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 old. His main symptoms were fever; symmetric, ascending paralysis; facial paralysis; bowel and bladder dysfunction; numbness and hyperesthesia; and a descending pattern of recovery. Roosevelt, commonly known as FDR, was left permanently paralyzed from the waist down. He was diagnosed with poliomyelitis at the time, but his symptoms are more consistent with Guillain–Barré syndrome (GBS) – an autoimmune neuropathy which Roosevelt's doctors failed to consider as a diagnostic possibility. In 1926, his belief in the benefits of hydrotherapy led him to found a rehabilitation center at Warm Springs, Georgia. The extent of his paralysis was kept from public view, as he avoided being seen using his wheelchair in public. However, his disability was well known before and during his Presidency and became a major part of his image. In 1938, he founded the National Foundation for Infantile Paralysis, leading to the development of polio vaccines.
- 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
- 1.2 Diagnosis
- 1.3 Warm Springs
- 1.4 Governor and President
- 1.1 Timeline
- 2 Personal impact
- 3 Social impact
- 4 Public awareness
- 5 Legacy
- 6 Retrospective diagnosis
- 7 See also
- 8 References
In August 1921, 39-year-old Franklin D. Roosevelt, at the time a practicing lawyer in New York, joined his family at their vacation home at Campobello, a Canadian island off the coast of Maine. As former Assistant Secretary of the Navy, he spent two weeks in Washington, D.C., giving testimony to a Senate committee investigating a Navy scandal in mid-July.:247–248 :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. On August 5, Roosevelt 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 Eleanor, their children, his political aide Louis Howe, his wife, and their young son.:40–42
On August 10, after a day of strenuous activity, Roosevelt exhibited an illness characterized by fever, ascending paralysis, facial paralysis, prolonged bowel and bladder dysfunction, and numbness and hypersensitivity of the skin.:47 Most of the symptoms resolved themselves, but he was left permanently paralyzed from the waist down.
Roosevelt came close to death from the illness. He faced a number of life-threatening medical problems including the possibility of respiratory failure, urinary tract infection, injury to the urethra or bladder, decubitus ulcers, clots in the leg veins, and malnutrition. Eleanor’s nursing care was responsible for Roosevelt’s survival.:148–151
- Roosevelt visited the Boy Scout Jamboree at Bear Mountain State Park.
- 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 traveled to Campobello on board the yacht Sabolo.
- Roosevelt and his family 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.:252 :235 Chills lasted through the night.:49
- In the morning, one of his legs felt weak. Roosevelt had fever.
- Dr. Eben H. Bennet, a general practitioner in the nearby village of Lubec who had know the Roosevelts for years, visited Roosevelt and diagnosed a bad summer cold.:50
- By the evening, one leg was paralyzed, and the other had become weak.:51
- Both legs were paralyzed. His temperature was 102 °F. Pain shot through his legs, feet and back.:51, 54
- Bennet returned and according to Eleanor was "mystified" at Roosevelt'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 known for his discretion in cases involving prominent people in public life.:57–58
- His legs were numb. They then became painfully sensitive to touch. He could not pass urine. By evening his hands 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 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.
- Eleanor and Howe began massaging Roosevelt's legs as instructed by Keen, bringing on agonizing pain.:60
- 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 urged that a lumbar puncture be done that same day, with the goal of making a diagnosis, but mainly because Levine believed there could be acute benefit from the procedure.:64–65, 327:192
- 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 follow-up 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. Keen contacted Dr. Robert Lovett, one of the directors of the Harvard Infantile Paralysis Commission, and asked him to visit Campobello.:66
- Lovett met Levine for dinner. Lovett asked 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 saw Roosevelt and performed a "more or less superficial" examination since Roosevelt was highly sensitive to touch. The arms were weak; the bladder was paralyzed; the left thumb indicated atrophy. Roosevelt could not stand or walk, and Lovett documented "scattered weakness, most marked in the hips".:68
- 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
- After a brief conference with Keen, Lovett saw Roosevelt.:69 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 Roosevelt.:75–76
- 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 Roosevelt's own personal physician. Lovett would consult from Boston.:76
- Roosevelt was still unable to urinate. His leg pain continued.:3
- Roosevelt was transported to New York, by boat and train, a long and painful journey.
- 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".
- Roosevelt exercised daily. His hamstrings tightened, and his legs were encased in plaster to straighten them by degrees.:238
- There was gradual recovery, but he remained paralyzed from the waist down.
After falling ill, Roosevelt was seen by four doctors. Eben Homer Bennet, the Roosevelt family doctor, diagnosed a heavy cold. William Keen, a retired neurosurgeon, thought Roosevelt had a blood clot. Robert Lovett, an expert on the orthopedic management of children paralyzed from poliomyelitis, diagnosed "infantile paralysis", as did George Draper, Roosevelt's personal physician.
Roosevelt's physicians never mentioned Guillain–Barré syndrome (GBS) in their communications concerning Roosevelt's case, indicating that they were not aware of it as a diagnostic possibility. All reports before 1921 of what is now called GBS were by European physicians, in European journals. The result was that very few American physicians knew that GBS was a separate disease. For example, Lovett mistakenly believed that Landry’s ascending paralysis, now termed GBS, was one of the clinical presentations of paralytic polio. In 1921, an American physician would assume that if an individual developed a sudden, non-traumatic flaccid paralysis, it was due to paralytic polio. The concept of GBS as a separate disease was not widely accepted in the United States until after the Second World War.:203,204,232
October 3, 1924 was the first time Roosevelt traveled to Warm Springs, Georgia and it soon became his home away from home. For many years to come Warm Springs would be where Franklin would retreat in comfort and do hydrotherapy for his legs. On April 29, 1926 he bought the center with the intention of making it into a rehabilitation center for polio patients.:33-34 One of Roosevelt's major goals was to get the American Orthopedic Association to endorse the resort, but he was rejected because there was no real progress in physical health. It is now the Roosevelt Warm Springs Institute for Rehabilitation, a comprehensive rehabilitation facility operated by the State of Georgia.
Governor and President
In 1929 Roosevelt was elected Governor of New York and moved into the Governor's Mansion in Albany. Before he could move in, the mansion underwent renovations due to Roosevelt's health. The mansion was made wheelchair friendly with ramps and an elevator.:68-87
Roosevelt won the Presidential election in 1932 in a landslide victory and become the first, and so far only, disabled person to be President of the United States. Before he moved into the White House, ramps were set everywhere in order to make it wheelchair friendly. To avoid the public, Roosevelt addressed the country through radio, and when shown on newsreels he was standing on his own. Any pictures of the President were taken at certain angles and at a distance.:88-105
Roosevelt was totally and permanently paralyzed from the waist down, and unable to stand or walk without support. For the next few months, he confined himself to indoor pursuits, including resuming his lifelong hobby of stamp collecting. In December 1921, after he had recuperated for several months, a physiotherapist began working with him to determine the extent of the damage. 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 law office at the Equitable Building, where a welcome-back luncheon had been arranged. 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". He did not return to his office for two months.:245
Roosevelt 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 Roosevelt 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
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 Roosevelt once landed a 237-pound shark after fighting it on his line for two hours.:241, 266–267
Roosevelt was the United States' first disabled president, so there has been discussion concerning how he handled his health. In Hugh Gallagher's book, FDR's Splendid Deception, he posits that Roosevelt was desperate to appear normal. When discussing his limited use of a wheelchair in the public, Gallagher states, "This was not by accident. It was a strategy served to minimize the extent of his handicap, to make it unnoticed when possible and palatable when it was noticed.".:xiv Historian James Tobin also argues that Roosevelt used his disability to his advantage. In his book, The Man He Became, Tobin states, "But he could, instead, show himself to be something he had never been seen as before: a fighter and, and better yet, an underdog; not a man to pity, not a man to envy, but a man to cheer.":273 Despite any controversy, he has become an inspirational figure for disabled people around the world.
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 Roosevelt'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 addressed the Congress in person on March 1, 1945, about a month before his death, he made public reference to his disability for almost the first time in 20 years.:36 "I hope that you will pardon me for this unusual posture of sitting down," Roosevelt began, "but I know you will realize that it makes it a lot easier for me not to have to carry about ten pounds of steel around on the bottom of my legs."
Journalist John Gunther reported that in the 1930s he often met people in Europe, including world leaders, who were unaware of Roosevelt'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.
The Roosevelt Memorial in Washington D.C includes a statue of Roosevelt in a wheel chair, although many believed that Roosevelt should not have been displayed as a disabled person because it would ruin the image the country had of him.
March of Dimes
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 Roosevelt'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 Warm Springs Institute for Rehabilitation
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 2003 peer-reviewed study of Roosevelt's paralytic illness, using three diagnostic methods - pattern recognition, reconstructing the pathogenesis, and Bayesian analysis - favored a diagnosis of Guillain–Barré syndrome (GBS) over poliomyelitis. For the purposes of the Bayesian analysis, a best estimate of the annual incidence of GBS was 1.3 per 100,000. For paralytic polio in Roosevelt's age group, an annual incidence of 1.0 per 100,000 was used. The paralytic polio rate was derived from the exceptionally severe polio epidemic that struck New York City in 1916, to give paralytic polio "the best chance to succeed". The prior probability of paralytic polio in Roosevelt’s age group in the United States in 1921 was likely much lower, because paralytic polio was at one of its lowest ebbs in the Northeastern region of the country at that time.:123  :26 In July 1921, three cases were reported in New Jersey. By late August some 100 cases were reported in the state of New York. Based on the incidence rates for GBS and paralytic polio, and symptom probabilities from the medical literature, Roosevelt's symptoms were analyzed by Bayesian analysis to obtain posterior probabilities. :125
Six of eight symptoms favored GBS, with the posterior probability of GBS shown for each:
- 98% - Roosevelt’s paralysis was symmetric and ascending, and progressed more than four days, whereas the paralysis in poliomyelitis is typically asymmetric, variable in its ascent or descent, and usually progresses for only two to four days. A review of the medical research literature revealed only one report of paralytic polio with a symmetric, ascending paralysis.
- 97% - Facial paralysis, as Roosevelt had, in the absence of other cranial nerve abnormalities, is not consistent with a polio diagnosis, but is common in GBS.
- 93% - Roosevelt had prolonged bladder and bowel dysfunction (difficulty urinating and defecating). Such protracted autonomic nervous system abnormalities are rare in paralytic polio, since polioviruses do not attack autonomic nerves, but are common in GBS.
- 98% - Roosevelt experienced numbness in his legs. Soon after, he endured protracted pain to the slightest touch (hyperesthesia). Such sensory abnormalities rarely if ever occur in paralytic polio (solely affects motor neurons), but are common in GBS (sensory neurons also affected).
- 93% - Meningismus (neck stiffness), a characteristic feature of paralytic polio, was absent in Roosevelt’s case.
- 98% - A consistent descending pattern of recovery from paralysis is absent in paralytic polio, but common in GBS.
Two of eight symptoms were in favor of polio, with the posterior probability of polio shown for each:
- 99% - Roosevelt had fever up to 102 °F, which is rare in GBS, although the pattern of the fever that Roosevelt experienced was atypical of paralytic polio.
- 72% - Roosevelt had permanent paralysis, which occurs in about 50% of polio survivors, and only about 15% of cases of GBS.
Using all eight symptoms in a Bayesian analysis, based on disease incidence rates and symptom probabilities from the medical literature, the overall probability that Roosevelt had GBS is over 99%.:242–250
It is possible Roosevelt was exposed to an infectious agent at the Boy Scout Jamboree in late July. However, the two-week interval before the onset of his neurological illness was in keeping with both the incubation period of poliomyelitis,:13–30 and with exposure to an infectious agent leading to GBS.:183 There are no reports that any scouts or personnel at the camp were ill around the time of Roosevelt’s visit. In 1912 and 1915, Roosevelt had illnesses compatible with Campylobacter jejuni, a major causative agent of GBS.:145
Several authors have stated that Roosevelt was especially vulnerable to polio since he was raised on an isolated family estate and had little contact with other children until he entered Groton at age 14. However, Roosevelt was not a "boy in a bubble". He had many possible exposures to polioviruses before 1921. Most polio cases are asymptomatic or a mild illness. Yet those asymptomatic individuals are able to transmit the viral infection.:109 When the prior probability of polio was artificially adjusted 100-fold (to 99.4%) to favor polio, overall Bayesian analysis of Roosevelt's symptoms still greatly favored GBS (99.97% posterior probability). Roosevelt’s symptoms are typical of GBS, not of paralytic polio, so they overwhelm the initial prior probability.:246
In 2014, historian James Tobin argued that a lumbar puncture was done, based on excerpts from an "unpublished note" by Dr. Samuel A. Levine of the Harvard Infantile Paralysis Commission. Tobin was not able to print or release the note. 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. . . . If Lovett had discovered a low white blood cell count, he would have doubted that poliomyelitis was the cause of Roosevelt's illness. Yet Lovett wrote George Draper that "I thought [the diagnosis] was perfectly clear as far as the physical findings were concerned.""
In 2017, the full "unpublished note" was published. Based on the full text, the note was not found to support the idea that a spinal tap was performed, because: 1) The note, written many years after 1921, had many errors. 2) Levine never saw Roosevelt. 3) Levine did not mention who did the procedure, or the results. 5) Lovett had made it clear he would not do the procedure. 6) None of Roosevelt's physicians at Campobello were equipped to do the procedure. 7) "Physical findings" means information gained from a physical examination of the patient. Lovett described many "physical findings": hyperesthesia, facial paralysis, etc. But neither he, any of Roosevelt's other physicians at Campobello, Roosevelt, Eleanor, nor any of Roosevelt's associates ever said that a spinal tap was done.
The book went on to say: "Given the invasive nature of a spinal tap, and the difficulty that would have occurred doing the procedure on a patient in FDR’s condition, it seems highly unlikely that a direct observer would have failed to mention anything about it. . . . Even if a spinal tap had been performed, it would have been done at the earliest about 15 days after the onset of the neurological illness, around when Lovett first saw Roosevelt. . . . One should keep in mind that the classical distinction between paralytic polio and GBS, the concentrations of leukocytes and total protein in CSF, blurs after the first several days of the onset of paralysis in both diseases.":193,198
"In any event, there was no cure for either disease in 1921," wrote biographer Jonathan Alter. However, Dr. Samuel Levine, who first made a polio diagnosis in Roosevelt's case, mistakenly thought that the main benefit of a spinal tap, if done, would be to improve the outcome by lowering elevated CSF pressure.:192 And even today, some authors mistakenly believe that Roosevelt's paralysis, assuming a polio diagnosis, could have been prevented with early intervention.:45,49,62,66 However, there is no objective evidence that a spinal tap lessens the possibility of paralysis in polio. And it is unlikely Roosevelt's physicians would have tried human serum injections into the CSF, or that it would have helped. Lovett did not think the injections were useful, and there were alarming meningeal symptoms associated with the injections, probably secondary to the formation of antigen-antibody complexes.:199-200 Concerning GBS, virtually all of the effective measures that are currently standard practice for the medical management of GBS were not developed until many decades after Roosevelt's 1921 illness, so Roosevelt's prognosis would not have improved even if GBS had been diagnosed.:238
- Polio Hall of Fame
- Sunrise at Campobello (1958 play)
- Sunrise at Campobello (1960)
- Eleanor and Franklin (1976)
- Warm Springs (2005)
- Collier, Peter; Horowitz, David (1994). The Roosevelts: An American Saga. New York: Simon & Schuster. ISBN 0671652257.
- Tobin, James (2013). The Man He Became: How FDR Defied Polio to Win the Presidency. Simon & Schuster. ISBN 0743265165.
- Goldman AS, Schmalstieg EJ, Freeman DH, Goldman DA, Schmalstieg FC (2003). "What was the cause of Franklin Delano Roosevelt's paralytic illness?" (PDF). Journal of Medical Biography. 11 (4): 232–40. PMID 14562158. Retrieved 2017-07-04.
- Goldman, Armond S.; Goldman, Daniel A. (2017). Prisoners of Time: The Misdiagnosis of FDR's 1921 Illness. EHDP Press. ISBN 978-1939824035.
- Cook, Blanche Wiesen (1992). Eleanor Roosevelt, Volume One 1884–1933. New York: Viking. ISBN 0-670-80486-X.
- Ward, Geoffrey C.; Burns, Ken (2014). The Roosevelts: An Intimate History. New York: Alfred A. Knopf. ISBN 9780307700230.
- Ditunno JF, Herbison GJ (2002). "Franklin D. Roosevelt: diagnosis, clinical course, and rehabilitation from poliomyelitis". Am J Phys Med Rehabil. 81 (8): 557–66. PMID 12172063. doi:10.1097/00002060-200208000-00001.
- Gallagher, Hugh (1985). FDR’s Splendid Deception. New York: Dodd, Mead & Company, Inc. ISBN 0918339502.
- Tobin, James (2013). The Man He Became: How FDR Defined Polio to Win the Presidency. New York: Simon & Schuster Paperbacks. pp. 222–226. ISBN 0743265165.
- "Roosevelt Warm Springs". Georgia Vocational Rehabilitation Agency. Retrieved 2015-09-28.
- Pressman, Matthew (July 12, 2013). "The Myth of FDR's Secret Disability". Time. Retrieved Aug 12, 2013.
- G. Wayne Clough (November 2009). "From the Castle - FDR's Stamps". Smithsonian.
- "Roosevelt's Polio Wasn't A Secret: He Used It To His 'Advantage'". Fresh Air. NPR. November 25, 2013. Retrieved 2015-09-25.
- Gunther, John (1950). Roosevelt in Retrospect. New York: Harper & Brothers. OCLC 466356.
- "Grand Central Terminal, Waldorf-Astoria platform".
- "Address to Congress on Yalta (March 1, 1945)". Mar 1, 1945. Retrieved Aug 12, 2013.
- Churchill, Winston 1950, The Grand Alliance, p.663
- "THE PRESIDENCY: New Quarters". Time. December 17, 1934.
- Goldberg, Richard T. (1981). The Making of Franklin D. Roosevelt: Triumph Over Disability. Cambridge, Massachusetts: Abt Books. ISBN 9780890115640.
- Rabinowitz, Dorothy (1997). "A Full Measure of FDR and His Enemies". 'newspaper'.
- Baghdady, Maddock J. (2008). "Marching to a Different Mission" (PDF). Stanford Social Innovation Review: 60–65. Retrieved 2015-09-25.
- Whitman, Alden (March 10, 1972). "Basil O'Connor, Polio Crusader, Dies". The New York Times. Retrieved 2015-09-26.
- Barrett, William P. "March of Dimes' Second Act". Forbes, November 19, 2008.
- "Circulating Coins - Dime". United States Mint. Retrieved 2008-10-11.
- Reiter, Ed (June 28, 1999). "Franklin D. Roosevelt: The Man on the Marching Dime". Professional Coin Grading Service. Archived from the original on August 20, 2008. Retrieved 2015-09-25.
- McKenna, M.A.J. (April 12, 2005). "Reflections on Warm Springs". The Atlanta Journal-Constitution.
- Wilkinson, Jack (October 8, 2006). "Warm Springs artisans fought polio's damage". The Atlanta Journal-Constitution.
- "History of Polio". The History of Vaccines. College of Physicians of Philadelphia. Retrieved 2015-10-03.
- "Find Infantile Paralysis; Three Cases Develop in Paterson". The New York Times. July 26, 1921. Retrieved 2015-10-03.
- "Infantile Paralysis is Spreading Up State". The New York Times. August 23, 1921. Retrieved 2015-10-03.
- Tobin, James (2014). The Man He Became: How FDR Defied Polio to Win the Presidency. Simon & Schuster. pp. 327–328 n. 69. ISBN 0743265165.
- Alter, Jonathan (2007). The Defining Moment: FDR's Hundred Days and the Triumph of Hope. New York: Simon & Schuster. p. 355. ISBN 9780743246019.