Presidential Medicine: Andrew Jackson

In honor of President's day I have some interesting Presidential pathology to present. I want to talk about Andrew Jackson and his myriad of diseases.

To say that Andrew Jackson had medical problems would be the understatement of the century. Starting with a head wound sustained while a prisoner during the Revolutionary War -- he was only 13 at the time, Jackson's entire life was spent plagued with one malady or another. He was shot at least twice in duels, both leading to chronic injuries. He also very likely got malaria during the War of 1812. This situation was complicated by the fact that the standard treatments for maladies during the 19th century was ingestion of heavy metals (either calomel -- mercurous chloride -- or sugar of lead -- lead acetate) and chronic bloodletting.

Evidence from samples of Andrew Jackson's hair -- 1815 and 1839 -- confirm that he had lead levels sufficient to show signs of lead poisoning. This lead came from two primary sources. First, in 1813, Jackson got in a gunfight with the Benton brothers in Nashville. A bullet lodged in his shoulder and later produced chronic osteomyolitis (a chronic bone infection that can sometimes burst through the skin). The bullet was only removed in 1832. Further, the treatment for most of his intestinal maladies was ingestion of lead acetate. (The authors of the above paper note that while bathes in lead acetate and eye washes were recommended, transdermal and transopthalmic absorption of lead is very low.)

Interestingly, one of the most common symptoms of lead poisoning in adults is peripheral neuropathy, and Jackson did not seem to show signs of this. He complained of rheumatism in the wrist, but this is not necessarily peripheral neuropathy. On the other hand, Jackson reported chronic diarrhea, abdominal complaints, and constipation throughout his life. It is difficult to attribute these to any specific cause considering that Jackson had so many. It is possible that the malaria caused the diarrhea, but exposure to heavy metals can also do that. He also reported coughing and chest pain. This is probably from a chest wound he received in another gun fight.

Jackson probably died of renal failure. At the time of his death, he was retaining a massive amount of fluid in his legs and later a generalized edema -- a condition called anasarca. Renal failure can result from chronic lead poisoning, but it can also be the consequence of osteomyolitis or malaria infection.

Two very interesting points related to Jackson's health:

1) Despite massive ingestion of mercury, evidence from the hair samples do not suggest that he got enough for mercury poisoning. This is probably because the mercurous ion is poorly absorbed by the intestinal tract. (This subject is not without controversy.)

2) Jackson was a trooper by any imaginable standard. He had the bullet removed from his shoulder with no anesthetic. He regularly bled himself, so he was walking around with all these diseases with less blood than he should have had. This, I think, explains why he could be hot tempered: he was constantly in pain.

It brings into stark relief the incident in which Jackson executed a young soldier -- John Woods. (The incident is described on pages 79-80 of R.V. Remini's biography.) During the Creek War, Jackson led the Tennessee militia against a faction known as the Red Sticks. Woods, an 18 year-old militia member, had left his post on the watch in order to get a blanket and ended up eating breakfast with his buddies. On confrontation by his superior officer, he became enraged and brandished a gun saying that he would shoot whoever laid a hand on him. Woods was later talked down, but the incident so angered Jackson that he determined to make an example of him. Jackson had him court-martialled for mutiny and shot before the entire army.

The incident apparently caused Jackson considerable guilt later in life. Furthermore, when it came to light it became a very serious election issue. It was clearly an excessive punishment for a young man who screwed up in the way young men often do: he lost his temper and did something stupid. On the other hand, Jackson had considerable recent experience with other mutinies, and he was understandably aware of the need for discipline in his ranks.

If you add to this complex issue the idea that Jackson was in paralyzing pain for his entire life, you begin to understand a little better why he got angry a lot. He pushed himself to excel in spite of his health problems, and he expected no less excellent behavior from everyone else.

For further reading, I recommend the biography by H.W. Brands.