Medical Mystery: Andrew Jackson, an ex-president in pain

Our current president, Donald Trump, lately expressed his admiration for our seventh president, Andrew Jackson, who served two terms in the White House, from 1829-1837.

Though Jackson lately has been criticized as a slaveholder whose actions against native Americans culminated in the infamous Trail of Tears, he was a popular, charismatic figure with a well-earned reputation as a man of action.

With his fiery red hair and a hot temper to match, Jackson was usually ready for a fight. He fought duels over business, legal matters, politics and love. And of course, he was a decorated military commander.

But all that action took a toll, leaving him in unremitting pain for decades before his death.

Jackson was born in 1767 in the Carolinas to Scots-Irish parents who likely immigrated through Philadelphia just a couple of years before his birth.

While just a child, he tasted battle, serving as a courier for the local militia during the Revolutionary War  with his brother. The boys were captured by the British, contracted smallpox and nearly starved to death. Indeed, he lost both his brothers and his mother to war-related causes.

After the war, orphaned at age 14, Jackson studied law books on his own, passed the bar exam and became a prosecutor in Nashville before entering politics, eventually being elected to the U.S. Senate. He joined the Tennessee militia in 1801, rising to the rank of general and embarking on a military career that culminated national hero status when he lead American soldiers in the Battle of New Orleans in January 1815. His troops nicknamed him "Old Hickory" for his steadfast toughness.

Eight years after leaving the White House, the 78-year-old Jackson was wearing out. He suffered severe shortness of breath for months, and had to be propped up at all times by pillows. Early in April 1845, his feet and legs had swelled dramatically, followed by his hands and abdomen. By late spring his face swelled as the tissues became filled with water.

For years, he suffered chest pains, coughed up blood, and complained of recurring chills and fever. The fevers could have been due to malaria, stemming from Jackson's battles in the mosquito-infested Florida swamps during the Seminole wars 25 years earlier.

Another possible culprit: tuberculosis he could have contracted as a teenager when he and his brother were locked up by the British; the disease killed Jackson's brother.

But his fondness for dueling also played a part in the symptoms he suffered at the end of his life.

By his 1829 inauguration, President Andrew Jackson was feeling the effects of his propensity for dueling, with two bullet wounds causing him unrelenting chest pain.

In an 1806 pistol duel, Jackson killed a Nashville lawyer – but not before the lawyer had managed to bury a bullet in the future president's chest wall, shattering two ribs. Though the bullet missed Jackson's heart, the wound never fully healed and caused Jackson pain and respiratory distress for the next four decades.

In 1813, another dueling opponent shot Jackson, shattering his left shoulder and causing so much damage that an amputation nearly was required. That ball, too, remained embedded in his body.

In 1831, while President Jackson was living in the White House, the left chest pain became so severe that he considered traveling to a Philadelphia hospital for the removal of the bullet in his chest, which migrated. But in 1832, a Navy physician went to the White House, cut into Old Hickory's chest and removed the bullet – without anesthesia.

Fourteen years later, in 1845, as the former president suffered with what then was called "dropsy," the accumulation of excess water, physicians tried purgatives or cathartics containing mercury and lead. Still, Old Hickory wrote, "It may be that my life ends in dropsy, all means hitherto used to stay the swelling has now failed to check it …. I am a blubber of water."

Today, a patient with the kind of edema Jackson suffered would likely be diagnosed with congestive heart failure. Cardiac medications and diuretics would be prescribed.

Jackson died on June 8, 1845, at the age of 78 – quite a great age at that time –of a combination of heart failure and tuberculosis. Though his dueling wounds caused him misery, they most likely didn't contribute to his death. Some historians reported that Jackson also suffered lead and mercury poisoning from the remedies he was given. 

Allan B. Schwartz, M.D., is a professor of medicine in the Division of Nephrology & Hypertension at Drexel University College of Medicine.