“General Grant: His Physicians and His Cancer”, 1976-10 ():
In early June 1884, 7 years after leaving office as President of the United States, General Ulysses S. Grant was found to have carcinoma of the right tonsillar pillar.
The General’s physicians kept a detailed record of the course of their patient’s disease. Speaking was quite painful for the patient, and his words and thoughts have been preserved on the scraps of paper on which he communicated to family, physicians, and friends.
The diagnosis, symptomatic treatment, and inexorably progressive course of General Grant’s mouth cancer taking place in an atmosphere of personal financial ruin are discussed in detail.
…In the preceding 200 years, 37 men have held the office of President of the United States. Only one of these, Ulysses S. Grant, died of cancer. In early June 1884, the 63 year old ex-president first complained of soreness in the right tonsillar region. By October, one of the lymph glands under the angle of the mandible on the right side became enlarged. An ulceration was seen at the base of the right tonsillar pillar. Medical consultation was sought, and microscopic examination of a biopsy of the lesion revealed “epithelioma”, or what today would be called squamous carcinoma.
The medical history of General Grant has been meticulously documented, and we are able to closely follow the natural history of his illness as well as his most intimate reactions to it. Grant was a national hero. Speaking was difficult and painful during the latter part of his illness, and he communicated by writing on scraps of paper. Because of the General’s fame, these were treasured by their recipients, and we have a record of the General’s deepest feeling about his disease and the specter of imminent death. We are able to read the patient’s own words and we are not dependent on memories dulled by the passage of time.
Grant, well aware of this, wrote in a note to one of his physicians: “I will have to be careful about my writing. I see every person I give a piece of paper to puts it in his pocket. Some day they will be coming up against my English”1. Many of these notes have been preserved. Some are quite mundane, some humorous, and others merely pathetic. All give some insight as to the nature of the patient.
Two of these notes by example are as follows: “Doctor, I feel worse this AM on the whole than I have for some time. My mouth hurts me and cocaine ceases to give the release it did. [Cocaine was recently introduced as a miracle painkiller drug, the only known local anesthetic] If its use can be curtailed, however, I hope it will soon have its effect again. I shall endeavor to rest again if I feel it possible”2. When Doctor George Shrady requested a larger spatula to use as a tongue depressor during one of his examinations, Grant wrote: “I said if you want anything larger in the way of a spatula—is that what you call it?—I saw a man behind the house here a few days ago filling a ditch with a hoe, and I think it can be borrowed”3.
…In relation to cigar smoking, the General told his aide, Horace Porter, about the inception of the habit. “Grant said that he had been a very light smoker prior to the attack of Fort Donelson in 1862. At Admiral Foote’s request, he had gone aboard the flag boat in the Cumberland River and had been given a cigar. On the road back to his command, he was met by a staff officer who told him the enemy was attacking vigorously. While giving the order for counterattack, Grant rode forward among the troops carrying the unlighted cigar in his hand. Grant states that ‘in the accounts given in the papers, I was represented as smoking a cigar in the midst of conflict; and many persons, thinking no doubt that tobacco was my chief solace, sent me boxes of the choicest brands from everywhere in the North. As many as 10,000 were received. I gave away all I could get rid of but having such a quantity on hand, I naturally smoked more than I would have under ordinary circumstances, and I have continued the habit ever since’”11.