Early on the morning of July 2, 1961, sixty-one year old Ernest Hemingway, one of America's greatest writers and the winner of both the Nobel Prize and Pulitzer Prize, sat in the foyer of his home and shot himself in the head with a double-barreled shotgun. I believe that his suicide was caused by his doctors' complete failure to diagnose hemochromatosis, a hereditary disease that was so well known and so easy to treat that he could have had no suffering at all (Front Neurol Neurosci, 2010;27:174-206). In 1961, the time of his death, I was a senior in medical school and I remember seeing hemochromatosis described clearly in just about every medical textbook, including all of the signs and symptoms that Hemingway's doctors missed. This disease has a simple treatment that would have prevented virtually all of his disability.
How His Doctors Failed Him
Doctors are supposed to take a family history on just about every patient they see. Other members of Hemingway's family who committed suicide included his grandfather, his father, his sister Ursula and his brother Leicester (and later, his granddaughter Margaux). All of them most likely had the same highly-treatable disease. His father suffered from diabetes, depression and memory loss, and his skin turned a bronze color later in life. Hemingway's symptoms were incredibly similar to those of his father.
Something was damaging every cell in his body. He repeatedly went to doctors for treatment of arthritis, cirrhosis of the liver, severe heart disease, arteriosclerosis, diabetes, depression and loss of teeth. He spent most of his life treating his total body pain with drinking mixtures of tomato juice and beer, gin and lime, Angostura bitters, or absinthe and champagne. Something was also damaging his brain. He was so depressed that he was repeatedly given brutal and horrible electric shock therapy. In 1961, he considered suicide and returned to the Mayo Clinic for more electric shock therapy. He lost even more of his memory and finally shot himself. He was driven to suicide by extreme pain, depression and loss of mental function. Taking a routine family history should have led his doctor to order a simple, readily-available blood test that would have led to the correct diagnosis and treatment.
Hemochromatosis Can Destroy Your Body and Brain
You need iron to stay alive because it helps your body carry and use oxygen, and functions in many of the chemical reactions in your body. However, iron is a potent oxidant that can deposit in and damage cells throughout your body. To protect you from being poisoned by too much iron, your intestines stop absorbing iron when you have enough. People with hemochromatosis lack the ability to stop absorbing iron when they have too much. Iron can accumulate:
• in the brain to make you lose your memory, cause depression, and interfere with every brain function such as thinking reasonably
• in your pancreas to cause diabetes
• in your liver to cause cirrhosis
• in your skin to turn your skin a bronze color
• in your eyes to cause loss of vision
• in your joints to cause horrible, painful arthritis
The Simple Treatment
If iron levels are kept in the normal range, there is no tissue damage and a person with hemochromatosis can live a perfectly normal life. Every few months the doctor does a blood test called ferritin, a measure of how much iron is deposited in the person's tissues. When blood levels of ferritin are too high, the excess iron is easily removed by drawing a pint or two of blood. This blood is perfectly healthy so it can be used in blood banks, although some (including the American Red Cross) refuse to accept it.
Hemingway's Productive but Miserable Life
Ernest Miller Hemingway was born on July 21, 1899 in Oak Park, Illinois. His father, Clarence Edmonds Hemingway, was a doctor. His mother was a talented but neurotic woman who dressed Ernest and his sister as little girls and tried to pass them off as twins. After high school, Ernest worked as a reporter for the Kansas City Star, but soon left to join the American Red Cross to serve as an ambulance driver in Italy during World War I.
In 1918, he was wounded by a mortar shell while delivering supplies to soldiers. He fell in love with a nurse, Agnes von Kurowsky, but she left him to marry an Italian officer. This experience was the inspiration for his novel, A Farewell To Arms. In 1921, he married Hadley Richardson and they moved to Paris where Hemingway covered the Greco-Turkish war for the Toronto Star. There Hemingway met Gertrude Stein, Ezra Pound and many other writers and artists; his journals from this period were published after his death as A Movable Feast. In 1926, he wrote The Sun Also Rises, based on drinking bouts with F. Scott Fitzgerald in Paris.
In 1927, Ernest Hemingway divorced Hadley Richardson and converted to Catholicism to marry Pauline Pfeiffer. In 1928, he moved to Key West, Florida. That year his father committed suicide. In 1937, he went to Spain to report on the Spanish Civil War, the basis of For Whom the Bell Tolls. Hemingway and Pauline supported opposing sides in the Civil War, and he responded by leaving the Catholic church. In 1940, he divorced Pauline and married fellow author Martha Gellhorn, who was a war correspondent for Colliers magazine.
In 1941, he convinced the Cuban government to outfit his boat so he could hunt for German submarines. He spent the later years of World War II as a correspondent in Europe and was present at the Normandy landings. In 1944, he divorced Gellhorn and married Mary Welsh, a Time magazine correspondent. The following year he returned to Cuba. The Old Man And The Sea, published in 1952, helped him to win the Pulitzer Prize in 1953 and the Nobel Prize in Literature in 1954. He spent the rest of his life suffering with chronic pain and depression. In 1960, electric shock therapy for depression caused him to lose his memory, which prevented him from writing. It also caused such severe weight loss that he hardly looked like his old self.
What If Doctors Had Made the Diagnosis Earlier?
In April of 1961, his wife found him holding a shotgun. She had him admitted to a local hospital and then sent to the Mayo Clinic for more electric shock treatments. He was released from the Mayo Clinic and came home on June 30. Two days later Hemingway shot himself.
If Hemingway had blood withdrawn every time his tissue levels of iron were too high, he could have avoided all of the horrible pain he suffered and probably would have lived a much longer life. He would not have had to suffer damage to his brain, liver, pancreas, eyes, joints and skin. His suicide can be explained by the pain of untreated hemochromatosis.
Medical records made available in 1991 prove that Hemingway was finally correctly diagnosed with hemochromatosis just before he died in 1961. Hemochromatosis is most common in people of Irish, Welsh, Scottish and other northern European descent, and Hemingway was of Celtic heritage. As many as one in every 200 North Americans suffer from this highly treatable genetic defect, and nearly 20 percent of the population carry the recessive genes associated with hemochromatosis. There are several different mutations that cause the disease; the H63D mutation is carried by 13.5 percent of North Americans and the C282Y mutation is carried by 5.4 percent. It is so common that I think the simple test for hemochromatosis should be included in a routine physical.
July 21, 1899 - July 2, 1961
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