THE HISTORY PRECEDING THE FIRST OPERATION.
On Sunday, June eighteenth, 1893, Dr. R. M. O 'Reilly -- later Surgeon-General of the United States Army -- the official medical attendant on officers of the Government in Washington, examined a rough place on the roof of Mr. Cleveland's mouth. He found an ulcer as large as a quarter of a dollar, extending from the molar teeth to within one-third of an inch of the middle line and encroaching slightly on the soft palate, and some diseased bone. The pathologist at the Army Medical Museum -- who was kept in ignorance, of course, of the name of the patient -- after examining the small fragment which Doctor O'Reilly had removed, reported that it was strongly indicative of malignancy.
Doctor O'Reilly, foreseeing the need for an operation, advised Mr. Cleveland to consult Dr. Joseph D. Bryant, long his medical attendant and intimate friend. Doctor Bryant quickly went to Washington and confirmed the diagnosis. The President, after the examination, with no apparent concern, inquired:
"What do you think it is, doctor?"
To which Doctor Bryant replied:
"Were it in my mouth I would have it removed at once."
This answer settled the matter.
During the discussion as to what arrangements could be made, "the President would not under any circumstances consent ... to a time and place that would not give the best opportunity of avoiding disclosure, and even a suspicion that anything of significance had happened to him. The strong desire to avoid notoriety ... was dwarfed by the fear he had of the effect on the public of a knowledge of his affliction, and on the financial questions of the time." He decided that July first was the earliest suitable date. Colonel Lamont, the Secretary of War, and a close personal friend, was then informed of tbe facts, and it was soon arranged that to secure secrecy the operation should be done on Commodore Benedict's yacht, the Oneida.
The next question was as to how soon after the operation the President could probably safely return to Washington. August seventh was decided on.
Meantime Doctor Bryant had written me, asking for a consultation "in a very important matter." As I was about to go to New England I suggested that I should go to New York at noon and that we meet at three-fifteen on the deserted deck of the Fall River boat, which did not leave till 6 P. M. There, without any interruption, we laid all necessary plans. The living rooms on the Oneida were prepared and disinfected; an operating table and all the necessary instruments, drugs, dressings, and so on, were sent on board. Arrangements were made with Dr. Ferdinand Hasbrouck, a dentist accustomed to giving nitrous oxid [sic], to assist.
My own family were kept in entire ignorance of the facts. To explain my absence I simply said that I was called to a distance for an important operation and would probably be absent for some days.
On June thirtieth I reached New York City in the evening, went to Pier A, and was taken over to the yacht, which was lying at anchor at a considerable distance from the Battery. Dr. E. G. Janeway, of New York; Doctor O'Reilly; Dr. John E. Erdmann, Doctor Bryant's assistant; and Doctor Hasbrouck had also secretly gone to the yacht. The President, Doctor Bryant and Secretary Lamont, at a later hour arrived from Washington, openly drove to Pier A, whence they were taken to the yacht.
At the time when he left Washington, on June thirtieth, Mr. Cleveland issued a call for a special session of Congress on August seventh, with the object of averting the financial danger by the repeal of the silver clause of the Sherman Act.
On arriving on the yacht the President lighted a cigar, and we sat on deck smoking and chatting until near midnight. Once he burst out with "Oh, Doctor Keen, those officeseekers! Those officeseekers! They haunt me even in my dreams!" I had never met him before; but during that hour or more of conversation I was deeply impressed by his splendid personality and his lofty patriotism. I do not believe there was a more devoted patriot living.
He passed a good night, sleeping well without any sleeping medicine. Before he dressed, Doctor Janeway made a most careful examination of his chest and found nothing wrong. There was little if any arteriosclerosis. His pulse was ninety. His kidneys were almost entirely normal.
I then examined him myself. He stated that he was sure the rough place was of recent origin; that it was not there on March fourth, when he was inaugurated, but had been first observed about six or eight weeks before July first. There were no perceptibly enlarged glands. I confirmed the facts as to the ulcer and deemed the growth to be unquestionably malignant. During the morning his mouth was repeatedly cleansed and disinfected.
The anesthetic troubled us. Our anxiety related not so much to the operation itself as to the anesthetic and its possible dangers. These might easily arise in connection with the respiration, the heart, or the function of the kidneys, etc., dangers which are met with not infrequently as a result of administering an anesthetic, especially in a man of Mr. Cleveland's age and physical condition. The patient was 56 years of age, very corpulent, with a short thick neck, just the build and age for a possible apoplexy -- an incident which had actually occurred to one of my own patients. He was also worn out mentally and physically by four months of exacting labor and the officeseekers' importunities. Twenty-four years ago we had not the refined methods of diagnosis, nor had we the greatly improved methods of anesthesia which we have to-day. After canvassing the whole matter we decided to perform at least the earlier steps of the operation under nitrous oxid, and the later, if necessary, under ether. Doctor Hasbrouck was of opinion that we could not keep the patient well anesthetized with nitrous oxid long enough to complete the operation satisfactorily.
Doctor Bryant and Secretary Lamont had spent the night at their homes, but returned to the yacht the next morning -- July first. The yacht then proceeded up the East River at half speed while the operation was performed.
So careful were we to elude observation that Doctor Bryant and all of us doctors, who might have been recognized by some of the staff of Bellevue Hospital, deserted the deck for the cabin while we were steaming through the East River in sight of the Hospital at Twenty-sixth Street.