What was the Cause of Franklin Delano Roosevelt's Paralytic Illness?

Abstract

In 1921, when he was 39 years of age, Franklin Delano Roosevelt contracted an illness characterized by: fever; protracted symmetric, ascending paralysis; facial paralysis; bladder and bowel dysfunction; numbness; and dysaesthesia. The symptoms gradually resolved except for paralysis of the lower extremities. The diagnosis at the onset of the illness and thereafter was paralytic poliomyelitis. Yet his age and many features of the illness are more consistent with a diagnosis of Guillain-Barré syndrome, an autoimmune polyneuritis. The likelihoods (posterior probabilities) of poliomyelitis and Guillain-Barré syndrome were investigated by Bayesian analysis. Posterior probabilities were calculated by multiplying the prior probability (disease incidence in Roosevelt's age group) by the symptom probability (likelihood of a symptom occurring in a disease). Six of eight posterior probabilities strongly favoured Guillain-Barré syndrome.

Franklin Delano Roosevelt: The Diagnosis of Poliomyelitis Revisited

“…Reprinted from Goldman AS, Schmalstieg EJ, Freeman DH Jr, Goldman DA, Schmalstieg FC Jr, Journal of Medical Biography (114/4), pp. 232‐240 [5], copyright © 2003, with permission from SAGE Publications, Ltd.…”

“…Of 11 clinical features listed in Table 3 [5], only 2 (fever and permanent paralysis) are listed as favoring polio. Many of the remaining 9 features are flawed, such as listing FDR's progression of paralysis at 10‐13 days.…”

“…Two papers authored by physicians in recent years have reported on FDR's immediate onset of paralysis, diagnostic considerations, and his progress through rehabilitation [5,17]. One of the papers questions the diagnosis of poliomyelitis and offers a rationale for the diagnosis of GBS based on a statistical interpretation of some of his symptoms and physical findings reported in letters and medical records [5]. That same paper states that “other etiologies of flaccid paralysis …were unknown,” despite referencing Landry's ascending paralysis as being mentioned in Lovett's 1916 textbook on poliomyelitis [5].…”

“…One of the papers questions the diagnosis of poliomyelitis and offers a rationale for the diagnosis of GBS based on a statistical interpretation of some of his symptoms and physical findings reported in letters and medical records [5]. That same paper states that “other etiologies of flaccid paralysis …were unknown,” despite referencing Landry's ascending paralysis as being mentioned in Lovett's 1916 textbook on poliomyelitis [5]. An extensive literature describing the signs and symptoms of acute ascending paralysis dates from at least 1859, the year Landry published his detailed report of an afflicted individual [18].…”

“…The existence of Landry's ascending paralysis (later to be labeled as GBS) certainly was known to expert physicians such as Lovett and Draper. The conclusions of that same paper questioning FDR's diagnosis of polio [5] have been reported in considerable detail in lay citations [6,8,9]. Although an effort to reexamine the evidence by calculation of probabilities based on interpretation of findings from letters and lay publications is interesting, it does not substitute for the accurate description and analysis by FDR's clinicians, who observed his illness firsthand and were preeminent experts in the disease.…”