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Editorial Reviews

From Library Journal
In 1955, Dwight Eisenhower became the first sitting president to suffer a heart attack. The political cover-up and, most significantly, the treatment he received for this attack, his chronic bouts of ileitis (Crohn's disease), and the four additional heart attacks that ultimately killed him are the basis for this fascinating, lengthy study. Lasby (history, Univ. of Texas, and a heart attack survivor) uses recently released medical records and physician papers to show that Eisenhower was a health-conscious and understandably obsessed patient who carefully monitored his diet, exercise, and cholesterol. He is portrayed as a military and medical hero who, with help from Mamie, his wife; Howard Snyder, his attending physician; and political supporters and friends courageously met each crisis and completed a full second term. Eisenhower and the military medical system receive a more positive treatment than found in Robert Ferrell's Ill-Advised: Presidential Health and the Public Trust (LJ 9/15/92) or Robert Gilbert's The Mortal Presidency (LJ 11/15/92). Strongly recommended, particularly for academic libraries as a good addition to the growing number of books on the health of leaders.?Karl Helicher, Upper Merion Twp. Lib., King of Prussia, Pa.
Copyright 1997 Reed Business Information, Inc.

From The New England Journal of Medicine, June 4, 1998
Imagine being the physician called to the bedside of the most powerful and beloved man in the world after he awoke with severe chest pain. This daunting task fell to Dr. Howard M. Snyder when President Dwight Eisenhower summoned him in the early-morning hours of April 24, 1955. Snyder was ill equipped to handle such an assignment. He had been a career army surgeon, but since 1945 his only job was that of Eisenhower's personal physician. Dr. Snyder, who had attended the president through many attacks of gastrointestinal distress, gave his patient morphine and sat at his bedside for the rest of the night while he slept.

It was not until nearly 12 hours later, when chest pain recurred, that Snyder summoned help from Fitzsimons Army Hospital and obtained the electrocardiogram that indicated that the president was in the throes of an acute anterolateral myocardial infarction. Clarence G. Lasby, in this compelling narrative, takes Snyder to task for missing the obvious diagnosis, which resulted in delayed hospital management, and for later covering up his error with revisionist memoirs that implied that he knew what was going on and even administered appropriate treatment in the form of heparin and papaverine.

Lasby, a professor of history at the University of Texas and himself a long-term sufferer of coronary artery disease, set out to write a history of coronary disease but along the way uncovered so much interesting material about the Eisenhower heart attack, including Snyder's error, that he created this book. His work details the events surrounding the heart attack and the subsequent course of the patient's medical history, but more important, it describes the way this medical illness affected the president, the political scene, the physicians involved, and the public perception of coronary artery disease.

First and foremost, this is a book about Eisenhower and how his illness influenced his subsequent life. Lasby understands well the impact that the myocardial infarction had on a man who had prided himself on physical prowess, self-reliance, and stoicism, who had been accustomed to commanding and controlling others, and who was possessed of such self-control that in 1949, when informed of the adverse health consequences of smoking, he quit his long-term, four-pack-a-day habit overnight. Recovery was made more difficult, because the prevailing attitudes about patients with coronary artery disease among doctors and the public in the 1950s were uniformly pessimistic; at that time there were no effective palliative treatments, such as surgery or angioplasty, or drugs to improve survival, and ideas about preventive measures were in their infancy. Many patients were consigned to invalidism, and the prognosis for long life was thought to be bleak. Ever the good soldier, Eisenhower was the model patient during the acute phase of his illness, and he later wrote of his gratitude to his physicians for the excellent medical care he received.

Lasby writes admiringly of the way in which the president took control of his own health after recovery. The military metaphor, which had served the general so well, he now applied to his own health to ensure his return to normal functional capacity and improve his prospects for survival. In this battle, he used his natural gifts of vitality, optimism, and strong-willed determination. Long before it was fashionable to do so, he became obsessed with maintaining a low blood cholesterol level through strict dietary and weight control. In like manner, he committed himself to a regular exercise program. Avoidance of stress was the most difficult part of his battle plan. His aides ensured that he had plenty of time for rest, but the control of the famous Eisenhower temper was the patient's responsibility. Before his attack he was prone to sudden, ferocious, purple-veined eruptions of anger, often over minor matters. It is clear that after his heart attack he worked hard to control the frequency and severity of these spells.

One of the reasons this book is enjoyable to read is that the author portrays the drama of many of the situations surrounding the president's illness so well. Medical readers will be particularly interested in the conflicts that arose among the physicians involved in the president's care. Lasby has meticulously reviewed the clinical and personal notes of all who were involved. Snyder, who was Eisenhower's close, personal friend and confidant, assumed the role of family physician. Thomas Mattingly, chief cardiologist at Walter Reed Army Hospital, was in constant attendance. He was convinced that there had been a previous myocardial infarction that had been misdiagnosed as an attack of inflammatory bowel disease. He was also certain that the infarction had resulted in a ventricular aneurysm. Accordingly, his prognosis was grim.

It was Mattingly who enlisted the consultative support of his friend and America's leading cardiologist, Paul Dudley White of Boston. Mattingly felt that the public and the patient would be well served with a civilian physician on the team. White directed the care of the president with consummate skill. Instantly he became the most celebrated doctor in the United States. He disagreed with Mattingly about the previous infarction and was certain that no aneurysm was present. The doctors disagreed about many other matters. For example, there was controversy about whether to use Samuel Levine's "radical" treatment of chair rest instead of the customary complete bed rest during the early weeks of recovery. They tried it, the patient had recurrence of chest pain (almost certainly pericardial), and they quickly abandoned it.

White enjoyed the limelight and the celebrity that his position afforded. Eisenhower was insistent that the public be informed of the medical aspects of his illness in order to avoid the deception about presidential health that had occurred with Cleveland, Wilson, and Franklin Roosevelt. However, neither Eisenhower nor his political aides wanted the public to know the opinions of the physicians about all aspects of his illness, such as the prognosis, particularly as it related to the feasibility of his running for another term. White's courting of the press and occasional comments that served as political fodder for the opposing party later caused him to lose favor with the politicians and ultimately with Eisenhower, who banned him from further press conferences a year after the acute attack.

After Eisenhower's recovery from the acute event, the next drama to unfold was the decision about whether he would run for reelection in 1956. This was a difficult decision, because in that era few felt that a 65-year-old man who had survived a major myocardial infarction would be able to withstand the rigors of a political campaign or the stress of another four years as leader of the free world. The Republicans and Eisenhower himself were certain that no other man in their party could win the election. The president shared the conviction of many that he alone was qualified to lead the nation during those perilous years at the height of the Cold War. He also wanted to be sure that the conservative programs he had initiated in his first term would come to fruition.

Two camps formed. Eisenhower's wife, Mamie, Snyder, and Denver cardiologist Byron Pollock, along with Republicans and most Americans, came down on the side of running again. His brother Milton, son John, Mattingly and White, and Democrats opposed the idea. Mattingly, of course, felt that the president's heart disease was more severe than it appeared to be. Lasby speculates that White's position was more ambivalent. White had for years been a strong proponent of liberating the coronary patient from the invalidism that so many physicians imposed. Therefore, advising the president to continue with his rigorous lifestyle would be in keeping with this philosophy.

Lasby thinks that overriding this view was White's concern that his progressive program for cardiac patients would be set back considerably if his most famous patient had another attack or died during a second term in office. In characteristic fashion, Eisenhower weighed the advice of both sides and ultimately made his own decision to seek reelection. Lasby's insight is surely correct that, for the president, winning the election was the ultimate battle and symbolically represented his conquest of his illness.

Professor Lasby's sure-handed prose style, his organization of a vast amount of material, his understanding of coronary artery disease and its history, and his sensitivity to the drama of the events he describes make history come alive in this highly readable book. He also provides excellent documentation of the influence that this illness in a great public figure had on bringing about more enlightened management of coronary artery disease.

Reviewed by Nicholas J. Fortuin, M.D.
Copyright © 1998 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.

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