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?
Appendix A. Bayesian Analysis Explained
Appendix B. Overall Bayesian Probabilities
Appendix C. Pathogenesis Example
Appendix D. Letters and Telegrams
Appendix E. Dr. Levine’s "Unpublished Note"
References
Glossary
Index
EHDP Press