Addison’s and J.F.K.

Illness strikes even the famous

John F. Kennedy, Florence Nightingale and Winston Churchill are revered in history for their deeds. Their achievements may have been greater but for illness with plagued. them. Medical writer Jim Leavesley discusses their ailments, and even suggests that Kennedy's was a factor in his death

John Fitzgerald Kennedy.

John Kennedy was assassinated in Dallas, Texas, on November 22, 1963. At that time he was already a very sick man.

In November 1955 there appeared in The American Medical Association's Archives of Surgery an article emanating from the Laboratory of Surgical Research and Anaesthesiology of Cornell University Medical College. It was entitled "Management of Adrenocortical Insufficiency During Surgery". The article concerned itself with operating, for one reason or another, on people who were deficient in the life-sustaining corticosteroid hormones released by a small gland situated just above the kidneys, a site from which it derived its unimaginative name, the suprarenal or adrenal gland. It listed three cases where the operation had been successful.

So what? You may well ask. Well, just this: The report on Case 3 almost altered the course of American history in the 20th century. Briefly, it told of a 37-year-old man who had had Addison's disease, or adrenocortical insufficiency, for seven years. He had managed well on desoxycorticosterone acetate pellets implanted every three months and cortisone in doses of 25mg daily.

The unnamed subject was in a great deal of pain from a back injury and it had been decided to do two bone fusions together with the insertion of a metal plate in the lower back. The operation was accomplished on October 21, 1954. On October 11, 1954, The New York Times reported that Senator John Kennedy had entered hospital for spinal surgery. The same newspaper, on October 21, reported that the senator had undergone the operation, adding that he had previously undergone surgery in l945 but his condition had worsened and he had had to use crutches on and off since. Then, on February 26, l955, The New York Times revealed that Senator Kennedy had had removed from his back a metal plate which had been put there four months previously.

It does not need Sherlock Holmes to conclude that two people of the same age, with the same spinal condition, who underwent similar surgery in the same hospital on the same day, and who returned at the same time four months later for removal of the plate, were one and the same person. All this would have been confined to the gossip columns except that John Kennedy put up for President of the United States in 1960. Just before polling day, a political opponent, Congressman Walter Judd, demanded that Kennedy confirm or deny he had Addison's disease. The reply was circumspect, but Kennedy conceded he had "partial adrenal insufficiency".

The cause of Kennedy's Addison's disease, for this indeed was what he had was probably an atrophy of the adrenal due to a type of autoimmune response ' the body against its own tissues. It is a rare and irreversible condition. The cardinal symptom is a progressive weakness and tiredness - hardly desirable circumstances in one of the most powerful men in the world. However, once diagnosed, treatment is very successful, although. life-sentence, and comprises replacement the corticosteroid hormone. The President's dose was increased when he went to the White House. An excessive amount can increase weight, especially the face, to produce a round, so-called ("moon face"). Pictures show this effect on Kennedy. Kennedy ruptured a disc in his back at Harvard in 1939 playing football. He subsequently joined the navy and saw service in the Solomon Islands, where his PT boat was rammed by a Japanese destroyer. This exacerbated his back injury. He was sent home and in 1945 a prolapsed intravertebral disc was removed. However persistent pain was to dog him for the rest of his life.

It must be remembered that, for the sake of a few votes, Kennedy continued to perform bone-crunching tasks such as sliding down a fireman's pole, digging holes for commemorative trees or pitching the first ball of the baseball season. When out of the public gaze, he use crutches for the last 10 years of his life, had his left heel built up, wore a corset-type brace and slept with a board under the mattress. But neither his back nor his hormones had anything to do with the way in which John F. Kennedy met his death. 0n November 22, 1963, three shots were fire at him allegedly by Lee Harvey Oswald who was located above, behind and to the right of his target in a sixth-storey window The first shot traversed Kennedy's neck then emerged; the second shot missed; and the third shot five seconds later hit the President's head and exploded to remove almost all the right side of the brain. Kennedy was wearing his corset support at the time. As was found when it was removed from the body, it was a rather wide affair with metal stays and a stiff plastic pad over the sacral area of the back which was tightly laced to the body.

There is no doubt, of course, the President died of a massive head wound, but if he had not had a back condition, he would not have been wearing a brace. This being so, it is quite likely that after the first shot he would have fallen to one side and out of sight, there being nothing to shore him up. That would have taken less than five seconds and so he would only have been wounded. The only snag is that an effect of the atrophy of the adrenal glands and long-term cortisone therapy is to reduce resistance to infection and to induce poor healing. Hence, in these circumstances, it is just possible that wound contamination from the first shot may have proved enough.

Regrettably, the autopsy report is strangely silent on details of the adrenals and vertebral column. They were regarded as privileged information by the family and not subject to public curiosity. Photographs of John F. Kennedy seem to radiate youthful drive and boundless energy. If anyone had a public image and a private agony it was he. He had the courage to withstand the ravages of two debilitating and depressing long-term conditions.

First appeared in the Australian Women's Day - May 1984