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Dr. Howard Markel
Dr. Howard Markel
Every member of “the greatest generation” can tell you where they were on Dec. 7, 1941, when the Japanese Air Force bombed Pearl Harbor. And every Baby Boomer has a similar clarity of mind when recalling the horrors of Nov. 22, 1963.
That, of course, was the day 56 years ago when Lee Harvey Oswald murdered President John F. Kennedy as his motorcade drove through the streets of Dallas. Yet it is only in the past few decades we have had a more thorough understanding of President Kennedy’s complex medical history.
To put it bluntly, long before he died at age 46, Kennedy was a very sick man.
As a child, Kennedy nearly died from scarlet fever and also had serious digestive problems — most likely spastic colitis or irritable bowel syndrome, which plagued him for the rest of his life. As a young man, he suffered from urinary tract infections, prostatitis, and a duodenal ulcer. Better known was his notorious spine and back problems that began while playing football in college. His lower back pain was so severe, he was initially rejected by the both U.S. Army and the Navy when he first volunteered for service in World War II.
Through his own tenacity and father’s connections, Kennedy joined the Naval Reserve and became an officer on a P.T. (patrol torpedo) boat. During a battle in the Solomon Islands, on Aug. 1, 1943, the ship was strafed in half by the Japanese destroyer Amagiri. PT-109 quickly sank and two of the crew members died. Eleven others, including Kennedy, survived, floundering in the Pacific. A few of them were seriously injured. Along with the crew, Kennedy swam several miles to an island, towing one of the injured men by a life-vest strap. He then swam to other islands in search of fresh water and a U.S. vessel. Eventually, the men were rescued thanks in part to a distress signal Kennedy carved on a coconut shell.
The following year, 1944, Kennedy underwent the first of four unsuccessful back surgeries; he had three more procedures between 1954 and 1957 while he was a U.S. senator. His spinal surgeries, which included fusions of the lumbar vertebrae and the placement of metal plates, were complicated by poor wound healing, painful abscesses, and osteomyelitis (an infection of the bone). He was so ill at a few points during this period that his Catholic priest administered last rites. During a long period of recuperation in 1956, he wrote the Pulitzer Prize-winning book “Profiles in Courage,” with the help of his eloquent speechwriter Theodore Sorenson.
Almost every day of Kennedy’s adult life, he experienced debilitating back pain, especially in the lumbar spine and the sacroiliac joints. Many times, his back was so stiff from pain and arthritis that he could not even bend over to tie his shoes. Few people who live free of this disability understand how badly it affects one’s life. Still, Kennedy soldiered on to make his indelible mark on the world — until his assassination.
Some physicians have argued that the rigid back brace he wore while sitting in the presidential limousine on Nov. 22, 1963, contributed to his death. After the first, non-fatal gunshot struck him, Kennedy was unable to bend down. Instead of crumpling to the bottom of the car, the stiff brace held him upright and he remained in Oswald’s gun sight so that the killer was able to shoot the president in the head.
Yet Kennedy’s most serious health issue was Addison’s disease. This is an insufficiency of the adrenal glands, the organs which produce the vital hormones that help control sodium, potassium, and glucose levels in the blood, and mediate the body’s reactions to stress. Addison’s disease patients often begin their illness by experiencing severe diarrhea, vomiting, fatigue and low blood pressure. If left untreated, it is a life-threatening disease. Since the late 1930s, doctors have been able to manage this serious illness with the prescription of corticosteroids, which, according to his biographer Robert Dallek, Kennedy probably began taking in one form or another since at least 1947, when he was officially diagnosed with adrenal insufficiency. Some reports, however, claim he may have taken the medication earlier. The chronic use of steroids over his lifetime likely caused osteoporosis of various bones in his body, most notably his spine, where he suffered from three fractured vertebrae.
During his presidency, Kennedy was also treated with a slew of opiate pain killers, local anesthetic (lidocaine) shots for his back pain, tranquilizers such as Librium, amphetamines and stimulants, including Ritalin, thyroid hormones, barbiturate sleeping pills, gamma globulin to stave off infections, as well as the steroid hormones he needed to keep his adrenal insufficiency at bay. According to The New York Times, during the Cuban missile crisis in October of 1962, the president was prescribed “antispasmodics to control colitis; antibiotics for a urinary infection; and increased amounts of hydrocortisone and testosterone along with salt tablets to control his adrenal insufficiency and boost his energy.”
In his 1965 book “A Thousand Days,” the historian Arthur Schlesinger Jr. described an interview with Kennedy in July of 1959, in which he asked the U.S. senator about the rumors of his having Addison’s disease. Kennedy, who was about to run for president, confidently told Schlesinger, “No one who has the real Addison’s disease should run for the presidency, but I do not have it.”
Here, Kennedy was being both a duplicitous politician and an astute historian of medicine. In 1855, Thomas Addison, the senior physician to London’s Guy’s Hospital, published his treatise, “On the Constitutional and Local Effects of Disease of the Suprarenal Capsules.” The adrenal insufficiency of the six patients he described in this publication was caused by a destructive and infectious tuberculosis of the adrenal glands. Kennedy had adrenal insufficiency of an unknown cause but he was not in any way, shape or form, infected with tuberculosis. So, technically, he did not have “real Addison’s disease.”
Such verbal flim-flam recalls a mordant observation often attributed to our 35th president: “Mothers all want their sons to grow up to be president, but they don’t want them to become politicians in the process.”
Dr. Howard Markel writes a monthly column for the PBS NewsHour, highlighting momentous historical events that continue to shape modern medicine. He is the director of the Center for the History of Medicine and the George E. Wantz Distinguished Professor of the History of Medicine at the University of Michigan and the author of “The Secret of Life: Rosalind Franklin, James Watson, Francis Crick and the Discovery of DNA’s Double Helix” (W.W. Norton, September ’21).
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