Doctors

Watching the HBO movie Warm Springs, we see Kenneth Branagh, after a long day of impersonating Franklin Roosevelt, run up to the house. But he is not quite as strong as he appears, and cannot hold on to his mail, which he drops on the porch. By the next scene, we find him as Roosevelt lying in bed, and he is having trouble moving his limbs. Later, he falls out of bed. Before a long a doctor examines him, and makes his diagnosis of polio.

That’s the abbreviated version for a movie whose real story is how Roosevelt dealt with his disease, how it humanized him, how the people around him helped him, and ultimately how he did not allow the disease to stop his political career. He’s one of my heroes, and I think our country was lucky as hell to have him.

But that abbreviated version does not tell the whole story. I happened to have bought around the same time the1134 page tome on Roosevelt’s life written by that villain, Conrad Black. I think it’s fair to use a biography that is so outsized as a reference book, so I repaired to chapter 4, to find out what really happened.[1]

A Heavy Cold

And it seems that on the 10th of August 1921, Franklin Roosevelt did come back from very vigorous exercise, and did read his mail, and an hour later he skipped dinner and went straight to bed and wrapped himself in blankets. The next day he woke and found himself in a lot of pain, and frightened and annoyed at having such difficulty gaining the use of his limbs.

Eleanor fetched the local doctor, and he reported that FDR had a heavy cold, and promised to return the next day. By the time he returned, Roosevelt could no longer stand without help, and he was having trouble urinating. No one believed the heavy cold diagnosis anymore.

A Blood Clot in the Spinal Cord

By this time in his life, Roosevelt was a partner in a law firm, and also worked half-days at Fidelity and Deposit Insurance Company as a vice president. His secretary at F&D was Louis Howe. Howe was at Campobello with his boss, and went off with the heavy-cold-doctor to his home in Lubec to use his telephone of which there were plenty few around, and made calls in the area until he came upon an 84 year-old surgeon from Philadelphia vacationing in the area.

This physician came to visit Roosevelt on the 14th and said he had a blood clot in the spinal cord. And because Roosevelt was able to move his toes in one foot, he said the clot was already dissolving.

But his condition continued to deteriorate, he could no longer urinate or defecate, and the local gp had had to show Eleanor how to give him an enema, and extract urine with a glass catheter with suction. It is not hard to imagine how this impacted a proud and vigorous man.

An Intractable Spinal Lesion

The next day, the 15th, Roosevelt started to improve a little. His fever had gone down some. And the Philadelphian had had time to think over his diagnosis, and sent the Roosevelt’s a letter. He had come to the conclusion that he had an intractable spinal lesion. And for the visit and letter, he sent a bill of $8,000.

That was a lot of money for those days. In 1908, my grandfather built the famous Frank Lloyd Wright home, the Robie House, for $8,000. There had been some inflation in the intervening years, but such a sum still bought a very substantial house. Imagine, we are outraged by emergency room doctors who are not part of the network. What must the Roosevelts have felt about the cost of emergency help they sought? We have conclude that this Philadelphia surgeon must have hated to be interrupted during his vacations. But Conrad Black reports that the Roosevelt’s paid the bill.

Finally, Infantile Paralysis (Polio) is Diagnosed

Louis Howe did not buy the clot diagnosis, and wrote to FDR’s uncle, Fred Delano, summarizing the case, and asked him to check it out with doctors in New York and Boston. The consensus was that he had a case of infantile paralysis. The expert in this disease was Dr. Robert W. Lovett, a Harvard professor and chief surgeon at Children’s Hospital. He visited Roosevelt on August 25th together with the clot-doctor from Philadelphia and the local heavy-cold doctor. It was clear to Lovett that this was a case of infantile paralysis, and the case was finally, after two weeks finally diagnosed.

So, instead of just one doctor diagnosing infantile paralysis as in Warm Springs, there were actually three doctors present at the time of diagnosis. And instead of just one simple diagnosis, the doctors had tripped all over themselves before getting it right, and at least one had presented a spectacular bill for the privilege of a mis-diagnosis, and even today Roosevelt’s diagnosis is still disputed.[2]

A Cure for Polio is Discovered in 1949 but Goes Ignored

In 1948, an epidemic of 60 cases of poliomyelitis came under the care of Fred R. Klenner, M.D. of Reidsville, North Carolina. He had read in the medical literature of the success of Jungeblut (1937) with vitamin C against polio in monkeys. So, Klenner treated these patients with vitamin C. Basically, his paper says that he gave 1 or 2 grams either orally or intramuscularly or intravenously every six hours. There were variations on the routine depending on how advanced the disease was, but within 3 to 5 days every single patient recovered.[3] Even though his success rate was 100%, this news was ignored and neglected, and ultimately vaccination was used as the means of taming the disease, and Jonas Salk was hailed as the conquering hero.

The vaccination route seems to have worked, but there are those with concerns. For example, it seems from 1962-1999 an oral polio vaccine contained a monkey virus (SV40, Simian Virus 40) that can cause various types of cancer (mesothelioma, brain tumors, medullablastomas, osteosarcomas, retinoblastomas, ependymomas or choroid plexus tumors).

The Lessons

What have we learned? That diagnosis is a tricky thing, it is difficult to get it right. I am not going to say, as in the case of Roosevelt that your chances are only 1 out of 3 that your doctor will get it right, but I will say that it is not necessarily a straightforward proposition, and doctors have my sympathy.

And there is hope on the horizon. The internet is an almost limitless fund of information, and eventually expert programs should be able to shed a lot of light in the way of possibilities of what the disease is and possible cures.

Secondly, that the cure is also a tricky thing. Vitamin C even 50 years later is not recognized as a treatment for polio. Klenner’s paper was presented at an AMA convention and completely ignored, which continues to the present day. According to the Merck Manual, “Polio can’t be cured, and antiviral drugs don’t affect the course of the disease.”[4]

Lastly, I would say you should do your own research. If an auditorium full of doctors can ignore a 100% cure for polio, and can continue to ignore it for 50 years, and if you have this disease, your doctor may not be aware of (because it has been so completely ignored), or he may simply pass over, a perfectly good treatment. That is, you are on your own. The idea behind this book is to provide information that you may not find elsewhere together with a few leads. Ultimately, we as patients must decide to accept the cure the doctor offers you, and in that sense, you are your own doctor. Educate yourself, so you can make a good decision.

[1] Black, Conrad, Franklin Delano Roosevelt Champion of Freedom, PublicAffairs (Perseus Books Group), 2003, pp. 137-140.

[2] Goldman, AS et al, What was the cause of Franklin Delano Roosevelt's paralytic illness?. J Med Biogr. 11: 232-240 (2003) A peer-reviewed study in 2003 found that probably Roosevelt had Guillain-Barré syndrome. As the word syndrome suggests, this is a disease without a well-understood causal agent, such as a bacterium.

[3] Klenner, Fred R., The Treatment of Poliomyelitis and Other Virus Diseases with Vitamin C, Southern Medicine & Surgery, July, 1949. http://www.orthomed.com/polio.htm

[4] The Merck Manual of Medical Information Home Edition, Merck Research Laboratories, Whitehouse Station, NJ, 1997, p. 1275