Prisoners of Time
The Misdiagnosis of FDR’s 1921 Illness, and Why it Matters
by Armond S. Goldman, MD
with Daniel A. Goldman, MD, MPH
Table of Contents
List of Portraits
List of Figures
List of Tables
Foreword
Acknowledgments
Most Important People in This Story
Timeline of Main Events in FDR’s Illness
Chapter 1. Prologue
Re-examination of FDR’s 1921 Illness in 2000 Publication of the Investigation and Its Impact (2003) Reactions to the Publication Why This Book Was Written
Chapter 2. Prelude to the Illness
FDR’s Childhood and Early Adulthood FDR’s Political Career Begins (1910) Election to New York Senate - “Typhoid Fever” Assistant Secretary of the Navy (1913) Acute Abdominal Illness (1915) United States Enters World War I (1917) FDR in Europe during World War I (1918) FDR Contracts Influenza (1918) Near End of FDR’s Marriage (1918) Mission to Europe - Tonsillectomy (1919) Vice Presidential Campaign (1920)
Chapter 3. Campobello Island
Environment of the Island Journey to Campobello - Summer of 1921
Chapter 4. Acute Neurological Illness
Onset (August 10, 1921) Dr. Eben Bennet’s Examination and Diagnosis Dr. William Keen’s Examination and Diagnosis The Illness Worsens Fears for the Family Dr. Samuel A. Levine’s Role in the Diagnosis of Polio Dr. Robert W. Lovett Diagnoses Paralytic Polio Further Progression of the Illness Regression to an Infantile State Dangers of Bladder Catheterizations Possible Nutritional Deficiencies Eleanor’s Nursing Care Fears for the Roosevelt Family during August 1921 Plans to Transfer FDR to a New York Hospital
Chapter 5. Hospitalization in New York
Transfer to New York City-Presbyterian Hospital Draper’s Assessment Letter to Lovett (September 24) Post-Hospitalization – Partial Recovery (10/21 - 1/22)
Chapter 6. Rehabilitation
Decision to Rehabilitate and Reenter Politics Efforts to Rehabilitate (1922) Long Stay at Warm Springs (1924) Development of Warm Springs Institute (1925)
Chapter 7. Return to Public Life
Governor of New York (1928) Health Assessment before First Presidential Run (1931) Elected President Four Times (1932-1945)
Chapter 8. Polio: Mid 19th to Early 20th Century
Polio Epidemics Emerge In the Nineteenth Century Experimental Transmission of Poliomyelitis (1908) Simon Flexner Confirms Landsteiner’s Discovery (1908) What Happened After Those Discoveries Tragic 1916 Epidemic of Paralytic Poliomyelitis What Was Known About Poliomyelitis in 1921 Seasonal Occurrence of Poliomyelitis
Chapter 9. The Diagnosis of Polio Persisted
Expertise of FDR’s Physicians No Neurological Consultation in FDR’s Case Fears of Paralytic Poliomyelitis Development of Poliovirus Vaccines Unsuccessful First Efforts to Develop a Vaccine (1936) Discovery of How Poliovirus is Transmitted (1941) Polioviruses Cultured In Vitro (1948) Salk’s Killed Poliovirus Vaccine (Early 1950s) Preparations for Clinical Trials of Salk’s Vaccine Field Trials of Salk’s Poliovirus Vaccine (1954) Approval and Widespread Use of Salk’s Vaccine (1955) Salk Vaccines Contain Live Virus - Remedial Measures Success of Revised Killed Poliovirus Vaccine First Live Attenuated Poliovirus Vaccine Sabin’s Live Attenuated Poliovirus Vaccine Public Reminders of FDR’s Poliomyelitis Famous People with Poliomyelitis Sunrise at Campobello “The Waltons - The Easter Story” “American Experience - The Polio Crusade” The Roosevelts. An Intimate History
Chapter 10. Cause of FDR’s Illness Questioned
Discovery at Windy Hill What to Do With the Discovery Plans to Reappraise FDR’s 1921 Neurological Illness
Chapter 11. Diagnostic Methods
Art and Science of Medical Diagnosis Pattern Recognition Bayesian Analysis Reconstruction of the Pathogenesis
Chapter 12. Unlikely Causes of FDR’s Illness
Coxsackie infection Rabies Viral encephalitis Botulism Tetanus Other Toxins Other Neurological Diseases Poliomyelitis and Guillain-Barré Syndrome Most Likely
Chapter 13. Was It Paralytic Poliomyelitis?
Prior Exposure to Poliomyelitis Vigorous Exercise and Paralytic Poliomyelitis Prior Tonsillectomy and Bulbar Poliomyelitis Fever and Permanent Paralysis in Paralytic Polio Improbability of Paralytic Poliomyelitis
Chapter 14. Was It Guillain-Barré Syndrome?
Discovery of Guillain-Barré Syndrome Octave Landry (1859) Louis Duménil (1864) Ernst von Leyden (1879) Georges Guillain, Jean Alexandre Barré, André Strohl (1916) Pattern Recognition Favors Guillain-Barré Syndrome
Chapter 15. Bayesian Analysis of Clinical Data
Prior Probability of Guillain-Barré Syndrome Prior Probability of Paralytic Poliomyelitis Bayesian Analysis Greatly Favors GBS
Chapter 16. Pathogenesis of FDR’s Illness
Poliomyelitis Initial Infection and Multiplication Systemic Spread of Polioviruses Uptake and Transport by Motor Nerve Axons Paralytic Poliomyelitis Inconsistent with FDR’s Illness Guillain-Barré Syndrome Role of Prior Infections in GBS Experimental Animal Model of Guillain-Barré Syndrome Inadvertent Creation of GBS by Treatment with Gangliosides Swine Flu Vaccine Triggers Guillain-Barré Syndrome Possible Association of GBS with Zika Virus Autoantibodies Interfere with Nerve Function and Repair Features of Main Inciting Agent - Campylobacter jejuni Epidemics of Guillain-Barré Syndrome in Children Principal Immunogens in Pathogenic Campylobacter Possible Past Campylobacter jejuni Infections in FDR Other Autoimmune Neuropathies FDR’s Illness Most Consistent with GBS
Chapter 17. Was FDR Close to Death in 1921?
Potential Respiratory Failure Lack of Artificial Respiratory Assistance Lack of Other Supportive Measures Other Potential Health Threats Eleanor Saved FDR’s Life
Chapter 18. Could FDR’s Outcome Have Been Improved?
Current Medical Management of GBS Immunotherapy of Guillain-Barré Syndrome Rehabilitation of Patients with GBS
Chapter 19. Other Famous People with GBS
Dr. Harvey Williams Cushing Military Service in World War I Cushing’s Neurological Illness (1918) Analysis of Cushing’s Illness Attendance at Meeting With George Guillain (11-11-1918) What Might Have Been Joseph Heller Heller’s Neuropathy Life in Intensive Care Rehabilitation Insights from the Cushing and Heller Cases
Chapter 20. Responses to Critics of GBS Diagnosis
Historian David Oshinksy (2005) Historian Susan Richards Shreve (2007) Historian Jean Edward Smith (2007) Physicians Gareth Parry and Joel Steinberg (2008) Physician Zachary Friedenberg (2009) Physician Stephen Lomazow (2010) Historian James Tobin (2013) Physicians Ditunno, Becker, and Herbison (2016)
Chapter 21. Confirmation Bias
Recognition of Confirmation Bias N-Rays Confirmation Bias in Medical Practice Possible Confirmation Bias in FDR’s Case Escalation of Confirmation Bias in FDR’s Case
Chapter 22. Epilogue
Beliefs Subject to Change A Cautionary Tale Irony of the Misdiagnosis Prisoners of Time What If FDR Had Died? Why it Matters Last Words?