Franklin D. Roosevelt's paralytic illness
Franklin D. Roosevelt's paralytic illness began in 1921, when the future President of the United States was 39 years of age and vacationing with his family at their summer home on Campobello Island. Roosevelt was diagnosed with poliomyelitis two weeks after he fell ill. He was left with permanent paralysis from the waist down, and was unable to stand or walk without support. Despite the lack of a cure for paralysis he tried a wide range of therapies, and his belief in the benefits of hydrotherapy led him to found a center at Warm Springs, Georgia, in 1926. He laboriously taught himself to walk short distances while wearing iron braces on his hips and legs by swiveling his torso, supporting himself with a cane, and he was careful never to be seen using his wheelchair in public. His bout with illness was well known before and during his Presidency and became a major part of his image, but the extent of his paralysis was kept from public view. A 2003 retrospective study of FDR's illness favored a diagnosis of Guillain–Barré syndrome rather than polio, a conclusion criticized by other researchers.
- 1 History
- 1.1 Timeline
- 1.1.1 July 28
- 1.1.2 July 29
- 1.1.3 August 5–8
- 1.1.4 August 9
- 1.1.5 August 10
- 1.1.6 August 11
- 1.1.7 August 12
- 1.1.8 August 13
- 1.1.9 August 14
- 1.1.10 August 15
- 1.1.11 August 17
- 1.1.12 August 19
- 1.1.13 August 20
- 1.1.14 August 22
- 1.1.15 August 23
- 1.1.16 August 24
- 1.1.17 August 25
- 1.1.18 September 1
- 1.1.19 September 14
- 1.1.20 September 15
- 1.1.21 October 28
- 1.1.22 Later
- 1.1 Timeline
- 2 Personal impact
- 3 Public awareness
- 4 Legacy
- 5 Retrospective diagnosis
- 6 See also
- 7 References
In August 1921, 39-year-old Franklin D. Roosevelt joined his family at their vacation home at Campobello, a Canadian island off the coast of Maine. Several weeks before, his wife Eleanor had moved the household — including five children aged 5–15, a governess and her mother, and 40 to 50 trunks — to the remote island for the summer-long vacation. As he usually did, Roosevelt stayed behind until things got settled. He spent two weeks in Washington, D.C., giving testimony to a Senate committee investigating a Navy scandal:247–248 in mid-July.:32 On July 28 he fulfilled a commitment associated with his recently being elected president of the Greater New York Council of the Boy Scouts. He spent the following day in his New York City office, then went to his home in Hyde Park to review old Navy papers. A few days later, on August 5, FDR sailed up the New England coast with his friend and new employer, Van Lear Black, on Black's ocean-going yacht. Among those at Campobello when Roosevelt arrived were his political aide Louis Howe, his wife and their young son.:40–42
Roosevelt spent a day talking business with Howe.:248 Then, on August 10, he spent a day of strenuous activity with his family.:47 Roosevelt soon exhibited an illness characterized by fever, ascending paralysis of the upper and lower extremities, facial paralysis, bowel and bladder dysfunction, and numbness and hypersensitivity of the skin. Most of the symptoms eventually resolved themselves, but he was left permanently paralyzed from the waist down.:232
- Newly elected chairman of the Greater New York Council of the Boy Scouts of America, Roosevelt sailed on the steam yacht Pocantico from New York City to Bear Mountain State Park, with a number of wealthy businessmen and city officials.:15 They docked in late afternoon for a picnic in a mess tent with 2,100 boys from New York and New Jersey. In autumn 1920, public health inspectors had documented that the park's water quality and sanitation had been compromised by its heavy use.:28–29
- Summer outbreaks of poliomyelitis became common in New York after an epidemic in 1916. In July 1921, three cases were reported in New Jersey. By late August some 100 cases were reported in the state of New York, and the state health commissioner advised parents to keep their children away from large gatherings and prevent them from becoming overfatigued. In early September there were 419 cases, 178 of them in New York City. By the end of the month, The New York Times was reporting the largest number of new polio cases recorded in any single week since the 1916 epidemic.
- FDR worked for a few hours at his office at the Fidelity & Deposit Company of Maryland, in the Equitable Building in Manhattan, assisted by his secretary Marguerite LeHand.:31
- Roosevelt went to the family home at Hyde Park, New York, where he reviewed papers related to a Navy scandal.:31:306 In the first days of August he returned to Manhattan. He prepared to join his family at their summer home — a large red cottage with 18 bedrooms:305 and no electricity or telephone — at Campobello Island.:40–41
- Roosevelt left New York on board the Sabolo, a yacht owned by his employer and friend Van Lear Black. They sailed the Atlantic for two days, up the coast of Maine. FDR took the tiller as they approached the Lubec Channel, a narrow passage he knew well. They anchored in Passamaquoddy Bay.:41–42
- After arriving at Campobello, FDR talked business with his political advisor Louis Howe,:248 who was there with his wife and young son. Although he told Eleanor that he was "logy and tired", Roosevelt wanted those aboard the Sabalo to have a fishing expedition. He had the yacht tender packed for it.:42–43
- Off the coast of Campobello, Roosevelt baited hooks for Black's fishing party, moving between the two cockpits of the yacht tender on a narrow plank.:45–46, 58 Roosevelt fell into the cold waters of the Bay of Fundy.:233
- FDR, his wife Eleanor, their daughter Anna:47 and sons James and Elliott spent the day on the family sailboat, the Vireo. On Cobscook Bay they went ashore on one of the islands and beat out a fire with pine boughs, then sailed back home. Roosevelt took his five children swimming at their favorite pond, then raced his sons the two miles back to their cottage. Afterward, Roosevelt complained of chills, nausea, and pain in his lower back. He skipped dinner and went to bed.:235:252 Chills lasted through the night.:49
- In the morning, as Roosevelt got out of bed, his right knee felt weak and he was unable to walk it off. He later told Eleanor he could not go on a camping trip they had planned, and complained of stabbing pain in the back of his legs. His temperature was 102°F. Eleanor stayed behind with the other adults and the two younger children, Franklin Jr. and John, and sent the older children on their camping trip. As their boat was being packed Eleanor asked the fisherman helping them to speak to the doctor in the nearby village of Lubec and ask him to visit Campobello.:49
- Dr. Eben H. Bennet, a general practioner the Roosevelts had known for years, visited FDR and diagnosed a bad summer cold.:50
- By afternoon, Roosevelt's right knee would not support him when he tried to stand. By the evening his left knee was weakening.:51
- Both of Roosevelt's legs felt rubbery upon his waking in the morning. His skin had sensation, but his legs were sluggish. Pain shot through his legs, feet and back. He became desperately anxious.:51, 54
- Bennet returned and according to Eleanor was "mystified" at FDR's symptoms.:54 He suggested a consultation with Dr. William W. Keen, an eminent physician vacationing nearby. Fifteen years retired and 84 years of age, Keen was a revered surgeon who was on the faculty while Bennet was studying medicine. He was also known for his discretion in cases involving prominent people in public life. Telephoning from Bennet's office, Howe located Keen at Bar Harbor.:57–58
- 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. He was unable to tighten the muscles of his buttocks or abdomen. By evening he could not hold a pencil and his thumbs were affected.:51
- 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.:234
- Keen traveled by car to Lubec, where he was met by Howe and a boat that ferried them to Campobello around 7:30 p.m. In Roosevelt's second-floor bedroom, Keen made what Eleanor described as "a most careful, thorough examination", and the household went to bed.:57–58
- Roosevelt continued to be unable to pass urine for two weeks, and required catheterization. His fever continued for six to seven days.:234
- Keen repeated his examination, a bending and prodding that Elliott later termed "excruciating" for his father.:58
- Keen diagnosed a clot of blood to the lower spinal cord, and prescribed massage of the leg muscles. He attributed FDR's condition to the "chill and exposure" of August 9–10. In Roosevelt's presence he said the condition would be temporary, and that his ability to move the toes of one foot was a "very encouraging" sign that the clot was already being absorbed.:58
- Outside of Roosevelt's hearing, Keen told Eleanor that FDR may be paralyzed for months, that the clot might take a long time to be absorbed. Roosevelt would need to stay at Campobello for several weeks.:58
- Keen instructed Eleanor to send for a professional masseuse. In the interim, she and Howe were to alternate in rubbing Roosevelt's legs, to stimulate circulation that would aid in dissolving the blood clot. Inexplicably, Keen's diagnosis ignored the fact that Roosevelt's fever and chills indicated an infection rather than a blood clot.:58–59
- Eleanor and Howe considered how much to tell those who must be informed of Roosevelt's illness. Letters she wrote to most family members repeated Bennet's vague diagnosis that FDR was "ill from the effects of a chill". She wrote a letter to James Roosevelt Roosevelt, FDR's older half-brother Rosy, and asked him to meet Sara Delano Roosevelt, FDR's mother, when she returned from Europe on August 31. If he were unable to meet her ship, Eleanor would ask Sara's brother, Frederic Adrian Delano, Roosevelt's favorite uncle. Eleanor would write a brief letter that could be given to Sara.:59–60
- Howe started answering Roosevelt's mail, choosing the same careful phrases that Eleanor used, and writing that FDR was under doctor's orders "not to so much as look at the postage stamp on a letter for some time.":61
- Eleanor and Howe began massaging Roosevelt's legs as instructed by Keen, bringing on agonizing pain.:60
- Howe wrote a long letter to Fred Delano. Although Howe's letter was subsequently lost, Delano's response clearly indicates that Howe provided a detailed recounting of events and expressed doubts about Keen's diagnosis. Some of the Roosevelt children showed symptoms similar to FDR's — chills and fever — that could not be due to blood clots, and Howe wanted another opinion. Howe himself was needed at Campobello and could not search for another doctor, so he asked for Delano's help. He also shared his suspicions about infantile paralysis, which he had not mentioned to Eleanor.:61–62
- Prostrate and mildly sedated, Roosevelt was occasionally delirious.:60
- Eleanor received a lengthy letter from Keen in which he reconsidered his diagnosis. He now concluded that Roosevelt's condition was probably not due to a blood clot, and instead believed it could be the result of an inflammation of the spinal cord. He projected that the recovery "might be a longer business", and enclosed a bill for the startling amount of $600.:62
- Delano received Howe's letter at his home in Washington, D.C. He called his son-in-law, a physician, who recommended he speak to another physician, a Dr. Parker. Parker told Delano that the case sounded like infantile paralysis, and that the leading authorities on the disease were at the Harvard Infantile Paralysis Commission, at Peter Bent Brigham Hospital in Boston. Delano caught a train and arrived the next morning.:64
- Dr. Samuel A. Levine was at his office when Delano telephoned Brigham Hospital on Saturday morning. Levine said the senior members of the Harvard Infantile Paralysis Commission were out of town, but he would try to answer Delano's questions. After reviewing the messages Delano had received from Campobello, Levine said Keen's diagnosis could be dismissed. In an unpublished manuscript, Levine later wrote that "it seemed to me that Mr. Roosevelt was suffering from acute poliomyelitis". He urgently recommended that a lumbar puncture be done that same day. A diagnosis of poliomyletis could be virtually confirmed if the ordinarily clear cerebrospinal fluid were clouded with white blood cells. Also, based on a few cases he had observed, Levine believed there could be acute benefit from the procedure.:64–65, 327
- Levine urged that a qualified doctor in Bangor or another larger city go to Campobello and immediately perform the lumbar puncture.:66
- Eleanor was called to the village to take a telephone call from Delano, who told her about his meeting with Levine. It was then that Eleanor first learned that poliomyelitis was suspected.:66 Delano wrote Eleanor a followup letter the same day,:239 advising her to stop massaging Roosevelt's legs, and to disregard Keen's advice: "I think it would be very unwise to trust his diagnosis where the Inf. Paralysis can be determined by test of the spinal fluid.":66
- Eleanor communicated with Keen, who "very strenuously" resisted the idea of poliomyelitis. He ordered no lumbar puncture, but he contacted Dr. Robert Lovett, one of the directors of the Harvard Infantile Paralysis Commission, and asked him to visit Campobello.:66
- Lovett called Levine, a 30-year-old doctor who was one of his former students, and invited him to dinner at the Harvard Club. He tested him on how to distinguish whether paralysis was caused by poliomyelitis or by a clot or lesion of the spinal cord.:67–68
- Lovett left for Campobello.:68
- Lovett met Keen in Eastport, Maine, and interviewed him about the case. A boat took them to Campobello Island.:68
- Lovett saw Roosevelt and performed a "more or less superficial" examination since FDR was highly sensitive to touch. Nerves that regulated his breathing were unaffected. The arms were weak; the muscles of the abdomen were "pretty normal"; the bladder was paralyzed; the left thumb indicated atrophy but the limbs were not deformed. Roosevelt could not stand or walk, and Lovett documented "scattered weakness, most marked in the hips". Some muscles appeared to be recovering, with "a pretty fair degree of power after two weeks".:68
- A lumbar puncture, a standard diagnostic procedure for infantile paralysis, was performed.:68–69
- 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.:234 The lumbar puncture, which sometimes had therapeutic effects as well as diagnostic value, had no impact.:69
- After a brief conference with Keen, Lovett saw Roosevelt.:69 With Eleanor, Howe, Bennet and Keen present, Lovett informed him that the "physical findings" presented a "perfectly clear" diagnosis of poliomyelitis.:70
- Lovett ordered an end to massage, which had no benefit and caused pain, and recommended a trained nurse to care for FDR. He privately told Howe that any improvement in Roosevelt's condition "would be very slight unless he had the most extraordinary will and patience".:75–76
- Lovett assured Eleanor that if her children and Howe's son had been infected with the virus they had fought it off.:75
- Lovett recommended that Roosevelt rest at Campobello until mid-September, and enter a New York hospital for convalescence under the care of Dr. George Draper, an expert on poliomyelitis who was coincidentally FDR's own personal physician. Lovett would consult from Boston.:76
- Sara Delano Roosevelt, who had been met at the pier by her brother and informed about her son, arrived at Campobello.:80
- Funds for the expenses of the Harvard Infantile Paralysis Commission were exhausted. A public appeal for donations was made two weeks later.
- FDR was strapped into a makeshift stretcher and carried downstairs by six men, beginning a long and painful journey to New York. A launch took him over choppy waters to the railroad station at Eastport. A private railway car took him the 600 miles to Grand Central Station and a waiting ambulance.:85:236–237
- Roosevelt was admitted to Presbyterian Hospital, at Madison Avenue and 70th Street in New York City.
- 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.:234
- Roosevelt was transferred from Presbyterian Hospital to his house on East 65th Street.:110 His chart still read "not improving". He was carried to a back bedroom on the third floor.:238
- Roosevelt's fever returned and his vision blurred, causing him to fear going blind. He exercised daily, probably to excess; his hamstrings tightened, and his legs were encased in plaster to straighten them by degrees.:238
- 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.:234
- In the late spring of 1922, due to tensions in the household, Roosevelt left his family in New York and went to live with his mother at Springwood.:239
Roosevelt was totally and permanently paralyzed from the waist down, and unable to stand or walk without support. In December 1921, after he had recuperated for several months, a physiotherapist began working with him to determine the extent of the damage. In time he was able to perform small exercises on his own, moving one muscle and then another. He was fitted with heavy steel braces that locked at the knee and provided enough stability that he could stand with crutches. In 1922, at Springwood, he worked diligently to make his way across the room. He set himself the goal of getting down the long driveway, managing to do it once but never trying again.:241
In October 1922 Roosevelt visited his office at the Equitable Building, where a welcome-back luncheon had been arranged, but the chauffeur assisting him failed to brace the tip of his left crutch and Roosevelt fell onto the highly polished lobby floor. Laughing, he asked two young men in the crowd of onlookers to help get him back on his feet. After the luncheon he told friends it was a "grand and glorious occasion", but he did not go back to his office for two months.:245
FDR believed that warmth and exercise would help rebuild his legs. He bought a run-down 71-foot houseboat, and in February 1923 he sailed to Florida with friends and a skeleton crew. Eleanor found it dull and left, but Roosevelt sailed for weeks, fishing and spending time with a succession of friends who came to visit. He designed a pulley system that lowered him into the water to swim. In May 1923 Lovett documented no overall improvement over the preceding year, but FDR would not accept his doctors' determination that further progress was unlikely. He tried a range of therapies, and made two more voyages on his houseboat, but his efforts had no effect.:247–249
"Between 1925 and 1928, Franklin would spend more than half his time — 116 of 208 weeks — away from home, struggling to find a way to regain his feet," wrote biographer Geoffrey Ward. "Eleanor was with him just 4 of those 116 weeks, and his mother was with him for only 2. His children hardly saw him.":248
In October 1924 Roosevelt visited the mineral springs of rural Georgia for the first time, and became convinced of the benefits of hydrotherapy. In 1926 he bought a resort at Warm Springs, Georgia, where he founded a center for the treatment and rehabilitation of people with polio.:257 It is now the Roosevelt Warm Springs Institute for Rehabilitation, a comprehensive rehabilitation facility operated by the state of Georgia.
Before his paralysis Roosevelt had weighed 170 pounds, thin for a man 6'2" tall, and had suffered many illnesses. Roosevelt lost the use of his legs and two inches of height, but the subsequent development of the rest of his body gave him a robust physique and he enjoyed many years of excellent health. Jack Dempsey praised his upper-body musculature, and FDR once landed a 237-pound shark after fighting it on his line for two hours.:219,241–242,266–267
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 only to go from one place to another. 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.
With his physiotherapist at Warm Springs, Roosevelt laboriously taught himself to walk short distances while wearing iron braces on his hips and legs, by swiveling his torso. For this "two-point walk", seen in a few rare films and photographs, he would grip the arm of a strong person with his left hand, and brace himself with a cane in his right. He would heave one stiff leg forward, from the hip, and then the other. He exhibited the walk for the first time when he addressed the 1928 Democratic National Convention — with such success that he was pressed to run for governor of New York.:264 FDR's walk was slow and seemingly natural, but the endeavor was always risky since he could easily fall.:264
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 FDR's paralysis.:239 However, Winston Churchill wrote in his memoirs that he "wheeled him in his chair from the drawing-room to the lift as a mark of respect, thinking also of Sir Walter Raleigh spreading his cloak before Queen Elizabeth."
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.
On January 3, 1938, Roosevelt founded the National Foundation for Infantile Paralysis, now known as the March of Dimes. Reconstituted from the Georgia Warm Springs Foundation he founded in 1927, it was an alliance between scientists and volunteers, with volunteers raising money to support research and education efforts. Basil O'Connor, an attorney and close associate of Roosevelt, helped establish the foundation and was its president for more than three decades. The organization 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 March of Dimes focuses on preventing premature birth, birth defects and infant mortality.
The organization's annual fundraising campaign coincided with FDR's birthday on January 30. Because he founded the March of Dimes, a dime was chosen to honor Roosevelt after his death. The Roosevelt dime was issued in 1946, on what would have been the president's 64th birthday.
Roosevelt's center at Warm Springs operates today as the Roosevelt Warm Springs Institute for Rehabilitation, a comprehensive rehabilitation facility operated by the state of Georgia. A center for post-polio treatment, it provides vocational rehabilitation, long-term acute care, and inpatient rehabilitation for amputees and people recovering from spinal cord injuries, brain damage and stroke.
A peer-reviewed study of Roosevelt's paralytic illness 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 analysis, 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; and descending recovery from paralysis. Two of the eight key symptoms — fever and permanent paralysis — favored polio.
Several aspects are in discordance with this retrospective diagnosis. In addition to two of the eight posterior probabilities in the Bayesian analysis favoring poliomyelitis over Guillain–Barré syndrome, FDR had an elevated fever up to 102°F, which is rare in Guillain–Barré syndrome. Additionally, he had permanent paralysis which occurs in about 50% of polio survivors, whereas it occurs in only 15% of cases of Guillain–Barré syndrome. 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.
Further, the 2003 study mistakenly states that no analysis of the cerebrospinal fluid, the gold standard for poliomyelitis diagnosis, had been done in Roosevelt's case.:236 However, historian James Tobin located an unpublished manuscript by Dr. Samuel A. Levine of the Harvard Infantile Paralysis Commission that clearly indicates that a lumbar puncture was done August 24, 1921, when Dr. Robert Lovett saw Roosevelt. Tobin wrote that "Levine's private note indicates that Dr. Lovett did examine the cerebrospinal fluid and knew very well that a high level of white blood cells was consistent with poliomyelitis." Tobin concludes:
If Lovett had discovered a low white blood cell count, he would have doubted that poliomyelitis was the cause of FDR's illness. Yet Lovett wrote George Draper that "I thought [the diagnosis] was perfectly clear as far as the physical findings were concerned." Absolute certainty about the diagnosis is impossible without the laboratory tests later developed to distinguish between polio and GBS. But the existing evidence, taken together, indicates that poliomyelitis was by far the most likely cause of Roosevelt's illness and the resulting paralysis.
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