[The following in an excerpt from the Summer 2003 edition of the Tennessee Historical Quarterly and is copyrighted 2003 to the Tennessee Historical Society.] 

Andrew Jackson was treated by dozens of physicians during his life, but historians have said little about the education and practices of these doctors. One the last to treat Jackson, John H. Esselman is pictured next to Sarah Yorke Jackson beside to the general’s deathbed, while Andrew Jackson, Jr., weeps and young Rachel Jackson prays. (Nathaniel Currier, Death of Genl. Andrew Jackson, 1845)

Andrew Jackson and American Medical Practice:

Old Hickory and his Physicians

 By Ludwig M. Deppisch, M.D.

             Andrew Jackson, the seventh president of the United States, had an acquaintance with numerous physicians during his eventful, energetic, and lengthy life. John Bassett’s compilation of the Jackson correspondence identifies no fewer than fifty-seven physicians in its index. This acquaintance was not limited to Jackson’s personal medical care; it also encompassed his economic (care of slaves), business (land transactions), and military (conflicts with the British, Spanish, and Native Americans) interests.¹

            Historians have said little about the physicians who treated Jackson for his myriad illnesses. Nor do we know much about the education and practices of his numerous doctors, the professional and academic lineage that influenced their therapeutic decisions, the president’s interactions with his physicians, and his compliance with their therapies.

            His biographers have concluded that Andrew Jackson experienced lead and mercury poisoning. Some have even suggested that heavy metal toxicity contributed to this president’s death. His physicians plied him with calomel (mercurous chloride) and sugar of lead (lead acetate), prescriptions from the early nineteenth century pharmacopoeia. A third integral part of his medical regimen was frequent and rigorous bloodletting, whether performed by a physician or servant or self administered. Venesection was the preferred mode to remove blood but the placing of heated glass cups on the skin, a process referred to as “cupping” was also employed.  Collectively these violent therapies together with a few others comprised the treatment philosophy known as heroic medicine.²

            Andrew Jackson lived for seventy-eight years. His medical history was encyclopedic. He was the target not only of endemic infectious diseases of his era, malaria and smallpox, but also of the therapeutic agents employed by the practitioners of heroic medicine, bleeding, calomel, and sugar of lead. Additionally Jackson assaulted his physical well being by his predilection for physical confrontation.

            As a teenage combatant in the Revolutionary War, Jackson’s forehead and wrist were lacerated by the saber of a British officer. Jackson contracted smallpox while imprisoned on a British prison ship in Camden harbor during the war. This disease contemporaneously sickened his brother, Robert, a fellow prisoner of war. Elizabeth Hutchinson Jackson obtained the release of both of her sons, but Robert died from his disease shortly thereafter. Mrs. Jackson nursed Andrew back to health. In 1806, he fought a duel with Charles Dickinson, the consequences of which long troubled Old Hickory. Dickinson shot Jackson in the left chest and the resultant lung infection persisted until Jackson’s death, thirty-nine years later. He suffered periodically from severe left-sided chest pain and episodic coughing of blood that may have produced chronic anemia. The most likely cause for these symptoms was a traumatic bronchopulmonary fistula.³

            In 1813, the future president was involved in a a gunfight that resulted in a bullet wound in his left shoulder. Chronic osteomyelitis of the left shoulder ensued and dead bone spontaneously extruded several years later. The retained lead slug produced occasional discomfort until it was surgically excised in 1823.⁴

            Old Hickory developed diarrhea during the War of 1812; this symptom afflicted him until his death. The initial cause of the diarrhea is unknown, but Jackson compounded his digestive difficulties by the excessive use of both mercury and lead therapeutics. Many authors make reference to Jackson’s malaria.⁵

            Finally, Jackson developed swelling of his ankles in 1829, that progressed to generalized edema in 1845, a condition referred to as dropsy. Fluid accumulated in his lungs and within his abdominal cavity. Tapping and drainage of the fluid, a procedure currently identified as paracentesis, relieved the latter. It is unknown whether Jackson’s terminal symptoms were due to either kidney or heart failure, or to a combination of the two.⁶

            Andrew Jackson’s physicians were educated in the therapeutic philosophy of heroic medicine. This academic lineage coursed from the teachings of Dr. William Cullen at the University of Edinburgh, crested with the pronouncements of the leading American physician of the period, Benjamin Rush at the University of Pennsylvania Medical School in Philadelphia, and flooded the American medical scene through Rush’s many students. Thus, by understanding Cullen and Rush, we then may begin to understand how physicians treated, and affected the health of, Old Hickory.

William Cullen (1710-1790)

            William Cullen was the professional ancestor of Benjamin Rush and countless other American doctors, including many if not most of Andrew Jackson’s physicians. Cullen attended the University of Glasgow and the new medical school at the University of Edinburgh. In 1775 he was appointed chair of the institutes (theory) of medicine and later sole professor of medicine at the latter institution, a position he filled until near his death. Cullen was an inspiring and forceful lecturer and was famous for his innovative teaching methods. He was the first to teach in English rather than in Latin and his lectures were delivered in the infirmary, rather than in the lecture hall.⁷

            Cullen held that successful therapeutics required the reestablishment of the balance of bodily fluids. Purgatives, the most important of which was calomel, were necessary to restore this balance. Benjamin Rush was instrumental in disseminating this philosophy to the United States.⁸

            Calomel is mercurous chloride, a heavy, solid, odorless, impalpable powder, that is insoluble in water or alcohol. The word calomel is derived from the Greek, calos, meaning good, and melas, meaning black, referring to the expulsion of dark stools containing mercurial sulfides, a result of the drug’s purgative action. This drug became a mainstay of the medicinal armamentarium of American practitioners in the early nineteenth century and beyond. The 1818 American Dispensary described calomel as “one of the best mercurials, made to increase, in a remarkable manner, almost any of the secretions or excretions.”⁹

            Cullen blistered patients and if the presenting symptoms suggested inflammation, he would employ bleeding, mainly venesection. The usual amount bled, about eight ounces (225 ml), was far less than later employed by Benjamin Rush and his adherents. The bleeding was sometimes repeated once or twice in subsequent days.¹⁰

            The early medical fathers relied on moderate bloodletting, prescribing according to age, sex, season, severity of the disease, and the unique constitution of the patient. Cullen apparently subscribed to this view.¹¹

Benjamin Rush (1746-1813)

            Benjamin Rush was the most influential physician in post-colonial America. His significance was due not only to his prominence as a medical practitioner and educator but also to his aptitude in marketing, and to his political importance as a public servant and as a friend to several Founding Fathers.

            Rush, recommended to Cullen by Benjamin Franklin, studied in Edinburgh for two years, receiving his medical degree there in 1768. He wrote in 1768, “the great unrivalled Dr. Cullen is going on unfolding each day some facet . . . .I think that I would not fail of having heard them for ten thousand pounds. .” During the Revolutionary War Rush had Cullen’s First Lines on the Practice of Physic published in Philadelphia. Upon receiving word of Cullen’s demise, Rush delivered a eulogy in his honor before the College of Physicians of Philadelphia on July 9, 1790.¹²

            Upon his return to the United States, Benjamin Rush, at age twenty-four, was appointed  professor of chemistry at the Philadelphia School of Medicine. With few interruptions from 1769 until shortly before his death in 1813, this educator taught medical students at this medical school and its successor, the University of Pennsylvania School of Medicine. In 1791 he was appointed professor of the institutes and practice of medicine and clinical practice.¹³

            The University of Pennsylvania was not only the first, but also the largest medical school in the United States. During the colonial and past colonial period, it graduated almost as many doctors as all other American medical schools combined. It has been estimated that between 1779 and 1812 Rush lectured to 2,872 prospective physicians. Many of Andrew Jackson’s future physicians, including doctors Sim, Huntt, Harris, and Robertson were amongst his students.¹⁴

            Rush’s therapeutic philosophy was crystallized during the deadly Philadelphia yellow fever epidemic of 1793 that slew more than 4,000. After his initial treatments had failed to deter the rapid spread of the epidemic, Rush uncovered a hoary medical paper that championed heroic strategies in quelling this disease. After the majority of his patients so treated recovered, Rush advocated “purge and bleed” as the answer to his therapeutic dilemma. He bled his patients prodigiously and prescribed heavy doses of cathartics, jalap and especially calomel. Jalap was prepared from the root of the bindweed, convolvulus jalapa.¹⁵

            Given Rush’s professorial podium and his expertise as a publicizer, his theories received wide distribution. Rush maintained that small bleedings did little to conquer the idiosyncratic harshness of American diseases. He believed that bleeding, “should be repeated while the symptoms which first indicated it continue  -- should it be till four-fifths of the blood contained in the body be drawn away.” Patients could be drawn until unconscious. Rush was by no means alone in his fervor; American doctor Philip Physick was known to draw ninety ounces (2660 ml) from a single victim. According to Flexner, “Until the middle of the nineteenth century most men who died on the North American continent had little Rushes standing by their bedsides with lancets in one hand and vials of calomel in the other.”¹⁶

Francis May (died 1817)

            Francis May significantly affected Jackson’s early medical treatment. His professional career and personal behavior epitomized the tradition of the American frontier. The extent of May’s medical education is unknown and there is no record of a formal medical degree or of his attendance at a medical school. He probably had been apprenticed to a frontier practitioner, but this is speculative. May commenced his practice in Nashville in 1790, but was forced to temporarily abandon it and flee to Knoxville after he killed a fellow physician, Frank Sappington, in a duel.¹⁷

            May was a native of Virginia and moved to Nashville from Winchester, Virginia. He returned to Nashville in 1804 from his exile in Knoxville, and died there in 1817. May “became an intimate friend of Gen. Jackson.” His name first appears in Jackson’s correspondence in March 1800 letter written in Knoxville. In a letter to John Coffee, dated April 13, 1804, Jackson wrote that he was awaiting Dr. May who would accompany him on an extended trip. Dr. Felix Robertson described May as having a “higher sense of honor. He possessed a high order of mind and was an intelligent and successful physician. He was a bosom friend of General Jackson and named a son Jackson in token of his friendship.”¹⁸

            May was the surgeon who accompanied and treated Jackson during the infamous duel with Charles Dickinson in Kentucky on May 30, 1806. This conclusion is supported by correspondence to and from Jackson in 1827-1828 that refers to an alleged letter written by the presumed eyewitness, May accusing Old Hickory of murder in that tragic affair. After initially defending Jackson’s conduct in the duel, May wrote an 1807 letter critical of Old Hickory’s behavior.¹⁹

            It is likely that May was one of the many Nashville physicians that attended Jackson’s shoulder wound that was sustained in his gunfight with the Benton brothers. It remains unknown whether May was the doctor who recommended that Jackson’s arm be amputated. Shortly, thereafter, May was asked whether the general could lead the Tennessee troops into the conflict that became known as the Creek War. He replied that “no other man could, and that it was uncertain whether, with his spunk and energy, he could; but that it was entirely uncertain what General Jackson could do in such circumstances.”²⁰

            May accompanied Jackson for the first several days of the march against the Creek Indians and introduced his patient to treatments with sugar of lead. The doctor stated “that they had to stop the General frequently and wash him from hand to foot in solutions of sugar of lead to keep down the inflammation; and that he was better, and he and his troops had gone on.”              Subsequently, Jackson became a user of this remedy to control lung hemorrhaging, and presumably, to control his persistent diarrhea, even though he may have recognized some of its adverse effects. “The doctors tell me I lost from the lungs, and by the lancet and cupping upwards of 60 ounces of blood, which stopped the hemorrhage, without the aid of that potent, but pernicious remedy to the stomach, sugar of lead.”²¹

            Sugar of lead (lead acetate) was a therapeutic familiar to the Romans, who boiled grape juice in lead pots to produce a sweet tasting syrup. After the sixteenth century it had widespread application: for the treatment of fevers, especially those produced by malaria; as a therapy for diarrhea, as an anti-aphrodisiac employed by monks sequestered in monasteries, and especially as a prescription for internal bleeding. Dr. Benjamin Rush even employed lead acetate to treat children with epilepsy. An 1855 medical journal reported that “the combination of opium and sugar of lead has been recommended as the best remedy in cholera.” During the Jacksonian era, it was used for a variety of purposes, including the control of bleeding and as a remedy for diarrhea, symptoms all too familiar to Old Hickory. Additionally May apparently treated Rachel Jackson with calomel and bleeding.²²

David Corbin Ker (1772-1840)

            David Corbin Ker was a well-trained physician, patriot, New Orleans civic leader, and colleague of Andrew Jackson. Ker was born in Virginia, and at a very young age traveled to Edinburgh where he studied medicine for three years. He came under the influence of William Cullen and after three sessions of lectures (1789-1792), he graduated with a medical degree.²³

            Ker returned to Virginia, but moved to New Orleans in the early 1800s. He prominently served under General Jackson during the New Orleans campaign of 1814-1815. In a letter, Jackson refers to Ker as hospital surgeon of the army, and in an earlier letter, wrote “their services, as did Doctors Ker and Flood; and were of great assistance to me.” There are at least four other Jackson references to Dr. Ker’s medical services to the army during this campaign, and in 1816, Ker wrote the General requesting support for his claim for compensation as acting apothecary general during the New Orleans campaign.²⁴

            Ker treated Jackson for dysentery. Jackson wrote that he had suffered from dysentery for four months “until five days ago, when Doctor Ker, Hospital surgeon succeeded in stopping it.”  Ker’s successful therapy is not further described. Ker became politically active, and after his old friend Andrew Jackson was elected president, he wrote, “I am almost mad with joy. I thank God that I have lived to see the downfall of the Yanky [sic] Dynasty.”²⁵

            This doctor also served in the Louisiana state legislature, and he headed a group of physicians who established the first medical society of the state in 1820. Ker was additionally the vaccine agent for the state. In 1823, due to a smallpox scare, the New Orleans Board of Health directed Ker to provide free smallpox vaccine to the poor. Later he was a successful physician-administrator of the New Orleans Charity Hospital. His fame included the setting of a compound fracture of the ankle of General Sam Houston, after the battle of San Jacinto in 1836. ²⁶

Henry Huntt (1782-1838)

            Dr. Henry Huntt was a leading physician in the nation’s capital during the early nineteenth century, and was called upon to treat five United States presidents. He was born in Calvert County, Maryland, and at age eighteen, commenced his medical education as an apprentice to his uncle, Dr. Clement Smith, a respected practitioner in Prince Georges County, Maryland. In 1805 and 1806, Huntt attended a course of medical lectures at the University of Pennsylvania; upon its completion he returned to Maryland where he became a partner in his uncle’s practice. He never acquired a formal medical degree, although in his later years several medical universities bestowed honorary degrees upon him.²⁷

            Huntt moved to Washington D.C. in 1810, and in 1811 the U. S. Navy appointed him a surgeon’s mate, a post that he resigned two years later. During the War of 1812, he was appointed an army surgeon and served as chief of the military hospital in Burlington, Vermont.  While there, his clinical powers of observation led to the publication of case reports dealing with the treatment of pneumonia and the effects of sugar of lead therapy.²⁸

            Of the wide use of sugar of lead, Hunt in 1815 remarked: “No one appreciates more highly than I do, this valuable article of the materia medica; but great caution ought to be observed in its administration, without which much is to be feared, and that it will oftener prove a bane, than an antidote to man, especially as some physicians express doubts of its deleterious effects.” He continued by quoting two cases of intestinal colic, secondary to sugar of lead, one of which was cured by calomel. ²⁹

            At the conclusion of the war, he returned to the practice of medicine in Washington, where, he took “a stand high among the physicians of that day. . . and few can boast of being more successful.” For twenty years, Huntt was distinguished both as a clinician and as an organizational leader. He was successful in treating many diseases, including pneumonia, pediatric illnesses, epilepsy, and scarlet fever, and became the first public health officer of the District of Columbia and was one of the organizers of its Board of Health, serving as its President for many years. Additionally Huntt was one of the founders of the Washington D.C. Medical Society.³⁰

            Jackson biographer John S. Bassett identified Henry Huntt as the Jackson family physician during the president’s tenure in Washington from 1829 to 1837. In a letter to Emily Donelson, the president refers to paying Huntt $175 for medical services during 1836. On the evening of November 19, 1836, Dr. Huntt was summoned to the White House when the president developed a severe episode of bloody coughing. Huntt bled Andrew Jackson and administered a preparation of salt, but the next morning the symptoms recommenced. Huntt was again summoned; he cupped and blistered the president. That evening the president was prostrate and in severe pain. Huntt again bled the president, withdrawing “upwards of 60 oz. blood.” The president survived both the organic illness and the physician’s heroic treatment. Jackson was relieved that the hemorrhaging ceased “without the aid of that potent, but pernicious remedy to the stomach, sugar of lead....” A review of President Jackson’s correspondence reveals that he paid more than $400 to Huntt for unspecified medical care to him and his family during the years 1833 to 1837.³¹

            The president was apparently pleased with Dr. Huntt’s care, since in 1836 when the office became vacant, he entreated the doctor to assume the office of surgeon general. After several verbal requests, the president formally offered the appointment in the form of a letter. Huntt, however, declined, and Thomas Lawson filled the position. Later Huntt developed pulmonary tuberculosis, and consulted Dr. Physick in Philadelphia. However, he died from his disease in 1838.³²

Thomas Sim (1770-1832)

            Dr. Thomas Sim was another prominent Washington physician who received his medical degree from Benjamin Rush’s University of Pennsylvania, probably in 1800. He signified his debt to Rush by delivering a eulogy to the eminent teacher on June 26, 1813, on the occasion of Rush’s death.³³

            His career paralleled that of his contemporary Henry Huntt. Sim was an incorporator of the Washington medical society and was one of the members of the district’s first board of health. Sim was president of the former organization when he was stricken and died during the cholera epidemic of 1832. It was during this same epidemic that Huntt heroically served the district.³⁴

            Sim appears to have possessed both political and personal attachments to Old Hickory.  The doctor was politically active during the 1828 campaign that elected Jackson to the presidency. Jackson biographer James Parton identified Sim as “an old friend, who was always the family doctor when Jackson was in Washington.” This reference was to Jackson’s tenure as a U.S. Senator during 1823-1825. Sim earlier served as a physician to President James Monroe.³⁵

            Sim’s medical reputation was somewhat suspect. During his senatorial stay in the nation’s capital, Jackson developed a severe infection at the site of the retained bullet fragment in his left upper arm. An appeal was made to Rachel Jackson “in the hope that through her influence, the General might be prevailed upon to call in another physician.” Mrs. Jackson did so entreat her husband, but was refused with the following rejoinder, “Dr. Sim(s) is my friend  -- an old and valued friend. His professional reputation, his standing as a physician, his feelings as a man, as a friend, are all at stake in this matter. My dear, the thing is impossible; it can not be. He shall cure me, or he shall kill me. I entreat you never to speak to me upon the subject.”³⁶

James Crowdhill Hall (1805-1880)

            Several accounts credit James Hall as the family physician of every United States president from Andrew Jackson to Abraham Lincoln. In Jackson’s collected correspondence there is a receipt, dated January 1, 1832, “to operating for hydrocele and subsequent attendance, $30.00.” It is uncertain who was the surgical patient, but presumably it was the president. In addition, Hall charged Jackson another $70 for various minor surgical treatments of the Jackson family between 1832 and 1835.³⁷

            Hall was “the head of his profession in the city of Washington D.C.” For many years he attended the family of every justice of the Supreme Court, the family of every cabinet member, every prominent United States senator and representative, and members of foreign legations, in addition to taking care of the medical needs of many presidents of the period. Hall also served the community with distinction during the 1832 cholera epidemic. A bachelor, he was a member of all the important regional medical societies, and also prominent in the establishment and maintenance of many of the capital’s philanthropic and cultural institutions.  He was one of the founding trustees of the famed Corcoran Art Gallery. Chronic illnesses of an unspecified identity curtailed his activities during the later years of his life, and he died unexpectedly in 1880 from a brief terminal illness.³⁸

            He was born in Alexandria, then a part of Washington, D.C. He was an 1823 graduate of Jefferson College in Pennsylvania, where he received an A.B. degree. He commenced the study of medicine with Dr. Thomas Henderson of Georgetown, and in 1825 began the first of two series of lectures at the University of Pennsylvania School of Medicine. He received his M.D. degree from that school in 1827.³⁹

            A year as a resident physician at Blockley Hospital in Pennsylvania preceded his return to Washington. He commenced his private practice there and on the side taught anatomy to medical students. From 1830 to 1839 Hall was professor of surgery at Columbia College in that city. His increasing consultative practice forced him to abandon his formal teaching career.⁴⁰

Thomas Harris (1784-1861)

            In 1832, navy surgeon Thomas Harris removed a bullet from the left shoulder of President Andrew Jackson. This bullet had been present since an 1813 gunfight and may have been the source of Jackson’s chronic lead poisoning. Harris was visiting the nation’s capital, and the president seized this opportunity to have the projectile excised by this skilled surgeon.⁴¹

            Harris made an incision, squeezed the president’s arm and expelled a “half ball of ordinary pistol size.” Its metal coating was flattened by contusion and hackled somewhat on its edge. Harris dressed the wound and the president returned to his work. According to the Washington Globe, “Dr. Harris displayed much skill in performing the operation, and particularly in disengaging the bullet. . . . from the muscle to which it was attached. The incision made, was necessarily of considerable extent, -- the ball being large and flatted.” The president appeared at dinner with his friends, his arm in a sling, a few hours later.⁴²

            Thomas Harris was born in eastern Pennsylvania, the son of a Revolutionary War general.  He attended the University of Pennsylvania School of Medicine from 1806 to 1809, where he received his medical degree. When the War of 1812 commenced, Harris was appointed a navy surgeon and saw combat. He remained a naval physician until his retirement in 1857.⁴³

            His professional career was distinguished. He was the principal naval surgeon in Philadelphia and was instrumental in organizing the Navy Medical Institute where he was a lecturer in operative and military surgery. President John Tyler appointed Harris chief of the Bureau of Medicine and Surgery in 1844, a post that he filled until 1853. He concluded his naval career by serving as president of the Examining and Retiring Board in Philadelphia.⁴⁴

            Harris apparently impressed Jackson with his surgical skill. In a letter to his friend Francis P. Blair in 1844, the former president wrote, “All congratulate you in your returning health and the skill of that good Doctor Harris  -- may you live long.”⁴⁵

Philip Synge Physick (1768-1837)

            This noted American physician was praised as the “Father of American Surgery” and was viewed as one of the leaders of post-colonial medicine in the United States. Physick could also trace his academic lineage to William Cullen and perhaps also to Benjamin Rush, who was his associate on the Pennsylvania School of Medicine faculty.⁴⁶

            Physick was born near Philadelphia and graduated from the University of Pennsylvania at age 17. Physick’s father insisted that his precocious son study medicine, and accordingly the scion was apprenticed to Dr. Adam Kuhn of Philadelphia, a former student of Cullen at the University of Edinburgh. Cullen’s reputation was so pervasive that the apprentice memorized First Lines of the Practice of Physic. In 1788 his father accompanied young Physick to London and introduced him to the famed anatomist John Hunter, under whom he studied for approximately three years. During the winter of 1791-1792, the younger Physick attended classes under Cullen at the University of Edinburgh, where he received his medical degree in 1792.⁴⁷

            Upon returning to Philadelphia, Physick became immersed in the medical emergency of the great yellow fever epidemic of 1793. Subsequently he became a clinical teacher on the staff of the Pennsylvania Hospital. His abilities were soon apparent and he was awarded the title of professor of surgery at the University of Pennsylvania Medical School, a post he held from1805 to 1819. His colleague was Benjamin Rush, who both attended and applauded Physick’s lectures.  In 1819, Physick became the professor of anatomy at the same medical school, a position he held in until 1831. Thereafter he was titled Emeritus Professor of Anatomy and Surgery, which expired only upon his demise.⁴⁸

            Physick was known as a conservative surgeon, but he had great faith in venesection. His contributions to the practice of surgery were notable and included reduction techniques for dislocations; the introduction of catgut sutures; pioneer work with gastric tubes; and the guillotine tonsillectomy. He was also a very skilled lithotomist, and performed a very difficult removal of innumerable bladder stones from Chief Justice John Marshall in 1831.⁴⁹

            This eminent physician’s career connected with that of the equally eminent Andrew Jackson. During the latter’s triumphal visit to Washington, D.C., in 1815, his “health collapsed and he nearly died. President Madison was so alarmed that he insisted on summoning the celebrated Dr. Physick from Philadelphia to attend the General.”  For unknown reasons this consultation did not occur and Physick did not treat Jackson until many years later. In 1833, the president visited Physick in Philadelphia with renewed bleeding from his lungs. Jackson wrote on June 10, 1833, “I have seen Dr. Physick, who encourages me, and says my heart is not affected in any way, and the pain in the side can be removed by cupping.”⁵⁰

            There is a letter from Jackson to Physick in 1835, wherein the president expressed his gratitude for the physician’s seeing his granddaughter, Rachel, who is “perfectly recovered and to your skill and kind attention. . . .”⁵¹

John Warren (1778-1856)

            Dr. John Collins Warren was the second preeminent American surgeon to examine President Jackson during his physical travails during the first half of 1833. In a letter to his wife, Jackson’s nephew, Andrew J. Donelson, identifies Warren as “the Quincy family physician,” who attended the president in Boston on June 24, 1833. Donelson’s identification was somewhat disingenuous since Warren, the son of the founder of the Harvard School of Medicine, was then the leader of the Boston medical community. His accomplishments included the founding of the Massachusetts General Hospital, the introduction of ether anesthesia, and leadership in establishing both the New England Journal of Medicine and the American Medical Association.⁵²

            Warren was a member of the American professional elite who could afford the opportunity to study medicine abroad. In 1799, he was a pupil in London of William and Astley Cooper and performed dissections at the Guy’s Hospital. Subsequently, Warren studied medicine for a year at the University of Edinburgh, where he achieved his medical degree. A year spent in Paris completed his European training. Warren returned to Boston in 1802 and resumed the practice of his ill father. In 1806, he was an adjunct to the elder doctor Warren as Harvard chair of anatomy and surgery. He succeeded his father to the professorship of anatomy and surgery in 1815.⁵³

            Jackson’s medical exposure to Warren was apparently limited to a single encounter on June 24, 1833. Donelson writes, “he began hemorrhaging. It started with a cold, and abscess formed and then ruptured.” Dr. Warren was summoned, “and the first thing he did was to bleed the president. When that procedure failed to gain results the good doctor bled his patient a second time.” Donelson continues with his opinion that “After two days of rest, and after the doctor ceased his infernal bleeding.” Jackson was stronger. The Boston Daily Atlas recorded in June 25, 1833: “The President was seriously indisposed yesterday. Dr. Warren was summoned early in the morning to attend him, and finding him with considerable fever, deemed it advisable to take blood. He was confined to his bed all day, and all communication with him was interdicted.”⁵⁴

            In June 1836, Warren and part of his family were the guests of President Jackson in Washington. On that occasion, the doctor recorded, “Mrs. Warren gave him (Jackson) some good advice about his health, and recommended him not to drink wine, to which he assented.”⁵⁵

Robley Dunglison (1798 - 1869)

            Robley Dunglison treated four presidents or ex-presidents, Jefferson, Madison, Monroe, and Jackson, during his illustrious American medical career. Thomas Jefferson’s emissary, Francis Walker Gilmer, selected Dunglison, while on a talent search in Europe for the charter faculty for the new University of Virginia in Charlottesville.  Jefferson’s preference for a non-American doctor to fill the sole medical faculty position at the new university was much criticized. However, his reasons for such a selection were cogent; he did not want to raid the faculties of the extant American medical colleges and the Charlottesville position was a unique one. Dunglison was to be the sole physician professor at the college of medicine whose mission was not to train students to become physicians, but rather to produce educated citizens.⁵⁶

            Dunglison, a native of Keswick, Cumberland, England, was apprenticed to a local surgeon, Dr. John Edmondson, at age seventeen. He subsequently attended medical lectures at Edinburgh, London, and Paris, and passed his examinations at London’s Royal College of Surgeons and the Society of Apothecaries in 1818. His medical degree was conferred in absentia by the University of Erlangen, since such degrees were not readily available at that time in London. Dunglison found general practice to be distasteful, and decided to restrict his practice to obstetrics, gynecology, and pediatrics. His 1824 work, Commentaries on the Diseases of the Stomach and Bowels of Children, impressed Francis Gilmer.⁵⁷

            Dunglison was a trailblazer at the University of Virginia. As the first full-time medical faculty member in the United States, his contract stipulated that his duties comprised full-time teaching and research; private medical practice was prohibited. In addition, Dunglison was the first to add a series of lectures in the history of medicine to the standard curriculum.⁵⁸

            However, Dunglison was granted an exemption to treat a private patient –  Thomas Jefferson, the founder of the University of Virginia. Dr. Dunglison treated the ex-president during his last year of  life for urinary tract obstruction, probably secondary to prostate hypertrophy. In contrast to his traditional abhorrence of the treatments of physicians, Jefferson abided by his new doctor’s prescriptions. Dunglison also attended to James Madison often; his last visit occurred in May 1836, when this ex-president suffered from an acute “rheumatic ailment” prior to his death few weeks later.⁵⁹

In 1833, Nicholas Trist, the private secretary to President Andrew Jackson, invited Dunglison to Washington to assist with the inactive gastric physiology experiments of William Beaumont. During one of these visits about June 1, 1833, Dunglison was requested to consult on the illness of the president. At that time Jackson was suffering from “pleurodyne,” related to his previous traumatic injuries. According to Dunglison, Jackson’s “usual remedy – for he was heroic in the treatment of his own case -- was to lose a quart of blood. Bloodletting had been practiced before I saw him on this occasion but he had not obtained his accustomed relief, owing, he said to the bleeder not having taken a sufficient amount from him.” The president’s excessive bloodletting startled Dunglison, who instead recommended strong counter irritation, in the form of a warm plaster, animated by cantharides, to be worn. The first plaster was beneficial, and Jackson requested a second one, which was apparently attended to by Dr. John Warren when Jackson arrived in Boston.⁶⁰

            In 1833 Dunglison departed from the University of Virginia and continued a successful academic career, first at the University of Maryland and then at Jefferson Medical College in Philadelphia.⁶¹

John N. Esselman, (1807-1862)

John N. Esselman attended Andrew Jackson both before and during the ex-president’s terminal illness at his estate, the Hermitage. On October 23, 1841, Old Hickory authorized the payment of three hundred dollars plus interest to Esselman for medical services. Esselman wrote in the Niles National Register that “I saw much of him during his last illness, and was present at his death. I have been frequently in his family, as a physician for several years past.” Jackson during this period suffered greatly from pulmonary hemorrhage and remarked that his only relief was from frequent venesections, presumably administered by Esselman.⁶²

Little is known about Esselman’s medical training or professional career. Like Francis May, Esselman was the second of Jackson’s physicians who likely had no benefit of a formal medical education. His background probably included an apprenticeship, which he himself provided to his nephew, John C. Esselman. Esselman was born in North Carolina and became a member of the Tennessee Medical Society in 1831; he reported the performance of a tracheotomy and hysterectomy in 1843. His cause of death in 1862 was listed as an “affection of the brain.”⁶³

In April 1845, Esselman was summoned to the Hermitage, when he “found Jackson very feeble laboring under a dropsical condition. . . form known as anasarca.” Esselman prescribed certain unknown medications that seemed initially to be beneficial, and “visited him occasionally.” However, the aged general’s abdomen again filled with fluid, and the doctor tapped the abdominal cavity to withdraw fluid, a procedure currently known as paracentesis.⁶⁴

Doctor Esselman was frequently at Jackson’s bedside during his last week of life. Late in the evening of Saturday, June 7, he was again called to the Hermitage to see what he could do, “to check his bowels but to no purpose.” Esselman apparently stayed overnight and on the following day administered an anodyne and an expectorant. Andrew Jackson discussed religion with the doctor for thirty minutes, but the old warrior fainted and was pronounced dead by Esselman at 6 p.m. on June 8, 1845. Four years later Dr. Esselman attended former President James K. Polk during the ex-president’s fatal illness in Nashville. ⁶⁵

Felix Robertson (1781-1865)

Felix Robertson was as much a part of the Nashville tradition as was his famous patient.  He was said to be the first white child born in the city of Nashville and was the son of the founder of that city, General James Robertson. He practiced medicine there from 1807 until ten or twelve years prior to his demise, and was a charter member and president of the Tennessee Medical Society. Robertson served as mayor of Nashville, and in 1854, a steamboat, constructed in Nashville, was named in his honor, The Doctor Robinson [sic].⁶⁶

Robertson studied under the Nashville physicians Joseph Hays and Thomas Augustin Clairborne. Subsequently he attended lectures at the University of Pennsylvania, where he received his medical degree in 1806, “at the age of twenty five, a period when Rush was the ruling spirit.” His medical reputation was excellent, and he was especially noted for his pediatric expertise. Robertson was very active in civic affairs. He was twice made mayor of the city in the years 1827 and 1828, and subsequently was president of the Bank of Tennessee. He was also a prominent member of the board of trustees of the University of Nashville, and was for many years physician to the state prison.⁶⁷

Many authors have called him a close friend of Andrew Jackson. In his various public activities, “the friendships which grew. . . were warm and devoted, and this was especially the case in regard to General Jackson, between him and whom there existed a cordial intimacy.”  Robertson had often been mistaken for Jackson on the streets of Nashville. “They had the same long slender head -- and bristling hair.” Dr. Robertson was present at the death of Jackson’s beloved wife Rachel, where Jackson ordered this physician to bleed his wife when she was in extremis.⁶⁸

Dr. Esselman called Robertson in consultation during the president’s terminal illness. On the Tuesday morning before Jackson’s death, Robertson “arrived from Nashville. Doctor Esselman having remained with the General through the night, a consultation was held, and all that had been done was approved; and all that could be done was to conform to the General’s temporary wants.”⁶⁹

In 1849, he was consulted during the terminal illness of a second Tennessee ex-president, James K. Polk, who was dying from the complications of cholera in Nashville. Robertson, then quite aged, recommended a younger physician in his stead.⁷⁰

John Waters (died 1873)

This Nashville physician was called to the deathbed of the dying Andrew Jackson. He arrived at the Hermitage with his more illustrious brother-in-law, Dr. Felix Robertson on the morning of Tuesday, June 3, 1845. He consulted with the ex-president’s attending physician John Esselman, and apparently concurred with the latter’s strictly palliative treatment regime. Parton writes “a consultation was held, and all that had been done was approved; and all that could be done was to conform to the General’s temporary wants.” Esselman acknowledged this consultation and, “We agreed on a prescription, which was administered, and which gave him temporary relief.”⁽⁷¹

Waters was a native of Montgomery County, Maryland, and graduated from the University of Pennsylvania Medical School in 1806. Water’s sister Lydia married Felix Robertson in 1808. Waters joined Robertson in the practice in Nashville shortly after graduation but their partnership was dissolved in the mid-1820s.⁷²

Little is known about Waters’s subsequent medical career other than he was a charter member of the Tennessee Medical Society, but was much less active than his brother-in-law. It is interesting that the long association of these two physicians was marked by their joint consultation at the death bed of Andrew Jackson.⁷³

Andrew Jackson, long lived and often ill, was a frequent consumer of medical services. A stubborn and headstrong individual, he was surprisingly complacent and compliant in his interactions with his doctors, accepting without significant objection their therapies, however malevolent they might be. He survived and endured despite the ill effects of calomel, sugar of lead, and chronic bloodletting.

His physicians comprised a varied lot, both with respect to training and to temperament, ranging from the empirical frontiersman Dr. Francis May to the Edinburgh educated Bostonian, Dr. James Warren. Their diversity exemplified the different pathways then extant in the United States towards acceptance as a physician.

However, in the main, Jackson’s physicians represented the professional legacy of the practice of medicine during his era: from Edinburgh to Philadelphia to the American frontier; from Cullen to Rush to the disciples of Rush flung far and wide across the young United States.  Heroic medicine was a legacy from which neither the president of the United States, nor countless numbers of its religion, could escape.

The author wishes to recognize the research expertise of Patricia Augustine, MLS, Janet White, Ingrid Ebner, and Robert Ray, MLS, and the editorial assistance of Irma Barragan.

^1. John S. Bassett, ed., Correspondence of Andrew Jackson (7 vols., Washington, D.C., 1926-1935). Twelve of the fifty-seven physicians who treated Jackson are included in this article.

^2. James Parton, Life of Andrew Jackson in Three Volumes (New York, 1860), III, 667; Robert V. Remini, Andrew Jackson: The Course of American Freedom, 1822-1832 (Baltimore, 1981), 2-3; Charles M. Caravati, “President Andrew Jackson: Despite Infirmities. A Strong Leader,” Virginia Medical Journal 110 (March 1983): 194-195; Francis T. Gardner, “The Gentleman from Tennessee,” Surgery, Gynecology and Obstetrics 30 (March 1949): 408: Rudolph Marx, The Health of the Presidents (New York, 1960), 108, 111; Margaret Fritz, “Andrew Jackson: A Medical History” (Masters thesis, University of Toledo, 1985), 57-58, 64-65.

^3. Caravati, “President Andrew Jackson,” 193-195; Gardner, “The Gentleman from Tennessee,” 404-411; Marx, The Health of Presidents, 101-119.

^4. Gardner, “The Gentleman from Tennessee,” 407-410; Marx, The Health of Presidents, 114.

^5. Gardner, “The Gentleman from Tennessee,” 405; Ludwig M. Deppisch, Jose Centeno, David J. Gemmel, and Norca Torres, “Andrew Jackson’s Exposure to Mercury and Lead: Poisoned President?,” Journal of the American Medical Association 282 (1999): 569-571; Abraham Blinderman, “Andrew Jackson: The President Who Would Not Die Conveniently,” New England Journal of Medicine, 72 (February 1972): 405-412.

^6. Robert V. Remini, “The Final Days and Hours in the Life of General Andrew Jackson,” Tennessee Historical Quarterly 39 (1980): 167-177; Marx, The Health of the Presidents, 116-119.

^7. Christopher Clayton, “William Cullen in Eighteen Century Medicine,” in William Cullen and the Eighteenth Century Medical World, Andrew Doig, et al., eds. (Edinburgh, 1993): 87-89.

^8. John S. Haller, Jr., American Medicine in Transition 1840-1918 (Urbana IL, 1981): 78; John S. Haller, Jr., “Medical Theory and the Abuse of Calomel in Nineteenth Century America,” Pharmacy in History 13 (2) (1971): 67-76.

^9. Haller, American Medicine in Transition, 78; John R. Coxe, The American Dispensary (Philadelphia, 1918): 284.

^10. Gunter Risse, “William Cullen in Eighteenth Century Medicine,” 143-145.

¹¹. John S. Haller, Jr., "The Decline of Bloodletting: A Study in 19th Century Ratiocinations,” Southern Medical Journal 79(4)(1986): 469-475.

^12. Andrew Doig, Joan P.S. Ferguson, and Iain Milne, “The Cullen Bicentenary Exhibition,” in William Cullen and the Eighteenth Century Medical World, 41; John M. O’Donnell, “Cullen’s Influence on American Medicine,” in William Cullen and the Eighteenth Century Medical World, 236-237; Doig, et al., “The Cullen Bicentenary Exhibition,” 44, 82.

^13. David Barton, Benjamin Rush:  Signer of the Declaration of Independence (Aledo TX, 1999): 67-68.

^14. James T. Flexner, Doctors on Horseback Pioneers of American Medicine (New York, 1984): 111.

^15. Barton. Benjamin Rush, 81-92.

^16. Haller, “The Decline of Bloodletting,” 47; Paul Starr, The Social Transformation of American Medicine (New York, 1982): 42; Haller, “The Decline of Bloodletting,” 470; Flexner, Doctors on Horseback, 103; ibid., 57.

^17. Felix Robertson, “Proceedings of Medical Societies,” Southern Journal of the Medical and Physical Societies 3 (May and July 1855): 230-231; David Hoth, personal correspondence, 2 September 1998.

^18. Obituary Notice for Francis May, Transactions of the Medical Society of the State of Tennessee 43 (1876): 84; Sam B. Smith and Harriet C. Owsley, eds., The Papers of Andrew Jackson, Volume I (Knoxville, 1980), 228; Harold D. Moser and Sharon Macpherson, eds., The Papers of Andrew Jackson Volume II (Knoxville, 1984), 16: Robertson, “Preceedings of Medical Societies,” 231.

^19. Moser and Macpherson, eds., Papers of Jackson Vol. II, 96; Bassett, ed., Correspondence of Andrew Jackson, I, 89; III, 369-370, 409, 422, 425; Moser and Macpherson, eds., Papers of Jackson Vol II, 104.

^20. Robert V. Remini, Andrew Jackson: The Course of American Empire 1767-1821 (Baltimore, 1977):185; Parton, Life of Andrew Jackson, III, 611-612.

^21. Ibid., 612; Bassett, ed., Correspondence of Andrew Jackson, V, 439.

^22. Herbert L. Needleman ed., Human Lead Exposure (Boca Raton, 1992): 10-12; M. Donovan, “On the Method of Exhibiting Opium and Acetate of Lead in Cholera,” Southern Journal of the Medical and Physical Sciences 3 (January and March 1855): 137-139; Coxe, The American Dispensatory, 437; Martyn Paine, Materia Medica and Therapeutics (New York, 1848): 321-322; Harold Moser, et al., eds., The Papers of Andrew Jackson Volume III (Knoxville, 1991), 59.

^23. Nancy Jo Theriot Texada, “Medicine in Louisiana: Two Centuries, One Family,” Louisiana Genealogical Register, 42 (September 1955): 302-303.

^24. Ibid., 303; Bassett ed., Correspondence of Andrew Jackson, I, 316, 128, 163, 172, 202-203; Harold Moser, David Hoth, and George H. Hoemann, eds., The Papers of Andrew Jackson Volume IV (Knoxville, 1994), 419.

^25. Bassett, ed., Correspondence of Andrew Jackson, I, 172; Texada, “Medicine in Louisiana,” 304.

^26. John Duffy, ed., The Rudolph Matas History of Medicine in Louisiana Volume I (Baton Rouge, 1958), 492-493, 376, 446-447; John Duffy, ed., The Rudolph Matas History of Medicine in Louisiana Volume II, (Baton Rouge, 1958), 45.

^27. Charles A. Roos, “The Physicians to the Presidents, and Their Parents: A Bibliography,” Bulletin of the Medical Library Association 49 (1961): 303; T. Miller, “A Biographical Sketch of the Professional Life and Character of the Late Henry Huntt M.D. of Washington City, D.C.,” in The Medical Examiner Volume I, eds. J.B. Riddle, M. Clymer, and W.W. Gerhard (Philadelphia, 1838), 363-365.

^28. Ibid.

^29. James Mann, Medical Sketches of the Campaigns of 1812, 1813, 1814 (Dedham MA, 1816): 136.

^30. Miller, “Henry Huntt,” 364; History of the Medical Society of the District of Columbia 1817-1909 (Washington, 1909): 214.

^31. Robert V. Remini, Andrew Jackson and the Course of American Democracy, 1833-1845 III (Baltimore, 1984): 369-370.; Bassett, ed., Correspondence of Andrew Jackson, V, 342, 433, 439; Library of Congress, Andrew Jackson Correspondence, 27 March 1833, 1 January 1836, 2 January 1836, and 3 January 1837.

^32. Roos, “Physicians to the Presidents,” 309; Miller, “Henry Huntt,” 365.

^33. University of Pennsylvania Archives, Medical Obituaries, personal communication; History of the Medical Society of the District of Columbia 1817-1909, 215.

^34. Ibid.

^35. Hoff, personal communication; Parton, Life of Andrew Jackson, III, 608; Roos, “Physicians to the Presidents,” 307.

^36. Parton, Life of Andrew Jackson, III, 608; Roos, “Physicians to the Presidents,” 307.

^37. Ibid., 310-316; History of the Medical Society of the District of Columbia 1817-1909, 228; “The Late Dr. Hall,” Boston Medical and Surgical Journal, 52 (January-June 1880): 621; Library of Congress, Jackson Correspondence, 1 January 1832, 9 January 1832, 14 September 1833, 9 June 1834, and 6 April 1835.

^38. History of the Medical Society of the District of Columbia 1817-1909, 228; “The Late Dr. Hall,” 621; “Report on James Crowdhill Hall,” Transitions of the American Medical Association 32 (1881), 506-513.

^39. Ibid.

^40. Ibid.

⁴¹. Remini, The Course of American Freedom II, 346; Deppisch, “Andrew Jackson’s Exposure,” 571; The Washington Globe, 14 January 1832.

⁴². Remini, The Course of American Freedom, II, 346; The Washington Globe, 14 January 1832.

^43. Louis Roddis, “Thomas Harris, M.D., Naval Surgeon and Founder of the First School of Naval Medicine in the New World,” Journal of the History of Medicine (Summer, 1950), 236-250.

^44. Ibid.

^45. Bassett, ed., Correspondence of Andrew Jackson, VI, 287.

^46. Caravati, “President Andrew Jackson,” 195.

^47. W.E. Horner, “Necrological Notice of Dr. Philip Singe Physick,” The American Philosophical Society (Philadelphia, 1838), 8; John M. O'Donnell, “Cullen’s Influence on American Medicine,” in William Cullen and the Eighteenth Century Medical World, 242; Horner, “Necrological Notice of Dr. William Synge Physick,” 9-10.

^48. Ibid., 10-13; Howard A. Kelly and Walter L. Burrage, American Medical Biographies (Baltimore, 1920), 912-913.

^49. Horner, “Necrological Notice of Dr. Philip Synge Physick,’ 13-21.

^50. Remini, The Course of American Empire, I, 320; Remini, The Course of American Democracy, III, 66, 69-70; Gardner, “The Gentleman from Tennessee,” 310; Marx, The Health of Presidents, 114; Bassett, ed., Correspondence of Andrew Jackson, V, 109.

^51. Ibid., 342.

^52. Remini, The Course of American Democracy, III, 77; Fielding H. Garrison, An Introduction to the History of Medicine, 4th edition (Philadelphia, 1963): 499-500.

^53. Kelly, American Medical Biographies: 1196-1197; Garrison, An Introduction to the History of Medicine: 499.

^54. Remini, The Course of American Democracy, III: 77; Parton, Life of Andrew Jackson, III: 492; Roos, “Physicians to the Presidents,” 311; Andrew Donelson to Emily Donelson, 24 June 1833, Donelson Papers; Boston Daily Atlas, Tuesday Morning, 25 June 1833.

^55. Howard P. Arnold, Memoir of Jonathan Mason Warren M.D., (Cambridge MA, 1886): 123n.

^56. Samuel X. Radbill, ed., The Autobiographical Ana of Robley Dunglison M.D., (Philadelphia, 1963): 9-10, 26, 32-33, 54-56; Irwin Richmond, “Robley Dunglison M.D.,” Pennsylvania Medicine 69 (November, 1966): 76; Todd L. Savitt, “Jefferson’s Vision of Medical Education and His Quest for a Professor of Medicine,” Virginia Medical Quarterly 122 (October, November, December 1995): 145-150.

^57. Radbill, ed., The Autobiographical Ana, 7-9; Richmond, “Robley Dunglison M.D.,” 76-77.

^58. Savitt, “Jefferson's Vision,” 247-249.

^59. Richmond, “Robley Dunglison M.D.,” Radbill, ed., The Autobiographical Ana: 26, 32-33, 55-56.

^60. Ibid., 54.

^61. Ibid., 69-110.

^62. John N. Esselman, Niles National Register (Washington, 5 July 1845): 383; Remini, “The Final Days,” 176; Library of Congress, Andrew Jackson Correspondence, 23 October 1841, 12 January 1842; Boston Medical and Surgical Journal (16 July 1845): 482-484.

^63. John Esselman, Northeast Arkansas Biographies and Historical Memoirs Database; David Hoth, personal correspondence; Mount Olivet Cemetery records, Reel I, Mf. Ac. No. 576, Internment Book (1855-1891): 9.

^64. Esselman, Niles National Register, 383; Boston Medical and Surgical Journal,  482-484.

^65. Esselman, Niles National Register, 482-484; Boston Medical and Surgical Journal, 482-484; Remini, “The Final Days,” 175; Anson Nelson and Fanny Nelson, Memorials of Sarah Childress Polk, Wife of the Eleventh President of the United States 1892; rep., Spartansburg, SC, 1974): 147.

^66. Philip M. Hamer, ed., The Centennial History of the Tennessee State Medical Association, (Nashville, 1930): 192-193; Nashville Daily Union (13 July 1865): 2.

^67. Hamer, ed., The Centennial History, 192-193; Nashville Daily Union (13 July 1865): 2.

^68. Reda Goff, “Dr. Felix Robertson 1781-1865, Father of the Nashville Medical Profession,” Paragraphs from the Nashville History Lecture Series (1975): 9; Hamer, ed., The Centennial History: 194.

^69. Esselman, Niles National Register, 383; Parton, Life of Andrew Jackson, III: 675; Blinderman, “Andrew Jackson,” 409.

^70. Goff, “Dr. Felix Robertson,” 10.

^71. Parton, Life of Andrew Jackson, III: 675; Esselman, Niles National Register, 383.

^72. Goff, “Dr. Felix Robertson,” 104-108.

^73. Hoff, personal correspondence.