A First-Rate Madness

by Nassir Ghaemi

  163 “The President slept later than usual this morning”: JFK Presidential Archives, Medical Records, PP, Box 45, typed memorandum dated June 16, 1961.

  163 Travell had just injected Kennedy: IV solucortef 100 mg given with 1.8 million units penicillin + tetracycline, hydrocortisone 40 mg orally. JFK Presidential Archives, Medical Records, PP, Box 45, June 16, 1961.

  163 give more steroids intramuscularly: Cortisone acetate 50 mg IM. JFK Presidential Archives, Medical Records, PP, Box 45.

  163 more oral steroids later that night: Hydrocortisone 10–20 mg. Ibid.

  163 From June 22 to July 3: In the week of June 22–29, he received intramuscular doses of 600,000 units of procaine penicillin twenty-seven times. He also received oral steroids (hydrocortisone 10 mg in the morning and 20 mg in the afternoon daily; 0.125 mg daily of Florinef), amphetamines (2–4 tablets of dextroamphetamine, “Dexatabs,” daily), and his usual daily dose of testosterone (10 mg daily of methyltestosterone tablets). Ibid.

  164 received doses of the narcotic codeine: Codeine phosphate 750 mg, and codeine sulfate 500 mg. Ibid.

  164 “mild viral infection”: Ibid., June 22, 1961.

  164 He came back to life: Ibid. Dr. Travell’s handwritten note on June 21, 1961, was ominous, describing a fever of 104.5 and “shivering,” blood cultures being drawn at 3:15 a.m., and symptoms of being “very chilly” and “perspiring profusely.” The next morning, his personal nurse’s neatly handwritten notes were unfiltered (edited below only for clarity and repetition; we have no available nurse’s notes for the nights of June 21 and into the early morning of June 22):

  June 22 830 AM—perspiring moderately. Complete sponge bath given. Pajamas and linen changed.

  9 AM—seen by doctors

  920 AM—influsion of 500 cc 5% dextrose and saline [solucortef omitted] started in right hand by Dr T

  930 AM—president asleep

  10 AM—another infusion started . . . perspiring moderately

  1010 AM—P asleep

  1020 AM—P awake. Examined by Drs. [four physicians, Dr. Preston Wade, an orthopedic surgeon from New York, Cohen, Travell, and George Burkley, a naval physician who conducted the president’s laboratory tests and filled in for Dr. Travell as needed]

  1030—seen by Mrs Kennedy

  1100—infusion running

  1120—President still awake. Appears to be feeling more comfortable.

  1125—Dozing lightly

  1130—Turned to left side.

  1135—President asleep

  1205—President awake. Stated he was cold. . . . Perspiring moderately

  1210—Patient appears to be sleeping.

  1255—President awake

  100—Mrs Kennedy with patient

  115—Penicillin G 600K units given in left deltoid . . . backrub given . . . per- spiration much less

  130—infusion running well

  135—President sleeping

  200—asleep

  245—President still asleep

  310—P awake . . . states he feels much

  better 315—Hydrocortisone tablet 1 20 mgm po taken

  330—sitting up

  430—President appears to be feeling much better. Shaved

  530—Mrs Kennedy with president

  715—Penicillin

  730—Dinner—ate with hearty appetite

  815—Temp 97.8

  The next day, he resumed his evening barbiturate sleeping pill (Tuinal), and Dr. Travell documented the amphetamine/narcotic/steroid/testosterone regimen that he mostly continued throughout his presidency (“AM: Dexatab 2 tab, Cod[eine] s[ulfate] 2 tab = 65 mg, Testosterone 25 mg IM by request, For pm today Dexatab 2 tab, [vitamin] C 500, Fl[orinef] pink 0.1 mg, HC [hydrocortisone] 10 mg, Cod[eine] S[ulfate] 32 mg”). The president recovered and went to Hyannisport for July Fourth. On the eighth, he had a chill at four in the afternoon, then at 6:10 p.m., according to Travell’s notes, a fever of 103.2 and a high pulse of 120. At 6:30 p.m., he again received intravenous steroids and intramuscular antibiotics (“Infusion saline glucose started + solucortef 50 mg, streptomycin penicillin im given”). Two hours later, he received 25 mg of cortisone intramuscularly. The next day, his temperature was 97.0: “Slept well no complaints,” wrote Travell. Another Addisonian relapse averted.

  164 urine culture finally confirmed . . . Aerobacter cloacae: Ibid. Dr. Travell’s handwritten note is as follows: “June 24—T note: Urine: aerobacter resistant to strep and pen . . . many mucus threads, much amorphous, straw hazy, rbc 2–-4 phf wbc 1–3 phf.” On June 26, a urine culture laboratory report states growth of the following organism: “Aerobacter cloacae.”

  164 fatal in 20 to 40 percent of cases: Michael E. Ellis, Infectious Diseases of the Respiratory Tract (Cambridge, UK: Cambridge University Press, 1998), 140.

  164 mainly found in the vaginal flora: Sebastian Faro, Sexually Transmitted Diseases in Women (Baltimore: Lippincott Williams & Wilkins, 2003), 98.

  165 His urologist’s records are silent on sexual habits: JFK Presidential Archives, Medical Records, PP, Box 45, Dr. Herbst’s notes, 1954–1955.

  166 Galbraith . . . and admired both presidents: John Kenneth Galbraith, Name Dropping (Boston: Houghton Mifflin, 1999).

  166 Jefferson scored highest: Dean Keith Simonton, Greatness: Who Makes History and Why (New York: Guilford, 1994), 271–276.

  166 “I know nothing can happen to him”: Seymour Hersh, The Dark Side of Camelot (Boston: Little, Brown, 1997), 15–16.

  CHAPTER 12 . A SPECTACULAR PSYCHOCHEMICAL

  SUCCESS: KENNEDY REVISITED

  170 William Osler once said: William Osler, Aequanimitas (Philadelphia: P. Blakinson’s Son & Co., 1914).

  171 Kennedy ingested a standard set of daily medications: Florinef 0.25 mg, hydrocortisone 20 mg, methyltestosterone 10 mg, and Meticorten 2.5 mg, Lomotil (a narcotic-derived antidiarrheal agent), thyroid hormone, and sometimes penicillin. JFK Presidential Archives, John F. Kennedy Personal Papers (hereafter PP), Medical Records, Boxes 45 and 46.

  171 he also took amphetamines and barbiturates: Dextroamphetamine (Dexatabs) and Tuinal (an equal mixture of secobarbital sodium and amobarbital sodium). Ibid.

  171 injections of procaine: Ibid., Box 46. David Owen, In Sickness and in Power: Illnesses in Heads of Government During the Last 100 Years (Westport, CT: Praeger, 2008), 161.

  171 Kennedy took mysterious injections from Max Jacobsen: Owen, In Sickness and in Power, 164–170. Robert Dallek, An Unfinished Life: John F. Kennedy (Boston: Little, Brown, 2003), 398–399. Richard Reeves, President Kennedy: Profile of Power (New York: Simon and Schuster, 1993), 146–147.

  171 “I don’t care if it’s horse piss”: Dallek, An Unfinished Life, 399.

  171 New York State investigated the doctor’s injections: Owen, In Sickness and in Power, 165.

  172 injected an anabolic steroid, methyltestosterone, at Kennedy’s frequent request: JFK Presidential Archives, Medical Records, PP, Boxes 45 and 46.

  172 a medical coup d’état: The medical coup d’etat was not a one-day affair. David Owen best discusses the timeline (In Sickness and in Power, pp. 176–177). The process began in October 1961, when Admiral Burkley, the naval officer assigned as the official White House physician, decided to take on Travell, Kennedy’s personal physician. Burkley had the important support of Dr. Eugene Cohen, a New York endocrinologist who was Kennedy’s prime consultant for Addison’s disease. Burkley and Cohen had decided that Travell’s many injections needed to be replaced by a physical exercise and muscle-training regimen, for which they enlisted a New York specialist, Hans Kraus, MD. Travell opposed the proposal, but, over a year, Burkley and Cohen, apparently with the support of Robert Kennedy, gained the president’s approval for the change. By October 1962, Owen notes, the medical coup d’etat was complete, and Travell, though still nominally personal physician to the president, was greatly weakened. The animosity and distrust between Travell and Burkley can be seen in a medical note in Burkley’s records: “3 February
1962 Requested the medical records on X [the president] for the last six months. Dr. Travell said she would like to straighten them up before she gives them to me. I said that this was not necessary, but she said she would like to straighten them up. . . . Within the last few days Dr. Travell has been inferring that all the recent improvement of X’s condition is due to the fact that he is now getting Gamma Globulin and injections of vitamins. Several days ago while discussing the chair for the helicopter a very obvious effort to cover information on the upper part of the sheet by covering it with an additional paper. Contents were not divulged to me” (JFK Presidential Archives, PP, Box 48). Burkley had the upper hand as the official physician, backed by the military and the White House bureaucracy; Travell had been hired by the president alone. Over time, Travell remained in the White House but was closely watched and controlled by Burkley. This is captured in a note by Jackie Kennedy to Burkley in late 1963: “Memo for Dr Burkley: August 21, 1963 I have asked Dr. Travell to put suitable bulbs and reading lights in all the places where the President and I read in the White House. So, please, let’s not get excited if you see her tip-toeing up to our floor in the elevator! JBK” (JFK Presidential Archives, PP, Box 48).

  172 He still took four kinds of daily steroids: As above except methyltestosterone injections were replaced by oral Halotestin 10 mg daily.

  172 suggested by gynecomastia: This is documented as early as 1955 during one of JFK’s hospitalizations. JFK Presidential Archives, PP, Medical Records, Box 45. New York Hospital admission note, August 29, 1955: “Gynecomastia, unknown etiology.”

  172 Kennedy always took anabolic steroids: Later Halotestin. JFK Presidential Archives, Medical Records, PP, Box 46.

  172 in 1966, in her oral history: JFK Archives, Oral History Program, interview of Janet Travell by Ted Sorensen.

  173 but she obeyed the commander in chief: For example, November 14, 1961: “Hypo Testosterone aq. Susp. 37.5 mg.im right buttock . . . requested med. For trip given to Dave Powers Requested MT. 25 q.d.” Or September 21, 1961: “7:15 pm Asked me to come up . . . back still aches. More tired today . . . asks if his medication has been cut back. . . . Pulse fast very keyed up and just back from pool. Given fluorinef 0. 1 stat. Also box of codeine 32 mg. Ritalin 5 mg. to take just before leaving shortly for state dinner, or during evening.” JFK Presidential Archives, Medical Records, PP, Box 46.

  After the somewhat haphazard care he had received in early 1961, culminating in his Addisonian crisis of June of that year, Kennedy’s doctors began to keep better track of his testosterone use, and they have left us monthly summaries of his total dosages for ten months from August 1961 onward. (JFK Presidential Archives, Box 46, Travell notes.) I have added up those doses, keeping in mind that for the first eight months he received methyltestosterone, and in the last two months (beginning May 1962) he was switched to Halotestin. In the first eight months, he received a total dose of 3010 mg of methyltestosterone, either orally or intramuscularly; this is about 12.5 mg of methyltestosterone daily. In the final two months tallied, he received 610 mg of Halotestin, or about 10 mg daily. These are not exceedingly high doses of anabolic steroids, but they are consistent and chronic.

  173 athletes take similar doses . . . to make themselves more “aggressive”: http://www.steroid.com/Halotestin.php (accessed February 11, 2010).

  173 At least three double-blind, placebo-controlled studies: F. Talih, O. Fattal, and D. Malone, “Anabolic Steroid Abuse: Physical and Psychiatric Costs,” Cleveland Clinic Journal of Medicine 74 (2007): 341–352.

  173 Summaries of large clinical populations: T. P. Warrington and J. M. Bostwick, “Psychiatric Adverse Effects of Corticosteroids,” Mayo Clinic Proceedings 81 (2006): 1361–1367.

  173 steroids improve mood and cause fewer psychiatric side effects: Penelope J. Hunt, Eleanor M. Gurnell, Felicia A. Huppert, Christine Richards, A. Toby Prevost, John A. H. Wass, Joseph Herbert, and V. Krishna K. Chatterjee, “Improvement in Mood and Fatigue After Dehydroepiandrosterone Replacement in Addison’s Disease in a Randomized, Double Blind Trial,” Journal of Clinical Endocrinology and Metabolism 85, no. 12 (2000): 4650–4656. E. Ur, T. H. Turner, T. J. Goodwin, A. Grossman, and G. M. Besser, “Mania in Association with Hydrocortisone Replacement for Addison’s Disease,” Postgraduate Medical Journal 68 (1992): 41–43.

  174 “a slight sniffle” . . . “Received a call” . . . a small dose of Stelazine: JFK Presidential Archives, Medical Records, PP, Box 46. The Stelazine dose was 1 mg twice daily. Note of Dr. George Burkley, December 13, 1962.

  175 The most extensive journalistic work is by Seymour Hersh: Seymour Hersh, The Dark Side of Camelot (Boston: Little, Brown, 1999).

  176 they prefer cocaine: C. E. Johanson and T. Aigner, “Comparison of the Reinforcing Properties of Cocaine and Procaine in Rhesus Monkeys,” Pharmacology Biochemistry and Behavior 15, (1981): 49–53.

  176 pleasurable feelings similar to those of cocaine: Bryon Adinoff, Kathleen Brady, Susan Sonne, Robert F. Mirabella, and Charles H. Kellner, “Cocaine-like Effects of Intravenous Procaine in Cocaine Addicts,” Addiction Biology 3 (1998): 189–196.

  176 the claim made by Kennedy biographers: The first historian to see most of Kennedy’s medical records (in 2002), Robert Dallek, documented the steroid use and other medications, but concluded that Kennedy, though ill, was unaffected in his role as president. As summarized by another historian, James Giglio, “despite the potential risks, his health seemed to have had no negative impact on his presidential performance.” James N. Giglio, “Growing Up Kennedy: The Role of Medical Ailments in the Life of JFK, 1920–1957,” Journal of Family History 31 (2006): 358–385 (quote on 379).

  176 has been challenged only by Dr. David Owen: Owen, In Sickness and in Power, 141–190.

  177 “When you commit the flag”: Reeves, President Kennedy, 71.

  177 “How could I have been so stupid?” . . . “Those sons-of-bitches” . . . “I’ve got to do something”: All from ibid., 103.

  177 “The President was completely overwhelmed”: Ibid., 174.

  177 “Too intelligent and too weak”: Ibid., 166.

  177 “Gentlemen, you might as well face it”: Ibid., 196.

  177 “Walking out on generals was a Kennedy specialty”: Ibid., 182.

  178 “Does this mean Germany”: Dallek, An Unfinished Life, 624.

  179 “The first advice I am going to give my successor”: Benjamin Bradlee, Conversations with Kennedy (New York: Pocket Books, 1976), 117.

  179 Robert Kennedy later described the pragmatic aspect: JFK Presidential Archives, Oral History Program, interview of Robert F. Kennedy by Ted Sorensen, 1966.

  179 Martin Luther King was invited to the White House: Reeves, President Kennedy, 100.

  180 “In the election, when I gave my testimony”: Harris Wofford, Of Kennedys and Kings (Pittsburgh: University of Pittsburgh Press), 128–129.

  181 “Negroes are getting ideas”: Reeves, President Kennedy, 357.

  181 “Don’t tell them about General Grant’s table”: Ibid., 359.

  181 “Go to hell, JFK!”: Ibid., 360.

  181 “People are dying in Oxford”: Ibid., 363.

  181 The president placed a phone call to Dr. Max Jacobsen: The role of Jacobsen is documented well by Dallek (An Unfinished Life) and Owen (In Sickness and in Power). Jacobsen first saw Kennedy in 1960. Owen documents the high likelihood that Jacobsen’s injections involved amphetamines and steroids. In fact, when the Bureau of Narcotics and Dangerous Drugs interviewed Jacobsen in 1969, it noticed track marks on his arms, and the doctor admitted to injecting himself with 25 mg of methamphetamine every two to three days (Owen, 165).

  There appears to have been a gradient of medical competence. Burkley and Cohen saw Travell as incompetent, and they all thought Jacobsen was a dangerous quack. Thus, in 1961, before the break between Travell and Burkley, all the White House physicians were banding together to get a handle on Jacobsen. In the JFK Library Archives, I believe I have found the first probab
le documentation of this effort involving Travell and the others. The following note by Travell refers to the president; GGB stands for George G. Burkley: “April 11 1962, 6:00 pm. Went upstairs early to rest. Did not swim, and said that he was too tired to do exercises. Creep in town, left White House about 8 PM. (GGB),—also yesterday PM” (JFK Presidential Archives, PP, Box 46). If we can infer that “Creep” refers to Jacobsen, then it appears that Burkley had discovered that Jacobsen had visited the president and had informed Travell. As with the medical coup d’etat, Jacobsen was not ousted overnight because the president resisted. However, Jacobsen’s visits became less frequent and faced overt opposition by the White House medical staff, Travell included. Robert Kennedy, as in many other matters, had a major impact, and his June 1962 intervention against Jacobsen was likely the beginning of the end. Thus, though Jacobsen injected the president as late as September 1962, his injections were less frequent and thus likely influenced the president for the worse to a lesser degree than had been the case in 1961.

  David Owen has reviewed Jacobsen’s unpublished memoirs and reports that Jacobsen mainly describes visits to the president on a frequent basis in the spring and summer of 1961, in the new administration’s first year, when Kennedy was at his worst politically and at his sickest physically and mentally. Jacobsen saw Kennedy less frequently in 1962, and it is highly probable that his last visit was during the Oxford, Mississippi, crisis of September 1962 (Owen, 169; Dallek, 582).

  The Jacobsen story, so similar to Hitler’s relationship with Theodor Morell, which is discussed in the next chapter, first came out in the media in 1972, but many of the facts were unknown at that time. Dallek’s 2003 biography first broke the story in detail. Owen’s book in 2008 first made the link to Kennedy’s performance.

  181–182 Come down here, Kennedy told him: Reeves, President Kennedy, 364.

  183 “I hope that every American”: Ibid., 521.