Keen immediately instituted antiseptic practices at St. Mary’s Hospital, where he was then practicing. It was the first hospital in Philadelphia to follow Lister’s advice. Almost overnight its postoperative mortality rate plummeted. Soon every hospital in the city followed suit. Within ten years, antiseptic surgery was practiced everywhere. Along with anesthesia, it was one of the great advances in medicine in the nineteenth century. Today the postoperative infection rate is less than 2 percent.
Joseph Lister died in 1912. Two years later his name was attached— without his family’s permission—to a new brand of mouthwash. He deserves a better memorial than Listerine.
After he left the army in 1864, Keen embarked on a tour of Europe. For nearly two years he traveled the continent, from Norway to Italy, studying and sightseeing. In Vienna and Berlin, Keen studied under some of Europe’s most renowned surgeons: Hyrtl, Škoda, and Virchow. In London, he watched the legendary British politicians Disraeli and Gladstone debate in the House of Commons. Though a practicing Baptist, he could not resist the urge to stand with the multitudes in St. Peter’s Square on Easter Sunday 1865 and receive the blessing of Pius IX—the pope who declared popes infallible. In Paris, Keen was shown the continent’s latest surgical instruments, including a cheek retractor— an ingenious device used to pull the cheek away from the jaw, allowing oral surgery to be performed wholly within the mouth. He’d never seen anything like it, so he bought one—though at the time he doubted he’d ever have much use for it.
Keen returned to Philadelphia in May 1866. He opened a private surgical practice and settled into a teaching job at Jefferson. In 1867, Tinnie Borden finally agreed to marry him, ending a courtship that had consumed eight years. Their union was productive—they had four children, all girls—but tragically abbreviated. On July 12, 1886, Tinnie suddenly died after a bout with dysentery. Keen was inconsolable; the death of his beloved wife plunged him into a crushing grief. “The one appalling disaster of my life,” he called it. At thirty-nine, he was a single parent with four young daughters. His only solace was work. He spent the next year editing a new American edition of Grey’s Anatomy, which became a standard textbook for a generation of medical students. He also edited The American Text-book of Surgery and Surgery: Its Principles and Practice, the latter being the first American textbook on surgery to incorporate Lister’s antiseptic principles.
Keen also pioneered brain surgery. On December 15, 1887, he successfully removed a large tumor from the brain of a patient named Theodore Daveler—perhaps the first operation of its kind in the United States, though, in this case, the patient’s resolve is at least as commendable as the surgeon’s. Daveler lived another thirty years, albeit with an inch-and-a-half hole in his head protected only by a crude helmet—a skullcap fitted with a piece of tin—that Keen fashioned for him. The case cemented Keen’s reputation.
Keen was pious, but he was no saint. He could be a bit overbearing—in the operating room, there were two ways to do things: his way and the wrong way. He was opinionated, too—he inundated the Philadelphia Public Ledger with letters to the editor. But his peers didn’t seem to mind, and he had become a full-fledged member of Philadelphia’s high society. He was invited to the most fashionable oyster parties. He belonged to some of the city’s most prestigious and important organizations, including the American Philosophical Society and the University Club. He had succeeded Samuel Gross as the chairman of surgery at Jefferson—and as the nation’s most famous surgeon. If not the emperor of American surgery, Keen was at least a prince. His place in the pantheon was secure.
Then he got Joseph Bryant’s letter.
Back on the ferry, Keen pondered Bryant’s preposterous request. As Keen well knew, Grover Cleveland was not the ideal candidate for radical surgery. He was overweight and out of shape. His neck was so thick, the joke went, he could take off his shirt without unbuttoning the collar. He probably had high blood pressure. And he was exhausted. Keen knew the president might not survive the operation. The anesthesia could trigger a heart attack or stroke. It was also possible—even likely— that Cleveland would lose a large amount of blood, which, considering that no means of transfusion had yet been devised, would prove fatal.
Yet Keen did not ponder Bryant’s request very long. “I readily agreed,” Keen later wrote.
Although he was a rock-ribbed Republican—in 1861, as a student at Jefferson, he’d attended a speech by President-elect Abraham Lincoln at Independence Hall—Keen’s respect for the presidency was nonpartisan. If the president requested his assistance, he would render it. In fact, it was Keen’s policy to give aid to all who asked for it, regardless of their station. He frequently operated on indigent patients for free. Besides, Keen believed Cleveland was all that stood between “us and widespread bankruptcy.”
Keen, whose passion for order and cleanliness was nearly obsessive, must have been aghast at the thought of such an important operation taking place clandestinely on a boat. But he agreed with Bryant that such secrecy was essential. “If it had been suspected that Mr. Cleveland was suffering from cancer,” Keen wrote, “the possibility that his life might be shortened or his considerable influence diminished would cause the politicians to desert him (as the setting sun) and flock to the support of Stevenson (the rising sun); the Silver Act would never be repealed, and the direst possible consequences for the country would follow.”
W. W. Keen in the operating theater at Jefferson Medical College, December 10, 1902. Keen is in white, standing to the right. The spectators are probably medical students. LIBRARY OF CONGRESS
By agreeing to take part in the secret operation on the president, Keen was putting his career—and his reputation—on the line. He had performed hundreds of operations but none like this. The identity of the patient and the high stakes involved would make it the most important case in American medicine since Garfield was shot twelve years earlier. And everybody knew how that turned out.
Outwardly, the president appeared remarkably calm as his appointment on the Oneida approached. He went about his business in his usual matter-of-fact manner. He prepared for the looming showdown with Congress over the Silver Purchase Act, vigorously lobbying representatives and senators. And he did his best to fend off the office seekers who continued to hound him.
Privately, of course, Cleveland was anxious. One senator who was friendly with the president later recalled that, at this time, “Mr. Cleveland seemed very much worried, and was continually talking about his physical condition and expressing great concern.”
Robert O’Brien, who had succeeded Dan Lamont as Cleveland’s private secretary, later wrote, “Mr. Cleveland had shown during the latter spring and early summer of that year a very marked tendency to get away from people, to avoid visitors, betokening some physical weariness or nervous apprehension.”
In the days leading up to the operation, Dan Lamont peppered Dr. Bryant with letters and telegrams containing questions from the president. How would his speaking voice be affected? Initially he will “exhibit a defect in speech,” Bryant answered. But once he was fitted with an oral prosthesis to replace the excised bits, his speaking voice should return to normal. Bryant was already in touch with Kasson Gibson, a New York dentist and prosthodontist who would go to Gray Gables after the operation to fashion an artificial jaw for the president.
The president wanted to know how soon after the operation he would be able to meet with government officials without revealing what had happened. The economic situation was dire; Cleveland was eager to set a date for the special session of Congress to convene. He preferred to summon the representatives and senators while the weather in Washington was still sultry. He hoped the heat would expedite the debate.
Bryant estimated it would take the president at least a month to recover and master the prosthesis. “When I say this I assume that everything will go as is usual in such cases,” Bryant wrote. But, he warned, “Further than this, human foresight cannot indicate.” If there were complicat
ions, the recovery time might be significantly longer. Bryant advised the president to schedule the special session no earlier than August 15, some six weeks after the surgery. Cleveland, of course, would be expected to return to Washington for the session. But that was not soon enough for Cleveland, Lamont wired Bryant. “Could your friend safely make engagement for seventh of August instead of fifteenth as proposed?” Reluctantly, Bryant agreed—another example of the patient, not the doctor, dictating the course of treatment.
What Bryant didn’t tell the president was that, if the cancer had spread too far, the lower part of his left eye socket would have to be removed—in which case the left side of his face would droop noticeably and his vision would be permanently impaired. In that event, of course, it would be impossible to conceal the fact that the president had had major surgery.
And then there was the small matter of Cleveland’s big moustache. The president undoubtedly insisted it be preserved. Even if he bore no visible scars after the operation, the sudden disappearance of his bushy ‘stache would arouse intense curiosity. Indeed, at the time a cleanshaven president was almost unimaginable. There hadn’t been one since Andrew Johnson left office in 1869, nearly twenty-five years earlier.
Except for some outlandish sideburns, such as those worn by John Quincy Adams and Martin Van Buren, no president sported facial hair until Abraham Lincoln, who, after his election in 1860, grew a beard at the suggestion of an eleven-year-old girl. Thereafter, excepting Johnson and McKinley, every president for the next fifty-two years was bewhiskered: Grant (beard), Hayes (beard), Garfield (beard), Arthur (moustache-meets-sideburns, a style known as the Franz Josef), Cleveland, Harrison (beard), Roosevelt (moustache), and Taft (moustache). (Although he grew a beard after his stroke, Wilson never appeared in public with it.)
How did facial hair become de rigueur for presidents? In part, the style was borrowed from British aristocrats who, by 1850, regarded shaving as “a most peculiar activity.” Beards had come to be regarded as healthy. They were thought to prevent bronchitis, as well as diseases of the throat. Also, during the Civil War, most soldiers had neither the time nor the inclination to shave, and after the war they simply kept their whiskers. By 1870, facial hair had become all the rage. Even Uncle Sam, previously clean shaven, had sprouted a goatee. In a photograph of the Harvard Class of 1870, each and every graduate is sporting a beard, moustache, or some variant. Yale’s yearbook that year even broke down the class by facial hair:
Moustache, 26
Sides, 19
Down (quite down), 18
Moustache and Sides, 13
Hopeful scrags, 12
Incipient hairs, 9
Moustache and Imperial, 6
Shave daily with no result, 3
Moustache and Whiskers, 3
Fuzzy in spots, 2
Feels confident that the soil is good, 1
Is applying blisters, 1
Yet, seemingly as quickly as it had become fashionable, facial hair fell out of favor. Since Taft left office in 1913, no president has had any facial hair, and only two major presidential candidates, Republicans Charles Hughes (1916) and Thomas Dewey (1944, 1948), have had any. (Hughes reportedly grew his beard to “save trips to the barber.” Dewey wore a pencil-thin moustache that made him look, in the memorable words of one socialite, “like the bridegroom on the wedding cake.” Although he was frequently advised to get rid of his ‘stache, Dewey refused because he said his wife liked it.)
As with its ascendency, several factors contributed to facial hair’s decline. In 1895, King Camp Gillette invented a disposable razor blade that made shaving easier and safer. Ironically, facial hair also came to be regarded as unhealthy. Proponents of a so-called hygiene movement postulated that beards were actually breeding grounds for “misanthropic microbes.” Then came World War I. Doughboys were required to be clean shaven so their gasmasks would fit snugly. After the war came the rise of hirsute communists Lenin and Trotsky, not to mention their bearded forefathers Marx and Engels. “Facial hair had acquired a new but entirely enduring twentieth-century meaning—that of dictator, communist, or revolutionary,” writes Allan Peterkin in One Thousand Beards, his history of facial hair. “The beard has been the kiss of death for Western politicians ever since.”
Though he regarded communism as “a hateful thing and a menace to peace,” Grover Cleveland was fond of his furry upper lip and was loath to lose it. He’d first grown his moustache as a young man back in Buffalo and can be seen sporting it in the first known photograph of him, taken in 1864, when he was twenty-seven. His moustache had become his trademark.
On June 26, the same day he met Dr. Keen on the ferry, Joseph Bryant also convinced another prominent doctor to join the secret surgical team. Like Bryant, fifty-two-year-old Edward Janeway was a former New York City health commissioner and a professor at Bellevue Hospital Medical College. Also like Bryant, he was an accomplished surgeon.
That night, Bryant returned to his handsome home at 54 West Thirty-Sixth Street and wrote a letter to Dan Lamont in Washington. “My dear Col.,” the letter begins,
My arrangements are now all but complete. I saw the gentleman from Philadelphia today. He will accompany us.
Now Col., if you do not intend that Dr. O’R. [O’Reilly, the White House physician] go along, for politic or other reasons, then you should let me know at once, for I must then find someone else. It is my intention to give the anesthetic myself until time to begin the operation. I do this because I can thus set the example, and also perhaps the patient will regard it with some degree of satisfaction. However, someone must begin when I leave off, and I had assigned Dr. O’R. to this duty, as I cannot expect either of the other gentlemen [Keen and Janeway] to do this for many good reasons. Telegraph me when you leave.
Do you not think that there should be a “cipher” code, which can be used? It seems to me that this will be especially important in case anything unfavorable happens. If anything “springs a leak” it may not be amiss. Tell our friend [the president] that I desire his urine examined two or three times before leaving for here. B. [Elias Benedict, owner of the Oneida] is entering into this matter with earnest and well-directed zeal. Does the wife know about it? I ask because she may write me and I wish to know what to say. Give my regards to the President.
A cipher was never used; although, considering Bryant’s abstruse wording and abysmal penmanship, it hardly seems to have been warranted.
In the end, it was decided that O’Reilly should be included on the surgical team, and in the following days, two more doctors were recruited: John Erdmann, Bryant’s twenty-nine-year-old assistant and protégé, and Ferdinand Hasbrouck, a forty-nine-year-old dentist who was also an experienced anesthetist. Born in Monticello, New York, around 1843, Hasbrouck was one of the first dentists to experiment with anesthesia, and he built a thriving practice in New York City, earning a reputation that “brought many noted people as patients.” In 1892 the New York Press called Hasbrouck “the most expert tooth extractor in the world” and estimated that he had pulled seventy thousand teeth. Since Cleveland’s tumor was very close to his molars, some of his teeth would need to be extracted. When Joseph Bryant was assembling his surgical team, Hasbrouck, with his expertise in dentistry as well as anesthesia, was a logical choice. However, Hasbrouck’s services were very much in demand, and he already had an appointment to assist a doctor named Carlos MacDonald with an operation in Greenwich the day after the operation on the Oneida. Hasbrouck told Bryant he would need to disembark soon after the surgery on the president had ended.
The surgical team was now complete: Bryant would be the lead surgeon; Keen and Erdmann would assist. Hasbrouck would handle tooth extractions and assist with anesthesia. O’Reilly would also assist with anesthesia, and Janeway would monitor the patient’s vital signs. All were sworn to secrecy.
Meanwhile, Bryant oversaw preparations on the Oneida, which Benedict had anchored in the East River that week. The yacht’s small, dark sal
oon was transformed into a makeshift operating room. It was cleared of all furniture except the organ, which was bolted to the floor. Then it was cleaned and disinfected. A large chair was lashed to the mast in the center of the room. Here the president would sit for the operation. There would be no operating table. The only artificial light would come from a single electric bulb connected to a portable battery. The larger pieces of equipment, including tanks of oxygen and nitrous oxide, were quietly delivered to the yacht. Regarding the unusual accumulation of medical paraphernalia, Dr. Keen later said the crew of the Oneida was told “that the president had to have two very badly ulcerated teeth removed and that fresh, pure air, and disinfected quarters and skilled doctors, all had to be provided, lest blood poisoning should set in—a very serious matter when the patient was the just-inaugurated President of the United States.” It would later be reported that the white yacht was repainted green in order to better conceal it, but that was not true. As Elias Benedict himself later noted, “Such an act would have created a suspicion which we all wished to avoid.” The intent, of course, was to make it look like a perfectly ordinary summer outing for the president and his friends.
5
THE ONEIDA
ON FRIDAY, JUNE 30, 1893, President Cleveland awoke around seven and read the morning papers over his usual breakfast of beefsteak and eggs. The headlines must have troubled him as greatly as the rough spot on the roof of his mouth. They told of more failed banks, more closed mines, more foreclosed farms, and more bankrupt businesses. Wheat prices were at an all-time low: seventy cents a bushel. Interest rates on Wall Street were at an all-time high: 74 percent. Stocks were plummeting accordingly.
The President Is a Sick Man Page 8
