History

When the President Vanished

Editor's note: Following is a fascinating story involving oral cancer, presidential politics, and subterfuge. Few people know that President Grover Cleveland was diagnosed with oral cancer and was operated on to remove it while he was in office. The president, his advisers and his doctors when to great lengths to conceal his ailment and subsequent surgery. This version of the story first appeared as a chapter in the book "Presidential Courage" by John B. Moses, MD, and Wilbur Cross. We thought it would make an interesting adjunct to our issue on oral pathology. Our thanks to Dr. Aaron B. Koran, retired oral surgeon and anesthesiologist, for bringing the story to our attention.

A little before seven on the hot, humid morning of Saturday, May 27, 1893, President Grover Cleveland shuffled drowsily into his White House bathroom and began brushing his teeth. That commonplace act touched off a series of events that are recounted in very few history books or biographies -- events that were ingeniously camouflaged to prevent a public panic that would have jolted the entire American economy.

Running his tongue across the roof of his mouth, the 56-year-old president felt a rough spot that disturbed him. Later in the morning, after dressing and eating breakfast, he asked one of his aides to summon Dr. Robert M. O'Reilly, a physician assigned to the care of government officials. There was no White House doctor during that era. Nor was there any practitioner in the Washington region who was familiar with Mr. Cleveland and his medical history, which included, among other infirmities, hypertension, obesity, and susceptibility to frequent biliousness.

Not liking what he saw when he examined his heavy-jowled, bull-necked patient, Dr. O'Reilly, a major in the Army Medical Corps, asked the White House dentist to look at the president's gums and teeth. When O'Reilly was solemnly informed that this was no mere dental problem, he immediately contacted Dr. Joseph D. Bryant, a friend of the president and a prominent New York City surgeon whose specialty was the head and neck. Dr. Bryant lost no time in visiting the White House and within the next 10 days he had examined the lesion several times, had taken small samples of tissue for biopsy review, and had proposed his plans for an operation.

The fears of the president's medical attendants were confirmed by Dr. William H. Welch, a noted pathologist at Johns Hopkins Medical School. After examining the tissues under the most powerful microscope available, he declared positively that the president had a cancer of the mouth and that it appeared to have spread to at least one side of his jaw. To be certain of this diagnosis, O'Reilly and Bryant sent the slides containing the specimens to the Army Medical Museum for examination by its staff of pathologists. The patient was not identified, but O'Reilly made it clear to his military colleagues that the matter was urgent, as well as confidential. The army specialists confirmed the findings of Dr. Welch.

From the start, all outsiders who examined slides or otherwise worked on the case were told to use the utmost diligence and skill, that the specimens were "the most important ever submitted for examination," and that the name of the patient could not be divulged for reasons of national security. All efforts -- sometimes devious or misleading -- were made to keep the secret not only from the press but from White House staff members, friends, and
even relatives.

When Grover Cleveland was finally informed that he had cancer, he showed less personal concern about the outcome than did the doctors who had to report the grim news. The president's greatest and most immediate fear was that the public might find out. "We cannot risk any leak that would touch off a panic," he confided to Bryant, "if a rumor gets around that I'm 'dying,' then the country is dead, too."

Cleveland had good reason to be apprehensive during the spring and early summer of 1893. Although he had displayed great optimism and confidence when he pressed a button opening the World Columbian Exposition in Chicago on May 1, he knew that the country was already in the grip of a spreading depression. The Philadelphia and Reading Railroad had recently gone bankrupt. The Atcheson, Topeka, and Santa Fe was shaky, following the revelation that its officers had defrauded the public of $7 million. And Wall Street was increasingly unstable, as experts tried to evaluate the impact of escalating unemployment and the failure of some 500 banks and 15,000 businesses. The country's financial footings had been left in a rickety state when Benjamin Harrison turned his office over to the new president, with the Treasury depleted by more than $100 million.

Faced with such adversities (later to be described by historian Charles Francis Adams as "the most deep-seated financial storm in the history of the country"), Cleveland was actually at his best -- a positive-thinking, active leader. He had already taken a firm stand in his adherence to the gold standard, despite continuing pressures from Western legislators who insisted on the free coinage of silver and the circulation of more money. Though winning that battle, he was fully aware that his control would be severed if his opponents sensed that he had a serious physical disability. He was concerned about his vice president, Adlai E. Stevenson of Illinois, assuming power. Stevenson was a free-silver man. To put it in the blunt phrases of the influential Commercial and Financial Chronicle, whose editors did not realize the import of their words, "Mr. Cleveland is about all that stands between this country and absolute disaster, and his death would be a great calamity."

Thus it was that Cleveland, rather than being unnerved by the diagnosis, looked upon the situation as a fateful challenge. After asking questions about the nature and extent of the facilities that would be needed to perform the operation, he appointed Dr. Bryant to take charge. At the outset, he made two points clear: First, he said, "I cannot leave here before the end of June under any circumstances. So I will say to you that I will be ready on the first day of July." Second, he ruled out hospitals as too risky from the standpoint of secrecy, even if he could be disguised and smuggled in after dark. The press would become suspicious about any unexplained absence from the White House, and there was always the chance that a nurse or orderly would leak the news, whether unintentionally or for personal gain.

They would all have to give the problem enough thought to come up with a foolproof alternative.

From that day on, all letters, memos, telegrams, and other communications referred to the president as "your friend" or "my patient" or "our guest." So jittery were the doctors that they might make a fatal slip that they took some measures which, in retrospect, seem too melodramatic to have taken place. Bryant, for example, decided that he would need the assistance of Dr. William Williams Keen, professor of surgery at Jefferson Medical College in Philadelphia, an outstanding surgeon and pioneer in neurosurgery. He wrote Keen a letter, requesting consultation "in a very important matter," and insisted on meeting one afternoon at 3:15 on the deserted deck of the Fall River Line boat on which Keen was to leave for Boston three hours later. Here, surrounded by empty deck chairs, gently slapping ropes, and clanking rail chains, they plotted a course of action.

O'Reilly, who had not intended to be present at the operation, became so involved in the conspiracy of silence that he feared his very nervousness and preoccupation would be a giveaway if he were to remain apart from the scene. So he elected to be present, but only after instructing his colleagues that henceforth he was to be referred to as "Major Mills," and in no way associated with his office of attending surgeon.

Now the big question was, where?

Gray Gables, Cleveland's summer home on Buzzard's Bay in Marion, Mass., was considered -- and quickly rejected. Although the excuse of a "brief vacation" sounded credible, there were too many reporters prowling about, certain to be curious about the arrival of unusual visitors or equipment, no matter how well disguised. The house would be a natural for the later period of recuperation. But the operation and the immediate postoperative care required a location that was beyond suspicion or access by outsiders.

UItimately, Cleveland himself came up with a solution. He would make arrangements with his good friend, the noted Commodore Elias C. Benedict, to spend a few days aboard the latter's 75-ton yacht, Oneida, on which he had already cruised upward of 40,000 miles enjoying respites from the demands of office during his first term, from 1885 to 1889. With the yacht floating at anchor in New York City's East River, members of the medical team could arrive by small boats, leaving, inconspicuously from any number of piers that lined the east side of Manhattan. Or the yacht could anchor in the Hudson River, with easy access from the New Jersey shore as well as from New York. Each could bring a share of the instruments and supplies in suitcases and handbags. Once under way, this floating operating room would be unassailable by either the press or the curious public.

Bryant was in full accord. A vessel of this size, cruising in protected waters, would pose no problems for experienced surgeons, providing they had adequate lighting and suitable support for the overweight patient. The doctor's greatest concern was that the president, under even the best of conditions, might not be able to withstand the radical surgery proposed without serious complications. Although generally in good health, the man suffered from the side effects of his obesity, was afflicted with gout, and had punished himself physically in earlier years with excessive eating, drinking, and partying. Moreover, no one knew how fatigued Cleveland really was after four arduous months in office with the growing financial crisis.

To cap it all off, no matter how successful the operation turned out to be, would the patient's condition be such that he could be seen by the public within a week or 10 days without causing instant alarm? It is no wonder that Dr. Bryant later commented to Commodore Benedict, "If anything happens to the president, get your navigator to run us on the rocks and sink us all!"

There seemed to be no other alternative. As a final safeguard, Bryant called in yet another noted specialist, Dr. Edward Gamaliel Janeway, professor of medicine at Bellevue Hospital in New York City and a member of an esteemed medical family associated with the profession for many generations. Janeway knew as much about anaesthesia as any doctor then in practice. He also knew that he could make no mistakes, for the mortality rate from anaesthesia alone was 14 percent during simple operations and a great deal higher for more radical surgery, especially if complications set in or if the patient had to be anaesthetized for longer than anticipated.

Now Janeway's ingenuity was put to the test. He would have to arrange for the secret transfer of tanks of compressed gas and other seldom-moved equipment from hospital to ship without arousing suspicion or curiosity. He laid his plans with the adroitness of an undercover agent. At the same time, he also took one step that widened the circle of those who were in on the secret and thus increased the chances of exposure. To lessen the risk of an accident with anesthetics, which were in those days somewhat unstable and unpredictable, as well as inadequately researched, he enlisted the aid of Ferdinand Hasbrouck, a young dentist with experience in the use of the recently discovered nitrous oxide. Janeway felt that nitrous oxide (later to be popularly known as "laughing gas") would hold the president for the duration of the operation.

Hasbrouck, who would also start the operation by removing several teeth before the surgeon took over, did not share Janeway's optimism. In his opinion, laughing gas could only hold the patient for the first part of the ordeal -- the removal of the teeth and possibly the cutting away of soft tissue in the gums. But ether would then be required to knock out the corpulent Cleveland for the removal of those parts of the jaw bone and hard palate tissues that were thought to be cancerous. Ether was tricky, difficult to administer under the most well-controlled conditions, and sometimes ineffective when metered out in doses that were considered safe. Ether frequently brought on pneumonia and almost always triggered side effects. A further risk, as yet unknown to Janeway, was that a urinary exam would indicate the beginnings of chronic nephritis, a condition that Dr Keen recognized as being dangerously aggravated by the administration of ether.

The president, informed of the risks and the lack of emergency equipment and facilities on shipboard, was unwavering in his decision to use the Oneida. Thus it was that at 4:20 on the afternoon of June 30, he left Washington on a private Pennsylvania Railroad car (belonging to Frank Thompson, one of the company's vice presidents), attached to the New York Express. Few people knew of his departure and even fewer of his arrival in Newark, where he was hustled into a waiting carriage and hidden from public sight. The carriage then crossed by ferry to the lower tip of Manhattan, where it proceeded almost unobserved along Cortland Street and part of Broadway to Pier A. There a launch transported Cleveland to the Oneida, lying at anchor some distance from shore. The president was accompanied by only a handful of people, including Secretary of War Daniel S. Lamont, who functioned as a personal aide and press secretary. The Oneida then proceeded slowly down the bay and anchored in the Narrows off Bay Ridge for the night.

June 30 was a Friday, a perfectly logical time for a brief sojourn away from the heat and pressures of Washington. That morning, in a bright show of confidence, Cleveland had issued a call for a special session of Congress to meet on Aug. 7 for the purpose of repealing the Sherman Silver Purchase Act. To all outward appearances, he was in robust health and so soundly in control of executive affairs that he could absent himself from the White House long enough to relax and enjoy life, and such a statement was released to the press.

Why was he not accompanied by Mrs. Cleveland, the pretty young Frances Folsom who was just half his age and the most attractive First Lady yet to grace the White House? To any who might inquire, there was good reason: She was in her seventh month of pregnancy and naturally had to avoid the risks of travel. There was little likelihood that Frances would slip up and reveal her husband's dark secret -- she did not even know that he was sick.

That night, the president was in excellent spirits and able to sleep without sedatives. A medical examination the following morning found him fit enough to proceed with the plans. At 8:30 he drank a single cup of coffee, ate a slice of toast, and was reported to have "moved his bladder and bowels in a natural manner." In the meantime, the Oneida was proceeding slowly up the East River, headed for Long Island Sound. A major crisis seemed imminent when Dr. Bryant noted that the vessel was almost as far upriver as 26th Street, the location of Bellevue Hospital. Hastily, he ordered all doctors and members of the president's party to leave the deck and go into a cabin where they could not be seen and inadvertently recognized. (It was later reported that some interns had set up a telescope on the roof and were observing the yacht. Whether true or not, nothing ever came of the incident.)

Besides the captain of the yacht and Commodore Benedict, the only member of the ship's crew who was aware of the proceedings was a steward (described as "extremely loyal and faithful") who had been assigned the arduous task of fetching hot water, towels, and other supplies on demand. The steward, together with members of the crew, had been informed that the president was to have two badly ulcerated teeth extracted and that extra precautions were being taken to prevent any blood poisoning, which naturally would be disastrous because of his high position. The explanation sounded logical enough to stir up little or no curiosity.

At noon on Saturday, July 1, the president steeled himself for the ordeal. At 12:25, he undressed in his cabin and by 12:31 was seating himself in a large chair that had been lashed to the interior footing of the ship's mast so that it would not slide in case the vessel rolled or pitched unexpectedly. He was wedged in a sitting position for the expected two-hour ordeal, head slightly tilted back and held securely in position by pillows that had been tied in place. In attendance were Doctors Bryant, O'Reilly, Keen, and Janeway; Hasbrouck, the dentist; Bryant's young assistant, Dr. John F. Erdmann; and Secretary of War Daniel S. Lamont.

At 12:32, Hasbrouck began administering the nitrous oxide gas, which took effect so quickly that he was able to swab the President's mouth thoroughly with Thiersch's solution, a disinfectant, and begin the removal of teeth by 12:40. A few minutes later, with the bleeding under control, Dr. Bryant stepped in to perform the critical part of the operation. He carefully injected cocaine along the lines of his intended incisions, then called upon Hasbrouck to administer the ether under the direction of Janeway, who was keeping a close watch on the patient's breathing, pulse, and general condition.

Together, Bryant, Keen, and Erdmann dissected part of the inner cheek, arresting the bleeding by applications of hot water and pressure. Among the unusual instruments of the day that were called into play were a "cheek retractor," an ingenious instrument Keen had brought back from Paris, and a "white-hot electric knife." The former made it possible for the doctors to hold back the heavy jowls so often caricatured in cartoons of Cleveland, without having to leave any external scars. The latter device, deriving energy from two large storage batteries, instantly cauterized tissues that were beginning to bleed. The front of the jaw was then chiseled loose and part of the palate removed. Examination revealed that the disease had begun at the roots of the left molars and spread into the antrum, the hollow cavity of the upper jaw, in the form of a gelatinous mass which Keen described as a sarcoma, or malignant tumor.

Faced with this evidence, there was nothing the surgeons could do but remove all but a small portion of the President's left upper jaw. Bryant, as surgeon in charge, made the critical decision to cut back as far as the orbital cavity (which contains the eye socket), beyond which he could not go without endangering the President's sight. Fortunately, there was no evidence that the lower jaw had been affected yet, or that the malignancy had spread to other areas.

By 1:55 that afternoon, the operation was finished. Erdmann disinfected the cavity with further applications of Thiersch's solution and packed it firmly with gauze. Janeway observed that the patient's pulse was 80, that the president was perspiring moderately, and that his color was good. He estimated that, despite their preoperative fears of hemorrhaging, they had been able to limit the loss of blood to well under a pint. Within two hours from the time the president was brought into the makeshift operating room, he was back in his own stateroom in bed, further drugged by an injection of morphine to kill the pain. At that time, no ill effects from the ether were noted.

A key decision on the part of the doctors, one largely motivated by Cleveland's insistence on secrecy, had been the agreement to perform the operation entirely through the mouth so there would be no external evidence that the chief executive had undergone anything but substantial dental work. It is doubtful that this could have been accomplished without Dr. Keen's "retractor," the newly invented cauterizing device, or the skill of the surgeons.

The president was described as "up and about" on July 3, following the removal of abscessed teeth. But the crisis was by no means over. As the doctors were well aware beforehand, the removal of such a large section of the jaw and palate would have a severe effect on the speech. However, when Bryant visited his patient, heard his pitiful attempts to communicate, and saw the anguish on his face, he was struck by a feeling of helplessness and dread. Had he cut away too much tissue? Would the President ever be able to talk again coherently? Everything would now depend upon the experience and skill of a New York dental surgeon, Dr. Kasson C. Gibson, who was at that very moment on his way to Cleveland's summer home, Gray Gables, on the Massachusetts shore. Gibson had been selected as the expert best suited to molding and fitting an artificial jaw.

By this time, the Oneida had cruised leisurely through Long Island Sound, eastward toward its destination, Buzzard's Bay. As it approached Plum Island, off the inner tip of Long Island, it veered suddenly northward toward New London, Conn. When Bryant inquired of the captain if anything were wrong, he was informed that Ferdinand Hasbrouck was being landed. Bryant knew that the president would be alarmed because of possible exposure to the prying eyes of the press. But Hasbrouck insisted so strongly that there seemed to be no alternative. He had already promised to be at New London a day earlier to administer nitrous oxide for a surgical operation at the hospital there. His unexplained delay and continued absence would arouse far more suspicion than any change in the vessel's course.

On the evening of Wednesday, July 5, the Oneida docked in Marion, Mass., and the president walked briskly from the shore to Gray Gables, unassisted and virtually unobserved. Thus far, he had avoided public notice.

Col. Lamont was experienced enough in communications to know that he could not press his luck too far. Therefore, he scheduled a "routine" press conference in a barn, some distance from Gray Gables on Friday of that week. How was the President? Well, he was feeling slightly better, following the extraction of a couple of teeth, but he was not going to try to get around for awhile because he had a lame knee and slight swelling of the foot. Nothing serious, but certainly more difficult for a man of Mr. Cleveland's size and weight than for the average citizen. In any case, he had spent the greater part of the previous day playing checkers with Mrs. Cleveland, who had arrived from Washington at the beginning of the week.

What about the rumor that the president had a malignant growth? A distorted account, engineered by his opponents who were trying to weaken his position on gold. One of the president's medical advisers was there and could confirm his health and general well-being. As a result of the press conference, the New York Times reassured the nation. "Dr. Bryant said the president is absolutely free from cancer or malignant growth of any description," reported the Times on July 8. "No operation has been performed except that a bad tooth was extracted."

Lamont, Bryant, and the others were able to put up a good front only because of the skill of Dr. Gibson, who had established a small dental laboratory in a back room at the cottage. He had fashioned an artificial jaw from vulcanized rubber and had already positioned it temporarily in place in the president's mouth. The effect was astonishing. Without this device, Cleveland's speech was described by Dr. Keen as being "wholly unintelligible, resembling the worst imaginable case of cleft palate." With it, however, Cleveland could speak in a manner that was easily understood, though his words sounded heavy and slow. Gibson confidently explained that it was now simply a matter of refining and refitting the prothesis and training his patient in its most effective use.

In mid-July, as Lamont was beginning to breathe more easily about the president's recuperation, he received a shock. Bryant had detected a suspicious-looking growth along the inner margin of the surgical wound. It would have to be removed immediately. Plans were quickly laid and announced for a short pleasure cruise around Martha's Vineyard and into Nantucket Sound. The president was gone for only two days, during which time the growth was surgically removed with no complications.

By Aug. 7, the scars of both operations had healed successfully enough, and the artificial jaw fit snugly enough, so that the president was able to entrain for Washington and address the special session of Congress which he had called for on June 30. His speech, though brief, was forceful enough to motivate the House to repeal the Sherman Act by a vote of more than two to one. Tired by the stress and tension of playing his role in public for the first time after his ordeal, Cleveland returned once more to his summer home.

The battle for secrecy was over. Or was it?

On Aug. 29, suddenly and unexpectedly, the Philadelphia Press published a disturbing letter from its investigative reporter in New York City, E.J. Edwards, who used the byline "Holland." The implications were sensational and alarming. Did Congress and the public know that the head of the nation was critically ill with a malignancy that was possibly terminal? The death of the president would split the country in two and make it vulnerable to the "absolute disaster" that had been prophesied by the Commercial and Financial Chronicle should such a misfortune occur. According to Edwards, an operation of the most critical kind had been performed on the president, raising the question of whether he was fit for office and capable of leading the country. Edwards named the doctors in attendance and supplied details that seemed too factual to be discounted.

The press was divided. Some newspapers termed the story an irresponsible hoax. The editor of a rival paper, the Philadelphia Public Ledger, denied that it had been scooped, since the story was obviously just another "cancer fake." Cabinet members -- notably Daniel S. Lamont, who was the foremost spokesman for the White House -- indignantly denied everything. They conceded only that Mr. Cleveland had been subjected to painful tooth extractions that were slow in healing. As for the doctors, they avoided the press for the most part, or when cornered asserted that it was unethical for any practitioner to break the confidentiality of the doctor/patient relationship. As Dr. Erdmann later confessed, "I did more lying during this period than in all the rest of my life put together."

One fact is certain: Every other member of the medical team who had been present on the Oneida was disgusted with Ferdinand Hasbrouck. The finger was clearly pointed at the young dentist as the source of the leak. It was said that he had blabbed the full story to a Dr. Leander Jones of Greenwich, Conn., after being chided for arriving late for his anesthesia appointment in New London. Jones later told the story to reporter Edwards, who then confronted Hasbrouck and somehow pressured him into talking. Dr. Bryant was so upset by the dentist's breach of his confidence that he never again spoke or wrote to him. In fact, when he finally paid Hasbrouck the sum of $250 for his services, he sent the check by messenger, with no note or other comment.

President Cleveland faced the challenge head-on and with remarkable fortitude. He was his own best press agent, simply by undertaking his normal duties at the end of the summer as though nothing unusual had taken place. He neither shied away from public appearances nor sought refuge in seclusion. Those who heard him speak publicly could not help being convinced that the story in the Philadelphia Press was fictitious, for the president's voice was stronger and clearer than ever, providing little comfort to his enemies that he might be in weakening health.

On Sept. 5, he welcomed Congress with a voice that was described as "even clearer and more resonant" than when he had given his inaugural address six months earlier. According to the Times, his speech "removed every lingering doubt of his entire soundness of body." Cleveland's position was further enhanced when, on Sept. 9, his pretty young wife, Frances, gave birth to a second daughter -- the first child of a president to be born in the White House.

The strange secret of Grover Cleveland was kept for more than two decades. Finally, in 1917, long after Cleveland's death, the full story was told in The Saturday Evening Post. The author was William Williams Keen, MD, who, in addition to having participated in that historic operation, was a prolific writer during his later years. Keen was able to state, with justifiable pride, that the cancer operation had been a complete success for the patient and doctors alike. Cleveland not only survived his second term of office but continued a fairly active life, living with his family in Princeton, N.J. In his last years, he continued to be plagued by gout and suffered a number of heart and kidney diseases. On June 24, 1908, at the age of 71, he died of a heart condition, undoubtedly complicated by his obesity but in no way related to his historic cancer operation.

For many years, the case of President Cleveland was shrouded in mystery, a controversial issue that provoked some doctors to assert that he had never had a cancer after all and that the whole story had been embellished. The tumor that was removed was described variously as an epithelioma, a sarcoma, and a malignant growth by the doctors present. Although the remains of the tumor were sealed in a bottle of alcohol in the possession of the Mutter Museum of the College of Physicians in Philadelphia, which also has John Marshall's kidney stones and Florence Nightingale's sewing kit, the curator steadfastly refused to permit any analysis of the sample. Only recently was the question resolved when pathologists were finally given the sample for examination. They pronounced it to be a "verrucoid carcinoma," common in smokers and very malignant.

The medical dilemma of President Cleveland, while perhaps more dramatic than some presidential illnesses, was by no means unique. The public -- and even people close to the White House -- would be astonished, if not horrified, to learn about the infirmities, accidents, and mental disorders that have been hushed up from the time of George Washington down to the present. It is ironic to think that Cleveland, despite his medical history of obesity, hypertension, stomach trouble, and cancer, can be numbered among our healthier chief executives. It is doubtful that many of our leaders would have survived the ordeal that Cleveland experienced, under the circumstances that prevailed in 1893. It is certainly safe to assert that few of them would have emerged robust enough to convince a jittery public that they had never had any operation at all.