While researching my new book, Pearl Harbor: FDR Leads the Nation Into War, I came across circumstantial evidence that FDR was treated on December 7, 1941, and perhaps on a regular basis throughout much of his presidency, with cocaine.

I came across the discovery by accident. A review of the White House usher files on December 7 revealed that Roosevelt spent 70 minutes with the White House physician. It seemed odd that in the midst of the unfolding military disaster at Pearl Harbor, FDR would spend from 5:30 to 6:40 p.m. isolated with his physician, Dr. Ross McIntyre, a prominent ear, nose, and throat (ENT) specialist who had joined the president's staff in 1937. What medical crisis was so pressing that it took precedence over the military crisis at Pearl Harbor?

Since most of Roosevelt's medical records went missing shortly after his death in 1945, we can only speculate about what took place during his appointment with McIntire. What we do know is that Roosevelt, a heavy smoker, was suffering from one of his chronic sinus infections that day. The question I tried to answer was simple: Given the state of medical care in 1941, what procedures would a highly-trained ENT such as Dr. McIntire have performed on the president? To answer that question I consulted medical journals and interviewed prominent ENTs, including two who began practicing in the 1950s. What I discovered surprised me.

Because there were no antibiotics to treat the underlying sinus infection, McIntire would have been forced to rely on daily treatments to relieve the symptoms. The therapeutic goal was to diminish the swelling of nasal mucosa and thereby increase the patient's ability to breathe. The key was to reduce the swelling without producing dryness or crusting.

McIntire had a few options available to him. He could have used cotton swabs to manually clear Roosevelt's sinuses. Attorney General Francis Biddle observed McIntire performing the procedure when he went to see the president a few days after Pearl Harbor. "He was swabbing out F.D.R.'s nose," Biddle noted.

It is also likely that McIntire "flushed" or irrigated the sinuses. This could be accomplished by inserting a curved hollow needle up the nose and into his sinuses. The needle would be connected to a machine that would pump saline solution into the sinus cavity. Oftentimes, the same machine would have the capability of then sucking out the fluid along with the pus and mucus.

But in the 1930s and 1940s, it was also common for physicians to use cocaine as part of these treatments. "They most likely used cocaine," observed Dr. Jordan S. Josephson, the director of the New York Nasal and Sinus Center. "Cocaine was the drug of choice for any ENT treating a nasal problem." The physician would apply the diluted cocaine solution directly to the sinuses using cotton swabs. The cocaine would shrink the tissue, offering immediate relief, while also numbing the area, preparing it for the insertion of the needle for flushing. "Cocaine is a very good constrictor," reflected Dr. Murray Grossan, a prominent ENT who recalled that cocaine was still being used when he started his residency in the 1950s. "It was not that unusual for an ethical doctor to use a one or two percent cocaine solution. In those days that was quite common."

As late as 1959, standard textbooks on otolaryngology recommended that physicians apply "1 per cent ephedrine sulfate, or 1 per cent ephedrine sulfate and a 1 per cent cocaine hydrochloride" solution for "temporary relief" of nasal swelling. As recently as 1975, after reviewing the medical literature on the subject, the Western Journal of Medicine noted that "cocaine remains a vital instrument in the otolaryngologist's armamentarium." Many doctors still use cocaine today for sinus surgery.

Even if McIntire did use a cocaine solution as part of his regimen, it remains unclear whether it would have had any impact on FDR's behavior. The effect would depend on the strength of the solution, and there does not appear to have been a common standard for treatment in 1941.

Whatever took place during those 70 minutes, Roosevelt apparently liked the results. His official schedule is littered with similar appointments throughout the remainder of his presidency. McIntire shadowed FDR for the rest of his time in office, and traveled with him whenever he left the White House, including attending his various wartime conferences.

If FDR was getting treated with cocaine on a regular basis, including the day of the Pearl Harbor attacks, he almost certainly did not know it. The medical literature at the time instructed physicians not to tell their patients that they were using the drug. "The habit-forming properties of this drug are well-known and must be ever guarded against," one medical textbook at the time explained. "Patients are never informed as to the nature or name of the drug used because in itself this may act suggestively."

It is up to medical historians to evaluate this evidence and determine its significance. Could regular cocaine use, even in a highly-diluted form for medical purposes, have long-term health consequences? Is it possible that cocaine use compounded FDR's other medical issues and contributed to his failing health in 1944-45? These are a few of the questions that now need to be explored.

Partially excerpted from Pearl Harbor: FDR Leads the Nation Into War, by Steven M. Gillon.