In May of 1893, two months into his second non-consecutive term as president, Grover Cleveland discovered a lesion in his mouth that would soon be diagnosed by his private physician as cancer. The timing of Cleveland’s illness could not have been worse: the economy was unraveling, the emerging divide between the rural and urban populations was fracturing both political parties, and America was already in the throes of what would become known as the Panic of 1893. The pressure on Cleveland’s new administration to fix the economy was extraordinary, and it grew with each passing week.
But on July 1, 1893, President Cleveland slipped away for what he told his cabinet was a five-day fishing trip. The next day, the president found himself lashed to the mast of his friend’s luxury yacht in nothing but his underwear, waiting for a team of six physicians to extract five teeth, a third of his soft palate, and a large portion of his left jaw bone. Cleveland resumed his duties after a short convalescence, and though a reporter scooped the story a few months later, the White House denied and discredited the reporter (effectively ruining his career), and the plan to keep the public in the dark succeeded. The secret of Cleveland’s surgery was kept for a quarter of a century, only made public in 1917, nine years after Cleveland had passed away. {1}
When Cleveland first discovered the lesion in his mouth shortly after returning to the White House, the anxiety caused him to spend several nights pacing his bedroom floor. History seemed to be cruelly echoing itself. Nine years earlier, four months into Cleveland’s first presidential term, the nation had been plunged into mourning when former President Ulysses S. Grant succumbed to what the doctor would later diagnose Cleveland with: squamous cell carcinoma. The media circus that surrounded every medical aspect and gory detail of Grant’s suffering solidified the synonymousness of a cancer diagnosis with a death sentence in the eyes of the American public. Now, with Cleveland’s second term barely underway, with the run on the banks intensifying, and the economy becoming increasingly unstable, the last thing America and the world needed was a dying man in office. The tumor and the operation to remove it would have to remain a secret.
The need for secrecy had set the stage for a unique medical procedure. It could not take place in a hospital; the public scrutiny that would accompany the president being in the vicinity of a hospital would be extremely limiting, and the sheer amount of staff and foot traffic would make it exceptionally difficult to ensure that the public would never hear of the procedure. President Cleveland was an avid fisherman (he would later publish a book about hunting and fishing), and both the press and the public were familiar with his habit of seeking respite at his summer home in Massachusetts, mainly to fish. He especially enjoyed fishing excursions with his friend Elias Benedict aboard the latter’s Oneida. It was decided that the procedure would be performed on Benedict’s 138-foot yacht, with a fishing trip acting as the perfect cover.
Cleveland upped the already-high ante by setting an extremely limiting recovery window. On June 30th, a day before departing for his secret surgery, Cleveland called for a special session with Congress in a last-ditch effort to save the economy scheduled for August 7th. This gave the President 35 days to recover, shortening the minimal recovery time prescribed by his doctors by over a week if the surgery went as well as expected. When Cleveland took a train from Washington to New York, where the Oneida was docked, his cabinet suspected nothing.
Waiting for Cleveland aboard the Oneida was his personal physician, Joseph Bryant, who would be performing the surgery. Bryant had assembled the rest of the medical team to whom he introduced the president. This covert surgical team was composed of elite medical professionals. In addition to Bryant’s twenty-nine-year-old surgical assistant, John Erdmann, who would go on to have a storied career as a New York City surgeon, was William Keen, already renowned as America’s first neurosurgeon. Bryant had also recruited Ferdinand Hasbrouk, a world-renowned dentist who specialized in extractions and had pioneered the use of anesthetics in dentistry. Hasbrouk was charged with extracting Cleveland’s teeth as well as being the anesthetist for the tumor surgery. Robert O’Reilly, the White House physician, was on board, as was Edward Janeway, an esteemed surgeon and former health commissioner.{2}
Even by modern medical (and non-nautical) standards, the surgery was extremely risky. Cleveland was a chronic smoker, obese, and had kidney issues. Additionally, his thick neck increased the odds of a stroke. Modern anesthetists would balk if confronted with a patient exhibiting these symptoms. Cleveland’s team was further limited by their operating theatre. The only light they had was natural, and the electricity needed for cauterizing the wound to stem the bleeding was produced by a hand-cranked generator. In case the President was given too much anesthetic, there was no oxygen to revive him, and the team had to work without suction, which increased the risk of his trachea closing up. Ether would have been the conventional anesthetic for the entire operation, but Cleveland’s kidney issues made it a less attractive option. Moreover, the combustibility of ether, especially in a closed structure such as a yacht saloon, made it dangerous not only for the patient but for the surgical team. Dr. Hasbrouk, the dentist on the team, insisted that nitrous oxide, or laughing gas would be insufficient to keep their patient anesthetized for long enough to complete the entire procedure. Indeed, the compromise that was struck proved Hasbrouck’s point. It was agreed upon to use nitrous oxide for the teeth extractions and switch to ether for the more involved part of the surgery. During the first phase of the operation, Cleveland began to wake up and they had to administer the nitrous oxide again.
Finally, and perhaps most significantly, the operation was performed while bobbing up and down in the Long Island Sound. And yet despite all of the challenges and risks, the operation was not only a success but continues to be referenced in medical journals to this day. Bryant’s medical team managed to perform the surgery in approximately 90 minutes; today, this surgery would take many hours. Scientists who performed a biopsy on Cleveland’s tumor in 1980 called it “one of the most unusual operations in American surgical history.”{3}
Though Cleveland’s secret surgery was a private and medical triumph, it was, in a sense, a fleeting victory. Cleveland’s failure to rein in the economic depression led to the biggest political realignment since the Civil War. The Republican party would come to power and stay there for the next three decades.