Medical mystery: The case of John Quincy Adams’ odd quivering

At age 11, traveling through Europe in 1778, young John Quincy Adams was urged by his father, Ambassador John Adams, to write home to his mother, Abigail.

"My Pappa enjoins it upon me to keep a journal, or a diary, of the Events that happen to me, and of objects that I See, and of Characters that I converse with from day,  to day," the boy wrote.

In his teens, he hesitated at the daily labor he later called "journalizing." His hand shook slightly when he wrote, similar to the tremors of his father — who called it "quiveration" — and cousin, Samuel Adams.

John Quincy's life soon proved so colorful he became a prolific diarist despite the tremor, writing 14,000 pages compiled in 51 volumes. He went on to become foreign minister and ambassador to multiple European countries including: Netherlands, Prussia, and later Russia. In 1802 he was elected to the U.S. Senate from his home state of Massachusetts and later served his country as a talented diplomat in Europe before returning home to become secretary of state, and author of the 1823 Monroe Doctrine.

The next year, after a multi-candidate race settled by a congressional vote that came to be known as the "corrupt bargain,"  John Quincy Adams became the sixth U.S. president at age 58. As president he proposed an infrastructure program including an interstate system of roads and canals and creation of a national university. He started the Chesapeake and Ohio Canal in 1828 and finalized the Erie Canal connecting the Great Lakes to the Hudson River.

His hand tremor, meanwhile, noticeably progressed when he was in his mid-40s. The tremors tended to be worse while he was using his hands for eating, drinking and writing than when his hands were at rest. Eventually, he had difficulty writing and drawing figures, especially when he was tired or stressed.

What caused John Quincy Adams' progressive tremor?

After losing his bid for reelection in a bitter campaign against Andrew Jackson in 1828, John Quincy Adams suffered what some modern observers have labeled a major depressive disorder, and went home to Massachusetts to recover. Yet in a couple of years he was back in Washington serving in the House of Representatives.

Alcoholism and depression affected several members of Adams' family, as did tremors. The problems affected both sides of his family — his parents were third cousins, making a genetic cause of the tremor very likely.

Most neurology opinions have labeled the Adams family as having "essential tremor" or "benign essential tremor," the most common of all movement disorders, affecting about 10 million Americans. As with Adams, the tremors tend to be rhythmic, and get worse during purposeful movement. They can affect the hands, head, trunk, voice, and legs.  This differs from Parkinson's tremor, which is worse at rest.

Essential tremor may start on one side of the body but becomes bilateral over years. The movements can be as frequent as four to eight times per second. The word "essential" refers to the fact that the cause of the tremor is unknown. About half of sufferers have at lest one family member who also has tremors.

Adams was in Congress for the rest of his life. He was a passionate supporter of free speech and universal education, and a vigorous opponent of slavery. His talent for argument earned him the nickname "Old Man Eloquent." Despite the tremors, he continued to write and published a volume of poetry. He has been considered the most scholarly U.S. president ever.

He suffered two strokes while in Congress; after the first in 1846, he recovered and returned a year later to Congress where he was greeted with a standing ovation. Two years later, while protesting the Mexican War, he had a second stroke and died on Feb. 23, 1848, at the age of 80.

Allan B. Schwartz, M.D., is a professor of medicine in the division of nephrology & hypertension at Drexel University College of Medicine.