The President Is a Sick Man

by Matthew Algeo

  If his doctors had never touched him, Garfield most likely would have survived. The bullet, it turned out, had lodged harmlessly in tissue. It hadn’t killed Garfield; his doctors’ obsession with finding it had. At his trial, Charles Guiteau argued—rather convincingly, according to many witnesses—that he was not responsible for Garfield’s death: the president’s doctors, by their incompetence, had killed him. It was compelling stuff, but the jury didn’t buy it. Guiteau was hanged on June 30, 1882.

  At least Grover Cleveland was in better hands. His personal physician, Joseph Bryant, was a former New York City health commissioner and an accomplished surgeon with a thriving practice said to be worth $25,000 a year (about $600,000 in today’s money). He was also a professor of surgery at Bellevue Hospital Medical College, and he would go on to serve as president of the American Medical Association. Bryant was a friend of Dan Lamont—their wives were sisters—and it was Lamont who had introduced Bryant to Cleveland shortly after Cleveland was elected governor. Bryant and Cleveland hit it off immediately, and the two men frequently went hunting and fishing together.

  Cleveland undoubtedly asked Bryant to be his White House physician, but Bryant was probably reluctant to abandon his lucrative private practice. So Cleveland turned to Robert O’Reilly, whose army biography describes him as having “great personal attraction, winning the affection and loyalty of all with whom he came into intimate contact.” O’Reilly had served as a Union medic in the Civil War. After the war, he attended medical school at the University of Pennsylvania, graduating in 1866. He returned to the army, and, after a stint fighting the Sioux in Wyoming, he was assigned to Washington, where “his attractive personality and his professional skill made him a prominent figure in the capital.” Apparently O’Reilly was a charming raconteur and accomplished violinist who killed at parties. Shortly after Cleveland arrived in Washington, he struck up an “intimate and agreeable” friendship with O’Reilly and appointed him White House physician. O’Reilly was a capable doctor, and he would go on to become chairman of the American Red Cross.

  But even having the best doctors doesn’t guarantee the best care, especially when the patient is a president. Proximity to power can cloud judgment. “The success of the presidential patient’s political agenda becomes intertwined with the success of the physician,” writes medical historian Ludwig Deppisch. “As a result, secrecy and misdirection can exaggerate and distort the traditional . . . doctor-patient relationship.” That was certainly the case with Grover Cleveland. By insisting on total secrecy, the president, not his doctors, dictated his course of treatment.

  Ponder for a moment the decisions that were made in the White House that warm early summer evening in 1893. The president has a cancerous tumor in his mouth but consents to its removal only if the operation is performed on a friend’s yacht and at a time of his choosing. The plan, Deppisch writes, “was hardly propitious for a successful conclusion.”

  Considering the risks, it’s hard to believe Joseph Bryant and Robert O’Reilly ever agreed to perform the operation at all. That they did is a testament to their courage and patriotism—as well as their vanity and foolishness.

  In the vernacular of their times, if anything went wrong, they’d be up to the hub in mud.

  ______________

  * Grant’s two-volume set of memoirs would sell three hundred thousand copies and earn his survivors $500,000.

  * This was a typically Clevelandian turn of phrase. “He had a tendency to mount polysyllabic stilts,” one of his secretaries recalled.

  * In 1967, seventy-four years after Cleveland’s operation, the Twenty-Fifth Amendment was ratified. It provides for the temporary transfer of power to the vice president when a president is incapacitated.

  * Arthur, apparently aware of his imminent demise, campaigned only halfheartedly for the Republican nomination in 1884. This, coupled with Arthur’s reformist tendencies, resulted in the nomination of James G. Blaine, who ultimately lost the election to Cleveland.

  * Given the dismal outcome, the snub probably saved Baxter’s career. He would later serve as Benjamin Harrison’s White House physician and surgeon general of the army.

  4

  DR. KEEN

  ON FRIDAY, JUNE 23, 1893, the same day that plans were first hatched for the secret operation, Joseph Bryant sent a letter by special delivery to his friend William Williams Keen, the head of surgery at Jefferson Medical College in Philadelphia. In the letter, Bryant cryptically asked Keen to meet him as soon as possible to discuss “a very important private matter.” Keen was intrigued, and a little unnerved; he was anxious to find out what merited such urgency—and such secrecy. On the following Monday, Keen would be in New York to catch a ferry to Providence. He immediately wired Bryant, suggesting they meet on the deck of the ferry at 4:00 p.m. that day. The boat wasn’t sailing until 6:15 that evening. It would be deserted. There they could discuss the “private matter” undisturbed.

  So, on June 26, Bryant met Keen on the empty ferry, which was docked at Pier 28 on the North River, now better known as the Hudson. It was raining lightly. Bryant and Keen took seats in wooden deck chairs. Each was impeccably dressed in a dark suit.

  Bryant began by gravely announcing, “Mr. Cleveland is suffering from a serious disease of his upper left jaw.” He went on to explain that an operation would be performed on the president in five days on board the Oneida, Commodore Elias Benedict’s yacht. The whole matter was being kept secret—for the nation’s sake, of course. Bryant said he was in the process of assembling a team of the finest surgeons for the operation, and he asked Keen if he would be willing to take part.

  W. W. Keen was fifty-six years old and at the pinnacle of a long and exceedingly eminent career that practically spanned the chasm between medieval and modern medicine. He was the most celebrated surgeon in the nation. His reputation was unimpeachable. And now he was being asked to risk it all—for a president he hadn’t even voted for.

  William Williams Keen was born in 1837—the same year as Grover Cleveland. But there the similarities end, for Keen was everything the president was not: pious, sober, almost Puritanical. Their upbringings were vastly different, too. Keen’s father had been a successful leather merchant in Philadelphia. The family had lived in a mansion—complete with a drawing room, chandeliers, and servants—at Thirty-Sixth and Chestnut Streets, in what was then the “country,” where they raised corn and potatoes and even a cow and some chickens. On Sundays the family ate cold roast beef, “so as to give the cook as little work as possible on the Sabbath.”

  William Williams Keen was one of the country’s most famous doctors when he was asked to join the surgical team that would secretly operate on the president. Keen’s career spanned from the Civil War to World War I.

  NATIONAL LIBRARY OF MEDICINE

  Keen’s parents were strict Baptists, and a fear of God was instilled in Billy early. He was a serious young man, though he also enjoyed playing hockey and baseball. His later interest in medicine was probably sparked by his family’s afflictions. He was the sixth of eight children, of whom only three survived childhood. Two of his siblings died of scarlet fever before he was born. Another died of diphtheria when Keen was twelve. When he was in his teens, his mother began falling regularly. “At first, we thought it was due to awkwardness and used to tease her about it in good humor,” Keen remembered. “After a while we recognized the fact that her falls were due to a muscular weakness in her legs.” Her arms were similarly affected. Perhaps she had ALS, also known as Lou Gehrig’s disease. She would die in 1877, bedridden, paralyzed, and unable to feed herself.

  Keen developed what he called a “love of order and exactness” at an early age. A good student, he was interested mostly in science, especially experimentation. As a young boy, he charted the growth of some grapevines in his backyard. One day he noted that a vine had grown one and three-quarter inches in just two hours. “Using a good magnifying glass, I could have literally seen it grow,” he wrote many
years later. “I have often been sorry that I did not repeat this kind of observation a number of times, to determine what the maximum rate of growth might be— and not only in grapes but also in other plants.”

  Keen was just sixteen when he graduated from Central High School, Philadelphia’s most prestigious public school. He then spent two years studying with a private tutor before going to college at Brown. He later said he went to Brown for its progressive curriculum, which permitted students to choose their own courses, but he also chose it because it was a Baptist school. Keen planned to become a minister, though in college he would find a different calling.

  Keen flowered at Brown. He joined a fraternity. Despite standing just five foot five, he played football and rowed. And he began dating. The object of his greatest affection was seventeen-year-old Emma Corinna Borden (a second cousin of the infamous Lizzie Borden), who attended a finishing school in Providence. Tinnie, as she was known, was the daughter of one of the richest businessmen in Fall River, Massachusetts. Keen fell in love with Tinnie, but his love was not immediately requited.

  At Brown, Keen also came under the spell of a charismatic and unorthodox science professor named George Ide Chace. Chace gave free lectures to Providence’s metalworkers, dabbled in metaphysics, and frequently invited students to his home for supper. He was also a bit of a heretic; his more conservative colleagues found him “dangerously rationalistic.” Keen, however, believed Chace was a “mastermind.” He later wrote, “I could hardly wait from one recitation to the next.” He especially enjoyed Chace’s lectures on anatomy and biology.

  Keen’s enthusiasm for science tempered his passion for the pulpit. By his senior year he’d decided he wasn’t suited for ministry. His religious convictions were changing. He no longer took the Bible literally and didn’t believe in the virgin birth. He called this his “anxious period of doubt.” He emerged from it “into a broader, happier, sunny belief in the goodness, mercy and love of God.” Keen remained a devout Baptist for the rest of his life, but he came to detest religious fundamentalism.

  Keen graduated from Brown at the top of his class in 1859—the same year Charles Darwin published The Origin of Species. The book had a profound effect on Keen, who was fascinated by what he called the “unfolding of human development.” Keen was one of Darwin’s earliest and most ardent advocates in North America and probably the first prominent American Baptist to publicly promote the theory of evolution. Keen had no difficulty reconciling science and religion. Evolution did not shake his faith. “To me,” he wrote, “the Bible is the Book of Books. It is a precious manual of Religion but not a textbook of science.”

  Instead of entering the seminary, Keen had decided to enter medical school. Eager to return to Philadelphia, he applied for admission to Jefferson Medical College and was accepted. He moved back into his parents’ house. He would live with them until he was almost thirty.

  On the morning of Monday, October 8, 1860, Keen woke early and put on his best suit. He climbed into his landau and told his coachman to drive him downtown. The inside of the carriage smelled of mink oil, and the leather seats gleamed. The fastidious Keen liked his carriage to be kept clean. Slowly, steadily, the horses made their way over the Market Street Bridge to the heart of the city, their hooves clip-clopping on the cobblestone streets. Union Jacks festooned the lampposts, hung in honor of the Prince of Wales (later King Edward VII), who was coming to Philadelphia the very next day. He would be the first British royal to visit what was once the second largest city in the empire.

  At Tenth and Sansom Streets, the carriage stopped in front of a saloon. Upstairs was Jefferson’s infirmary, two dim rooms with five or six beds each. Keen, a confirmed teetotaler, must have smiled at the irony. The medical school itself was in a building across the street. Keen stepped out of the carriage and began his medical career.

  There were sixty-five medical schools in the United States in 1860. None were regulated, licensed, or formally accredited. Few required even a high school diploma for admission. Most were operated solely for profit, with dreadful faculties and facilities. Things weren’t much better fifty years later, when a Carnegie Foundation report on the state of medical education in the United States concluded that “there has been an enormous overproduction of uneducated and ill-trained medical practitioners.”

  Jefferson was better than that. Its admission standards were high and its faculty among the finest in the nation. The chairman of surgery was Samuel Gross, the most famous surgeon of his age. Gross was known as the Emperor of American Surgery, a title he wasn’t inclined to refute.

  But in 1860, even Jefferson—or Jeff, as it is sometimes called—was wanting. The school didn’t even own a single microscope. The table that was used for cadaver dissections was also used for operations on living patients.

  At the time, surgery was, in Keen’s words, “crude and simple.” Some doctors had begun experimenting with anesthetics, but they were not yet widely available. Keen remembered the first operation he witnessed at Jefferson as being rather gruesome. “I had just eaten my luncheon. By throwing out all my grappling hooks, I barely succeeded in holding it down.” Before they performed operations, surgeons rarely bothered to wash their hands—much less their instruments—for they knew nothing of germs. In fact, most doctors stored their instruments in velvet-lined cases, a veritable breeding ground for bacteria. Surgeons worked in heavy black dress jackets covered with the blood of scores of operations. They wore the soiled jackets with pride, for the accumulation of crusty bloodstains attested to their surgical experience. Operating rooms were dark and filthy. Hospitals—of which there were fewer than two hundred in the nation—were considered places where people went to die, not to be made well. “The wards were full of fear,” Keen remembered.

  Just seventeen months after he entered Jefferson, Keen received his medical degree. It was March 1862, and Keen, a fervent abolitionist, offered his services to the Union Army. He was commissioned an acting assistant surgeon and spent much of the Civil War in hospitals, studying gunshot wounds, but on August 30, 1862, the last day of the Second Battle of Bull Run, he was unexpectedly ordered to Manassas. Keen led a convoy of thirty-six wagons from Washington to the battlefield. In Centreville, Virginia, he came upon a small stone church filled with badly wounded soldiers, the remnants of Union general John Pope’s decimated army. The air was thick with anguished moans and the stench of putrefaction. Most of the casualties would soon die because their wounds were infected. During the Civil War, a soldier with an infected wound was doomed. “At the field hospital,” one surgeon remembered, “the cases were very frequent. Statistics are unnecessary; they proved uniformly fatal.” Keen believed there was a correlation between the squalid conditions in field hospitals and the staggering mortality rate of wounded soldiers, but it wasn’t until Joseph Lister promulgated the germ theory of disease that Keen fully grasped the connection.

  Surgery pre-Lister was a gamble that most patients were bound to lose. Even if you survived the operation itself—no mean feat, especially in the days before anesthetics—there was a better than 50 percent chance you would die of a postoperative infection. In especially unsanitary hospitals, the mortality rate often approached 100 percent. The deaths were usually attributed to “hospitalism,” a vague term used to describe a variety of infections, the most prevalent and dangerous of which was gangrene. Exactly what caused hospitalism was a matter of intense and often acrimonious debate. Some doctors believed a poisonous miasma surrounded hospitals. Others believed oxygen contaminated wounds. Still others clung to the theory of spontaneous generation. The proposed cures were equally varied and fabulous. The common remedy was amputation, though this, of course, was not always feasible, and, in any event, usually led to another infection. A Scottish surgeon named James Simpson called for the abolition of hospitals altogether. He said they should be replaced with portable “villages of iron huts,” which could be torn down and reassembled whenever they became infected with hospitalism.<
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  Joseph Lister, a professor of surgery at Glasgow University, wasn’t sure what to believe until 1864, when he read a paper by Louis Pasteur, who postulated that invisible organisms—germs—lived in the air and were responsible for making wine turn sour. Lister connected the dots. “It occurred to me,” he wrote, “that decomposition in the injured part might be [caused by] the floating particles.” By preventing germs from entering wounds, Lister believed hospitalism would be ended. Pasteur had discovered the germ theory of disease; Lister would evangelize it.

  Lister began touring the world, tirelessly urging his colleagues to adopt “antiseptic” surgical practices. He told them dangerous microbes were everywhere—in the air, on their scalpels, even under their fingernails. He implored them to sanitize their operating rooms and sterilize their instruments. His pleas often fell on deaf ears. Many surgeons were loath to trade in their comfortable, crusty coats for crisp, clean smocks. Some didn’t fully comprehend what Lister was getting at. If a doctor dropped a sterilized scalpel on the floor, he just picked it up and wiped it on his handkerchief. When the patient developed gangrene, he concluded that antiseptic surgery was pointless. Many doctors found Lister’s claims farfetched. The editor of one medical journal huffed, “We are as likely to be as much ridiculed in the next century for our blind belief in the power of unseen germs as our forefathers were for their faith in the influence of spirits.”

  Lister persevered. In 1876 he traveled to Philadelphia to preach his gospel at a medical conference that was being held in conjunction with the city’s Centennial Exhibition. In the audience was W. W. Keen. “I became a convert at once,” Keen later wrote. After the speech Keen introduced himself to Lister. The two doctors were alike in many ways. They were both abolitionists, deeply religious but wary of fundamentalism, intensely interested in scientific research, and gifted writers. And they were both fanatical about cleanliness. They instantly became friends.