Launched in 1938, the March of Dimes campaign brought in $233 million for all aspects of polio patient care. Dime by dime, Jonas Salk and Albert Sabin were funded to develop their vaccines that have all but put an end to polio.
A disease that spreads like the flu and can cause profound paralysis, an inoculation against polio was bound to happen eventually. But it’s hard to deny that the effort was fast-tracked largely because of Franklin Delano Roosevelt’s dance with grey marrow inflammation.
But- and hear me out- what if FDR never actually had polio?
Today’s Moment of Science… Will Guillain and Barré please explain themselves?
Back before we all became certified brain swab technicians for the latest pandemic, how did we differentiate between pneumonia or super fucking terrifying novel pneumonia? When the disease wasn’t well understood and tests weren’t widely available, doctors did their best. Diagnoses were based on clinical presentation and a dash of guesswork. Which almost definitely misdiagnosed idk like four people.
Disease presentation can vary from person to person, and symptoms overlap between plenty of ailments. For most people in otherwise good health in non-plague times, an exact diagnosis is unnecessary from the established plume of mostly harmless rhinoviruses, coronaviruses, enteroviruses, and adenoviruses, aka common colds. At least for now, the same medications are used to manage the symptoms for all of them, and there’s no cure other than time.
I told you that story to tell you this story.
In 1921 when FDR came down with an acute case of ‘these legs don’t work for shit,’ there weren’t many well understood causes to pin a diagnosis on. Cases that looked like this were mostly diagnosed as polio in the US. But in a French hospital in 1916, doctors found another horrifying way humans can break.
So, Guillain-Barré syndrome (GBS).
When French physician Jean-Baptiste Landry discovered and wrote about this acute ascending paralysis, he suffered from doing so in 1859 when we weren’t great at running diagnostic tests. Nearly seventy years later, Georges Guillain and Jean Alexandre Barré were able to diagnose the disorder both by clinical observation and testing for specific abnormalities in the spinal fluid.
An immune system tantrum on the peripheral nervous system, the cause varies case by case. In a majority of patients, GBS starts with an infection. Weakness that’s sometimes accompanied by tingling and pain begins in the hands and/or feet, then ascends on up towards more vital bits. These symptoms worsen over time, taking up to a month to hit maximum levels of ‘what god did I displease?’
While most make a full recovery, the acute phase of the disease can be ugly. Only ⅓ of GBS patients never lose the ability to walk, but about 80% regain it after six months. Half of patients have some bilateral facial weakness. Around 25% of patients develop respiratory failure that requires artificial ventilation at some point. A severe type of the disorder involving brainstem encephalitis can cause a coma. 7.5% of all Guillain-Barre syndrome cases are fatal. For comparison, it’s estimated that 75-95% of polio cases are asymptomatic; 1% of cases involves paralysis, and about 5% of paralytic cases are fatal.
(Covid is deadlier than polio, and you should probably vaccinate for both).
“Ms. Auntie SciBabe,” I hear one impatient reader beg, “what does this all have to do with FDR and his obvious case of polio?”
FDR’s illness started on August 9th of 1921, and by the 12th his legs were paralyzed while both being numb and in extreme pain. The next day, the paralysis had claimed his chest, and his arms were growing weak. Roosevelt was in agony from the mere weight of his clothes. He grew to experience facial muscle weakness. While pain and weakness started in his left hand by the 25th, it soon climbed both forearms. His bladder was paralyzed, his muscles in his lower back were wasting away, and by October he wasn’t getting worse but it didn’t seem like he was getting better.
With a lack of widely available testing, he was diagnosed with polio based on clinical presentation and a time-honored dash of guesswork.
But was it polio or was it Guillain-Barré syndrome? Because the latter only existed in name five years before FDR’s illness, which perhaps wasn’t enough time for every doctor to sort out the difference with 1920s internet.
A 2003 analysis suggests it’s much more likely the illness Roosevelt recovered from was Guillain-Barré. With polio, paralytic symptoms set in entirely over the course of just a few days, and no established therapy exists to bring back what was lost to a significant degree. In FDR’s illness, the ascending symmetrical paralysis that developed over the course of weeks is all but never seen in polio. His recovery from paralysis was descending from the top down to the tuchus, which is unheard of in polio but a common pattern in GBS. The facial paralysis along with bladder and bowel dysfunction were also much more indicative of GBS. Though some symptoms were a bit more likely to happen with polio (fever and permanent paralysis), they’re not unheard of with GBS. And though I was doubtful before I read up on it, to me the case is solid that he had GBS.
Is it a problem that he got a ton of people to mail in dimes for research to end polio based on his (likely) misdiagnosis? If a problem exists here, I can’t seem to find it.
Would a correct diagnosis have made a difference at the time? Not really. Much like the many common colds, there were no effective treatments for polio or GBS, and what they tried wasn’t dangerous. He got the best medicine had to offer when the fever receded. Though he remained without the use of his legs, he had quite the remarkable recovery, and one that looks a lot more like GBS with the advantage of time.
Then he became president, single handedly ended the depression, cured polio, and won WWII. So I guess it worked out.
This has been your Moment of Science, reminding you that your doctors have the internet, so you should demand a proper diagnosis in this, the year of our lord and savior, John Waters.
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