Medical Mystery: Ike's emergency 'stomach pains'

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President Dwight Eisenhower at his 1953 inauguration. Eisenhower’s constant pain could have harmed his reelection bid.

Dwight David Eisenhower, our 34th president, had suffered recurrent abdominal distress ever since he was a young Army officer.

On June 8, 1956, he awoke in the White House at about 12:30 a.m. because of intense pain. His physician arrived at the White House 30 minutes later.

Eisenhower had complained of stomach problems for years, starting shortly before he underwent an appendectomy in 1923 in a military hospital. After a severe digestive disorder in March 1949, Eisenhower recuperated at President Truman's Little White House in Key West, and then at Augusta National Golf Club through mid-May. The diagnosis was not reported.

The president suffered a heart attack in 1955 while on vacation visiting his in-laws in Denver, and was taken to Fitzsimons Veterans Hospital. It was a complicated recovery, with the president suffering premature ventricular and supraventricular beats and pericarditis, an inflammation of the sac-like tissue that surrounds the heart.

On that June night in 1956, his physician found that the president's abdomen was moderately distended, but his examination revealed no point that was especially tender.

Eisenhower slept only fitfully as the pain continued. In the morning, tap water enemas were administered, but didn't help. Later, the pain came and went, concentrated around the umbilicus (belly button) and right lower quadrant of his abdomen.

At 10:30 a.m. the patient vomited about three pints of bile-stained fluid. His pulse was 92, and his blood pressure fell from 140/100 to 100/76. Later, his pulse increased to 120.

The White House physician, Gen. Howard McCrum Snyder, who had known Eisenhower since they served together in England during World War II, took his patient to Walter Reed General Hospital, as it was then known, and said surgery was needed immediately.

Plain film X-rays showed his entire small bowel above an obstruction was filled with gas. A barium swallow X-ray study showed a "string sign," frequently associated with Crohn's disease.

The president was examined by a surgeon, Major Gen. Leonard D. Heaton, and consultants, including I.S. Ravdin, of the University of Pennsylvania, who had served under Eisenhower in Europe, and Paul Dudley White of Harvard University, the president's cardiologist. The consultants deliberated for 12 hours - operating on a man who had a heart attack the previous year was a complicated decision. At 1 a.m. June 9, the consultants finally agreed that surgery was needed. Medication was given to counteract the blood thinner, and the operating room was prepared.

What was wrong with the president? And what would the impact be on his effort to win a second term?


Solution:

President Eisenhower was taken to the operating room on the morning of June 9, 1956. Finding that the terminal ileum was indeed obstructed, the surgeon, Major Gen. Leonard D. Heaton, decided to bypass the blockage rather than remove roughly a foot of small intestine. The normal ileum near the diseased segment was connected directly to the transverse colon, leaving the disconnected segments in the abdomen, a controversial maneuver.

Heaton had avoided a more complicated procedure of removing the diseased segment to minimize the surgical time and reduce the risk to the 65-year-old president, given his history of heart disease. The surgery was completed in two hours without complications.

Heaton defended his decision, referring to the inflamed small intestine left in the abdomen as a "dry" type of inflammatory process, indicating a chronic condition, and not a "wet" or acute inflammation. Later, Heaton described the surgery at a meeting of the Southern Surgical Association and in two issues of the Annals of Surgery.

The diagnosis was a chronic inflammatory condition, ileitis, with small intestinal obstruction. Whether he actually had Crohn's disease, which can lead to ileitis, has been a matter of some controversy.

"Three decades would pass before I would learn the cause of my repeated distress, when doctors described it as 'a young man's disease,' ileitis." Eisenhower wrote in his 1967 book, At Ease: Stories I Tell to Friends.

The president spent three weeks in the hospital after his surgery, and when he left on June 29, his double-breasted suit was noticeably baggy and he appeared weak. With the election just four months away, reporters asked whether he was going to seek a second term in view of his medical history and the latest crisis.

"There has been no talk about his personal plans," replied press secretary James C. Hagerty.

As it turned out, the election of 1956 was a rematch of 1952, pitting Eisenhower against Democrat Adlai Stevenson. And again, Eisenhower was the victor.

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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