Jefferson's Secrets

Yes, he very much meant it. But he also said it for effect. He was referring to life as an accountant might in balancing the “happiness” column against the “pain” column. He had performed similar accounting in the already cited 1816 exchange with John Adams on the matter of his willingness to relive his life, taking the good and bad together. As an octogenarian in 1825, Jefferson was even older than Adams had been when he posed his “frivolous” question. Nothing had altered the Virginian’s belief that the world was framed on a principle of benevolence.

Jefferson was still reaping happiness from the constant company of his family; from a university long conceived and, finally, about to commence operation; from a library constantly being refreshed with books of science, philosophy, and the Greek and Roman classics. But even these gifts did not erase the effects of physical debility on the old man’s psyche. He had long since exceeded the average life span of an American male, and he was thoroughly convinced that incapacity would very soon outweigh mental acuity, which he still possessed in full. He wanted to avoid living on after he started feeling useless; he wanted to avoid facing a lingering death. With eighteen months of life ahead of him, Jefferson had in mind what we now call “death with dignity.” It was his suspicion of what lay just ahead that provoked this statement: “There is nothing I have ever so much dreaded.” And to this he added: “Altho’ subject to occasional indispositions, my health is too good generally not to give me fears on that subject.”²

There had been no lessening of his intellectual passion during retirement. In health, he occupied his mind with grand ideas and mass movements, and yet he paid attention to details in such a way that nothing appeared too trivial to be noticed. He responded to any written work that challenged the boundaries of knowledge: a Greek grammar, a dry dock system for the navy. Familiar with the range of his interests, inventors and authors constantly sent along their designs and schemes and productions to the ex-president, requesting comments. And despite his aches and pains, Jefferson eventually obliged them all.

His life of the mind began with an adoration of the natural sublime and extended to aspects of nature that could be measured and modified. As a student of science, mathematics, and medicine, he marveled at the world’s endowments and contemplated how human energies could be directed toward improving every quality of life. He insisted that although nature could not be stopped, it could be regulated in small but significant ways—such as flood control. But death was the exception: It held the full force of the oceans, sweeping over everyone and everything. As the philosopher-anthropologist Ernest Becker has reminded us, human values are mental ones, and nature’s values are those of the aching, bleeding material body. That Jefferson seems to have intuited as much suggests some of the ways in which his consciousness was a modern one.³

Jefferson the worshipper of science was certainly no masochist. And so, getting back to the letter to Dr. Waterhouse, what he feared was not life’s termination but the hopeless deterioration preceding it, what the littérateurs of his time called “the imbecility of age.” It was what correspondents meant when they signed off letters, as the portrait painter and natural historian Charles Willson Peale did in a letter to Jefferson in 1815: “May you, my dear Sir, last until you feel no pain in leaving this world”; and Jefferson did in writing to John Adams in 1820: “I love you with all my heart, and pray for the continuance of your life until you shall be tired of it yourself.”⁴ In January 1825, Jefferson may not have calculated, with the nearly blind Adams, on the two more Fourth of Julys that the frail ex-presidents would live to greet; but it was his neighbor Adams’s declining health that Dr. Waterhouse was reporting on, and that prompted Jefferson to pass judgment on the quality of life generally.

His hair had gone from red to a sandy color; his skin, sensitive to the sun, peeled easily, giving his face what his grandson called a “tettered” appearance.⁵ At the time he was writing to Waterhouse, a Harvard medical authority with whom he had corresponded for a quarter century, Jefferson could scarcely take a stroll through his mountaintop garden without fatigue. Yet he still rode his horse, Eagle—a reliable mount with white hind ankles and a white spot on its nose—up to ten miles a day. The old man reckoned that this kind of activity could not last. He awaited the moment, he said, when a slight misstep would “cut short the toughest thread of life.” He claimed he was ready, and rather willing, to escape “the evils of dotage.” And yet, as his body weakened, he remained a persistent scholar to the end, complaining occasionally of memory loss while in actual fact retaining an impressive mind for detail.⁶

The conscientious Robley Dunglison was Jefferson’s physician at the close of this exceptional American life. The twenty-seven-year-old Englishman arrived in Virginia in the spring of 1825, three months after Jefferson had penned his fatalistic letter to Waterhouse. Dunglison had been recruited in London the year before by Jefferson’s gifted neighbor, Francis Walker Gilmer, a lawyer and amateur botanist who had been deputed by the Board of Visitors of the University of Virginia to select several of its faculty—including a worthy professor of medicine.

If Dr. Dunglison had been in less of a hurry to win the heart of a young woman, he might never have crossed the ocean. In his matter-of-fact memoir, the doctor says that his destiny turned on the urgency of love: “I was ardently attached to a daughter of Mr. Leadam [a physician], whom I could not expect to be able to marry if I remained in London, for years to come; whilst if I embraced the American offer I could do so immediately.” Presenting a pretext for prompt action to his prospective father-in-law, Dunglison made his courtship brief, married Harriette Leadam in London, and set sail for America. In his personal and professional choices, the young doctor was not disappointed.⁷

Nor was Jefferson, who had long expressed deep reservations about inexperienced physicians. On June 24, 1826, which appears to be the last day on which Jefferson picked up his pen to write, this man whose life emerges from his love of the written word finished two meaningful letters: One was an eloquent response to the Washington, D.C., committee that had invited him to be guest of honor at the upcoming Fourth of July festivities; and another, more hastily drawn, was carried down the mountain and over to the university; this letter requested his doctor’s presence—“begging me to visit him,” Dunglison recorded. The young professor stayed at Monticello, attending his patient constantly during the final days.

It was not just youth that Jefferson distrusted in a physician. He repeatedly told Dr. Dunglison that, as a rule, he put little faith in a profession that meant well but too often did more harm than good. “It is not to physic that I object,” he quipped, “so much as to physicians.” Though known for his restraint and subtlety rather than direct humor, Jefferson had once joked in front of an uncomfortable medical practitioner (who happened to serve James Monroe and family), that whenever he encountered three physicians together he cast his eyes skyward to see whether a turkey buzzard was hovering nearby.⁸

During his presidency, Jefferson had explained his skepticism to Caspar Wistar, professor of anatomy and midwifery at the University of Pennsylvania, and author, in 1808, of the first American textbook on anatomy. It was generally observable, Jefferson told the distinguished doctor, that mother nature provided relief for most forms of illness: “She brings on a crisis, by stools, vomiting, sweat, urine, expectoration, bleeding, &c., which, for the most part, ends in the restoration of healthy action.” The average physician, he went on, “substitutes presumption for knowledge,” often taking credit for what nature had accomplished. “I bow to the utility of medicine,” he allowed, but only when it was applied to “well-defined forms of disease”; otherwise, in his view, there were too many “adventurous” doctors.

One unnamed physician whose judgment Jefferson trusted had admitted to him that he routinely committed the “pious fraud” of giving out bread pills (placebos) to his patients, rather than take chances with medicines the properties of which were uncertain. Jefferson approved. He was most disturbed by the tendency of the contemporary experimental physician to jump to conclusions on the basis of insufficient data. He called their recourse to “visionary theories” an “ingenious dream.” Jefferson allowed that nature’s secrets would some day be known, but until then he preferred to leave discovery to the “slow hand of accident” rather than to murderous guesswork. “I would wish the young practitioner, especially, to have deeply impressed on his mind, the real limits of his art,” he advised, and “to be a watchful, but quiet spectator of the operations of nature.”⁹

The art of humbling doctors was not one that Jefferson indulged in alone. The prominent Philadelphian Dr. Benjamin Rush, his close friend and a signer of the Declaration of Independence, recognized inadequacies in his own medical knowledge when he noted in his Commonplace Book, with deadpan humor, the words of a failing patient: “Mrs. Mease told me when dying that among other sins she had to repent of one was too much confidence in my remedies.” More cynically, Rush wrote to New York’s Dr. David Hosack of the rarity of medical friendships, given jealousy and the competition for business: “Alas! while merchants, mechanics, lawyers, and the clergy live in friendly intercourse with each other, and while even the brutes are gregarious . . . physicians, in all ages and countries, riot upon each other’s characters!” It was a common refrain. Benjamin Franklin, as the creator of Poor Richard’s Almanack, routinely spoofed the medical community with such wonderfully piquant maxims as “He’s a fool that makes his doctor his heir” and “There’s more old drunkards than old doctors.” If physicians held the key to longer and better life, then why did patients who broke all the rules so often survive them?¹⁰

Jefferson in 1825–1826 confronted a condition that did not allow for light humor. Early in their association, he enjoined Dr. Dunglison to treat him for a painful “irritability of the bladder.” His previous doctor, Thomas Watkins, had been unable to afford his patient permanent relief. To Henry Dearborn, his former secretary of war, Jefferson wrote while under his new doctor’s care: “My health has become less certain as might be expected with the advance of age. I am suffering at present under an attack of dysury [dysuria: difficult or painful discharge of urine] which confines me to my couch.” Dunglison determined that the problem was an enlargement of the prostate gland, and he rode up from the university twenty-one times between May 17 and July 26, 1825, to look in on his patient at Monticello. That summer, he instructed Jefferson in the dangerous self-application of a bougie, a thin metal or elastic gum cylinder that dilated the urethra canal and helped pass urine. By August, Jefferson could write that his health was “tolerably good” and his “senile complaints . . . of uncertain duration” now that he had put himself in the “able hands” of Dr. Dunglison.¹¹

The bladder problem had already bothered Jefferson “for some time,” Dunglison reported. The gradual intensification of this condition could not but have affected Jefferson’s sense of his physical prospects. As he made clear in the 1825 letter to Dr. Waterhouse, if life, with its attendant anxieties, was to be worth living, one’s “channels of enjoyment” had to be “in full exercise.” A channel was a conduit or passage, and life a different kind of passage—in Jefferson’s prose, often a metaphorical journey or voyage. A blockage in the channel of enjoyment, or a blockage or stricture in the channel of the urethra, made life’s pain much greater than its remaining pleasures, so that the prolongation of the voyage became an unwished-for thing, and decease the welcome “shore” of Jefferson’s deathbed adieu.

He was thankful to his London-trained doctor. The routine Dunglison prescribed did so much to remedy the discomfort that a trusting relationship evolved. When William Short, a diplomat who had commenced his career as Jefferson’s secretary in Paris, wrote from Philadelphia urging his ailing friend to see that city’s famed urological specialist, Dr. Philip Syngh Physick, Jefferson answered that he had his own Dr. Physick in Dr. Dunglison. The transplanted English doctor years later reflected that, in spite of his suspicions with regard to the medical profession, Jefferson was “one of the most attentive and respectful” of patients.¹²

Watkins married into the family of a different Jackson, in east Tennessee, but left the state in 1817 and became Jefferson’s personal physician in the autumn of 1819. He lived close by at Glenmore, an estate that had been in the Randolph family, where he sought prominence as a member of the Albemarle County Agricultural Society. Farmer Watkins claimed that he had always wished to make agriculture his “exclusive pursuit,” directly stating that his medical practice only got in the way of—“in perpetual confliction” with—his desire to experiment in planting. He sounded a bit like Jefferson himself, who frequently complained that politics kept him from his science, philosophy, and gardening.¹⁴

Overlooking the soap opera that was Watkins’s life, Jefferson quickly gained confidence in the frustrated planter’s medical skills, writing to James Madison in January 1821: “As a physician I should put myself in his hands with more confidence than any one I have known in this state, and am indebted to his experience and cautious practice for the restoration of my health.”¹⁵ But Dr. Watkins found himself answering critics who got wind of another entanglement, this time concerning his handling of a Tennessee will. The distressed doctor appealed to his old nemesis Jackson, recently retired from the U.S. Army, who, as a presidential hopeful in 1822, was in a forgiving mood. The general wrote directly to Jefferson attesting to the good character of the physician he had challenged to a duel nearly two decades before.¹⁶

Like his distinguished patient, but with less versatility, Watkins used the language of medicine in taking a political stand. Censuring the banking industry for its role in ruining Virginia farmers’ prosperity, he diagnosed the “delirium” that had produced “delusions” and “unhappy paroxysms.” And like the physiocratic Jefferson, he assured that it was “from the earth we derived our prosperity and independence, and to the earth, rural and domestic economy, we must return.” Watkins added with pungency that an over-dependence on foreign commerce had “ruinous and corrupting consequences” (i.e., “luxury,” in the idiom of the day); as the populist he professed to be, he demeaned the “coffeehouse gentry—the windy votaries of commerce.” A Jeffersonian maxim followed : “Experiment to be relied on, must be reduced to a science.” The ambitious doctor was evidently trying to display what was called “useful knowledge” before his new community.¹⁷

In 1823, he took an excursion, thinking he had the right connections to insinuate himself into national politics. He cast his eye on the clerkship of the U.S. House of Representatives. In a letter to Jefferson posted from “the road to Tennessee,” Watkins requested that Jefferson send him, as Jackson had earlier, a testimonial to his good character—meant to be shown to any Jefferson admirers he should perchance to meet. At the same time, with due diligence, he reported gossip to Jefferson about a plan already afoot to position Jackson for the presidency. Neither of them wanted Jackson to succeed. The doctor’s political ambitions were never realized, and he eventually returned to Jefferson’s neighborhood.¹⁸

But not before landing himself in another mess or two. During his absence from Virginia, he learned, “enemies” had been practicing “intrigue and malevolence, directed against my feelings and success.” These unspecified efforts were ostensibly intended to impair the doctor’s “connexions” to “the Monticello family,” and involved, at least in part, his behavior in a case of nonpayment for medical services. He defended himself before his most illustrious patient: “I practiced among you with fidelity and feeling.... My first and best feelings and concern were for the lives and salvation of my patients—my last for my necessary fee and fame. Do I deserve to be so traduced!” As far as Jefferson was concerned, no explanation was needed—he understood human behavior, and he fully supported the hypersensitive Dr. Watkins.¹⁹

The presidential election of 1824 was to be the last that Thomas Jefferson would live to see. And it was the first not to feature a candidate from Virginia. The South had divided its hopes between Jackson of Tennessee and William Harris Crawford of Georgia, secretary of the treasury under outgoing President James Monroe. Crawford was Virginia’s choice—and, in defending the “old republican” embrace of small government and states’ rights, Jefferson’s as well, though Jefferson refused to make a public declaration. At the core of Jefferson’s ideology was a distrust of any (typically northerners) who retained respect for the elitist, pro-growth model of development that seemed British; he had always wished to protect an America that basked in its provincial comforts. Jefferson distrusted Jackson for a different reason: The Tennesseean appeared to him as a militarist lacking a coherent political doctrine.

As the campaign accelerated, Jefferson’s doctor found himself in the middle of a new political drama. In September 1823, just before he was due for a visit at Monticello, candidate Crawford suffered an apparent stroke.²⁰ The ubiquitous Dr. Watkins, though bound for Tennessee at that time, was called to the scene, to the home of the Virginia senator (and former governor) James Barbour. There he treated the ailing candidate for a few weeks when he felt obliged to respond to a “painfully urgent summons” to attend to his family in the west. He had wished to do more for his patient, but when he left he thought that all was as well as could be: Others had wanted to bleed the patient, to draw an additional thirty ounces beyond what had been taken before Watkins’s arrival—so as to “save” him. Watkins prevailed on those assembled (“my point carried with difficulty”) not to do so.

Nevertheless, Washington was abuzz in rumor, and Watkins learned while in Tennessee that he was being blamed for Crawford’s miserable condition. “It is still believed,” he wrote to Jefferson a year later, “that the extremity of Mr. Crawford’s suffering and danger was induced by excessive bleeding and other maltreatment . . . for which I was responsible!!” Lest there be doubts about his intentions or attentiveness, Watkins declared, “I do not here attempt to defend my medical practice in his case—but only to maintain that I promptly, feelingly & faithfully exerted my best efforts for his benefit.” Certain that his insistence on stopping the practice of bleeding had rescued Crawford from deadly medicine, he wrote: “I felt rejoiced at having contributed to so valuable a life.”²¹

Jefferson wrote back, reassuring the doctor that he wholeheartedly approved his actions. “That you have met with enemies and backbiters is the lot of all men, and of talents especially. Had you been good for nothing you would have stood in nobody’s way and been spoken of as a good creature.” Professing not to have heard any of the malicious things said about his personal physician, Jefferson added of his neighbors that they knew better than to fill his ears with such talk: “I hear them not,” he reported, referring at once to his self-declared aversion to gossip and to his declining ability to hear.

As to the Crawford matter, Jefferson was even more definitive: “It is entirely understood here that the mischief done him was after you left him. When I visited him I saw that they were killing him by bleeding and mercury and intimated my apprehension cautiously to himself and those about him. ... I have always lamented he had not been spared one day more so as to have reached us, where under your care he would have been restored in one fortnight. You know that your leaving our neighborhood was a real affliction to us.” It may not have been entirely true, but the style was typical of Jefferson’s genteel letter-writing posture, and it was the vote of confidence Dr. Watkins had no doubt prayed for.²²

The much impaired, fifty-two-year-old Crawford stayed in the race and won enough electoral votes to qualify for a runoff in the House of Representatives. Andrew Jackson had earned ninety-nine electoral votes, John Quincy Adams eightyfour, and Crawford forty-one, but Jackson did not have a sufficient number to secure the presidency. In the end, though Jackson had led in popular votes, too, Adams won a majority of the state congressional delegations. Incensed by the backroom politicking that tainted an already convoluted election, the Jacksonians would have to wait four more years to exact revenge. And there was probably nothing that a healthier William Crawford could have done to alter these results—with or without the services of Thomas Watkins and Thomas Jefferson.²³

The medical practitioners who played so important a role in Jefferson’s last years, Watkins and Dunglison, appear never to have met. But the story does not end there: Some years after Jefferson’s death, the celebrated Dr. Dunglison would have occasion to treat President Andrew Jackson for a pain in his side—and not before having been called upon by former Presidents Madison and Monroe as well. How odd it seems, then, that Dr. Watkins began his career as Jackson’s physician and went on to become Jefferson’s intimate; and Dunglison, who came to America at gentle Jefferson’s behest, eventually tended to the rough-hewn Jackson.

Dunglison was Watkins’s opposite, a professional who was unseduced by the prospect of becoming a Virginia planter and took little apparent interest in national politics. During Jefferson’s prime, however, the political and scientific worlds had been conjoined in noteworthy ways. In a tradition established by the proactive Franklin, scientists and physicians held government appointments in the new United States: Mathematician-astronomer David Rittenhouse, a hero to Jefferson, served in the Pennsylvania Assembly and as director of the U.S. Mint; Dr. Rush, a Pennsylvania member of the Continental Congress and the constitutional ratifying convention, was treasurer of the Mint during Rittenhouse’s tenure there; William Shippen, a medical doctor, professor of surgery, and member of the American Philosophical Society who helped found both the University of Pennsylvania and Princeton, served in the Continental Congress. (He was well known to Jefferson, having inoculated him against smallpox in 1766.) Josiah Bartlett of New Hampshire was another signer of the Declaration who was trained in medicine; his son, also a practicing physician, served one term in Congress. Dr. Hugh Williamson, surgeon general to North Carolina troops during the Revolution, published on medical matters, and was later a member of the House of Representatives. Dr. David Ramsay, who practiced in Charleston, South Carolina, attended medical school in Philadelphia, served in the Continental Congress, and was the author of the first history of the American Revolution (1789). Jefferson’s secretary of war, the New Englander Henry Dearborn, began his career as a physician. The list goes on. As president, Jefferson was famed for inviting congressmen to dinner and directing long conversations about scientific subjects without reference to politics.²⁴

Among the friends and correspondents of his late years, Jefferson counted several medical doctors. After Rush and Wistar died in 1813 and 1818 respectively, the most noteworthy was Waterhouse, a pioneer in vaccination, whose work Jefferson championed. As president, he had personally collaborated with the New Englander to set up the first smallpox vaccination clinics in the South, and he maintained extensive records charting the success of their joint project. He saw to it that Lewis and Clark took a supply of vaccine on their westbound journey.²⁵ As an ex-president, Jefferson shared private thoughts with his physician-correspondents, sometimes venturing into history, politics, religion, and general education, as well as medical science. And though Dunglison and Watkins were themselves very different people, Jefferson appreciated both, or at least made both feel entirely welcome at Monticello.

Dysuria, which is the proper denomination of your case, may proceed from various diseased states of any part of the urinary canal.... There would seem to be a chronic state of inflammation or ulceration of the prostatic part of the urethra or neck of the bladder or perhaps both. I have not thought it proper to enquire whether you may have had in early life any continuance of gonorrhæa.²⁷

His question appears innocent. The word continuance here does not indicate that Jefferson admitted having suffered from a venereal disease at one time, and that it might or might not have continued to afflict him after its initial appearance. In the vocabulary of this era, “continuance” could just as well mean “duration,”²⁸ in which case the question is being posed, without the supposition of knowledge, to mean: “Did you have to endure, at any time in early life, an eruption of gonorrhea?” The answer could be yes or no; either way, no answer was forthcoming. Watkins had ceased to serve as Jefferson’s doctor, and had not felt comfortable, at any point before his departure, in directly posing this question to Jefferson.

Believing that contracting gonorrhea “might have predisposed the urethra to diseased lodgment” in Jefferson’s later life, Watkins noted: “The increased frequency of your promptings to discharge urine, is rather indicative of inflammation about the neck of the bladder—the occasional sprouting of the current—of some obstruction or stricture—spasmodic & temporary or ulcerative and permanent.” He called for the application of the purgative castor oil “and warm water fomentations” in the immediate area, as well as abstinence from physical exercise and irritating food and drink, including wine. If this regimen failed, Watkins proposed “half a grain of opium with one grain of calomel [mercurous chloride], every night for a few weeks.” He assured Jefferson that his condition was not life threatening.

Watkins was content to yield authority to his successor. “I am happy to reflect that you will have so excellent a resource in professor Dunglison,” he wrote at the end of his evaluation. Presumably, his intention was that Dr. Dunglison would read the document and comprehend what Watkins verbosely called “the hystory of your sufferings consequent upon your present indisposition.” Dunglison’s solution, as above stated, was to teach Jefferson to use a bougie, an early version of the urinary catheter. This instrument succeeded in alleviating his obstructive uropathy, or blockage of urine. Watkins had mentioned the bougie to Jefferson, but had not pursued its use.

As to a younger Jefferson’s sex life, we cannot say whether he was a virgin when he married the widow Martha Wayles “Patty” Skelton in 1772, or whether his sexual behavior had exposed him to venereal disease. Obscure references in Jefferson’s Memorandum Books in the summer and autumn of 1770, written in shorthand code, give women’s names—one is a married woman—and may indicate sexual encounters. (Indeed, the shorthand entries are graphically depicted by the editors of the Memorandum Books, with the thought that they might bear such a meaning.) Subsequently, from Paris in 1785, and by now a widower, Jefferson wrote home anxiously to a Virginia acquaintance whose son was about to embark on a European tour. In the letter, Jefferson was exceedingly direct in cautioning American men against exposure to the “luxury and dissipation” of European ways. To him, an impressionable American “is led by the strongest of all the human passions into a spirit for female intrigue destructive of his own and others happiness, or a passion for whores destructive of his health.” Were his moralistic pronouncements from Paris the result of a painful personal experience, or observation of the conduct of others around him, or simply formed from stories he had heard? It is impossible to know. And then, of course, there is the speculation about his sexual relationship with his slave Sally Hemings, which, if it took place, began after 1787, after she arrived in Europe. If Jefferson did contract gonorrhea—which is by no means clear and, on the surface, seems less than likely—we cannot determine how or when the disease occurred.²⁹

In analyzing Watkins’s report, modern medical specialists are generally doubtful that Jefferson suffered a venereal complaint earlier in life. True, this was an age, before antibiotics, when symptoms of the disease could have disappeared, only to lead in later life to urethral strictures causing chronic pain and difficulty urinating. Yet if Jefferson had contracted the sexually transmitted disease, he most likely would have developed urethral and urinary problems much earlier, and there is no evidence of it before the 1820s.

Thomas Watkins might have been a magnet for political trouble, but his medical diagnosis was in the main correct. Jefferson’s problem, prostatic hypertrophy, was benign, and did not, at least directly, cause his death. On the other hand, if the condition developed into a bacteriological infection after his repeated use of the bougie, it might have played a role in worsening Jefferson’s medical outlook.³⁰

His medical history is that of a generally fit man who kept to a moderate diet and who exercised regularly. “He was never a great eater,” reported Edmund Bacon, Monticello’s overseer during the retirement years, “but what he did eat he wanted to be very choice.”³² His library contained more than a hundred medical guides and treatises on subjects ranging from general medicine and the fairly recent practice of inoculations to dentistry, gout, rabies, venereal disease, and hysterics. For longer than a half-century, each morning upon rising he bathed his feet in ice-cold water, which he believed prevented the onset of colds.³³ He could not recall ever having had a fever that lasted for more than twenty-four hours.

From 1764, as he was becoming a lawyer, through his retirement from political office, Jefferson suffered from what he called his “periodical head ach,” or “fits,” that were apparently caused by tension; they lasted from sunrise to sunset and were at times so debilitating that he could not function for days on end, choosing to closet himself in darkness while he waited for the pain to go away; and if he worked at all during these episodes, it was in the evening, by candlelight. He never recorded another of his “periodical” headaches after retiring to Monticello at the end of his two-term presidency in 1809. He read constantly, and his eyes remained strong: “I use spectacles only at night,” he wrote to Charles Willson Peale in 1824.³⁴

Jefferson’s worst extended episode as a suffering retiree occurred in 1818–1819, when he endured unremitting rheumatism. He first encountered the disease in a mild form in 1808, when he found walking painful. He next experienced “a total prostration of the muscles of the back, hips and thighs,” in 1811. In 1813, he was sufficiently troubled that he was “almost tempted” to permit a “medical gentleman” to try out a new machine on him, invented by a Lynchburg, Virginia, doctor, that was called “a Panacea.” A tin tube blew alcohol fumes “into the bed of the patient, under the bedclothes.” But, on second thought, as Jefferson explained self-mockingly to Dr. Samuel Brown, “I consider that an old crazy carcase like mine is not a safe subject for new experiments.”³⁵

In 1818, when his rheumatism returned, Jefferson finally sought relief by traveling to Virginia’s fashionable Warm Springs to bathe in the curative waters. He ended up with painful boils over his body. “A large swelling on my seat,” he wrote to his daughter, “increasing for several days past in size and hardness disables me from sitting but on the corner of a chair. Another swelling begins to manifest it self to-day on the other seat.... Perhaps these swellings may yet disappear, but I have little hope of that.” Back at Monticello, his hapless doctor at the time exacerbated the problem by applying mercury and sulfur, so that Jefferson languished for weeks more, unable to leave his house. One of his literate slaves, Hannah, expressed her concern in a note to her master: “I was sorry to hear that you was so unwell.” In the summer of 1819, just as financial panic devastated the Virginia economy and put extreme pressure on Jefferson personally, his rheumatism recurred, the swellings more serious than before. He purchased flannel to wrap his shoulders, wrists, and knees, but was only slowly restored to comfort. It was in the aftermath of these events that Dr. Watkins entered the picture.³⁶

Although dysuria may have played a role in bringing on his final illness, the official cause of Thomas Jefferson’s death was chronic diarrhea. His bowel troubles dated back at least to his first year as president. In 1803, “after all my life having enjoyed the benefit of well formed organs of digestion, and departation,” Jefferson confided his complaint in his old friend Dr. Rush, who had bravely, if ineffectively, combated the yellow fever epidemics of the 1790s. Rush in turn wrote to Jefferson about an “old nurse” who, after a three-year stretch of diarrhea, was cured in one month by “drawing the breasts of a woman . . . and swallowing her milk.” Cow’s milk, with sugar added, would have had the same effect.

Rush provided him with several other solutions: (1) the stomach should never be full or empty; (2) horseback riding is preferred to walking or sitting in a carriage; (3) to avoid “fatigue of body,” resist “midnight studies” and go to bed no later than 10:00 P.M.; (4) permit proper excretion through the skin—perspiration—through mid-day bathing: cold baths in summer and warm baths in cool weather. A layer of flannel was to be worn next to the skin, and feet kept warm; for the feet, Rush insisted, were “the avenues of half the paroxysms of all chronic diseases when cold.” He also said that he had witnessed “the happiest effects” from a syrup made by boiling “oak galls” and cinnamon in water, straining and combining with brandy and sugar, and reducing over a slow fire.³⁷

The model of the human body was thought of as a system of energy and economy. For this reason, evacuations were no less critical to the medical imagination than a healthy appetite.³⁸ In the first year of his retirement, Jefferson planted rhubarb, which was used medicinally to relieve diarrhea.³⁹ In 1815, immediately after selling his personal library to the government (to replenish the Library of Congress, which had been incinerated by British troops the year before), Jefferson requested from a Washington bookseller James Ewell’s Medical Companion. Dr. Ewell, originally from Savannah, Georgia, had set up a practice in the nation’s capital and had dedicated his 1808 medical guide to then President Jefferson. Ewell described diarrhea as “a purging without sickness or pain,” caused by “acid or putrid elements—obstructed perspiration—acrid bile—drinking bad water—violent passions, or a translation of morbid matter of other diseases to the bowels,” and recommended “a dose of rhubarb or castor oil, followed by forty drops of laudanum [the widely available opiate] at night.”⁴⁰

In 1822, Jefferson commiserated with fellow sufferer Judge Spencer Roane of Richmond. Euphemistically referring to “the visceral complaint,” he expressed his conviction that the stagnant air of the Virginia tidewater was somehow the cause of Roane’s diarrhea; without mentioning Rush, Jefferson noted helpfully that the best advice he had received was that of the English physician Thomas Sydenham, who, more than a century before, had prescribed, in Jefferson’s words, “long journies on a hard trotting horse, and that he found infallible.” (In this instance, the Harvard-trained Dr. William Eustis had referred him to Sydenham, and corroborated the efficacy of the old method from his own experience.) And so, concluded Jefferson, “a couple of hours riding every day relieved me from a case tolerably manifest, although but incipient.”⁴¹

It was common, as a part of daily conditioning, to monitor bowel movements. In 1802, a friend of a friend, Sir John Sinclair, sent President Jefferson a copy of his book on good health. He observed that excess sleep inhibited the desired daily morning discharge, and confirmed that in advanced years “loose and abundant stools” were as much a problem as irregularity; Britain’s Sinclair agreed with Philadelphia’s Rush that keeping the feet warm and wearing flannel close to the skin not only promoted a healthy perspiration but also strengthened the bowels. In the same mission, he noted, red wine was preferable to white.⁴²

Diarrhea was understood to have various causes. According to Dr. Buchan’s Domestic Medicine, that which was defined as a normal “salutary evacuation” did nothing to weaken the person. Diarrhea proceeding from “violent passions or affections of the mind,” however, was best treated, as Jefferson’s was, with an opiate, until the antispasmodic effect was felt and “ease, cheerfulness and tranquility of mind” returned. Any diarrhea, normal or abnormal, was to be answered only with certain food preparations: rice, boiled with milk and flavored with cinnamon, was one; “the lighter sorts of flesh-meat” was another. As to drink, the patient could take thin water-gruel, or a weak broth made from lean veal or sheep’s head. (Dr. Rush preferred peppermint tea.) But not beef or chicken broth, or meats of hard digestion. Also to be avoided was exposure to “cold, moisture, or whatever may obstruct the perspiration.... All violent passions, as fear, anger, &c. are likewise carefully to be guarded against.”⁴³ But how was a president, especially one so embroiled in partisan debate as Jefferson was, to guard against predictable feelings?

In his prime, Jefferson the unrelenting natural philosopher and political moralist was himself a candidate for Dr. Tissot’s science, as he evidently realized. As a man with a highly structured daily routine, and not known for his spontaneity, he could not escape Tissot’s warning that “a strict habit is downright servitude,” and that some men of letters became “such slaves to their régimes that the spirit became completely dependent upon the body.”⁴⁵ Tissot was manifestly concerned with the lives of scholars, because he considered their nerves especially reactive, and their digestion poor. Geniuses of the first order were often reduced to objects of pity, listless and forgetful, who suffered severe stomach and intestinal cramps. There was a consensus among clinical specialists that a pathological sympathy existed between the head and the stomach, and we have every reason to believe that Jefferson thought of his own irritable bowel in this way. Tissot went so far as to warn scholars against taking up new subjects in their later years: New ideas that brought into action previously unexercised fibers in the brain would do violence to the nerves generally. The entire mind and body would suffer as a result.⁴⁶

Aside from being known for commanding moderation, Tissot notably warned of the dangers of “self-pollution,” or masturbation. Like intensive study, masturbation was seen as draining and unproductive, wasting the vital energy of the body. Why Tissot and others thought that the social elite suffered especially in this way is less clear, though the logic Tissot followed led him to conclude that nervous degeneration among those who studied excessively carried over into their seminal fluid. This explained for him “why it is so rare that great men have sons worthy of themselves.” One could never be entirely secure about the effects of mental exertions, and Jefferson reflected this belief when he told Dr. Rush that he had retired after two terms not only because of George Washington’s political precedent but because, at the age of sixty-six, he feared “the progress of decay”—the relaxation of nerve fibers, the reduction of mental vigor—if he were to remain in office. “The sedentary character of my public occupations sapped a constitution naturally sound and vigorous.”⁴⁷

Title page of famed Swiss medical theorist Samuel Auguste David Tissot’s popular study of the mental and physical risks linked to poor diet and exercise, and unfulfilling sexual behavior. This was translated into English as An Essay on Diseases Incident to Literary and Sedentary Persons. Jefferson owned Tissot’s collected works in French, and appears to have regulated his daily life in line with Tissot’s counsel.

Jefferson’s friend Dr. Waterhouse took his cue from the European medical community in repeating that the sedentary life to which intellectuals were prone damaged their health. “Sedentary thoughtfulness will wear out the body and generate diseases that shorten life,” he wrote. “A dyspeptic stomach, emaciated body, and irritable feelings, compose the heavy tax, which men of fine intellects and deep study pay for their eminence.... Here the body is not worn but rusts out.” In every part of the transatlantic medical community, it was a given that mental exhaustion threatened to bring on every imaginable ailment.⁴⁸

Sedentary men were also said to have a tendency to overindulge in alcohol and tobacco. Dr. Ewell’s guide warned: “The lovers of wine and cider should remember that those beverages, however pleasant and exhilarating, have a tendency to aggravate all diseases of the kidneys and bladder.”⁴⁹ These were two of the main beverages served at Monticello. More sensitive to the dangers of hard liquor, Jefferson wished to promote brewery operations in his neighborhood as a substitute for the ever-increasing popularity of whiskey, which, he claimed, “kills one-third of our citizens and ruins their families.”⁵⁰

As he aged, he discovered all too well, if he had not seen long before, what the abuse of alcohol could do. His eldest grandchild, Anne, was terrorized by her violent husband, Charles Bankhead. Early in the marriage, a longtime Jefferson friend, Eliza House Trist, lamented: “Bankhead has turn’d out a great sot always frolicking and carousing at the Taverns of the Neighbourhood. Poor Ann I feel for her.” “With respect to Bankhead,” Jefferson wrote several years after this, in an attempt at fair-mindedness, “if ever he becomes a sober man, there will be no difficulty of reconciliation on Anne’s account, but as long as he is subject to drink, his society is dangerous & we shall reject it.”⁵¹

Waterhouse was particularly harsh on those who poisoned their systems with Virginia tobacco. Whether smoked or chewed, tobacco was “pernicious,” a “nasty custom” that turned faces “pallid” and made a person “restless, and dissatisfied with himself.” The long-term effects were obvious to him: They led to a sedentary existence. “As a sedentary man advances in life, he perspires less, while his lungs labour more.” Jefferson, who reluctantly grew tobacco but never smoked, escaped the pallor and disorder of the smoker’s fate by breathing good air and preserving his ruddy features. He approved Waterhouse’s denunciation of tobacco, writing realistically of the doctor’s treatise: “However sound in its principles, I expect it will be but a sermon to the wind.”⁵²

In the gendered philosophy of nervous activity, men were thought “naturally” more suited for the stimulation provided by books and scientific investigation, women for the delicate tasks of ordering the home and influencing children. Male and female obsessions were distinguished along similar lines: Men, filled with public ambition, could excessively crave intellectual accomplishment; women, bound to domestic reality, could succumb to obsessions of the heart. A woman’s temperament was the more readily excitable, vulnerable to her own feelings; but a man operated under stronger outward passions and consequently indulged his sexual appetite.⁵³ Wariness about polluting the body conspicuously absorbed Jefferson and his physician friends as they speculated constantly on the natural environment and the interaction of male and female impulses. The accuracy of their speculations would never be effectively resolved in any of their lifetimes, however. The best they could expect was to do no harm to themselves.

Tissot was an eighteenth-century thinker, and Waterhouse began writing about the smoker’s vice during Jefferson’s presidency early in the nineteenth. At the time of Jefferson’s death in 1826, a new breed of American moral reformers was just gearing up to root out contamination in a society that appeared increasingly coarse as it democratized politically. They were something like cultists, applying methods of religious faith in pursuit of better health. Less concerned with the body of medical knowledge bequeathed by classical antiquity, the reformers capitalized on Tissot’s success by intensifying their concern with the “solitary vice” of masturbation, at the same time associating human physiology more and more with the diseased imagination and a subversion of knowledge. In a combined effort to uphold middle-class respectability and religious discipline, they preached reliance on a self-restraining inner voice. At the same time, they doubted they could succeed without regulating by legal means what people read. If the pursuit of happiness was beginning to be associated with vernacular culture and commercial erotica, reformers forecast the increasing abuse of medical knowledge. Texts that might stimulate, even inadvertently, had to be suppressed. Victorian values were on the horizon.⁵⁴

But Jefferson was a moralist of a different kind. He supported that which tended to dignify and promote human happiness. He engaged in a quiet pursuit of inner contentment, what we have already identified in his phrase “tranquil permanent felicity.” At about the time Jefferson was heading for college, the Scottish philosophe Adam Smith was explaining the concept that we now think of as Jeffersonian: “Happiness consists in tranquility and enjoyment,” Smith wrote. “Without tranquility there is no enjoyment; and where there is perfect tranquility there is scarce anything which is not capable of amusing.”⁵⁵

Tranquility was considered a natural, or primitive, state of man, which in advanced society was rather an ideal. In old age, Jefferson related it at once to a medical state and to happy thoughts (“not to be pained in body, nor troubled in mind”). This was a dictum of the Greek philosopher Epicurus, which Jefferson expressed simply: “To procure tranquility of mind we must avoid desire and fear, the two principal diseases of the mind.”⁵⁶ When Jefferson used the word tranquility during his retirement, it was as often to appeal for release from political disputation. Though inundated with requests by letter, he would say, as to a Georgia politician in 1815, that he wished for his opinion to be read but not disseminated, and above all to be kept out of the newspapers; for, in this evening period of life, he was striving “to enjoy the privileged tranquility of a private and unmeddling citizen.”⁵⁷

By remaining conscious of his duty to exhibit “justice” and “magnanimity,” the tranquility-seeking Jefferson was ever conscious of his behavior toward acquaintances, guests, and strangers. This was why he answered so many of the letters that came from correspondents whom he had never met. His graciousness was not just good breeding but a moral quality known alternately as “firmness” and “self-command.” Having an active commitment to justice, a predisposition to be magnanimous, and a steady ability to convey firmness and self-command was the sum of eighteenth-century masculinity. These same qualities proved useful, too, in political life, as Jeffersonians showed an inclination to place the adjective firm before the word republican.

Jefferson was himself conscientious in trying to live and eat moderately, particularly in the years after his digestive complaints increased in frequency. As Dr. Waterhouse noted: “The first effect of violent grief or trouble of mind is deprivation of the powers of digestion.” Observing loss of appetite after a person received sudden “afflicting news,” he posed, “Now what connexion is there between a piece of bad news and a man’s stomach, full or empty?” He answered the question as follows: “Because the animal spirits or action of the nerves, whatever be the secret cause of their power, are called off to supply and support the tumultuous agitation of the brain, and the stomach with all its appendages and secretions is left powerless and paralytic.” Taking a holistic approach, Waterhouse advised: “Perfect health requires the temperate action of the vital influence through every part of the system. In perfect health food is sought with appetite, enjoyed with relish, and digested with facility.”⁵⁹

Tempering his scholarly exertions, Jefferson ate little meat (his granddaughter Ellen described his meat as “a seasoning for his vegetables”), exercised daily by walking and riding, took up gardening with his grandchildren, and slept between six and seven hours. As Waterhouse prescribed, “A ride with the cheerful scenery of a new and beautiful country will give you health, vigour, and vivacity, sound sleep, and a keen appetite.” No drug matched “a regular course of moderate exercise.” The penalty for ignoring the doctor’s advice was chronic illness, including “depraved appetite” and “the long and gloomy train of nervous disorders.”⁶⁰

In his sixty-eighth year, the year before he died, Dr. Rush described his daily regimen to Vine Utley, a fellow physician:

I generally sleep about seven hours in the four-and-twenty, and spend from three to seven hours at my desk every day, according to the greater or less hurry of my business. I continue to prefer tea and coffee with their usual accompaniments to all other kinds of aliment. At dinner, but at no other time, I eat sparingly of animal food, with the common garden vegetables of our country, and generally drink one glass and a half of old Madeira wine after them. I never drink ardent spirits in any way nor at any time.⁶¹

Dr. Utley wrote to Jefferson seven years later, describing Rush’s regimen and asking the now seventy-six-year-old Virginian for his own secret to longevity. Here was his reply:

Like my friend the Doctor, I have lived temperately, eating little animal food, and that not as an aliment, so much as a condiment for the vegetables, which constitute my principal diet. I double, however, the Doctor’s glass and a half of wine, and even treble it with a friend; but halve its effects by drinking the weak wines only. The ardent wines I cannot drink, nor do I use ardent spirits in any form. Malt liquors and ciders are my table drinks, and my breakfast, like that also of my friend, is of tea and coffee.

At this point not yet seriously troubled with a recurrence of the diarrhea he earlier complained of to Dr. Rush, he added: “I have been blest with organs of digestion which accept and concoct, without ever murmuring, whatever the palate chooses to consign to them, and I have not yet lost a tooth by age.” Dr. Utley was so impressed that he framed Jefferson’s “account of your Physical habits,” and displayed it where visitors to his home could not miss it. “It is an example of strict temperance,” he later wrote.⁶²

For Jefferson, a human being was not powerless, and health, more often than not, was a state of mind. Influenced equally by the medical writings of the age and his own experience, he liked to think that positive activity served the heart and cleared the head, just so long as a body did not lapse into sedentary pursuits. For this reason, he thought horseback riding prompted internal as well as external movement, the combined force of the muscles stimulating circulation.

In his personal life, in all Jefferson did, he was conscientious and actively sought to counteract whatever depressive force challenged his accustomed outlook, temperate and optimistic, or threatened to bring on restlessness and inner dissatisfaction. He was so closely attuned to the stealthy threat of nervous disorders in his world—it was apparent in the books on his shelves and in the tone of so many of his written texts—that he strained to maintain a moderate means of living, as paradoxical as that might sound. He constantly reassured himself that he was living properly.

He sought advice and gave advice. Well into his retirement years, he retained the high level of confidence and moral self-regard that such self-monitoring had conditioned him to feel, despite the physical deterioration he increasingly reported in his correspondence. His regular diet of vegetables, with moderate portions of meat and wine, bears this out. His friend Dr. Waterhouse insisted that there was “an inseparable sympathy and a beautiful balance” between the processes of breathing and digestion,⁶³ and Jefferson concurred. The quest to maintain that sympathetic balance was subservient to nothing and, in his mind, only surrendered to the ultimate power of nature over the doomed human organism.

Jefferson believed that he was simply practical and humane in his politics, when his approach to government in fact re-created the personal system (the self) that his study of the human body had led him to prefer. The republic was grounded, then, in a hybrid faith that consisted of the concepts he applied to his health: (1) structured diet and exercise, and (2) a “natural” sensibility.

In the first, daily physical exercise translated as reduced spending (only what was needed), to insure the longevity of the organism/body politic; its opposite, sedentary speculation, or “idleness,” led to the growth of immoderate passions, or an unhealthy love of wasteful, opulent display—what was then called “luxury.” As for the second feature of Jefferson’s medico-political faith, “sensibility,” this is a word that tends to be used nonspecifically today, but which encompassed almost every quality of feeling in Jefferson’s age. Jefferson understood it as “susceptibility,” which was felt as a pleasant or unpleasant disruption within the body—but more remarkably as susceptibility translated into social policy on the basis of philanthropic inclinations. Well-honed nerves led to superior taste and imaginative commitment—socially progressive legislation. Others, across two centuries, have identified Jefferson as a political thinker influenced by pure science and natural philosophy; but no one until now has presented him as a politician who was in effect a medical practitioner.

Medical reality as Jefferson understood it shaped his thinking about a host of ostensibly unconnected issues. As a self-confident man of letters and a discriminating patient, Jefferson as he aged intellectualized what he felt viscerally—his own deterioration. He divided the human experience into cultural categories: pleasure and pain, courage and timidity, calculated temperance and passionate excess, purity and pollution (of the human body and external environment alike). These so-called natural passions are all, in fact, elements of culture.

Despite the humbling experience of physical weakness and decay, Jefferson continued to toil on behalf of the next generation. It seems almost peculiar that the various, and often agonizing, ailments that he endured did not produce an unusual amount of distress among the doctors, friends, and loved ones who interacted with him. Indeed, it tells us a great deal that Jefferson was regarded as an unusually hale and hearty man for his day. He sometimes, though infrequently, meditated on the death that awaited, but he was more preoccupied with comprehending life.

In the self-revealing letter of 1785 in which Jefferson celebrated the “tranquil permanent felicity” with which he imagined his country blessed, he asserted that the tranquil character of American society enabled citizens to follow “steadily those pursuits which health and reason approve.” It is significant that he paired “health” with “reason.” To a man of the Enlightenment, “reason” harnessed all knowledge; the Enlightenment equated science with progress. And it is just as meaningful that “health” bespoke America’s advantages over others in the world.⁶⁴

Politics and Medicine Mix

“whether you may have had gonorrhæa”

“an old crazy carcase like mine”

“affections of the mind”

“a keen appetite”