• 7/13/2007
  • Dublin, Ireland
  • Dr Robert O’Sullivan
  • Irish Medical Times (www.imt.ie)

Ulysses S Grant, for Americans is one of the most famous past presidents of their country. No child in America can expect to leave school without having a knowledge of his civil war exploits and it is the image of Grant that graces the American fifty dollar bill.

He was elected to the office of president twice and accepted the surrender of Robert E Lee, one of the final acts of the civil war. As well as the civil war, his exploits in the Mexican-American war of the 1840s are the stuff of legend.

As US President his terms of office were marred by years of scandal and corruption, however he is well remembered for helping African-Americans and his tough stance against the Ku Klux Klan.

The end was nigh

Seven years after leaving office, Grant developed a sore throat, the first symptom of the cancer that would end his life. He had been declared bankrupt after bad investments and being the victim of investment fraud and he was hastily writing his memoirs to generate some much needed income.

Having been promised a large sum of money by Mark Twain for producing this book, the last thing he needed at this stage was the terrible news of his own impending demise.

Grant was said to have to been a stubborn man and he attended his physician only because of his wife’s insistence. The sore throat was only getting worse and the pain apparently was exacerbated by eating peaches, which was a favourite food.

Grant was holidaying in New Jersey at the time and the doctor he attended suggested he see his usual physician upon his return to his home in New York. By the time Grant finally attended a specialist nearly three months had passed.

Dr John Douglas, who was one of the world’s leading throat specialists, diagnosed a carcinoma of the tonsillar pillar, accompanied by a small node in the neck. Dr Douglas believed that the lesion was epithelial in origin and he explained to Grant that it was “sometimes capable of being cured”.

Early in the civil war Grant was responsible for a series of union victories that brought him considerable fame and admiration. A story from the time goes that a published photograph of Grant smoking a cigar caused admirers to send him presents of cigars, such that in a short space of time he had several thousand to go through.

Another tale of his legendary consumption of tobacco goes back again to his civil war exploits. During the exchanges in what became known as the first ‘Battle of the Wilderness’ he consumed twenty cigars in less than one day. Grant was also a heavy drinker, particularly of bourbon.

No family history

There was no record of a family history of any sort of cancer at the time. Grant had orthopaedic problems for several years at the time of diagnosis, but was otherwise in excellent health, something that was remarkable at the time for a man of 62.

Indeed only a few years before the diagnosis he considered running for a third term in office only to be beaten for the nomination by the eventual winner, James Garfield.

The initial management of the lesion included gargling solutions of salty water, carbolic acid and a cocaine solution. Smoking was also ceased. Grant’s symptoms worsened and by the end of 1884 the cancer had clearly spread.

Squamous tumour

A biopsy was obtained and it was decided that the specimen was a malignant squamous tumour. Surgery, involving total resection of the tumour and much of the surrounding tissue was planned but not performed.

The possible reasons for not operating are legion but quality of life, the high risk of infection and the remoteness of any possibility of cure must have figured highly in the thoughts of the surgeons.

These were the days before antibiotics and wound infections were an all too common cause of surgical mortality. Sterile techniques and cleanliness were far from ideal and although anaesthesia was around for many years it still carried a far larger risk than we have today.

As time passed Grant developed difficulty in breathing and his gasping could be heard over some distance. He became concerned that he would choke to death in his sleep and began sleeping in an armchair.

He was unable to speak and communicated only by writing. Dr Douglas visited him frequently but was unable to achieve much by way of practical help. Grant wanted to discuss the future course of his illness on several occasions with his family members but was met with considerable resistance, particularly by the female members of his family.

He felt that it would be better at the end if they knew what to expect but he was met with outpouring of grief by some members and constant attempts to change the subject by others. This is believed to have contributed to a depression that Grant was slipping into.

That said it is clear that his family knew that death from the cancer was inevitable. Grant could not understand why, if his death was certain, it was not discussed. Eventually his wishes to talk about the matter culminated in causing a large amount of grief to his immediate family and he regretted ever going near the matter.

In June 1885 Grant moved to the town of Mount McGregor, New York. This was done in order to provide a quieter setting with cleaner air to alleviate some of his suffering.

By how much the fresh air helped is debatable; nevertheless the General was able to continue writing despite his failing health. A few weeks after arriving he finished his memoirs. The book went on to become an award winning bestseller and earned the family nearly half a million dollars.

His health began to seriously decline and several doctors were called for, including Dr Douglas.

It had been feared that in the earlier stages of the disease that he would die from the local effects, perhaps suffocation.

At this stage his medical team agreed that exhaustion was much more likely as he had lost so much weight. His breathing became much more rapid and his pulse increased.

A combination of gently heating his cold peripheries with hot rubs as well as regular application of brandy was used to relieve the suffering. Before the final stages of his illness set in Grant recorded his admiration for his doctors and said that medical science had helped him in as much as it could.

At one stage a nurse asked him would he like anything to which he replied “water”. It was his last word. On the 23rd of July 1885 he was pronounced dead, with Dr Douglas on one side and his son, Colonel Grant on the other.

Highlighted cancer

Grant was not the only president to suffer from oral cancer; some year’s later president Grover Cleveland underwent an operation for the removal of a suspicious tumour which turned out to be a verrucous carcinoma.

Grant’s death, however, had wider ramifications. The details of his illness and death were very public. For perhaps the first time Americans began to fear cancer. The news of a man as strong as General Grant wasting away in the space of months, coupled with a statesman of his calibre being left unable to speak sent shock waves through the homes of the emerging power.

Fifty years later General MacArthur made his famous ‘Old soldiers never die’ speech. In the case of General Grant, he faded away before everyone’s eyes.

References:
Jafek BW, Murrow BW ENT Secrets 3rd edition, New York Times, July 24th 1885.