The Health Of The President: Andrew Jackson

Andrew Jackson (1767 — 1845)

May 30, 1806, marked the halfway point and the dramatic crisis in the life of Andrew Jackson. On that day Jackson killed a man in a duel and in turn received a chest wound from which he never fully recovered and which eventually caused his death. As in the Greek drama, the tragic guilt of the hero was inexorably followed by his punishment and his redemption. After the fatal duel Jackson was doomed to semi invalidism for thirty-nine more years, kept alive by an iron constitution and driven by a superhuman will.

During this period Jackson transcended his physical handicap and became a great general; he rose from country politician to selfless American patriot.

The fatal duel was the climax of a long and bitter feud between Jackson and the young Nashville snob, Charles Dickinson, who had made slurring remarks in public about Andrew’s wife, Rachel. Dickinson was well known as a crack pistol shot, whereas Jackson was no great marksman.

The dueling parties met on the bank of the Red River in a clearing in the poplar woods. General Overton was Jackson’s second; Dickinson’s, a Doctor Cattlet. A pair of identical pistols owned by Jackson were the weapons to be used. The guns, with seven-inch barrels, were loaded with deadly one-ounce 70-caliber lead bullets.

A distance of twenty-four feet was paced off. The principals took their stance. Dickinson wore a short coat of blue with gray trousers. Jackson wore a bulky dark blue overcoat and trousers to match. He liked to wear his coats well-padded and loose, to hide his extremely narrow shoulders which gave his long, lean body a quixotic appearance.

General Overton called, “Gentlemen! Are you ready?” “Ready,” said Dickinson.

“Yes, sir,” said Jackson.

“Fire!” cried Overton.

Dickinson fired instantly. He had boasted that he would shoot Jackson through the heart. The ball tore a large hole in Jackson’s coat. He felt a searing pain in his chest and clutched his side with his left hand. For an instant he felt he was dying, wondering what kept him standing. Then he steadied himself and, as in a dream, slowly raised his pistol and took careful aim, mechanically carrying out his plan to hold his fire for one careful shot, whatever the risk.

Opposite him Jackson saw his horror-stricken enemy standing defenseless with folded arms and averted eyes. He pulled the trigger. There was a metallic click as the hammer of the pistol stopped at half cock. He pulled it back and aimed again. This time it fired.

Dickinson swayed and slumped to the ground. The bullet had hit him squarely in the abdomen, tearing through his intestines. His friends tried to comfort him saying that his bullet had lodged in Jackson’s chest and would inevitably kill him. They did not know how close this pious lie was to the truth. Dickinson died that night after a day of agony.

Jackson made light of his own wound, though blood was oozing from his chest and filling his left boot. He did not want Dickinson’s cohorts to know he was badly hurt. Refusing help, he mounted his horse. We can only marvel how a man in his condition was able to ride horseback to Nashville, a distance of forty miles.

Back home Jackson’s doctors told him how serious the wound was. Dickinson’s bullet had missed his heart. The loose overcoat had deceived the sharpshooter’s calculation of the vital mark, but the bullet had shattered the chest wall, breaking a couple of ribs and embedding itself deep in the left lung, and probably carrying in its track pieces of cloth and fragments of bone.

The heavy lead bullet was to remain in Jackson’s chest as a life-long memento of the duel—a wound that never healed. No surgeon of that time dared to remove the ball from its dangerous position near the heart. Even today, it is only some fifty years since surgeons first invaded the living chest cavity, one of the last areas inviolate to surgery. The abdominal cavity, once held in equal dread, had become the “surgeon’s playground” in the 1880’s.

Jackson remained in bed for a month after the duel until his wound had closed superficially and he had recovered from loss of blood. Then, against the advice of his doctors, his restless spirit drove him to get up; but from this time on Jackson was never the same.

He had possessed a comparatively sturdy constitution until the duel, otherwise he might not have survived to the age of thirty-nine the prevalent diseases along with the poverty, deprivation, and hardship of his youth.

After this fateful affair of honor Jackson suffered from ever-recurring attacks of chills and fever, pain in the chest, followed by coughing and hemorrhages from the lungs. Some of the attacks of fever might have been caused by malaria, from which everyone in the South suffered but which could usually be controlled by quinine. The symptoms point to another diagnosis—that the bullet, together with the particles of cloth and bone, caused an abscess of the lung. As long as this abscess was sealed off, it would produce fever and pain in the chest. The abscess would spread gradually, the fever rise, and chills and fever would alternate with profuse sweating. Finally, the pressure of the abscess and the digestive power of the pus would cause a perforation into a bronchial tube. Through this opening the pus would drain and be coughed up with blood. The severe strain of the coughing and the sudden emptying of the abscess cavity would leave the patient feeling faint and exhausted, but soon afterward the fever would drop and he would feel relieved.

A period of relative well-being for Jackson would follow, lasting as long as the connection between the abscess and the bronchial tube remained patent and draining. Then the only discomfort would be caused by intermittent coughing spells which brought up bloodstained mucus. After a while, granulation tissue would gradually fill up the fistulous tract and occlude the channel which had served as a valve for the septic process. Then the pus in the abscess cavity would accumulate again, the temperature of the patient would rise and the same succession of symptoms recur.

Occasionally the pus would erode a larger blood vessel in the vicinity, bringing on a copious hemorrhage and an acute crisis. This vicious cycle of septic fever and malaise when the abscess was sealed off, alternating with remissions of relative well-being while the abscess was draining, repeated itself over the years with ceaseless regularity. Gradually it sapped Jackson’s vitality and undermined his iron constitution.

Contemporary doctors interpreted his combination of symptoms, fever and sweats, and coughing of blood and pus as typical for pulmonary tuberculosis. They believed that in Jackson’s case the tuberculosis possibly had been activated by the severe chest wound. This diagnosis has been accepted by most later historians but is improbable in the light of modern medicine. Tuberculosis of the lungs, with Jackson’s severe symptoms, would, without proper treatment, have taken a more rapid downward course. It would not have allowed Jackson to live so long following the duel.

After the tragic duel with Dickinson, Jackson was involved in several other such acts of ceremonial mayhem and took part in numerous fights of a more informal nature. He was a born fighter. He had to be to survive, for he grew up in a world of struggle. His father, also named Andrew, was a tenant farmer from Northern Ireland who, in 1765, had emigrated to America with his wife and two sons, settling in the wilderness of North Carolina. The elder Jackson died two years later, a few weeks before the birth of Andrew in Waxhaw, South Carolina.

In 1780, when Andrew was thirteen, he served as a mounted messenger to an American encampment. He was captured with his older brother, Robert, by a body of British dragoons. The officer in command ordered the boys to clean his boots. They refused, whereupon the enraged officer drew his sword and struck them. His slashing blow cut Andrew’s upraised wrist to the bone and crashed on his forehead, leaving a scar which he carried for life. It left an even deeper scar on Andrew’s mind, an indelible hatred of everything British which was to become one of the leading motivations of his life.

His brother Robert was even more seriously wounded in this encounter. As prisoners, both boys contracted smallpox. They were released in the custody of their plucky mother who had come for them. Robert soon died of his wounds and the smallpox. Andrew recovered after several weeks of critical illness, probably complicated by malaria. Soon afterward, Andrew’s mother died from deadly typhus fever contracted while she was nursing other American boys captured by the British. Andrew’s oldest brother Hugh had died the year before.

At fourteen, Andrew was left to shift for himself. He was a tall, skinny, freckle-faced youngster with red hair and steel-blue eyes; unfortunately he drooled when he talked, especially when excited. Because of this failing he was the butt of many cruel jokes, against which he could retaliate only with his fists.

At sixteen, Andrew inherited three to four hundred pounds sterling from his wealthy Irish grandfather. This sum he spent on high living, gambling, and horses. The brief taste of the better things of life was enough to arouse in the boy a determination to acquire them again. After a short period at school he decided to study law, relying on the standard law books for his theoretical training. He served as clerk for two attorneys, and obtained enough practical experience to be admitted to the bar within two years. Soon afterward, at twenty-one, he was appointed prosecutor at the court of Nashville, presided over by twenty-six-year-old Judge John McNary.

In Nashville began the great romance of Andrew Jackson’s life. He was living at the boarding house of Mrs. John Donelson and there met and fell in love with her attractive daughter Rachel. Their courtship, difficult from the start, had about it the flavor of a medieval romance. Like an Arthurian knight, Jackson was the fearless soldier and devoted lover throughout their years of marriage.

When the two first met, Rachel was the estranged wife of Lewis Robards of Kentucky. After a brief and futile attempt at reconciliation, Lewis informed his wife that he had started divorce proceedings. Rachel and Andrew Jackson were married in 1791, unaware that Robards meanwhile had dropped the proceedings. Two years later they were shocked to learn that Robards was now asking for a divorce on the grounds of his wife’s adulterous second marriage. Though they had married in good faith, Andrew and his wife were to be plagued until the end of their lives by the circumstances surrounding Rachel’s separation and remarriage. The divorce eventually was granted, and in 1794 the Jacksons went through a second ceremony. Jackson’s enemies, in addition to their other charges against him in political campaigns, always dropped innuendoes that he had married an adulteress. Throughout the years Jackson defended his wife’s name with every weapon at his command—whips, fists, and pistols, as he did when, in defense of her honor, he received his chest wound.

The wretched poverty of his youth as an orphan created a yearning in Jackson for a life of a gentleman farmer in the Virginia style. Now, as a successful lawyer, he was able to acquire The Hermitage, near Nashville, which he enlarged and improved until it became the plantation of his dreams, among the finest in Tennessee. But though Jackson had achieved his idyll, his fighting spirit did not allow him to enjoy the peace of the countryside for long. The scent of battle and the clamor of party politics lured him again and again from his retirement and into the thick of the fray until chronic invalidism eventually confined him to The Hermitage.

When Tennessee became a state in 1796, Jackson, as its first representative in Congress, became an irreconcilable opponent of President Washington. Later he was to serve as United States Senator, as Justice of the Tennessee Supreme Court, and, in 1802, as major general of the militia. In 1812 he was appointed major general of the U.S. Volunteers and, two years later, became major general of the Regular Army.

Jackson, even after narrowly escaping death in the duel with Dickinson, with the reminder still giving him pain, never learned to control his violent nature nor to balance valor with discretion. He challenged and fought his peers at the drop of an invective. In 1813 he got mixed up in another gun battle, the outcome of a tavern brawl in Nashville. For some reason, Jackson was trying to horsewhip his former friend and later champion, Thomas Hart Benton. He was shot from behind by Benton’s brother Jesse.

The bullet shattered his left upper arm at the shoulder joint, causing an open compound fracture. Andrew was carried across the street to the Nashville Inn, where doctors tried in vain to arrest the hemorrhage. The blood stopped only after two mattresses had been soaked through and the patient’s blood pressure had dropped to shock level. All the doctors except one advised Jackson to have his shattered arm amputated in order to save his life. The one who was against amputation probably thought it was too late anyway, but Jackson refused to have his arm cut off. And, as throughout all his life, he fooled the doctors, keeping arm and life both.

An inevitable infection of the bone set in, which became chronic and plagued Jackson for the next nineteen years, in addition to his pulmonary abscess. The shoulder wound would close at times and the break open again. It did not heal completely until 1832, when the lead ball was finally cut out.

A short time after the Benton shooting, the news reached. Nashville that the Creek Indians in the nearby Mississippi Territory had risen up, sacked Fort Mims, and massacred two hundred and fifty settlers. A committee on public safety hastened to The Hermitage where the wounded General was recuperating. He received them at his bedside and assured them that he would be ready to go in a few days.

“The health of your general is restored. He will command in person,” he said, propped against a pillow, his shattered arm in a sling. In the words of Marquis James, “Jackson was too sick to leave his bed but strong enough to make war.”

It sounds unbelievable that a man in Jackson’s condition, just five weeks after a serious injury, should have been able to take active command of a whirlwind campaign and lead his infantry on a forced march of thirty-two miles in nine hours. This Jackson did. If it is true that an army marches on its stomach, Jackson’s army had little to march on. The supply system was deplorable. That “meager monster, Famine,” which Jackson dreaded more than the hostile Indians, was stalking his column. There were only a few cattle for two thousand men. Jackson ordered these butchered, taking for himself and his staff only the leavings, on which they lived without bread or salt. A few acorns supplemented this starvation diet.

Jackson spent most of his days in the saddle. His festering arm was in a sling; he suffered also from intestinal cramps and diarrhea. Eyes hollow and stomach empty, he ignored discomfort, pain and fatigue, planning and directing all the details of the campaign. With his men, he spent his nights on the frozen ground. At critical moments of a battle he would rush to the scene to rally the wavering ranks. Like the real soldier he was, he gave vent to his personal misery not by complaining but by swearing like a top sergeant. His men could not help admiring their general, who scorned polished brass buttons and was as tough as hickory. It was they who gave him his famous nickname, Old Hickory.

Jackson’s dysentery, aggravated by lack of care and improper diet, also became chronic. His digestive system from this period on remained delicate, disposed to new flare-ups of diarrhea and cramps. This tendency was not alleviated by one of the medical panaceas of the time, the mercurial calomel which Jackson took in large doses for his intestinal upsets. An overdose of mercury alone can cause spasms. Unknowingly, Jackson added these cramps to the bacillary paroxysms of the bowels. All this time the wound in his left upper arm was draining pus. While Jackson was on the way to New Orleans, in the fall of 1814, a large fragment of bone sloughed off. Jackson, with a gruesome sense of humor, sent it to Rachel as a token of his love.

Wrecked by his two chronic infections and his dysentery, Jackson was not the picture of a victorious general when he entered New Orleans, in December of 1814, to defend it against Wellington’s veterans. An eyewitness described his ghostlike appearance—”. . . a tall, gaunt man, very erect . . . with a countenance furrowed by care and anxiety. His dress was simple and nearly threadbare. A small leather cap protected his head, and a short blue Spanish cloak his body, while his . . . high dragoon boots [were] long innocent of polish or blacking . . . His complexion was sallow and unhealthy; his hair iron grey, and his body thin and emaciated like that of one who had just recovered from a lingering sickness . . . [a] fierce glance . . . [lighted] his bright and hawk-like eye.”

If the appearance and physical condition of the General were not conducive to confidence he amazed people by his accomplishments. The compulsion of hatred which, several years before, had given the badly wounded fighter the strength to kill Dickinson, now made him forget his weakness and summon the last ounce of his energy to get revenge on the archenemy of his life, the British.

A few days after his arrival, the English navy, by an unexpected coup, took possession of Lake Borgne, only a few miles from New Orleans. General panic gripped the city. The sudden threat aroused Jackson to feverish activity. According to Marquis James, “Jackson galloped to his headquarters in Royal. Street, and for thirty-six hours the place shook with his tumultuous energy. Too ill to stand he laid on a sofa, and, whipping his strength up by force of will, and an occasional sip of brandy, exhausted a corps of robust aides with the dictation of orders, the enlistment, concentration and dispatch of troops, and the multitudinous details which before another sun had set were to transform frightened New Orleans into an armed camp.”

The results are well known. In the famous battle of New Orleans on January 8, 1815, Jackson inspired his motley array of backwoodsmen, Negro troops and former pirates to defeat the most renowned English regiments of the line. Jackson wrote, immediately after the battle, that the body of the English commander, General Packenham, was already on its way to the fleet “in a casket of rum, and to be taken to London,” an interesting sidelight on the primitive embalming methods practiced at the time by the British navy.

The multitude and severity of Jackson’s ailments profoundly affected his moods, his behavior and, ultimately, his character. It was an almost unbearable trial for him, who was by nature impatient and aggressive, to suffer in sullen helplessness the ever-occurring attacks of sickness and pain. His violent resentment and anger, normal reactions to the assaults of disease, smoldered, ready to burst through the shell of self-control when ignited by the least provocation.

Thomas Jefferson mentioned with a shudder Jackson’s “terrible rages.” In 1817, when Jackson was still an active general, he challenged General Winfield Scott to a duel, calling him “a hectoring bully” and one of the “intermeddling pimps and spies of the War Department.” Scott, not without reason, had accused Jackson of an act of mutiny, and in reply to this outburst said that though he acknowledged Jackson as his master in the use of epithet, he had to decline the challenge on religious grounds, and added that he preferred to risk his life to a better purpose “in the next war.”

In 1818 Jackson received the command against the Seminole Indians. His conduct in pursuing them into the Spanish territory of Florida, and in executing two British subjects as spies, led to international complications and bitter criticism in Congress. To get out of the way this headstrong General, who was too difficult to control and too popular to censure, President Monroe appointed him military governor of the newly purchased territory of Florida.

During the few months of his governorship of Florida Jackson suffered from new attacks of severe dysentery; he used this condition as an excuse to resign from his office, which was not to his liking. He returned to The Hermitage in the fall of 1821, suffering from a “distressing cough and inflammation of the lungs.” In the following year he had a prolonged spell of constipation with severe cramps. Dr. Philip Marshall Dale of Los Angeles, thinks that these colics were produced by lead poisoning, caused by the two large slugs of lead he carried, from which enough poison could eventually be absorbed to kill a normal person.

As if this were not enough, he introduced more of the same metallic poison into his system by habitually using lead acetate (sugar of lead), a time-honored remedy which has only lately been ingloriously discarded. Jackson used it freely as a cure-all, externally and internally. He bathed his eyes with the cooling solution, poured it into his wounds, and often drank it for his intestinal cramps, adding further insult to his long-suffering intestines. In the same year Jackson contracted a bad cold in a church at Nashville, which brought a relapse of his chest condition and of his old bowel complaint. He wrote of “having in the last twelve hours upwards of twenty passages,” and ended, “In short, sir, I must take a rest or my stay on earth cannot be long.”

Any other man but Jackson, with so many crippling ailments, would have retired from public life. Although deep in his heart he wished to spend his remaining years in his beautiful Hermitage with his adored Rachel, his character and his fate dictated otherwise. Counting on the enormous popularity of Jackson as a national hero, the general assembly of Tennessee drafted him as a nominee for President in 1822. He accepted this call to duty with the reservation that his health would not permit his active participation in the campaign.

All during the campaign Jackson was in poor health. He repeatedly complained of copious sputum—”great quantities of slime,” as he called it. The pus which had been draining over the years from the lung abscess had gradually infected the adjoining branches of the bronchial tree, and in time was leading to a chronic condition known as bronchiectasis, a dilatation of the bronchial tubes combined with profuse secretion of infectious mucus. In spite of his inability to do any personal electioneering in the presidential campaign of 1824, he received the majority of votes.

Through the political machinations of Clay, John Quincy Adams, who had the second largest vote, was elected President. Jackson felt cheated; his fighting spirit was aroused. Ignoring his precarious health, he carried on a most vigorous political campaign for the next four years, which was crowned by his overwhelming victory in the election of 1828.

In 1825, a severe fall caused profuse hemorrhage from the abscess cavity of the left lung. The chronic systemic infection contributed also to a softening of the gums and tooth decay, a complication which was not helped by his habitual use of calomel, itself damaging to the gums. Thus the tortures of toothache were now added to the chest pains and shoulder wound and the recurring abdominal pain.

If the presidential campaign was strenuous for him, it was even harder on his sensitive wife. The archconservative enemies of Jackson, the champion of the people, hated and feared him. They used any means to prevent his election, even stooping so low as to revive the old story about the Jackson’s early marital mix-up. Rachel was deeply hurt by the cruel insinuations against her, printed in scandal sheets that were widely circulated. She was a naïve and kind-hearted woman, who had spent most of her life in the country. Short and dumpy, she had no idea how to wear fashionable clothes, and she liked to smoke a corncob pipe. She dreaded moving into the limelight of the capital as the first lady of the land.

“I assure you, I had rather be a doorkeeper in the house of God than to live in that palace at Washington,” she told a friend in November, 1828. Her wish was soon granted. In December 1828, Rachel had a severe heart attack, probably coronary thrombosis. The hastily summoned doctors bled her repeatedly and thereby apparently benefited her condition temporarily. Bloodletting, indiscriminately and unscientifically employed as it had been through the ages for practically any kind of ailment, can be useful and even life-saving for a failing heart, relieving the back pressure into the pulmonary circulation. After three days the patient felt better and by the sixth she was fairly comfortable. On the evening of that day she was permitted to get up. As she was sitting by the fire, smoking her corncob pipe, she repeated her previous remark, “I had rather be a doorkeeper in the house of God than to live in that palace.” Twenty minutes later she cried out, “I am fainting!” — and collapsed.

The desperate husband could not comprehend the irreversible fact of her death. He could not understand that his unconquerable will, which had triumphed over all his mortal enemies and defied the greatest afflictions of his own body, had not power against the finality of death of the one he most loved. Frantically, he had her bled at the wrist, and, when no blood appeared, at the temple. Two drops, no more, stained her cap. He had her body placed on a table, covered with blankets, and kept watch the whole night, waiting in vain for a sign of breath, feeling a pulse which never returned.

Heartbroken and lonely, a physical wreck, the sixty-two-year-old President arrived in Washington in March 1829 for his inauguration. Weak as he was, on his inauguration day, he rose to the occasion, as usual, and walked bareheaded from the capitol to the White House.

During the first year of his administration, the President was more than ever a picture of misery, suffering from the afflictions of Job, without Job’s patience. The chronic infectious processes passed through some of their more acute phases, leading to new complications. His breathing became short and wheezing and alarmed those in the same room with him. His legs and feet started to swell, and the doctors feared a fatal attack of “dropsy.”

He had excruciating headaches; his vision became blurred; the diarrheas recurred with a vengeance. The opinion has been expressed that the combination of these symptoms pointed to an inflammation of the kidneys, a nephritis, caused by the bacterial toxins circulating in his system.

The tortures of his body did not improve Jackson’s moods, and he became, if possible, more edgy, short-tempered, and quarrelsome than ever. He would not tolerate any contradiction; he fired most of the members of his first Cabinet for their refusal to accept socially the wife of his friend, Secretary of State John Henry Eaton, because of Mrs. Eaton’s questionable reputation. He replaced the dismissed Cabinet members with more pliable personalities. Not that he ever paid much attention to his official Cabinet—preferring to consult with his circle of old friends, cronies, and yes men, his so-called “Kitchen Cabinet.”

A visiting surgeon from Philadelphia had the courage to cut out Jesse Benton’s bullet from Jackson’s left shoulder. The bullet had by this time traveled below the skin where it could be easily felt. The operation, in 1831, was done with dispatch, without anesthetic, and with the patient standing up. It is reported that Jackson’s health promptly improved after the excision of the bullet which had probably kept up the suppuration of the bone.

In 1838, Jackson consulted the most famous surgeon of the time (remarkably named Dr. Philip Sying Physic), for his persistent chest pain. But even the renowned Dr. Physic could advise nothing for the chest condition but “cupping,” the application of heated suction cups to the skin overlying the painful area.

From Philadelphia the President went on a tour through conservative New England. The trip was a surprising personal triumph. In Cambridge the august faculty of Harvard University condescended to confer the honorary degree of Doctor of Laws on the lowly born President who had never seen the inside of a college. (Only John Quincy Adams violently objected to this disgrace to his alma mater. He hated Jackson, who had defeated him in the election for a second term, and called him a “barbarian” who could hardly read and write.)

The President’s round trip from Washington took twenty-seven days, and while it was a great political success, medically it was a nightmare. During his stay in Boston, Jackson contracted a heavy cold which brought on one of his more severe pulmonary hemorrhages. Yet his powers of recuperation were so extraordinary that he finished the trip as planned and returned in fair condition to Washington.

During his second term, the President’s health was possibly even worse than during the first term. He still held a firm grasp of the reins of government, and once having made a decision, nothing could move him to alter it. Sickness and age only in creased Jackson’s suspicion and hatred of those he considered his enemies. His fierce clashes with Clay, Calhoun and Webster are well known. He considered Nicholas Biddle, director of the Bank of the United States, as his archenemy, convinced that Biddle had used the resources of the bank to finance the campaign of his opponent at the presidential election.

Jackson had the peasant’s suspicion of banks. He did not understand that the function of the Federal Bank was to regulate the supply of money in circulation with the blind hatred of ignorance, he fought the bank relentlessly, and in his last presidential year succeeded in having its charter revoked. By this and other ill-advised economic measures, Jackson sowed the wind for the great depression of 1837; his unfortunate successor, Van Buren, reaped the whirlwind.

Jackson’s unyielding stubbornness, which led to such disastrous domestic results, served him better in international politics. The stern language of his notes convinced the various European nations that they had better pay the long overdue claims for damages inflicted during the Napoleonic Wars. We may not agree with some of Jackson’s principles, and regret his prejudices and arbitrary methods, but we should never forget that as a whole his aims and actions as President and statesman were not dictated by selfishness but by the sincere belief they were for the best interests of the United States and the common man.

In his last year as President, Jackson suffered from an unusually severe attack of coughing, leading to another profuse pulmonary hemorrhage. It is reported that his doctors treated Jackson by bleeding him of two additional quarts of blood. The indestructible patient survived even this murderous therapy.

To the surprise of all, the President, who had been considered physically unable to outlast his first term, survived his second term in March 1837, though in such poor shape the doctors thought he could not stand the three-week trip back to The Hermitage. Against their advice the patient insisted on departing immediately, and at President Van Buren’s request, the surgeon general and a relay of other army doctors accompanied him all the way.

Jackson arrived safely and lived eight more years in the quiet surroundings of The Hermitage, but even there he had no peace. He could not bear to sit quietly by and watch from a distance the political upheaval which, after four years, dethroned the Democratic Party and brought the Whigs into power. From his armchair, Jackson hurled his thunderbolts at anyone who dared to disagree with him, and quarreled violently with his most intimate friends. He was the intransigent champion of the cause of slavery which he believed to be in danger.

His sick body tormented him without let-up. Since 1829, Jackson had passed through several episodes of dropsy, with swelling of the feet and legs. This condition had occurred and subsided a number of times, but during his last years it was constant. The swelling gradually increased and spread upward in the body. Dr. Gardner, a medical biographer, presented the plausible theory that Jackson’s terminal dropsy was caused by a specific degenerative condition of the body called amyloidosis. This had developed as a consequence of the various suppurative processes. Amyloidosis, a rare condition at present, can be brought on by severe chronic infections. It is characterized by the formation of a peculiar protein-like substance in various organs, especially the kidneys, liver and spleen, and leads to a water-logged state of the tissues called edema.

Any pathological process which diminishes the viscosity of the blood below a certain point will induce edema. The normal circulation within the blood vessels depends on a certain thickness of the blood maintained by the proper amount of protein. If the protein content is reduced below a critical level by much loss of blood, by severe secondary anemia, or by nephritis or amyloidosis, the watery blood plasma seeps through the vessel walls and accumulates in the adjacent tissues. The degree of the dough-like swelling of dropsy corresponds to the severity of the primary process responsible for it.

In Jackson’s case, we are unable to determine the causes of the dropsy episodes he suffered. He repeatedly lost great quantities of blood by pulmonary hemorrhages; his chronic infectious process in chest, shoulder and bowels led to a severe secondary anemia and also to inflammatory and degenerative changes in his kidneys. The repeated bleedings increased his anemia.

Contributing to Jackson’s misery were the financial worries which beset his last years, and the heartache which his adopted son, Andrew Jackson Donelson, brought him. Like other strong, lonely and childless men, such as both Michelangelo and Beethoven before him, Jackson tried to fill the void of his paternal frustration by adopting a nephew as his son. His fatherly devotion, like theirs, was repaid by ingratitude and disappointment. Andrew Junior proved to be an improvident wastrel, who mismanaged The Hermitage plantation during his father’s long absence in Washington, and brought him to the verge of bankruptcy.

There were further afflictions which struck Jackson during his last few years. In 1837 he became blind in his right eye. A year later, he developed a condition suggestive of erysipelas, high fever and delirium, followed by a huge swelling of head and ear that broke out in blisters. His shortness of breath made it more and more difficult for him to move around. Yet each day he walked the few steps to Rachel’s grave.

Sick as he was, in January 1840 the General accepted an invitation to New Orleans to commemorate the twenty-fifth anniversary of his great victory over the British. On the way he hemorrhaged so badly that on his arrival he was too weak to make a speech, but he managed to make a short personal appearance, supported on each side by a friend, and to force a smile and wave to the enthusiastic crowd. The tonic of public aduladon invigorated the old warrior so much that he was able to continue his trip for more celebrations at Jackson and Vicksburg and somehow to get back to The Hermitage. This was his last long trip.

Finally, the chain reaction of disease affected the one organ which had for so long withstood the ravages—his sturdy heart. There can be no doubt that Jackson’s chronic pulmonary disease strained and weakened the right chamber of the heart, which had to pump the blood through the pulmonary vessels increasingly constricted by scar tissue. The right ventricle reacted to the increased burden with hypertrophy of its muscles, followed in time by overstretching of the muscle fibers and impairment of function. The blood started to stagnate in the veins and the plasma extravasated into the tissues. Thus a dropsy of cardiac origin became superimposed on a pre-existing edema from a deficiency of blood proteins.

In 1843 the physical deterioration was accelerated by a more acute phase of gastroenteritis. Inexorably the dropsy climbed higher and higher. The shortness of breath forced Jackson to give up his brief daily walk to Rachel’s grave. By 1844, he could not walk at all, but had to be lifted from a sitting position in bed to the same position in a chair. His mind, however, remained clear. In May 1845, he wrote to his foster son, “I am swollen from my toes to the crown of my head and in bandages to my hips.”

At this late time a fashionable French painter arrived to make a portrait of Jackson. The artist found a tall man propped up in a chair, fighting for breath, his face a mask of swollen flesh crossed by the lines of pain; one eye was covered by a white scar, the other a glowering slit between puffed eyelids. Jackson was a gruesome sight. The Frenchman fled, preferring to copy a painting of Jackson made several years previously by another artist and to embroider it with his own imagination.

The end was near. On June 2, 1845, the abdomen became so distended that Dr. Esselman of Nashville had to tap it. He obtained “much water” without giving the patient much relief. Opiates were freely administered but did not quiet the restless spirit. He could not eat. He could not sleep. Up to the last, Jackson’s greatest concern was the fate of the Union. Two days before his death, he dictated a letter to President Polk, commending his strong stand on the Oregon question and expressing confidence in a settlement, peaceful or by war, but to the advantage of the United States.

The end came on June 8, 1845. The old warrior’s great spirit, which for so many years had animated a broken body, was finally faltering and longing for rest. He who had so often defied death no longer resisted but welcomed him as a friend.