Medical Secrets of Two Great Leaders

Two larger than life men in medical history are John Fitzgerald Kennedy and King Henry VIII. Stories about them frequently mix fact with fiction, so let’s see if we can separate the two.

In November 1955 an article appeared in a highly regarded American medical journal concerning an operation which had been carried out on three people who suffered from Addison’s Disease. This condition is caused by a deficiency of life-sustaining corticosteroid hormones from the adrenal glands. Not common, but in the 1950s giving an anaesthetic to such people was tricky, so worth writing up in this kind of publication. Why am I recounting all this? Well, the report on case three almost altered the course of history.

Briefly, it told of a 37-year-old man who had been receiving cortisone replacement therapy for seven years. He was in great pain from an old back injury, and bone fusion with the insertion of a metal plate was regarded as a last resort. Of course, for ethical reasons, no name was given but an unnecessary throwaway line inserted near the end was to cause sporadic detonations in the press for years. It merely said ‘the operation was accomplished on 21 October 1954’.

Now on 11 October 1954, buried inside the New York Times, it was reported that the well known Senator John F Kennedy had entered hospital for spinal surgery. On 21 October it confirmed the operation had been done, gratuitously adding he had undergone surgery in 1945 but his condition had worsened. Finally on 26 February 1955 the newspaper revealed that Kennedy had had the metal plate removed. Significantly, there was never any talk of Addison’s Disease. Now, if you read both journal and newspaper you did not need to have been an Einstein to conclude that two people of the same age with the same spinal condition having undergone surgery in the same hospital on the same day were one and the same person.

That should have been the end of the matter, but in 1960 the same man put up for President of the United States and, typical of the hurly-burly of American politics, just before the poll an opponent demanded that Kennedy confirm or deny he had Addison’s Disease. JFK admitted he had a ‘partial adrenal deficiency’ and had received top-up hormone therapy for the incurable condition since 1947. But did it matter one way or the other? Is illness dishonourable?

Well, when Thomas Addison first described the condition in 1855, he wrote, ‘the patient gradually falls off in health and becomes languid and weak, indisposed to either bodily or mental exertion.’ Hence, with such symptoms, it did matter, but so far his palliative treatment had been successful and, as we all know, he was elected.

In 1960 ideal cortisone doses had not been completely worked out and on JFK entering the White House the dose was increased, which resulted in significant side effects such as weight gain, especially noticeable in the face, to produce a nice round ‘moon face’ which made him look even more youthful and handsome than he actually was.

On the other hand his energy increased and I wonder if Kennedy’s well- documented bedroom athleticism had anything to do with that. Such activities could not have done his back much good.

Out of the public gaze he used crutches. He also wore a corset brace and famously found relief in a rocking chair. His tolerance of his discomfort coupled with his youthful good looks added lustre to his heroic image and he is remembered as a great president.

If anyone in history had a greater heroic image than JFK it was our second man, the larger than life Englishman King Henry VIII (1491-1547). Most of Hans Holbein’s portraits of the 188 centimetre-tall monarch (30cm more than the average for the 16th century) have him hand on hip, feet planned firmly apart and looking resolutely at the painter and at us 450 years on, the living embodiment of a Renaissance sovereign, a king’s king, so to speak.
Unlike Kennedy, any appraisal of Henry’s health at this distance is conjectural and coloured by rumour and distortion. We do know he was a fine athlete, wrestler, ‘real’ tennis player and snappy dresser, being regarded as ‘the glass of fashion and the mould of form’. But he ran to seed and when he died aged 55 his waist was 137cm and chest 144cm. We know all that from various pieces of his armour still in existence. If the codpiece in the Tower of London is to be believed, either the rest of his anatomy was in similar proportions or he had a very flattering armourer.

As regards his health, Henry was keen on jousting, sustaining several serious injuries, including one when a lance lacerated his face through his visor and another in 1536 when he was unseated and his armour-clad horse fell on top of him. He was unconscious for two hours and the next day Anne Boleyn miscarried a longed-for male child. Henry never fought again.

Thereafter his health deteriorated and he developed a very nasty-looking ulcer on his right thigh, the site of an old injury. It lasted until his death 10 years later and raises the question which seems to fascinate people: was the ulcer really due to syphilis rather than a wound? And if so, did he pass it on to his various wives to cause their many miscarriages?

It is doubtful, or at least arguable. Major epidemics of the disease did occur between 1490 and 1500, but if he did have it where did he acquire it? In the goldfish bowl of court, dalliance was soon spotted and doubtless would have been the subject of dispatches from various ambassadors to their governments. None have surfaced. Moreover, none of the four live children Henry sired displayed any stigmata of congenital syphilis.

But the most telling evidence against is the fact that mercury was the contemporary treatment of choice, where just enough was given to kill the nastiness but not the patient. It needed nice judgment and the dose was assessed by the amount of the salivation mercury characteristically produces. The right dose stimulated about three pints a day, the course lasted two months and the foul humours of the malady, it was said, were excreted in the saliva. As loathsome as it was useless, the treatment could not be taken in lofty isolation – everyone watched you spit, including court spies.

So if not syphilis, what did Henry have? All those sporting injuries took their toll, especially the one to the thigh where syphilitic lesions are very rare. My view is that a piercing injury caused infection of the bone leading to chronic infection, or osteomyelitis. The resulting abscess broke down again and again. Such a prolonged condition commonly leads to so-called amyloid disease which slowly destroys the cells of the vital organs and eventually causes death. I feel that this is the disease from which the king suffered, not syphilis.

Both Jack Kennedy and Henry Tudor were fine-looking, vigorous and charismatic leaders and both bore prolonged and painful diseases with fortitude. It is tantalising to wonder if their maladies actually strengthened their characters to make them even greater leaders than they would have been in full health. AMP