In Kennedy File, a Portrait of Illness and Pain
November 17, 2002 By LAWRENCE K. ALTMAN and TODD S. PURDUM
WASHINGTON, Nov. 16 - The first thorough examination of President John F. Kennedy's medical records, conducted by an independent presidential historian with a medical consultant, has found that Kennedy suffered from more ailments, was in far greater pain and was taking many more medications than the public knew at the time or biographers have since described.
As president, he was famous for having a bad back, and since his death, biographers have pieced together details of other illnesses, including persistent digestive problems and Addison's disease, a life-threatening lack of adrenal function.
But newly disclosed medical files covering the last eight years of Kennedy's life, including X-rays and prescription records, show that he took painkillers, antianxiety agents, stimulants and sleeping pills, as well as hormones to keep him alive, with extra doses in times of stress.
At times the president took as many as eight medications a day, says the historian, Robert Dallek. A committee of three longtime Kennedy family associates, who for decades refused all requests to look at the records, granted Mr. Dallek's, in part because of his "tremendous reputation," said one of them, Theodore C. Sorensen, who was the president's special counsel.
Mr. Dallek is writing a biography, "An Unfinished Life: John F. Kennedy, 1917-1963," to be published next year by Little, Brown. He was allowed to examine the records over two days last spring in the company of a physician, Jeffrey A. Kelman, and to make notes but not photocopies. Their findings appear in the December issue of The Atlantic, and they discussed them in interviews with The New York Times. The new information shows how far Kennedy went to conceal his ailments and shatters the image he projected as the most vigorous of men. It is a remarkable example of a phenomenon that has been seen many times, notably in the case of Franklin D. Roosevelt.
Yet for all of Kennedy's suffering, the ailments did not incapacitate him, Mr. Dallek concluded. In fact, he said, while Kennedy sometimes complained of grogginess, transcripts of taped conversations during the Cuban missile crisis in 1962 and other times show the president as lucid and in firm command.
By the time of the missile crisis, Kennedy was taking antispasmodics to control colitis; antibiotics for a urinary tract infection; and increased amounts of hydrocortisone and testosterone, along with salt tablets, to control his adrenal insufficiency and boost his energy.
The records show that Kennedy was hospitalized for back and intestinal ailments in New York and Boston on nine previously undisclosed occasions from 1955 to 1957, when he was a senator from Massachusetts, campaigning unsuccessfully for the 1956 Democratic vice-presidential nomination - and quietly planning his 1960 presidential bid.
In December 1962, after Jacqueline Kennedy complained that he seemed "depressed" from taking antihistamines for food allergies, he took a prescribed antianxiety drug, Stelazine, for two days. At other times he took similar medications regularly.
The records show that Kennedy variously took codeine, Demerol and methadone for pain; Ritalin, a stimulant; meprobamate and librium for anxiety; barbiturates for sleep; thyroid hormone; and injections of a blood derivative, gamma globulin, presumably to combat infections.
In the White House, Kennedy received "seven to eight injections of procaine in his back in the same sitting" before news conferences and other events, Dr. Kelman said.
The president had so much pain from three fractured vertebrae from osteoporosis that he could not put a sock or shoe on his left foot unaided, the records reveal. He sometimes reported waking before dawn with severe abdominal cramps.
In August 1961, the records show, Mrs. Kennedy rushed in from another room when he screamed in pain as the White House physician, Dr. Janet G. Travell, injected procaine deep into his back muscles to numb them.
While not a complete record of Kennedy's lifetime medical history, much of which remains sealed in private hospitals, the disclosures provide a broad, authoritative view.
The records are largely from Dr. Travell, a specialist in internal medicine and pain management who treated Kennedy for years before ultimately being eased aside after bitter arguments with other doctors about his care. She gathered files from before and after he became president in 1961. Kennedy's widow and brothers, Robert and Edward, donated them in 1965 to the Kennedy Library, Deborah Leff, the library's director, said, and a half-dozen scholars who sought permission to see them over the years were rebuffed.
In The Atlantic, Mr. Dallek writes that while Kennedy's secrecy can be taken as "another stain on his oft-criticized character," the records also reveal the "quiet stoicism of a man struggling to endure extraordinary pain and distress."
Senator Edward M. Kennedy said that his family abided by the committee's decision to make all judgments like releasing the medical records.
"While not aware of the exact details of my brother's medical condition," Mr. Kennedy said, "I did see the great courage he exhibited throughout his life in triumphing over illness and pain."
Dr. Kelman, a specialist in internal medicine and physiology in Collington, Md., said: "The most remarkable thing was the extent to which Kennedy was in pain every day of his presidency."
Mr. Dallek first sought permission to examine the records about three years ago. The committee that controls them is led by Burke Marshall, 80, a former Justice Department official under Robert F. Kennedy. The other members are Mr. Sorensen, 74, and Samuel Beer, 90, an emeritus professor of government at Harvard.
Mr. Marshall and Professor Beer favored granting Mr. Dallek's request, he said, but Mr. Sorensen was reluctant.
"I was with J.F.K. for 11 years," Mr. Sorensen said in an interview, "and for so many of those I was trying to refute, rebut rumors that he was suffering from this disability or that, and that's why as a general rule, if those medical files were placed in the library under very restricted conditions by the family, as the family's nominee, I just couldn't agree that they would be opened to any Tom, Dick or Harry because I knew a bunch of them would seek to exploit them."
But he and Mr. Dallek "had a long talk, and I just decided on the basis of that talk that I could trust him," Mr. Sorensen said, adding with a rueful chuckle, "probably contrary to everything J.F.K. taught me."
Mr. Dallek said that in the archives, he and Dr. Kelman found boxes apparently untouched for years, including about 10 boxes of X-rays.
For many years, Kennedy's back problems were largely attributed to injuries suffered when his Navy patrol boat, PT-109, was sunk in World War II. In fact, he had back pain before that. Mr. Dallek said his vertebrae may have begun degenerating as a result of the steroids he may have taken for intestinal problems in the late 1930's.
For much of his life, Kennedy also suffered from severe and potentially dangerous bouts of diarrhea, which doctors suspected might have been from ulcerative colitis. Repeated examinations did not confirm that. Their ultimate diagnosis was spastic colitis, which today would be described as irritable bowel syndrome.
Kennedy took antidiarrheal drugs like Lomotil for relief, and he lost so much weight and strength from his ailments that he received the male hormone, testosterone, to build up his muscles. He also had high blood cholesterol, often in the range of 300, once at 410, which is twice the level now considered desirable.
In 1954, doctors in Manhattan inserted a metal plate to fuse Kennedy's damaged vertebrae, but an abscess forced its removal. Later he developed abscesses at the site of injections, and one had to be drained surgically, the records show.
The records show that Kennedy had "a tremendous proclivity for infections," Dr. Kelman said, contradicting Dr. Travell's assertion in 1960 that Kennedy had "a better than average resistance to infection" and "astounding vitality."
Dr. Travell, who died in 1997, had also said that Kennedy's back trouble was cured, which the records clearly show was not the case.
The records say nothing about treatment by Dr. Max Jacobson, a Manhattan physician who later lost his medical license for prescribing amphetamines. The Times detailed his involvement years ago, but the files said "nothing, nil," about Dr. Jacobson, Mr. Dallek said.
Earlier accounts have said that Kennedy was first known to have adrenal insufficiency in 1947, but there are strong hints that he was treated many years earlier. The disease affects the adrenal glands, which produce hormones to regulate blood sugar, sodium, potassium and the response to stress. Its symptoms, including fatigue, vomiting, diarrhea and low blood pressure, can be life-threatening. Treatment with steroids was first used in the late 1930's.
Dr. Kelman and Mr. Dallek said the records suggested at least two hypotheses about Kennedy's illnesses. One is that he developed a number of medical conditions independently early in life, including colitis and osteoporosis. If so, he had "markedly washed-out bones at an early age," Dr. Kelman said. X-rays in the new files showed the spinal fractures and metal screws in the vertebrae. This is especially intriguing because Kennedy's autopsy report found "no significant gross skeletal abnormalities," aside from the bullet wounds in the skull. Many experts have criticized the report, and Mr. Dallek's findings raise new questions.
A second theory is that Kennedy developed adrenal insufficiency as a youth, and that steroid treatment for colitis alleviated the undiagnosed adrenal condition, possibly leading to the spinal fractures and chronic adrenal insufficiency. The only evidence to support this is a witness account of Kennedy's implanting pellets in his leg in 1946, a year before receiving the "official" diagnosis from doctors in London.
Addison's disease was first described in the 1850's, when most cases were from tuberculosis. Kennedy, his family, Dr. Travell and other aides obfuscated the issue by denying that he had Addison's from tuberculosis. Dr. Travell said in 1959 that the PT boat incident and possibly malaria led to "a depletion of adrenal function from which he is now rehabilitated," without saying he was still being treated. The records show no evidence that Kennedy was tested for tuberculosis, Dr. Kelman said.
In November 1960, asked by a reporter about the rumor of Addison's disease, the newly elected president flatly denied having it.
Arthur M. Schlesinger Jr., the historian and Kennedy aide, wrote in "A Thousand Days" that he asked Kennedy in 1959 about Addison's and was told: "No one who has the real Addison's disease should run for the presidency, but I do not have it."
In an interview this week, Mr. Schlesinger, 85, said that Kennedy "did draw a distinction between true Addison's and broadly construed Addison's" but that he did not know why. He said he had never been aware of the president's pain, except when he was unable to pick up his children, for example. "I mean, he never uttered a word of self-pity or complaint," Mr. Schlesinger said.
Indeed, in one of his most famous presidential epigrams, Kennedy declared in 1962, "Life is unfair." Most citations omit the words that followed, "Some people are sick and others are well."
http://www.nytimes.com/2002/11/17/politics/17JFK.html?ex=1038479954&ei=1&en=97cc511baee4692a
-- Marta Russell Los Angeles, CA http://www.disweb.org