Dr. Lahey's dilemma
Why the founder of the Lahey Clinic chose to conceal his report on President Franklin D. Roosevelt’s medical exam – and how it was finally revealed six decades later.
IN MARCH OF 1944, prominent Boston surgeon Frank Lahey received a highly unusual request: Come to the White House to consult on the health of President Franklin D. Roosevelt. With the presidential election approaching in November, rumors had been circulating about the 62-year-old Roosevelt’s health, including speculation he was suffering from a paralytic stroke, heart disease, cancer of the prostate, and a mental breakdown. He had lost considerable weight, and his once robust appearance had given way to a tired and haggard look, which his personal physician, Vice Admiral Ross McIntire, attributed to the stress of the war years, claiming Roosevelt was “IN EXCELLENT CONDITION FOR A MAN OF HIS AGE.”
That was a blatant lie.
In fact, Lahey, who was chairman of the Navy’s medical consulting board, would ultimately agree with the diagnosis of Dr. Howard Bruenn, a cardiologist at the National Naval Medical Center in Bethesda, Maryland. Prompted by Roosevelt’s concerned daughter, Bruenn had been asked by McIntire to examine him further. Bruenn diagnosed the president with heart failure due to hypertensive heart disease and recommended rest, salt restriction, and weight loss and prescribed digitalis, a heart medication. This spurred McIntire to get additional opinions from two naval medical consultants, one of whom was Lahey. Lahey concurred with the diagnosis of heart failure and predicted that Roosevelt did not have the physical capacity to complete another term in office.
This knowledge presented Lahey, a past president of the American Medical Association, with a dilemma. Was a doctor obligated to keep that information confidential? Or did the country have a right to know about the health status of its elected leader?
As a doctor and the director of medical ethics at the Lahey Clinic, I was intrigued by the tough decision Lahey had faced. There was tremendous pressure on Lahey to keep his consultation with Roosevelt confidential; at the same time, he must have felt an obligation to speak out because of the enormous implications. If the public had known how sick Roosevelt was, he might not have been reelected. Americans would have scrutinized his vice presidential candidate selection more carefully. They might have questioned Roosevelt’s ability to lead the country in wartime.
Lahey, a man with a reputation for integrity, must have agonized over what to do.
Ultimately, he decided to remain silent. But he left behind a memorandum to posthumously protect his reputation and justify why he didn’t release the information. On July 10, 1944, he typed a single-spaced note on his consultation – a document that would become known as the Lahey Memorandum. That note would be hidden away in a vault of the Boston law firm Herrick and Smith, only to be uncovered years later by a surgeon and amateur medical historian.
WITH KNOWLEDGE OF Roosevelt’s health problems effectively kept from the public, the popular president was reelected to a fourth term in November – only to collapse and die a few months into his term on April 12, 1945, in Warm Springs, Georgia, of a massive cerebral hemorrhage, probably related to hypertension.
Even 66 years later, speculation about Roosevelt’s physical condition and cause of death persists. In 1970, Bruenn had published an article in the Annals of Internal Medicine attempting to “set at rest . . . all the rumors and suspicions” surrounding FDR’s medical history. In a follow-up 1980 letter to another journal, after the publication of a theory that Roosevelt had malignant melanoma, he lamented, “Apparently, I failed.” As late as 2009, the book FDR’s Deadly Secret claimed there was a successful conspiracy to hide the melanoma the authors believed killed Roosevelt.
Much of the continued speculation concerning Roosevelt’s health can be blamed on the actions of McIntire, Roosevelt’s physician. After Roosevelt’s death, no autopsy was performed because, as McIntire would later write in his book, White House Physician, there was “no useful purpose to be served by it.” Had one been performed, many of the persistent controversies would be moot. Soon after Roosevelt died, his medical records, which were kept in the safe at the National Naval Medical Center in Bethesda, disappeared. Only three individuals – one of them McIntire – had access to them. It is generally believed that McIntire removed and destroyed those records, fueling the speculation there was a well-hidden secret about Roosevelt’s health.
However, some of the responsibility lies with the president. Following an attack of polio in 1921, Roosevelt camouflaged the extent to which he was disabled, wearing steel braces that let him stand erect if he held the arm of an aide. The press complied; only three photographs of Roosevelt in a wheelchair are said to exist. For most of his long term in office, the public never realized Roosevelt could not stand or walk unassisted. The legacy of this determination to conceal his disability is the belief that he and the people around him were also capable of concealing other medical problems.
In this atmosphere of deception, lies, and missing records, it was speculated that the truth about Roosevelt’s health might be found in the document Lahey had left behind.
FRANK HOWARD LAHEY was born in Haverhill on June 1, 1880. His father owned a successful contracting company, Fletcher and Lahey, and wanted Frank to join him in the business. Instead, after graduating from Harvard, Lahey went to Harvard Medical School and trained as a surgeon. When he returned from medical service in World War I, he opened his own practice in Boston.
Lahey started a multi-specialty group practice, which was a revolutionary idea in 1920s Boston – and not particularly popular with the conservative medical community. The original Lahey Clinic opened in 1926 in Kenmore Square; it is now a major clinical, teaching, and research medical center in Burlington and other sites.
In 1944, it was Lahey’s connection to the Navy’s medical consulting board that led to his invitation to examine the president.
Following the consultation, Lahey gave the memorandum to his business manager and a trustee of his clinic, Linda Strand, with instructions that if he “should ever be posthumously criticized for his conduct in relation to his consultation with [Roosevelt], and his failure to make a public report thereof, the document was to be published if [Strand] saw fit.”
In 1953, Lahey suffered a heart attack while operating and subsequently died.
Strand deposited Lahey’s memorandum for safekeeping with her Boston law firm, Herrick and Smith. With the approval of Lahey’s widow, Strand was appointed director of the clinic. However, the clinic’s physicians found this intolerable. According to The Knife That Saves: Memoirs of a Lahey Clinic Surgeon, by a former clinic director, Dr. Herbert Dan Adams, Strand was secretive and kept physicians in the dark about the clinic’s finances. She was also considered extremely intrusive and read personal mail addressed to physicians. As one retired physician told me, “The doctors despised her.”
Eventually the doctors managed to get her fired. Strand retaliated with a lawsuit, claiming Lahey had promised her a lifetime pension. In October 1962, a settlement was reached giving Strand a lump sum payment, a monthly pension, and, most significantly to history, the rights to her “supplementary documents, letters and papers.”
Strand’s lawyer informed the Lahey Clinic of the memorandum’s existence and stated it would be held by his firm “until such time comes, if it ever does . . . that the document should be redelivered to [Strand] in order that she may carry out the conditions upon which it was given to her. In the event of [Strand’s] death, the document will be destroyed if it is still in our possession.”
IN 1963, Dr. Harry Goldsmith, who later became a professor of surgery at Boston University’s School of Medicine, heard a lecture by Dr. George Pack at Memorial Sloan Kettering Cancer Center in New York on the historical impact of illness in world leaders. Pack, a cancer surgeon, mentioned that his friend Frank Lahey had told him that he had examined President Roosevelt in 1944 and had told Roosevelt that he would not live to carry out the duties of his last term in office. According to Pack, Lahey told Roosevelt he should not run for a fourth term.
Once he learned of the memorandum’s existence, Goldsmith was tenacious in his effort to get it. Lahey had no motive to leave behind a posthumous lie. There was good reason, Goldsmith believed, to think the truth about Roosevelt’s health would be found there.
Goldsmith eventually found an “inexperienced” secretary at the Lahey Clinic who was mailing Linda Strand’s pension checks; she gave him Strand’s address, which turned out to be a post office box in Florida. Goldsmith wrote Strand two letters that went unanswered. Utility companies refused to give him her address. The Secret Service denied his request to find her, saying doing so would violate her civil rights. He debated waiting in front of her post office box until she arrived to get her mail. Finally, a 1983 search at the county deeds office pulled up a potential lead, a reference to her neighborhood.
Goldsmith, a professor of surgery on a mission, stopped a large garbage truck and asked the driver if he knew anyone in the area named Strand. He was able to direct Goldsmith to the area where she lived. Goldsmith rang doorbells. At one house, a “short, overweight, extremely alert and feisty woman” came to the door. Goldsmith said he was looking for Mrs. Strand.
She replied, “I’m Mrs. Strand.”
LINDA STRAND, as the result of her dismissal, was no friend of the Lahey Clinic. Goldsmith says he pressed upon her the historical importance of the memorandum and persuaded her that there had been criticism of Frank Lahey, obliging her to retrieve the document.
At the time, Strand was in her late 80s; time was of the essence. But getting the memorandum back proved to be more difficult than either of them anticipated.
The law firm of Herrick and Smith refused to return the document, claiming the conditions for its release – criticism of Lahey – had not been met. Strand, with Goldsmith’s support, sued the firm in a Massachusetts superior court. The Lahey Clinic supported Herrick and Smith, claiming the need to protect President Roosevelt’s confidentiality, and it was willing to allow the historic memorandum to be destroyed after Strand’s death. However, the National Archives and Records Administration would eventually file an amicus brief that supported Strand, stating the memorandum was “a unique and important historical document; there is substantial public interest in ensuring its preservation.”
The court ruled against Strand; an appeal was filed. Aware of the importance of the case, the Supreme Judicial Court of Massachusetts bypassed the appeals court and took the case. It ruled in favor of Strand in 1986, finding there had been “posthumous criticism” of Lahey.
The criticism of Lahey was of dubious significance. It included comments from David Boyd, a Lahey Clinic thoracic surgeon and author of an unpublished book on the clinic’s history, who noted, “The silence by the ordinarily direct and honest Lahey is especially hard to accept.” He added, “Were these well-intentioned doctors . . . guilty of what in the ’70s became known as the ultimate in political chicanery, the ‘coverup’?”
The court ruled Lahey’s instructions did not necessarily require the criticism of Lahey to be valid and ordered the memorandum returned to Strand.
After the court decision, John French of Herrick and Smith removed the memorandum from the firm’s safe and turned it over to Strand’s lawyer, who delivered it to Strand in Florida. Later, while having lunch with Goldsmith, Strand took the memorandum out of her pocketbook and gave it to him.
Goldsmith kept the document’s contents to himself for almost 20 years, hoping it would help sell his planned book to a publisher. In 2005, he shared it with Newsweek magazine in return for a promise to publicize his book. In 2007, he self-published A Conspiracy of Silence: The Health and Death of Franklin D. Roosevelt, which contained the full text.
Last year, I spoke with Goldsmith, and he gave me a copy of the memorandum, which now hangs at the Lahey Clinic.
In his report, which contains Roosevelt’s medical diagnoses, Lahey’s dilemma is spelled out. Did the country have a right to know about the health of its president, or was a doctor, even in these circumstances, bound by the rules of medical confidentiality? Lahey’s ambivalence is evident. He states he cannot violate “possible professional confidence,” but in the same paragraph says the memorandum should be “opened and utilized” if there were to be “criticism . . . later” directed toward him for not making public a report of his consultation with Roosevelt.
Did Lahey discharge his obligations to history? Lahey said he told McIntire that Roosevelt had a “very serious responsibility” concerning who is vice president. McIntire said he agreed with Lahey and would inform Roosevelt. Lahey’s justification for not making this information public, the fact that he told McIntire, is questionable, since he probably knew McIntire was untrustworthy.
MEDICAL CONFIDENTIALITY is not an absolute right and can be violated if, for example, there is a substantial threat to an identified person. Whether the physician to a US president can violate medical confidentiality to prevent a perceived threat to the country is a complicated matter that, in my opinion, has yet to be fully discussed and resolved.
Can the revelations of the Lahey Memorandum be taken as the final word on Roosevelt’s health?
Lahey’s words here are unequivocal: Roosevelt had heart failure due to longstanding hypertension and a question of coronary damage. There is no mention of malignant melanoma or any other cancer. In the absence of an autopsy, the truth may never be known definitively, but the memorandum is our best hope that this historical mystery can finally be laid to rest.
Dr. David Steinberg is a hematologist at the Lahey Clinic. He founded and heads the Lahey Clinic Section of Medical Ethics. Send comments to firstname.lastname@example.org.