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    EMP: Biot #677

    Dr. Hans KrausMedical Care of JFK

    ot #677:January 03, 2010

    ustrian-born Hans Kraus, M.D. (1905-1996), the colorful twentieth century physical medicine and

    habilitation pioneer, cared for President John F. Kennedy in his final years, from October 1961 to

    ovember 1963. Initially contacted by a White House physician to assess the presidents back pain, D

    raus refused, citing the ethical impropriety of treating a patient under the care of Dr. Janet Travell,

    nior White House Physician, President Kennedys personal physician since 1955, and a respected

    ecialist, like Dr. Kraus, in physical medicine and rehabilitation.

    hen Dr. Travell eventually called Dr. Kraus, apparently under pressure from others, Dr. Kraus agreevaluate President Kennedy. His life forever changed by the heady and exhausting experience, Dr

    raus successfully forged in President Kennedy a strong fitness habit. Dr. Kraus developed a unique

    pinion of how John F. Kennedys back originally became so weak and tight.

    Dr. Hans Kraus in white coat. Source:

    http://www.fitness.gov/images/

    HansKrausMD.jpg; accessed January 6,

    2010.

    Close up of Dr. Hans Kraus. Source: http://

    www.ihpra.org/chapter_3.htm; accessed

    January 6, 2010.

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    1. Early Years

    Hans Kraus was born in 1905 in the history-drenched port of Trieste at the head of the Adriati

    Sea, seventy miles due east of Venice, Italy. (1) Trieste was then the sole seaport of the otherw

    land-locked Austro-Hungarian Empire, whose capital Vienna was 215 miles to the northeast (

    the crow flies). Trieste was an entry point into Central Europe. (2)

    Map showing the location of Trieste.

    Source: http://www.pickatrail.com/jupiter/location/europe/italy/map/trieste.

    gif; accessed January 6, 2010.

    Postcard of Trieste in 1908, three years

    after Hans Kraus was born there.Source: http://www.i-italy.org/files/

    consulate_events_thumbnails/

    Svevojoyce2_1214837915.jpg;

    accessed January 6, 2010.

    Hansfather, Rudi, was born and raised in Pilsen (Western Bohemia, Czech Republic), about

    miles west of Prague, where hisfather owned a grocery store. As a young man, Rudi moved

    southward about 300 miles to Fiume (Rijeka, Croatia), a seaport on the Adriatic, about 40 mil

    southwest of Trieste, where he accumulated shipping industry experience and married Ella

    Schlessinger (1904). A year later, they moved to Trieste where he founded his shipping comp

    Marittima, while Ella bore Hans, Sisi (born 1910) and Franz (born 1916). (3)

    Hans received private tutoring at home until age 11 years (1916), because cholera, diphtheria,

    typhus, smallpox, influenza, and other contagious diseases frequently visited the seaport,

    resulting in high mortality rates, particularly among children. The private tutoring made Hans

    feel apart, isolate, and constrained.(4)

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    In spring 1914, Rudi sensed imminent war in Europe and used his shipping contacts to arrang

    move his business and family to Zurich. He transferred many assets into Swiss banks. On Jun

    28, 1914, Serbian and Bosnian anarchists assassinated Archduke Franz Ferdinand and his wif

    Sophie in Sarajevo, Serbia. Rudi and Ella paid their respects to the dead royals on July 1, 191

    when the dolorous armada put-in at Trieste where the funeral caskets were transferred from t

    black-garlanded ship to a black-garlanded special train, to the accompaniment of booming gu

    salutes, regiments presenting arms, and lowered colours.(5) Twenty-four hours later, the bod

    reached Vienna and then the border of the Wachau region of Austria, where they were laid to

    beneath Artstetten Castle. (6)

    Archduke Franz Ferdinand and his wife Sophie lying in state in Sarajevo after their

    assassination in June 1914. Source: http://www.btinternet.com/~j.pasteur/Aftermath.html; accessed January 6, 2010.

    On August 12, 1914, as Trieste swarmed with soldiers, the Kraus family departed the city by

    train to reach Zurich, about 275 miles to the northwest. (7) Hans was 9 years old. He grew to

    Zurich, because of its nearby mountains, whose foothills he climbed. James Joyce, the Irish

    literary master (1882-1941) who was living in Zurich at the time, taught English to the Kraus

    family.

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    James Joyce when he lived in Trieste. Source: http://www.harpers.org/media/image/blogs/misc/stanjoyce.jpg; accessed January 6, 2010.

    After the war ended, Rudi moved his business headquarters and family from Zurich to Vienna

    370 miles to the east. Rudi began to groom Hans to take over the shipping business. When Ha

    was in high school, however, he most enjoyed science courses taught by Dr. Schmidt, a recen

    medical school graduate and a former lieutenant in the Austro-Hungarian mountain troops.

    In 1921, at age 16 years, Hans attended a summer camp called Wandervogel where he and afriend named Marcus together climbed a mountain in the Austrian Alps, down which Marcus

    to his death by his own fault. This event traumatized Hans for decades.

    2. Hans Becomes a Physician

    Hans attended medical school at the University of Vienna, much to his fathers disappointmen

    while continuing to rock climb in the Austrian Alps. He graduated in 1930 at age 25 and inter

    in the large hospital attached to the University of Vienna Medical School. (8) He then special

    in fracture surgery(orthopedics), because he could dosomething for the patient with a broklimb, he said. Internal medicine lacked appeal for him, because it focused on diagnosis; there

    little available by way of treatment in the 1930s. Following his specialty training, Hans contin

    to work as a fracture specialist at the Fracture Emergency Clinic at the University of Vienna

    Hospital.

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    University of Vienna Hospital, ca. World War II. Source: http://history.amedd.army.

    mil/booksdocs/wwii/civilaffairs/ch14fig70.jpg; accessed January 6, 2010.

    Hans met a retired circus performer (strongman) named Heinz Kowalski who owned a gym

    beneath Hansmedical office on the second floor of a building across the street from the hosp

    Kowas short like Hans (56). Most of Hansclosest male friends were short. Ko believed

    musculoskeletal injuries healed fastest and best when they were immediately gently mobilized

    The standard of care was immobilization of the injury for weeks or even months. Ko told Han

    about the circus:

    We got sprains and fractures all the time, but we couldnt afford to immobilize them in

    casts. Instead, when we twisted a knee or sprained a shoulder, we wrapped the injury in

    towel soaked in alcohol, then held the whole thing close to steam from a boiling kettle

    Doing this numbs the injured area, which allows you to start moving it gently. We wou

    do this several times a day, the steam treatment followed by the gentle movements. Pre

    soon, the whole injured area loosens up, and stops hurting. After a few days of treatme

    we could find the injury healed, and we could go back to work at the circus. (9)

    This approach to healing and technique resonated with Hans, who had discovered that patient

    with casted wrist fractures who performed simple exercisesmovements like shrugging their

    shoulders and rolling their wrists--healed better and faster than the ones who had not exerciseeven if their injuries were worse. (10)

    Instead of Kos alcohol, Dr. Kraus used ethyl chloride to numb the skin over an injured area t

    facilitate early gentle movement. Since his approach was based on movement, in contrast to

    traditional immobilizationtreatments based on bed rest and casts, Kraus decided to name his

    approach, immediate mobilization.(11) His private medical practice in Vienna began to

    flourish when people, especially athletes, learned about his immediate mobilization technique

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    Dr. Kraus observed that some of his patients whose injuries were long standing found only pa

    relief with his early mobilization technique. To learn more about muscle function, he read

    Muskelharten(1913), a book by orthopedic surgeon Dr. Max Lange, which described a muscl

    condition characterized by hard, localized lumps of dead muscle fiber named trigger points.

    Lange noted the most common areas for trigger point development was in the muscle overlyin

    the hips, buttocks, lower back, shoulders, and neck. (12) Dr. Kraus learned to break up with

    needles the tissue associated with trigger points before starting his patients on exercises desig

    to restore muscle strength and flexibility.

    3. Emigrating to America

    In 1928, the Kraus family watched Austrias economy falter as unemployment and inflation r

    increased. In 1933, Hitler became German Chancellor, and in 1934, he became absolute dicta

    In 1935, he began his pogrom against German Jews by passing the Nuremburg Laws, which

    stripped them of their citizenship, legal rights and protection. Hans told his biographer that hi

    mother was baptized Catholic and his father Protestant, yet each had one Jewish parent, which

    Hitlers eyes, qualified them as Jewish. The Kraus family needed to get out of Austria.

    In 1934, Rudi arranged for 29-year-old Hans to visit Chicago, about which he was ambivalent

    and New York City, which he loved, to observe medical advances and scout places for the fam

    to live, transfer funds, and execute various financial arrangements as the early stage of

    emergency plans to escape Austria.(13) Rudis preparedness moves saved the family fortune

    During this trip Hans met Dr. William Darrach (1876-1948), a well-connected and well-respe

    orthopedic surgeon at Columbia Presbyterian (since renamed New York-Presbyterian), who

    shared Hanspassion for the importance of movement in rehabilitating orthopedic injuries and

    who protested the discrimination to which Nazi Germany was subjecting Jewish doctors and mof science. (14)

    Four years later, as Hitlers army marched into Vienna, Hans Kraus left Vienna on a train bou

    for Trieste (March 14, 1938). After a few days in Trieste, he entered Switzerland where he

    withdrew money Rudi had deposited, and then went to France, London, back to Trieste, and t

    to Naples where he boarded the nearly empty Conte Biancamanoship for New York City. Th

    rest of the Kraus family followed later.

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    Dr. William Darrach. Source: http://

    library.cpmc.columbia.edu/hsl/archives/

    imgtimelines/darrach_L.jpg; accessedJanuary 6, 2010.

    Columbia Presbyterian Medical Center,

    Broadway and 168th Street, New York

    City, November 16, 1937, underconstruction. Founded in 1921 with the

    affiliation of Columbia University and

    Presbyterian Hospital, the Center was

    intended as a first-rate teaching hospital

    serving the poor. Ground was broken in

    1935. Source: Columbia Presbyterian

    http://www.mcny.org/museum-

    collections/berenice-abbott/a262.htm;

    accessed January 6, 2010.

    Once in New York, Dr. Kraus again called on Dr. William Darrach, who directed him to talk

    with the staff of the hospitals so-called Fracture Service. The interview went well and a few

    days later, he [Dr. Darrach] asked me to join the hospitals staff as an assistant surgeon,said

    Hans. Here I was, no immigration papers, no medical license, no professional recommendati

    nothing. But Uncle Bill[Dr. Darrach] wanted me, so he made sure that the hospital hired

    me.(15) Dr. Darrach had served as dean of the College of Physicians and Surgeons at

    Columbia from 1919-1931.

    Hans worked three days per week for Dr. Darrachs clinic while he studied for his New York

    State medical licensing examination, which he passed. He then set up his medical practice,

    traveling periodically to climb the Shawangunks, 300-foot cliffs in Ulster County, less than tw

    hours north of midtown Manhattan.

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    Shawangunks, Ulster County, New

    York. Source: http://away.com/images/

    outside/200709/shawangunks-skytop-

    cliff.jpg; accessed January 6, 2010.

    Shawangunks, looking up. Ulster

    County, New York. Source: http://www.

    supertopo.com/climbing/thread.php?

    topic_id=697229; accessed January 6,

    2010.

    4. K-W Testing and Exercising

    Beginning in 1940, Dr. Kraus worked with Dr. Sonya Weber, a fellow Austrian migr at

    Columbia Presbyterian, in the hospitals Posture Clinic for children, which she had establishe

    treat children with posture problems. Drs. Kraus and Weber developed their six Kraus-Weber

    tests (also known as K-W tests) to measure their patientslevel of strength and flexibility in th

    back, stomach, and hip muscles used to hold the body erect. They prescribed various correctiv

    exercises, and from time to time would compare the results of these exercises with physical

    changes in the patients. (16)

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    Diagram of Kraus-Weber Tests. Source: http://www.ihpra.org/chapter_3.htm;

    accessed January 6, 2010.

    In 1944, Dr. Barbara Stimson, a prominent New York orthopedic surgeon, asked Drs. Kraus a

    Weber to participate in a special back clinic she had organized at Columbia-Presbyterian

    Hospital, under the auspices of Dr. William Darrach and Dr. Clay Ray Murray. Subsequently,

    Howard Rusk (1901-1989), considered by many the father of modern rehabilitation medicine

    pursued the work at the Institute for Physical Medicine and Rehabilitation at New York

    University. Dr. Stimson had started the clinic to find the cause for the rapidly increasing numb

    of back-pain sufferers in the armed services, industry and everyday life. In 80% of patients wi

    back pain so examined, physicians (orthopedic surgeons, internists, neurosurgeons, psychiatri

    and neurologists) found no abnormalities in the back X-rays and routine laboratory tests. (17)

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    Dr. Howard Rusk. Source: http://www.worldrehabfund.org/how_it_all_began.htm;accessed January 6, 2010.

    Drs. Weber and Kraus studied this 80% set of patients with backaches. Hans wrote:

    We decided to use the six key tests we had developed for children at the Posture Clinic

    Upon administering the tests to the back patients, we at once discovered that not only

    were they weak and tense but we could see exactly where the deficiencies were. Exerc

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    were prescribed to fit each individual case. The benefits of the exercises were soon

    evident. The patients who did them faithfully often found relief from back pain in a few

    weeks or months. Those who did not exercise continued to suffer. Their suffering was

    understandable, because muscles are healthy only when they are properly used. (17)

    The two physicians began to give the Kraus-Weber tests to healthypeople. People who fail

    one or more of the six tests were prime candidates for developing future back pain; thus, the K

    tests, Drs. Kraus and Weber believed, had predictive power.

    5. International K-W Testing

    Dr. Kraus first began to generate controversy when he announced the results of cross-country

    W testing at a New York State Medical Society meeting in 1954. He found that European

    children (Austrian, Italian and Swiss) outperformed American children on the K-W tests, and

    declared that American children were not as fit as they needed to be. He attributed the differen

    in performance between the European countries and the United States to the era of prosperity

    complete with television, automobiles, and appliances,that had swept over the U.S. after WoWar II. Dr. Kraus wrote, Failure rates on tests shot up as a country became more prosperous

    the most prosperous nation in the world, the United States was in an ignominious position. It h

    and still hasthe most physically unfit youngsters.(18)

    American physical educators disputed these facts and designed their own tests, which include

    running, jumping, and throwing a softball. They calculated the average performance for each

    and schools across the United States tested their students against this average, declaring their

    students were meeting the average. Dr. Kraus objected to the methodology and the conclusion

    drawn for performance of the American tests, since children from other countries outperformethe American children on the American physical fitness tests (except for the softball throw). (

    Dr. Kraus performed additional research, learning that physicians often put their patients on d

    saying little about exercise. He developed the term hypokinetic diseaseto describe all the ailm

    from back pain to heart troubleinduced at least in part by underexercise. (18)

    During the early 1940s, Dr. Kraus left orthopedics, because increasingly, he could cure most

    his patients with exercise. When in 1946, Columbia Presbyterian formed a brand new departm

    specializing in Rehabilitation Medicine,Dr. Kraus moved into it. (18) Around 1950, he

    transferred his affiliation from Columbia Presbyterian Hospital to New York Universitys Ru

    Institute of Rehabilitation Medicine. (19)

    6. President Eisenhower Creates Federal Agency for Physical Fitness, Calls it Youth Fitnes

    Dr. Kraus noted American school gym programs focused on team sports, particularly football

    baseball and basketball. He believed that sports by themselves do not get children fit. Rather,

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    children need to be fit to play sports. In most team sports the activity level is stop-and-go ins

    of the crucial, sustained movement that children need,he said. Plus, team sports cater to a

    small number of children who are the starsgenerally the fittest or tallestwho get most of t

    playing timeThe ones who are overweight and out of shape are the ones who need exercise

    school the most, but with team sports, theyre the ones who sit on the bench.(20)

    Dr. Kraus wrote many articles about physical fitness. Olympian gold medalist rower John B.

    Kelly (father of actress Grace Kelly) read one and forwarded it to a friendly senator, whoforwarded it to U.S. President Dwight D. Eisenhower. The president invited Dr. Kraus to a W

    House luncheon on June 29, 1955, to present his K-W childrens test results to a group that

    included Vice President Richard Nixon and various American fitness experts and sports

    celebrities. (21) In September 1955, President Eisenhower survived a serious heart attack,

    remaining in bed for seven weeks after the event. He established the Presidents Council on

    Youth Fitness (Executive Order 10673) on July 16, 1956. (22-23) Originally named Presiden

    Council on Physical Fitness,objections by physical educators and others resulted in the chan

    to Youth Fitness,according to Dr. Kraus.

    John B. Kelly. Source: http://www.

    rowinghistory.net/JBK%20Sr-1920.jpg;

    accessed January 6, 2010.

    President Dwight D. Eisenhower on

    youth fitness. Source: http://www.

    fitness.gov/50thanniversary/photos-

    firstfiftyyears/DwightDEisenhower-

    circa1956.jpg; accessed January 6,

    2010.

    President Eisenhower never gave the council a budget or any ability to enforce recommendati

    rather, he charged original executive director Dr. Shane McCarthy with influencing exercise

    habits through persuasion. The president appointed Dr. McCarthy, skipping over Dr. Kraus or

    Kraus recommendation. The council grew to 119 members; Hans Kraus was unimpressed and

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    disappointed.

    Writer Robert H. Boyle covered the June 29, 1955 White House fitness event for Sports

    Illustrated(August 15, 1955) in a long piece titled The report that shocked the president.Bo

    wrote that Dr. Kraus told the audience, 57.9% of U.S. youngsters tested for physical fitness

    failed one or more of six tests for muscular strength and flexibility while only 8.7% of Europe

    youngsters failed.(24) Furthermore, Dr. Kraus explained the

    Kraus-Weber Tests [were] designed to determine only the minimum levels of muscula

    fitness, not the optimum levels. The tests determine whether or not the individual has

    sufficient strength and flexibility in the parts of his body upon which demands are mad

    normal daily living. For example, the [K-W] sit-up test in which the knees are bent tes

    abdominal muscles. If a person fails, it means that his abdomen muscles cannot lift the

    weight of his upper body, and such a condition indicates a lack of sufficient

    exercise.(24)

    7. Senator John F. Kennedy Embraces Physical Fitness for Country, Then Self

    Senator John F. Kennedy in a brilliant move adopted Dr. Krausphysical fitness message as h

    own during his campaign for the U.S. presidency. John Kennedy worked hard to persuade the

    media he was the healthiest and most vigorous candidate and therefore deserved to win over

    others without these characteristics. This bold approach worked to neutralize his adversaries i

    three ways. First, it refuted accusations made by supporters of Senator Lyndon B. Johnson, w

    claimed that Kennedy suffered from Addisons disease and other medical illnesses and was

    therefore not fit for office. Second, it deflected the words of former President Harry Truman,

    poked Senator Kennedy for being too young and too immature for the office of the presidency(25-29) Third, it redirected attention away from the senators Catholicism, which many observ

    believed was his political Achilles heel. Beyond declaring himself the most fit of all the

    candidates, Senator Kennedy dropped to the press the tidbit that four out of seven presidents

    during his lifetime had suffered from heart disease, a none-too-veiled reference to Lyndon

    Johnsons heart attack in 1955. (30) Not surprisingly, Senator Johnsons supporters howled ab

    Senator Kennedys muscle flexing and boasting about his youth and vigor.

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    Sports Illustratedcover with Jack and Jackie Kennedy, boating. Photographed by:

    David Drew Zingg. Source: http://sportsillustrated.cnn.com/vault/cover/featured/7698/index.htm; accessed January 6, 2010.

    Schwartz writes:

    By the time Kennedy was running for president in 1959, he looked like he could have

    been a climber partnering [Dr. Hans] Kraus at the Gunks [Shawangunks]: tanned, trim

    seemingly toned, turning out that dazzling smile and glowing with apparent health and

    gah.Kennedy and his supporters saw a supreme opportunity to market his athletic,

    outdoors image. Staged photos showed him sailing, swimming, playing football; often

    bare-chested, muscles rippling in the sun.

    Kennedys appearance became a huge asset in his presidential campaign. An aide to

    Kennedys main rival, Lyndon Johnson, declared grumpily, that Kennedy appears so

    health that its almost illegal.Even sophisticated media, such as The New York Times

    were bowled over, Crowds responded warmly to a masculine presence, a lithe figure,

    suntanned face and a natural smile.(31)

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    In truth, Senator Kennedy was not a well man. He had many serious medical problems, the na

    of which his handlers, including his personal physician and later White House Physician Dr.

    Janet Travell, knowingly withheld from the American plebiscite. Indeed, as if to make things

    even worse, Senator Kennedy received injections filled with amphetamines and other

    components, at least as early as September 1960 near the time of the Nixon-Kennedy debates

    from the notorious Dr. Max Jacobson, a 1936 German migr to New York City. Senator

    Kennedy said he took the injections to counter his exhaustion. (32-33)

    John Kennedy was elected president in November 1960 and almost immediately underscored

    Americas need to improve her citizenslevel of physical fitness. The following list of article

    exemplifies the intensity of his effort:

    Kennedy to push fitness program; president-elect in magazine article says flabbiness

    menaces U.S. security.The New York Times, December 21, 1960.

    Jack Kennedy practices the fitness that he preachesin Sports Illustrated, December 2

    1960;

    Bess Furman: President opens a fitness appeal.The New York Times, February 21, 1

    Kennedy is lauded on fitness plans.The New York Times, March 5, 1961.

    Janet Travell and David Lewis: Fit to be president.Sports Illustrated, April 3, 1961.

    Fitness of youths urged by Kennedy; Kennedy asks 15 minutes a day of rugged exerc

    in schools.The New York Times, July 19, 1961.

    Fitness parley: State officials are invited to start Kennedy program.The New York

    Times, July 22, 1961.

    Physical fitness in schools gaining.The New York Times, July 31, 1963.

    Then came the following article on the front page of The New York Times(October 20, 1961)

    Kennedy exercising daily to help back; Kennedy begins daily exercises.What was this?

    8. President Kennedy Takes the Kraus Cure: Exercise

    In June 1961, President Kennedys endocrinologist, Dr. Eugene Cohen, of New York Hospita

    contacted Dr. Hans Kraus to ask him to treat President Kennedy for an acute exacerbation of hchronic back pain. The president had re-injured his back lifting a shovel of soil in Ottawa,

    Canada, during a tree planting ceremony in May 1961. His back hurt so much during a

    subsequent trip to Europe in June 1961 to meet Khrushchev, among other leaders, that he

    required multiple vitamininjections from Dr. Max Jacobson, whom he ferreted to Europe

    unbeknownst to White House physicians, Dr. Janet Travell and Dr. George Burkley, who

    accompanied the president. (32)

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    Dr. Kraus listened to Cohen, neither flattered nor excited, as Cohen explained that he was

    seriously worried about Kennedys worsening back problems and that Kennedys current Wh

    House back doctor [Dr. Janet Travell] wasnt helping him. To Cohens surprise and dismay,

    Kraus politely refused, No, I really cant, Gene.Kraus explained to Cohen that he was

    sympathetic to Cohens worries, but added, You know I cant see Kennedy unless his curren

    back doctor personally asks me. It wouldnt be ethical. (35) Schwarz continues:

    Kraus didnt bother adding that he also realized that treating the President of the UniteStates would be a total commitment, consuming what little free time he had on weeken

    for his family [he had married and had two daughters] or to climb, already interrupted

    his regular practice and his unofficial practice of treatingfor freeall injured climbe

    at the Shawangunks. Without having met Kennedy, Kraus wasnt sure he was willing t

    take on that commitment. Kraus explained further, Too many people judge other peop

    on their rank or money. But to me, it wasnt that. What mattered was whether I felt the

    were a good person. I couldnt treat anyone I didnt like.(35)

    One more thing bothered Dr. Kraus about accepting President Kennedy as a patientPresidenKennedys multiple earlier back operations. Even a single back operation could permanently

    incur so much damage, that it could be too late, even for Kraus,wrote Schwarz. Dr. Kraus

    opined, Once someone has had a back operation, even once, you never know. Backs dont lik

    to be operated on.(35)

    On October 14, 1961, Dr. Travell telephoned Dr. Kraus directly to invite him to the White Ho

    to examine President Kennedy. Dr. Kraus complied. The next day he was in Washington, D.C

    setting up temporary facilities in Dr. Travells three-room medical office on the first floor of t

    White House. He noted President Kennedy was 44 years old, six feet tall, and 179 pounds. DrKraus was 56 years old. He put the president through the K-W tests and palpated for muscle

    anomalies. Dr. Kraus took no X-rays and read none of Dr. Travells notes or X-rays. He

    concluded the following about President Kennedy (as told to his biographer Susan B. Schwar

    Kennedy was so weak that he couldnt do a single sit-up and he was so tight that his le

    muscles felt as taut as piano wires.When Kraus asked his patient to touch his toes [o

    of the six K-W tests], Kennedys fingertips dangled a good twenty inches off the floor

    even reaching his knees. It was clear to Kraus that whatever else was going on with

    Kennedys back, Kennedy was in abysmal shape. (36)

    Kraus wasnt sure how much he could help Kennedy, considering Kennedys back

    operations and subsequent treatments. But from the little Kraus had seen of the man, h

    had a good feeling about him, and wanted to try to help him. And Kraus had no doubt

    about one thing: Kennedy needed to exercise [which, after all, is what Kennedy was

    urging the country to do]. Otherwise, his muscles would grow weaker and tighter, caus

    only more pain and immobility. Kraus delivered his assessment to Kennedy bluntly, y

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    will be a cripple soon if you dont start exercising. Five days a week. And you need to

    start now.

    Dr. Kraus described his clinical plan to President Kennedy. Dr. Kraus would treat the presiden

    personally at least three times during the week, and would train the three White House therap

    so that they could supervise the two additional weekly exercise sessions in Krausabsence.

    Kraus would also commit, on a moments notice, to fly to Kennedy for emergencies, whenev

    he needed him, wherever he was, no matter how oftenThen Kraus got to the crucial part: whe expected from Kennedy and the other White House doctors.

    Kraus explained to everyone in the room that to him, this was his most important

    condition, on which he was absolutely unyielding and completely unwilling to

    compromise. It was the only way he would work with any patient, whether president o

    the United States or a Gunks climber: I must have absolute control,Kraus announce

    He would brook no interference from any doctor, whether Travell or even Cohen or

    Burkley. He would entertain no second opinion, unless he sought it. If the other doctor

    or Kennedy, didnt like his conditions, that was fine with him. In that case, he simplywouldnt take Kennedy on as a patient. (36)

    President Kennedy expressed concern reporters would notice Dr. Krausregular presence at th

    White House and ask questions about the presidents health again, which he dreaded. Dr. Krau

    shot back, Its your decision, but when you get worse, what will they write then?President

    Kennedy agreed, on one condition: absolute secrecy, that Dr. Kraus receive no publicity for

    being his back doctor, and instead remain hidden and operate completely behind the scenes. I

    press tried contacting Kraus he wasnt to speak to them, even off the record, and instead refer

    them to Kennedys press secretary, Pierre Salinger.(36) President Kennedy even installed aline(telephone) for direct secure access to Kraus. Furthermore, according to Krausbiograph

    As a precaution, when Burkley, Cohen and Kraus needed to talk on the phone, they always u

    pay phones.(37) John Kennedys need for unconditional silence from his numerous physicia

    is the main reason Americans know little about his medical history, even today.

    President Kennedy did not offer to pay Dr. Kraus for his services and Hans did not raise the is

    for over a year. Finally, he wrote to Evelyn Lincoln, the presidents secretary, to request

    reimbursement for plane fares. (36) Dr. Kraus rationalized that treating the president for free w

    a form of public service.

    Schwarz avers the arrangement between Kraus and Kennedy added another layer to Kennedy

    presidential health cover-upTo help maintain the fiction, when Kraus stayed overnight to tr

    Kennedy for the weekend, holidays, and emergency flare ups that occurred regularly when

    Kennedy visited his family, Kraus stayed tucked away discreetly at small pensiones. (38)

    Yet, the professional relationship between Dr. Kraus and the president was well publicized. F

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    example, a story ran on October 20, 1961 (the day after they met) in The New York Times title

    Kennedy exercising daily to help back.It read:

    President Kennedy has started a daily program of exercise designed to strengthen his

    muscles and remove fear that his chronic back trouble will flare up again. He began th

    exercises in the White House gymnasium yesterday under the supervision of Dr. Hans

    Kraus, associate profession of physical medicine and rehabilitation at the New York

    University Medical School. Dr. Kraus was a member of the Presidents Council onPhysical Fitness during the Eisenhower Administration. He is regarded by Mr. Kenned

    regular physician, Dr. Janet G. Travell, as an expert on the therapeutic approach to

    physical fitnessAt Dr. Travells invitation, Dr. Kraus worked out an exercise program

    for the President. He plans to come to Washington three times a week for about two

    months to supervise Mr. Kennedys workouts in a small gymnasium adjoining the Wh

    House swimming pool. The President exercised yesterday for about fifteen minutes, us

    only body motion, not weights and pulleys with which the gymnasium is equipped. Th

    President is apparently hopeful that after a couple of months of studied muscle

    strengthening, he will return to such favorite outdoor pursuits as golf and possibly oceaswimming at his fathers home at Palm Beach, Florida.

    There is nothing omitted or inaccurate about this story. Dr. Burkley had set up a small area ne

    to the swimming pool with gym equipment where Dr. Kraus and the White House physical

    therapists put the president through his exercises five days a week.

    Dr. Kraus grew to admire President Kennedy. His Manhattan office was ransacked once, whic

    President Kennedy and others blamed on J. Edgar Hoover of the Federal Bureau of Investigat

    Dr. Kraus cracked, Even if Hoover had gotten his hands on Kennedys files [which he didntall that would have happened is that he would have discovered that Kennedy did exercises.(

    Occasionally, Dr. Kraus would administer procaine injections at trigger points, just as Dr. Tra

    had done for President Kennedy, but he kept this procedure as an adjunct to exercise therapy,

    as the sole treatment.

    9. President Kennedy Strengthens Back

    Hans Kraus discerned that President Kennedys relapses of back pain always took place on

    weekends and holidays.For example, when Mr. Kennedy spent Thanksgiving (1961) with hi

    family at the Hyannis Port compound, he developed severe back spasms. As had become

    routine, Kennedy called Kraus and sent Air Force Two for him. Six weeks later, when Kenne

    spent Christmas with his family in Palm Beach, [he] suffered another relapse, this time far

    worse.(39)

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    President John F. Kennedy in rocking

    chair. Source: http://www.

    humanillnesses.com/original/images/

    hdc_0001_0001_0_img0007.jpg;

    accessed January 6, 2010.

    White House swimming pool. Source:

    http://clean-sweep-pool.com/

    SwimmingPoolOne/

    SwimmingPoolOne.html; accessed

    January 6, 2010.

    In spite of these setbacks, President Kennedy continued faithfully to perform his exercises and

    by late 1961, Dr. Kraus was tapering off his visits to the White House to twice a week. An art

    titled Presidents back reported betterin The New York Timesdated December 13, 1961, rea

    President Kennedy is swimming and taking muscle-strengthening exercises every day,

    White House aides said today. His bad back apparently is tremendously better. The

    President is hoping and expecting to pick up his golf game during the holiday season a

    Palm Beach, Fla. He has not played a round since he strained his back last May whilelifting a shovel of dirt at a tree-planting ceremony on a visit to Ottawa. This was just

    before a rigorous trip to France, West German and Britain on which the President

    concealed his injury. After he returned home he was on crutches for several weeks. Ab

    six weeks ago, a New York expert, Dr. Hans Kraus, began coming to the White House

    supervise a series of muscle-strengthening exercises. Dr. Kraus still makes the visit on

    or twice a week, Presidential aides said, and he has done wonders for the President.

    By the spring of 1963, Dr. Kraus was visiting the White House once very few weeks. (39) He

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    was able to do this, because the head White House therapist ChiefHendrix, whom Dr. Krau

    had trained in the K-W exercises, put the president through them, traveling everywhere with h

    After Kennedys assassination, Chief Hendrix left the White House to work for Dr. Kraus in

    Manhattan, until he retired in the 1980s. Dr. Kraus said of him, He was the best therapist I ev

    saw.(40)

    10. Kennedys Life Ends

    In October 1963, Dr. Kraus wanted President Kennedy to throw out his corset (which he had

    worn since he was sophomore at Harvard College) and his crutches, and shift from physical

    therapy exercises to exercises designed for staying in shape. (41) But as is common among

    people who suffer chronic bad painthe psychological adjustment lags behind physical progr

    Kennedy did not quite dare give up the trappings of his infirmity just yet.He did promise

    Kraus that he would do so in the new year, 1964. Dr. Kraus last saw President Kennedy in

    October, but was looking forward to attending his first State Dinner to which President Kenne

    had invited him and his wife, which was scheduled for Monday, November 25, 1963. Presiden

    Kennedy was assassinated on Friday, November 22, 1963 in Dallas, Texas.

    Evelyn Lincoln and Kennedy aide Kenneth ODonnell independently recalled how healthy

    President Kennedy was in the last months of his life. Lincoln said, I have often stated that in

    last six months of President Kennedys life he was in the best health he had ever been. He wa

    really in good health.ODonnell said that on the last day of his life, Kennedy turned to him a

    said, I feel greatMy back feels better than its felt in years.(42)

    President Lyndon Johnson asked Dr. Kraus to remain a member of the White House team of

    physicians, but he preferred to return to New York and his family. Drs. Burkley and Cohen dinot plan to write memoirs of their experience caring for Mr. Kennedy, because they, like Krau

    had given him their word, promising secrecy. (43) Yet even without capitalizing on his Kenn

    connections, Krauspractice finally took off.He treated patients, wrote books, climbed his

    beloved Shawangunks, spent time with his family, and finally died in 1996 of prostate cancer

    age 91 years.

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    Hans Kraus, age 50 (1960). Source:

    http://www.climbaz.com/interviews/

    kraus.html; accessed January 6, 2010.

    President Kennedys physical fitness

    patch, awarded to students who met

    certain fitness requirements. Source:

    http://www.jfklibrary.org/Historical

    +Resources/JFK+in+History/The

    +Federal+Government+Takes+on

    +Physical+Fitness.htm; accessed

    January 6, 2010.

    11. How President Kennedys Back Originally Became Weak and Tight

    Dr. Hans Kraus believed that John F. Kennedy grew up as an invalid,because of the

    astonishing number of weeks and months he spent lying in bed in hospitals, clinics, and

    infirmaries to undergo diagnostic testing and treatment for his many mysterious and unending

    illnesses. After the testing and treatment, he would withdraw for days, weeks, and sometimesmonths to Hyannis Port or Palm Beach to recuperate, again lying down most of the time. (44)

    Without chances to run around and play games, the boyhood Kennedy would not have

    developed normal muscles,averred Dr. Kraus. By late teenager years, Kennedys muscles

    would have been growing too weak to support his maturing, heavier frame. As an adult, Kenn

    was going to be a prime candidate for developing back pain anyway, but he sealed his fate in

    college [by] permanently donning an artificial support that keeps muscles from working--whe

    back corset, brace or crutches.These supports are about the worst thing a back pain sufferer

    like Kennedy could do.(44)

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    otes:

    1. Justin Coffin writes, The history of Trieste can be read as the record of ascendancy in Middl

    Europe. The Romans founded the city as they expanded their empire in the second century BC

    When Rome collapsed in the fifth century AD, Trieste was overrun by the Huns, and then fell

    under Byzantine rule. Next in line were the Carolingians, followed by the Venetians. For one

    year, 1381 to 1382, Trieste held a tenuous independence, which ended when it submitted toAustria as a preferable alternative to Venetian rule. The French, this time led by General

    Bonaparte, conquered it again in 1797 and handed it over to the Austro-Hungarian Empire.

    Finallyor rather, for nowit has been a part of Italy, having been awarded after World Wa

    as a trophy for Italys participation on the side of the Allies. Recent decades have not been so

    calm in neighboring Istria, which was part of Yugoslavia and now sits on the border between

    Slovenia and Croatia.Source: Justin Coffin: Microcosmsby Claudio Magris(book review

    Boston Review. February/March, 2001. Available at http://bostonreview.net/BR26.1/coffin.ht

    accessed January 3, 2010.

    2. For more about the history and culture of Trieste, see

    Jan Morris: Trieste and the Meaning of Nowhere. Cambridge, MA: Da Capo Press, 2002; and

    Claudio Magris:Microcosms. Translated by Iain Halliday. London: Harvill Press, 2001.

    3. Susan E.B. Schwartz:Into the Unknown: The Remarkable Life of Hans Kraus. New York:

    IUniverse, 2005, p. 4.

    4. Ibid, p. 5.

    5. Franz Ferdinand: Aftermath.Available at http://www.btinternet.com/~j.pasteur/Aftermath.

    html; accessed January 4, 2010.

    6. Arstetten Castle.Available at http://www.schloss-artstetten.at/englisch/schloss.htm; accesse

    January 4, 2010.

    7. Susan E.B. Schwartz:Into the Unknown. New York: IUniverse, 2005, p. 6.

    8. Ibid, p. 22.

    9. Ibid, p. 39.

    10. Ibid, p. 38.

    11. Ibid, p. 41.

    12. Ibid, p. 46.

    13. Ibid, p. 52.

    14. Hitlerism scored by doctors here. Forty-nine sign statement condemning discrimination again

    physicians. They assert science should not recognize and racial or political boundaries.The N

    York Times, July 10, 1933.

    15. Susan E.B. Schwartz:Into the Unknown: The Remarkable Life of Hans Kraus. New York:

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    IUniverse, 2005, p. 64.

    16. Hans Kraus:Backache, Stress and Tension: Cause, Prevention and Treatment. New York:

    Fireside Book, 1965, pp. 38-39.

    17. Ibid, pp. 44-46.

    18. Susan E.B. Schwartz:Into the Unknown: The Remarkable Life of Hans Kraus. New York:

    IUniverse, 2005, p. 91.

    19. Ibid, p. 112.

    20. Ibid, p. 114.

    21. Susan E.B. Schwartz:Into the Unknown: The Remarkable Life of Hans Kraus. New York:

    IUniverse, 2005, p. 121.

    22. Hans Kraus:Backache, Stress and Tension: Cause, Prevention and Treatment. New York:

    Fireside Book, 1965, pp. 47-48.

    23. The Federal Government takes on physical fitness.Available at http://www.jfklibrary.org/

    Historical+Resources/JFK+in+History/The+Federal+Government+Takes+on+Physical+Fitne

    htm; accessed January 5, 2010.

    24. Robert H. Boyle: The report that shocked the president.Sports Illustrated, August 15, 1955

    Available at http://sportsillustrated.cnn.com/vault/article/magazine/MAG1130060/index.htm;

    accessed January 10, 2010.

    25. Margaret R. OLeary: Dr. Janet Travells Rendezvous with JFK.Securitas Magazine, Apr-S

    2009, Volume 8, Issue 2. Available at http://www.semp.us/publications/securitas_reader.php?

    SecuritasID=40#Article4; accessed January 5, 2010.

    26. Janet Travell: Office Hours: Day and Night.Cleveland, OH: New American Library, 1968, p.328.

    27. W.H. Lawrence: Johnson backers urge health test.The New York Times, July 5, 1960.

    28. Robert Dallek: The medical ordeals of JFK.The Atlantic Monthly, December 2002. Availab

    at http://www.theatlantic.com/doc/200212/dallek-jfk; accessed September 6, 2009.

    29. Lee R. Mandel: Endocrine and autoimmune aspects of the health history of John F. Kennedy

    Annals of Internal Medicine, September 2009, Volume 151, Number 5.

    30. Richard Norton Smith: The president is fine and other historical lies.Columbia Journalism

    Review, September 2001. Available at http://www.entrepreneur.com/tradejournals/article/print/78535553.html; accessed January 5, 2010.

    31. Susan E.B. Schwartz:Into the Unknown: The Remarkable Life of Hans Kraus. New York:

    IUniverse, 2005, p. 165.

    32. Michael R. Beschloss: The Crisis Years: Kennedy and Khrushchev 1960-1963. New York:

    HarperCollins, 1991, p. 190.

    33. Boyce Rensberger: Amphetamines used by a physician to lift moods of famous patients.Th

    New York Times, December 4, 1972.

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    34. Jack Kennedy practices the fitness that he preaches.Sports Illustrated, December 26, 1960.

    35. Susan E.B. Schwartz:Into the Unknown: The Remarkable Life of Hans Kraus. New York:

    IUniverse, 2005, p. 166.

    36. Ibid, pp. 178-179.

    37. Ibid, p. 188.

    38. Ibid, pp. 180-181.

    39. Ibid, p. 192.

    40. Ibid, p. 193.

    41. Ibid, p. 203.

    42. Ibid, p. 207.

    43. Ibid, p. 211.

    44. Ibid, p. 236.

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