Master of His Fate by James Tobin (free ebooks for android txt) 📗

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 raised 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