Early on the morning of July 2, 1961, sixty-one year old Ernest Hemingway, one of America's greatest writers and the winner of the Nobel Prize and Pulitzer Prize, sat in the foyer of his Ketchum, Idaho 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 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). Other members of Hemingway's family who committed suicide include his grandfather, his father, his sister Ursula, his brother Leicester and his granddaughter Margaux. All of them most likely had the same treatable disease.
In 1961 I was in medical school, and I remember seeing his disease described clearly in medical textbooks, including all of the signs and symptoms that Hemingway's doctors missed. This disease has a simple treatment, well-known at that time, that would have prevented virtually all of his disability.
Hemingway the Man
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 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 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 Martha Gellhorn.
In 1941, Hemingway joined the Navy and was sent to Cuba to try to sink German submarines. Later, he was sent to Europe as a correspondent for Colliers magazine. In 1944, he divorced Gellhorn and married Mary Welsh Hemingway. The following year he returned to Cuba.
In 1952, he wrote 'The Old Man And The Sea' which helped him 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.
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.
But What Really Killed Him?
See if you can put these clues together to diagnose one disease:
• Throughout his life, he suffered severe arthritis, cirrhosis of the liver, severe heart disease, arteriosclerosis, diabetes, depression and loss of teeth.
• His father suffered from diabetes, his skin turned a bronze color later in life and he committed suicide.
• Hemingway's last years were incredibly similar to those of his father: severe depression, loss of memory, diabetes, and suicide.
• He was of Celtic heritage.
• His liver damage was not caused just by his heavy drinking.
• The year before he died he spent 56 days in the Mayo Clinic being treated for liver, heart and kidney damage, diabetes, arthritis, and depression (one disease can cause all these symptoms). His treatments included electric shock therapy.
• He spent every minute of the last few years of his life suffering from pain all over his body. He treated his total body pain with drinking mixtures of tomato juice and beer, gin and lime, Angostura bitters, or absinthe and champagne.
• In 1961, he considered suicide and returned to the Mayo Clinic for more electric shock therapy. He lost even more memory and finally he shot himself. He was driven to suicide by extreme pain, depression and loss of mental facilities.
Medical records made available in 1991 prove that Hemingway was finally diagnosed with hemochromatosis just before he died in 1961. Hemochromatosis is a hereditary disease that most likely affected the five other members of his family who committed suicide. It is most common in people of Irish, Welsh, Scottish and other northern European heritage.
How Hemochromatosis Can Destroy Every Cell in Your Body
You need iron to stay alive. It functions in many of the chemical reactions in your body. It also helps your body carry and use oxygen. However, iron is a potent oxidant that can deposit in and damage every cell in your body. To protect you from being poisoned by too much iron, your intestines stop absorbing iron when you have too much.
People with hemochromatosis lack the ability to stop absorbing iron when they have too much. This genetic defect causes people to suffer damage to every part of their bodies. Iron can accumulate:
• in your brain to make you lose your memory, cause depression, and interfere with every brain function
• 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
How Is Hemochromatosis Treated?
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 can easily be 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.
What If Doctors Made the Diagnosis Earlier?
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 completely by the pain of untreated hemochromatosis. As many as one in every 200 people suffer from this highly treatable genetic defect.
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