The Clandestine Operations Performed on President Grover Cleveland and the Rationale for Surgical Secrecy.

The 1893 operations to remove a maxillofacial tumor from President Grover Cleveland aboard a private yacht remained a secret until long after his unrelated death from heart disease. Many historical studies have suggested that Cleveland kept his health and surgical care confidential because of the fragility of the economy during the Panic of 1893. Although that observation is true, it does not fully address the underlying reason for why the public would react poorly to news about an operation on the president. The death of Ulysses S. Grant eight years prior unearthed the denial, stigma, and fear of cancer felt by many Americans. Despite revolutionary 19th century advances in anesthesia, pathology, and surgery, the social history of "cancerphobia" ran deep.

Head and neck cancer in two American presidents: Case reports.

Two former U.S. presidents, Ulysses S. Grant and Grover Cleveland, were diagnosed with head and neck cancer in 1884 and 1893, respectively. A historical review of the risk factors, diagnoses, and treatments is examined and compared with modern-day interpretations. A comparison was made using the original diagnoses with today's equivalent diagnosis. Different treatment outcomes at the time of the original diagnoses relative to today's treatment are reviewed. Clinicians must be familiar with risk factors, signs, symptoms, diagnosis, and treatment of head and neck cancer.

Further observations on the removal of an enormous facial tumour by Robert Liston in 1834.

In 1834, shortly before Robert Liston (1794-1847) left Edinburgh to take up the post of senior surgeon to the North London (now University College) Hospital, he operated on Mrs Fraser, from Banchory, in north-east Scotland. Her tumour was believed to have originated as a result of trauma to the left maxillary antrum. It was immense in size when he first saw it, and produced an enormous degree of facial distortion. The tumour was associated with drooping and disfigurement of the left angle of her mouth and extended forwards from her left external ear to the left side of her nose. Its upper part eventually obstructed the vision of her left eye, while its lower part extended for some inches below the level of her mandible. The volume of the tumour was just slightly less than that of her face. Liston provided a detailed description of her appearance when he first saw her, and gave a detailed history that suggested its possible aetiology. Descriptions of her pre-operative cast were previously published in this Journal in 2000. Since then, additional casts showing her post-operative appearance and that of her tumour have been located, and these form the basis for this follow-up account.

Excision of a remarkable tumour of the upper jaw in 1834 by Robert Liston.

A series of pre-operative casts of the head, one of plaster of Paris and the other of wax, have recently been discovered in the Department of Anatomy, Edinburgh, of a patient with an immense tumour of the left maxillary antrum which produced an enormous degree of facial distortion. These casts complement a series of engravings published in the contemporary literature. This lady's tumour was successfully excised by Robert Liston in 1834 in the Royal Infirmary of Edinburgh, only a month before he left Edinburgh for London. The tumour was believed to be benign, and was removed without the benefit of anaesthesia. The patient returned the following summer to have a gold palate fitted, and while her voice was initially indistinct, it subsequently recovered.

Franz Kafka, Sigmund Freud and Markus Hajek. A connection in life and death.

When Sigmund Freud was taken ill in 1923 with a malignant tumor of his right upper jaw he was initially treated by the famous Viennese rhino-laryngologist, Professor Markus Hajek. One year later, Franz Kafka, who was suffering from pulmonary tuberculosis which had spread to the larynx, was likewise placed under the care of this distinguished specialist. Neither of the encounters proved beneficial from the professional point of view and both well-known patients received remarkably poor attentions in keeping with the general autocratic attitude by clinical chiefs of the time in Vienna. Franz Kafka was terminally ill when he came to Hajek and no treatment was yet available for the disabling and painful laryngeal complication of his advanced tuberculosis. He died about a month after leaving Hajek's ward in Vienna. Sigmund Freud required repeated subsequent operations on his jaw and the insertion of a prothesis. Hajek had handed Freud over to Hans Pichler for further care and it was entirely due to the skill of this extremely competent and empathetic maxilliary surgeon that Freud lived for another 16 years, working to almost full capacity.

An ancient "tumour" from pre-Columbian Chile.

A case of an expansile facial lesion discovered in the more than 600 years old skeletal remains of a 22-25-year-old female is discussed. Gross, radiographic and histological studies were accomplished on the specimen. Although a definitive diagnosis could not be derived because of the age and condition of the specimen, differential diagnoses are discussed and a probable diagnosis rendered.

Extraradicular cemental fragments in the alveolar bone of prehistoric American Indians: report of three cases.

Heretofore unreported, grossly observable structures composed of cementum were found in the superficial alveolar bone--but not attached to the tooth root--in three prehistoric American Indian skeletons from South Dakota. The macroscopic, radiographic, and histologic morphology of these fragments is described and compared with other cemental structures that occur in the alveolar process.