Franklin Delano Roosevelt Illness Campobello Island
January 20, 2012 by staff
Franklin Delano Roosevelt Illness Campobello Island, Franklin D. Roosevelt’s paralytic illness began in 1921 at age 39, when Roosevelt got a fever after exercising heavily at a vacation in Canada. While his bout with illness was well known during his terms as President of the United States, the extent of his paralysis was kept from public view. After his death, his illness and paralysis became a major part of his image. He was diagnosed with poliomyelitis two weeks after he fell ill. However, a 2003 retrospective study favored a diagnosis of Guillain-Barré syndrome.
In August 1921, at the age of 39, while vacationing at Campobello Island in Canada, Roosevelt contracted an illness characterized by fever; protracted symmetric, ascending paralysis of the upper and lower extremities; facial paralysis; bladder and bowel dysfunction; numbness; and dysesthesia. The symptoms gradually resolved except for paralysis of the lower extremities.
Roosevelt fell into the cold waters of the Bay of Fundy while boating.
Roosevelt went sailing on the Bay of Fundy with his three oldest children, put out a fire, jogged across Campobello Island, and swam in Lake Glen Severn and the Bay. Afterward, he felt tired, complained of a “slight case of lumbago”, and had chills. He retired early. Chills lasted through the night.
One leg was weak. By afternoon, it was paralyzed. That evening, the other leg began to weaken. E.H. Bennet, the local family physician, was called that evening and diagnosed a cold.
Roosevelt could not stand. He had bilateral paralysis. His legs were numb. He also had painful sensitivity to touch, general aches, and fever of 102°F. He could not pass urine. Bennet reevaluated Roosevelt and suggested a consultation with William W. Keen, an eminent physician vacationing nearby.
He was paralyzed from the chest down. On that day and following, his hands, arms, and shoulders were weak. He had difficulty moving his bowels and required enemas.
Keen diagnosed a clot of blood to the lower spinal cord, prescribed massage of the leg muscles, and predicted a gradual improvement over a period of months. Roosevelt continued to be unable to pass urine for two weeks, and required catheterization. His fever continued for six to seven days.
Roosevelt was briefly delirious. Keen reconsidered his diagnosis and now believed that the cause was possibly a lesion in the spinal cord.
On examination by physician Robert Lovett, Roosevelt’s temperature was 100°F. Both legs were paralyzed. His back muscles were weak. There was also weakness of the face and left hand. Pain in the legs and inability to urinate continued. Lovett and Bennet concluded that the diagnosis was poliomyelitis.
In mid-September, at New York City Presbyterian Hospital, there was pain in the legs, paralysis of the legs, muscle wasting in the lower lumbar area and the buttocks, weakness of the right triceps, and gross twitching of muscles of both forearms.
There was gradual recovery from facial paralysis, weakness in upper extremities and trunk, inability to urinate, inability to defecate, dysesthesia in legs, and weakness in lower back and abdomen. But he mostly remained paralyzed from the waist down, and the buttocks were weak.
The unquestioned diagnosis at the time and thereafter in countless references was paralytic poliomyelitis, which was understandable because polio was epidemic in the adjoining northeastern United States during the late nineteenth and early twentieth centuries, and because one of the foremost polio experts in the world, Dr. Lovett, made the diagnosis based on personal observations of the patient. Also, the disease struck in mid-summer, when poliomyelitis was more common. Furthermore, it has been reported that motor neurons innervating muscles vigorously exercised at the start of polio are those more likely to be paralyzed. Finally, fever usually occurs in polio.
However, Roosevelt’s age (39 years) and many features of the illness are more consistent with a diagnosis of Guillain-Barré syndrome (an autoimmune peripheral neuropathy). During the early twentieth century, almost all cases of paralytic polio were in children, and few adults over 30 years contracted the disease, having acquired immunity during childhood. Paralytic polio is rarely symmetric or ascending. The paralysis in polio usually progresses for only three to five days. In paralytic polio, the fever usually precedes the paralysis. Meningismus is common in paralytic polio. The studies suggesting a link between exercise and paralytic polio are subject to recall bias. In contrast, every neurological feature of Roosevelt’s illness was consistent with Guillain-Barré syndrome. Fever is found in some cases, and about 15% of severe cases have permanent neurological sequelae.
Roosevelt’s principal physicians during his illness, Robert Lovett and George Draper, were experts in polio. It is possible that the diagnosis of Guillain-Barré syndrome was not on their minds, since the disease was not as well known at the time. In 1916, Georges Guillain and Jean Alexandre Barré described the cerebrospinal fluid finding in two soldiers with ascending paralysis, loss of deep tendon reflexes, paraesthesia, and pain on deep palpation of large muscles.
A peer-reviewed study published in 2003, using Bayesiananlysis, found that six of eight posterior probabilities favored a diagnosis of Guillain-Barré syndrome over poliomyelitis. For the purposes of the Bayesiananlysis in the 2003 study, 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.
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