Monday, February 22, 2010

Cleveland's Secret Surgery

The Arizona Health Sciences Library has an exhibit on the "Secret Illnesses of the Presidents." President Cleveland underwent a secret surgery during his second term:
In 1893, soon after entering his second term as president, Grover Cleveland became aware of a rough spot on the roof of his mouth. When presidential doctor Major Robert O’Reilly came by for a social call, the president asked O’Reilly to take a look at it. O’Reilly discovered a lesion that he described as “nearly the size of a quarter with cauliflower granulation.” (Hoang and O’Leary).

O’Reilly had the sample sent anonymously to the Army Medical Museum and consulted with Dr. William Welch at Johns Hopkins. Both diagnoses reported malignancy, the former using the then current phrase epithelioma, “terminology for a carcinoma” (Hoang and O’Leary).

O’Reilly decided to consult two of the best surgeons available on the president’s condition. William W. Keen and Joseph D. Bryant. Bryant has been described by Hoang and O’Leary as “an intelligent choice, since he had only 3 years earlier written a review of 250 cases of excision of the superior maxilla.” The physicians agreed that the president would have to undergo surgery.

However, there were political considerations. A nationwide depression had just gotten underway and in the name of strengthening the economy, the president was leading a movement to repeal the Sherman Silver Purchase Act and uphold the gold standard. In August, the president had to address Congress and thus, he had to be able to recover from the surgery’s effects by that time. It was already late June. Furthermore, the president was concerned that reports of his condition could prove even more unsettling, so the surgery would have to be done in secret.

Commodore Elias Benedict, a friend of the President, had a yacht, the Oneida, and it was decided to perform the surgery there. The yacht’s saloon was converted into a surgical center. Besides O’Reilly, Bryant and Keen, the surgical team would consist of a dentist, Ferdinand Hasbrouk, Edward Janeway, and J.F. Eidmann. Hasbrouk would be the one who would administer anesthesia to the president, a not-uncommon practice at that time. His presence proved useful at a later point when rumors circulated about the surgery; White House aides said that the president’s only problem was the removal of a tooth and fortunately, a dentist was on board.

The surgery was performed on July 1, 1893. The President’s mouth received disinfectant and Hasbrouk administered anesthesia and removed two of the president’s teeth. Cocaine was used as a topical anesthetic as Bryant and Keen, making use of a French made cheek retractor began the surgery. Ronald Spiro describes the work:
“(A)n incision was made through gingival and palate mucosa to the underlying bone. Supplemental ether inhalation was then used to facilitate a partial maxillectomy,including the left upper alveolus from the first bicuspid to justbehind the last molar tooth, the hard palate to the midline, anda small portion of the soft palate.

Only at this point was it appreciated that the tumor had extendedinto the antrum, involving the floor around the roots of the molar teeth. For this reason, the remaining left maxilla, exclusive of the medial was and infraorbital plate, was apparently removed in piecemeal fashion, and the cavity was packed with iodoform gauze.” (Spiro, pp. 394-5)

The surgery took nearly an hour and a half. However, the President’s speech was affected by the loss of 2.5 inch x 13/16 inch loss of his palate (Carlson and Reddi p. 192). At this point, one Kasson Gibson, a prosthodontist, was brought in and he was able to fashion a vulcanized implant. Cleveland made a steady recovery, although some days after the first surgery, a lesion was removed in a second operation aboard the yacht.

Cleveland was able to address Congress that August but he lost much of his old energy, was often irritable and suffered some loss of hearing. The depression would persist for the remainder of his term and by the time he left office in 1897, his party had pretty much disowned him.

Hasbrouk had apparently been the source of a report that appeared in the papers soon after the surgery, but the White House was able to cover up the story. It was not until 1917, nine years after Cleveland died, that the public finally learned about the president’s secret surgery.

You can also check out other secret illnesses for Presidents Arthur, Kennedy, Roosevelt and Wilson.


coriolan said...

Did Cleveland actually address Congress in person? It seems unlikely - I've read that such personal appearences before Congress were discontinued by Jefferson and not resumed till Wilson. More than likely, the "address" - I assume it to be the August 8 1893 message discussing remedies for the Panic of 1893 - was simply written by Cleveland and read to Congress by a clerk (as was the usual practice).

The speech itself is at this link:

Jennie W said...

As far as I know, he didn't do it in person. I think this exhibit, which is written for a medical audience, probably didn't bother to look into the nuaces that we, the politcal/historical audience, would care about. I pulled the biography I have of Cleveland here at home and couldn't find anything that said he did it in person, which I think would have been mentioned. They were just trying to show that he was quickly back at work. My biography (Grover Cleveland by Henry Graff) has this to say on his recovery:
"the prothesis [his artificial jaw] left his appearance and speech unaffected. And after a stay at Gray Gables, somewhat thinner and somewhat more irasible, the president was back at his desk, slaving away as usual." (pg. 116)