Physician Report by Dr. Wallace Graham for Former President Harry S. Truman

MÉDICAL RECORD R! ARCH HOSPITAL AND MEDICAL CEI R TRANSCRIPTION MEYER BOULEVARD AT PROSPECT AVENUE + KANSAS CITY, MISSOURI 64132 + PATIENT'S NAME ATTENDING PHYSICIAN TRUMAN, HARRY S. Wallace H. Graham, M.D. MEDICAL RECORD NUMBER ROOM NUMBER : 01-98-68 This 88-year-old Caucasian male, former President of the United States, was admitted to the Research Hospital after having been seen and examined again in his home. He has been treated regularly and there have also been Navy corpsmen at his side constantly to assist and care for him in every physical respect. His medications have been given adequately and regularly. This patient has deteriorated tremendously in the past 18 months; in the past 24 months, particularly. This deterioration was first noticed when he began having considerable memory lapses. Then increasing nerve damage was noted, having difficulty with the sphincters; also having considerable difficulty with walking. He has developed a rather shuffling gate, or more adequately described as scooting, with relatively short steps. He is totally incontinent of the rectal sphincter, and partially incontinent of the urethral sphincter. Through the latter weeks, he has developed a decubitus ulcer be- tween the scrotum and around the rectal areas and over the gluteous, and in spite of seemingly good care, adequate vitamin intake, and protein intake, it has been very difficult to keep this area from breaking down. He has been rather obstinate and reluctant to accept therapy. In the past few months, much of this has been secondary to his extreme modesty and sensitivity, and when he would lose control of his bowels, he was extremely reluctant to call for help or to allow the corpsmen or myself to get him out of bed to have him cleansed, and I have found him struggling around, trying to cleanse himself before he was found. The excreta has been very irritating to the skin and has finally broken down the inguinal area as described. It is raw and certainly painful. He has been treated for this condition. It is difficult to keep him in Chux adequately as he is very reluctant to wear them, and has actually refused. He has an increasing, fine, rapid, senile tremor. Usually this is with voluntary movements, however, constant at times. It is very marked and is present in the limbs while at rest. His muscle tone has altered considerably. Yet, he has some fair strength. This does not seem to be a true tremor of Parkinsonism, as he will make decided movements with the hands, flipping them over on the dorsum in sometimes athetoid-like movements, which was somewhat indicative of having both cerebellar and extraparameteral-like features occurring both at rest and with movement. As he is observed at the present time, he is lying in bed, switching his knees and legs in a rather involuntary motion of movement and occasionally slapping his hands and arms to the side of the bed and on the bed clothes. He has a marked senile tremor of his lips and mandibular clicking of his teeth (or of him gums, actually) and when his teeth were in, he would click his teeth considerably, indicating cerebellar damagé or injury or sclerosis in origin, and simulates, to a degreee, multiple sclerosis, but not accompanied by the rigidity. There are noted to be multiple muscular fasciculations indicative of disturbance of acetylcholine formation at the myoneural synapse and seen in progressive spinal muscular atrophy. In speaking to him directly, he responds. He recognizes me as his doctor and has so stated. And again, on greeting him here in the hospital, he has stated, and I quote, "Doctor, I think we are going to have a very difficult time in this particular instance. But if anybody can get me out of this position, you can. This shows his mental cerebrations are normal to a certain degree. However, in speaking with him later, he was generally disoriented, and the athetoid movements became more prevalent. He has lost considerable weight, having lost approximately 50 to 60 pounds the past 2 years. REPORT TITLE PATIENT'S NAME RUMAN NARA HISTORY AND PHYSICAL TRUMAN, HARRY S. FORM 10-4A 40M 10-73 1