Franklin D. Roosevelt's paralytic illness
Franklin D. Roosevelt's paralytic illness began in 1921 at age 39, when he got a fever after exercising heavily during a vacation in Canada. While Roosevelt's bout with illness was well known during his terms as President of the United States, the extent of his paralysis was kept from public view. After his death, his illness and paralysis became a major part of his image. He was diagnosed with poliomyelitis two weeks after he fell ill. A 2003 retrospective study favored a diagnosis of Guillain–Barré syndrome, a conclusion criticized by other researchers.
Timeline and history of illness
In August 1921, at the age of 39, while vacationing at Campobello Island in Canada, Roosevelt contracted an illness characterized by fever; protracted symmetric, ascending paralysis of the upper and lower extremities; facial paralysis; bladder and bowel dysfunction; numbness; and dysesthesia. The symptoms gradually resolved except for paralysis of the lower extremities.
- August 9
- Roosevelt fell into the cold waters of the Bay of Fundy while boating.
- August 10
- Roosevelt went sailing on the Bay of Fundy with his three oldest children, put out a fire, jogged across Campobello Island, and swam in Lake Glen Severn and the Bay. Afterward, he felt tired, complained of a "slight case of lumbago", and had chills. He retired early. Chills lasted through the night.
- August 11
- One leg was weak. By afternoon, it was paralyzed. That evening, the other leg began to weaken. E. H. Bennet, the local family physician, was called that evening and diagnosed a cold.
- August 12
- Roosevelt could not stand. He had bilateral paralysis. His legs were numb. He also had painful sensitivity to touch, general aches, and fever of 102°F. He could not pass urine. Bennet reevaluated Roosevelt and suggested a consultation with William W. Keen, an eminent physician vacationing nearby.
- August 13
- Roosevelt was paralyzed from the chest down. On that day and following, his hands, arms, and shoulders were weak. He had difficulty moving his bowels and required enemas.
- August 14
- Keen diagnosed a clot of blood to the lower spinal cord, prescribed massage of the leg muscles, and predicted a gradual improvement over a period of months. Roosevelt continued to be unable to pass urine for two weeks, and required catheterization. His fever continued for six to seven days.
- August 18
- Roosevelt was briefly delirious. Keen reconsidered his diagnosis and now believed that the cause was possibly a lesion in the spinal cord.
- August 25
- On examination by physician Robert Lovett, Roosevelt's temperature was 100°F. Both legs were paralyzed. His back muscles were weak. There was also weakness of the face and left hand. Pain in the legs and inability to urinate continued. Lovett and Bennet concluded that the diagnosis was poliomyelitis.
- In mid-September, at New York City Presbyterian Hospital, there was pain in the legs, paralysis of the legs, muscle wasting in the lower lumbar area and the buttocks, weakness of the right triceps, and gross twitching of muscles of both forearms.
- There was gradual recovery from facial paralysis, weakness in upper extremities and trunk, inability to urinate, inability to defecate, dysesthesia in legs, and weakness in lower back and abdomen. But he mostly remained paralyzed from the waist down, and the buttocks were weak.
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The unquestioned diagnosis at the time, and thereafter in countless references, was paralytic poliomyelitis, which was at the time widespread. One of the foremost polio experts, Dr. Lovett, made the diagnosis based on personal observations of the patient. Also, the disease struck in mid-summer, when poliomyelitis was more common. Furthermore, it has been reported that motor neurons innervating muscles vigorously exercised at the start of polio are those more likely to be paralyzed. Finally, fever usually occurs in polio.
Guillain–Barré vs. Polio
A peer-reviewed study published in 2003, using Bayesian analysis, found that six of eight posterior probabilities favored a diagnosis of Guillain–Barré syndrome over poliomyelitis. For the purposes of the Bayesian analysis in the 2003 study, a best estimate of the annual incidence of Guillain–Barré syndrome was 1.3 per 100,000. For paralytic poliomyelitis in Roosevelt's age group, the best estimate of the annual incidence was 2.3 per 100,000.
Based on the incidence rates for Guillain–Barré syndrome and paralytic polio, and the symptom probabilities for eight key symptoms in Roosevelt's paralytic illness, six of the eight key symptoms favored Guillain–Barré syndrome:
- Ascending paralysis for 10–13 days
- Facial paralysis
- Bladder / bowel dysfunction for 14 days
- Numbness / dysesthesia
- Lack of meningismus
- Descending recovery from paralysis
Two of the eight key symptoms favored polio:
- Permanent paralysis
Furthermore, it remained unclear where exactly Roosevelt could have contracted the polio virus. According to J.D. Wilson in his 1963 monograph on polio vaccination, Margin of Safety, there had been a small epidemic in New York that year with several hundred cases, but no cases were reported on or near Campobello Island.
Marinos Dalakas, chief of the National Institute of Neurological Disorders and Stroke's neuromuscular diseases unit, called the study "a significant stretch", stating that Roosevelt's reported symptoms strongly suggested polio.
There are two factors that contradict the hypothesis of Guillain–Barré Syndrome: FDR had elevated fever up to 102 Fahrenheit which is rare in GBS and he had permanent paralysis which occurs in approximately fifty percent of polio survivors whereas it occurs in fifteen percent of GBS. Moreover, he was left with an asymmetric paralysis of his left lower extremity, which was his weaker side. Photographs taken of him during his governorship and presidency show a family member such as his son or an aide clenching his left arm as if in a vise. FDR contracted polio either in Washington, D.C., while testifying in Congress before the U.S. Naval Affairs Committee in July, 1921, or at a Boy Scout camp in New York, while coming back from Washington on the way to Campobello Island in New Brunswick. The incubation period for polio varies from three to thirty five days. He exhibited his first symptoms on August 10, 1921, within the expected range. He was especially vulnerable to polio since he was raised on an isolated estate at Hyde Park, New York, and had little contact with other children until he entered Groton at age fourteen. The gold standard for diagnosis is made by analysis of the cerebrospinal fluid which was not done in FDR's case. 
Roosevelt was totally and permanently paralyzed from the waist down. Fitting his hips and legs with iron braces, he laboriously taught himself to walk a short distance by swiveling his torso while supporting himself with a cane. Despite the lack of a cure for paralysis, for the rest of his life Roosevelt refused to accept that he was permanently paralyzed. He tried a wide range of therapies, but none had any effect. Nevertheless, he became convinced of the benefits of hydrotherapy, and in 1926 he bought a resort at Warm Springs, Georgia, where he founded a hydrotherapy center for the treatment of polio patients which still operates as the Roosevelt Warm Springs Institute for Rehabilitation, with an expanded mission.
Before his paralysis Roosevelt had weighed 170 pounds, thin for a man 6'2" tall, and had suffered many illnesses. The loss of his legs and two inches of height, and the consequent development of the rest of his body, gave Roosevelt a robust physique—Jack Dempsey praised his upper-body musculature, and he once landed a 237-pound shark after fighting it on his line for two hours—and many years of excellent health.:219,241–242,266–267
After he became President, he helped to found the National Foundation for Infantile Paralysis, now known as the March of Dimes. The March of Dimes initially focused on the rehabilitation of victims of paralytic polio, and supported the work of Jonas Salk and others that led to the development of polio vaccines. Today, the Foundation focuses on preventing premature birth, birth defects and infant mortality.
Public awareness of FDR's disability
Roosevelt was able to convince many people that he was in fact getting better, which he believed was essential if he was to run for public office again. In private he used a wheelchair. But he was careful never to be seen in it in public, although he sometimes appeared on crutches. He usually appeared in public standing upright, while being supported on one side by an aide or one of his sons. For major speaking occasions, an especially solid lectern was placed on the stage so that he could support himself on it; as a result, in films of his speeches Roosevelt can be observed using his head to make gestures, because his hands were usually gripping the lectern. He would occasionally raise one hand to gesture, but his other hand held the lectern.
Roosevelt was very rarely photographed while sitting in his wheelchair, and his public appearances were choreographed to avoid the press covering his arrival and departure at public events, which would have shown him getting into or out of a car. When possible, his limousine was driven into a building's parking garage for his arrivals and departures. On other occasions, his limo would be driven onto a ramp to avoid steps, which Roosevelt was unable to ascend. When that was not practical, the steps would be covered with a ramp with railings, with Roosevelt using his arms to pull himself upward. Likewise, when traveling by train as he often did, Roosevelt often appeared on the rear platform of the presidential railroad car. When he boarded or disembarked, the private car was sometimes shunted to an area of the railroad yard away from the public for reasons of security and privacy. A private rail siding underneath the Waldorf Astoria was also used. When Roosevelt's trains used a ramp and the president was on a publicly known trip, he insisted on walking on the ramp no matter how difficult. In 1940 an elevator was installed.:140
When Roosevelt gave a speech on March 1, 1945 to Congress about the Yalta Conference he spoke sitting down, and said that doing so "makes it a lot easier for me not to have to carry about ten pounds of steel around on the bottom of my legs". One biographer has written that the speech, a month before his death, was "almost for the first time in twenty years" that he mentioned his disability in public.:363 In keeping with social customs of the time, the media generally treated Roosevelt's disability as taboo. News stories did not mention it, and editorial cartoonists, favorable and unfavorable, never caricatured his immobility. Many people, including world leaders, were unaware of his paralysis.:239 David Brinkley, who was a young White House reporter in World War II, stated that the Secret Service actively interfered with photographers who tried to take pictures of Roosevelt in a wheelchair or being moved about by others. However, there were occasional exceptions. 15. Goldberg,Richard T.,The Making of Franklin D. Roosevelt: Triumph Over Disability.Cambridge, MA, Abt Books, 1981.
- Ditunno JF, Herbison GJ (2002). "Franklin D. Roosevelt: diagnosis, clinical course, and rehabilitation from poliomyelitis". Am J Phys Med Rehabil 81 (8): 557–66. doi:10.1097/00002060-200208000-00001. PMID 12172063.
- Goldman AS, Schmalstieg EJ, Freeman DH, Goldman DA, Schmalstieg FC (2003). "What was the cause of Franklin Delano Roosevelt's paralytic illness?" (PDF). J Med Biogr 11 (4): 232–40. PMID 14562158. Retrieved 2012-02-27.
- Gallagher, HS, FDR's Splendid Deception, New York, Dodd, Mead (1985)
- Horstmann DM (1950). "Acute poliomyelitis relation of physical activity at the time of onset to the course of the disease". J Am Med Assoc 142 (4): 236–41. doi:10.1001/jama.1950.02910220016004. PMID 15400610.
- John Rowan Wilson: Margin of Safety: The Story of Poliomyelitis Vaccine. (1963); p. 63 of the hardcover German edition: Polio! Die Geschichte eines Impfstoffes. Paul Zsolnay (ed), Vienna/Hamburg 1964
- Sources: Richard Thayer Goldberg, The Making of Franklin D. Roosevelt: Triumph over Disability, Cambridge Massachusetts, Abt Books, 1981; Also, Richard T. Goldberg, Polio, In: Franklin D. Roosevelt: His Life and Times. Ed. Otis L. Graham, Jr. and Meghan R.Wander, Boston, G.K. Hall,1985.
- Gunther, John (1950). Roosevelt in Retrospect. Harper & Brothers.
- "Circulating Coins - Dime". United States Mint. Retrieved 2008-10-11.
- Reiter, Ed (June 28, 1999). "Franklin D. Roosevelt: The Man on the Marching Dime". PCGS. Retrieved 2008-10-11.
- "Grand Central Terminal, Waldorf-Astoria platform".
- "Address to Congress on Yalta (March 1, 1945)". Mar. 1, 1945. Retrieved Aug. 12, 2013.
- Pressman, Matthew. "The Myth of Roosevelt's Wheelchair". Retrieved Aug. 12, 2013.
- "THE PRESIDENCY: New Quarters". Time. December 17, 1934.