"Too Busy To Be Sick"

Recurrent illness over the last two years had made it plain that Anna Eleanor Roosevelt needed the detailed attention of a specialist in diagnosis. But she was as contemptuous of fuss and feathers in regard to her health as in other matters; she brushed aside suggestions that she subject herself to major medical procedures. Mrs. Roosevelt was unfitted by temperament to be an invalid. She liked to say: "I'm too busy to be sick."

From the Marrow. For at least two years, Mrs. Roosevelt had been anemic. Doctors established that her bone marrow was not producing enough blood cells, but why this was they had no idea. Each time her hemoglobin and hematocrit (red-cell concentration) readings fell alarmingly low, a blood transfusion lifted them above the danger level. Early this year, she was put on a regular dosage of cortisone-type hormones. This treatment carried the risk of reducing her resistance to infections. Not surprisingly, Mrs. Roosevelt began to run a fever. Nobody knew what was causing it. The common everyday infections, from common cold and flu to strep and staph, were soon ruled out by bedside observation and lab tests.

The fever persisted; but only on the promise that it would be a short stay was Mrs. Roosevelt persuaded to go into Manhattan's famed Columbia-Presbyterian Medical Center. There, a specimen of Mrs. Roosevelt's bone marrow--the body's main factory for various elements in the blood--was taken by puncturing a hipbone with a big hypodermic needle. The hematologists who examined the marrow smears under the micro scope could not agree. Though there were enough cells present to rule out aplastic anemia, one of the deadliest forms of the disease, some of the experts thought that the abnormal cell forms suggested an obscure type of leukemia. Others said not.

A chest X ray indicated recent changes in the lungs--but again, nothing definite. This and other hints suggested that the anemia might be complicated by a tuberculous infection. So the doctors at once prescribed vigorous treatment with the most potent combination of anti-tuberculosis drugs: streptomycin, PAS (para-aminosalycylic acid) and isoniazid.

Culture Proof. With a younger patient, in better general condition, the treatment would almost certainly have knocked out TB of the ordinary infectious type. But Mrs. Roosevelt got no better. After doggedly trying to carry on her work from a hospital bed, and still protesting that she did not want her life prolonged by extraordinary and heroic medical measures. Mrs. Roosevelt left the hospital.

About a week before she died, a culture inoculated with Mrs. Roosevelt's bone marrow produced the bacilli of tuberculosis. This was almost certain proof that TB had been the mysterious and stubborn lung infection, and an immediate cause of her fever. Most of the dozens of doctors called in on the case agreed that in patients of Mrs. Roosevelt's age, it is not unusual to find the blood-forming mechanism out of kilter in some obscure fashion. And in anybody as determined to keep going as she was, it was not surprising that TB germs (which nearly everybody carries around at times without getting sick) were able to multiply and damage the lungs.

At the autopsy, the pathologists found no medical surprises. Idiopathic (by which doctors mean unexplained) anemia, complicated by tuberculosis, was the cause of death. And the TB overruled Mrs. Roosevelt's cherished wish that her corneas be sent to an eye bank. The infection made them unacceptable.

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