Foreign Relations of the United States, 1969–1976, Volume E–5, Part 2, Documents on North Africa, 1969–1972

150. Telegram 1 From the Embassy in Tunisia to the Department of State¹ ²

Tunis, January 1, 1971, 1800Z

Subject:

• Illness of President Bourguiba

Ref:

• State 210077 and previous

1. Doctors Barnes and Magal have examined President Bourguiba on three occasions during past two days and have held lengthy consultations with team of Tunisian doctors, as well as with Mrs. Bourguiba who is in almost constant attendance with the President. Doctors will see President again Saturday, Jan. 2, at 5:00 p.m. at which time Swiss doctor and French psychiatrist who treated Bourguiba in Paris will also be present.

2. Barnes’ and Magal’s preliminary diagnosis is that the President was suffering from “involutional melancholia” and that possibly superimposed on this condition now is organic brain disease, probably arteriosclerosis. The doctors report that in the past the involutional melancholia has been treated in Paris with shock therapy (two series). The doctors feel, however, that Bourguiba has not had adequate diagnostic studies, e.g. he has not had skull x-rays, brain scan, pneumoencephalogram, glucose tolerance test, special lectroencephalograms, or spinal tap, and that their likely recommendation, which will be given after the Saturday examination, will be that President Bourguiba go to some unspecified medical center (such as Zurich, London) where such studies can be made. Certain tests cannot be done in Tunisia. While they indicate that Bourguiba may well be moving downhill rapidly toward progressive enfeeblement, they cannot rule out the chance that he has a treatable condition, which can only be determined with further tests.

3. The doctors report that President Bourguiba Spends all his time in bed, under heavy sedation. Despite this medicine, he has constant insomnia. Bourguiba has serious speech impediment which may be partly due to heavy sedation or organic brain disease. He starts sentences and then stops in the middle searching for word or phrase and usually turns to his wife for help. Bourguiba can follow through with ideas, but these show signs of psychological deterioration. Bourguiba is obsessed with idea that he is nearing the end and that his passing will also bring the end of Tunisia. He constantly refers to his earlier role in unifying Tunisia and identifies himself completely with Tunisia. He depicts himself, with arms outstretched, as a modern Atlas holding up Tunisia. He is in a very emotional state, tears flow frequently, and he frequently uses words such as “triste” (sad), “fatigue” (tired) and “faible” (weak) and refers to Tunisians as his children. He referred to being surrounded by friends and “traitors,” harping at length on the perfidious Ben Salah, and “divisions” ahead. The President constantly returns to the past and exculpates himself of all wrongs, and credits himself with all the positive developments in recent Tunisian history.

4. The doctors report further that the President himself, Mrs. Bourguiba and the Tunisian doctors indicate that Bourguiba seems to become most agitated during the afternoon. In such “crisis” moments, according to Mrs. Bourguiba, the President asks for a revolver in order to end his life. He complains that he is completely useless. Mrs. Bourguiba reports that the President has tried to choke her, claiming that he wants her to die with him. As the President is still physically strong, Mrs. Bourguiba says she is afraid of the President and can’t go on much longer. As there is a danger the President may try to commit suicide, he must be watched continually by attendants.

5. Doctors Barnes and Magal report that they also talked with Prime Minister Nouira at the palace today. The Prime Minister feels under urgent pressure to issue a communique on the President’s health. The Prime Minister also wants a written report from the doctors. The doctors have indicated that they will naturally delay making any recommendations until after the consultation with the Swiss and French doctors tomorrow. However, they advised me that they are presently planning to make a report to the Tunisian doctors (probably to Dr. M’barek, who is the Tunisian psychiatrist on the medical team) which, in cautious language, will merely state that the President should go someplace where he can have the proper diagnostic tests. The doctors report there seems to be some reluctance on the Tunisian side, mainly from the tunisian medical team, to letting the President go abroad, and the Tunisian doctors seem to be the ones pushing for an American medical team to come in and help take care of the President. Barnes and Magal said that the President indicated to them that he would be willing to go abroad if that were the recommendation.

6. Comment.

A. The Prime Minister is obviously feeling the pressure to report to his cabinet and then to issue a communique on the President’s condition and plans. In such a communique, reference may well be made to the consultative services of the American doctors, as well as to the Swiss and French doctors, if this occurs, we believe it would not only be necessary but advisable for the Tunisian Government to issue such a public statement mentioning American participation.

B. Doctors Barnes and Magal believe that they must give the Tunisian doctors a cautiously worded written report. Though it will not be submitted until after the Saturday consultations with the Swiss and French doctors, they do not anticipate any change in their recommendation. (Their report would be addressed to the Tunisian doctors in their capacity as consultants.) The doctors will refrain from reconmending any specific place outside of Tunisia for these further diagnostic tests. However, Barnes and Magal anticipate that the Tunisians may suggest that Bourguiba go to the United States for this purpose.

C. The Prime Minister will undoubtedly request further assistance from the United States, even though he fully understands that the services of the American doctors have been given without further commitment.

D. We will comment further after tomorrow night’s meeting. The doctors are tentatively planning to leave Tunis on Sunday but will remain longer if necessary. In the meantime Washington comment would be appreciated.

Relph

1. Source: National Archives, RG 59, Central Files 1970–73, POL 15–1 TUN. Secret; Immediate; Nodis. In telegram 6097 from Rabat, December 26, the Embassy had conveyed the urgent request of Prime Minister Nouira for a U.S. psychiatric team to be dispatched to Tunisia to treat Bourguiba. (Ibid.) In telegram 209981 to Rabat, December 29, the Department advised the Embassy that an American internist and psychiatrist would arrive in Tunis on December 31. (Ibid.)
2. The Embassy transmitted a report by a special team of U.S. doctors which had diagnosed President Bourguiba with “involutional melancholia” and, possibly, arteriosclerosis. It then goes on to discuss Bourguiba’s mental state, the possibility for political succession, and potential requests to the U.S. Government for assistance.