The Karabots Fellows Enter the Dragons’ Lair

Students in the Karabots Junior Fellows Program talk with Michael Rankin, director of strength and conditioning at Drexel University. They stand in the midst of various exercise equipment (a treadmill is in the center frame).

Earlier this month the students of the Karabots Junior Fellows Program received a hands-on look at some exciting careers in sports medicine, courtesy of Drexel University’s Athletic Program.

On February 11, the Fellows traveled to the Daskalakis Athletic Center (aka “the DAC”) where they met with some health care professionals involved in Drexel sports. Michael Rankin, Drexel’s Director of Strength and Conditioning, led them through workout facilities and explained how he helps athletes prepare their bodies for competition. Next, Andrea Irvine, the Dragons’ Sports Dietitian, talked about the science and career potential surrounding sports nutrition. Afterwards, The Fellows received a tour of Drexel’s athletics facilities followed by a trip to see the Drexel men’s basketball team take on the Towson Tigers. While Drexel ultimately lost to Towson (69-65), the Fellows gained valuable experience and fresh perspective on sports medicine.

The basketball court at the Daskalakis Athletic Center prior to the Drexel men's basketball game against Towson on February 11.

 

CEPI Curiosities: “It is a Bad Looking Tenant” – Grover Cleveland’s Secret Tumor

CEPI Curiosities: Tales from Medical History's Strange Side

Greetings, once again, fellow historico-medico aficionados, and welcome to another installment of CEPI Curiosities, our monthly journey into the realm of the medically unusual.

Observant regular readers will notice this publication appears on the twentieth of every month. It just so happens that February 20th is Presidents Day, our yearly celebration of America’s highest elected office; in honor of the day, it seems fitting that we do another issue on Presidential medical history. We’ve done more than a few of those here, from whether Zachary Taylor was murdered by arsenic poisoning, to the questionable mental state of Presidential candidate William Jennings Bryan, to whether a long inaugural address or the White House itself killed William Henry Harrison. Perhaps a more timely topic than I had initially planned, this issue examines the clandestine efforts of a select group to seek out and remove a dangerous foreign invader with very close connections to the President of the United States himself! Of course I’m talking about President Grover Cleveland’s tumor and the secret surgeries to remove it (what did you think I was talking about?).

Portrait of Grover Cleveland, 22nd and 24th President of the United States

Grover Cleveland; Image Credit: NARA

Grover Cleveland is another one of those Presidents who to modern audiences falls in that historical void between more famous Presidents such as Abraham Lincoln and Theodore Roosevelt. Born in New York in 1837, he served as Mayor of Buffalo and Governor of New York and was elected President in 1884 and again in 1892, making him technically the 22nd and 24th US Presidents. Cleveland holds the distinction of the only US President to serve two non-consecutive terms.

In June 1893, a few months into the start of his second term, Cleveland visited his personal dentist, Dr. Kasson C. Gibson, complaining of discomfort in his upper jaw. Dismayed by what he saw, Gibson arranged for Robert Maitland O’Reilly, the US Army’s attending surgeon and later US Surgeon General, to examine Cleveland’s mouth whereupon he discovered what he described as “an ulcerative surface nearly as large as a quarter, with cauliflower granulations, and crater edges with at least one sinus extending to the bone, which is apparently roughened” on the roof of the President’s mouth (R.M. O’Reilly to Joseph Bryant, June 19, 1893, William Williams Keen’s Material Related to the Operation of President Cleveland, 1893, 1915-1918, MSS2/0076-07, box 1, folder 1, Historical Medical Library of the College of Physicians of Philadelphia). In other words: Grover Cleveland had a tumor growing in his upper jaw. Understandably concerned, the President consulted with his personal physician, a doctor by the name of Joseph Decatur Bryant. When asked whether Cleveland should have the tumor removed, Bryant frankly replied, “It is a bad looking tenant. Were it in my mouth I would have it removed at once” (Joseph D. Bryant to Col. Daniel Lamont, May 9, William Williams Keen’s Material Related to the Operation of President Cleveland, 1893, 1915-1918, MSS2/0076-07, box 1, folder 4). A small collection of doctors along with Daniel Lamont, Cleveland’s Secretary of War, arranged to evict the President’s “bad looking tenant.”

However, secrecy was to be maintained at all costs. The American economy was in a tumultuous state in 1893. Speculation, especially over railroads, had been responsible for a series of severe recessions dating back to the infamous Panic of 1873. The 1870s and 1880s were characterized by high unemployment, inflation, and labor unrest. Another economic meltdown plunged the country back into recession in early 1893 (again brought upon part by railroad speculation), known now as the Panic of 1893. A year later, Cleveland himself would send federal troops to Chicago to put down a strike involving Pullman railroad workers. Cleveland feared news of his ill health would place greater strain on an already strained economy. As a result, he was emphatic that his tumor remain a secret.

A portrait of College of Physicians Fellow William Williams Keen

William W. Keen; Image Credit: NIH

Lamont, Bryant, and O’Reilly organized with a small group of medically-minded confederates to arrange for Cleveland to have his surgery on the Oneida, a yacht owned by a friend of the President named E.C. Benedict. Among the doctors involved was William Williams Keen. Keen was an extremely accomplished surgeon and a Fellow of the College of the Physicians of Philadelphia. Born in Philadelphia in 1837, Keen studied at Jefferson Medical College, served as an Army surgeon during the Civil War, and penned a paper with Silas Weir Mitchell (also a Fellow) on the treatment of gunshot wounds. After the war he became a pioneer in the study of brain surgery and was reportedly the first American to successfully remove a brain tumor. Along with Bryant, O’Reilly, and Keen, E.G. Janeway, John F. Erdmann, and Fred Hasbrook rounded out the rest of the team charged with removing President Cleveland’s tumor.

On June 30, 1893, Cleveland arrived in Jersey City, NJ, and from there boarded the Oneida where the surgical team awaited him. Bryant successfully removed the tumor, along with five teeth and part of his jaw, the following day. The President was by all accounts in good spirits given the situation, and he remained on the Oneida until July 5, when he returned to Gray Gables, his Cape Cod estate. By all outward appearances, he had just returned from a long Fourth of July vacation. When a second tumor was discovered several days later, Cleveland returned to the Oneida on July 17th to have the second growth removed.

Discretion was to be maintained at all times. Bryant removed the tumor using specialized tools that would allow him to remove it through Cleveland’s mouth. Rumors hold this was because he didn’t want to lose his trademark mustache, but it is just as likely Cleveland wanted there to be no physical evidence of his procedure. Gibson designed a hard rubber prosthetic to replace the excised section of Cleveland’s jaw, allowing the President to speak unimpeded. He also cast a mold of his jaw, followed by a second one several years later to monitor’s Cleveland’s healing progress. As for Keen, Bryant wrote to him on July 6, praising his efforts and re-affirming the need for confidentiality.

A July 6, 1893, letter from James D. Bryant to William W. Keen praising him for his work in Grover Cleveland's surgery and asking for his discretion

J.D. Bryant to W.W. Keen, July 6, 1893; used by the kind permission of the College of Physicians of Philadelphia, photograph by Kevin D. Impellizeri, Copyright 2017, The College of Physicians of Philadelphia

However, even the best-kept secrets, especially when they involve the Commander in Chief, can be found out. On August 29, 1893, Elisha Jay Edwards of the Philadelphia Press broke the story in an article bearing the provocative title “The President is a Very Sick Man” (journalist Matthew Algeo later used this as the title for his 2011 book covering Cleveland’s secret surgery). White House officials flatly denied the affair until September 22, 1917, when Keen published an article explaining the whole affair followed by a book later that year.

A jar containing parts of a tumor removed from US President Grover Cleveland

Today you can view both Cleveland’s tumor as well as a “cheek retractor,” one of the tools used in the procedure, at the Mütter Museum (Keen and Gibson donated the tumor to the College of Physicians of Philadelphia on October 5, 1917). The jar containing the Presidential mass offers a fitting reminder of the secretive circumstances that led it its removal. The jar’s label bears the warning, “Not to be photographed for newspaper or other similar public use.”

Until next time, catch you on the strange side!

Philly Teens Help Raise Awareness at National Black HIV/AIDS Awareness Day

Four students in the Teva Pharmaceuticals Internship Program stand behind a registration table at National Black HIV/AIDS Awareness Day

This past Saturday, the College of Physicians hosted a day of events devoted to National Black HIV/AIDS Awareness Day 2017 (NBHAAD), and students from the Teva Pharmaceuticals Internship and Out4STEM Programs were there to provide a helping hand.

The students offered outreach to visitors and helped register people for HIV testing (provided by Bebashi Transition to Hope, Prevention Point Philadelphia, The COLOURS Organization, and Q-Spot). Gloria Harley, an intern in both the Teva and Out4STEM Programs, joined ten other artists from The New Wave in a performance attended by over thirty Philadelphia teens.

Also attending the event were Dr. Loren Robinson, Deputy Secretary for Health Promotion and Disease Prevention of the Commonwealth of Pennsylvania and a Fellow of the College of Physicians of Philadelphia, and Pennsylvania State Senator Vincent Hughes who delivered speeches on HIV Prevention and a demonstration on condom use.

Group photo of Philly teens, students in the Teva and Out4STEM programs, artists from New Wave, and Dr. Loren Robinson and Senator Vincent Hughes at the 2017 National Black HIV/AIDS Awareness Day at the Mütter Museum on February 11, 2017

Overall it was a great day of HIV Awareness and artistic expression thanks to our distinguished guests and our dedicated interns! Most important, 85 people received HIV/AIDS testing (and earned free admission to the Mütter Museum in the process).

National Black HIV/AIDS Awareness Day at the Mütter: February 11, 2017

Four students in the Teva Pharmaceuticals Internship pose with signs displaying various facts about HIV/AIDS at World AIDS Day 2016

Did you know that the rate of HIV infection among African Americans is eight times that among whites, or that gay and bisexual men make up the majority of new infections among African Americans? February 7 is National Black HIV/AIDS Awareness Day (NBHAAD), a day for spreading awareness of the impact HIV plays in the African American community. The goal is to encourage more people to get tested and dispel the social stigmas surrounding the disease.The logo for National Black HIV/AIDS Awareness Day, a black field with a red and green strip running vertically along the left side and a white vertical bar along the right. The words FIGHT HIV/AIDS are printed in white block letters in the middle and the hashtag #NBHAAD appears in black block letters in the white bar

This Saturday, February 11, 2017, the College of Physicians of Philadelphia will be observing NBHAAD with a day-long event. We will be offering FREE HIV testing courtesy of Bebashi Transition to Hope and Q-Spot. Never taken an HIV test? Fear not, as the test is painless, takes only a minute (literally 60 seconds) and entitles you to FREE admission to the Mütter Museum. There will be live performances and information about HIV/AIDS to help expand your understanding of the impact of the impact of the disease. 51% of HIV-positive people don’t know they have it; help us spread the word about the disease and take a trip to the Museum! The event will take place from 10 AM to 4 PM.

Looking Back on PA Teen Health Week 2017

Philadelphia teens pose for a group photo with Dr. Laura Offutt at the Teen Health Week Party Photo: Hieu Pham

January 9-13, 2017, marked the second annual Pennsylvania Teen Health Week. To commemorate its conclusion, the College of Physicians of Philadelphia hosted Friday the 13th at the Mütter, a public event celebrating teen health. The event opened with remarks from Dr. George Wohlreich, CPP Director and CEO, followed by several Fellows who were actively involved in THW’s development, including Dr. Laura Offutt (host of “Real Talk with Dr. Offutt” and the driving force behind THW’s inception), Dr. Loren Robinson (Deputy Secretary, Health Promotion and Disease Prevention for the Commonwealth of Pennsylvania), and Dr. Robert Sharrar. A representative from the Philadelphia Mayor’s Office read Mayor Jim Kenney’s proclamation of Teen Health Week (a fitting bookend to Gov. Tom Wolfe’s proclamation from the beginning of the week).

Following opening remarks, several Philly teens took part in Teen Health Week Challenge, a teen health related quiz show. Hosted by Youth Program Coordinator Kevin Impellizeri, three teams of Philly teens put their knowledge to the ultimate test by answering questions related to teen health for the chance at fabulous prizes. It was a light-hearted conclusion to Pennsylvania Teen Health Week 2017.

We would like to thank the following sponsors who helped make Pennsylvania Teen Health Week 2017 a success: the Pennsylvania Southeast Region Area Health Education Center (AHEC)System of Care, a program of the Delaware County Department of Human Services; the Craig Dalsimer Division of Adolescent Medicine, Children’s Hospital of Philadelphia; and Honeygrow. Stay tuned for more teen health resources and we hope to see you all for Pennsylvania Teen Health Week 2018!

CEPI Now Accepting Applications for the 2017/2018 Out4STEM Program

Students from CEPI's various youth programs pose for a group photo on the steps of the PA State House with Dr. Rachel Levine and Dr. Loren Robinson

Students from CEPI’s youth programs (Out4STEM, Teva Pharmaceuticals Internship, and Karabots Junior Fellows) pose with Dr. Rachel Levine (front, left), the first transgender women to hold the office of Physician General for the Commonwealth of Pennsylvania, and Dr. Loren Robinson (front, center), Deputy Secretary for Health Promotion and Disease Prevention of the Commonwealth of Pennsylvania

Attention: Philadelphia 10th and 11th Graders! We are now accepting applications for enrollment in the Out4STEM Program. The Out4STEM Program aims to provide Philadelphia’s LGBTQ+ youth with STEM-centered mentorship, academic support and career advice in an inclusive, safe space.

This one-year program will address the unique challenges facing LGBTQ+ youth while providing a safe environment to learn about careers in science and medicine. The Out4STEM Program covers the following areas:

  • Introduce students to careers related to science, technology, engineering, mathematics, and healthcare/medicine.
  • Acquire practical job skills in a healthcare field by successfully completing a Phlebotomy Technician Certification (CPT)
  • Cultivate relationships between like-minded, motivated Philadelphia LGBTQ+ students.
  • Develop a greater understanding of the body’s physiological response to stress.
  • Facilitate stress relieving techniques.
  • Address the impact of bullying and discrimination and develop responses.
  • Learn to communicate, heal, and build a community.

The next cohort will start in March 2017 and continue through the 2017-2018 academic year. The program will consist of after-school sessions once a week (every 1st and 3rd Tuesdays) and summer sessions on select days in July.

10th and 11th grade students in the Philadelphia School District (including charter, private, and parochial schools) are eligible to apply. To be considered all interested candidates must complete an application, obtain one letter of recommendation from an adult affiliated with a related high school or after-school program (examples: a teacher, coach, counselor, principal, volunteer leader, or church or community leader), and submit a 1-2 page essay. Applicants must also obtain a Pennsylvania state work permit (more information on obtaining one can be found here) and receive permission from a parent or guardian. Note: There are no costs to enroll or be enrolled in the Out4STEM Program.

Completed applications can be submitted via email or standard mail to the following address:

Attn: Quincy Greene (Out4STEM Internship)
The College of Physicians of Philadelphia
19 South 22nd Street
Philadelphia, PA 19103

The deadline to apply is FRIDAY, FEBRUARY 17, 2017 (all mailed applications must be postmarked by that date to be considered). If you have any questions, please contact Quincy Greene, Youth Support Coordinator. For more information about the Out4STEM Program, please consult our website.

 

CEPI Curiosities: What Killed William Henry Harrison?

CEPI Curiosities: Tales from Medical History's Strange Side

Hello, fellow historio-medico aficionados, and welcome again to another installment of CEPI Curiosities, a monthly foray into the interesting and unusual of medical history. This time around, we are celebrating two milestones. For one thing, it is the first CEPI Curiosities of 2017. It also happens to be the one-year anniversary of this now staple of the CEPI Blog. Over the course of twelve months, it has been my pleasure to let you in on the inside stories of such topics as measuring faces for moral character, electrocuting faces for scientific research, stealing bodies for research, manufacturing bodies for profit, reanimating the dead using root vegetables, and the whereabouts of the skull of one of history’s greatest musicians. This is to say nothing of guest articles from our Karabots Junior Fellows on the difference between venom and poison, the unfortunate life of Harry Eastlack, Chevalier Jackson’s swallowed objects, and the exploits of Chang and Eng Bunker.

For our one-year anniversary, I felt it necessary and proper to go back to our roots: Presidential weirdness. If you recall our first episode, we covered the controversy surrounding the death of Zachary Taylor, which led to his body being exhumed in 1991 and tested for arsenic poisoning. Since today is inauguration day, allow me to shed light on what has to be one of the most unusual inauguration stories: the death of William Henry Harrison.

James Reid Lambdin's Presidential portrait of William Henry Harrison

Harrison is mostly known as a historical footnote these days, known primarily for holding the shortest tenure as president (32 days). Born on February 9, 1773, to a wealthy Virginia family, he went on to serve for twelve years as Governor of Indiana Territory where he gained popular distinction with an armed clash with Native American confederations at the Battle of Tippecanoe (November 7, 1811). He went on to serve in the US House of Representatives and the US Senate and earned the 1836 Whig nomination for president, losing to Democrat Martin Van Buren (electoral count 170-73).

He faced Van Buren again in a Presidential rematch four years later, this time defeating the incumbent (electoral college count 234-60) thanks in no small part to the Whig’s campaign strategies. Advocates for Harrison painted him as a war hero under the catchy slogan of “Tippecanoe and Tyler, Too.” Democrats criticized Harrison’s advanced age (67) and argued he should be put to pasture, not given America’s highest office; Democratic writer John de Ziska commented about Harrison, “Give him a barrel of hard cider, and settle a pension on him…he will sit the remainder of his days in his log cabin by the side of the fire and study moral philosophy!” The Whigs, in a move that should be familiar to modern audiences, spun the attack into a focal point of their campaign, casting Harrison, despite his aristocratic background, as a common salt-of-the-earth man who could connect to lower class and rural white voters (the campaign came to be known as the “Log Cabin Campaign”).

Harrison was sworn in as America’s ninth President on March 4, 1841 (US Presidents originally received the oath of office on March 4, until the passage of the Twentieth Amendment in 1933, which moved it to the current day of January 20). He proceeded to deliver a verbose, rambling, two-hour (8445 word) inaugural address, a speech that remains to this day as the longest inaugural address in Presidential history. Despite it being a cold, rainy day in March, Harrison refused to dress for the weather, foregoing hat, coat, and gloves, as he dispensed long paragraph after paragraph on the historic evolution of representative democracy and the basic duties of the government.

Lithograph depicting the inuaguration of William Henry Harrison

Source: Library of Congress

Roughly three weeks after his inauguration, Harrison began to feel unwell. On March 26, he called upon Dr. Thomas Miller, his personal physician, complaining of fatigue and dyspepsia. Initially, Miller prescribed rest; however, Harrison’s symptoms persisted and he began to experience chills, constipation, and severe pain followed by a heavy cough. Miller prescribed numerous remedies, including laxatives, enemas, and applications of mustard plaster to his stomach (a common 19th century treatment for numerous ailments, including pneumonia); he later blistered the President’s skin (to balance out his humours) and gave Harrison laudanum to relieve pain (a brief report of Miller’s treatment can be read here). Despite initial signs of improvement, his conditioned worsened over the course of the week; on April 3, 1841, at 8:45 PM, President Harrison succumbed to his illness, dying a mere thirty-two days after taking the oath of office. His death gave him the dubious distinction as the first US President to die in office (his death triggered a Constitutional crisis over how succession would work in the event of a President’s death, but that’s for another article).

Most historical accounts cite pneumonia as Harrison’s cause of death, laying the blame on Harrison’s advanced age and long inaugural speech in the cold without proper winter wear as the instruments of his demise.

However, recent scholarship has placed the pneumonia diagnosis into question. To understand why, you need to briefly understand how pneumonia affects the body. According to the American Lung Association, pneumonia is a respiratory disease caused by numerous factors (viruses, bacteria, fungal infection, complications from another respiratory illness such as influenza); whatever variety of the disease, when it infects the lungs, pneumonia causes air sacks called alveoli to fill up with fluid. This fluid buildup can restrict the amount of oxygen the lungs take in when a person breathes; that lack of oxygen can cause cell damage that can eventually be fatal. People of any age can contract pneumonia but it is especially serious when the patient is very young or very old. Symptoms include a heavy cough, fatigue, fever, chills, and difficulty breathing.

Some of Harrison’s symptoms, namely the chills, pain, and heavy cough may point to pneumonia. His advanced age would have made him more susceptible to infection and complications. Pneumonia’s incubation period (the period between infection and when symptoms begin to manifest) is between 1-4 weeks depending on the strain, so it is plausible he could have contracted it during his speech; remember, he reported symptoms to Dr. Miller on March 26 and it isn’t clear how long he was ill before that. However, pneumonia is a respiratory illness (affecting only the lungs) and would not adequately explain his gastrointestinal distress. Recent scientific studies have suggested cold weather may help contribute to illness; however, a person ultimately catches pneumonia from exposure to an infected person, and Harrison’s choice to forego gloves and coat might make him more susceptible to hypothermia (depending on how cold it actually was, and there is some debate over the actual weather conditions in DC on March 4, 1841) rather than pneumonia. Even Dr. Miller himself was reticent to conclude that pneumonia was ultimately what did in President Harrison. In a report in the 1841 edition of Medical Examiner, Miller expressed his doubts with his own diagnosis:

“The disease was not viewed as a case of pure pneumonia; but as this was the most palpable affection, the term pneumonia afforded a succinct and intelligible answer to the innumerable questions as to the nature of the attack.” (Thomas Miller, The Case of the Late William Henry Harrison, President of the United States, Medical Examiner, Vol. 4 (1841), pp 309-12.)

So if it wasn’t pneumonia, what killed William Henry Harrison? A pair of recent scholars have offered an alternative cause of death. Jane McHugh and Philip A. Mackowiak examined Miller’s report and conducted a differential diagnosis based on Harrison’s reported symptoms. In their 2014 report published in Clinical Infectious Diseases, they concluded Harrison’s constipation and abdominal pain pointed toward “enteric fever,” a gastrointestinal illness caused by either salmonella typhi  or salmonella paratyphi, better known as typhoid fever and paratyphoid fever, respectively. Both are spread through contact with contaminated food or water and cause high fever, cough, malaise, rash, and diarrhea or constipation.

Possible presidential assassin? Image Credit: Sanofi Pasteur, Used under CC BY-NC-ND 2.0

Possible presidential assassin? Image Credit: Sanofi Pasteur, Used under CC BY-NC-ND 2.0

As to where he contracted it, while Harrison’s speech may not have killed him, his living in the White House very well may have. McHugh and Mackowiak pointed to Washington DC’s lack of an adequate sewer system and the White House’s proximity to a marsh where much of the Nation’s Capital’s human waste accumulated. These conditions combined with general poor sanitation and cleanliness practices in the 1840s created breeding grounds for such diseases as cholera, dysentery, and enteric fever. They further offered these conditions as an explanation for two other Presidential deaths within ten years of Harrison: James K. Polk (cholera, 1849) and our friend Zachary Taylor (cholera morbis, 1850). According to their report:

There is ample reason to conclude that Harrison’s move into the White House placed him at particular risk of contracting enteric fever. In 1841, the nation’s capital had no sewer system (nor, for that matter, did any other American city). Until 1850 sewage from nearby buildings simply flowed into public grounds at a short distance from the White House, where it stagnated and formed a marsh. The White House water supply, which came from springs in the square bounded by 13th, 14th, I, and K streets NW [now known as Franklin Square], was situated below a depository for night soil that was hauled there each day from the city at government expense. This might explain why 3 antebellum US presidents, Harrison, James Polk, and Zachary Taylor, each developed severe gastroenteritis while residing at the White House. (Jane McHugh and Philip A. Mackowiak, “Death in the White House: President William Henry Harrison’s Atypical Pneumonia,” Clinical Infectious Diseases, Vol. 59 (October 1, 2014), 993-994.)

Following Harrison’s death, Vice President John Tyler ascended to the Presidency, where he was nearly killed in a cannon explosion in 1844. As we’ve already covered, Harrison’s son–John Scott Harrison–was stolen by resurrectionists and sold to an Ohio medical college after his death.

Until next time, catch you on the strange side!