BJS Bookshelf: Presidents Under the Knife by Per-Olof Hasselgren

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This extraordinary work is a combination of biographies, histories and surgical case reports of 9 American presidents that have undergone surgery in extraordinary circumstances while in office. The prose encompasses brief biographies of these American presidents across the spectrum of the history of United States. It also includes the pertinent history of America in those times. And, in the context of both the history and the biographies of Washington, Jackson, Garfield, Cleveland, McKinley, FD Roosevelt, Eisenhower, LB Johnson and Reagan, the author brings us to the point that each of these presidents ultimately underwent one or more significant operations. We also learn about how the private health of the most public of people in the US has an impact on all of us throughout history. In addition, for us surgeons, we learn a bit more about the details of the operations and the outcomes that non-physicians/surgeons might not find as interesting.

This work could not have been created without passion and expertise in Medicine, in particular Surgery, History in particular medical history and a unique skill with digestion and synthesis of complex consequences of individual events on current society and future history.

As surgeons we are aware of what impact our work, successes and failures, has on our individual patients and their families. Some of us may be fortunate enough to operate on a prominent politician or a celebrity. However, rarely do any of us have the opportunity to imagine that our care for an individual person no matter how great or common, would have an impact on the nation as a whole or any future history. Anyone, but especially surgeons, will read this book with great interest to learn and understand how history and politics can come together focused around interventions for injuries and illnesses of influential individuals.

Although this book is a combination of biography and history, there are lessons in the case reports that can teach even the experienced surgeon about the conditions, treatments and the ethics involved in the care of presidents that could have benefits in our own practices.

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Presidents Under the Knife offers readers a fascinating, in-depth look into the surgical care provided to the nine presidents who underwent surgery—or, in some cases, multiple surgeries—while in office, from George Washington to Ronald Reagan. Written in an engaging style for the layperson and medical professional alike by a Harvard surgeon with a longstanding interest in American medical history, this book offers a surgeon’s perspective on the operations performed on U.S. presidents and the decision-making processes and skills of the surgeons who performed them.

Significantly, the book presents the political and economic landscape that led to the often-extraordinary measures, some of which posed additional risks to the patient, to hide the president’s condition and treatment from the press and the public. Most notable, perhaps, was the operation to remove an oral tumor from President Grover Cleveland that, to ensure secrecy, was performed by a team of surgeons aboard his yacht as it sailed along the Long Island coast.

As the book’s subtitle states, not all operations, like that of Ronald Reagan after the attempt on his life, were a success. Indeed, some were utter failures resulting in the president’s death. The author recounts the treatment of President James Garfield, for example, who died not as a result of the bullet fired by a deranged political opponent but rather, many painful weeks later, from widespread infection caused by the dirty fingers of his surgeons, who knew of but refused to employ the antiseptic practices introduced by the English surgeon Dr. Joseph Lister.

Throughout, this reader was often struck by the stoicism of the presidents, some of whom endured terrible pain in the era before anesthesia, and the courage and commitment of many of the surgeons, whose successes—or failures—would impact the rest of their professional lives and, in no small measure, the course of history.

Surgeons who are interested in the history and evolution of their profession will enjoy and benefit from reading this book, as will those who simply like reading about American history. What makes this book especially relevant to surgeons is that it was written by an experienced Professor of Surgery at Harvard Medical School, who offers an expert’s perspective on each featured president’s case, while providing critical context about the knowledge and resources available to surgeons at the time.