LENGTH: 927 words
HEADLINE: AN AUTHOR-PHYSICIAN EXAMINES PRESIDENTS' INFIRMITIES
BODY:
Andrew Jackson
By RUTH GERCHICK
ACCORDING to John B. Moses, a Scarsdale internist, when someone becomes
President, ''he's owned by the public; the public should know what they've
bought.
Dr. Moses, is the co-author, along with Wilbur Cross, of 'Presidential
Courage,' a book recently published by W. W. Norton & Company that deals with
the health of Presidents, their medical treatment and how they were able to
function despite their infirmities.
George Washington, Dr. Moses said in a interview, ''was a hypochondriac.
Jefferson went into a blue funk when his wife died, and rode around crying;
Madison had hysterical epilepsy. Lincoln was manic-depressive, and Harding got
carried off to a sanitarium for upset nerves.
Others suffered from physical illnesses, Dr. Moses said. He cited Andrew
Jackson, for example, who had chronic dysentery, smallpox, chronic urticaria
(body itching), osteomyelitis (bone infection) and blindness in one eye, among
other ailments.
' 'Some of our best Presidents,' he said, ''might never have become chief
executives if people had known they were so sick. The amazing thing is that they
managed to run the country as well as they did. Nevertheless, it seems to me a
man should not be allowed to carry that responsibility if he has a brain tumor
or is suffering from such terrible coronary artery disease that he can't pass a
stress test or a psychiatric test designed to identify severe disturbances. I'm
not talking about peculiarities or neuroses.
Dr. Moses's interest in Presidents has been virtually lifelong. ''As a boy,
I had always admired Washington and Lincoln, he said. ''I was brought up to
think they were the greatest; I even used to keep scrapbooks on them. But it
wasn't until one summer vacation in New Hampshire, when my wife began to collect
political buttons as a hobby, that our conversations became centered on former
Presidents and Vice Presidents. We spent a lot of time reading and talking about
Presidential families, and as a physician, naturally, I began to think about
their health.'
Shortly afterward, Dr. Moses said, he was asked to prepare a medical paper
for White Plains Hospital, the subject of which was Andrew Jackson's health.
When a program on hypertension pre-empted his talk, he delivered the lecture
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5
(c) 1980 The New York Times, July 20, 1980
anyway, at a cocktail party arranged by his wife for friends and colleagues.
In 1972, when the Democratic Vice Presidential candidate, Senator Thomas F.
Eagleton, was eliminated from the ticket after disclosing his history of
recurrent depression, Dr. Moses decided to broaden the scope of his research.
'II had read enough by then to realize that a great many of our Presidents
suffered from emotional illness, he said. 'Eagleton's problems were minuscule
compared with those of Lincoln, Jefferson and Madison. I began studying
Rutherford Hayes, who became President despite an extremely difficult childhood,
which included an abnormally intense emotional tie with his sister. Then I came
across a tremendous amount of medical information on Presidents who had been
assassinated.
''From reading, he continued, ''I found that many Presidents in the past
had had poor medical care, mostly because their doctors were not the best
available but old pals, usually, from the military. Both Woodrow Wilson and
Franklin Roosevelt chose as physicians casual acquaintainces who they remembered
as good conversationalists. Some of the things these doctors did were outlandish
even according to the knowledge of their time. But then overwhelming
personalities, like Presidents, just don't take to standard-type doctors.
Should the public be informed of the health of Presidents? "Many physicians
say not unless the patient gives permission, Dr. Moses replied. ''Even if you
discover a tumor, you have no right to say anything about it publicly because of
the confidentiality between doctor and patient. This is a very difficult
problem. I'm not sure I agree with them when disclosure involves political
figures.
As for whether candidates for the top two posts in the country should be
required to make disclosures on their health, Dr. Moses said, ''I really don't
know the answer.
think some programs should be set up, he suggested, 'whereby the
candidate's physician would send the candidate to a clinic like Mayo or Leahy,
for a complete checkup, including CAT Scans of his brain and pancreas,
echo-cardiograms, stress tests and blood tests galore. Today, some tests reveal
diseases that will kill a person in a year.
"When the findings are in,'' he added, ''the candidate and his doctor should
decide what they will tell the electorate. Between the two of them, they got
to solve it somehow.
The internist, who was born in New Rochelle and has lived and worked in
Scarsdale for 27 years, said he has just begun to explore the field of
Presidential medical history. There are Presidents we haven't covered in this
book, he said, ' 'and First Ladies, who were just as interesting, or more so.
And then there are the Vice Presidents and the guys who didn't make it, like
Henry Clay and Robert Taft. What I'd like to do in the future is have my
publisher give me a huge advance. Then I could take a couple of months off and
just go digging around.
GRAPHIC: Illustrations: Photos of Thomas Jefferson, Rutherford B. Hayes, James
Madison and
LEXIS NEXIS LEXIS NEWIS
U.S. News & World Report
VOLUME LIX-No. 16
WASHINGTON, D.C.
-USN&WR Photo
A grave President pauses in the busy week before his surgery
A
PRESIDENT'S HEALTH
Its Meaning to the Nation
When President Johnson went under the surgeon's knife, Vice President Hum-
phrey stood ready: In this nuclear age, the nation cannot risk a leadership gap
while a President is disabled. Then came the doctors' report: Operation a success.
A President's health in today's dangerous world takes on
The operation, however, went well. Surgeons pronounced
the highest importance to the nation.
it a "complete success." In an early-morning operation that
Only the President holds power to make basic decisions
lasted two hours and 15 minutes, surgeons removed the
in time of war operations, such as those in Vietnam. A Pres-
President's gall bladder, which was found to contain a gall-
ident alone is empowered to act in a nuclear attack.
stone. They also removed a kidney stone in one ureter.
The nation's security demands that there be no time gap
By midday, the President was reported once again able
in the exercise of presidential powers.
to "make decisions." In the meantime, no need for any
When President Lyndon B. Johnson underwent a gall-
presidential decisions had arisen. Another crisis-for the
bladder operation on October 8, Vice President Hubert
nation and for Mr. Johnson-appeared safely past.
Humphrey stood by, ready to take over the presidential
Lyndon Johnson has had a series of health problems, ex-
powers at once, if necessary.
tending back 28 years to 1937. On September 7, he en-
By mutual agreement between himself and the President,
countered a new kind of health problem. While at his Texas
Mr. Humphrey was to step in as temporary acting President
ranch for the Labor Day week-end, he suffered abdominal
if the operation should leave Mr. Johnson unable, for any
pains. X rays and other examinations showed the presence
considerable period, to perform effectively as President.
(continued on next page)
U.S. NEWS & WORLD REPORT, Oct. 18, 1965
33
U.S. News & World Report
WHEN PRESIDENTS
[continued from preceding page]
approaching death, in 1945 when he
HAVE BEEN DISABLED-
N
took part in fateful decisions at the Yalta
of a gallstone and a poorly functioning
Conference that affected the shape of
Twice in its history, this
gall bladder. It was decided by the Presi-
the postwar world. Mr. Roosevelt's ill
health is believed to have contributed
country has been leaderless
dent's doctors that he should undergo
to the victories that Russia's Joseph
for long periods because its
ch
an operation.
President was disabled.
One examining physician was quoted
Stalin won in that conference.
Woodrow Wilson was an invalid, his
In 1881, on July 2, Presi-
as saying the operation could be de-
dent James A. Garfield was
scribed as "preventive maintenance."
brain damaged by a stroke for a 17-
shot. For 80 days he lay dis-
So
The idea was to prevent the movement
month period from 1919 to 1921, during
abled until his death on Sep-
of the gallstones into a more dangerous
which this country refused to join the
tember 19.
area, or a rupture of the gall-bladder
League of Nations he had fostered.
President James Garfield, after being
In 1919, on September 25,
an
lining.
President Woodrow Wilson
On October 5, the President himself
shot in 1881, was incapacitated for 80
suffered a stroke. He was un-
made the announcement that he would
days before dying.
able to perform his presiden-
pr
submit to the operation.
In those times, before the era of nu-
tial duties much of the time
Pe
Then, as though to show that he was
clear weapons and the threat of almost
for 17 months that remained
still vigorous, the President set out on a
instant destruction, not so much hinged
of his term, which ended
two-day whirlwind of activity.
upon having a President in full control
of his faculties at all times. The absence
March 4, 1921.
Mr. Johnson signed some bills and
Several Presidents have
in
proclamations. He made two speeches.
of effective capacity for decision making
been incapacitated for short
He received various delegations. He re-
was not felt so acutely.
periods.
viewed the foreign situation with his
A question of survival. The intricate
Abraham Lincoln, shot on
top advisers. He took newspapermen on
machinery of Government in the U.S.
April 14, 1865, was uncon-
a brisk walk around the White House
today-when survival of the nation may
scious until his death the fol-
grounds and into the White House. He
depend on instant decision-presents a
lowing day.
ou
dropped in unexpectedly on a luncheon
far different problem.
In 1893, Grover Cleveland
at the National Press Club.
This fact came to be recognized dur-
was smuggled aboard a yacht
Late on October 7, the President en-
ing the Administration of President
in New York Harbor for a
tered the National Naval Medical Center
Dwight D. Eisenhower. He considered
cancer operation on his palate
in Bethesda, Md., just outside Washing-
resigning after a 1955 heart attack that
that was kept a secret for 25
ton, D. C. Early on October 8, the opera-
put him out of action for months. After
years.
tion was performed.
that, he had an ileitis operation in 1956
William McKinley was shot
For the President, his gall-bladder at-
and a stroke in 1957.
on Sept. 6, 1901, and died
tack was the first trouble of that type.
It was not until early 1958 that an
eight days later.
But he had suffered many other types of
understanding was reached between
Warren G. Harding lin-
illnesses, as listed in the chart on
President Eisenhower and Vice President
gered several days after a
P1
page 35.
Richard Nixon that the Vice Presi-
heart attack before dying on
to
Mr. Johnson has had recurrent attacks
dent would step in as acting President in
Aug. 2, 1923.
of kidney stones. Most were removed by
case the President were incapacitated
Dwight D. Eisenhower suf-
an
manipulation. However, major surgery
again.
fered three major illnesses
was required in 1955, followed by six
The late President John Kennedy had
0
during his two terms in the
weeks of convalescence.
a similar arrangement with his Vice
White House: a heart attack
Later in 1955 came Mr. Johnson's most
President, Lyndon Johnson. And Mr.
P
on Sept. 24, 1955; an opera-
severe illness-a heart attack which
Johnson, when he succeeded to the Pres-
tion for ileitis in June, 1956;
threatened his life. He spent six months
idency, made the same kind of agree-
and a stroke on Nov. 25,
in
recuperating from that.
ment with Vice President Humphrey.
1957.
Doctors say there has been a complete
Under this agreement, as described
During all the presidential
recovery from the heart attack.
on page 37, Mr. Humphrey takes over as
disabilities of the past, presi-
Since becoming President in 1963,
acting President at any time when the
dential work simply went un-
Mr. Johnson has had some wartlike
President is unable to act.
done.
is
growths removed from his skin. In Jan-
Congress now has proposed a perma-
In the past, there was no
b
uary, 1965, after exposure to bad weath-
nent solution to the problem of presiden-
arrangement, as there is now,
b
er at his inauguration, he was hospital-
tial disability in the form of a constitu-
for the Vice President to take
ized for three days with a severe cold
tional amendment, the terms of which
over temporarily.
is
accompanied by a heavy cough.
are set out on page 37.
Mr. Eisenhower was the
Illness of a President, no matter how
However, it is expected to be 1967
first President to have such
o
mild, creates tremors of concern and
before this proposed amendment is rati-
an arrangement. He put it in
gives rise to questions about what would
fied by 38 States as required before it
writing that Vice President
th
happen if he were incapacitated for any
can become the law of the land.
Richard M. Nixon was to be
considerable period-or should die.
In the meantime, it is the personal
"acting President" in case of
ca
A look at history. Several U.S.
agreement between Mr. Johnson and Mr.
a disability emergency. But
d
Presidents in the past have lain incapac-
Humphrey which assures the country of
that arrangement was not
itated by illness or gunshot wounds for
continuing presidential leadership.
made until 1958-after all the
long periods, as related on this page.
The latest illness struck Mr. Johnson
major illnesses of Mr. Eisen-
Some presidential illnesses have OC-
in the first year of his first term as an
hower's White House years
curred at critical periods in the nation's
elected President. He became 57 years
were past.
history.
old last August. He will be 61 when his
Franklin Roosevelt was a sick man,
(continued on page 36)
U.S. NEWS & WORLD REPORT, Oct. 18, 1965
NE
34
MEDICAL HISTORY OF
1955: Kidney stone removed by
August 8 until Congress convened
surgery at Mayo Clinic, Rochester,
the following January.
LYNDON JOHNSON
Minn. Six weeks of convalescence.
1955-62: Bronchial illnesses, with
Suffered a severe heart attack-cor-
heavy colds.
Childhood: The usual diseases of
onary thrombosis. Serious fears for
1963: Kidney stone. Treatment
childhood.
his life; given only 50-50 chance to
with medication.
1937: Appendectomy.
survive. In hospital five weeks, then
1964: Skin ailment described as
1942-43: Bronchiectasis, contract-
recuperated at Texas ranch from
hyperkeratosis, necessitating removal
ed while serving as a naval officer in
of two wartlike growths from Mr.
South Pacific. The disease, first no-
Johnson's hand. Over a period of 20
ticed during high-altitude flights,
years, he has had nearly a dozen
made him susceptible to heavy colds
small growths removed from various
and pneumonia.
parts of the body. All these growths
Slight fungus infection.
have been benign.
Stricken with near-fatal case of
1965: The current year's record:
pneumonia in New Guinea, taken to
January 23-severe cold with heavy
Pearl Harbor for treatment.
cough, for which Mr. Johnson was
1943-48: Heavy colds, some of
taken by ambulance to Naval Med-
them approaching pneumonia.
ical Center at Bethesda, Md. Hos-
1948: Went to hospital for clear-
pitalized 3½ days.
ing of bronchial tubes.
September 7 - Bothered with
Kidney stone was removed by
stomach pains while at Texas ranch.
manipulation.
Gall-bladder trouble was suspected.
1948-55: Number of bronchial ill-
-UPI Photo
October 8-Operated on for re-
nesses and heavy colds.
Ten years ago, Mr. and Mrs. John-
moval of gall bladder at Naval Med-
Small kidney stones passed with-
son posed at the hospital as he be-
ical Center, Bethesda, Md. A kidney
out difficulty.
gan recovery from a heart attack
stone also was removed.
WHAT DOCTORS SAY ABOUT GALL-BLADDER SURGERY
A gall-bladder operation, such as
bladder trouble is gallstones-solid
President Johnson underwent on Oc-
particles that block the normal
tober 8, is classed as "major" sur-
flow of bile. President Johnson was
gery, yet doctors generally class it
found to have a gallstone. In addi-
among the less hazardous abdominal
GALL
tion, a kidney stone was found in
operations.
the right ureter, and this stone was
The fatality rate is less than one
BLADDER
LIVER
removed.
patient in every 400 in top medical
Medical scientists are not agreed
centers.
on just how gallstones are formed.
The operation consists of remov-
STOMACH
They know, however, that as people
ing the gall bladder.
eat richer foods and exercise less,
This is a bluish, pear-shaped or-
gallstones and gall-bladder trouble
gan, about 2 to 4 inches long and a
become more common. It is esti-
little over 2 inches wide at its wid-
BILE ENTRY
mated that approximately 10 per
est part. It lies under the liver and
is partially attached to it. The gall
TO
cent of all men and 25 per cent of
all women in the U.S. develop gall-
bladder is on the right side of the
INTESTINES
COMMON BILI DUCT
stones before the age of 60.
body just below the rib cage.
Gallstones are not necessarily dan-
It acts as a reservoir for a green-
gerous, but they can cause great
ish, watery fluid called bile, releas-
Area of surgery on the President
pain. They can lead to serious infec-
ing this fluid to aid in the digestion
involved gall bladder and bile duct
tion, to jaundice, possibly to cancer.
of fats.
Most doctors recommend surgery as
Bile is formed in the liver. When
soon as stones are detected.
the gall bladder is removed, as in
to the intestines. When the gall
For a while after surgery, there is
the President's case, the liver itself
bladder is gone, this duct increases
some pain in the wound area.
can normally supply enough bile to
sufficiently in size to take over the
Usually there is no need for spe-
do the job of digesting fats without
reservoir function formerly per-
cial care after the patient leaves the
the reservoir previously provided by
formed by the gall bladder. The en-
hospital. But physicians advise stick-
the gall bladder.
largement process usually takes
ing to a "gall-bladder diet"-one
It does this through the common
three to four months.
that is low in fats-for at least a
bile duct, which leads from the liver
The commonest cause of gall-
year after the operation.
965
U.S. NEWS & WORLD REPORT, Oct. 18, 1965
35
U.S. News & World Report
U.S.
A PRESIDENT'S
Press Secretary reported that the Presi-
-that a slowdown would be advisable,
dent was down to 202 pounds as of Oc-
HEALTH
from the standpoint of the President's
dent.
tober 5.
health.
a clos
The President tends to be a driver at
Long-time observers of the Washing-
lem t.
his work, not inclined to spare himself.
ton scene have learned to be wary of
For
[continued from page 34]
He keeps irregular hours, sometimes
medical reports and forecasts related to
a repu
works far into the night.
Presidents.
Presio
first full term ends. Under the Constitu-
People with long experience in Wash-
Medical reports on Woodrow Wilson,
troub
tion he is eligible for re-election to serve
ington doubt that any other President
after his stroke, tended to be optimistic,
he ha
until 1973, when he will be 65.
worked harder at what many regard as
hiding the seriousness of his condition.
fough
The President is a big man-6 feet 3
an impossible job for any one man.
Reporters saw Franklin Roosevelt fad-
sectio
inches tall, with a large, heavy frame.
Aides' advice: slow down. Mr. John-
in be
ing before their eyes, only to be reas-
His tendency is to be a big eater, with
son insists that he thrives on hard work.
sured by White House doctors.
smoot
a fondness for fattening foods and dishes
Up until his latest illness, doctors had
on the
Today, with the nation's security pos-
that are highly seasoned.
pronounced him in good health. But
sibly at stake, Americans are keeping an
Frie
After suffering pain on September 7,
there long has been a feeling among
dent
extremely close eye on the health of their
he went on a diet and lost weight. His
White House aides-and Johnson friends
side O
President.
tegrat
oppor
issues
gent
Mr
ever,
WHEN ATTENTION TURNS
books
He 1
Housi
TO THE VICE PRESIDENT-
means
"Grea
At
that
Opinions about Hubert Humphrey usually are strong, never
spend
muted. Ever since he became Vice President, speculation about the
ning
rights
kind of leader he would be has been important. Once, many busi-
more
nessmen considered him a strident "liberal." Has he changed? How
future
Th
-USN&WR Photo
much? Here's a close-up of the Government's No. 2 man.
the ti
big p
said
Whenever a President's health comes
to the White House, he would carry for-
omy. He and President Johnson have
land
into question, the Vice President's name
ward socialist-type programs further and
been somewhat alike in this regard.
Fo
instantly enters the public mind.
faster than would Lyndon Johnson.
At the same time, Mr. Humphrey
Presio
Hubert H. Humphrey, as Vice Presi-
Even before the 1964 election, Mr.
has not turned his back on his labor
ers lo
dent, was the object of that kind of in-
Humphrey set out to convince business
friends. He shows no signs of lagging in
give
terest and conjecture when President
leaders that he was not the radical they
his enthusiasm for prolabor legislation,
world
Johnson faced an operation. People won-
imagined. He stressed much the same
and in the future is expected to be bat-
Fo
dered what kind of leader the Vice Pres-
concern that President Johnson voiced
tling for an increase in the minimum
eign
ident would be if decisions at the top
over the need for a profitable and ex-
wage. In any showdown between busi-
been
level were forced upon him.
panding system of private enterprise.
ness and labor, insiders believe, he would
the
In his 10 months in office, Mr. Hum-
P
Bid for new image. As Vice Presi-
choose to side with labor.
said:
phrey has been busy seeking to over-
dent, he has traveled around, speaking
The Vice President built his political
stick
come an impression once widely held
to business and scholastic groups, seeking
base in Minnesota with farmer-labor sup-
among businessmen and others that he
to establish a new image. He told the
port. And, say those who know him best.
sellin
would be a real radical in the White
U.S. Chamber of Commerce:
he would never dissipate one of the big
doesr
House.
"You businessmen are more generous
assets of the Democratic Party-the vot-
Th
How far to "left"? The Vice Presi-
than any government. This is the most
ing support of organized labor.
ested
dent, during his early days in the U.S.
compassionate, most kindly, most eco-
Anti-Communist record. Mr. Hum-
popu
Senate, came to be regarded as favoring
nomically just society on the face of the
phrey always has been strongly anti-
policy
the extremely "liberal" side of public
earth."
Communist. As mayor of Minneapolis, he
tion?
questions. He had been one of the or-
Mr. Humphrey, however, always has
led in the successful fight to drive Com-
"H
ganizers and top leaders of Americans
advocated federal expansion. He has
munists out of the Democratic Farmer-
for Democratic Action (ADA). Most
son P
been on the side of big spending by
Labor Party, which had elected him.
to red
labor leaders gave him strong support.
Government. A balanced budget is not
In 1954, he was the author of legisla-
of the
The Vice President was viewed as be-
one of his preoccupations.
tion in the Senate outlawing the Com-
Pre
ing on the "left" side of most issues-
As one who struggled through the
munist Party of the U.S. as the agent of
hard
more strongly prolabor than Lyndon
Great Depression and who knew the ruin
a hostile foreign power. This did not
He h
Johnson, an advocate of even bigger
that struck the farms and small business
please many of his "liberal" friends.
walls
spending and bigger Government, a cru-
enterprises in rural areas in that period,
In the Vice Presidency, Mr. Hum-
at nig
sading "liberal" on racial problems.
Mr. Humphrey has favored strong fed-
phrey, more than anyone before him, has
work
The feeling was that, if he went on
eral programs to assure a growing econ-
been trained to be a "standby" Presi-
says.
36
U.S. NEWS & WORLD REPORT, Oct. 18, 1965
U.S. News & World Report
A PRESIDENT'S HEALTH-HOW MUCH
SHOULD THE PUBLIC KNOW?
had not picked up the mouth droop, the unsteady walk, the
slurred speech.
Once again, there is speculation about the health of an
"Lord Moran had done what many physicians to the illus-
American President.
trious had done, waited until the deaths of their patients
Every bit of information from the White House-official
and then divulged information not revealed as an essential
and unofficial-is that Lyndon B. Johnson is in the best of
part of securing treatment and not discrediting the dead.
health for a man of his age. The President himself tells vis-
itors he feels fine. Those
"Vice Adm. Ross T. McIntire, Franklin Roosevelt's physi-
cian, in collaboration with George Creel wrote 'White House
close to him say he looks
Physician' in 1946. Like Lord Moran, he describes his travels
and acts like a man in ex-
with Roosevelt and the political events he witnessed, as well
cellent physical condition.
as his patient's medical condition. McIntire found the Presi-
Yet, many are im-
dent generally sound for a man of his age, and he states his
pressed by the fact that
death from a cerebral hemorrhage could not have been pre-
he looks older when they
dicted. On the other hand, Irwin Richman, of the William
see him on television. He
Penn Museum, writing in a recent issue of 'Pennsylvania
has obviously lost weight.
Medicine,' states:
Sometimes, in speeches,
" "The public was uninformed about the President's series
his voice sounds weary.
of "little strokes," arteriosclerosis and a series of respiratory
All of this raises once
inflammations ranging from colds to severe bronchitis.'
more the question about
The President on television
how much information the
"In the case of Wilson, his physician, Dr. Grayson, co-
public does have-or should have-on the health of its top of-
operated with Mrs. Wilson to keep information about the
ficials. The following are excerpts from an article in the
President's stroke from the nation.
Oct. 30, 1967, issue of "The Journal of the American Medi-
"In the case of Harding, the story of his sudden death
cal Association." Dr. Jonas B. Robitscher, the author, is a
still remains mysterious. In Kennedy's case, the full details
practicing physician who also holds a law degree.
of his adrenocortical deficit, the medications he was receiv-
ing, as well as the extent of his orthopedic problem, were
kept from the public
"It is a characteristic of the health reports which the doc-
tors of Presidents reveal to the press that they tend to em-
phasize normal findings and eliminate adverse material
"When Lord Moran, who had been Winston Churchill's
6
Roosevelt's arteriosclerosis and Kennedy's adrenocortical sta-
personal physician and constant companion from 1940 until
tus and also the extent to which he was orthopedically dis-
Churchill's death, published his book ['Churchill: Taken
abled at the time of his death were equally soft-pedaled.
From the Diaries of Lord Moran'] about his famous patient
"The adrenal status is particularly significant, since the
and friend, based on the diaries he had kept during this
knowledge that he was suffering from a disease hitherto con-
whole period, there was indeed furor
sidered usually fatal, as well as the psychological effects of
"Why the outcry? The book contains two types of revela-
receiving cortisone, could both have been factors in the mak-
tions. One is the chronicling of what Churchill did and said,
ing of major presidential decisions. In addition, the reliabili-
his encounters with Roosevelt and Stalin, his remarks on the
ty of the health report issued during the course of the 1960
conduct of the war.
campaign by the candidate's physicians can be judged only
"The second type of revelation concerns Churchill's physi-
on the basis of whether important information was withheld
cal condition-his series of strokes, his gradual deterioration,
from the public.
his attempt to maintain his prestige and power in the 1950s.
*
*
As SO often happens in the case of the physical ills of the
"The principle followed by the doctors of the politically
great, when Churchill had his stroke in 1953 the public was
great during their lives appears to be selective release of
merely informed that the Prime Minister was suffering from
public information, although the public is encouraged to be-
giddiness and would need a month's rest. This rest was
lieve the whole truth is being bared. The physician is thus
stretched out to a longer period of time. Eventually, four
not only a doctor to his patient, but he also fulfills a public
months after the stroke, an important public occasion could
role-he gives reassurance to the public concerning the health
not be delayed-Churchill journeyed to Margate to deliver
of its elected officials.
a major address to the Conservative Party.
"I submit that under such circumstances there can be jus-
"Churchill rose to the occasion; the test was passed; he re-
tifiable exceptions to the principle that the patient's state of
mained Prime Minister for two more years. I wonder if the
health is a private rather than a public matter. Certainly
British doctors who struck out at Lord Moran for his 'breach
during the lifetime of the patient his doctors should not re-
of confidentiality' in letting information of this kind be
veal information without his consent. After his death it
known, long after it had become history and when Church-
would seem appropriate to set the record straight in the
ill's death had made it impossible for harm to result from
hopes that history's lessons can be useful in the evaluation
disclosure, were not, in fact, reacting to their chagrin: they
of similar situations which will inevitably arise."
[END]
52
U.S. NEWS & WORLD REPORT, April 22, 1968
[574]
Nov.
3
Public Papers of the Presidents
lakes from the growing menace of pollution.
thing really be more basic to a Great Society?
Like the problem of the cities, water pol-
Could anything really be more vital to our
lution can no longer be attacked piecemeal.
children?
Our attack must be comprehensive if it is
I have signed many bills in the 3 years that
to be total. Pollution is not a problem of
I have been President. I will sign perhaps
the individual cities or even the individual
a thousand this year. But none has given
States. It is a problem of the entire river-
me greater pleasure than the ones that we
sheds and water basins. And there is where
are about to sign this afternoon. For they
the problem must be fought.
are proud additions to the legacy of a greater
The new measure will allow us to do that.
America.
It enlarges and it strengthens the compre-
I welcome each of you to the East Room
hensive approach that is already begun. It
this afternoon as participants at this his-
creates new incentives for our States and for
toric occasion.
our cities. It strengthens their partnership
Thank you very much.
with industry and with the Federal Gov-
NOTE: The President spoke at I:06 p.m. in the East
ernment. It enables us to work together on
Room at the White House.
sound and practical plans for controlling
As enacted, the Demonstration Cities and Metro-
pollution once and for all.
politan Development Act of 1966 is Public Law
89-754 (80 Stat. 1255), and the Clean Water Resto-
Clean streets and clear rivers-could any-
ration Act of 1966 is Public Law 89-753 (80 Stat.
1246).
575 The President's News Conference of
November 3, 1966
THE PRESIDENT'S PLAN To UNDERGO SURGERY
recommendation that the operation take
place within 15 or 18 days from now.
THE PRESIDENT. Good afternoon, ladies
The doctors also intend at that time to
and gentlemen.
remove a small polyp from my throat.
I wanted you to know that my doctors
They have recommended that I begin a
have recommended that I undergo surgery
reduced schedule of activity in preparation
to repair a defect at the site of the incision
for the operation. I intend to leave tomor-
made during the gallbladder operation a year
row for Texas.
ago.
I would expect to put in a rather heavy
About 6 months ago a small bulge began to
day tomorrow on desk work and bills and
appear in the region of the scar on the right
leave sometime in the afternoon.
side of my abdomen. Although it would
Mr. Moyers 1 is here with the doctors who
disappear from time to time, I experienced
will take part in the operation, and who
a continuing soreness and a drawing, pulling
have participated in the diagnosis.
sensation. The protrusion has enlarged re-
They will come in and be glad to answer
cently and the soreness has recurred, and the
any questions you may have to ask. They
doctors have therefore recommended surgery.
will be Dr. Burkley; Dr. James Cain of
After final discussions with Dr. Burkley
Mayo's; Dr. Devine, the throat man from
in Seoul, Korea, on Tuesday, I accepted his
1 Bill D. Moyers, Special Assistant to the President.
1310
Lyndon B. Johnson, 1966
Nov. 3 [575]
Mayo's; and Dr. Gould, the throat specialist
in the region of the scar localized where the
from New York who has been treating me.
drains had been removed. In April 1966 a
small protrusion was noted.
INTRODUCTION OF PRESIDENT'S PHYSICIANS
There has been a continuing soreness and
a drawing sensation in this area. The pro-
MR. MOYERS. The President will go back
trusion has enlarged somewhat in the last 3
to his office and I will bring the doctors in.
weeks and is now approximately the size of a
We will have a session with them before
silver dollar. It is reducible when the
anyone leaves.
President is either lying down or wearing a
These will all be in the material you will
back brace.
receive as you leave here, but Dr. James
Since there has been some recent enlarge-
Cain is to my far left. Dr. Cain is a long-
ment of the protrusion and recurrent sore-
time personal physician to the President's
ness, surgical repair is therefore advisable.
family.
In August, a small polyp in the region
Next on my left is Adm. George Burkley,
of the right vocal cord of the President's
Physician to the President.
throat was noted. This cleared up from time
On my right is Dr. W. James Gould, direc-
to time. This polyp was again noted just
tor of otolaryngology at the Lenox Hill
prior to the Asia trip and Dr. W. J. Gould
Hospital.
of New York City and Dr. Kenneth Devine
You will have biographical sketches of the
of the Mayo Clinic recommended that it be
doctors.
removed. At the time the abdominal wall
Dr. Hallenbeck is not here. He is the
is repaired, the polyp will be removed from
surgeon who performed the operation last
the throat.
year, and will again be the principal surgeon.
There is no indication of any serious prob-
Dr. Kenneth D. Devine is to my right.
lem in either instance, and his general health
He is a member of the section of plastic
continues to be excellent.
surgery of the Mayo Clinic.
Dr. Hallenbeck is head of a section on
QUESTIONS
general surgery and head of the section of
surgical research of the Mayo Clinic.
Q. What is the nature of the protrusion?
Dr. Burkley has a statement, a copy of
DR. BURKLEY. As the word itself implies,
which will also be in the material you receive
it is just as you look at something, there is a
as you leave here.
little hump, that is what the connotation is.
Q. Doctor, could you define a polyp for
STATEMENT ON THE PRESIDENT'S CONDITION
us?
DR. GOULD. The polyp is a soft tissue
DR. BURKLEY. At the time of the Presi-
protrusion, that is like a grape, actually.
dent's gallbladder surgery, drains were
Q. Like what?
placed in the abdominal wall about I inch
DR. GOULD. A small grape.
from the end of the incision on the right side.
Q. What would cause it?
This is routine procedure in such surgery.
DR. GOULD. In this instance, excess voice
Following removal of the drains, the
usage.
wound appeared to heal completely. On
Q. What would be the size of the polyp,
several occasions, a drawing pain was noticed
sir?
1311
[575] Nov. 3
Public Papers of the Presidents
DR. GOULD. Three millimeters, sub-
can make an incision over it and pull the
cortical.
muscles together and close it.
Q. That might be an explanation for
Q. Is this a frequent development?
hoarseness from time to time?
DR. CAIN. It is a frequent development.
DR. GOULD. Yes.
It is reasonably frequent. You hope it won't
Q. How do you characterize it-a minor
happen, but it happens often enough that I
surgery?
think you would say it was frequent.
DR. GOULD. Any surgery is a surgical
Q. What do you think causes it beyond
procedure and minor or major, according to
that?
the individual. It is a small amount of
DR. BURKLEY. Well, the drainage area
tissue. I will put it that way.
doesn't have the same opportunity to heal as
Q. Would this polyp be tested for a
when the whole thing is tied tightly, and
malignancy?
that sometimes makes that area a little
DR. GOULD. Yes.
weaker and more apt to occur in that area.
Q. Dr. Burkley, do you expect the surgery,
Q. Do either of these two procedures that
the operation, to be held in Bethesda Naval
you describe present problems normally,
Hospital?
with the average patients?
DR. BURKLEY. The decision on where the
DR. BURKLEY. No, there is no particular
surgery is to be performed has not been de-
problem.
cided, it has not been made.
Q. Is it the plan that the President will
Q. What is the size of the protrusion?
remain at the ranch until the operation?
DR. CAIN. I think that you ought to be
MR. MOYERS. That hasn't been definitely
sure you understand this pretty well. There
decided.
is a small defect at the end of the scar, as
DR. BURKLEY. It is recommended that the
Dr. Burkley mentioned, where the drains
President have approximately 2 weeks' rest,
were removed. This is about the size of the
at least 2 weeks' rest before any procedures
end of your finger, perhaps, the area there.
are attempted.
Then, out from this, there is a protrusion
Q. What effect does the removal of the
about the size of a silver dollar, or maybe
polyp have upon the speaking after the op-
a golf ball. Let me show you here. It is
eration? That is, for any period of time,
something kind of this way.
will it be difficult to speak?
Say there is a hole there, and the protru-
DR. GOULD. There will be hoarseness for
sion is something like that [illustrating],
2 or 3 weeks, due to local tissue swelling,
and when he lies down, it goes back in.
but there should be no permanent effect
Q. What caused this, doctor?
upon speech.
DR. CAIN. Well, it is a weakness in the
Q. How long would he ordinarily be hos-
wall there at the area where these drains
pitalized for this procedure?
were in, and the muscles have spread apart
DR. GOULD. Overnight for the polyp.
just a small amount there.
DR. CAIN. He will be in the hospital for
Q. Do they call this an incisional hernia?
several days all together, with this, but he
DR. CAIN. That would be a proper name
will be in good shape as soon as he is out
for it.
from under any anesthesia that he is given,
Q. How do you repair it?
and it will be a very minor disability from
DR. CAIN. It is very simple in that you
that standpoint.
1312
Lyndon B. Johnson, 1966
Nov. 3 [575]
Q. Will both operations be done at the
DR. CAIN. It is not an emergency in that
same time and under the same anesthesia?
way.
MR. MOYERS. Yes.
Q. Did the doctors recommend against a
Q. Would it require as much anesthesia
weekend political trip with all of its talking?
as in the last operation?
DR. BURKLEY. I recommended that the
MR. MOYERS. No.
President, inasmuch as this was indicated,
Q. How long is the operation?
or this surgery was indicated, have it done
MR. MOYERS. Probably less than an hour
at an early date. On the basis of that, I rec-
for both things, from beginning to end.
ommended that he have a period of rest of
Q. Are these things of an emergency na-
approximately 2 weeks beforehand.
ture, that they have to be done?
I feel that that indicates against a week-
DR. CAIN. No, these things are things that
end trip, as you mentioned.
we have recognized, actually, as Dr. Burkley
Q. Did this Asian trip aggravate the situa-
mentioned, for some time. Many people
tion at all, Doctor?
have these, and ordinarily, or often, you can
DR. BURKLEY. I beg your pardon?
do nothing about them. But during this
Q. Did the trip to the Far East aggravate
trip, as some of you know, he was quite
this?
active in doing an awful lot of standing and
DR. BURKLEY. It aggravated it, but the
walking and so forth, and this seemed to be
symptoms were there. There was a slight
enlarging very slightly.
increase, and we noted a slight increase in
Dr. Burkley, at that time, I think, decided
the size of the protrusion during that trip.
that he thought we ought to go ahead and
Therefore, I would think that there was
repair these.
some effect from the strenuous trip.
While doing it, we decided we would take
Q. Did it cause him great pain during the
care of both things at the same time and get
trip?
it done.
DR. BURKLEY. Not great pain, but just
Q. Could it have waited until next week?
stress, a little disturbance there, and a pull-
DR. CAIN. Well, once the decision is made,
ing sensation, and a drawing sensation in
I think you ought to go ahead and get it
the area.
done. This is the thing.
Q. You mentioned he was wearing a back
I do think that extra working and exercise,
brace. Has the President worn a back brace
and so forth, adds to the enlargement a little
very often?
bit.
DR. BURKLEY. He has been wearing it
Q. Did the President ask if it could be
quite regularly, since this protrusion was
delayed any?
noted. It was noted in April.
DR. CAIN. He asked our advice about
MR. MOYERS. The protrusion was noted in
whether it should be delayed, and Dr.
April, and the polyp was noted in August.
Burkley and I certainly concur that, for
Q. Dr. Gould, is a polyp like this generally
many reasons, one, because of the fatigue of
malignant or generally not malignant?
this trip, and so forth, and getting ready for
DR. GOULD. It is not generally, but it will
this operable procedure, I thought that he
be tested, regardless.
ought to take some time off. I hope he will.
Q. Will anyone fill in for the period when
Q. You don't describe this in the nature
the President is under anesthesia?
of an emergency?
MR. MOYERS. I don't believe SO.
74-767-67-Vol. II-11
1313
[575] Nov. 3
Public Papers of the Presidents
Q. Would it be fair to say that further
Those of you who wish to may leave at
effort on the President's part would further
this point.
aggravate his condition?
Q. What is the President's weight? Can
DR. BURKLEY. It is my opinion that inas-
we get some vital statistics on the President,
much as he has noted some change in it dur-
like what does he weigh?
ing this Asian trip, that it would be advisable
DR. BURKLEY. He weighs somewhat over
not to do a similar trip until the repair is
200 pounds.
accomplished.
Q. Somewhat over?
MR. MOYERS. Let me make certain that
DR. BURKLEY. He contemplates a diet
you understand the material in the package.
program during this period prior to the
You will get the biographical sketches of the
surgery.
men who are here-Dr. Burkley, Dr. Devine,
Q. Do you want him below 200 pounds?
Dr. Cain, and Dr. Gould. You will also get
DR. BURKLEY. We would like to have him
a biographical sketch on Dr. Hallenbeck,
around the same weight as he had at the
who is not here, but who will again perform
time of the other surgery.
the surgery.
Q. Which was what?
You will also get a biographical sketch
DR. BURKLEY. Around 198 or 196, I think,
on Dr. Edward Paul Didier, consultant in
but he may not lose that much. He is a tall
anesthesiology in the Mayo Clinic, and in-
man, and actually a lot of men smaller than
structor in anesthesiology in the Mayo Grad-
he is weigh around 200 or 210, and think
uate School of Medicine, who was the
nothing of it. If he gets down to that, he is
President's anesthetist last fall.
really doing very well.
There is also a biography of Dr. J. Willis
Q. How much over 200 is he?
Hurst, professor and chairman of the De-
DR. BURKLEY. I don't know exactly. He
partment of Medicine, of the Emory Univer-
had been ranging around between 200 and
sity School of Medicine, and continuing con-
215. I don't know exactly what his weight
sultant to the President.
has been the last few days or weeks.
Also there will be a sketch on Dr. Lay
MR. MOYERS. Thank you, gentlemen.
M. Fox, the White House physician.
NOTE: President Johnson's eighty-first news confer-
ence was held in the Cabinet Room at the White
House at 3:30 p.m. on Thursday, November 3, 1966.
576 Remarks at the Signing of the Truth-in-Packaging and Child
Protection Bills. November 3, 1966
Mr. Vice President, Secretary Connor, Sen-
you will pardon my being a little late.
ator Hart, Congressman Staggers, and
We have come here this evening to fulfill
Members of Congress:
two obligations that we have to the Amer-
First I ask your indulgence and under-
ican family.
standing because I have been talking to
-We are here to defend truth.
Speaker McCormack, Senator Mansfield,
-We are here to avoid tragedy.
and Senator Dirksen, reporting on my trip
The two laws that I shall sign this evening
and my physical condition. I thought that
will help the American housewife to save
rather desirable and necessary. And I know
her pennies and dimes, and the American
1314
U.S. NEWS AND WORLD REPORT
February
9,
1976
MEDICAL PROFILE
OF GERALD FORD
Age: 62 on July 14, 1975
TELLING ALL ABOUT
Height: 6 feet 1 inch.
Weight: 194 pounds-16 less
A PRESIDENT'S HEALTH
than when he assumed the Presi-
dency in August, 1974.
Heart and vascular systems:
A
UNUSUALLY FRANK REPORT on the
sin's bullet nearly four years ago. Cover-
"Excellent"
health of President Ford is putting
nor Wallace says he is physically able to
pressure on other candidates to "go
be President and that he would agree to
Pulse: 60 beats per minute-
public" on their medical secrets, if any.
an independent medical exam if other
"slow
as generally seen in
After Mr. Ford's annual physical ex-
candidates do likewise.
conditioned athletes."
amination late in January. his doctor
A
dissenting voice. Dr. William Ln-
described him as being as healthy "as a
kash, the President's personal physician.
Blood pressure: 120 over 70.
conditioned athlete."
disagrees on the total disclosure of
Mr. Ford, in making public his de-
medical records and examinations. He
Cholesterol count: 275-within
tailed medical record, was following his
worries about the harm to the confiden-
normal range of 190-310.
own stated feeling that it would be a
tial patient-physician relationship, along
"good idea" for all candidates to give
with the "bad precedent" of such a
Eyes: Is nearsighted, requiring
voters a close look at their health.
move.
glasses only for distant vision.
Some- contenders-Democrats Sar-
As for the President's health, both
gent Shriver and Fred Harris, among
Mr. Ford and Dr. Lukash agreed on the
Knees: Some minor degegerative
them-have issued public statements
"fit as a fiddle" analysis. The doctor said
changes in both knees, with ten-
giving a general picture of their phys-
the President's athletic background has
dency to swell occasionally after
ical condition. A number of others have
disciplined him to daily exercise, a
skiing.
supplied medical records to the publica-
closely watched diet and plenty of vig-
tion Medical World News.
orous activity such as skiing, golfing and
Smoking: Six or seven pipeloads
The extent of detail varied consider-
swimming.
a day. with no pulmonary compli-
ably, however, ranging from broad sum-
Mr. Ford's daily routine begins at
cations or irritation of mouth.
maries to results of laboratory tests. In
5:30 a.m. with 10 minutes of calisthen-
general. their phy sicians found the can-
ics, leg lifts with a 35-pound weight for
Workday: 14 to 15 hours, seven
didates in "good health." Many had
his bad football knees and a half-mile
days a week in recent months.
cause to seck more than routine medi-
"ride" on a stationary bicycle. At might,
cal treatment for a variety of problems.
the President likes to cap his 14 or 15-
Exercise: Follows vigorous daily
Focus on health. Public attention
hour workday with swimming 24
routine, usually including weight-
has been focused on the health issue
lengths-br a quarter mile-in the
lifting to strengthen knees. riding
before, but rarely to the degree that it
White House pool.
on exercise bicycle, calisthenics.
is coming up in-this election year. Politi-
Mr. Ford has lost 16 pounds-down to
quarter mile of swimming.
cal observers say pressure for detailed
194 from 210-in the 17 months he has
accountings may grow more intense,
been President
Medical history: Appendectomy
perhaps even for examination by inde-
During the last year. Mr. Ford has
as a child. Fracture of right collar-
pendent medical experts.
had a bad cold, had a small benign wart
bone at age 14. Knee operations
Part of the reason for the heightened
removed from his lip and has had some
in 1929 and 1972. Hemorrhoidal
interest in the health issue is the condi-
slight swelling of his knees-both of
surgery in 1945. Heavy cold with
tion of Governor George Wallace of Al.
which have been operated on-after
sinus infection in October, 1975.
abama, who is paralyzed from the waist
skiing. His doctor reported no ill effects
Benign wart on left upper lip Te.
down as the result of a would-be assas-
from any of these conditions.
moved in December.
18
Services of Mead Data Central
PAGE
7
1ST STORY of Level 1 printed in FULL format.
Copyright (c) 1978 The Washington Post
March 26, 1978, Sunday, Final Edition
SECTION: Outlook; C1
LENGTH: 3260 words
HEADLINE: We Must Know More About Our Leaders' Health;
The Public's Right To Health Data
BYLINE: By Victor Cohn; Cohn a medical writer for the Washington Post, is
currently a visiting fellow at the Harvard School of Public Health.
BODY:
DO WE Americans have a right to know whether our elected officials are
phisically and mentally fit to serve us?
Such a right is still far from established. Many doctors are only too
willing to obfuscate for their political patients, to remain uninformative or
inaccessible or to tell the public 50 much less than the truth that they mislead
us.
A5 Dr. William J. Curran, professor of legal medicine at Harvard University,
wrote in the New England Journal of Medicine last September, doctors treating
public figures "have sometimes imposed too impenetrable a barrier around the
patients grees a white gauze curtain - to the extent of actually distorting the true
picture."
The recent death of Sen. Hubert Humphrey of Minnesota, a case in which the
public knew so little for 50 long about his 10-year bout with cancer, has
brought this point sharply home againg. But the Humphrey case is only the
latest of several still in public memory, to say nothing of others more distant.
There was the Eagleton affair, in which a man with a history of emotional
breakdowns may might have become vice president without the public ever learning
of his medical past. There was the time during during the Kennedy presidency
when, in the midst of a crisis that could have led to nuclear war, the president
was taking a medicine that often creates euphoria.
Such events prompt Dr. Joseph Fletcher, professor of medical ethics at the
University of Virginia, to remark: "It seems absurd to have laws that requires
candidates or public officeholders to disclose their bank accounts, but allow
them to pursue office or function in office while secretly suffering illnessess
that could interfere with their performance. I'd rather have a rich man, with
some temptation to favor his investments, in public office than I would a man
with a brain tumor."
Similarly, Dr. James Nicholas, who once treated President Kennedy, says: "It
is appalling to have candidates running for office who have documented
infirmities that they don't permit the public to know."
Harvard's Dr. Curran adds: "WE need to begin to develop public policy and
some kind of regular procedure" to give the public the facts about "the health
of their officeholders
We need to think about putting into law such
requirements
One place where we might start would be regular
LEXIS NEXIS LEXIS NEXIS
Services of Mead Data Central
PAGE
8
(c) 1978 The Washington Post, March 26, 1978
examinaions to measure the continuing capacity of those already in office."
Melancholia and Migraines
THE QUESTION is not whether illness or disability should automatically
disqualify a person from publlic office. Abran Lincoln suffered severe bouts of
depression, known then as melancholia. Thomas Jefferson was often laid low with
migraine headaches. Both Dwight D. Eisenhower and Lyndon Johson won election
after suffering heart attacks, and John F. Kennedy's admirers would maintain
that mede a better president with some adrenal insufficency than Richard Nixon
did at the height of his health.
But the point is that informed voters, not officeholders, should be the ones
to make the decision.
Sen. Humphrey told me himself in April, 1976: "I don't believe in having sick
people in office, though I don't say a person can't have minor disabilities and
serve his country well." But politicians, like the rest of us, are not inclined
to face their own mortality, to accept deadly diseases as more than minor
disabilities, or to relinquish their power, and for a long time Sen. Humphrey
was no exception.
Understandable as it may have been, his long reluntance to lay bare all his
medical records might have had serious consequences. If he had won the
Democratic Presidential normination again in the summer of 1976, his illness
would have left his party badly in the lurch. For once he checked into the
Memorial Sloan-Kettering Cancer Center for drastic cancer surgery that October,
just a month before the election, his race would have been ended.
As he said on that painful occasion: "There's no question that I would have
had to step aside" as the candidate. That almost certainly would have thrown
the race to Gerald Ford.
Yet even after that operation and after that statement by Humphrey, a
Memorial Sloan -Kettering press release papered over the grim meaning of his
advanced cancer. And when a few reporters explained that the press release
meant a patient with Humphrey's condition had one chance in four of surviving
five years, they were castigated by some persons close to Humphrey as heartless
and misleading. These included the senator's personal physician, Dr. Edgar
Berman, who called a Washington Post report "irresponsible" and "inaccurate."
CONSIDER the deaths of the Humphrey case. In June, 1937, when Humphrey was
vice president, some red blood cells first showed up in his urine. As Dr. W.
Dabney Jerman, his urologist, said later, that was "the beginning" of what
turned out to be his fatal illness.
An examination a year later showed what was then termed a "dysplssia," or
abnormality of his bladder lining. Although Humphrey was about to run for the
presidency, scarcely anybody in the country was aware of his condition.
In the early 1970s most doctors began calling the type condition he had in
situ carcinoma and talking it more seriously. Carcinoma means "cancer," and in
situ means in a limited site, without the invasion of the surrounding area that
sounds the greater alarm. Doctors differed, and still differ somewhat, on
whether this condition should be attacked like a fully invasive bladder cancer.
Doctors differed in the Humphrey case. But there was no public hint of this
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debate, though Humphrey by then was back in the Senate representing Minnesotans.
In 1972 Humphrey's doctors began regularly using an anti-cancer chemical - as
a "precaution" or "presentative," they said four years later, when this first
became publicly known. Over the years, in fact, the physicians who actually
treated Humphrey - a team headed by Dr. Jarman - remained largely silent,
leaving press statements chiefly to Humphrey's medical adviser and friend, Dr.
Berman. Berman consistently issued rosy views.
In 1973 the doctors treated a "more potentially cancerous" change with
X-rays. This was publicized. But through 1974 and 1975 there was no mention of
any further life-threatening problem or the continuing chemotherapy, though in
situ carconoma cells were still appearing in every examination.
The fact that Sen. Humphrey had been flirting with actual or incipient cancer
since 1967 was finally discloced by him and his doctors in April, 1976. This
was done only in response to a press inquiry. That January, as Humphrey's name
came to the fore as a presidential contender, those close to him recall,
Humphrey suggested to Dr. Jarman that an honest statement be prepared to answer
any inquiries. Thus the statement was ready when The Washington Post inquired
(though Dr. Berman still argued publicly that the in situ carcinoma it described
was not significant).
That summer Humphrey kept emphasizing his "excellent health." But when
Medical World News, a physicians' magazine, broke new ground by succesfully
asking all the avowed presidential candidates for their medical records,
Humphrey declined to release his because he had not formally declared himself.
That fall came his Memorial Sloan-Kettering cancer surgery. Some days later
Dr. Willard Whitmore, the surgeon, issued the following statement:
"Sen. Humphrey continues to do exceptionally well in recuperating
The
pathology report
indicates that the cancer was of low grade
histologically, but had penetrated the bladder wall and involves some of the
regional lymph nodes. A systematic regional lymph node dissection was
performed. The margins of dissection were made clear by microscopic
examination; no transsection of the tumor occured. There was no evidence of
spread beyond the perimeter of surgery. Therefore, it is entirely possible that
the surgery has been curative."
"Let Them Be Completely Candid"
AN ORDINARY reader might have interpreted such a statement as good news,
meaning "they got it all." Wire services, TV networks and most newspapers indeed
carried reports which said or implied that cheery outcome.
Only The Minneapolis Tribune, The New York Post and The Washington Post added
the information necessary to make the meaning clearer: National Cancer Institute
statistics show that in bladder cancer with lymph node involvement the five-year
survival rate is only 23 per cent, whether all the obvious cancer is removed or
not. Hubert Humphrey, of course, remained an individual to whom the statistics
might or might not apply. But the Memorial doctors knew they were dealing with
an alarmingly advanced case of a particularly recalcitrant type of cancer.
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Humphrey, too, knew these facts and, according to a former Humphrey aide, he
often told his staff: "Let the doctors, not the public relations people, make
all the statements. Let them be completely candid. Nothing else will be
credible." That he or his staff or his doctors did not always meet this goal may
speak in part of politics, in part of human hesitation when an ugly disease must
be faced.
And the evasion had not yet quite ended by then. Last August - when Humphrey
entered the University of Minnesota Hospitals for what doctors there felt was
certainly a further growth of his malignancy - the university's first statement,
prepared by a Humphrey aide, told the public he was merely "accomodat[ing] his
vacation" by having a "checkup" and continuing his chemotherapy in Minnesota
instead of Washinton.
This bald evasion deeply disturbed the university surgery chief, Dr. John
Najarian. Najarian told a Humphrey aide that if he was expected to tell the
public anything less than the truth, he would withdraw and let someone else do
the surgery. He did not withdraw and he told the fuller truth: that Humphrey's
cancer was "inoperable" and "terminal."
This was one of two recent cases of notable candor. Another doctor early
last year insisted on giving the public the facts in a sentitive political case.
The patient this time was Maryland's malfeasant governor, Marvin Mandel. A
sudden stroke or apparent stroke had raised serious questions about his ability
to stand a second trial after the first ended in a mistrial. His reported
illness aroused skepticism among many persons who were convinced Mandel had
found a new way to avoid facing justice.
A murky or overblown medical report might have helped Mandel avoid the second
trial that ended his political life. But before even examining him, Dr. Marvin
Korengold, the Washington neurologist consulted by Mandel's family doctor, told
the governor that if he entered teh case, he would be candid with the public no
matter what he found. Dr. Korengold was candid. He said Mandel had had a
stroke but would in time be able to stand trial. Bot truth and justice were
satisfied.
Historical Evasion
UNFORTUNATELY, however, such candor historically has been the exception, not
the rule. President Grover Cleveland underwent cancer surgery on a yacht in New
York harbor 50 that the news, so he said, wouldn't affect the stock market.
Woodrow Wilson suffered a physical collapse in September, 1919, and a stroke a
week later. For more than a year the nation was run in large part by his wife
while Wilson's disappearance was only vaguely explained.
Americans learned of Franklin Roosevelt's failing heart and advanced
hypertension only after his death. Dwight Eisenhower's physicians were
generally candid about his illnesses, but John Kennedy never admitted that he
had Addison's disease, conceding only to a onetime "adrenal insufficiency,"
which means the same thing. Nor did he disclose that he was taking steroids,
which can make the taker unnaturally euphoric, and was taking them at the time
of the Bay of Pigs and Cuban missile crisis.
Dr. Nicholas, the New York orthopedic surgeon who later gained attention as
custodian of Joe Namath's knees, wrote the facts about Kennedy (as an unnamed
former patient) in the Archives of Surgery in 1955. Another doctor who knew
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Kennedy said to me a few years ago: "I treated him when he was a senator. I
took care of him in moments of adrenal crisis. Throughout his campaign when
there was more and more evidence that he was being treated with steroids, one
could not help but wonder what kind of mental decisions he might make and about
his emotional states."
Lyndon Johnson showed us his operative scar after his gall bladder operation
and carried a copy of his electrocardiogram to show he had recovered from a
heart attack. He did conceal the removal of a skin cancer, a highly curable one
common to sun-beaten Texans.
Only this winter Sen. George McGovern disclosed his psychiatric consultants'
reactions when they learned that his running mate, Sen. Thomas Eagleton, had a
history of mental depression and hospitalization serious enough to require
electro-shock therapy on two of his three stays. In his autobiography, "From
Grassroots," McGovern writes that Dr. Karl Menninger reluctantly advised him
that "for the interest of the nation
you can afford no risks and I would
therefore hope and you would ask Mr. Eagleton to step down."
In this case as in others, the facts had long been concealed from the public.
McGovern writes that "when [Eagleton] left for the Mayo Clinci in 1966 in a
serious mental depression that resulted in weeks of hospitalization and
electro-shock treatment, the story his office released was that he was at
Johns Hopkins
for treatment of a gastric disturbance."
When president Roosevelt's physician, Adm. Ross McIntyre, was asked by the
press about Roosevelt's health shortly before FDR's reelection to a fourth term,
he said it was "that expected of a man in his sixties" except for "a little
sinus trouble." The press was successfully dissuaded, sometimes in force by the
Secret Service, from ever photographing FOR sitting in his weekchair, moving
laboriously on his crutches or, more often as the years went by, being carried
bodily from place to place.
There is no doubt that Eagleton's withdrawals as vice presidential candidate
in 1972 helped prompt all the avowed presidential and vice presidential
candidates in 1976 to agree to bare their medical records to Medical World News.
Jimmy Carter not only released his, but insisted that all six contenders for the
Democratic vice presidential slot do the same. One result was the first
disclosure that then Sen. Walter Mondale had hypertension (successfully
controlled by medication).
President Ford became the first president in office to reveal all the details
of his routine physical this, again, to Medical World News. But President
Carter, who was so medically candid a candidate, has so far permitted the
release of only an unspecific, 130 word press release = one with no
corroborating details or statistics - on his latest physical, despite I request
for a full report by the same medical magazine.
What of lesser officials? In 1972 New York Democratic Rep. William F. Ryan
denied reports that he had cancer while running for reelection. He died during
the campaign. In 1974 Manhattan District Attorney Frank Hogan was hospitalized
for a "checkup," or so he said. He too actually had cancer. He was reelected -
but had to resign because of his illness. The governor, not the voters, chose
his successor.
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Last September the suggestion that all major federal appointees and
candidates for Congress routinely disclose their medical histories was made by
Federal Judge Frank M. Johnson Jr., who had just been nominated to head the FBI.
Ironically, he made it while he was recovering from surgery; when he was slow to
recover, he had to give up the job.
Harvard's Dr. Curran thinks that even the Johnson suggestion might not be
enough. What we need, he says, is "not just disclosure of the statement of a
physician engaged by the patient" - or, in the case of a president, the
statement in most instances of a military doctor - but "an independent,
nonpartisan medical evaluation." Dr. Curran thinks such a requirement should be
written into the law governing presidential succession, which now allows a
president to make his own decision about his capacities.
The University of Virginia's Dr. Fletcher thinks doctors sometimes should go
even further on their own. He believes that if a president or presidential
candidate refuses to reveal "whatever information is relevant to the public's
ability to form a judgment [on] whether he is competent to serve," the physician
should speak up if the facts are "manifestly vital to the public's interest."
"When the greatest good of the greatest number is at stake, no individual's
rights or interests should be allowed to dominate," he contends. "This is a
problem that arises in medicine all the time. Sometimes the vell of
professional secrecy has to be lifted to protect a family or the public."
Dr. Fletcher cites a case where secrecy should have been lifted but was not:
"That of Winston Churchill. In the last year or more of his tenure as prime
minister, his deterioration was both mental and physical. He was subject
because of changes in his brain to all sorts of odd and outrageous behavior and
ideas. The cabinet was puzzled and, because of respect for him, reluctant to
act. Had Lord Moran, his physician, told them, 'He is a man suffering from a
physical breakdown and unreliable to rely on,' they would have acted.
Interestingly, it was Mrs. Churchill rather than Lord Moran who finally told
them he was really not competent."
When Private Matters Become Public
SOME DOCTORS probably will continue to obfuseate or remain silent on demand.
They might note that the American Medical Association's Judicial Council, the
main arbiter of American medical ethics, has said a doctor may not discuss a
patient's health with the press without the consent of the patient or a
representative.
But the council added: "Public figures are in a different position, in regard
to publicity, than the ordinary citizen. One of the penalties of being in the
public eye is the automatic surrender of a portion, at least, of one's right of
privacy A patient by virtur of his position may have an obligation to
others. If so, he must know and discharge that obligation ito the electorate or
to the stockholders or to others to whom the is responsible). The physician
should insure the accuracy of any authorized report A physician may,
within the limits of good taste, encourage the patient or his family to state
the cause of illness when this information is requested by a bona fide
representative of the press.*
By Dr. Najarian's and Dr. Korengold's examples last year, physicians shouls
not only encourage disclosure, but in some cases refuse to take the patient
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without it. The doctor who does less may cure his patient but damage the public
and injure his own reputations as well.
Dr. Curran does not think Americans would lightly or foolishly turn thumbs
down on an officeholder or seeker for any but the most serious mental or
physical reasons. He says: "The knowledge and sophistication of the American
public about disease and treatment is much more sophisticated than we sometimes
think. We're living with a good deal of chronic disease in this country. And
the public tends to be eternally optimistic."
But whatever the decision, it should be the public's.
GRAPHIC: Illustration 1, no caption, by Ray Driver for the Washington Post;
Illustration 2, no caption, by John Twohey for the Washington Post; Picture, Dr.
John Najarian explains operation performed on Sen. Hubert Humphrey. UPI
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