Dr. William W. Keen was the first major brain surgeon in America in the 19th Century. He lived long enough to have both served in both the Civil War, World War I, and become a consultant on Franklin Delano Roosevelt’s polio case in 1921.

Born on January 19, 1837 in Philadelphia, PA, he studied at Brown University in Rhode Island. His first degree was in literature in 1859. He spend an extra year at Brown preparing for his entrance into medical school in 1860. Dr. Keen, from the start, had the best of the best in American Medicine as teachers. His surgery teachers were Dr. Samuel D. Gross and Dr. Joseph Pancost. His anatomy course was from Dr. D. Hayes Agnew and his Physiology course from S. Weir Mitchell. In addition, he served in the offices of Dr. Jacob DaCosta (studied PTSD during the war) and Dr. John H. Brinton (served to build the Medical museum for the Surgeon General during the war).

Before graduating in 1862 from Jefferson Medical College, he had already served in the Union Army. Dr, Brinton assisted in his appointment after his first year of medical school as a replacement surgeon for the 5th Massachusetts Regiment. He joined the regiment in July of 1861 right before the Battle of Bull Run. Dr. Keen described the situation as thus: “I never received a single order from either colonel or any other officer, medical inspector, surgeon of my regiment or anyone else.” He further described the battle in the words of a correspondent as “Bull Run, They Run, We Run.” Soon afterwards his commission expired, as the regiment was a 90 day unit. Dr. Keen returned to medical school with this experience on the battlefield.

Graduating in March 1862, Dr. Keen took the exam and was approved as a medical officer. One of his first orders was from Dr. Letterman to go to the Ascension Episcopal Church and the 8th Street Church in Washington City and prepare them as hospitals within 5 days. A quick learner, Dr. Keen was able to understand the military red tape and complete the task in 3 days. On the 4th day, two hundred wounded were delivered to the new hospitals.

During 1862, he led a supply train to General Pope’s army, witnessed the Second Battle of Bull Run, the aftermath of Antietam and was finally ordered to Satterlee Hospital in West Philadelphia, PA. At Satterlee, he treated a man injured at Gettysburg who had been hit by a mini-ball. When the man died 56 days later, he did the autopsy, theorizing from the brain that a left side of the brain injury resulted in the right side convulsions of the man.

In 1863, at the suggestion of Dr. Weir Mitchell, he was ordered by Surgeon General Hammond to Christian Street Hospital which was devoted to injuries and diseases of the nervous system. In addition to Dr’s Mitchell and Keen, Dr. George Morehouse, a distinguished physiologist was assigned. This began a triad of doctors who studied neurological injuries both at Christian Street but also at Turner’s Lane Hospital when the former’s patients were transferred there. Dr. Keen, as the resident surgeon of the three, lived at the hospital. This hospital became the transfer location for stable patients with disorders of the nervous system.

Among the patients there, Dr. Keen indicated that, “…were representatives of every conceivable form of nerve injury, from shot and shell, from sabre cuts, contusions, and dislocations,” As the number of patients increased, so did the commonplace of the types of patients seen which would have been unusual in other hospitals. An example of this was that there were over 80 patients with epileptic seizures at any one time.

Dr. Mitchell planned the three doctors (he, Morehouse & Keen) to take extensive notes on the patients. These notes were turned into the monographs Reflex Paralysis: The Result of Gunshot Wounds (1864) and Gunshot Wounds and Other Injuries to Nerves (1864). Dr. Keen wrote On Malingering, Especially in Regard to the Simulation of Diseases of the Nervous System (1864).

His Malingering paper was almost 30 pages long, discussing feigned diseases of the nervous system and methods to uncover these “fakes.” He studied cases of alleged blindness, deafness, lameness, pain, insanity, back pain, paralysis, and epilepsy. One method was to anesthetize the patient and observe the feigned disease while coming out of the chloroform or ether. He indicated that many men showed that they were not injured using this method.

Dr. Keen, at the end of the Civil War, studied in Europe in both France, Austria, and Germany. Upon his return in 1866, he taught surgery at Jefferson Medical College and became the head of the Philadelphia School of Anatomy.

He even was involved in several editions of the Gray’s Anatomy textbook of the time. He continued his writings with over 60 of his over 400 publications covering neurological surgery including the brain, spinal cord, and peripheral nerves. During the 25-year period starting in 1876, he was the number one contributor to neurological research in America.

He performed the first modern cerebral surgery in 1887. The operation was performed at St. Mary’s Hospital. Everything was sterilized including the room and all instruments. His hands were cleaned with both soap and alcohol. Using ether, a hole was made in the skull, the mass found and the tumor removed. Not only did the patient live another 30 years after the operation, His epilepsy was improved and the patient was able to travel.

The doctor’s next case was even more dramatic. He used electric stimulation of the brain to locate the site in the brain of a hand tremor and excised (removed) the area, giving some relief to the hand of the patient and reduced his epilepsy.

In mid-June 1893, White House physician Dr. Robert Maitland O’Reilly diagnosed a large growth along the roof of President Cleveland’s mouth as a malignant tumor. Dr. Keen assisted a team of five doctors that performed a secret surgical operation to remove a cancerous jaw tumor on then President Grover Cleveland aboard Elias Cornelius Benedict’s personal yacht. The operation was kept secret because of its potential impact on the financial markets.

The United States had a banking panic start in February, 1893 and the start of a depression in the economy that would last until 1897.

Dr. Keen and four other doctors made their way to the yacht by boat from separate points in New York with Cleveland and Bryant boarding in the evening for the night aboard before sailing the next morning on a “fishing trip”. With calm weather, the surgery was done shortly after noon as the ship transited Long Island Sound.

The team removed the tumor and five teeth, as well as much of the upper left palate and jawbone.

The operation was performed using a special cheek retractor the Dr. Keen had brought home from Paris in 1866.

This secret operation was so successful that President Cleveland lived for 15 more years. The truth on the details of the surgery remained unknown for nearly twenty-five years.

Dr. Keen, with the permission of President Cleveland’s former wife, finally published his account of President Cleveland’s surgery in a Saturday Evening Post article on September 22, 1917.

Still writing in his 80’s, Dr. Keen wrote from his extensive study of World War I injuries, his volume The Treatment of War Wounds. He stated in this book that, “The only proper hospital to interfere surgically with a cranial wound is one in which facilities are skilled, in both neurologic and surgical, and the best x-ray apparatus, are to be had.”

Dr. Keen was called in as one of many doctors when FDR fell ill in the summer of 1921. Dr. Keen insisted the issue stemmed from a blood clot located in the lower spinal cord and recommended that he receive lumbar massages daily in order to help circulation. Days later, Dr. Keen thought that his earlier diagnosis was incorrect and instead he claimed the distress was being caused by spinal lesion, notified FDR.

The massage therapy continued but did not prove to be successful in curing the paralysis. On August 25, 1921, another physician, Dr. Robert Lovett, correctly diagnosed FDR with infantile paralysis (i.e. polio). At that time, polio had no known cure and often resulted in full or partial paralysis and the erosion of one’s motor skills.

Dr. Keen was one of the first surgeons to use Dr. Lister’s antiseptic surgery system. He helped to start a new era in surgery in America. His work on the nervous system and all branches of surgery was considerable. He inspired a whole generation of surgeons to their best. Perhaps the best thing said about him was, “He was a great man, a great American, a great surgeon, and the beloved Dean of our medical profession.”

Your obt. Servant

Dr. T.T. Steinbach USV