13 Famous Patients

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Text originally published in 1960 under the same title.

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13 FAMOUS PATIENTS

Franklin D. Roosevelt

Adolf Hitler

Mohandas Gandhi

Woodrow Wilson

Marcel Proust

D. H. Lawrence

James Joyce

F. Scott Fitzgerald

Sigmund Freud

Clarence Darrow

Paul Gauguin

George Gershwin

Enrico Caruso

by

NOAH D. FABRICANT

TABLE OF CONTENTS

Contents

TABLE OF CONTENTS 3

DEDICATION 4

PREFACE 5

PORTFOLIO OF ILLUSTRATIONS 7

THE POLITICIANS 36

The Respiratory-Cardiovascular Story of FRANKLIN D. ROOSEVELT 36

The Medical Decline and Fall of ADOLF HITLER 57

The Medical Life and Times of MOHANDAS GANDHI 69

The Presidential Disability of WOODROW WILSON 80

THE WRITERS 92

The Asthmatic Life of MARCEL PROUST 92

The Lingering Cough of D. H. LAWRENCE 102

The Ocular History of JAMES JOYCE 109

A Medical Profile of F. SCOTT FITZGERALD 116

SIGMUND FREUD’S Ordeal 127

When CLARENCE DARROW Had An Earache 134

THE ARTISTS 139

PAUL GAUGUIN: A Medical Portrait 139

GEORGE GERSHWIN’S Fatal Headache 147

The Last Year of ENRICO CARUSO 152

BIBLIOGRAPHY 158

FRANKLIN D. ROOSEVELT 158

ADOLF HITLER 159

MOHANDAS GANDHI 159

WOODROW WILSON 159

MARCEL PROUST 160

D. H. LAWRENCE 160

JAMES JOYCE 160

F. SCOTT FITZGERALD 160

SIGMUND FREUD 161

CLARENCE DARROW 161

PAUL GAUGUIN 161

GEORGE GERSHWIN 161

ENRICO CARUSO 161

REQUEST FROM THE PUBLISHER 162

DEDICATION

To

ABRAHAM FAE LASH, M.D.

Surgeon, Teacher, Friend

PREFACE

THIS is a book about an unsung hero—that often forgotten and yet most important figure in medicine called the patient. When Alexander Pope proclaimed that the proper study of mankind is man, he might have added that the patient is for the physician more than a subject for diagnosis and therapeusis; in reality, the patient is the entire reason for the physician’s existence. More precisely, this is a book about thirteen famous patients who faced their ailments with courage or fear, with hope or despair, with tenacity or resignation. In the face of disease they differed little from other people, for illness sometimes deals harsh blows, physical, emotional, and economic.

In one sense, the medical profiles of the famous patients are unique; they avoid the coldness of many strictly medical case histories and rely instead on an abundance of quotations and excerpts from letters, diaries, conversations, impressions, and medical observations. These breathe the warmth of life into medical portraiture. They have been culled from various authoritative sources—comments by the patient’s themselves, conversations with friends, impressions of associates and contemporaries, and medical observations and findings by physicians.

The value of what patients have to say about the coming and going of their symptoms should never be minimized. Actually, patients occasionally make more astute medical observations about themselves than do physicians who are limited to periodic visits and examinations. Apart from complete candor in conversation, excerpts from letters are most revealing, for they enable the reader to gain insight into the writer’s reactions to disease over periods of months and years.

In still another sense, this book constitutes a running commentary on twentieth-century medical knowledge. The most revealing data on the medical progress of an epoch is supplied not by listing its most prominent physicians and discoveries, but by poring over the medical case histories of patients. Carefully documented medical case histories will unfold the concept of disease that prevailed in a given period, depict the physicians unending search for the nature of disease, and portray his effort to understand his patients and their environment. This, in brief, is a way of looking at patients with fresh eyes and penetrating comprehension.

Thus, treatment of the common cold is no more effective today than it was during the lifetime of Franklin D. Roosevelt. Lack of psychiatric attention in the case of Adolf Hitler demonstrates how mental disease can alter the course of world history and affect our lives. The problem of presidential disability created by the illness of Woodrow Wilson is still unsolved; here physicians are sometimes caught, wittingly or unwittingly, in the meshes of national power politics. Had Marcel Proust, D. H. Lawrence, F. Scott Fitzgerald, and James Joyce been alive during the past decade, their respective asthmatic, tubercular, and ocular lives would have been favorably influenced by the administration of steroid hormones and anti-tuberculosis drugs. The bizarre pattern of life and death that characterizes the progress of cancer is revealed in the battles of Sigmund Freud and George Gershwin against the disease. Freud lived for sixteen years with cancer of the mouth and jaw, Gershwin only briefly after diagnosis of a brain tumor had been made. The syphilitic affliction that threatened Paul Gauguin is no longer a formidable enemy, thanks to the discovery of antibiotics, yet the problem of alcoholism that troubled F. Scott Fitzgerald remains a source of widespread concern. Several decades ago a mastoid infection caused Clarence Darrow six months of intense pain and suffering and nearly cost him his life. An ear infection can now be successfully dealt with in a few days and at little cost. Similarly, had Enrico Caruso been alive today, use of antibiotics or sulfonamide drugs would have saved his life. Mohandas Gandhi’s concept of dietetics and drugs was often based on pure, unadulterated medical whimsey. Medical whimsey still influences many people all over the world, sometimes to their detriment.

Several of the medical profiles, originally published in the Eye, Ear, Nose and Throat Monthly, have been revised and expanded. For help extended in various ways I am greatly indebted to Jens Nyholm, Director of the Northwestern University Library; Mrs. Amy Nyholm, Manuscript Librarian of the Newberry Library, Chicago; Ira Gershwin; Dr. Gabriel Segall; Groff Conklin; Herman Kahn, Director of the Franklin D. Roosevelt Library, Hyde Park, New York; Richard Ellmann, Professor of English, Northwestern University; Harry T. Moore, Professor of English, Southern Illinois University; Mrs. Anne Targ; and Elmer Gertz. I would like further to acknowledge the assistance of Elizabeth Peurifoy who graciously typed the manuscript. And, as always, my grateful thanks go to my wife and my daughter Phoebe for their encouragement during all stages of the preparation of this book.

NOAH D. FABRICANT, M.D.

PORTFOLIO OF ILLUSTRATIONS

FRANKLIN D. ROOSEVELT

ADOLF HITLER

MOHANDAS GANDHI

WOODROW WILSON

MARCEL PROUST

D. H. LAWRENCE

JAMES JOYCE

F. SCOTT FITZGERALD

SIGMUND FREUD

CLARENCE DARROW

PAUL GAUGUIN

GEORGE GERSHWIN

ENRICO CARUSO

THE POLITICIANS

The Respiratory-Cardiovascular Story of FRANKLIN D. ROOSEVELT

FRANKLIN DELANO ROOSEVELT was the only man ever elected President of the United States four times. During the crisis-packed period between his first inauguration in 1933 when he put through the main body of the New Deal and his death on the eve of military victory in 1945, Roosevelt was passionately loved and hated, worshiped and despised, glorified as a dedicated crusader and vilified as a dictator. Indeed, no other President since Abraham Lincoln made a greater imprint on American history and aroused such deep devotion or such intense bitterness. Living at a time of the most distressing economic depression in American history and the most destructive war in world history, Roosevelt influenced the uneasy direction of both.

Had the fates decreed that a young wife and her infant son should die during childbirth on the evening of January 30, 1882, because of an overdose of chloroform, the course of American history would have been irretrievably altered. Instead, joyful excitement reigned in the Hyde Park home of James Roosevelt, the proud 54-year-old father, as he recorded the arrival of his offspring in a diary. At quarter to nine, he wrote, my Sallie had a splendid large baby boy. He weighs ten pounds without his clothes. Actually, the mother of Franklin Delano Roosevelt had a very hard time, the father notified his sister-in-law in a telegram. The mother of a president-to-be was to summarize her obstetrical experience years later in these words: When he was born I was given too much chloroform, and it was nearly fatal to us both. As a matter of fact, the nurse said she never expected the baby to be alive and was surprised to find that he was.

Chloroform fumes are irritating to respiratory mucous membranes. It is therefore not surprising, in light of the over-dosage to which mother and infant had been subjected, that the common cold, by far the most democratic of all the ills that were to plague young Franklin the rest of his life, occurred when he was several days old. For this affliction the doctor prescribed a flannel cap, and it was apparently an efficacious remedy. Franklins care, his mother tells us, would be considered very unscientific as measured by modern standards. We never had a formula. Nurse and I used our own discretion about his feedings, and I know that he was not allowed nearly the variety of food children are permitted under the present-day diets. There were no such people as baby doctors who came in every couple of weeks and weighed, measured and made tests of their tiny patients.…When Franklin was ill, we sent for a doctor immediately. When he was well, we were duly grateful, and let it go at that.

At the very outset plump, pink and nice, the infant Franklin gave his parents little trouble. Within a few weeks after his birth he was placed under the care of a nurse who remained with the family for nine years. Although the services of a nurse were taken for granted, Franklin’s mother believed that every mother ought to learn to care for her own baby, and so she bathed and dressed her infant son and for almost a year breast-fed him. As the months went by, every step of the baby’s development was recorded in a diary, and no item was too trivial for the delighted mother. On November 11, 1882, she wrote: Baby tries to imitate Budgy [the dog] and the cats, and manages to say a semblance of Papa and Mama. And on the following May 17 this was entered; Baby walked quite alone. He is quite proud of his new accomplishment.

When he was three years old, Franklin was taken to Europe for the first time. Two days out from Liverpool, the ship ran into heavy seas, smashing a bulkhead over the Roosevelt cabin through which water poured. Mrs. Roosevelt was certain the ship would sink. Wrapping a fur coat about her son who seemed to enjoy the excitement, she exclaimed to her husband, Poor little boy. If he must go down he is going down warm. The year Franklin was four he was left under the immediate care of his nurse and a Scottish girl he called Tiddle for three months while his parents toured Mexico and California. As a result, he was not as over-mothered as he might have been, at least for the period of his parents’ absence.

The first recorded letter of Franklin D. Roosevelt, written when he was five years old, dealt with the common cold. He knew his letters, his mother explains, but was told how to spell the words. She had been ill in her quarters, and he wrote to her from another part of the house. The letter was penned in ink, it ignored punctuation, it began with the breezy first-name familiarity with which so many young children now address their parents, and was enclosed in an envelope addressed to Mrs. James Roosevelt/Hyde Park/N.Y. The salutation Sallie referred to his mother and the name Mary to the daughter of a neighbor.

1887

Dear Sallie

I am very sorry you have a cold and you are in bed I played with Mary today for a little while I hope by tomorrow you will be able to be up I am glad to say that my cold is better your loving

Franklin D. Roosevelt

At the age of ten, on February 27, 1892, the future President of the United States whose grandfather, incidentally, was a physician who never practiced medicine, good-humoredly wrote his darling mumkin and Pap: I am dying of school fever and you will be horrified to hear that my temperature is 150°. But really I have got a ‘petit rhume’ only I am in the hands of the celebrated Dr. Sandoz—He came up to see me this morning and ordered 5 drops of camfer on sugar twice in the mornin; a hot toe bag, breakfast in bed & stay at home all day tomorrow if not clear of the disease. The celebrated Dr. Sandoz refers to his governess, Mlle Sandoz. The regimen of rest prescribed for young Franklin would currently receive a nod of approval from many physicians. It confined him to his home and limited the possibility of transmitting the common cold to others.

Franklin’s distaste for a scheduled round of activities under the supervision of his mother sometimes took the form of mild circumvention. There were times when he balked, as do many young boys, at the idea of regular Sunday morning church attendance. One cold winter day when he was ten he came down precipitously with an almost undetectable ailment, which he had laughingly predicted the day before. By the time he was twelve years old the symptoms struck with such great regularity that his mother commented, Franklin has what his dear Popsy calls a Sunday headache. Nor was this all in the matter of feigned illness. To get around distasteful piano and drawing lessons, he fell back on allegations that his hand hurt just a little or that he had "un petit bobo," small cut on a finger. In marked contrast, when he was really hurt, he stoically maintained silence so as to avoid alarming his parents.

In September, 1896, when he was fourteen, young Roosevelt was enrolled at Groton School. Here he moved from one discipline to another, from the steady, gentle routine of life at Hyde Park to the rigid, Spartan simplicity maintained by the headmaster, the Reverend Dr. Endicott Peabody. What Dr. Peabody admired most, next to God, was public service, and he invited a stream of speakers to challenge the undergraduate body to go forth and right wrongs in a multitude of fields ranging from heathen China to the slums of New York. All this had its effect upon Franklin for four impressionable years of his life, and there can be little doubt that this influence extended into the years that followed.

Allusions to the common cold appear repeatedly in the lengthy correspondence maintained by Franklin and his parents during the four years—1896 to 1900—that he attended the Groton School. Although he had measles, scarlet fever, and dental cavities, less emphasis was placed on these conditions than on the common cold.

Here are some of the allusions to upper and lower respiratory tract afflictions that plagued Franklin during his boarding school days, and they are as timely in their comment today as they were then.

Sept. 30, 1897. I have had a cold for two days, but today I am much better as a result of playing foot-ball violently.

Jan. 5, 1898. I feel really better today and my cold has almost disappeared.

Jan. 25, 1898. I have been up here since Saturday night, with a sore throat, but it is not at all serious. I was in bed on Sunday & yesterday so could not write you, but today I am up in the convalescent room.

Feb. 17, 1898. Many thanks for your letters and the Bromo-Quinine and Gum-Arabic. I have taken the B-Q two or three times a day and I think my cold is much better.

Sept. 23, 1898. "My cold is almost all gone & I do not notice it at all."

Jan. 20, 1899. About half a dozen boys are in the infirmary with colds and grip, the first of a long series this term I ought to escape, as I shall try to be careful and am taking my C.L.O. regularly.

Jan. 29, 1899. Don’t you think I’d better have another bottle of C.L.O. The one I have is almost empty, and I know it does me good and keeps me from getting cold.

Feb. 2, 1899. I have only a sad and long tale of woe for you up here. First I have a slight touch of grippe which I took in the cold chapel on Sunday. It felt like bronchitis yesterday but I put a mustard plaster on my chest last night and today I am better ‘tho achy and sleepy and tired.

Feb. 5, 1899. My cold has entirely gone now and I’ve never felt better in my life. The mustard plaster took all symptoms of bronchitis away and that without having to go to the Infirmary once.

Feb. 28, 1899. Yesterday, after posting my Sunday letter to you, I went to the Infirmary, as I felt a cold coming on, and my throat was sore. I spent the day in bed, and as a result, I am absolutely well today, and have been to school and taken an examination so you need not worry in the least.

April 18, 1899. I…saw Mr. Peabody for a minute or two. He asked me how my cold was, I didn’t know how he knew about [it]…

April 19, 1899. My cough is better and my neck nearly alright, so you need not worry. I take the mixture four times a day, and have begun the C.L.O.

Oct. 6, 1899. Today we practiced in a pouring rain & I have a slight cold as a result nothing at all.

Oct. 8, 1899. My cold is slight.

Oct. 10, 1899. Cold almost gone.

Jan. 9, 1900. "…I still feel tired & sleepy, tho’ the cold in my head is really better, and I have not coughed as much. Feb. 1, 1900. …Just at present I am suffering from a slight cold in the head and have not been out today, but have sat and read in my study all morning. The infirmary is packed with colds."

Feb. 4, 1900. My cold is practically gone.

To judge from young Roosevelt’s letters, he probably had three to four colds each school year. Today, this is still par for the common cold obstacle race, as every American parent of a school child knows. Mrs. Roosevelt worried constantly about her son’s health. As long as she lived—the mother died in 1941 in her eighty-seventh year—she would not permit him to leave the house without inquiring whether he was dressed warmly enough or urging him to wear his rubbers or put on a sweater under his coat.

Life at Groton during the four years Franklin attended was characterized by Spartan rigidity. The Spartan atmosphere and a chilly environment extended to sleeping arrangements and presumably contributed to the propagation of the common cold. At that time, Groton boys slept in doorless cubicles. A cubicle measured six feet wide and nine or ten feet deep; its walls were seven feet high, above which a vacant space extended to the ceiling. A cloth curtain served as a door. Each cubicle contained a bed, a bureau, a chair, and a small rug.

Groton boys had to arise before 7 A.M., take a cold shower each morning, wash in a tin basin, attend chapel, then go to classes. Afternoon school periods were followed by athletics, chapel once more in the evening, then a study period in the schoolroom. At night, before the boys retired, the Rector and his wife