Health and Medical History of President

John Adams

President #2
Lived: 1735-1826 Served: 1797-1801

Timeline from 1776: ← 2013

"I have lived in this old and frail tenement a great many years; it is very much dilapidated; and, from all I that I can learn, my landlord doesn't intend to repair it." 2a

Maladies and Conditions

small, but muscular
Adams, as a teenager, was described by his father: "He was almost a man grown. He wasn't tall, not above five feet tall, but his shoulders were heavy. He was well knit, muscular, and quick and sure in his movements. His color was unusually high; just now his face was red from exertion, his blue eyes blazed." 3a

breakfast beer
At age 15 Adams was admitted to Harvard, where the food was described as "very poor." His breakfasts consisted of beer and bread 3a. Comment: It is possible the word "beer" in the mid-1700s did not always refer to an alcohol-containing beverage.

respiratory infection
He developed a severe cold during the winter of his first year at Harvard. Home on winter vacation in February, his mother remarked: "He was positively puny, and where were his fine red cheeks?" 3a

smallpox inoculation
As Adams finished his first winter vacation at home, there was an outbreak of smallpox in Boston. He had not yet been inoculated against the disease. Instead of undergoing inoculation and missing four weeks of classes (see below), Adams braved the epidemic and returned to campus 3a.

During the smallpox epidemic of 1764 in Massachusetts, Adams, pressured by his mother 3b, decided to be inoculated. This was no small matter, as vaccination eventually became in the 20th century. Patients prepared themselves days ahead of time, and were often sick for weeks afterwards 1. Comment: Inoculation is different from vaccination. Inoculation introduces smallpox virus into the recipient. Vaccination introduces vaccinia virus into the recipient. Vaccinia confers protection against smallpox infection, but with far fewer side effects, since it is a much less virulent virus. Edward Jenner, the inventor of vaccination, should be high on everyone's list of greatest-ever human beings.

Ultimately, Adams was inoculated and spent three weeks in the hospital, suffering headaches, backaches, kneeaches, gagging fever, and eruption of pock marks MORE.


healthy youth
Adams had good health in youth and early adulthood. From 1755 (age 20) until 1770, he mentions only three illnesses, two of which were one-day episodes of nausea. The third was a bout of upset stomach and headaches lasting a few days, consistent with food poisoning or a virus 7a.

Adams kept a diary, wrote many letters, and wrote an autobiography. "On or near his birthday in most years, Adams reflected in his diary on the previous twelve months. During his twenties and early thirties, he never mentioned ill-health; 'feel well,' he sometimes observed in these annual inventories" 7a.

Comment: Ferling and Braverman 7 appear to have missed the 1756 episode of illness, related below.


baldness
Adams' chrome-dome baldness ran in the family MIM 109200. Comment: This can be a sign of carrying a variant of the polyscystic ovary gene 5 4. Dr. Zebra has not seen evidence that Adams was "abnormally hairy," which is another sign of males carrying the variant gene MIM 184700.

There may have been some hair loss during his Presidency 1a.


depression
Adams' health broke down several times during his life. The first was from recurring attacks of depression in 1756, while studying law. At one point he reported that a ride from Worcester to Shrewsbury left him "weak and aching" 3b. Dr. Nahum Willard (with whom he lodged and boarded) attributed this illness to Adams' long and close hours of study which had "corrupted his whole mass of blood and juices" 3b.

diet, heartburn, purging
Dr. Willard (see above) started Adams on a then-trendy treatment: a milk diet. Adams was told to avoid meats, spices, and spirits in favor of bread, milk, vegetables, and water. Adams improved, but developed severe heartburn which he treated with large portions of tea 3b.

Fourteen years later, Adams was still on this "milk and toast" diet 3c, leading to one description of him as a "food faddist" 1b. "Sometimes Adams would purge himself by taking a vomit of tartar emetic and turpeth mineral, a cathartic prepared from East Indian jalap" 1c. This preparation, Adams lamented, "worked seven times and wrecked me" 1c.

A descendant noted that during the time Adams lived in Philadelphia, he "throve well on turtle, jellies, varied sweetmeats, whipped syllabubs, floating islands, fruits, raisins, almonds, peaches, wines, especially Madeira" 1d.


seasickness
Adams sailed from Massachusetts to France in 1778. The entry in his diary for Feb. 18 10, his first full day at sea, says: "The constant Rolling and Rocking of the Ship, last night made Us all sick -- half the Sailors were so.... I was seized with it myself this Forenoon."

The next day Adams felt well enough to theorize: "The Ship rolls less than Yesterday, and I have neither felt, nor heard any Thing of Sea Sickness, last night nor this Morning.... The Mal de Mer seems to be merely the Effect of Agitation. The Smoke and Smell of Seacoal, the Smell of stagnant, putrid Water, the Smell of the Ship where the Sailors lay, or any other offensive Smell, will increase the Qualminess, but do not occasion it.


smoked and chewed
Adams started smoking intermittently at age 8, continued until at least age 70, and probably beyond. When Adams was 70 years old, his physician, Dr. Benjamin Waterhouse, tried to get Adams to quit, sending him a copy of a lecture entitled "Caution to a Young Person Concerning Health ... showing the Evil Tendency of the Use of Tobacco." Adams read it, apparently enjoyed it, and confessed that he regretted his practice. There is no evidence he quit 1e.

Adams also chewed tobacco, at one point betting a pair of gloves with his landlady (Mrs. Willard, 1856) that "she would not see me chew tobacco this month." The result: "Adams loved tobacco too much to give up the weed" 1e.


somatization
John Adams had a bewildering and vast array of physical symptoms MORE which would manifest during times of stress. Given the times in which he lived, and the work he did, they had cause to manifest often. The earliest episode was in 1756. He had major "collapses" in 1771, 1775 (while serving in the Continental Congress in Philadelphia), and 1781 (while minister plenipotentiary to Europe). As President in 1797, impending war with France elicited his usual constellation of symptoms, but the crisis abated before they became severe.

The symptoms would cluster in time. The shortest of these clusters lasted weeks. The longest lasted years. The 1781 episode supposedly had him comatose for 5 days.

Dr. Zebra spent a huge amount of time trying to convince himself that hyperthyroidism was responsible for these illnesses, as per the theory of Ferling and Braverman 7, but remains unconvinced. Blinderman 1 labels many of these episodes merely as "colds" and accepts that Adams was susceptible to catching cold. Bumgarner 3d suggests that allergies may have been involved.

Comment: There is no obvious way to make sense of it all on the basis of organic illness. Read the tabulation of Adams's ailments and judge for yourself, remembering that the man lived to age 90 -- clearly the [non-]hypochondriac's epitaph ("I told you so") did not apply to Adams. Still, "hard findings," such as Adams' 5-day coma in 1781, cause Dr. Zebra to keep an open mind. For example, Adams had several features of variegate porphyria, a protean disease that can be triggered by psychological stress. The "hard" features that Adams had include coma, weakness, a chronic skin disorder, and a relapsing-remitting course over decades 9. MORE

Far more common than variegate porphyria, however, is somatization -- a disorder in which psychological ailments are translated into physical ailments. It is not an intentional process. No doubt Adams did have episodes of organic disease between 1756 and 1800, but the signal-to-noise ratio is too low to tease them out 200 years later.


somatization #2
Adams knew his health deteriorated under stessful circumstances. As a lawyer he could retreat from stressful situations. But in the Continental Congress and as a diplomat, there was no escape, and he had become dreadfully ill 7b.

As President, Adams was once again able to step back from work and politics. He left the capital when Congress was not in session, spending as much as two-thirds of each year at Peacefield, his home in Massachusetts 7b. This conduct was criticized, including accusations of "a kind of abdication." In 1799 a loyal supporter from Baltimore told Adams outright that the public was outraged by his continued absence: "The people elected you to administer the government. They did not elect your officers ... to govern, without your presence or control" 7c.


erratic
"Historians have long believed that John Adams was given at times to irrational behavior that could only be attributed to emotional instability" 7. Labels such as "manic-depressive," "slightly paranoid," and "a man consumed by an irrepressible urge to master the world" have been applied to Adams MORE 7d. Both he and his mother had quick tempers and labile moods, able to move from the highest spirits to the deepest despondency. Adams could be meek or rash, cautious or explosive 3c. Further musings on this topic will be left to psychiatrists.

maybe hyperthyroid
Ferling and Braverman suggest the underlying cause of Adams' erratic behavior and multiple maladies over a period of decades was unrecognized hyperthyroidism. (The function of the thyroid glad was unknown in Adams' time.)

Adams had several classic signs and symptoms of hyperthyroidism, including: weakness, heat intolerance, sweating, tremor, protruberant eyes, weight loss despite eating well, and a growth in his neck (perhaps a goiter).

Comment: Their hypothesis is tenable because hyperthyroidism is one of the few disorders that can produce enough different symptoms to rival the symptoms Adams displayed. It is weakened, however, by the clear association of mental stress with the waxing and waning of Adams' illnesses. There are some reports that Graves disease (a common cause of hyperthyroidism, as George H.W. Bush discovered), can flare during stress, but the stress correlation in Adams is too profound to be explained by Graves disease. There is also the question of Adams' apparently complete remission from his unusual symptoms once he began the transition out of political life in 1800. Ferling and Braverman mention that little is known about the natural history of untreated Graves disease, so their hypothesis is not clearly able to explain this striking feature of Adams' history.


liked alcohol
In May 1777 sea lanes were constrained, and Adams was deprived of his favorite alcoholic beverages 3e, with Madeira wine possibly near the top of the list 1d. From Philadelphia, Adams wrote to his wife in Massachusetts:
I would give three guineas for a barrel of your cyder. Not one drop of it to be had here for gold, and wine is not to be had under sixty-eight dollars per gallon, and that very bad. I would give a guinea for a barrel of your beer. A small beer here is wretchedly bad. In short, I am getting nothing that I can drink, and I believe I shall be sick from this cause alone. Rum is forty shillings a gallon, and bad water will never do in this hot climate in summer where acid liquors are necessary against infection 3e.
This note reminds us that bad water was a major threat to life in the 18th century, and that alcohol might then have been the healthier alternative.

boils
While in Holland in April 1782, Adams developed numerous boils. 3f.

snored
Reliability of this information is uncertain. 6

tremor
Adams had a tremor, which he called "quiverations," in his hands for many years 3f. Tremor appeared as early as 1775 7e and got worse as he got older 3f. As the newly inaugurated Vice President in May 1789, Adams addressed the Senate, but his hands shook so much (despite pushing on his hat to steady them) that he could read the speech only with difficulty. Ultimately he gained more control and was able to finish 3f.

poor vision
As part of his somatization, Adams frequently complained about his eyes MORE. By the end of his Presidency, he doubtless had real ocular problems: "his eyes weakened so that he could barely read or write." In 1811 Adams reported that he read better since spectacles had been prescribed for him 1a.

no teeth, lisped
When Adams lost his teeth, he refused to wear false ones. As a result, he had a lisp when speaking 1c. In later years Adams had trouble speaking. After encountering a fellow senior citizen in 1811, Adams wrote: "He is above 80. I cannot speak, and he cannot hear. Yet we converse" 1a.

rheumatism
Rheumatism afflicted Adams late in life. Dr. Waterhouse recommended rubbing a coarse Russian "krosh" cloth over the affected areas, being "careful not to rub off the skin." (Waterhouse believed that brushing a horse was done to prevent rheumatism.) 1f

old age
Aged 90, Adams's death was ascribed by a descendant to "merely the cessation of the functions of a body worn out by age" 1a. Bumgarner, admitting the paucity of evidence, hypothesizes congestive heart failure as the cause of death 3.

It is often related that Adams' last words were: "Thomas Jefferson survives." In fact, "the last word was indistinct and imperfectly uttered" 1a.

Odds & Ends
Resources
 
McCullough
1020 reviews
Ferling
35 reviews
 
Ferling
14 reviews
Diggins
15 reviews
Brown
1 review
Cited Resources
  1. Blinderman, A. John Adams: fears, depressions, and ailments. NY State J Med. 1977;77:268-276. Pubmed 320523. ap. 274 bp. 268 cp. 273 dp. 269 ep. 270 fp. 273-274 gp. 273 (Blinderman says 1788, but Adams' diary dates the amputation as March 14, 1778) hp. 272
    Comment: Covers all aspects of Adams and medicine. Sections include Adams' relation to the medical profession, his thoughts on health, his health history, and his encounters with smallpox.
  2. Boller, Paul F. Jr. Presidential Anecdotes. New York: Oxford University Press, 1981.0195029151 Libraries 80-27092. ap. 36
  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. ap. 9 bp. 10 cp. 11 dpp. 9-15 ep. 12 fp. 13
    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. Carey AH, Waterworth D, Patel K, et al. Polycystic ovaries and premature male pattern baldness are associated with one allele of the steroid metabolism gene CYP17. Hum. Mol. Genet. 1994;3:1873-6. Pubmed 7849715.
  5. Carey, A. H.; Chan, K. L.; Short, F.; White, D.; Williamson, R.; Franks, S. Evidence for a single gene effect causing polycystic ovaries and male pattern baldness. Clin. Endocr. 1993; 38: 653-658. Pubmed 8334753.
  6. Dugan, James. Bedlam in the boudoir. Colliers. 22 Feb. 1947; pages 17, 69-70.
    Comment: Credibility is dubious. Just before a list of Presidents, the article states: "Twenty of the 32 Presidents ... are proved or believed on a thick web of circumstance to have been nocturnal nuisances in the White House."
  7. Ferling, John; Braverman, Lewis E. John Adams's health reconsidered. William and Mary Quarterly, 3rd series. 1998;LV(1):83-104. ap. 85 bp. 98 cp. 104 dp. 84 ep. 88
    Comment: Thanks to Shawn Pirelli for this reference.
  8. Montgomery-Massingberd, Hugh (ed). Burke's Presidential Families of the United States of America. 2nd ed. London: Burke's Peerage Limited, 1981.0850110335 Libraries. app. 57, 69
    Comment: Enumerates the ancestors and descendants of American presidents up through Ronald Reagan.
  9. Web page: http://www.masshist.org/digitaladams/aea/
    Comment: The Massachusetts Historical Society has searchable transcriptions of Adams' letters and autobiography available online. Letters written by his wife are also included. One of variegate porphyria's hallmarks is urine that turns red after a time. On Dec. 15, 2003 Dr. Zebra searched for the following terms in the documents above, without finding any references to Adams' urine: "urin*", "make water", "piss*", "color" (which also included colour), and "discharg*".
  10. Web page: http://www.masshist.org/digitaladams/aea/
Other Resources
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