The President Is a Sick Man

by Matthew Algeo

  On Thursday, April 17, 1924, E. J. Edwards was dictating to a stenographer in his New York office when he suffered a massive stroke. He was taken to his son’s home in Greenwich, where he died eight days later. He was buried in Norwich, Connecticut, on Monday, April 28— the same day his final “Holland” letter was published in the Wall Street Journal. His passing elicited little note. The New York and Philadelphia papers ran brief obituaries. None mentioned his woebegone beat in 1893. A short tribute in a small New Hampshire paper said, “He was the kind of man who honored journalism by his connection with it.”

  In 1918, Dr. William Williams Keen was commissioned an officer in the Medical Reserve Corps of the U.S. Army. Thus he served as a commissioned officer during both the Civil War and World War I, a distinction that may be unique. Keen’s role in the latter conflict, however, was purely symbolic. His chief value to the army, he admitted, was as a “stimulating example.” Recruiters would implore civilian doctors to volunteer by invoking Keen’s vaunted name. “Aren’t you husky young fellows going to volunteer,” they’d ask, “when Dr. W. W. Keen, almost eighty, was among the first to do so?” According to Keen, “This fetched them, again and again.”

  Though his military service was token, Keen’s medical expertise was still in demand. In August 1921, Keen was vacationing in Bar Harbor, Maine, when he received an urgent telephone call summoning him to Lubec, a town about one hundred miles up the coast. A doctor there, Eben Bennett, had a patient whose symptoms included a high fever and partial paralysis. Bennett thought it was just a bad cold, but he wanted a second opinion. Keen went to Lubec, and from there he took a boat to an island a few miles offshore to see the patient. The island was called Campobello. The patient’s name was Franklin Delano Roosevelt. Keen knew who Roosevelt was, of course: he was a former assistant secretary of the navy, and just the year before he had been the Democratic Party’s vice presidential candidate.

  Keen must have seemed a godsend to Roosevelt. Harvard had recently awarded the doctor an honorary degree, proclaiming him the “Dean of American Surgery.” But Keen was in his eighties now, and virology was not his specialty. He misdiagnosed Roosevelt badly. Keen believed the paralysis in Roosevelt’s legs was caused by a blood clot or lesion in the spinal cord. He prescribed vigorous massaging, which Roosevelt found so painful that he demanded another opinion. A doctor from Boston quickly concluded that Roosevelt had contracted polio— and that the massaging was doing much more harm than good. (Medical historians now believe FDR may have actually been suffering not from polio but from a different paralytic illness known as Guillain-Barré syndrome.)

  Nevertheless, Keen would remain on good terms with Roosevelt— even after sending him a bill for $600. And, for his part, Roosevelt would go on to orchestrate one of the most fantastic medical masquerades in the annals of the American presidency, passing himself off as able-bodied when he wasn’t.

  But Keen’s reputation was secure. The same year he misdiagnosed FDR, a lavish dinner was held at the Bellevue-Stratford Hotel in Philadelphia to celebrate Keen’s eighty-fourth birthday. Speakers lauded him as “one of the greatest American surgeons” and “field marshal of the medical profession.” More than two hundred telegrams of congratulations were read, and Keen was presented with a life-size bronze bust of himself.

  In an after-dinner speech Keen said, “Long since, I gave up the rather opprobrious phrase ‘old age’ and have substituted for it the more seductive locution ‘accumulated years.’ The latter connotes a certain joy in continued acquisition, a sort of pride in adding one annual sparkling jewel after another to an already precious store.”

  The doctor also prescribed some rules for life. “Mix merry laughter with earnest labor. Always have some as yet unfinished, but not too urgent job waiting just outside your door. Then you will never know ennui. To ‘kill time’ is murder in the first degree.”

  W. W. Keen would live another eleven productive years. At ninety-one, he wrote an article for the Atlantic Monthly decrying the high cost of practicing medicine. A year later he wrote an article in defense of vivisection for the journal Science. In his last years he read voraciously, especially histories and biographies. “I’ve got to cultivate my intellect,” he told an interviewer on his ninety-fifth birthday. A little less than six months later, on the night of June 7, 1932, he died quietly in his sleep. His obituaries were lavish. None failed to mention his role in the secret operation on Grover Cleveland.

  Frances Folsom Cleveland Preston would live to see the Great Depression, the only economic downturn in American history worse than the one derisively named for her first husband. In 1947 she was seated next to Dwight Eisenhower at a formal dinner. Her place card identified her only as Mrs. Thomas Preston. Ike had no idea who she was until they began chatting about Washington. Frances mentioned that she had lived there a long time ago.

  “Really?” said Ike. “Where?”

  Only then did Frances identify herself as the former First Lady.

  Frances died later that year. She was eighty-three. She had been married to Thomas Preston for thirty-four years, twelve more years than she had been married to Grover.

  Frances is buried next to Grover in the Princeton cemetery. Their last surviving child, Francis Grover Cleveland, died in 1995 at age ninety-two.

  John Erdmann, who had been Joseph Bryant’s twenty-nine-year-old assistant at the time of the Cleveland operation, was the last living witness to the events on the Oneida. Erdmann enjoyed a long and productive career as a surgeon in New York City. In his later years he traditionally performed an operation on his birthday. (One wonders how his patients felt about this peculiar custom.) On his eighty-sixth birthday in 1950 he removed an appendix. Erdmann would live to see what we would consider the modern antiseptic operating room. In his old age, he enjoyed recounting his role in the Cleveland operation, and he would reflect nostalgically on the folly of it. “We [the surgeons] put our aprons over our street clothes,” he told one interviewer, “but we did boil the instruments.”

  Erdmann died on March 27, 1954—his ninetieth birthday. He did not perform his traditional operation on his final day. His obituaries noted that he had taken part in more than twenty thousand operations in his lifetime—but only one patient was identified by name.

  The ultimate fate of the Oneida is unknown. Around 1914, Elias Benedict sold the yacht, which was rechristened the Adelante and converted into a towboat. During World War I the Adelante was commandeered by the U.S. Navy and put into service setting up a network of maritime radio stations along the Maine coast. After the war, it went back into service as a towboat, operating out of New York under the names John Gulley and Salvager. By 1941, the boat, once one of the grandest yachts in the world and the site of a unique episode in American history, had been abandoned. Presumably it was sold for scrap.

  And what became of the tumor that was removed from Grover Cleveland’s mouth in 1893? Shortly after the operation it came into the possession of Kasson Gibson, the dentist who fashioned Grover’s oral prosthesis. Gibson kept the tumor in a small glass jar filled with a clear preserving fluid. Apparently he stored it in his New York office, a bodily souvenir of his work on the president.

  While researching his Saturday Evening Post article, W. W. Keen discovered that Gibson still had the tumor, as well as two of the casts Gibson had made of Grover’s mouth to prepare the prosthetic devices. At the time, Keen was an active member of the College of Physicians of Philadelphia (not a college in the usual sense, but a private medical society). Keen sent a letter to Gibson urging him to donate the tumor and the casts to the college.

  I spoke to Mrs. Preston about the final disposal of the specimens, etc. and suggested this to her; that as they were of such national interest and as I am going to deposit in the Museum of the College of Physicians of Philadelphia the unusual retractor which we used to draw back the angles of the mouth and expose the seat of the operation ... it would be desirable that the specimens that you have from the jaw, and,
if you are willing, the casts (or duplicates of them) should all be deposited finally with the College of Physicians.

  The tumor removed from the mouth of Grover Cleveland in 1893. After the operation, the tumor came into the possession of the dentist Kasson Gibson, who donated it to the College of Physicians of Philadelphia in 1917.

  MÜTTER MUSEUM OF THE COLLEGE OF PHYSICIANS OF PHILADELPHIA

  Gibson agreed to donate the tumor to the college, as well as photographs of the casts. The casts themselves he donated to the New York Academy of Medicine.

  On October 3, 1917, Keen presented to the college the tumor, the cheek retractor, and the photographs of the casts, as well as a small laryngeal mirror that was also used in the operation.

  The tumor was subsequently put on display in the college’s Mütter Museum, where it resides to this day. Named for a nineteenth-century doctor, the Mütter (pronounced MOO-ter) has become a repository for all manner of odd medical specimens, including a piece of John Wilkes Booth’s thorax, a section of the brain of Garfield assassin Charles Guiteau, Chief Justice John Marshall’s bladder stones, and the Chevalier Jackson Collection, featuring foreign bodies removed from human air and food passages, including bones, pins, hardware, nuts, seeds, teeth, toys, medical instruments, and food.

  Grover’s tumor is still in the same glass jar it was in when Kasson Gibson donated it to the college in 1917. In the summer of 2010, the tumor sat on a shelf in a large and crowded display case, crammed between a massive ovarian cyst and the skeleton of a twenty-five-year-old Bohemian woman with fused vertebrae. The curatorial text that accompanies the tumor blandly announces:

  Tumor—Specimen Removed from the maxillary (upper) left jaw of President Grover Cleveland on July 1st, 1893. 1172.50

  The tumor is remarkably well preserved. It looks a bit like a piece of limp cauliflower, though it actually consists of at least ten fragments of tissue and bone, as well as five teeth, including one with a filling—gold, naturally. It’s really not much to look at, but for decades this amorphous whitish blob tantalized medical and presidential historians, some of whom had come to question whether Grover Cleveland had suffered from a malignancy at all, or whether his lesion was actually some type of benign tumor. In fact, that blob had the potential to answer a host of lingering questions:

  Exactly what kind of tumor was removed from Grover’s mouth?

  Was it related, as some believe, to an intestinal tumor that eventually killed him?

  Was the radical surgery that was performed on Grover the most advisable treatment?

  Did Grover have syphilis?

  It was this last question that stymied attempts to examine the tumor. As early as 1939, pathologists asked the College of Physicians for permission to conduct tests on the tissue. But the requests were always denied because Grover’s children feared the results might reveal that their father suffered from the venereal disease.

  In 1967—seventy-four years after the operation—the children finally relented. “My family and I have no objection to having a pathologic examination conducted on the tumor removed from my father’s mouth,” Grover’s elder son Richard wrote in a letter to the college. “I hope that a re-examination of the tumor in the light of present day pathologic knowledge will shed additional light on the true nature of the tumor.” If the results were found to be “of a questionable nature,” however, the family reserved the right to forbid their publication.

  Another eight years passed before the college finally released the tumor for a pathological examination. In 1975, Gonzalo Aponte and Horatio Enterline, eminent Philadelphia pathologists who also sat on the board of the Mütter, were permitted to examine the tumor, “provided that only minimal damage to it would result.” Aponte died unexpectedly soon thereafter. He was replaced by John S. J. Brooks, who had only recently completed his residency in pathology. “I guess they needed a gofer,” Brooks recalled in a 2010 interview. “I went to the museum and photographed all the fragments of tissue.” Brooks also extracted tiny samples from several of the fragments for microscopic examination. This was all done under the careful watch of museum officials, who would not allow the tumor to be removed from the premises. “It was like being back in a high school chemistry class,” Brooks remembered.

  Brooks and Enterline ultimately determined that the tumor in Grover Cleveland’s mouth was a verrucous carcinoma, or VC, a very rare type of cancer that, while technically malignant, grows slowly and does not metastasize. VC accounts for as little as 1 percent of all oral cancers. It’s so rare that John Brooks, who is now an esteemed Philadelphia pathologist himself, said he has seen only two other cases in his career besides Grover’s.

  VC predominantly occurs in the mouths of men between fifty and eighty years of age (Grover was fifty-six), and it often appears in users of snuff and chewing tobacco (Grover’s tumor was on the “cigar-chewing side” of his mouth). It is also associated with the use of alcohol. Pathologists grade cancerous tumors on a scale of one to three, with one being the least dangerous. John Brooks estimated that Grover’s tumor was “probably about a one-half.” “It’s almost a benign tumor,” Brooks said. If left untreated, however, VC tumors can kill, because they can grow large enough to make eating and breathing impossible.

  Grover Cleveland’s oral cancer was not, as his doctors believed, exactly the same as Ulysses S. Grant’s, which was a more common and more lethal form of squamous cell carcinoma. Brooks and Enterline also concluded that the gelatinous mass removed from Cleveland’s antrum, which had so puzzled his doctors, was actually an inflammatory reaction to the tumor—in other words, a kind of infection.

  It’s not surprising that Grover’s doctors were unable to correctly diagnose his tumor. VC wasn’t even identified until 1948, when a pathologist named Lauren Ackerman recognized it as a distinct variety of oral cancer. Even today, medical textbooks warn pathologists that VC is very difficult to diagnose, because the tumors closely resemble other, more lethal cancers.

  Since VC tumors don’t metastasize, Brooks and Enterline also concluded that it was “improbable that the [oral tumor] was the source of Mr. Cleveland’s terminal gastrointestinal symptoms,” though the “possibility that the former president died of cancer is not eliminated.” If Grover did die of intestinal cancer, it likely had nothing to do with his oral tumor.

  Finally, Brooks and Enterline found that Grover did not have syphilis.

  The recommended treatment for VC today is “complete surgical excision,” so, while Grover’s dream team of doctors never knew exactly what kind of tumor was in his mouth, their treatment was certainly appropriate. In fact, they probably overtreated their patient by removing more tissue than was necessary. Today the procedure that Grover Cleveland underwent is known as an intraoral partial maxillectomy, and rather than being fitted with vulcanized rubber prostheses, patients receive reconstructive surgery with bone grafts.

  John Brooks and Horatio Enterline published their findings in the March 1980 issue of Transactions & Studies of the College of Physicians of Philadelphia. It was not exactly front-page news, though the Philadelphia Inquirer ran a small story, noting that the results came “a little late to be of use to Cleveland.”

  Brooks and Enterline’s study concludes, “The character of the original tumor and the skill and aggressiveness of the surgeons combine to explain the successful outcome of the primary illness.” Even in 2010, Brooks still marveled at the operation. “I can’t believe they did it on a boat,” he said, “and they did it in an hour and a half. That’s fast! An operation like that today would take a substantial number of hours. It was really one of the most unusual operations in American surgical history.”

  Brooks wasn’t surprised that W. W. Keen decided to publish his account of the operation in the Saturday Evening Post instead of a medical journal. “He was a surgeon,” Brooks said. “He thought, ‘I cured him.’ And he wanted to tell the world.”

  The public’s perception of cancer has changed dramatically since 1893. No
longer is the word itself avoided in polite company. Nor is cancer considered an automatic death sentence. But the disease has not been conquered, and in some ways it remains the same “dread and mysterious enemy” that E. J. Edwards wrote of in his story about the secret operation on Grover Cleveland. When a large tumor was removed from President Ronald Reagan’s colon in 1985, First Lady Nancy Reagan would not allow the words “cancer” or “malignant” to be used in the statement announcing the operation. Instead, it was announced that the president was undergoing surgery “for removal of a polyp.” Two weeks later a small lesion was removed from Reagan’s nose and submitted for a biopsy under a false name, “Tracy Malone.” Afraid that her husband would be seen as “cancer-prone,” Mrs. Reagan ordered the president’s press secretary, Larry Speakes, to tell reporters that the scab on the president’s nose was caused by the tape used to attach a tube to his nose during his colon surgery.

  What followed was reminiscent of the scene inside the barn at Gray Gables ninety-two years earlier, when Dan Lamont insisted President Cleveland was suffering from nothing worse than a bad case of dentistry. At a chaotic press briefing on August 1, 1985, Speakes said the scab on President Reagan’s nose was “an irritation from the tape that... held the . . . nasogastric tube in place.”

  “The reporters sensed that something was up,” Speakes wrote in his memoir, “and the questions came fast and furious.”

  Question: He had a surgical procedure?

  Speakes: Yes.

  Question: And what was it that was removed?

  Speakes: I don’t know exactly what it was. It was a skin irritation . . . caused by the tube.

  Question: Was it a growth?

  Speakes: I don’t know. I wouldn’t characterize it as a growth. I’d characterize it more as a skin irritation or a gathering of the skin, piling up of the skin or something like that.