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Encyclopedia > Franklin D. Roosevelt's paralytic illness
One of only a few known photographs of Roosevelt in a wheelchair
One of only a few known photographs of Roosevelt in a wheelchair

Franklin D. Roosevelt's paralysis has become a major part of his image today, even though during his life it was kept from public view and rarely discussed in public. Roosevelt's paralysis was originally diagnosed to be paralytic poliomyelitis.[1] However, one retrospective study concludes that he more likely had Guillain-Barré syndrome.[2] Download high resolution version (1206x1238, 567 KB)http://teachpol. ... Download high resolution version (1206x1238, 567 KB)http://teachpol. ... FDR redirects here. ... Poliomyelitis (polio), or infantile paralysis, is a viral paralytic disease. ... Guillain-Barré syndrome (GBS) (IPA pronunciation: is an acute, autoimmune, polyradiculoneuropathy affecting the peripheral nervous system, usually triggered by an acute infectious process. ...

Contents

Timeline and history of illness

In August 1921, while the Roosevelts were vacationing at Campobello Island, New Brunswick, 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.[2] Campobello Island is a Canadian island located in the Bay of Fundy near the entrances to Passamaquoddy Bay and Cobscook Bay. ... FDR redirects here. ... An analogue medical thermometer showing the temperature of 38. ... Paralysed redirects here. ... This article is about the urinary bladder. ... The intestine is the portion of the alimentary canal extending from the stomach to the anus and, in humans and other mammals, consists of two segments, the small intestine and the large intestine. ... Dysaesthesia (dysesthesia in American English) is a tactile hallucination. ...


August 9

  • Roosevelt fell into the cold waters of the Bay of Fundy while boating.

The Bay of Fundy (French: ) is a bay located on the Atlantic coast of North America, on the northeast end of the Gulf of Maine between the Canadian provinces of New Brunswick and Nova Scotia, with a small portion touching the U.S. state of Maine. ...

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"[3], and had chills. He retired early. Chills lasted through the night.

See also back pain Low back pain is a common musculoskeletal disorder which affects the lumbar segment of the spine. ...

August 11

  • One leg was weak. By the afternoon, it was paralyzed. That evening, the other leg began to weaken.

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.

August 13

  • He 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. He continued unable to pass urine for two weeks, and required catheterization. His fever continued for six to seven days. On August 18th, he was briefly delirious.

Late August

  • 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.

Mid-September

  • In mid-September, at New York City Presbyterian Hospital, there was pain in the legs, paralysis of the legs, muscle wasting in lower lumbar area and the buttocks, weakness of the right triceps, and gross twitching of muscles of both forearms.

Later

  • 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 the lower extremities remained paralyzed, and the buttocks were weak.

Possible causes

The unquestioned diagnosis at the time and thereafter in countless references was paralytic poliomyelitis, which was understandable because polio was epidemic in the adjoining northeastern United States during the late nineteenth and early twentieth centuries. 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.[4] Poliomyelitis (polio), or infantile paralysis, is a viral paralytic disease. ... This article is about the disease. ... In epidemiology, an epidemic (from [[Latin language] epi- upon + demos people) is a disease that appears as new cases in a given human population, during a given period, at a rate that substantially exceeds what is expected, based on recent experience (the number of new cases in the population during... Poliomyelitis (polio), or infantile paralysis, is a viral paralytic disease. ...


Yet his age (39 years) and many features of the illness are more consistent with a diagnosis of Guillain-Barré syndrome (an autoimmune peripheral neuropathy). During the early twentieth century, almost all cases of paralytic polio were in children, and few adults over 30 years contracted the disease. Paralytic polio is rarely symmetric or ascending. The paralysis in polio usually progresses for only three to five days. In paralytic polio, the fever usually precedes the paralysis. Meningismus is common in paralytic polio. The studies suggesting a link between exercise and paralytic polio are subject to recall bias. In contrast, every neurologic feature of Roosevelt's illness was consistent with Guillain-Barré syndrome. Fever is found in some cases, and about 15% of severe cases have permanent neurological sequelae.[2] Guillain-Barré syndrome (GBS) (IPA pronunciation: is an acute, autoimmune, polyradiculoneuropathy affecting the peripheral nervous system, usually triggered by an acute infectious process. ... Autoimmune diseases arise from an overactive immune response of the body against substances and tissues normally present in the body. ... Peripheral neuropathy is the term for damage to nerves of the peripheral nervous system, which may be caused either by diseases of the nerve or from the side-effects of systemic illness. ... Meningism is the triad of nuchal rigidity, photophobia (intolerance of bright light) and headache. ... In psychology, recall bias (or reporting bias) is a type of systematic bias which occurs when the way a survey respondent answers a question is affected not just by the correct answer, but also by the respondents memory. ... Guillain-Barré syndrome (GBS) (IPA pronunciation: is an acute, autoimmune, polyradiculoneuropathy affecting the peripheral nervous system, usually triggered by an acute infectious process. ...


Roosevelt's principal physicians during his illness, Robert Lovett and George Draper, were experts in polio. It is possible that the diagnosis of Guillain-Barré syndrome was not on their minds, since the disease was not as well known at the time. In 1916, Georges Guillain and Jean Alexandre Barré described the cerebrospinal fluid finding in two soldiers with ascending paralysis, loss of deep tendon reflexes, paraesthesia, and pain on deep palpation of large muscles.[2] There were several people named Robert Lovett: Robert A. Lovett (1895–1986), United States Secretary of Defense Robert Lovett, Chairman of the Southern Pacific Company Executive Committee (1909–1913) This is a disambiguation page — a navigational aid which lists other pages that might otherwise share the same title. ... George Draper can refer to: George A. Draper, American textile industrialist George O. Draper, American textile industrialist George Draper Dayton, founder of Daytons department store Category: ... Guillain-Barré syndrome (GBS) (IPA pronunciation: is an acute, autoimmune, polyradiculoneuropathy affecting the peripheral nervous system, usually triggered by an acute infectious process. ... Georges Charles Guillain (March 3, 1876 - June 29, 1961) was a French neurologist. ... Jean Alexandre Barré (May 25, 1880 – April 26, 1967), French neurologist, worked in 1916 on the identification of the Guillain-Barré syndrome. ... Cerebrospinal fluid (CSF), Liquor cerebrospinalis, is a clear bodily fluid that occupies the subarachnoid space in the brain (the space between the skull and the cerebral cortex—more specifically, between the arachnoid and pia layers of the meninges). ...


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.[2] Bayesian inference is statistical inference in which probabilities are interpreted not as frequencies or proportions or the like, but rather as degrees of belief. ... The posterior probability of a random event or an uncertain proposition is the conditional probability it is assigned when the relevant evidence is taken into account. ... Incidence is a measure of the risk of developing some new condition within a specified period of time. ... Guillain-Barré syndrome (GBS) (IPA pronunciation: is an acute, autoimmune, polyradiculoneuropathy affecting the peripheral nervous system, usually triggered by an acute infectious process. ... Incidence is a measure of the risk of developing some new condition within a specified period of time. ...


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:[2] Incidence is a measure of the risk of developing some new condition within a specified period of time. ... Guillain-Barré syndrome (GBS) (IPA pronunciation: is an acute, autoimmune, polyradiculoneuropathy affecting the peripheral nervous system, usually triggered by an acute infectious process. ...

  1. Ascending paralysis for 10–13 days
  2. Facial paralysis
  3. Bladder / bowel dysfunction for 14 days
  4. Numbness / dysesthesia
  5. Lack of meningismus
  6. Descending recovery from paralysis

Two of the eight key symptoms favored polio: Dysaesthesia (dysesthesia in American English) is a tactile hallucination. ... Meningism is the triad of nuchal rigidity, photophobia (intolerance of bright light) and headache. ...

  1. Fever
  2. Permanent paralysis

Exact disease incidences and symptom probabilities are not known. When disease incidences were artificially changed in favor of polio to values that were still somewhat realistic, six of eight key symptoms still favored Guillain-Barré syndrome. The only symptom that was somewhat sensitive to changes in symptom probabilities was fever. However, the reasonable change in the symptom probabilities caused the presence of fever to favor Guillain-Barré syndrome. Unfortunately, Roosevelt's cerebrospinal fluid was never examined. The number of leukocytes is increased and concentration of protein is usually normal in the cerebrospinal fluid of patients with polio. The converse occurs in Guillain-Barré syndrome.[2] Guillain-Barré syndrome (GBS) (IPA pronunciation: is an acute, autoimmune, polyradiculoneuropathy affecting the peripheral nervous system, usually triggered by an acute infectious process. ... Cerebrospinal fluid (CSF), Liquor cerebrospinalis, is a clear bodily fluid that occupies the subarachnoid space in the brain (the space between the skull and the cerebral cortex—more specifically, between the arachnoid and pia layers of the meninges). ... White Blood Cells is also the name of a White Stripes album. ...


The cause of Roosevelt's paralysis may never be determined with certainty. However, this one study supports a diagnosis of Guillain-Barré syndrome. Other experts are skeptical of the study's conclusion.[1][5]


Personal impact

Regardless of the cause, the result was that 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. Although the paralysis had no cure at the time, 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). Warm Springs is a city in Meriwether County, Georgia, United States. ... The Roosevelt Warm Springs Institute for Rehabilitation is a rehabilitation facility located in Warm Springs, Georgia. ...


Charitable legacy

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 Dr. Jonas Salk and others that led to the discovery of the polio vaccines. Today, the Foundation focuses on preventing premature birth, birth defects and infant mortality. The March of Dimes is a voluntary health charity founded in 1938 by United States President Franklin Delano Roosevelt as the National Foundation for Infantile Paralysis to defeat polio, a disease which crippled him. ... March of Dimes official logo March of Dimes is the name of health charities in both the United States and Canada. ... Jonas Edward Salk (October 28, 1914 – June 23, 1995) was an American biologist and physician best known for the research and development of the first effective polio vaccine (the eponymous Salk vaccine). ... Two polio vaccines are used throughout the world to combat polio. ...


Roosevelt's association with the March of Dimes led to his image being placed on the face of the American dime.[citation needed]


Public awareness of the disability

At the time, when the private lives of public figures were subject to less scrutiny than they are today, 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 from it; as a result, in films of his speeches Roosevelt can be observed using his head to make gestures, because his hands were gripping the lectern.


See also

View of the hall. ... Sunrise at Campobello is a 1960 film which tells the story of the struggle by President Franklin Delano Roosevelt against polio. ... Warm Springs is a 2005 movie about Franklin D. Roosevelts struggle with polio, his discovery of the Warm Springs spa resort and his work to turn it into a center for the aid of polio victims, and his resumption of his political career. ...

References

  1. ^ a b 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. 
  2. ^ a b c d e f g Goldman AS, Schmalstieg EJ, Freeman DH, Goldman DA, Schmalstieg FC (2003). "What was the cause of Franklin Delano Roosevelt's paralytic illness?". J Med Biogr 11 (4): 232–40. PMID 14562158. Retrieved on 2008-03-02. 
  3. ^ Gallagher, HS, FDR's Splendid Deception, New York, Dodd, Mead (1985)
  4. ^ 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. PMID 15400610. Retrieved on 2008-03-02. 
  5. ^ Lerner BH (2007). "Crafting medical history: revisiting the "definitive" account of Franklin D. Roosevelt's terminal illness". Bull Hist Med 81 (2): 386–406. PMID 17844721. Retrieved on 2008-03-02. 
2008 (MMVIII) is the current year, a leap year that started on Tuesday of the Anno Domini (or common era), in accordance to the Gregorian calendar. ... is the 61st day of the year (62nd in leap years) in the Gregorian calendar. ... 2008 (MMVIII) is the current year, a leap year that started on Tuesday of the Anno Domini (or common era), in accordance to the Gregorian calendar. ... is the 61st day of the year (62nd in leap years) in the Gregorian calendar. ... 2008 (MMVIII) is the current year, a leap year that started on Tuesday of the Anno Domini (or common era), in accordance to the Gregorian calendar. ... is the 61st day of the year (62nd in leap years) in the Gregorian calendar. ...

 
 

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