FDR’s Paralysis: A Fortuitious Misdiagnosis?

A few days ago, an antivaxxer by the name Mayer Eisenstein made a comment that FDR may have gotten Guillain-Barre Syndrome (GBS) from a reaction to a flu shot. This, I found, is simply not possible because the first influenza vaccines were not available for far more than a decade after Roosevelt fell ill. So, big fake facts out of the big fake health guru.

Nonetheless, an interesting story lies behind Eisenstein’s painfully inaccurate mutterings. Roosevelt’s diagnosis of polio was made in 1921, after a string of misdiagnoses (the first doc said it was a bad cold, the second doc first diagnosed a blood clot in spine and then a lesion). The diagnosis that ultimately stuck is polio.

Several reasons appear responsible for the original diagnosis and why it remains a popular diagnosis today. First, Roosevelt fell ill in an era when polio was rampant, and several outbreaks had occurred in previous summers, mostly in cities. It’s a virus spread by interpersonal contact, either oral-oral or oral-fecal. Children are especially vulnerable. At the time FDR fell ill, polio was one of a fairly limited number of known diseases that caused flaccid paralysis, muscular weakening with no immediately obvious cause (like traumatic nerve damage).

After bouncing, metaphorically, from physician to physician, Roosevelt was diagnosed by Boston doctor Robert W. Lovett, who Pierce A. Grace describes “the leading American authority on polio.” He immediately diagnosed polio. It was a fairly late stage in the disease by this point, and he shortly thereafter began his slow recovery. I suspect that once his initial crisis had passed, the urgency of coming up with a diagnosis may have abated, but that’s speculation on my part.

Another factor that seems to have contributed to the story found in the biographies is the fact that on July 28, 13 days before he fell ill, Roosevelt had toured and visited a Boy Scout camp for disadvantaged city youth, something that Roosevelt delighted in. Historians have speculated, and this is the story that I was familiar with, that he contracted the disease while he was at the scouting event. I haven’t seen anything to suggest that there had been polio at the camp, but someone who is infected but not yet showing symptoms can be contagious. Regardless, it’s plausible that Roosevelt contracted polio at the camp, because the incubation period of the disease is between 3 and 35 days.

Other people have looked to the immense stress that Roosevelt had recently been under. He was in the middle of an especially saucy sex and vice scandal, in which a Senate Naval Affairs committee alleged that members of a vice-squad at a naval training facility under his command (and not necessarily AT his order) were reported to have engaged in sodomy while attempting to entrap homosexuals among recruits. Stress may leave people susceptible to infection, and perhaps there was a perfect storm of stress and filthy children that led to his contracting the disease, which was, after all fairly rare in adults.

And let’s not overlook FDR’s symptoms, the major one being progressive paralysis, which at its worst extended from his chest down and was ultimately permanent in his legs, accompanied by a fever (102 degrees). Marooned in a wheelchair for much of the rest of his life, Roosevelt certainly looked like a polio survivor (though remarkably few photos of the man in his wheelchair exist).

In the years following his disease, Roosevelt became an advocate of polio research and in 1938 founded the National Foundation for Infantile Paralysis, which became known as the March of Dimes and supported the development of Jonas Salk’s vaccine. As a sort of recognition of his association with that organization (in 1946, the “March of Dimes” was the group’s annual fundraiser), the disembodied head of FDR now graces the US dime:

See?

Regardless of what condition Roosevelt suffered, his name will always be closely associated with polio.

As best I can tell, a serious challenge has been raised to the diagnosis of
polio. Now, as historical questions go, this is not as pressing an issue as, say, “Did the Holocaust happen?” but it is an interesting question, the type of point that you could possibly argue on Jeopardy if the question they accept is, “What is polio?” Hey, that could be worth money.

Anyway, in 2003 the Journal of Medical Biography published an article by Goldman, Schmalstieg, Freeman, another Goldman and yet another Schmalstieg (apparently the University of Texas was suffering from an outbreak of Goldman-Schmalstieg in 2003). The article, “What was the cause of Franklin Delano Roosevelt’s paralytic illness?” The researchers looked at 11 features of the disease reported in FDR’s medical record. Then they did something called Bayesian Analysis, which as I understand it is a retrospective analysis of probability based on a subsequently established incidence rate (in this case of disease) in a population. So, they were asking questions like, “What is the relative probability that someone FDR’s age would have contracted polio versus GBS?” and “What is the relative probability that someone with polio would have fever versus someone with GBS?” (GBS, by the way, is a condition where the immune system, which has started fighting an infection, mistakenly starts to attack parts of the nervous system. Dr. House is always ruling it out.)

By comparing the features of FDR’s disease, the Goldman-Schmalstieg-infected Freeman makes a strong case that the GBS hypothesis is worth serious consideration (from Goldman):

Click to embiggen!

It really does seem as if most of FDR’s symptoms are most commonly associated with GBS. This is not, however, conclusive diagnostically. At the same time, it seems to me that a good Bayesian analysis would need to accurately determine the prevalence of the diseases and symptoms at the time, and I have no way of assessing that and still maintain a blog. The only way to do be sure of what Roosevelt had would be to tap his spine. Modern interventions gor GBS had not yet been developed, and the authors conclude that it is unlikely his treatment would have changed if FDR had a different diagnosis.

The nearly complete elimination of polio from the planet is a powerful testimony to the efficacy of vaccination, and one may wonder how the course of history might have been altered if Roosevelt’s intense interest in polio research had been redirected toward autoimmune disorder research. Whether he had it or not, FDR will always be closely associated with polio and the search for the cure.

RJB

References

Goldman, Armond, et al. “What Was the Cause of Franklin Delano Roosevelt’s Paralytic Illness?” Journal of Medical Biography 11.4 (2003): 232-240.

Grace, Pierce A. “With Reluctant Feet–The Story of FDR’s Struggle with Polio.” Journal of the Irish Colleges of Physicians and Surgeons 21.1 (1997): 58-61.

8 Responses to FDR’s Paralysis: A Fortuitious Misdiagnosis?

  1. Jeff says:

    Dr. House is always ruling it out.

    You should ask House. He’s nearly always right – and he figures it out in under an hour.

    Bob, btw – does it bother you that he’s now, as Candace Bergen put it last week, “schtupping” Cuddy? You have a thing for her, as I recall.

  2. Bob says:

    Yeah, but House gets it wrong at least once every 12 minutes, often badly wrong. And always before a commercial…hm….

    I think it is a bad idea for House to get it on with Cuddy. That was one of the few interesting relationships in the series. (The other one was Chase and his hair, but they cut that one too! Heheh.)

    I’ll live, if only vicariously through Hugh Laurie. :)

    • Jeff says:

      Yeah, but House gets it wrong at least once every 12 minutes, often badly wrong.

      Yes, but only because “everyone lies”!

    • Pacal says:

      Tried watching House a couple of times. Was not impressed. So Hugh Laurie can act like a mega douchebag asshole. So what. Still preferred him as the super stupid / waste of space Prince in Blackadder 3.

  3. Bob says:

    But a megadouchebag asshole with a limp and snazzy American accent. He was best as Bertie in Jeeves and Wooster–awesome series.

  4. [...] was reading Skeptical Humanities at the time, Baysian analysis appeared in our examination of whether FDR had polio or an autoimmune condition. By looking at the frequencies of different symptoms in known polio cases, researchers were able to [...]

  5. MinorityView says:

    Recent biography of Roosevelt spotted something interesting. Two of his children had a minor illness at the time, a bit of fever and stuff. Polio appears as a mild sickness occasionally, most of the time there are no symptoms at all. Actual paralytic polio appears at a rate of between 1 in 200 and 1 in 1000 cases. So it seems likely that he did have polio. The question is why his case became paralytic.

    There are various clues to things that provoke paralytic polio. One is injections but that definitely doesn’t fit with this case. Exposure to toxins plays a role sometimes. Further research as to what Roosevelt ate or where he went in the days before he became ill might provide clues.

    Interesting blog, thanks!

    For info on the split between paralytic polio, mildly symptomatic polio and invisible polio see the CDC Pink Book.

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