During his time in the White House, despite public indications of continuing back difficulties, Kennedy enjoyed an image of robust good health. But according to the Travell records, medical attention was a fixed part of his routine. He was under the care of an allergist, an endocrinologist, a gastroenterologist, an orthopedist, and a urologist, along with that of Janet Travell, Admiral George Burkley, and Max Jacobson, an émigré doctor from Germany who now lived in New York and had made a reputation by treating celebrities with "pep pills," or amphetamines, that helped to combat depression and fatigue. Jacobson, whom patients called "Dr. Feelgood," administered amphetamines and back injections of painkillers that JFK believed made him less dependent on crutches.
When Kennedy went to France, in June of 1961, to meet Charles de Gaulle, Travell and Burkley accompanied him on Air Force One. Unknown to Travell and Burkley, Jacobson flew on a chartered jet to Paris, where he continued giving the President back injections. In addition Travell was injecting him with procaine two or three times a day to relieve his suffering, which in the spring and summer of 1961 had become unbearable. On August 27 she noted in her records that Kennedy's cry of pain in response to the injections brought Jackie in from another room to see what was wrong. In June of 1961, after Senator George McGovern had expressed sympathy to Bobby about JFK's suffering, Bobby acknowledged its seriousness. If it were not for Travell's care during the previous several years, Bobby wrote in response, his brother "would not presently be President of the United States."
The Travell records reveal that during the first six months of his term, Kennedy suffered stomach, colon, and prostate problems, high fevers, occasional dehydration, abscesses, sleeplessness, and high cholesterol, in addition to his ongoing back and adrenal ailments. His physicians administered large doses of so many drugs that Travell kept a "Medicine Administration Record," cataloguing injected and ingested corticosteroids for his adrenal insufficiency; procaine shots and ultrasound treatments and hot packs for his back; Lomotil, Metamucil, paregoric, phenobarbital, testosterone, and trasentine to control his diarrhea, abdominal discomfort, and weight loss; penicillin and other antibiotics for his urinary-tract infections and an abscess; and Tuinal to help him sleep. Before press conferences and nationally televised speeches his doctors increased his cortisone dose to deal with tensions harmful to someone unable to produce his own corticosteroids in response to stress. Though the medications occasionally made Kennedy groggy and tired, he did not see them as a problem. He dismissed questions about Jacobson's injections, saying, "I don't care if it's horse piss. It works."
In 1961 Burkley concluded that the injections, along with back braces and positioning devices that immobilized Kennedy, were doing him more harm than good. Burkley and some Secret Service men, who observed the President's difficulties getting up from a sitting position and his reliance on crutches, feared that he would soon be unable to walk and might end up in a wheelchair. Out of sight of the press, Kennedy went up and down helicopter stairs one at a time. After a meeting with JFK, in Bermuda in December of 1961, British Prime Minister Harold Macmillan recorded, "In health, I thought the President not in good shape. His back is hurting. He cannot sit long without pain."
In the fall of 1961 Burkley insisted to Travell that Kennedy consult Hans Kraus, an orthopedic surgeon who, like Jacobson, was a European émigré. When Travell resisted the idea, Burkley threatened to go to the President. Kraus, a brusque Austrian, confirmed Burkley's worst suspicions: he told Kennedy that if he continued the injections and did not begin regular exercise therapy to strengthen his back and abdominal muscles, he would become a cripple. Fearful that frequent visits by Kraus to supervise such therapy might trigger press inquiries and unwanted speculation, Kennedy was initially reluctant to accept the recommendation. The lost medical kit and the apparent attempts to steal his medical records during the 1960 campaign had put Kennedy on edge about the potential political damage from opponents armed with information about his health problems.
But mindful that ignoring Kraus's advice might eventually result in his being confined to a wheelchair, Kennedy accepted that something had to be done. He and Kraus agreed to describe the therapy sessions as exercises to upgrade the President's condition from very good to excellent. Kennedy then began a regimen of three exercise sessions a week in a small White House gymnasium next to the swimming pool. Limiting Travell's access to the President, Burkley and Kraus used exercises, massage, and heat therapy to ease Kennedy's back spasms and increase his mobility. Performed with his favorite country and western and show tunes playing in the background, the exercise therapy became a respite from the demands that crowded Kennedy's schedule. In the event of an emergency, he had immediate access to Kraus by means of a phone installed in Kraus's car. (Travell, meanwhile, was kept on at the White House so that she wouldn't reveal Kennedy's secrets to the public; if she had been forced out, she might have been tempted to talk.) By January of 1962 Burkley and Kraus saw JFK having a better month than at any time in the previous year. At the end of February they described the past four weeks, "medically speaking," as the "most uneventful month since the inauguration; since the 1960 campaign, for that matter." And in April they pronounced his general condition "excellent."
Nevertheless, Kennedy continued to need extensive medication. His condition at the time of the Cuban Missile Crisis is a case in point. The Travell records show that during the thirteen days in October of 1962 when Moscow and Washington brought the world to the brink of a nuclear war, Kennedy took his usual doses of anti-spasmodics to control his colitis, antibiotics for a flare-up of his urinary-tract problem and a bout of sinusitis, and increased amounts of hydrocortisone and testosterone, along with salt tablets, to control his Addison's disease and boost his energy. Judging from the tape recordings made of conversations during this time, the medications were no impediment to lucid thought during these long days; on the contrary, Kennedy would have been significantly less effective without them, and might even have been unable to function. But these medications were only one element in helping Kennedy to focus on the crisis; his extraordinary strength of will cannot be underestimated.
This is not to suggest that Kennedy was superhuman, or to exaggerate his ability to endure physical and emotional ills. On November 2, 1962, he took ten additional milligrams of hydrocortisone and ten grains of salt to boost himself before giving a brief report to the American people on the dismantling of the Soviet missile bases in Cuba. In December, Jackie complained to the President's gastroenterologist, Russell Boles, that the antihistamines for food allergies had a "depressing action" on the President. She asked Boles to prescribe something that would assure "mood elevation without irritation to the gastrointestinal tract." The Travell records reveal that Boles prescribed one milligram twice a day of Stelazine, an anti-psychotic that was also used as a treatment for anxiety. In two days, Kennedy showed marked improvement, and he apparently never needed the drug again.
From the start of his presidency John F. Kennedy had the example of FDR, who had functioned brilliantly despite his paralysis. Roosevelt, however, never needed the combination of medicines on which Kennedy relied to get through the day. When Kennedy ran for and won the presidency, he was in fact 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. Then again, given the way Richard Nixon performed in the White House, how many people would retrospectively offer him their votes for 1960, even knowing of Kennedy's health problems?
There is no evidence that JFK's physical torments played any significant part in shaping the successes or shortcomings of his public actions, either before or during his presidency. Prescribed medicines and the program of exercises begun in the fall of 1961, combined with his intelligence, knowledge of history, and determination to manage presidential challenges, allowed him to address potentially disastrous problems sensibly. His presidency was not without failings (the invasion of Cuba at the Bay of Pigs and his slowness to act on civil rights were glaring lapses of judgment), but they were not the result of any physical or emotional impairment.
Lee Harvey Oswald killed Kennedy before the President's medical ailments could. But the evidence suggests that Kennedy's physical condition contributed to his demise. On November 22, 1963, Kennedy was, as always, wearing a corsetlike back brace as he rode through Dallas. Oswald's first bullet struck him in the back of the neck. Were it not for the back brace, which held him erect, the second, fatal shot to the head might not have found its mark.