Theodore Roosevelt, 26th U.S. president and hero of the Spanish American War, went to Brazil four years after leaving the White House to explore the newly discovered "River of Doubt" with a group of naturalists and adventurers. His 1912 "Bull Moose" campaign having failed to get him back into the White House, the 54-year-old Roosevelt accompanied his son Kermit and famed Brazilian naturalist Candido Rondon on a search of the 1,000-mile river.
The 1913-14 exploration was sponsored by the American Museum of Natural History to collect new animal and insect specimens. The naturalists found their wilderness samples as they hiked through dangerous regions of malaria-carrying mosquitoes and paddled boats through carnivorous piranhas, raging rapids and waterfalls. Roosevelt and his team of explorers were constantly threatened by dysentery, starvation and disease during their exploration. Three of the 19 members of the team died.
The explorers had to haul their heavy, dugout canoes when the rapids became impassable. Some of the men grew sick and died. Roosevelt developed severe lethargy, delirium and fever. One day, two canoes broke loose, drifting downstream. The former president, always the hero, dove into the rapids to recover a canoe and gashed his left leg on the rocks. Within days, his wounded leg became deeply infected. His fever climbed, and pus containing bone fragments drained from the wound. As his condition worsened, the team feared for his life.
Then a group of seringueiros, poor rubber tree tappers, happened upon the group, and helped them down the rest of the River of Doubt to the Brazilian town of São João. By the time they got there, Roosevelt was near death.
What was the condition responsible for this hearty man's near demise?
President Roosevelt left Brazil and returned home to New York, where his wound was diagnosed as post traumatic osteomyelitis, a rare and serious bone infection, with pus draining fistula.
Today, the incidence of chronic osteomyelitis is increasing because of the prevalence of predisposing conditions such as diabetes mellitus and peripheral vascular disease. It is treated with intensive antibiotics, and sometimes surgery to remove diseased tissue. In extreme cases, amputation may be required.
Of course, there were no antibiotics in Roosevelt's day. And the river accident damaged the very same leg he injured in 1902 when his horse-drawn carriage was hit by an electric trolley in Pittsfield, Mass., where he was headed to settle a coal miners' strike. The accident resulted in a left leg chronic osteomyelitis that led to flare-ups of pain and fever for the rest of his life. The president referred to his condition as "rheumatism."
Roosevelt, who grew up a sickly child, hated to admit to any weakness. He kept his 1902 injury and his need for a wheelchair secret when he returned to the White House.
But after the River of Doubt injury, stoicism grew tougher. As Roosevelt wrote, "The Brazilian wilderness stole away 10 years of my life."
In February 1918. Roosevelt was hospitalized for several days with a flare-up of his chronic osteomyelitis. Reports labeled the infection as "erysipelas", a bacterial infection in the upper layer of the skin, but his true condition was far deadlier.
In July 1918, Roosevelt's son Quentin, a military pilot, was killed in action over France. The grieving father continued to deteriorate and by December he was back in the hospital with something termed "inflammatory rheumatism."
He went home to Sagamore Hill, N.Y., for Christmas. But early the morning of Jan. 6, 1919, his valet noticed the sleeping Roosevelt's breathing was labored and called the nurse in. The former president died in his sleep at age 60.
Thomas Marshall, Woodrow Wilson's vice president, later said, "Death had to take him sleeping. For if Roosevelt had been awake, there would have been a fight."
Doctors declared that the Amazon adventure had aggravated his osteomyelitis, leading to deep vein thrombophlebitis (DVT). A clot broke loose and traveled to his lungs, causing a fatal pulmonary embolism.
Just as there were no antibiotics for the bone infection back then, neither were there anticoagulant medicines to prevent vein clots and pulmonary embolism.
Despite the agonies of the River of Doubt expedition, the explorers managed to collect more than 2,000 species of birds and 500 species of mammals. Roosevelt also had started mapping the interior of Brazil before becoming severely ill. Today, the River of Doubt is known as the Rio Roosevelt.
Allan B. Schwartz, M.D., is a professor of medicine in the Division of Nephrology & Hypertension at Drexel University College of Medicine.