FDR May Not Have Had Polio, Study Says

The paralysis that struck Franklin Delano Roosevelt (FDR) in 1921 probably was not caused by poliomyelitis, as has been universally assumed by physicians and historians, according to a study to be published Nov. 1 in the Journal of Medical Biography, published by Royal Society of Medicine Press. According to evidence presented in the journal by medical researchers from the University of Texas Medical Branch (UTMB) in Galveston, the most likely cause of FDR's paralysis was Guillain-Barré syndrome.

The researchers acknowledge that Roosevelt's vigorous exercise preceding the illness, fever during the initial phase of the disease, and permanent paralysis were consistent with a diagnosis of poliomyelitis. However, many other features "were inconsistent with paralytic poliomyelitis that affects motor neurons but were typical of Guillain-Barré syndrome, an autoimmune disease that damages sensory and motor nerves," said Dr. Armond S. Goldman, an emeritus professor in the Department of Pediatrics at UTMB who has treated patients with both illnesses.

The features that were typical of Guillain-Barré syndrome included FDR's age at the onset of the disease (39 years), the near symmetry and ascending nature of the paralysis, his facial paralysis early in the course of the disease, the duration of the progression of the paralysis, the numbness, extreme prolonged pain, bladder and bowel dysfunction, and the descending pattern of recovery from his paralysis. Whereas patients with mild to moderate Guillain-Barré syndrome usually recover entirely, those with severe disease who are not treated by modern methods often experience permanent paralysis, the authors noted.

The diagnosis of Guillain-Barré syndrome was supported by a statistical analysis that took into account the frequency of paralytic poliomyelitis and Guillain-Barré syndrome in adults of Roosevelt's age in 1921 and the likelihood of his symptoms occurring in either of the two diseases. Six of eight probabilities in the analysis favored the diagnosis of Guillain-Barré syndrome, whereas only two (fever and permanent paralysis) favored poliomyelitis.

Although Guillain-Barré syndrome is the most likely diagnosis, Dr. Goldman noted that "no one can be absolutely sure of the cause of Roosevelt's paralysis because relevant laboratory diagnostic studies were not performed or were not available at the time of his illness." In that respect, an examination of his cerebrospinal fluid would have aided in determining whether the diagnosis was poliomyelitis or Guillain-Barré syndrome. Furthermore, even if Guillain-Barré syndrome had been diagnosed in 1921, Goldman said Roosevelt's outcome would have been the same because treatment for that disease was not discovered until the latter part of the 20th century.

Despite his residual paralysis, Roosevelt became the 32nd President of the United States, a leader of the Allies during the Second World War and an architect of the United Nations. He also helped to create a philanthropic organization called the National Foundation for Infantile Paralysis, popularly known as the March of Dimes. The Foundation strongly supported the rehabilitation of victims of paralytic poliomyelitis and the development of vaccines that prevent poliovirus infections, one of the major achievements of 20th century medicine.

In addition to Armond Goldman, the investigators were Drs. Frank C. Schmalstieg, Elisabeth J. Schmalstieg, Daniel H. Freeman and Daniel A. Goldman.

Note: Advance copies of the article, "What was the cause of Franklin Delano Roosevelt's paralytic illness?" from the Journal of Medical Biography, 2003; 11:232-240 are available from UTMB Public Affairs, embargoed for release until 7 p.m. Oct. 30, U.S. Central Standard Time. Following the embargo, copies of the article will be available at the web site for the Royal Society of Medicine Press:(http://www.rsmpress.co.uk/jmb.htm)