9/12/2016

Disease can break a lot of people. As a new film by Ken Burns and an exclusive video clip show, it helped make Franklin Roosevelt


This much is painfully certain too: somehow, the virus that inhabited the boy found its way to the man, settling first in his mucus membranes, and later in his gut and lymph system, where it multiplied explosively, finally migrating to the anterior horn cells of his spinal cord. On the evening of August 10, a feverish Roosevelt climbed into bed in his summer cottage on Campobello Island in Canada’s Bay of Fundy. It was the last time he would ever stand unassisted again.
Roosevelt’s polio, which struck him down just as his political star was rising, was supposed to be the end of him. The fact that it wasn’t is a self-evident matter of history. Just why it wasn’t has been the subject of unending study by historians and other academics for generations. This year, Roosevelt and his polio are getting a fresh look—for a few reasons.
October 28 will be the 100th birthday of Jonas Salk, whose work developing the first polio vaccine was backed by the March of Dimes, which was then known as the National Foundation for Infantile Paralysis and which itself grew out of the annual President’s Birthday Balls, nationwide events to raise funds for polio research, the first of which was held on FDR’s 52nd birthday, on January 30, 1934, early in his presidency. That initial birthday ball raised a then-unimaginable $1 million in a single evening, a sum so staggering Roosevelt took to the radio that night to thank the nation.
“As the representative of hundreds of thousands of crippled children,” he said, “I accept this tribute. I thank you and bid you goodnight on what to me is the happiest birthday I have ever known.”
This year too marks one more step in what is the hoped-for end game for the poliovirus, as field-workers from the World Health Organization, Rotary International, UNICEF and others work to vaccinate the disease into extinction, focusing their efforts particularly on Pakistan, one of only three countries in the world where polio remains endemic.
Then too there is the much-anticipated, 14-hr. Ken Burns film, The Roosevelts: An Intimate History, which begins airing on Sept. 14. It is by no means the first Roosevelt documentary, but it is the first to gather together all three legendary Roosevelts—Franklin, Theodore and Eleanor—and explore them as historical co-equals. It’s the segments about FDR and his polio that are perhaps the most moving, however—and certainly the most surprising, saying what they do about the genteel way a presidential disability was treated by the media and by other politicians in an era so very different from our own.
“We think we’re better today because we know so much more,” Burns told TIME in a recent conversation. “But FDR couldn’t have gotten out of the Iowa caucuses because of his infirmity. CNN and Fox would have been vying for shots of him sweating and looking uncomfortable in those braces.”
That’s not a hard tableau to imagine—the competing cameras and multiple angles, shown live and streamed wide. And what Americans would have seen would not have been pretty, because never mind how jolly Roosevelt tried to appear, his life involved far, far more pain and struggle than the public ever knew, as a special feature from the film, titled “Able-Bodied,” makes clear. That segment, which is not part of the broadcast and is included only on the film’s DVD and Blu-Ray versions, which are being released almost contemporaneously with the film, was made available exclusively to TIME (top).
Concealing—or at least minimizing—the president’s paralysis was nothing short of subterfuge, the kind of popular manipulation that wouldn’t be countenanced today. But it’s worth considering what would have been lost by exposing the masquerade that allowed FDR to achieve and hold onto power. Roosevelt, as the Burns film makes clear, was a man whose ambition and native brilliance far exceeded his focus and patience. It was a restlessness that afflicted cousin Teddy too, causing him to make sometimes impulsive decisions, like pledging in 1904 that he wouldn’t run again in 1908—an act he regretted for the rest of his life and tried to undo with his failed third-party presidential bid in 1912.
“Who knows what would have happened if Teddy had had the great crises Franklin had—the Depression and World War II?” Burns says. “I do know he was unstable and always had to be in motion. It fell to FDR, who could not move, to figure out a way to outrun his demons.”
George Will, in an artful turn in the “Able-Bodied” clip, observes that when the steel went onto Roosevelt’s legs it also went into his soul. That may have been true in FDR’s case, but it’s true too that suffering is not ennobling for everyone. Some people are broken by it; some are embittered by it. As polio nears the end of its long and terrible run, the things FDR achieved despite—even partly because of—his affliction remain nothing short of remarkable.

Post Polio Litaff, Association A.C _APPLAC Mexico

The Polio Crusade

THE POLIO CRUSADE IN AMERICAN EXPERIENCE A GOOD VIDEO THE STORY OF THE POLIO CRUSADE pays tribute to a time when Americans banded together to conquer a terrible disease. The medical breakthrough saved countless lives and had a pervasive impact on American philanthropy that ... Continue reading..http://www.pbs.org/wgbh/americanexperience/polio/

Erradicación de La poliomielitis

Polio Tricisilla Adaptada

March Of Dimes Polio History

Dr. Bruno

video

movie

movie2

A 41-year-old man developed an acute illness at the age of 9 months during which, following a viral illness with headache, he developed severe weakness and wasting of the limbs of the left side. After several months he began to recover, such that he was able to walk at the age of 2 years and later was able to run, although he was never very good at sports. He had stable function until the age of 18 when he began to notice greater than usual difficulty lifting heavy objects. By the age of 25 he was noticing progressive difficulty walking due to weakness of both legs, and he noticed that the right calf had become larger. The symptoms became more noticeable over the course of the next 10 years and ultimately both upper as well as both lower limbs had become noticeably weaker.

On examination there was wasting of the muscles of upper and lower limbs on the left, and massively hypertrophied gastrocnemius, soleus and tensor fascia late on the right. The calf circumference on the right exceeded that on the left by 10 cm (figure1). The right shoulder girdle, triceps, thenar eminence and small muscles of the hand were wasted and there was winging of both scapulae. The right quadriceps was also wasted. The wasted muscles were also weak but the hypertrophied right ankle plantar flexors had normal power. The tendon reflexes were absent in the lower limbs and present in the upper limbs, although the right triceps was reduced. The remainder of the examination was normal.

Figure 1

The patient's legs, showing massive enlargement of the right calf and wasting on the left

Questions

1
What is that nature of the acute illness in infancy?
2
What is the nature of the subsequent deterioration?
3
What investigations should be performed?
4
What is the differential diagnosis of the cause of the progressive calf hypertrophy?

Answers

QUESTION 1

An acute paralytic illness which follows symptoms of a viral infection with or without signs of meningitis is typical of poliomyelitis. Usually caused by one of the three polio viruses, it may also occur following vaccination and following infections with other enteroviruses.1 Other disorders which would cause a similar syndrome but with upper motor neurone signs would include acute vascular lesions, meningoencephalitis and acute disseminated encephalomyelitis.

QUESTION 2

A progressive functional deterioration many years after paralytic poliomyelitis is well known, although its pathogenesis is not fully understood.2 It is a diagnosis of exclusion; a careful search for alternative causes, for example, orthopaedic deformities such as osteoarthritis or worsening scoliosis, superimposed neurological disorders such as entrapment neuropathies or coincidental muscle disease or neuropathy, and general medical causes such as respiratory complications and endocrinopathies.3

QUESTION 3

Investigations revealed normal blood count and erythrocyte sedimentation rate and normal biochemistry apart from a raised creatine kinase at 330 IU/l (normal range 60–120 IU/l), which is commonly seen in cases of ongoing denervation. Electromyography showed evidence of denervation in the right APB and FDI with polyphasic motor units and complex repetitive discharges, no spontaneous activity in the left calf and large polyphasic units in the right calf consistent with chronic partial denervation. Motor and sensory conduction velocities were normal. A lumbar myelogram was normal. Magnetic resonance imaging (MRI) scan of the calves is shown in figure2.

Figure 2

Axial T1 weighted MRI scan (TR 588 ms, TE 15 ms) of the calves, showing gross muscle atrophy and replacement by adipose tissue on the left, and hypertrophy of the muscles on the right, with only minor adipose tissue deposition

QUESTION 4

The differential diagnosis of the progressive calf hypertrophy is given in the box.

Causes of calf muscle hypertrophy

Chronic partial denervation

  • radiculopathy

  • peripheral neuropathy

  • hereditary motor and sensory neuropathy

  • spinal muscular atrophy

  • following paralytic poliomyelitis

    Neuromyotonia and myokymia

  • Isaac's syndrome

  • generalised myokymia

  • neurotonia

  • continuous muscle fibre activity due to: chronic inflammatory demyelinating polyradiculopathy, Guillain Barre syndrome, myasthenia gravis, thymoma, thyrotoxicosis, thyroiditis

    Muscular dystrophies

    Myositis

    Infiltration

  • tumours

  • amyloidosis

  • cysticercosis

    Link here