XVI: Mythbust Monday — The President’s Paralysis

Franklin Delano Roosevelt, the 32nd President of the United States, is famous for a whole lot of things, including being the only president to serve more than two terms and hiding the fact that he was paralyzed from the waist down so well that much of the American public never knew he was paralyzed until after he died during his 13th year in office. Today, every 3rd grader knows that FDR was paralyzed by polio, a disease which he contracted at the age of 39.

Now I know what you’re thinking. The age of 39? Isn’t polio a childhood illness?

That’s why I call it “Mythbust Monday.” Was it polio that paralyzed FDR? Or was it a far rarer illness — Guillain-Barre syndrome?

To start, paralytic poliomyelitis, or polio, as it’s known, is a disease caused by the highly contagious poliovirus, most commonly contracted through contact with contaminated food or water. Children are extremely susceptible. Once you’ve been exposed to the poliovirus, you can’t get polio again, but back in 1921, the odds of surviving an encounter with poliovirus unscathed were extremely slim.

In the most common form of polio, called spinal polio (which makes up 97% of polio cases), the virus infects the neurons of the spine or the spinal grey matter, both of which are responsible for muscle movement. This causes a limb (or in rare cases, multiple limbs) to weaken, atrophy, and eventually become completely paralyzed. This takes two to four days, and is almost always accompanied by fever and severe pain. It is almost always asymmetrical, affecting one side of the body but not the other. The lasting symptoms include lack of sensation, muscle atrophy, limb paralysis, and lack of tendon reflexes.

So what were FDR’s symptoms?

On August 10, 1921, Franklin Roosevelt began to complain of chills and slight back pain after falling off a sailboat while vacationing in an area where no cases of polio had been reported. By the evening of August 11, both of his legs were weak and mostly paralyzed. The next day, his legs were completely numb and paralyzed, and he experienced  dysesthetic pain upon being touched and a raging fever, as well as muscle pain. He had also lost control of his bladder and bowels. As the days continued, the paralysis moved its way up Roosevelt’s body until he was entirely paralyzed, and his fever persisted. On August 25, more than two weeks after the start of his symptoms, still paralyzed in the face, arms, chest, and legs and burning with fever, he was diagnosed with polio. After that, Roosevelt’s condition began to improve, and by mid-September of 1921, he recovered from the fever and upper body paralysis, and was left only with pain and paralysis in both legs and slight muscle atrophy in the lower back.

Doesn’t quite match up with polio, does it?

Now let’s see how it fits with Guillain-Barre syndrome.

First identified only five years before FDR became paralyzed, Guillain-Barre syndrome (also known incorrectly as French polio) is an autoimmune disease caused by an infection which prompts the individual’s immune system to accidentally target its own nerve cells instead of the foreign pathogens. It begins with symmetrical weakness of the lower limbs which gradually spreads up the body over a period of days. Paralysis occurs in the legs, face, and arms, sometimes accompanied by dysesthetic (strange, inappropriate, or causeless) pain and deep muscle pain. In severe cases, bladder dysfunction can occur. If untreated, Guillain-Barre syndrome can leave patients severely disabled, although this disability tends more toward muscle weakness than paralysis.

Those symptoms sound pretty familiar.

While it’s almost certain that the polio diagnosis was incorrect, there are two things that don’t fit the GBS diagnosis: the fever and the permanent paralysis. Neither of those is a symptom of Guillain-Barre syndrome. But that doesn’t mean FDR absolutely didn’t have GBS. It’s possible his case, severe enough to cause loss of bladder control, was also severe enough to allow another disease to enter his system. It’s quite plausible that he was suffering from both Guillain-Barre syndrome and another illness simultaneously, and the severe hit to his immune system made him less able to recover, resulting in the paralysis.

But Katie, you ask, did FDR have GBS or not? Is this myth busted?

The truth is, we will probably never know. The only way to confirm a diagnosis would be if we had a sample of Roosevelt’s spinal fluid collected during those infamous weeks in the summer of 1921.

But no matter what caused his paralysis, FDR overcame his handicap and went on to be one of the greatest and most beloved presidents in American history, and to this day, he remains a symbol of true American grit.

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