Thursday, September 15, 2011

The President is a Sick Man

The President is a Sick Man (Matthew Algeo, 2011) is my kind of book. A crisply written, popular history describing a fairly well-known yet astonishing incident in presidential history, namely Grover Cleveland's cancer and its secret treatment. The book fleshes the story out with plenty of interesting context and detail. Such as the extreme dread cancer posed for those living in the 19th century. Who can doubt it? Cancer is dreadful enough now. Imagine when the diagnosis meant an almost certain lingering death, the kind that Ulysses Grant suffered.

Turns out that President Cleveland had a rarer, much less dangerous kind of tumor in his mouth than former President Grant. But it was dangerous enough. It seems that medical science was just advanced enough in 1893 for Cleveland's doctors to excise the growth without killing the president, but it must have been a near thing.

"It's worth mentioning just a few of the tools that the surgeons would not have had at their disposal, simply because they had not been devised or perfected," writes Alego. "They would have no suction apparatus for draining blood or other fluids from the operative site and no means of artificially resuscitating the patient should his heart stop. There would be no electronic monitors, no ventilators, no laryngoscopes, no endotracheal tubes. Surgery had come a long way since the Civil War -- but still had a long way to go."

And, of course, no blood transfusions or antibiotics. Fortunately for Cleveland, his doctors were fully persuaded of the benefits of sterile surgery, then a fairly new idea. As Algeo put it, "surgery pre-Lister was a gamble that most patients were bound to lose." So Cleveland got vastly better treatment than poor President Garfield did only 12 year earlier, when doctors examining his GSW couldn't be bothered to wash their hands, even though they must have heard of Joseph Lister's ideas by then.

The medical drama's only part of the story, however. Doubly astonishing is the fact that the July 1, 1893, operation -- performed on the yacht Oneida in Long Island Sound, of all places -- was kept a secret until 1917, long after Cleveland had died of another kind of cancer (probably) elsewhere in his body.

Well, not quite a secret. One of the best-known journalists of the day, E.J. Edwards of the Philadelphia Press, found out about the operation and published a major exposé. But in an age when newspapers -- being the cable news of their time -- weren't above completely making things up, Edwards was discredited. Mostly because the president and everyone else on the ship lied like dogs about what had happened. President Cleveland just went fishing for a few days, that's all. Oh, and he had a few teeth pulled on board. And he has a touch of rheumatism. E.J. Edwards is damnable liar! The book's subtitle tells the tale: "Wherein the Supposedly Virtuous Glover Cleveland Survives a Secret Surgery at Sea and Vilifies the Courageous Newspaperman Who Dared Expose the Truth."

Conspiracy buffs, take note. Edwards found out about the operation because one of the doctors involved blabbed about it to a colleague, who then told someone who knew Edwards, who then went to the doctor who'd first blabbed, who then confessed the whole thing to Edwards.

The president was able to pull off the deception for a number of reasons, but probably most of all because he made a remarkable recovery, and was able to wear a vulcanized rubber prosthetic jaw so lifelike that no one noticed it. (A fact I remember learning in high school U.S. history class from a fine teacher, Mrs. Collins. It amazed me then, and still does.)

Also, to be fair to President Cleveland, he was certain that maintaining secrecy was the right thing to do, since news of his cancer -- about the worst health problem he could have, and still be alive -- would have made the Panic of 1893 even worse, and it was bad enough as it was, idling countless workers and bringing much commerce to a halt. He made a political calculation, too. Being perceived as ill with cancer would have hurt his chances of persuading Congress to repeal the Sherman Silver Purchase Act, a cause dear to Cleveland, who was a gold-standard man. It's hard to imagine now the passion of the 1890s political quarrel between goldbugs and silverites, but some of it comes through in the book. It was the polarizing issue of the time, a collision of vested interests.

Cleveland got lucky, too, in that questions about his health were pushed off the front pages by a couple of large hurricanes that hit the United States in the late summer of 1893. One Category 2 storm hit New York City, and among other damage, destroyed an entire barrier island off Long Island. Another storm hit the Sea Islands of Georgia and South Carolina, an estimated Category 3 that probably killed a few thousand people and made tens of thousands more homeless.

The story of the Sea Islands Hurricane of 1893 is a fascinating aside in Algeo's book for a number of reasons, such as the fact that such a tremendous storm, on par with Katrina, has been completely forgotten (as has the 1900 storm that nearly destroyed Galveston or even the deadly New England Hurricane of 1938). It's also worth noting that neither the states nor the federal government provided much relief to the victims of the hurricane, partly because most of them were Gullah subsistence farmers, and partly because the Cleveland administration didn't believe disaster relief was within the purview of the federal government. Federal disaster relief is a 20th-century idea and, as far as I'm concerned, an important bit of progress since the Gilded Age, no matter what Ayn Rand-inspired jackasses tell us in our time.

The President is a Sick Man has a happy ending of sorts, in that in 1917 one of the surviving doctors, William Williams Keen, a dean of American medicine, wanted to tell the world what had happened. Cleveland's widow (the remarried Francis Cleveland Preston) agreed to it, so Dr. Keen published a long article about the operation in The Saturday Evening Post. Newspaperman E.J. Edwards was elderly at the time, but still alive, so he lived to see his vindication.

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