President Franklin Delano Roosevelt ended Prohibition, pulled the United States out of the Great Depression, and bolstered Allied Forces during World War II. He also suffered from paralysis, which was widely believed to have been caused by polio.
After his death, physicians argued that he actually suffered from Guillain-Barre Syndrome. It could be the most famous misdiagnosis in history.
On an early August day in 1921, a 39 year-old Roosevelt summered with his immediate family at a retreat in Canada. Roosevelt dove (or fell, depending on the account) into the Bay of Fundy while boating. Over the next two weeks, he experienced paralysis that began in his legs and extended to his chest, resulting in a lack of movement and bowel control.
This came at a pivotal point in his political career. Roosevelt would have been Vice President under James Cox if the Democrats won the 1920. But he'd retreated to private life after the Democratic ticket lost the election in a landslide.
Did FDR Have Polio?
Roosevelt visited a Boy Scout Camp two weeks before onset of his paralysis. Roosevelt's presence at this gathering played a major role in his diagnosis, because the gathering of youth provided a likely origin for the polio virus. The physician who diagnosed FDR, Robert Lovett, had an expertise in the field of polio, possibly lending additional bias to the diagnosis.
Physicians and scientists have struggled with the diagnosis of polio in the decades after Roosevelt's death, as Roosevelt's advanced age made him an unlikely candidate for the disease. Roosevelt also experienced paralysis in both legs, while polio usually affects only one side of the body. Polio does not often affect the intestinal tract, yet the events of August 9th left FDR without control of his bowels. The future president continued to experience pain and other sensations in his legs. Confounding the diagnosis, Roosevelt exhibited a fever, a key diagnostic criteria for polio.
There are notes of clinical cases of Guillain-Barre Syndrome from this time period, with two soldiers diagnosed with the disease in 1916 using samples of spinal fluid. Testing of spinal fluid for increased protein levels without a concomitant increase in white blood cell count continues to be a key factor in the diagnosis of Guillain-Barre Syndrome. Whether any of FDR's physicians knew of the then-obscure Guillain-Barre Syndrome is completely unknown.
A 2012 study published in the Journal of Medical Biography conducted a probability analysis based on Roosevelt's symptoms, with the outcome suggesting Roosevelt likely suffered from Guillain-Barre Syndrome instead of polio.
Treating Guillain-Barre Syndrome in FDR
If a physician did diagnose Roosevelt with Guillain-Barre Syndrome, his prognosis would have strayed little. Guillain-Barre Syndrome is a viral infection of the body without a specific cure. The disease causes cells to attack other cells, leading to an eventual wasting away of the myelin sheath that surrounds nerves.
Guillain-Barre is currently treated with doses of immunoglobulins in the hopes that the body's immune system will attack these foreign proteins instead of itself. Immunoglobulin therapy did not exist in Roosevelt's time, but if it did, it would have been prohibitively expensive.
Guillain-Barre is also treated through the difficult process of plasma exchange. Plasma exchange removes blood and sequesters white and red blood cells before re-introducing the cells to the body. For a short time, plasma exchange lowers the patient's blood plasma volume with the hope of removing antibodies that are causing the body to attack itself. If available, this treatment would have exposed FDR to infection at the site of blood withdrawal as well as complications involving blood clots and calcium deficiencies.
An FDR diagnosed with Guillain-Barre would have little to gain over one diagnosed with polio due to a deficit in possible treatments.
The Misdiagnosis that Saved Lives
Roosevelt did not hide his diagnosis, forming a polio rehabilitation center Georgia before running for president. He did downplay the affliction's role in his life, hiding the weakness of his legs behind sturdy podiums, relying on an aide or his son to help him remain standing at public events, and ordering a swift secret service detail to cover any shots of him in a wheelchair.
As president, Roosevelt founded the National Foundation for Infantile Paralysis in 1937, a organization headed by polio victim and Roosevelt's former law partner, Basil O'Connor. In time the National Foundation for Infantile Paralysis would become known as the March of Dimes, with donations going to fund research grants at a number of universities searching for a cure and setting the table for Jonas Salk's successful development and implementation of a vaccine against the virus in 1952.
A final verdict on whether FDR suffered from Polio or Guillain-Barre Syndrome is impossible, and will continue to be. The only method to accurately diagnose the former president with Guillain-Barre Syndrome involves testing spinal fluid. No matter the degree of scientific curiosity, we are unlikely to exhume the body of one of our greatest presidents to test for proteins that have long since degraded.
While we will never truly know if Roosevelt suffered from polio, the attention Roosevelt brought to the illness ended the most rampant cause of death and paralysis in human history, a disease dating to Ancient Egypt. Not a bad outcome for a possible misdiagnosis.
Top image from dantegeek/Flickr. Additional images by Seva Mafin/Flickr and the U.S. Army.