Medical mystery: The foe that even Chairman Mao couldn't defeat

When President Richard Nixon announced in 1971 that he was going to visit the People's Republic of China the following year, it was big news, closely chronicled by the world's media.

"There is no place on this small planet for a billion of its potentially most able people to live in angry isolation," Nixon famously said that year.  The United States revoked its ban on travel to China, and Chairman Mao Tse-Tung challenged the U.S. Ping-Pong team to visit and play the Chinese national team.

Time magazine called it "the ping heard round the world."

Nixon's visit, in February 1972, was the first time a U.S. president set foot in the People's Republic of China since its creation in 1949 after Mao's Red Army defeated  Chiang Kai-Shek's Nationalists. In early 1950, Mao signed a formal diplomatic alliance with the USSR, already the United States' Cold War foe.

So Nixon's announcement  marked the end of a quarter-century estrangement between the United States and China, as well as a major turning point in the Cold War.

Nixon's week-long tour was documented thoroughly by American journalists, who sent home articles and  images of  the president and his advisers touring the Great Wall, meeting with Mao and top party leaders, and  First Lady Pat Nixon touring schools and hospitals.

But what the pictures didn't show — and Nixon didn't realize — was that Mao's health was dire. Hospitalized with  congestive heart failure and a lung infection, he was released just nine days before the president arrived.

Li Zhisui, Mao's physician (and later his biographer), noted that Mao's pulse was steady and strong after his meeting with the president. Li said Mao was 'delighted with Nixon's visit. ... He speaks forthrightly - no beating around the bush."

By 1974, Mao had grown so weak that he gradually lost the ability to walk and perform basic personal hygiene. He had difficulty swallowing, and his speech became hesitant and slurred. His closest companions could not understand him. Attendants first fed him by hand, then he had to take his nutrition through a  nasogastric tube.

Mao increasingly became short of breath with a persistent cough.  By then, Nixon knew of Mao's disability, and even sent him a respirator as a gift. Nixon never told the media of Mao's condition, which also remained a secret from the Chinese public.

What was the condition that felled the man who led the world's largest nation through decades of war and revolution?

Mao Tse-tung suffered from ALS (amyotrophic lateral sclerosis), the progressive neuromuscular degenerative disease often known as Lou Gehrig's disease, for the New York Yankee who died from it, as well.  As the condition progresses, the spinal cord loses the ability to carry impulses through the body, leading to muscular weakness, atrophy, paralysis and, ultimately, death.

Mao also suffered from vision loss due to cataracts in both eyes, and lost his hearing. From 1974 until his death, he  required multiple caregivers, including 16  doctors and 24 nurses. He was frequently sponged down by young dancers dressed as nurses, his physician later wrote in a controversial biography published in 1994 to loud denunciation in China.

On Sept. 2, 1976, Mao suffered a massive heart attack, his third. His lung function declined further and his kidneys began to shut down.

After attempts at life support, Mao died on Sept. 9, 1976, at age 82 – half-blind, deaf, unable to speak or swallow — but mentally clear to the end.

Allan B. Schwartz, M.D., is a professor of medicine in the Division of Nephrology & Hypertension at Drexel University College of Medicine.

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