Boris Yeltin's heart surgery - 27 September 1996

"Russia," said the editor of a Moscow magazine, "Russia has this awful centuries old tradition of hiding things, and it's very hard to break." It was a comment on the embarrassing contradiction between the word of the Kremlin that Mr Yeltsin is thoroughly up to his job, and the weekend word of his doctors, that he might not be fit enough to have a heart bypass operation, let alone to run the country. Within a day or two the contradiction was well, not resolved but very much challenged, when there arrived on the scene Dr Michael DeBakey, the pioneering American heart surgeon who'd been brought in to consult with Russia's chief cardiologist, a former student of Dr DeBakey who will do the bypass.

Dr DeBakey examined Mr Yeltsin and declared first, in the face of lurid rumours about the president's liver and kidneys and lungs, that they were all normal. In general, Mr Yeltsin he said: "Is contrary to the reports...not in bad shape at all." He is in need of a triple, possibly a quadruple bypass, but the proposed delay in the procedure is not due to a fear that Mr Yeltsin is too frail to withstand it, but that his heart needs a little time to stabilise after a heart attack during the summer.

However, I'm not thinking about Russia's problem of leadership or even about the truth of Mr Yeltsin's health, but of the lament of that editor that it's taken centuries for the health of a Russian leader to be talked about and written about while he's still alive and in power. Certainly most of us know how throughout the seventy years of communism, all Soviet leaders were pictured to the people as normally fit even when they were tottering at death's door. When one of them had a serious illness and couldn't appear in public, he was reported to have a cold or to be taking a well-earned rest.

No doubt many of us, most, will nod our heads sagely and think yes, mustn't it be awful to live in a country whose government can keep so much from the people. But instead of feeling sorry for the Russians, we might well reflect that on one subject that vitally affects the running of any government, most, if not all the nations of the West, including France, Britain, Germany and the United States, have this same centuries old tradition of hiding things, and that subject is the health or ill health of their leader or leaders.

The most dramatic example of suppressing such news...No, suppression is the wrong word, it suggests a positive act of stifling something that's trying to get out. Say rather, that the examples I'm thinking of are instances of a code of official conduct, which was so taken for granted that none of us reporters – of whom I was one – ever thought of it as a bad thing.

I'm thinking of Prime Minister Winston Churchill in Britain and President Roosevelt in the United States. Think what not one citizen in a million knew at the time: Britain was led by a man in his late sixties who, during the most turbulent and perilous times of the second war, had two serious strokes and two minor ones, three pneumonias, two heart attacks, eye and ear trouble, and a catalogue of other afflictions that his doctor once presented to him like a laundry list, in the hope of persuading him to stay in bed, to take it easy, not to fly the ocean or otherwise put a dangerous strain on his creaking body. A hope that was most of the time disappointed.

Once, during Mr Churchill's first visit to America, just after the United States had come into the war, he had a heart attack. His doctor, who since the day Mr Churchill came to power had been with him everywhere, was quickly sent for. All this was going on in the White House, by the way. The doctor examined him and thought to himself the textbook treatment for this is at least six weeks in bed. The doctor, if not the patient, had a sleepless night wondering how he could keep this disaster from the world or whether his patient could possibly recover sufficiently so that the truth would not have to be published. It would certainly have meant the prime minister's resignation and a damaging shock to the morale of the British people. The doctor decided simply to hope.

Next morning Mr Churchill got out of bed, engaged in a prolonged argument with General Marshall, then he spent some time with the president. Then he threw himself into composing and memorising a speech. He left the White House at nightfall, took an overnight train. Next day was hailed by tumultuous crowds in Ottawa, had an official lunch, an official dinner, and the day after made to the Canadian Parliament, a speech that was as triumphant and comical as the one he'd made a few days earlier to the Congress in Washington.

Years later, during Churchill's second administration, after a paralysing stroke, his doctor crept next day into his bedroom and saw his patient sitting up in bed smoking a cigar. "You thought," the patient said, "that I wouldn't be able to speak again, didn't you?" There are times, the doctor reflected, when he didn't know which was more worrisome, Churchill's frightening illnesses or his powers of recovering from them.

The Roosevelt story is by now familiar to the whole world, but I ought to remind you, that it wasn't familiar to the American people until the very end of his twelve years in the White House, and not really familiar to non-Americans until, quite recently, a splendid four-hour television documentary came out, in which was, photographs never before shown, often not known to exist, of Roosevelt in his wheelchair, Roosevelt's spindly legs beneath the massive upper body, Roosevelt at the wheel of a car specially designed to be operated by hands alone.

We've talked about this before and I've heard from one or two people who say, calling on hindsight, of course all Americans knew Roosevelt was paralysed from poliomyelitis. Well that's literally true in their head, but from the day the forty year old Roosevelt was stricken at his summer place in Canada, until he died, there were no photographs, still or moving, of him in action. Every newspaper and magazine and newsreel obeyed the unwritten rule, never to show him in movement. So for twenty-five years, there being no visible sign of his paralysis, it was natural for the great mass of people to forget or overlook the fact that they were voting for a governor and then a president who had lost the use of his legs.

I said it took twelve years as president for him to say anything in public about his affliction, and that was a shocker indeed.

I remember sitting in the press gallery when the two houses of Congress sat in joint session to hear the president report on the Yalta conference. This was February 1945. Instead of standing at a lectern, supported by his invisible leg braces and his powerful arms, as he always did, for the first time ever, the president sat in the well of the house and his opening words sent a shudder of disbelief, and then a shower of applause around the house. He'd never said a word about this.

He began: "I hope you will pardon me for this unusual posture of sitting down during the presentation of what I want to say, but I know you will realise that it makes it a lot easier for me not to have to carry about ten pounds of steel around on the bottom of my legs". By that time, Roosevelt was gravely, mortally ill. We didn't know that either. Six weeks later, he collapsed and died.

The United States held to this same tradition of public silence for almost two hundred years. Nobody heard anything about the health of a president until he died. All the more reason for thundering publicity and screaming headlines when – and it's happened four times – a president was assassinated.

A late 19th century president woke up once with a sore throat. He was diagnosed, correctly, as having a cancer, sailed off into the Atlantic on a yacht. He was operated on. He sailed back to Washington, rested up for three weeks in the White House. No newshounds panting around, where's the president? Why has he vanished? And the country heard about it, I think fifty years after Cleveland's death.

In 1920 President Wilson, the architect of the Versailles peace treaty, had a massive stroke that left him immobile and barely sentient behind darkened windows in the White House for eighteen months. His wife decided who should see him and who shouldn't.

The first break in the long American tradition came, I guess, in 1955 when President Eisenhower towards the end of his first term had a heart attack. He himself insisted on a public statement saying that he would have to go on a regime of orderly activity punctuated by rest and recreation. And for the first time in history, a president's doctor held regular press conferences.

But eight years later, after John Kennedy was assassinated, Congress got busy with a constitutional amendment – which the states ratified, called the Presidential Disability Amendment – to say how a president might declare himself unfit to serve and who, if he's round the bend like George III, may declare him unfit and arrange the succession.

Ever since then, candidates for the presidency have made a habit of getting a thorough medical examination and publishing the results in elaborate clinical detail. We know everything about Mr Dole's health, the five or six revelations of his blood test, the pills he takes. Very strangely, President Clinton hasn't published a health report and people are beginning to ask why.

The publication of the report on Mr Dole, which was about two thousand words, made me wonder if you too demand to know all about the medical history and condition of your leaders? In Britain, for instance, do you know if Mr Major, like Mr Dole, has diverticulosis and takes Metamucil every morning? Has Mr Blair published his sedimentation rate, his triglyceride count, his diastolic blood pressure? No? And you talk about the awful centuries old Russian tradition of hiding things!

Frankly, I don't know where all this revelation gets us. The suggestion has been made in high medical circles in Europe that all candidates for high office should be examined by an impartial, politically independent panel of doctors. Find one. And then they should say sorry, you can't run for president or prime minister. Of course such a panel has never happened and never will in the practical circumstances of life. As for Mr Churchill and President Roosevelt, thank goodness they were never examined and turned down. I'm sure most of us would rather have had a chronically ill prime minister and a paralysed president than two healthy men who lost the war.

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