Thursday, May 15, 2008

Grover Cleveland and Jaw Cancer

I read an article talking about how some presidents have hid their illnesses while others were frank about them. Health Media Lab has a section on presidential illnesses as well. They write:
Over the past century, the health of our presidents has become a political as well as a medical issue. Beginning with Chester Alan Arthur's administration in 1881, the perceived political consequences of disclosing a president's medical problems have sometimes conflicted with the public's concern for accountability and openness. Presidents Arthur and Kennedy chose to keep their incurable diseases secret. President Dwight D. Eisenhower, on the other hand, advocated full disclosure. President Lyndon B. Johnson chose at first not to disclose information about his gall bladder problem He later changed his mind, even showing reporters the scar left from his surgery.

One of their articles is about the secret operations performed on Grover Cleveland for mouth cancer:
On 1 July 1893, an operation was performed on President Grover Cleveland to remove a cancerous lesion from his left upper jaw. The operation took place on a private yacht as it steamed up Long Island sound to the President's summer home in Massachusetts. Performing the surgery was Dr. Joseph D. Bryant of New York, assisted by Dr. W. W. Keen of Philadelphia, three other doctors, and a dentist.

The surgeons performed the entire operation inside the mouth without making an external incision. Two weeks later, a second operation was done, again on the yacht, to remove additional suspicious tissue. A vulcanized rubber plate was made for the President, which restored his speaking voice so well that when he reappeared in public no one could detect that an operation had taken place.

Despite all the care taken to prevent publicity, the story broke on 29 August in the Philadelphia Press. It was firmly denied by the White House and Cleveland's friends and family. The official word was that the President had had a bad tooth extracted.

The reason for the secrecy was that the country was in the middle of a financial crisis caused by the inflationary Sherman Silver Purchase Act of 1890. Cleveland had been elected to a second term on a platform that called for repeal of the Act and his leadership was essential to that process, which was to begin at a special session of Congress on 7 August 1893. His Vice-president, Adlai Stevenson, was a "silver man" and opposed to the repeal. Feeling that any sign of ill health might be interpreted as weakness and throw support to the pro-silver side, Cleveland decided to keep the operation secret.

President Cleveland was the standard-bearer of a Democratic Party that was split into two factions - the conservative pro-business gold standard faction which he led, and the free-silver faction led by William Jennings Bryan. Cleveland defeated President Benjamin Harrison's re-election bid in 1892 by campaigning on a sound-money platform, but was able to carry his party only by choosing free-silver advocate Adlai Stevenson as his running mate.

Given the political climate, Cleveland decided that the operation should be kept secret. Plans were made to assemble a surgical team selected by Dr. Bryant on the private yacht Oneida, owned by Cleveland's friend, Commodore Elias C. Benedict.

Dr. Keen wrote that, "The entire operation was done within the mouth, without any external incision, by means of a cheek retractor, the most useful instrument I have ever seen for such an operations, which I had brought back from Paris in 1866."

Dr. Kasson C. Gibson, a New York prosthodontist, was called up to the President's summer home to make a vulcanized rubber prosthesis to fill in the large defect in the President's palate and restore his speech to normal.

From the time of the operation, questions lingered as to the exact nature of the lesion and its malignancy. In 1975, a reexamination of the tissue determined that it was a verrucous carcinoma of the hard palate and gingiva, which fit the clinical features of the case as described by Drs. O'Reilly, Keen and others. Unlike the highly metastatic oral cancer squamous carcinoma, it is usually cured by surgical excision.

Dr. Keen was professor of surgery at Jefferson medical College from 1889 to 1907, and was known as a bold and innovative surgeon and was recognized as a leader in the field. Keen concluded that Cleveland's decision to keep the operation a secret had been a wise one.
After his operation, Cleveland returned to Washington for the special session of Congress he had called on 7 August. With his urging, the House passed the repeal of the Sherman Act on 28 August. The fight in the Senate continued at greater length, and the repeal was not finally passed until 30 October.

In a letter to Dr. Kasson C. Gibson, written 14 October 1893, Cleveland writes: "My dear Doctor, I hasten to announce that you have scored another dental victory and a greater one than has before attended your manipulation of my corpus. The new plate came last night...I have worn it all day with the utmost ease and wife says that my voice and articulation are now much better than they have been for a number of days...If I could only regain my strength and hearing I should feel quite like myself."

Verrucous carcinoma is typically associated with the use of tobacco and alcohol. Cleveland occasionally drank spirits and was very fond of beer; he also enjoyed smoking both cigars and pipes.

This project - When the President is a Patient - has many fascinating articles to explore!

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