The Medical Ordeals of JFK

Recent assessments of Kennedy's presidency have tended to raise "questions of character"—to view his Administration in the context of his sometimes wayward personal behavior. Such assessments are incomplete. Newly uncovered medical records reveal that the scope and intensity of his physical suffering were beyond what we had previously imagined. What Kennedy endured—and what he hid from the public—both complicates and enlarges our understanding of his character
What Steroids Did to Him

In the late 1930s the first clinical use of corticosteroids—which are compounds derived from adrenal extracts, and which have come to be used to reduce tissue inflammation—was made possible when doctors learned how to administer DOCA (desoxycorticosterone acetate) in the form of pellets implanted under the skin. It is now well established that Kennedy was treated with DOCA after his Addison's disease was diagnosed, in 1947. But it is possible that Jack was taking DOCA as early as 1937. Early that year, in a handwritten note to his father after a family vacation, Jack worried about getting a prescription filled in Cambridge, Massachusetts, where he was a freshman at Harvard College. "Ordering stuff here very [illegible word]," he wrote to his father. "I would be sure you get the prescription. Some of that stuff as it is very potent and he [Jack's doctor] seems to be keeping it pretty quiet." Given that corticosteroids had just become clinically viable and were being touted as a therapeutic cure-all, it is reasonable to hypothesize that the prescription Jack asked for was DOCA. Moreover, nine years later, in 1946, Paul Fay, one of Jack's friends, watched him implant a pellet in his leg. The way in which the medication was administered indicates it was DOCA. Fay remembers Jack's using "a little knife ... [to] just barely cut the surface of the skin, try not to get blood, and then get underneath and put this tablet underneath the skin, and then put a bandage over it." Then, he said, "hopefully this tablet would dissolve by the heat of the body and be absorbed by the bloodstream." In short, it appears that Jack was on steroids—still an experimental treatment, with great uncertainty as to dosage—for his colitis well before the Addison's disease diagnosis.

If so, he may have paid a high price. Physicians in the 1930s and 1940s did not realize what is common medical knowledge today—namely, that corticosteroids are effective in treating acute colitis but have deleterious long-term effects, including osteoporosis of lower-back bones and increased incidence of serious infection (owing to suppression of the body's immune system). Kennedy would suffer from all these problems, including outright degeneration of his lumbar spine. In addition, the long-term use of cortico-steroids suppresses normal adrenal function; it may have been the cause of Kennedy's Addison's disease. (Jack's sister Eunice also had Addison's, however, indicating that his disease may have had an inherited component.)

From September of 1934 to June of 1935, Jack's senior year of prep school, the school infirmary had kept a close watch on his blood count; Joe Kennedy passed these records on to the Mayo doctors. At that time there was still concern that Jack might be suffering from leukemia. In retrospect, any changes in his blood count may have been a reaction to the drugs he was taking. When he fell ill the following autumn, a doctor advised that Jack had agranulocytosis, a decrease in granular white blood cells, which made him more susceptible to infections.

Shortly after leaving Choate, Jack had to spend two months at the Peter Bent Brigham Hospital, in Boston. Uncertain whether they were dealing strictly with colitis or with a combination of colitis and ulcers, and worried that his medicines were playing havoc with his white-blood-cell count, his doctors performed additional tests. According to a letter Jack wrote to Billings, his white-blood-cell count was 6,000 when he entered the hospital and down to 3,500 three weeks later. "At 1500 you die," Jack joked. "They call me '2000 to go Kennedy.'"

By the end of January 1936 he was more worried than ever about his health, though he continued to use humor to defend himself against thoughts of dying. "Took a peak [sic] at my chart yesterday and could see that they were mentally measuring me for a coffin. Eat drink & make Olive [his current girlfriend], as tomorrow or next week we attend my funeral. I think the Rockefeller Institute may take my case ... Flash—they are going to stick that tube up my ass again as they did at Mayo."

From 1938 to the end of 1940, while Kennedy attended Harvard, intestinal problems plagued him relentlessly. In February of 1938 he had gone back to the Mayo Clinic for more studies, but with no good results. In June he spent two weeks in New England Baptist Hospital for the same complaints, but again with no improvement. In October he was still "in rotten shape," but he refused to re-enter the hospital for more of what now seemed like pointless tests. In February of 1939, however, he gave in and went back to the Mayo Clinic. It was the same old routine: a diet of bland foods three times a day and another inspection of his colon and digestive system. By November, under the care of William Murphy, of Harvard, the physician and Nobel laureate who co-discovered the treatment for pernicious anemia and had an uncommon faith in the healing power of liver extracts, Jack recorded that he was going to "take my first liver injection today and I hope they work." They did not. A year later he was still wrestling with abdominal pain, spastic colon, and low weight. If he was taking DOCA and it was limiting the effects of his colitis (and it is not clear that it was), it was certainly worsening his stomach problems. The steroids may also have contributed to the onset of duodenal ulcers, which weren't diagnosed until November of 1943. But there would be no public acknowledgment of any of these ailments, or any outwardly evident self-pity. Refusing to let health concerns stop him became a pattern that allowed Kennedy to pursue a political career.

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