VIP HEALTH WATCH

• Document Type: SPECIALCOLLECTION
• Collection: FOIA Collection
• Document Number (FOIA) /ESDN (CREST): 06500678
• Release Decision: RIFPUB
• Original Classification: U
• Document Page Count: 11
• Document Creation Date: March 16, 2022
• Document Release Date: April 19, 2016
• Case Number: F-2016-00594

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No For Dissem
Facets of a program for assessing foreign
leaders' physical and psychic states.
VIP HEALTH WATCH
Myles Maxfield
and
Edward G. Greger
An inconspicuous article in a London newspaper of 2 July 1964
noted that a Dr. David M. Wallace had suddenly cancelled pending
appointments and left for Bucharest, Rumania. No other information
was given. Dr. Wallace, it developed, was a world-famous urologist.
Why would a famous Western specialist suddenly be summoned to
a communist country? Rumania had adequate medical facilities, in-
cluding competent specialists in urology, and its propaganda boasted
of giving its people the best of medical care. The calling of a non-
communist foreign physician was then a major aberration which could
only be explained by supposing that one of the highest dignitaries of
the regime was seriously ill.
Last Days of Cheorghiu-Dej
Files showed that Gheorghiu-Dej, First Secretary of the Party and
,actual ruler of Rumania, had a urinary tract problem. Although he
now appeared to be in robust health, he had undergone one operation
in the fall of 1962 and a follow-up in January or February 1963 for
a polyp of the bladder. Official reports stated that the operations had
been successful. This fy-pe � of polyp, however, tends to recur and
often undergoes malignant degeneration. If so, it becomes invasive
and spreads rapidly, offering an extremely poor prognosis. The
British specialist's unknown patient might therefore in fact be
Gheorghiu-Dej. This possibility, although there was no direct evi-
dence for it, was reported to the State Department and the White
House.
Half a year or so later, although official reports still insisted that he
was in perfect health for a man of his age, Dej turned over many of
his duties to a chosen successor, Ion Gheorghiu Maurer. On 20
March 1965 he died. The final medical bulletin gave the cause of
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death as cancer of the lung and liver, a metastatic extension of a
primary urinary tract carcinoma. U.S. officials had had an eight-
month warning of the possibility of this change of government.
The VIP Program
The importance of foreseeing changes in government is only one
of the reasons why an effective VIP health watch is of value to intelli-
gence. There are countless historical cases in which the health of a
leader has affected the policy of a nation. Alexander the Great, an
epileptic, died at the age of 33 before his conquests could be com-
pleted or stabilized; the health of Julius Caesar and of Napoleon,
among others, is said to have adversely affected their historical roles.
In more recent times, the incapacitation of Woodrow Wilson in his
last few months severely prejudiced his programs. The deterioration
in Franklin Roosevelt's health toward the end of the war has been
linked with the Western failure to check Soviet political advances in
Eastern Europe.
Thus the mental and physical health of foreign leaders may often
have a significant and sometimes a critical impact on U.S. security
and foreign policy. For this reason the CIA maintains a program for
the collection, analysis, evaluation, and dissemination of VIP medical
intelligence. The collection program is one of the most varied, compli-
cated, and challenging in the intelligence community, a real test of
the guile and ingenuity of the collection agencies. Materials range
from open unclassified information such as that used in the case of
Gheorghiu-Dej to highly sensitive reports with very limited distribu-
tion. Personal sources will include some who are trying too hard to
please and others who are actually hostile. The accuracy of agent
reporting tends to vary directly with the professional calibre of the
agent.
It will be instructive to review in some detail several contemporary
cases in which the physical or mental health of a world leader has
played a significant role.
The Last Laugh
Medical diagnostics has opened a new and exciting chapter in the
field of medicine. Along with recent advances in bio-cybernetics,
symptom diagnosis and the prediction of future illnesses have been
greatly simplified for the modern physician. These advances have
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given an invaluable tool to the medical analyst who is called upon to
make definitive diagnoses on the basis of reported symptoms which
are often nothing more than wishful thinking on the part of political
opponents or opportunists. A diagnostician of some experience, by
utilizing his knowledge of biostatistics, may be able to make a tenta-
tive diagnosis as his patient first walks into his office.
A person with a moderately advanced case of cancer, for example,
can often be identified at first sight by his pallor, weight loss, and
drawn appearance; physical examination and laboratory tests only
provide confirmation. The expression Facies Gastrica, literally "gastric
appearance," has long keen in use to describe people with peptic
ulcers; it is easily recognized by the trained physician. Recently pub-
licized statistics have made the entire world aware of the higher
incidence of lung cancer in heavy smokers. Race, age, weight, cli-
mate, and habits are only a few of the factors the physician can use
in his diagnosis, prognosis, and predictions.
Yet predictions can be tricky. A simple case where symptoms and
statistics pointed to a terminal illness was that of Marshal Radion
Malinovskiy, the late Soviet Defense Minister. The 68-year-old Malin-
ovslciy was the prototype of the old-guard Soviet military officer�
working-class family, fought as enlisted man for the Tsar in World
War I, volunteer for the new Red Army, distinguished command record
in World War II, Marshal of the Soviet Union. He succeeded Zhukov
as Defense Minister in 1957.
He had been reported in ill health for several years, but the reports
became more numerous in about 1964. He began to miss some im-
portant gatherings, so there was speculation that he might be out
of favor politically if he was not seriously ill. It was known that he
was very much over-weight ( 300 lbs. at 5'7"), a diabetic, a heavy
drinker, suffering from hypertension (high blood pressure) and radi-
culitis ( spinal nerve root inflammation). In addition he was reported
to have a "weak heart," and there were rumors that he had a heart
attack in September 1966.
Such information ,as this would almost make the medical analyst
feel guilty at taking any pay for predicting the outcome. It did not
even require the mechanical competence of a computer to add up a
prime cardiovascular problem for the ailing Marshal. His age, obesity,
hypertension, history of diabetes, and heavy drinking all pointed di-
rectly to this diagnosis. Eighty percent of people at the age of 70
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have arteriosclerosis; this of course predisposes to a cerebro-vascular
accident ( stroke) or myocardial infarction ( heart attack).
An analysis to this effect was officially recorded in February 1967,
with the notation that Malinovskiy was indeed ill physically rather
than politically and would probably succumb to his affliction in the
near future. He cooperated and died on 31 March, but�with char-
acteristic Bolshevik intransigence�of cancer.
False Alarm for Aidit
Medical misdiagnosis can also play an important part in political
developments. A most striking example of this was a mistaken prog-
nosis for President Sukarno of Indonesia just preceding the abortive
communist coup in September 1965. Although his bedroom proclivities
have almost become legend, Sukarno does have a serious health prob-
lem. He has lost the use of his left kidney because of two large
stones, and he has a large staghorn stone in his right kidney. He has
a moderate hypertension which is aggravated at times of stress. This
combination of impaired renal function and hypertension could give
rise to sudden complications that might cause his death at any time.
On the other hand, he could live five or more years with his condition.
In addition to his kidney condition and possibly related to it, Sukarno
reportedly had a urinary bladder polyp, a urinary bladder calculus
(removed in a Vienna clinic), and three attacks of coronary insuffi-
ciency. He was also reported to have suffered a minor stroke, to have
had swollen ankles and feet, and to have numerous other complaints.
In short, he would not be considered a good insurance risk. His medi-
cal history was of great concern not only to U.S.. intelligence but
evidently to that of communist China also, as may be seen from what
follows.
Sukarno had been receiving medical treatment in Vienna from the
internationally known internist Professor Karl Fellinger. It was Fel-
linger who had diagnosed Sukarno's kidney stones and in collaboration
with Professor Ubelhoer, a Viennese urologist, had removed the large
calculus from his bladder. Dr. Fellinger strongly recommended that
Sukarno return to Vienna to have his left kidney and the large stone
in his right kidney removed surgically: failure to do so would result
in further kidney damage.
Sukarno, however, had an almost pathological fear of surgery, since
a soothsayer had once predicted that he would die by steel. Because
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of this fear and at the suggestion of Foreign Minister Subandrio, who
was a physician himself, he turned to communist Chinese physicians in
Djarkarta, who promised help by nonsurgical techniques. Given
acupuncture treatments and oriental herb medicines, he was convinced
that his condition was improving. This reliance on the Chinese phy-
sicians gave the Chinese intelligence service and the PKI ( the Indo-
nesian Communist Party) an immediate source of critically important
information, for if Sukarno were suddenly removed from the scene
they could expect the anti-communist Indonesian army to move im-
mediately to crush the PKI.
Against this eventuality the PKI, with Chinese military aid, were
preparing a coup which would eliminate the army threat while main-
taining Sukarno as a figurehead. The Chinese physicians in the mean-
time were to monitor Sukarno's state of health and keep the PKI
leader, D. N. Aidit, informed. At this point fate and misdiagnosis
played their role. On 28 September 1965 Sukarno, while making a
speech, was stricken with such a severe pain originating from his
kidney that he was forced to leave the speaker's platform. ( It is
quite possible that he had passed a small stone from his kidney to
his bladder, a process usually accompanied by excruciating pain.)
The Chinese doctor who attended him thought this the end; he de-
clared that Sukarno would not live more than a week.
This was the signal for the PKI to move. At that point, however, the
coup was only in the early stages of preparation; weapons that had been
smuggled in for PKI paramilitary units had not been distributed, were
still in their crates. Therefore it failed. Although several of the top
generals were murdered by communist execution squads, the army
chief, General Abdul Nasution, managed to elude capture. He quickly
called up the Siliwangi Division under Generals Suharto and Adjie
and prevented a PKI take-over. His aide, General Mokoginta, effec-
tively handled the situation in Sumatra. If the coup had been delayed
until the PKI was fully armed and prepared, the outcome could
easily have been reversed. Thus a medical misdiagnosis by a com-
munist physician precipitated the miscarriage of a communist bid to
take over the largest country in Southeast Asia.
The Resurrection of Segni
Every newly graduated physician tends to jump to definitive
diagnoses and prognoses based on textbook symptoms. Very soon in
his career, however, he finds that some patients do not behave accord-
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ing to hoyle. Those who by all standards should die within hours
sometimes live on for months or even years; on the other hand those
with a favorable prognosis may die the next day. For the VIP Health
Watch analyst this problem is aggravated. Instead of making a phy-
sician's direct examination of the patient's subjective and objective
symptoms and complaints, he must usually work through a third- or
sometimes fourth-party relationship. Symptoms are sometimes re-
ported through a source who may be depending on rumor or even
wishful speculation; many sources play amateur diagnostician.
Such was the case of the 73-year old President Antonio Segni of
Italy. The silver-haired Segni had a history of circulatory troubles and
was suffering from an unspecified stomach ailment, probably ulcers.
On 7 August 1964 he had a stroke which paralyzed all motor faculties
on the right side of his body and affected his speech. On 15 August,
at 1515 hours Rome time, a person close to Segni reported that he
was in a deep coma, that the doctors had given up all hope for his
recovery, and that he was being kept alive as long as possible for the
sake of his family but would die by nightfall. There were other
similar reports.
Every medical intern has seen many such cases in which stroke
patients suffer permanent brain damage and are kept alive only through
the use of drugs and a mechanical respirator. In the light of the
familiar symptoms and the reliability of the sources reporting them,
the conclusion seemed obvious that Segni would not be with us much
longer. This prediction was dutifully made in official intelligence
publications; the Italian President was given only hours to live. But
a month later he was sitting up in his hospital bed -speaking with little
difficulty and drinking coca cola. In the halls of the CIA there is
now a more cautious and (one hopes) wiser medical prognosticator
who is still jokingly reminded of the "grave" finding he made in 1964.
Good Medicine for Wheelus
The discovery in 1958 of major oil deposits in the young country
of Libya, ruled by King Mohammad Idris, has changed it from one
of the poorest countries in the world to one of comparative wealth.
Before that, ever since its independence in 1951, it had relied heavily
on Great Britain and the United States for economic and military aid.
In 1954 the United States, in exchange for her economic assistance,
had been granted rights for the construction of the Air Force complex
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at Wheelus. This base served as an important link in the world-wide
network of the Strategic Air Command.
The oil freed Libya from dependence on U.S. aid and at the same
time aroused Egyptian President Nasser's interest in the country. An
Egyptian propaganda campaign in 1964 against Western bases and
"colonialists" aroused considerable Libyan popular protest, especially
in urban areas, where there were violent demonstrations. The U.S.
Air Force officers assigned to renegotiate the base rights with King
Idris that year were quite concerned. Wheelus still served as a
valuable tactical base, a storage facility for critical material and weap-
ons, and a key site for U.S. air rescue operations.
VIP Health Watch analysts were able to furnish the USAF some
useful information concerning the 74-year-old King. Although his,
health was fairly good for a man of his age, he tended to be concerned
about it, and he had become almost completely dependent on medical
care afforded him and his family at the Wheelus Base Hospital. He
had great faith in American physicians, openly proclaiming them the
best. In 1959 they had treated him for trachoma, from which he
enjoyed a complete recovery. In 1960, after he fell and sustained a
painful hematoma on his knee, this was likewise treated at the
Wheelus facilities (by Dr. Watson Jones, a British physician). Every
year Idris receives a complete physical examination there. In addi-
tion he is thankful to USAF physicians for a successful hysterectomy
on his wife.
Under these circumstances Air Force negotiators were able to con-
clude a favorable new lease on the base, and in spite of the recent
turmoil in the Near East it is still there.
How Does a Gamal Grow
A study of the character of Egypt's President Gamal Abdel Nasser
on the basis of his psychological and medical background provides in-
sight into his behavior vis-a-vis the Soviets, the West, Israel, and the
rest of the Arab world. At the age of eight years Gamal was sent
for schooling to live in Cairo with his Uncle Khalil, who had recently
been released from imprisonment for organizing demonstrations
against the British. Here the boy developed a taste for intrigue and
became fiercely independent, objecting violently to authority of any
kind, whether that of his father, his adult neighbors, his _teachers, or
the police. He was not told until he returned home for the summer
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vacation that his mother had meanwhile died in childbirth; this made
him very bitter and widened the gulf between him and his father.
The father remarried, and Carnal never again lived happily at home.
At the age of twelve, Nasser participated in a riot and was arrested.
As a young man he continued his classical revolutionary development,
joining the Young Egypt Party, leading demonstrations, becoming dis-
illusioned and switching to the Wafd Party, leading more demonstra-
tions. He became very popular with his fellow students, disputed
bitterly with the school headmaster and the police, and spent some
more time in jail. When he was refused readmission to school, his
fellow students rioted until he was admitted. He refused hospitaliza-
tion for a head injury received during a riot against the British. His
antagonism toward authority and rules was extraordinary.
At the age of 20 he graduated from the Egyptian Royal Military
Academy and as a young lieutenant organized the "Free Officers,"
a secret society of young Egyptian Army officers whose principles
were to give allegiance to no one, form no alliances, make no promises,
and have no ideology. When he was 34 he participated in an un-
successful assassination attempt against General Sirry Amir, and then
he led the coup unseating King Farouk and establishing General
Mohammed Naguib as President. At the age of 36 he deposed Naguib
and became President himself.
It would be surprising if Nasser's independence, defiance of au-
thority, and taste for leadership had changed on assuming the presi-
dency, and indeed they have been evident from the first in actions
like his repression of Egyptian communists while taking Soviet aid,
his seizure of Suez, his attempts to establish an expanded United
Arab Republic and exercise leadership over the entire Arab World.
Notable on the other hand in the established pattern of his behavior
are his quiet and respectable family life and his fond admiration for
President Tito of Yugoslavia, although he has few close personal
friends.
Physically strong, Nasser is afflicted with a diabetes that is ap-
parently difficult to control. ( He is dependent on Western insulin,
especially Swiss, for this; Soviet Bloc drugs have not been favorably re-
ceived in Soviet-aided countries, and even some high Soviet officials
prefer Western drugs, including specifically insulin, to their own.)
The diabetic's requirement for insulin depends upon his rate of
food intake and rate of metabolism, and these both vary with physi-
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cal activity or emotional stress. In some diabetics, and apparently this
is the case with Nasser, the balance is quite delicate, difficult to
maintain, and definitely affected by emotional incidents. There have
been at least two episodes reported in which he has been forced to
cease his activities immediately and get emergency medical aid�one
during the Suez crisis and the second very recently. Such at-
tacks may recur and limit his activities somewhat, but not seriously
for some years to come if competent medical care is quickly available.
Chinese Puzzle
The enigma of Red China, the most denied of denied areas, chal-
lenges us to make the most of any information we can develop bear-
ing on the hidden springs of the regime's policies and actions. A
psychological and medical analysis of its key personality, Mao Tse-
tung, may contribute to understandifig some aspects of its course in the
past, including even the bizarre irrationality of the late "cultural revo-
lution."
Mao was born on 26 December 1893 in Shaoshan village, Hsiang
t'an hsien, a rural county some 20 miles south of the Hunan provin-
cial capital at Ch'angsha. He was the eldest of three sons and a
daughter. His father was a moderately wealthy farmer who earned
a good living trading rice. He was a hard-bitten peasant, however,
sharp-faced and bigoted, with a taste for Confucian classics; he had
fought for the Marichus and he respected the empress dowager. He
treated his servants and farm laborers with contempt, had few friends,
and took little interest in his family. He was restless, ill at ease,
and hot-tempered, an unattractive exemplar of the type of petty
capitalist that was to become a target of his son's revolutionary regime.
On one occasion Mao ran away into the woods for three days, re-
turning only because of the thought that his mother would have no
one to defend her. His mother, in contrast to his father, was placid
and devoted to her family. She was a deeply religious Buddhist and
averse to killing or any kind of brutality. For a period during his
childhood Mao attended the Buddhist ceremonies with his mother,
who wanted him to be a priest. This early religious experience is
still evident in some of his writings and utterances. Only in recent
months this archpriest of an atheistic ideology referred to his eventual
demise as a "going to Cod."
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When Mao was thirteen years old there was a famine in his pro-
vince. The peasants protested against the local government and
demanded that the rice granaries be opened to them. Instead of
receiving help they were reprimanded, punished, and the leaders
executed. In the same year the Secret Society of Peasants (Ko
Lao Hui) was in conflict with the landlords in Shaoshan. They
too were repressed and the leaders publicly executed. The young
Mao, in strong sympathy with the peasants, was left with an in-
delible impression of these injustices which must have had an in-
fluence on his later revolutionary doctrine.
Feeling the conflict between his studies and working in the fields,
he decided, under the encouragement of a school teacher, to go to
middle school. After a long argument with his father, who wanted
him to stay in the family enterprise, he went off with no extra money
beyond his tuition fees. In school he was at first lonely, poor, and
despised. He was known as "the dirty little peasant from Shaoshan."
When he went to the head of his class for excellence in studies, that
made him even more despised among the anti-intellectual students.
He became an intellectual, discussing the reform movement with stu-
dents of like inclinations. He was much moved by a book entitled,
"Great Heroes of the World," and especially its biography of George
Washington. During the rest of his education periods of excellence
were broken by some poor work as his interests developed and changed.
He became a leader of progressive movements and excelled in essay
writing and debating.
After refusing to consummate an early, arranged marriage, Mao
eventually married three times. In 1919, while in Peking attending
lectures at the University, he fell in love with Yang K'ai-hui, the
daughter of a professor of philosophy, and he married her the fol-
lowing year in Shanghai. She was executed by Ho Chien, a Chinese
warlord, in 1928. His next wife, Ho Tzu-ch'un, in the course of
seven years bore him five children, three of whom they left in the care
of peasants they met on the Long March. Later attempts to locate
these were unsuccessful. Eventually this marriage ended in divorce.
His current wife Lam P'ui (Chiang Ching), a former Shanghai act-
ress, he married in 1939.
One of Mao's sons by Yang K'ai-hui (probably the one wife he
really loved) was killed in the Korean War. This has had a very
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strong emotional effect on him and may account in part for his almost
paranoid xenophobia, especially with respect to the United States.
A current medical review of the now 73-year-old Mao shows it
very unlikely that he any longer has the mental or physical stamina
to engage in continued personally demanding activities. His phys-
ical health is deteriorating and the prognosis for his life over the
next 3 to 5 years is not good. There is acceptable evidence that
he has arteriosclerosis and hypertension, with one stroke in December
1965 or January 1966 and possibly others previously. These dis-
orders form a coherent clinical entity, a disease that may account
in part for the loss of mental alertness, increasing rigidity of outlook,
and stubborness. The disease itself is serious, limiting his life ex-
pectancy and his physical stamina.
There is additional evidence that Mao's condition is compounded
with parlcinsonism. This is a chronic progressive neurological disorder
which is frequently accompanied by mental depression; it will further
impair his physical and mental� stamina. Heavy sedation is required
to control the tremors associated with parkinsonism. This very likely
explains the almost vegetable appearance of Mao on public occasions.
The natural progression of these diseases includes a high likelihood
of further strokes or heart attacks, increased rigidity of thought, un-
willingness to change ideas, and the development of paranoia. These
latter symptoms could quite possibly have been reflected in the
recent turmoil in China. Continued careful medical analysis will be
a factor in determining whether Mao can remain in command or is
likely to have power taken from him.
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