Health and Medical History of President

John Kennedy

President #35
Lived: 1917-1963 Served: 1961-1963

Timeline from 1776: ← 2013

"When Kennedy ran for and won the presidency, he was essentially gambling that his health problems would not prevent him from handling the job. By hiding the extent of his ailments he denied voters the chance to decide whether they wanted to share this gamble. It is hard to believe that he could have been nominated, much less elected, if the public had known what we now know about his health." 7a

UNDER CONSTRUCTION
Maladies and Conditions

a mess
From a medical standpoint, Kennedy was a mess. For example, there is the simple fact that Kennedy was hospitalized more than three dozen times in his life MORE and given the last rites three times (see below).

Bumgarner provides an excellent short recap of Kennedy's medical history 3a, although the new medical sources pioneered by Dallek 7 6 are leaving it behind.

Dr. Lee Mandel 10 has recently offered a unifying medical diagnosis for Kennedy: auto-immune polyendocrine syndrome type II (APS II).

Dr. Mandel notes that Kennedy had signs of adrenal failure as early as 1940, and that his autopsy almost certainly indicates this was auto-immune in origin. Kennedy was diagnosed with hypothyroidism in 1955 and was under treatment for years (see below). 10 Comment: [Technical] APS II is a polygenic disorder defined as: (a) auto-immune adrenocortical failure plus (b) evidence of adrenal inflammation plus (c) either auto-immune thyroid disease or type 1 diabetes mellitus. The peak age of onset is 30. (JFK was 30 when his adrenal insufficiency was diagnosed.) Other associated autoimmune disorders include: atrophic gastritis (with or without pernicious anemia), hypergonadotrophic hypogonadism, and celiac disease.

The diagram below summarizes the possible interplay between Kennedy's medical problems. The rest of this page has details.


scarlet fever
Contracted scarlet fever in Feb. 1920 (age 2 years, 9 months) and almost died 3b.

measles
He also contracted measles while 2 years old, as well as whooping cough and chicken pox. As a child he was susceptible to frequent upper respiratory infections 3c and bronchitis 6a.

jaundice
He suffered at least one episode of jaundice as a youth 3d. Jaundice in 1935 has been interpreted as Addisonian hyperpigmentation, but Dr. Zebra rather doubts the two conditions are easily confused 11a.

sports injuries
As a child Kennedy sustained "many injuries and bruises [while participating] in sports where his physique was inadequate." For example, when he had a bicycle collision with his brother Joe, Joe walked away unhurt, but Jack (JFK) needed 28 stitches 3d 6b.

minor childhood ills
Kennedy's mother kept a card file on the medical problem of her children 3d 6c. The entries for John (more commonly known as Jack) included 3e:
  • Between 1920 and 1928 a Dr. Reardon "took care of ear."
  • 1928: German measles
  • June 15, 1930: "Examined by Lahey Clinic, tonsils and adenoids OK"
  • Aug. 31, 1933: "Tonsils and adenoids out -- Dr. Kahill, St. Margaret's Hospital"
Kennedy also had German measles and whooping cough 6a.

sickly child
JFK's mother remembered him as "a very, very sick little boy" (probably in connection with the scarlet fever) and "bed-ridden and elfin-like" 3d.

reading glasses in youth
Another entry in the Kennedy card file says "March 21, 1931: Glasses prescribed for reading by Dr. John Wheeler" 3e. If the glasses were really for reading, this would be an indication that Kennedy had presbyopia (far-sightedness) at age 13 -- a distinctly unusual occurrence. Diphtheria is one of the few reasons a young person needs reading glasses. (See Harry Truman.) Kennedy underwent a Schick test for diphtheria in 1928 3e, so there was at least a suspicion that he had it.

colitis
Kennedy had digestive troubles as early as 1934 (age 17) 6d. Years later, when he joined the Navy, these were described as "severe spastic colitis" 6e. Dallek believes steroid treatment of Kennedy's colitis began in 1937 6d and ascribes several later medical problems to complications of steroids (see below).

height and weight
During his freshman year in college, Kennedy was six feet tall and weighed 149 pounds. He consumed "massive amounts" of ice cream and otherwise worked hard at gaining weight, but failed to add bulk all through college 11b.

From age 20 to age 43, available data show that Kennedy's weight was more or less constant -- about 155-160 pounds 10, (corresponding to a body mass index of about 21-22 kg/m/m). Between July 1960 and January 1961, however, he gained 15-20 pounds, causing his mother to remark to her diary on Nov. 3, 1960: "Jack looks unusually well. His cheeks have filled out amazingly since I saw him in June. He has lost that lean Lincolnesque look which I secretly like better" 10.


blood type AB+ (?)
During its coverage of JFK's assassination, NBC news announced (at about 2:30 pm) that B+ blood was prepared for him at Parkland Memorial Hospital. [One reader brought to my attention a published statement that JFK had type AB blood. The printed source is too embarassing to cite. Note, however, that a person having AB+ blood can classically receive B+ blood safely.]

pernicious anemia (?)
In 1966 Dr. Janet Travell recalled: "When I first saw him [May 26, 1955 16a] he was extremely anemic. He had impaired vibration sense which is indicative of peripheral neuritis... characteristic of a vitamin B1 deficiency" 10. (Note: Deficiency of vitamin B1 does not cause anemia, but deficiency of vitamin B12 causes anemia and impaired vibration sense.) She further recalled: "Senator Kennedy was put on a course of vitamin B12, vitamin B1, and B-complex injections. His blood count -- his hemoglobin and red cells -- did respond" 10.

The problem with Travell's recollection is that Kennedy was hospitalized the same day she met him, and the hospital records neither say Kennedy was anemic nor list anemia as a diagnosis 10. Thus, Travell's memory may be inaccurate. Comment: It would not be surprising if Kennedy had pernicious anemia, as it may be part of the APS II syndrome.


hypothyroidism
One of JFK's physicians, Dr. Janet Travell, reported that Kennedy was diagnosed with a sub-normally functioning thyroid gland in May 1955 and underwent iodine treatment. Hospital records show that Kennedy's thyroid function was only mildly subnormal (a "basal metabolic rate of -15"). He took iodine throughout his Presidency (liothyronine, 25 mcg twice daily). 10

In both 1935 and 1939, Kennedy's basal metabolic rate was -11, which Dr. Walter Alvarez regarded as "well within normal limits" 10.


gonadal function
Kennedy took daily testosterone pills throughout his Presidency 10.

The reason(s) he took this medication are unknown. Certainly, his body was not completely devoid of testosterone, as he fathered four children from 1956 to 1960. It is possible that his testosterone level was reduced by the cortico-steroids he chronically took, or as a consequence of APS II (see above) 10. It has been written that Kennedy took testosterone to keep his weight up 10a. This may be true, as he gained 15-20 pounds between July 1960 and January 1961 10.


steroid complications
Dallek believes steroid treatment of Kennedy's colitis began in 1937 6d. Steroid therapy often comes at a cost, because of its propensity to cause adverse health effects. This was especially true in Kennedy's case, as steroid therapy was still new to medicine in the 1930s. The consequences of steroid excess, now known as "Cushing syndrome," were not described by Cushing until 19__.

Dallek believes steroids were the "principal contributor" to Kennedy's duodenal ulcer (see above) and back problems (see below) 6d. (Steroids cause thinning of bones.) Steroids also altered the shape of Kennedy's face (see below) and, perhaps, body.

Another complication of steroid use is suppression of adrenal gland function. Kennedy was diagnosed with underactive adrenal glands in 1947, a condition known as Addison disease (see below). If Dallek is correct, Kennedy had by then been on steroids for 10 years, although not continuously 6. This makes it extremely difficult to know if Kennedy's Addison disease was the result of chronic steroid use, or whether it was the result of some other process (e.g. auto-immunity).


?sexually transmitted disease
Kennnedy had "occasional burninng when urinating, which was the result of a nonspecific urethritis dating from 1940 and a possible sexual encounter in college." This was left untreated and became a chronic condition by 1946 6f. At some point the illness was described as "a mild, chronic, non-specific prostatitis." Sulfa drugs were able to suppress the symptoms. 6f. As late as May 1955 he still had "prostatitis marked by pain when urinating and ejaculating, as well as urinary tract infections" 6g.

In January 1956 he underwent cystoscopy under anesthesia 6h. Comment: Was this a sexually transmitted disease? (1) The response to sulfa suggests it was infectious. (2) Kennedy had a large number of sexual contacts before he was even out of college, and (3) it seems unlikely he practiced safe sex 6i. As one female acquaintance remarked, "He was not much for planning ahead" 6j.


back
Back problems started in 1938. From 1941 they were "a constant source of difficulty" 6d. [There is much history here, yet to come.] Dallek has suggested that steroid treatments, "which apparently began in 1937," may have been causative 6d.

He wore a back brace. For example, on the day he was shot, he wore a brace that consisted of a canvas brace with metal stays, together with an Ace bandage with extra padding 4a. Some people think this back brace killed him. (See below.)


coral wound
In August 1943, JFK's PT-109 was sunk by a Japanese destroyer in the South Pacific. Kennedy and the other survivors swam to an island three miles away, where they were rescued several days later. Afterwards, JFK wrote to a friend: "I went in to see the Doc about some coral infections I got. He asked me how I got them -- I said `swimming!' He then burst out with, `Kennedy, you know swimming is forbidden in this area, stay out of the goddamned water!'" 2a

Kennedy took 10 days to recover from "symptoms of fatigue and many deep abrasions and lacerations of the entire body, especially the feet" 6k.


malaria? and green skin
Kennedy may have contracted malaria while stationed in the Pacific. He had an illness with high fever in 1945 that was treated with atabrine (a.k.a. quinacrine). Atabrine can cause yellowish discoloration of the skin. Kennedy was well-known by Washington newspaper correspondents to have a "greenish complexion" after the war 11c. Whether the green hue was caused by atabrine, Addisonism, or something else is unclear.

cigars
Kennedy liked to smoke cigars, but did not like to be photographed doing it. He feared it made him look like a stereotypical "old Irish pol, which he didn't want to be sees as" 1.

campaign exhaustion
Kennedy was exhausted by the 1960 Presidential campaign. At a press conference the day after the election, "his hands, although out of camera range, trembled" 6l. Even two weeks later he had not fully recovered: advisor Ted Sorenson found JFK's mind neither "keen" nor "clear" and the President elect "tired" and reluctant to tackle work 6m.

fatigue or hypersomnolence
Kennedy was not especially concerned with the Department of Agriculture. While interviewing a candidate for ?secretary, Kennedy fell asleep 6n. Comment: Dallek sees this incident as indicating Kennedy's boredom with the man and the discussion, as well as evidence that Kennedy intended to rely little on his cabinet. Most sleep physicians, however, view falling asleep in a conversation as a cardinal sign of hypersomnolence. It would be interesting to know more of the interview setting, i.e. whether it was a one-on-one interview or a group effort. Falling asleep in a one-on-one conversation would be remarkable indeed.

Addison disease
Kennedy's Addisonism was diagnosed in 1947 by a physician in London. Kennedy had probably been suffering (literally) from the disease for years, if not decades. After the diagnosis, he was given less than a year to live. He was so ill during the sea voyage home from England, in October 1947, that he was given the last rites 3f. Yet, during the 1960 presidential race, the JFK campaign flatly denied that JFK had Addison disease. The Kennedy campaign used a very narrow definition of Addision disease, namely, insufficiency of the adrenal glands caused by tuberculosis. This was deliberate, calculated, and grossly misleading. Bumgarner calls it "undoubtedly one of the most cleverly laid smoke screens ever put down around a politician" MORE 3g. Adrenal insufficiency, no matter how caused, is a serious matter. MORE

Dallek reports that "Doctors who treated Jack's Addison's or read closely about his condition have concluded that he had a secondary form of the disease, or a 'slow atrophy of of the adrenal glands,' rather than a rapid primary destruction" 6o. Dallek is hinting that Kennedy's Addisonism was due to chronic use of steroids, but he does not take a stand.

While a U.S. Senator, Kennedy underwent major surgery on his back even though the effects of Addison disease on the tolerance of surgery was largely unknown at the time. 12. In fact, JFK's case was published in the medical literature in 1955, although this was not publicly realized until 1967 4b. Post-operatively, he developed a urinary tract infection and had a transfusion reaction, characterized by "mild angioneurotic edema." He also had a repeat operation four months later 12.


moon facies
Kennedy worried about the effects on his appearance of the steroids he took as treatment for Addison disease. The steroids made his face look puffy and made him look overweight. Four days before his inauguration Kennedy caught sight of himself in a mirror and declared "My God, look at that fat face, if I don't lose five pounds this week we might have to call off the Inauguration." Kennedy's secretary heard this and could barely contain her laughter. 6p

Comment: Steroids classically cause a facial appearance known as "moon facies." This refers to the round shape the face assumes. Dr. Zebra always checks for moon facies by looking at the outer corner of the eye sockets. If there is facial tissue behind the eyes that projects laterally from the bony outer border of the orbit, then some degree of moon facies are present. Several photographs of Kennedy have this appearance.


year-round tan
It is sometimes mentioned that Kennedy had a tan year-round. In most of North America, this is unusual, and raises the question of disease. Addison disease, for example, causes bronzing of the skin that is often mistaken for a tan. (An Addisonian tan would suggest that, despite the use of steroids, Kennedy's Addisonism was under-treated.)

To be sure, Addisonism may not be the whole story. Even in youth, Kennedy liked having a tan, saying "It gives me confidence. ... It makes me feel strong, healthy, attractive" 6q.


celiac disease?
There is speculation that Kennedy's gastrointestinal ills were due to celiac disease. Of note, there is an association between celiac disease and Addison disease 13.

libido
In 1963 JFK confided to Britain's Prime Minister Macmillan that he got a headache if he went too long without a woman 15a. Kennedy's close friend, Senator George Smathers, once remarked "He has the most active libido of any man I have ever known," and a fellow congressman observed that "traveling with him was like traveling with a bull" 15b.

Kennedy was taking testosterone in 1963 10, and this could have had an (enhancing) effect on his libido. It is not clear when Smathers' statement was made and whether Kennedy was then taking testosterone.


invasion diarrhea and UTI
Immediately before and after the failed invasion at the Bay of Pigs in Cuba (April 17-18, 1961), Kennedy had "constant," "acute diarrhea." He simultaneously had a urinary tract infection. The treatment included increased anti-spasmodic medication, a puree diet, and penicillin. He was also scheduled for a sigmoidoscopy. 6r

post-invasion depression
Though composed and philosophical in public, in private Kennedy was deeply depressed after the Bay of Pigs invasion fiasco. On April 19, 1961 his wife Jackie remarked that the only time she had seen him more depressed was in connection with surgery. The same day Pierre Salinger found him weeping in his bedroom. Shortly after Kennedy appeared at a meeting with Senator Albert Gore (the father), his hair unruly and his tie askew 6s. At a Cabinet meeting on April 20 he looked "quote shattered" and would talk to himself. Even weeks after the invasion he could not sleep 6r.

psycho-active poly-pharmacy
During the first six months of his presidency, Kennedy's physicians "administered large doses of so many drugs that [Dr. Janet] Travell kept a `Medicine Administration Record'" 7b. Many of the drugs Kennedy received affect thinking:
cortisone[injected] Cortisol has profound psychological effects. At one extreme, "steroid psychosis" can result. At the other, a profound sensation of well-being can occur. In between, the effects are more difficult to characterize.
cortisone[oral]
lomotilFor diarrhea. Contains anti-cholinergic compounds, which, in toxic doses, can make someone "mad as a hatter."
paregoricFor diarrhea. Contains opium. Mentation is probably unaffected if used in reasonable doses, but Kenndey was taking at least 3 medications for diarrhea, suggesting that doses were high.
phenobarbitalA classic "downer"
testosteroneWas Kennedy's "bull-like" libido a side effect of testosterone? Was his cholesterol level of 410?
trasentineAn anti-diarrhea medication. There is very little published about this drug. Side effects include giddiness and euphoria.
TuinalA mixture of secobarbital and amobarbital Kennedy used to help him sleep. Amobarbital is better known as Amytal, one of the more common "truth serum" drugs.
amphetaminesPost and Robins, writing in 1993, thought it was "highly suggestive" that Kennedy took amphetamines while President, but considered it unproven 14a. The recent Atlantic article states definitively that Kennedy received injections of amphetamines and painkillers from "Dr. Feelgood," a.k.a. Max Jacobson 7b. Kennedy dismissed concerns about the injections, saying, "I don't care if it's horse piss. It works." Jacobson's medical license was revoked in 1975. Previously, in 1969, all controlled substances in his possession were confiscated by the Bureau of Narcotics and Dangerous Drugs 14a. It is thought that Kennedy was under the influence of amphetamines when he made his "Ich bin ein Berliner" speech 14a.

To put things in a different light, if an officer in the U.S. Air Force were taking any one of these medications, he or she would not even be allowed to talk on the radio to aircraft as supervisor of flying. Kennedy, as commander-in-chief, was supervisor for the entire Air Force.

Question: Did the Bay of Pigs result from Kennedy talking, or was it the testosterone talking? MORE


head movement
Massive sympathetic discharge is postulated to cause his head to move toward the bullet's approach path 8.

Some think that Kennedy's back brace killed him 4a 7. It kept him erect after Oswald's first bullet went through his neck. Had he been able to fall forward after this first bullet hit, the second, fatal bullet may have missed him.


resuscitated?
There is a legend that Kennedy's heartbeat was resuscitated in the Parkland ER. But now what are you going to do with a President whose brain has flowed out onto the stretcher?

three last rites
Kennedy received the last rites three times:
    1. On the ocean liner Queen Mary in September 1947, bringing him home from London where he had received the diagnosis of Addison disease and been hospitalized 6t
    2. A post-operative urinary tract infection in October 1954 put Kennedy into a coma 6u
    3. [Presumably after being shot. Still looking to see if there was an additional time.]
Odds & Ends
Resources
 
Kennedy
207 reviews
 
Dallek
131 reviews
 
Kennedy
114 reviews
 
Schlesinger Jr.
25 reviews
Brinkley
8 reviews
Giglio
4 reviews
Cited Resources
  1. Beschloss, Michael. [Interview]. PBS NewsHour with Jim Lehrer. KQED-TV, San Francisco, 21 January 2005. The interview was about an exhibition at the National Archives of photographs of Presidents in casual situations..
    Comment: Web site for the interview, including a picture: http://www.pbs.org/newshour/bb/media/jan-june05/exhibit_01-21.html
  2. Boller, Paul F. Jr. Presidential Anecdotes. New York: Oxford University Press, 1981.0195029151 Libraries 80-27092. ap. 300
  3. Bumgarner, John R. The Health of the Presidents: The 41 United States Presidents Through 1993 from a Physician's Point of View. Jefferson, NC: MacFarland & Company, 1994.0899509568 Libraries 93-42000. app. 234-249 bp. 234, 235 cpp. 234, 235 dp. 234 ep. 235 fpp. 240-241 gp. 243
    Comment: Devotes one chapter to each President, through Clinton. Written for the layperson, well-referenced, with areas of speculation clearly identified, Dr. Zebra depends heavily on this book. Dr. Bumgarner survived the Bataan Death March and has written an unforgettable book casting a physician's eye on that experience.
  4. Cooper, Pauline. The Medical Detectives. New York: David McKay, 1973.067950382X Libraries 73-79947. ap. 198 bp. 209
  5. Crenshaw, Charles A.; Hansen, Jens; Shaw, J. Gray. JFK: Conspiracy of Silence. New York: Signet, 1992.0451403460 Libraries NIL. ap. 74
    Comment: This book has been roundly criticized by other physicians involved in the Kennedy case.
  6. Dallek, Robert. An Unfinished Life: John F. Kennedy 1917-1963. Boston: Little, Brown, 2003.0316172383 Libraries 2002116388. ap. 27 bp. 28 cp. 71 - this practice was recommended by a prominent pediatrician of the day dp. 103 ep. 102 fp. 123 gpp. 195, 212 hp. 212 ip. 46 - worried about fathering a child jp. 150 kp. 99-100 lp. 299 mpp. 299-300 np. 320 opp. 105 pp. 322 qp. 37 rp. 367 sp. 366 tp. 153 up. 196 vp. 33 wp. 370 xp. 372 yp. 105 zpp. 22, 71 aap. 72 abp. 11
  7. Dallek, Robert. The medical ordeals of JFK. Atlantic Monthly. 2002 (Dec);290(5):49-61. ap. 61 bp. 60
  8. Lattimer JK, et al. An experimental study of the backward movement of President Kennedy's head. Surg Gynecol Obstet. 1976 Feb;142(2):246-54. Pubmed 1108248.
  9. MacMahon, Edward B. and Curry, Leonard. Medical Cover-Ups in the White House. Washington, DC: Farragut, 1987.0918535018 Libraries 87-81241. ap. 121 bp. 120 cp. 133
  10. Mandel LR. Endocrine and autoimmune aspects of the health history of John F. Kennedy. Annals of Internal Medicine. 2009; 151: 350-354. aciting Dallek and Kelleman
    Comment: Available on the web at: http://annals.org/cgi/content/full/151/5/350
  11. Marion, Robert. Was George Washington Really the Father of our Country?. Reading, MA: Addison-Wesley, 1994.0201622556 Libraries 93-26588. ap. 174 bp. 175 cpp. 177-178
  12. Nicholas JA, Burstein CL, Umberger CJ, Wilson PD. Management of adrenocortical insufficiency during surgery. Archives of Surgery. 1955;71:737-742.
    Comment: JFK is case 3
  13. O'Leary C, Walsh CH, Wieneke P, O'Regan P, Buckley B, O'Halloran DJ, Ferriss JB, Quigley EM, Annis P, Shanahan F, Cronin CC. Coeliac disease and autoimmune Addison's disease: a clinical pitfall. QJM. 2002 Feb;95(2):79-82. Pubmed 11861954.
  14. Post, Jerrold M. and Robins, Robert S. When Illness Strikes the Leader: The Dilemma of the Captive King. New Haven, CT: Yale University Press, 1993.0300063148 Libraries 92-25302. app. 69-70
    Comment: At one time Post worked for the CIA, profiling foreign leaders.
  15. Summers, Anthony; Dorril, Stephen. Honeytrap: The Secret Worlds of Stephen Ward. London: Weidenfeld & Nicolson (91 Clapham High St. SW4 7TA), 1987.0297791222 Libraries. a(plate caption) bp. 69
    Comment: Much sensationalism and drivel has been written about JFK. Thus, it is very hard for anyone devoting less than full time to Kennedy studies to discern what is credible and what is not. This book strikes me as containing a mixture of credible, verifiable statements and statements best treated with skepticism.
  16. Travell, Janet. Office Hours: Day and Night. Cleveland, OH: New American Library, 1968. Libraries 68-57422. ap. 5
    Comment: Travell was one of Kennedy's physicians during his Presidency. Although all autobiographies are inherently narcissistic, the level in this one is tough to stomach -- almost as bad as Jerry Linenger's, in fact.
Other Resources
Alternate index terms: John Fitzgerald Kennedy, Jack Kennedy, JFK
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