Hektoen International

A Journal of Medical Humanities

Did Casimir Pulaski have 21-hydroxylase deficiency?

Gregory Rutecki
Lyndhurst, Ohio, United States

“. . . I could not submit to stoop before the sovereigns of Europe, so I came to hazard all the freedom of America, and desirous of passing the rest of my life in a country truly free and before settling as a citizen, to fight for liberty.”1 -Casimir Pulaski

An advertisement featuring a color illustration of General Casimir Pulaski.
Casimir Pulaski, from the Great Generals series (N15) for Allen & Ginter Cigarettes Brands. Allen & Ginter. 1888.
Metropolitan Museum of Art.

Although Polish by birth and military training, Casimir Pulaski (1745-1779)like his countryman Tadeusz Kosciuszkois remembered as a hero of the American Revolution.2 Unlike Kosciuszko, however, recent attention to Pulaski has been focused on the possibility he was intersex.3,4,5 In this regard, his retrospective and hypothetical adrenal saga is an intriguing intellectual journey from medical, historical, and ethical perspectives.

Before arriving in America during the Revolution, Pulaski’s European experiences were turbulent.4 In 1768, to counter increasing Russian interference in Polish affairs, Pulaski, a cavalryman, joined the revolutionary Polish Bar Federation in an effort to militarily stem the Russian tide. He exhibited prodigious battlefield skills as an officer, albeit for a losing cause. He narrowly escaped Poland with a “price on his head,” but was sentenced to death in absentia. Things went from bad to worse for him in Europe, and later in France he was sentenced to serve time in debtors’ prison.

When Pulaski’s future seemed most bleak, he was introduced to Benjamin Franklin. Franklin was impressed by his battlefield exploits. He penned a letter to George Washington stating, “Count Pulaski of Poland, an officer famous throughout Europe for his bravery and conduct in defense of the liberties of his country against the three great invading powers of Russia, Austria, and Prussia, may be highly useful to our service.”6 In 1777, Pulaski arrived in America. He was present with Washington, ostensibly as an observer, at the Battle of Brandywine. When the British forces began to overwhelm the Colonials, he asked General Washington for thirty of his horsemen. He then led a bold charge against the British, thus saving the American forces.7 He may have also saved George Washington’s life.8 At Germantown, Nathanial Greene’s retreat was successfully covered by Pulaski.9 His Corps also expelled the British from Charleston.2

Congress subsequently named him “Chief of Cavalry.”2 Today, he is often identified as the “Father of the American Cavalry.” In 1779, he was mortally wounded during the battle in Savannah. Although his military exploits have long been praised, in light of recent evidence he may also have boldly and selflessly represented intersex individuals, a group that has been largely ignored in generalnot only in the historical record.

When Pulaski’s presumed final resting place in Savannah was investigated, the remains were consistent with a woman’s body.5 The exhumed pelvis had a female shape, providing a 95% certainty the corpse had XX chromosomes.4 The skeleton suggested a height of only five foot two inches. But adding to the mystery, the interred body revealed signs of extensive horseback riding and of a battle wound scar to the right hand consistent with Pulaski’s military history.4 Confusing as the find was, the “female” remains genetically matched (mitochondrial DNA with a 99.98% certainty) a Pulaski grand-niece.4 The most viable hypothesis entertained has been that Casimir Pulaski was intersex, possessing a reproductive or sexual anatomy that does not seem to fit the traditional definitions of female or male.

How might Pulaski’s “female” remains—in the context of his presumed military exploits—be explained? The congenital adrenal disease, 21-hydroxylase deficiency, is the most common cause of genital ambiguity.10 The consequent pathologyespecially as relevant to Pulaskican be posited as follows.10 Persons with the genetic defect for the deficiency cannot synthesize cortisol. Contingently, pituitary ACTH rises. For female fetuses in utero, the excess ACTH stimulates the adrenal gland to produce those steroids not requiring 21-hydroxylase activity. A consequent robust androgen cascade is initiated by the adrenal-driven output of 17-hydroxyprogesterone, DHEA, and androstenedione, providing the gonads with the precursors necessary for an overabundance of testosterone. Genetically female fetuses (XX chromosomes) are thus prenatally exposed to excessive testosterone. The result is a variable spectrum of phenotypic “male” expressions of ambiguous genitalia in unequivocally genotypic females.

One may conclude that:

“In light of new evidence, Pulaski can be seen as a valiant representative of a group (intersex persons) that has largely been erased from the historical record—not only through omission, but also through deliberate attempts to shoehorn intersex individuals into one gender or another, sometimes with surgeries that have been deemed unnecessary and damaging.”2

It is imperative that medical professionals positively engage those persons who fall under the umbrella of intersex. These individuals have been characterized as the “Invisible I” in LGBTQIA.11 Wiseman has insightfully observed, “Biological, psychological, and social factors have an influence on the outcome (of being intersex) and make each intersex condition unique.”12 Ignoring this demographic has led to ethical travesties including disfiguring surgeries and a novel vocabulary of Optimal-Gender Policy, Full-Consent Policy, and even Gender Eugenics.12, 13 In the words of Hida Viloria, “We’re out here, and we’re thriving, and we’re in every realm of society . . . intersex people are real and an ancient community.”11


  1. Jamro R.D. Pulaski: A Portrait of Freedom 1981, The Printcraft Press, Inc, Savannah, Ga. p. 199-200
  2. Storozynski A. The Peasant Prince Thaddeus Kosciuszko and the Age of Revolution, Thomas Dunne Books, New York, 2009.
  3. Katz B. Was the Revolutionary War Hero Casimir Pulaski Intersex? https://www.smithsonianmag.com, April 9, 2019.
  4. Schoenberg N. New documentary argues Revolutionary war here Casimir Pulaski was intersex. https://herald-review.com, April 4, 2019.
  5. Siemaszko C. DNA appears to show this Revolutionary War general was a woman or intersex. https://www.mnnofa.com, April 4, 2019.
  6. Hickman K. Poland’s Count Casimir Pulaski and his role in the American Revolution. At Thoughtcompany.com, 2-13-2018.
  7. Ferreiro L.D. Brothers at Arms: America’s Independence and the Men of France and Spain who saved it. Vintage books, New York, 2016, p.145.
  8. Shores D.B, Kazimierz Pulaski: General of Two Nations. CreateSpace Independent Publishing Paltform, 2014, out of print.
  9. Ketchum R. M. (Ed.) The American Heritage Book of the Revolution American Heritage Publ. Co. New York, 1971, p.215.
  10. White P.C and Speiser P.W. Congenital Adrenal Hyperplasia due to 21-Hydroxylase Deficiency. Endocrine Reviews 2000; 21:245-291.
  11. Schoenberg N. New Documentary argues Revolutionary War hero Casimir Pulaski was intersex. Chicago Tribune, April 4, 2019.
  12. Wiesemann C, Ude-Koeller S, Sinnecker G.H.G, & Thyen U. Ethical Principles and recommendations for the medical management of differences of sex development (DSD)/intersex in children and adolescents. Eur. J. Pediatr. 2010; 169:671-679.
  13. Sparrow R. Gender Eugenics? The Ethics of PGD for Intersex Conditions. The Amer. J. of Bioethics 2013; 13:29-38.

GREGORY W. RUTECKI, MD, received his medical degree from the University of Illinois, Chicago in 1974. He completed Internal Medicine training at the Ohio State University Medical Center (1978) and his fellowship in Nephrology at the University of Minnesota (1980). After twelve years of private practice in general nephrology, he entered a teaching career at the Northeastern Ohio Universities College of Medicine, the Feinberg School of Medicine, Northwestern University, and the University of South Alabama in Mobile, Alabama. While at Northwestern, he was the E. Stephen Kurtides Chair of Medical Education. He now practices general internal medicine at the Cleveland Clinic.

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