by James Tobin
Hour after hour, the process repeated itself. New viruses invaded new cells and cranked out more copies. One after another, the cells burst, sending more viruses downstream to find more cells to destroy.
The multiplying virus triggered a reaction from FDR’s immune system, the vast network of cells whose job was to swarm around viruses and bacteria and kill them.
But it seems that FDR’s immune system had never been very strong.
At his parents’ country estate at Hyde Park, New York, one hundred miles north of New York City, he had grown up as an only child, and his mother seldom allowed him to play with the few children who lived nearby. He didn’t go to school for the early grades. He was taught at home by private tutors. So he never caught many of the germs that most children pass around and develop a resistance to in their early years.
In high school and college he came down with scarlet fever, measles, mumps, and dozens of sinus infections and colds. On his honeymoon in 1905, he had hives—itchy lumps on the skin that can be caused by a sputtering immune system. While he was assistant secretary of the navy, he had appendicitis, two severe throat infections, influenza, double pneumonia, and tonsillitis. His boss at the navy department said FDR seemed to catch every bug that came along.
In most people who caught the poliovirus, immune cells would kill it and send it out of the body in the urine and feces before it could cause any trouble. In one person out of ten, there would be symptoms like the ones caused by an ordinary “flu bug”—fever and chills, a stomachache, a headache, sluggishness. But the immune system would win out, the symptoms would vanish, and the incident would be forgotten.
In Roosevelt’s case, the virus went up a wrong alley and passed through a filtering system that doctors call the blood-brain barrier. Normally, that barrier keeps harmful particles in the bloodstream out of the nervous system. But the poliovirus is small enough to pass through the filter. When it does, it turns dangerous.
The nervous system is a fabulously complex network of cables that carry electrical signals between the brain and the rest of the body. One set of cables transmits sensations—hot or cold, rough or smooth, wet or dry, painful or pleasant. A second set of cables controls the movements of the muscles. The signals move at unimaginable speeds through long, threadlike nerve cells called neurons. The cables are built in sections, each section linked to the next, strung by the billions through all parts of the body. The number of cellular cables in the body is flabbergasting—about one hundred billion. If the nerve cables in a single human body were laid out end to end, they would stretch for ninety thousand miles.
In the spinal cord, neurons come to junctions called horn cells. (The cells live in a part of the cord that looks a bit like the horn of a trumpet.) Some are in the front—the anterior horn cells. Some are in the back—the posterior horn cells. The posterior cells carry the signals of the senses—seeing, hearing, smelling, touching. The anterior cells carry the signals that tell the muscles what to do.
The poliovirus only locks with the anterior horn cells, the ones controlling muscle movement. No one knows why the virus works that way, but when it happens, just as in the intestines, the virus penetrates a nerve cell and cranks out so many copies of itself that the cell explodes and dies. Then the process repeats itself over and over, wiping out more and more anterior horn cells.
Imagine the brain sending a signal to the big toe of a healthy person’s right foot, telling the toe to wiggle. The signal flashes down the spinal cord to an anterior horn cell, which routes the signal smoothly down to the toe—and the toe moves.
But if the poliovirus has destroyed that horn cell, the brain’s electrical signal just stops. The toe never gets the signal. Nothing’s wrong with the muscles and bones in the toe. They can work. They just don’t.
A nerve cell that dies can never come back to life. But that’s not a problem as long as a person doesn’t lose too many. The body has many more nerve cells than it needs, including anterior horn cells. So other cells pick up the slack. They carry the brain’s signal to the toe, just by a different series of cables.
But if too many cells die, the signal begins to stutter, and little things start to go wrong—hypersensitivity in the sensory nerves, for example, and weakness in the limbs.
* * *
There were no news reports that Boy Scouts who attended the Bear Mountain campout had come down with infantile paralysis.
So why only FDR?
Here, too, Dr. Lovett could not have said much. It might have been just a million-to-one case of bad luck. But there were two reasons why FDR may have been particularly susceptible to the poliovirus.
First, he simply may have been born with a weak immune system. His tendency from an early age to pick up infections suggests this was so.
Then there was the physical environment of his childhood, which may have made his immune system even weaker.
When we hear about infectious diseases, we think of bad sanitation. We think of places with polluted water and no toilets and people who haven’t washed their hands.
The strange truth about polio is that it tends to spread where sanitation is good.
In the 1880s, when FDR was a boy, almost nobody had a flush toilet, and few cities and towns had sewer systems to pipe human waste away for decontamination. So people’s waste was stored in underground pits, and the stuff sometimes spread through the ground to wells where drinking water was drawn. In many places people relieved themselves in chamber pots, also called slop jars and thunder mugs, and then emptied the pots into the streets. (The smell was horrific. People approaching a big city like New York in the mid-1800s could smell it from miles away.)
One way or another, even if people tried hard to keep their homes clean, human feces spread through water and dirt and dust. That meant the poliovirus spread, too. It got into pretty much everybody, including babies.
That sounds dangerous, but it seldom was. Babies have extra-powerful immune cells passed to them from their mothers. In practically every baby, those cells would overwhelm the poliovirus. At the same time, the baby’s own immune system would create special polio-fighting cells called lymphocytes. They stay in the body forever, so if the poliovirus reenters that person later in life, those anti-polio lymphocytes stop the virus cold.
All this means that in the 1800s, just about everyone grew up with a natural immunity to polio. That’s why so few people came down with the disease.
Until the coming of toilets and sewers.
By the late 1800s, people in the fast-growing cities of North America got so fed up with the smell and the danger of so much human waste that they started building good sewer systems and installing flush toilets. Not everywhere, but in a lot of places.
When that happened, things changed for the poliovirus, too. There weren’t so many specks of human waste passed from hand to hand. In places with good plumbing and sewers and plenty of clean water, children began to grow up without ever catching the poliovirus. So they never developed those special polio-fighting immune cells. As the years went by, more towns and cities were full of children without that immunity.
Good sanitation systems didn’t kill the poliovirus. They just kept it out of the neighborhood. So if someone carrying the virus visited one of those places with good sanitation, the virus could cause a lot of trouble.
Sure enough, in the 1890s and 1900s, polio epidemics followed in the footsteps of the sanitation revolution in places like Boston, Massachusetts, and Rutland, Vermont, where the sanitation systems were good.
But nobody made the connection between polio and good sewers—not yet. In the great polio epidemic of 1916, people feared that polio was spreading in dirty, crowded neighborhoods where poor people lived. It was only later, when experts took a closer look, that they noticed polio was more likely to strike in middle- and upper-class neighborhoods, where sanitation was better. They didn’t know why.
What did all this have to do with Franklin Roosevelt?
He had been r
aised on a country estate with plenty of clean water drawn from a spring behind his house. He had no brothers or sisters, only a much older half-brother. He seldom played with other kids. So it’s likely that the young Franklin Roosevelt never came within a country mile of the poliovirus. And because he probably never picked up and fought off the poliovirus as a child, he lacked the disease-fighting lymphocytes that might have protected him when bad luck struck years later at Bear Mountain.
There might have been one more factor to blame.
Once the poliovirus gets into the nervous system, there’s no telling how many cells it will destroy, or which parts of the body will be affected, before the immune cells kill it off.
In some people, the virus creeps on and on, climbing up the spinal cord until it reaches the brain. In the worst cases, the nerves that control the automatic in-and-out process of breathing can be ravaged. In those cases, many victims die. In other people, the attack on the nervous system promptly stalls right after it starts, leaving hardly any damage at all.
Doctors have never discovered why one attack is deadly, another mild. But they’re sure about one thing: In a case that might go either way, mild or severe, the best thing the infected person can do is go to bed and rest. The immune cells need as much of the body’s energy as they can get. The worst thing to do is to get a lot of hard exercise, the sort of exercise that comes with several days of “whooping, romping, [and] running” with young children and then spending an afternoon fighting a forest fire.
* * *
The Roosevelts must have asked Dr. Lovett: What about the future? When would FDR be able to stand up and walk again? Was there any danger that his legs would be permanently paralyzed?
Dr. Lovett chose his words carefully.
Roosevelt was famous and powerful. Even a doctor as experienced as Dr. Lovett would hesitate to tell such a person that he may face a future radically different from his past.
Dr. Lovett knew perfectly well that at this early stage of the disease, no doctor could predict exactly what would happen. It all depended on how many nerve cells had been wiped out. And on the surplus nerves that might or might not take up the slack. And on the patient himself—would he be tough enough to fight for a strong recovery?
But it’s difficult for a doctor to tell everything he knows to a patient who has just been given a shocking diagnosis. It may even hurt the patient. A good doctor knows that for many patients, the chance of recovery depends partly on the state of the patient’s mind. If the patient loses hope, the body seems to lose hope, too. But if a patient is optimistic and determined, sometimes the body follows the mind’s lead.
So Dr. Lovett spoke truthfully. But he also gave the Roosevelts reason to hope.
Compared to the worst cases he’d seen, this one was fairly mild, even “within the range of possible complete recovery,” he said.
A few days later, Dr. Lovett described his talk with the Roosevelts in a letter to their personal doctor in New York. Lovett wrote: “I told them very frankly that no one could tell where they stood, that the case was evidently not of the severest type, that complete or partial recovery to any point was possible.”
He also told the Roosevelts that “disability was not to be feared.”
Now, Dr. Lovett was well aware that some degree of disability was quite possible. So he must have meant only that complete disability was not to be feared. That is, FDR would not have to stay flat on his back for the rest of his life. Eventually he’d be able to get up and move around, though probably with metal braces on his legs and crutches.
Eleanor was anxious about her children. Were they in danger?
Almost surely not, Lovett said. The flu-like symptoms that Louis Howe had noticed in the children after FDR’s arrival might have been caused by the poliovirus. But if so, the children’s immune systems had fought it off. And now their father was no longer contagious.
Dr. Lovett said FDR would have to rest at Campobello for several weeks before going home to New York. In the meantime, Eleanor should stop the painful massage. It was doing no good. In fact, it might be damaging FDR’s muscles. After a few weeks they would see where things stood, then decide what to do next.
Dr. Lovett said he was very sorry, but the only thing to do was to wait and see what would happen. The worst would soon be over. At that point FDR could expect to feel some strength returning in the damaged muscles.
The doctor got ready to leave. Louis Howe asked him for a private word.
Howe wanted a straight answer to the hardest question: What were the chances that FDR would walk again?
Lovett decided to level with Howe.
It was just barely possible, he said. It would take “the most extraordinary will and patience” over a long period of time—“hours, days, weeks, months and years of constant effort.”
And even if FDR worked that hard for that long, Lovett said, no one could guarantee he would ever again walk on his own.
Chapter 3
“HARD, CRUEL FACTS”
Day after day FDR lay in his bed, waiting.
He listened as Howe read aloud from the newspapers. When Eleanor came in to wash him or to help him relieve himself in a bedpan, all he could do was push his body up a bit from the bed with his hands and arms. Again and again he tried to move his legs. Nothing.
Another man who had polio described what this felt like. “You drive the thought of it with all your might down from your mind toward the lifeless leg,” he wrote. “But the thought doesn’t get there. Some deadly barrier lies between.”
It was like what happens when you sleep half the night with your arm pinned under you. When you wake up, the arm feels heavy and dead, as if a big bag of sand has been tied to your body.
The quiet days passed. Eleanor let the children come to the door of FDR’s bedroom to say hello and chat for a minute.
“He grinned at us,” Jimmy Roosevelt remembered, “and he did his best to call out, or gasp out, some cheery response to our tremulous, just-this-side-of-tears greetings.”
Eleanor and Louis broke the news to a few close relatives and friends in careful letters. Howe sent a brief notice to the newspapers saying only that FDR had been “seriously ill” but was “now improving.”
Howe was keeping back the whole truth partly because FDR’s mother, Sara Roosevelt, was about to set sail for the United States after a summer in Europe. They didn’t want Sara to be shocked by a newspaper story saying FDR had infantile paralysis.
When making any family decision, Franklin and Eleanor had to think carefully about his mother.
Since the death of her husband, James Roosevelt, when Franklin was in college, Sara had been a wealthy woman. She had inherited her husband’s substantial fortune and the estate on the Hudson River. This was the place FDR considered his true home, and the whole family—Sara, Franklin, Eleanor, and the children—spent many weekends and holidays there together. But Franklin’s work as a politician and lawyer required a base in New York City, too. So their main address was 49 East Sixty-Fifth Street in Manhattan, a fine, six-story townhouse. Sara had given that house to the couple as a wedding gift and then moved in next door at No. 47, with doors connecting the twin houses on alternate floors.
The bonds between Sara and “my children,” as she called Franklin and Eleanor, were strong but often strained. Sara covered many of the family’s expenses, which gave her a silent source of power in many family decisions. And she worried about the welfare of her only child as if he were still a boy in school. If Franklin—a grown man with five children of his own—said he was about to leave the house on a rainy day, Sara would warn him that he must wear his rubber boots.
So they had to think carefully about how Sara would learn that her son was half-paralyzed, and they certainly didn’t want her to read about it in the newspapers.
They had to tell other friends and associates, too, though how much they said depended on the person.
To FDR’s secretary, a highly capable young woman
named Marguerite LeHand, Eleanor wrote only that her husband had caught “a severe chill … which resulted in fever & much congestion.”
FDR’s own first letter from Campobello went to Langdon Marvin, his friend and partner in the New York law firm of Emmet, Marvin & Roosevelt. He had to let the firm know he would not be able to work for some time. He was more honest than Eleanor had been with Miss LeHand, though he tried hard to sound upbeat.
“My case has been diagnosed by Dr. Lovett as one of poliomyelitis,” he wrote, “otherwise [known as] infantile paralysis. Cheerful thing for one with my gray hairs to get. I am almost wholly out of commission as to my legs but the doctors say that there is no question that I will get their use back again though this means several months of treatment in New York.”
* * *
He was not getting better.
Day after day, the muscles of his legs and buttocks were shriveling. At first he could barely notice the change, but soon it became obvious.
Muscles have to move to stay healthy. Otherwise their cells start to die, and the muscles wither. It seemed impossible, but FDR’s legs were getting skinnier by the day.
Above the waist, he was feeling a bit better. The hint of paralysis in his hands had disappeared. His arms felt stronger. But his legs …
Dr. Bennet was dropping in often to see FDR. Finally he sent a telegram to Dr. Lovett, who was now back in Boston.
FDR was feeling “much anxiety,” Bennet wrote. “Can you recommend anything to keep up his courage?”
No, Dr. Lovett wrote back, he had nothing more to say. There was nothing to do but wait and see how many muscles would recover on their own.
* * *
On the first day of September, a week after Dr. Lovett left Campobello, Sara Roosevelt arrived on the island. She had stepped off the ship in New York to find her brother Fred waiting for her. He gave her the news. Now, with Eleanor and Dr. Bennet, she hurried up the stairs to her only child’s sickbed.