Medical Mystery: Grover Cleveland’s secret operation

Grover Cleveland was the only U.S. president to serve two nonconsecutive terms, making him both our 22nd and 24th presidents.

Although he won three consecutive popular votes for president, 1884, 1888 and 1892, he lost the 1888 election when Benjamin Harrison won the electoral college vote.

Three months into his second term in office, Cleveland noticed he had a sore spot on the roof of his mouth. It was on the upper left side - his favorite side for tucking in a pinch of tobacco between his cheek and gum, a habit that meant the White House always kept a spittoon near the president. Cleveland also was an avid cigar smoker who inhaled the vapors deeply, and as photos from the time show, he held his cigars on the left side of his mouth.

After first locating the sore spot with his tongue, the president pulled out a mirror and saw a large, craterlike ulcer with a granulated surface on the left side of his hard palate (the roof of his mouth). He called Robert O'Reilly, the White House physician, who examined Cleveland's mouth and saw the lesion, the size of a quarter, and recommended immediate surgery.

This was a serious matter: Oral surgery this close to the eyes was dangerous medically, to say the least. 

At the same time, Cleveland worried that the news would shock the country, which was already facing an economic depression. The president feared a Wall Street panic if the news of his risky surgery leaked, causing the market to collapse, so he demanded that his staff maintain secrecy from the press and public. Even the vice president, Adlai Stevenson (whose namesake grandson ran for president in the 1950s) was not told.

What exactly was the lesion in the president's mouth? And what is the Philadelphia connection to this story?


Solution:

The White House physician saw a tumor and immediately thought it was cancer, the reason for urgent surgery.

To explain his absence from the White House, President Grover Cleveland announced that he was taking his friend Elias C. Benedict's yacht, the Oneida, on a four-day fishing trip from New York Harbor to his summer home in Cape Cod over the Fourth of July holiday.

Under cover of darkness early on June 30, 1893, Cleveland and six physicians climbed aboard the yacht, where they decided to do the risky surgery. On July 1, the president and the doctors went below to the yacht's parlor, which had been equipped with sterilized instruments and nitrous oxide and ether for anesthesia.

Cleveland instructed the surgeons to preserve his trademark mustache so the public would not suspect surgery had been performed. In a 90-minute operation, done using a special cheek retractor, doctors removed the tumor, along with five teeth and part of Cleveland's upper left palate and jawbone. As the procedure was done entirely within the mouth, there were no external facial scars.

The procedure was completed without complications, and the yacht sailed on, reaching the president's summer home on July 5.

In mid-July, a vulcanized rubber prosthetic was applied to fill the gap left in the president's mouth. Cleveland rapidly regained his usual speaking voice. As far as the press and public knew, the president had merely suffered a toothache. His mustache was unchanged. 

Congress was unaware of the surgery during a special summer session called by the president to address the financial crisis.

But the secret was not to last. On Aug. 29, 1893, the Philadelphia Press reported the story of the surgery - which the president firmly denied. The journalist who broke the story wound up in disgrace until one of the doctors came forward years after Cleveland's death in 1908 of a heart attack, and confirmed the story. 

The surgery - made even more challenging by the fact it was done on a moving yacht - yielded a gelatinous mass, thought to be a malignant sarcoma, though different pathologic diagnoses were reported. Finally, in 1980, 87 years after the surgery, the tissue was reexamined, and found to be verruccous carcinoma, a less virulent cancer than the White House physician had feared, a finding reported in the Journal of the American Medical Association. You can go see that tumor for yourself, preserved in a glass bottle of formalin, at the College of Physicians' Mutter Museum in Philadelphia.

Allan B. Schwartz, M.D., is a professor of medicine in the Division of Nephrology & Hypertension at Drexel University College of Medicine.


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