Franklin D. Roosevelt's paralytic illness

Rare photograph of FDR in a wheelchair, with Ruthie Bie and Fala, taken by his cousin Margaret Suckley (February 1941)

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 diagnosis of FDR's illness favored Guillain–Barré syndrome rather than polio, a conclusion criticized by other researchers.

History

The Roosevelt family at Campobello (1920)
Roosevelt supporting himself on crutches at Springwood in Hyde Park, New York, with visitors including Al Smith (August 7, 1924)
FDR and Eleanor Roosevelt at Hyde Park (September 16, 1927)
FDR at Warm Springs (1928)
FDR in his wheelchair aboard Vincent Astor's yacht, the Nourmahal (April 1935)
FDR in his wheelchair with a group assembling on the terrace of Springwood, before a Hudson River cruise on the USS Potomac (September 12, 1937)

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. 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. 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[1]:247–248 in mid-July.[2]: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.[2]:40–42

Roosevelt spent a day talking business with Howe.[1]:248 Then, on August 10, he spent a day of strenuous activity with his family.[2]: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.[3][4]:232

Timeline

July 28

July 29

August 5–8

August 9

August 10

August 11

August 12

August 13

August 14

August 15

August 17

August 19

August 20

August 22

August 23

August 24

August 25

September 1

September 14

September 15

October 28

Later

Personal impact

FDR at Warm Springs (1929)

Roosevelt was totally and permanently paralyzed from the waist down, and unable to stand or walk without support.[17] 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.[18] 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.[11]: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.[11]: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.[11]: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."[11]: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.[11]:257 It is now the Roosevelt Warm Springs Institute for Rehabilitation, a comprehensive rehabilitation facility operated by the state of Georgia.[19]

Before his paralysis Roosevelt had weighed 170 pounds, thin for a man 6'2" tall,[20]:220 and had suffered many illnesses.[20]:219 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.[20]:241, 266–267

Public awareness

FDR used crutches when nominating Al Smith at the 1924 Democratic National Convention, the speech that marked his return to public life (June 26, 1924)
"No movies of me getting out of the machine, boys": FDR exiting a car during a campaign trip to Hollywood, California (September 24, 1932)
Photograph by Margaret Suckley showing FDR walking with assistance toward the dedication ceremony for the home of Woodrow Wilson (May 4, 1941)

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.[11]:264 FDR's walk was slow and seemingly natural,[18] but the endeavor was always risky since he could easily fall.[11]: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.[21] 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.[20]: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.[20]:36 "I hope that you will pardon me for this unusual posture of sitting down," FDR 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."[22]

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. Journalist John Gunther reported that in the 1930s he often met people in Europe, including world leaders, who were unaware of FDR's paralysis.[20]: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."[23]

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.[17][24][25]

Legacy

FDR accepts a $1 million check, the proceeds of the first national President's Birthday Ball to benefit the work of the Georgia Warm Springs Foundation (1934)
FDR with Basil O'Connor (1944)

On January 3, 1938, Roosevelt founded the National Foundation for Infantile Paralysis, now known as the March of Dimes.[26] Reconstituted from the Georgia Warm Springs Foundation he founded in 1927,[27] 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.[26] 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.[26]

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.[28][29][30]

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.[19] 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.[31][32]

Retrospective diagnosis

A 2003 peer-reviewed study of Roosevelt's paralytic illness, using Bayesian analysis, found that six of eight posterior probabilities favored a diagnosis of Guillain–Barré syndrome over poliomyelitis.[3] 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.[4]:235

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.[4]:236–237

Several aspects are in discordance with this retrospective diagnosis. 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.[33] FDR likely would have been especially vulnerable to polio since he was raised on an isolated family estate[18] and had little contact with other children until he entered Groton at age 14. Thereafter he suffered from a succession of illnesses suggesting a weak immune system.[34]:38–40

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.[4]:236[25][35] 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."[34] 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.[34]

"In any event, there was no cure for either disease in 1921," wrote biographer Jonathan Alter,[36] and the study concluded that Roosevelt's medical treatment would have been the same.[4]:238

See also

References

  1. 1 2 3 4 Collier, Peter; Horowitz, David (1994). The Roosevelts: An American Saga. New York: Simon & Schuster. ISBN 0671652257.
  2. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 Tobin, James (2014). The Man He Became: How FDR Defied Polio to Win the Presidency. Simon & Schuster. ISBN 0743265165.
  3. 1 2 "What was the Cause of Franklin Delano Roosevelt's Paralytic Illness? (abstract)". Journal of Medical Biography. Sage Publications. Retrieved 2015-10-15.
  4. 1 2 3 4 5 6 7 8 9 10 11 12 Goldman, Armond S.; Schmalstieg, Elisabeth J.; Freeman, Daniel H., Jr.; Goldman, Daniel A.; Schmalstieg, Frank C., Jr. (November 2003). "What was the cause of Franklin Delano Roosevelt's paralytic illness?" (PDF). Journal of Medical Biography 11 (4): 232–240. PMID 14562158. Retrieved 2012-02-27.
  5. ↑ "History of Polio". The History of Vaccines. College of Physicians of Philadelphia. Retrieved 2015-10-03.
  6. ↑ "Find Infantile Paralysis; Three Cases Develop in Paterson". The New York Times. July 26, 1921. Retrieved 2015-10-03.
  7. ↑ "Infantile Paralysis is Spreading Up State". The New York Times. August 23, 1921. Retrieved 2015-10-03.
  8. ↑ "Infantile Paralysis Toll". The New York Times. September 10, 1921. Retrieved 2015-10-03.
  9. ↑ "Infantile Paralysis Cases Increasing". The New York Times. September 25, 1921. Retrieved 2015-10-03.
  10. 1 2 Cook, Blanche Wiesen (1992). Eleanor Roosevelt, Volume One 1884–1933. New York: Viking. ISBN 0-670-80486-X.
  11. 1 2 3 4 5 6 7 8 9 10 11 12 Ward, Geoffrey C.; Burns, Ken (2014). The Roosevelts: An Intimate History. New York: Alfred A. Knopf. ISBN 9780307700230.
  12. ↑ Wojtas, Joe (June 17, 2001). "Mystic Seaport to Display F.D.R.'s Sailboat". The New York Times. Retrieved 2015-09-26.
  13. 1 2 3 4 5 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.
  14. ↑ "Aiding Crippled Children; Harvard Infantile Paralysis Commission Soliciting Funds". The New York Times. September 14, 1921. Retrieved 2015-10-03.
  15. ↑ "Roosevelt Taken to New York Home". The Boston Daily Globe. September 15, 1921. Eastport, Me, Sept. 14 — Confined to a cot, too weak to sit up, and accompanied by a trained nurse, Franklin D. Roosevelt, ex-Assistant Secretary of the Navy, today was placed aboard a special car here …
  16. 1 2 "F. D. Roosevelt Ill of Poliomyelitis". The New York Times. September 16, 1921. Retrieved 2015-09-24.
  17. 1 2 Pressman, Matthew (July 12, 2013). "The Myth of FDR's Secret Disability". Time. Retrieved Aug 12, 2013.
  18. 1 2 3 "Roosevelt's Polio Wasn't A Secret: He Used It To His 'Advantage'". Fresh Air. NPR. November 25, 2013. Retrieved 2015-09-25.
  19. 1 2 "Roosevelt Warm Springs". Georgia Vocational Rehabilitation Agency. Retrieved 2015-09-28.
  20. 1 2 3 4 5 6 Gunther, John (1950). Roosevelt in Retrospect. New York: Harper & Brothers. OCLC 466356.
  21. ↑ "Grand Central Terminal, Waldorf-Astoria platform".
  22. ↑ "Address to Congress on Yalta (March 1, 1945)". Mar 1, 1945. Retrieved Aug 12, 2013.
  23. ↑ Churchill, Winston 1950, The Grand Alliance, p.663
  24. ↑ "THE PRESIDENCY: New Quarters". Time. December 17, 1934.
  25. 1 2 Goldberg, Richard T. (1981). The Making of Franklin D. Roosevelt: Triumph Over Disability. Cambridge, Massachusetts: Abt Books. ISBN 9780890115640.
  26. 1 2 3 Baghdady, Maddock J. (Spring 2008). "Marching to a Different Mission" (PDF). Stanford Social Innovation Review: 60–65. Retrieved 2015-09-25.
  27. ↑ Whitman, Alden (March 10, 1972). "Basil O'Connor, Polio Crusader, Dies". The New York Times. Retrieved 2015-09-26.
  28. ↑ Barrett, William P. "March of Dimes' Second Act". Forbes, November 19, 2008.
  29. ↑ "Circulating Coins - Dime". United States Mint. Retrieved 2008-10-11.
  30. ↑ 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.
  31. ↑ McKenna, M.A.J. (April 12, 2005). "Reflections on Warm Springs". The Atlanta Journal-Constitution.
  32. ↑ Wilkinson, Jack (October 8, 2006). "Warm Springs artisans fought polio's damage". The Atlanta Journal-Constitution.
  33. ↑ Horstmann DM (1950). "Acute poliomyelitis relation of physical activity at the time of onset to the course of the disease". Journal of the American Medical Association 142 (4): 236–241. doi:10.1001/jama.1950.02910220016004. PMID 15400610.
  34. 1 2 3 Tobin, James (2014). The Man He Became: How FDR Defied Polio to Win the Presidency. Simon & Schuster. pp. 327–328 n. 69. ISBN 0743265165.
  35. ↑ Goldberg, Richard T. (1985). "Polio". In Graham, Otis L.; Wander, Meghan R. Franklin D. Roosevelt: His Life and Times. Boston: G. K. Hall. ISBN 9780816186679.
  36. ↑ Alter, Jonathan (2007). The Defining Moment: FDR's Hundred Days and the Triumph of Hope. New York: Simon & Schuster. p. 355. ISBN 9780743246019.
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