L. Frank Baum is said to have died from congestive heart failure in 1919 at age 62, almost 20 years after the first of his legendary “Wizard of Oz” stories was published. Doctors at that time had limited means of diagnosing or treating heart problems.

With the benefit of hindsight provided by multiple biographies and papers that were written about the famous Central New Yorker, Harold Smulyan MD, a professor of medicine in cardiology at Upstate, questions some of the assumptions about Baum‘s health and death.

Listen to the interview with Dr. Smulyan

Baum, born in 1856 in Chittenango, a village east of Syracuse, concocted the adventures in the Land of Oz only after a “heart specialist” prescribed a sedentary job.

“Many productive authors have had their careers cut short by serious illness, but this was not true in Baum‘s case. It is probably accurate to say that heart disease finally enabled him, after a life of repeated failures in several occupations, to find his true calling,” Smulyan wrote in The Pharos journal this summer with co-author, Robert Pinals MD. Pinals was part of the Upstate faculty before joining the Robert Wood Johnson School of Medicine in New Jersey.

Baum‘s oldest son and biographer blames a congenital heart defect for Frank being a frail, sensitive child, less physically active than other children and prone to “heart attacks,” in which he fainted when emotionally stressed. Smulyan and Pinals suspect these episodes were not cardiac in nature. The stethoscope, which can detect heart murmurs, was widely used by doctors during Baum‘s lifetime. Cardiac birth defects usually are accompanied by heart murmurs or a blueness of the skin -- signs that the physicians say were never used in describing Baum.

Some biographers theorize Baum had rheumatic fever, but Smulyan and Pinals aren‘t convinced of that diagnosis either. “It is possible that he could have lived to age 62 with congenital or valvular heart disease, but this would not account for the progressive chest pain, which was his most prominent symptom,” they write.

At the age of 12, in 1868, Baum had an especially severe fainting episode after being disciplined at the military academy he attended in Peekskill. He had another at the age of 26, prior to his marriage to Maude Gage, the daughter of Matilda Gage, a leader in the Women‘s Movement. “Afterward, he was apparently stable for many years and able to work at various occupations to support his growing family,” Smulyan and Pinals write, listing his various occupations: farmer, actor, playwright, variety store owner, business manager for a baseball team, newspaper publisher, traveling salesman.

In 1897 at age 41, Baum developed severe nosebleeds with gripping chest pain. A doctor in South Dakota diagnosed “angina,” a term first used in 1772 to describe chest pain that was associated with exertion and which often radiated to the left arm. Today we know this as a symptom of coronary heart disease, but back then angina was not known to be related to a heart disorder.

As for the care Baum might have received, Smulyan and Pinals say "it is possible that Baum's blood pressure was never measured." The first measurement of blood pressure by feeling a patient's pulse was taken in the late 1800s, but the device used to take blood pressure today was not in wide use until around the time of Baum's death in 1919. They add that it is also possible that Baum never underwent chest X-ray to estimate his heart's size. Even though the first X-ray images were produced in 1895, General Electric did not refine the technology until 1913, and it was not until near the time of Baum's death that equipment was commercially available.

Cardiology was not an established specialty when Baum relocated his family to Chicago where a “heart specialist” suggested he find a sedentary occupation. At that time only a few general physicians, with post-graduate training at European medical schools, called themselves heart specialists, and their tools were limited. EKG machines weren‘t commercially available until after Baum died.

Dr. James B. Herrick, the most notable of these pioneering heart doctors, had an office a little more than a mile from Baum‘s home. He may have been the doctor who treated Baum. Herrick was the first to suggest that angina was a symptom of heart trouble. He wrote papers describing how a sudden blockage in an artery that feeds the heart – which causes chest pain, or angina – was not always fatal. But most of his peers did not believe in such a connection at that time.

Baum‘s life changed when he switched occupations. He began publishing a trade journal and in his spare time made up stories to tell his children and their friends about the fantasyland of Oz and a girl named Dorothy.

“The Wonderful Wizard of Oz” was published in 1900 and then made into a movie. Its financial success allowed Baum to lead a less healthful lifestyle, raising his risk for coronary heart disease. Smulyan and Pinals write: “He chain-smoked good cigars and upgraded his diet. He had meat and eggs for breakfast, with five cups of coffee laced with heavy cream and sugar. His dinner usually included a thick cream soup, roasted meat and a rich dessert.”

Baum moved his family to a Hollywood mansion in 1909. Bad investments led to bankruptcy, and by 1914 he was grappling with a series of health problems. He suffered painful tics to one side of his face. His chest pain and irregular heartbeats became more frequent. He developed trouble breathing and abdominal pain.

In December 1917 he had his gallbladder removed, along with what was described as his “badly inflamed” appendix. The surgery was said to have further damaged his heart. Baum also developed “kidney trouble.” After five weeks in the hospital, he went home and was confined to his bed, where he remained for the rest of his life. Baum continued to write, smoking cigars and taking morphine for pain. He finished “Glinda of Oz” before lapsing into a coma.

Just before death, his heartbeat was erratic and his breathing difficult. “This might reasonably be ascribed to atrial fibrillation or frequent atrial or ventricular premature beats and congestive failure,” Smulyan and Pinals say, describing common cardiac diagnoses of today. “Even if Baum died, as we suspect, of coronary heart disease, his physicians would probably not have been able to recognize it.”

Listen to the interview with Dr. Smulyan.