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.
Guillain–Barré vs. poliomyelitis
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
However, several aspects are in discordance with this retrospective diagnosis. Two of the eight posterior probabilities in the Bayesian analysis favored poliomyelitis over Guillain–Barré syndrome. FDR had an elevated fever up to 102°F, which is rare in GBS. Additionally, he had permanent paralysis which occurs in about 50% of polio survivors, whereas it occurs in only 15% of cases of GBS. Furthermore, the onset of disease following a day of strenuous exercise and the eventual asymmetric paralysis of Roosevelt's legs and arms is consistent with a study showing that motor neurons innervating muscles vigorously at the start of polio are those most likely to become paralyzed. FDR likely would have been 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 14.
The gold standard for poliomyelitis diagnosis is made by analysis of the cerebrospinal fluid, and no such analysis has been thought to have been done in Roosevelt's case. However, FDR biographer James Tobin located an unpublished note by Levine clearly indicating that such an analysis was performed:
- "I ... learned that when Dr. Lovett saw the patient [on August 24-25] the lumbar puncture had not been done and it was not done till Wednesday [August 24] (four days after I advised it). ... During those several days further paralysis had taken place. It will never be known whether a more prompt removal of spinal fluid would have altered the outcome."
Tobin argues that since Levine's note indicates that Lovett did perform lumbar puncture, he would have had some doubt based on physical findings that FDR had polio, but in a letter to George Draper held at Harvard University, Lovett wrote that he "thought [the diagnosis] was perfectly clear as far as the physical findings were concerned."
Roosevelt was totally and permanently paralyzed from the waist down. He was able to stand only by using full-leg steel braces that locked at the knee and bracing himself against a lectern or other immovable object. He could walk haltingly for very short distances while using a cane in one hand and grasping someone's arm in the other.  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. Track 61, 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. The Secret Service commonly destroyed photographs they caught being taken in this manner; however, there were occasional exceptions.
- 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.
- 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.
- Tobin, James (Sep 2, 2014). he Man He Became: How FDR Defied Polio to Win the Presidency. Simon and Schuster. pp. 327–328 n. 69. ISBN 0743265165.
- 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 (July 12, 2013). "The Myth of FDR's Secret Disability". Time. Retrieved Aug 12, 2013.
- "THE PRESIDENCY: New Quarters". Time. December 17, 1934.
- 15. Goldberg,Richard T.,The Making of Franklin D. Roosevelt: Triumph Over Disability. Cambridge, MA, Abt Books, 1981.