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 and given the last rites three times.
Bumgarner provides an excellent short recap of Kennedy's medical history, although the new medical sources pioneered by Dallek are leaving it behind.
Dr. Lee Mandel 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 1995 and was under treatment for years.
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.
Infections scarlet fever Contracted scarlet fever in Feb. 1920 (age 2 years, 9 months) and almost died.
Infections
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 and bronchitis.
Liver jaundice
He suffered at least one episode of jaundice as a youth. Jaundice in 1935 has been interpreted as Addisonian hyperpigmentation, but Dr. Zebra rather doubts the two conditions are easily confused.
Traumav 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.
Miscellaneous minor childhood ills
Kennedy's mother kept a card file on the medical problem of her children. The entries for John (more commonly known as Jack) included:
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.
Miscellaneous 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".
EyeInfections reading glasses in youth
Another entry in the Kennedy card file says "March 21, 1931: Glasses prescribed for reading by Dr. John Wheeler". 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, so there was at least a suspicion that he had it.
Gastrointestinal colitis
Kennedy had digestive troubles as early as 1934 (age 17). Years later, when he joined the Navy, these were described as "severe spastic colitis". Dallek believes steroid treatment of Kennedy's colitis began in 1937 and ascribes several later medical problems to complications of steroids.
Anthropometrics 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.
From age 20 to age 43, available data show that Kennedy's weight was more or less constant -- about 155-160 pounds, (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".
Blood
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.]
Blood pernicious anemia (?)
In 1966 Dr. Janet Travell recalled: "When I first saw him [May 26, 1955] he was extremely anemic. He had impaired vibration sense which is indicative of peripheral neuritis... characteristic of a vitamin B1 deficiency". (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".
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. 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.
Endocrine 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).
In both 1935 and 1939, Kennedy's basal metabolic rate was -11, which Dr. Walter Alvarez regarded as "well within normal limits".
EndocrineReproductive gonadal function
Kennedy took daily testosterone pills throughout his Presidency.
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. It has been written that Kennedy took testosterone to keep his weight up. This may be true, as he gained 15-20 pounds between July 1960 and January 1961.
DoctorEndocrineMusculoskeletonGastrointestinal steroid complications
Dallek believes steroid treatment of Kennedy's colitis began in 1937. 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 and back problems. (Steroids cause thinning of bones.) Steroids also altered the shape of Kennedy's face 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. 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).
UrologicInfections? 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. At some point the illness was described as "a mild, chronic, non-specific prostatitis." Sulfa drugs were able to suppress the symptoms. As late as May 1955 he still had "prostatitis marked by pain when urinating and ejaculating, as well as urinary tract infections".
In January 1956 he underwent cystoscopy under anesthesia. Comment: Was this a sexually transmitted disease? The response to sulfa suggests it was infectious. Kennedy had a large number of sexual contacts before he was even out of college, and it seems unlikely he practiced safe sex. As one female acquaintance remarked, "He was not much for planning ahead".
Musculoskeleton back
Back problems started in 1938. From 1941 they were "a constant source of difficulty". [There is much history here, yet to come.] Dallek has suggested that steroid treatments, "which apparently began in 1937," may have been causative.
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. Some people think this back brace killed him.
SkinTrauma 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!'"
Kennedy took 10 days to recover from "symptoms of fatigue and many deep abrasions and lacerations of the entire body, especially the feet".
InfectionsSkin 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. Whether the green hue was caused by atabrine, Addisonism, or something else is unclear.
Tobacco 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".
EnergyPsychiatry 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". 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.
Sleep fatigue or hypersomnolence
Kennedy was not especially concerned with the Department of Agriculture. While interviewing a candidate for ?secretary, Kennedy fell asleep.
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.
Endocrine 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. 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". Adrenal insufficiency, no matter how caused, is a serious matter.
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". 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. In fact, JFK's case was published in the medical literature in 1955, although this was not publicly realized until 1967. 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.
EyeAnthropometrics 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.
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.
SkinEndocrine 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".
Gastrointestinal 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.
PsychiatryReproductive libido
In 1963 JFK confided to Britain's Prime Minister Macmillan that he got a headache if he went too long without a woman. 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".
Kennedy was taking testosterone in 1963, 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.
GastrointestinalUrologic 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.
Psychiatry 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. 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.
Psychiatry 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'" [6b]. 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] lomotil
For diarrhea. Contains anti-cholinergic compounds, which, in toxic doses, can make someone "mad as a hatter."
paregoric For 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.
phenobarbital
A classic "downer" testosterone
Was Kennedy's "bull-like" libido a side effect of testosterone? Was his cholesterol level of 410?
trasentine An anti-diarrhea medication. There is very little published about this drug. Side effects include giddiness and euphoria.
Tuinal
A 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.
amphetamines
Post and Robins, writing in 1993, thought it was "highly suggestive" that Kennedy took amphetamines while President, but considered it unproven. The recent Atlantic article states definitively that Kennedy received injections of amphetamines and painkillers from "Dr. Feelgood," a.k.a. Max Jacobson. 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. It is thought that Kennedy was under the influence of amphetamines when he made his "Ich bin ein Berliner" speech.
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?
Trauma head movement
Massive sympathetic discharge is postulated to cause his head to move toward the bullet's approach path.
Some think that Kennedy's back brace killed him. 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.
TraumaDeath 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?
Death three last rites
Kennedy received the last rites three times:
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
A post-operative urinary tract infection in October 1954 put Kennedy into a coma
[Presumably after being shot. Still looking to see if there was an additional time.]
JFK had scarlet fever, diphtheria, and whooping cough as a child. At age 14 he weighed 95 pounds.
JFK had allergies, poor hearing, a sensitive stomach, and an old knee injury that occasionally caused him to limp.
On school entrance exams in 1931, Kennedy scored 119 on an IQ test.
Commenting on Kennedy's temperament, a White House speechwriter observed: "there was an inner hardness, often volatile anger, beneath the outwardly amiable, thoughtful, carefully controlled demeanor of John Kennedy". Kennedy described himself as "always on the edge of irritability" as President.
JFK's sister, Eunice Kennedy Shriver, had Addison disease. His son, John F. Kennedy Jr., had Graves disease.
Another sister, Rosemary, was retarded from the time of her birth during the 1918 influenza pandemic. However, the cause of her condition was (and remains) unknown. At age 21 she became violent and underwent a pre-frontal lobotomy that "proved to be a disaster." She spent the rest of her life in an institution.
McKusick cites Jacqueline Kennedy Onassis as exemplar of telecanthus (increased separation of the medial canthi without abnormal separation of the orbits).
JFK's history number at Parkland was 24740. Governor John Connally was #24743.
The first physician to see Kennedy at Parkland had delivered Oswald's baby one month before.
Kennedy's mother was the product of a consanguineous union between second cousins. This clearly did not affect her longevity!
Where are his adrenals now? NIH?
