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RENEE MONTAGNE, host:

The president of the United States remains easily the most watched person in America, and possibly the world. It's been that way for many years.

STEVE INSKEEP, host:

President Ronald Reagan waved on his way to a helicopter, and it appeared on TV screens all across the nation.

MONTAGNE: President Bush paused between words, and the camera lingered on his every breath.

INSKEEP: And it was national news when President Obama swatted a fly.

MONTAGNE: Yet, presidents have also managed to keep many secrets, and that includes a health secret that one president kept all through his administration. In July of 1893, President Grover Cleveland disappeared for five days. The writer Matthew Algeo explored what happened in a book called "The President is a Sick Man."

INSKEEP: What was wrong with Grover Cleveland?

Mr. MATTHEW ALGEO (Author): Well, shortly after he took office for the second time in 1893, he noticed a little bump on the roof of his mouth, and there was a lot going on in the country at the time. The country was actually entering a depression. Understandably, he didn't think too much about it. He had bigger things on his plate.

But around June, this lump in his mouth, he had noticed it had grown quite large, and the doctor diagnosed it as cancer. And he said it's a bad-looking tenant, and I would have it evicted immediately. But because the country was in such a panic at the time financially, Cleveland was afraid if it came to be known that he had cancer that Wall Street would panic, the markets would crash, that there would be terrible repercussions for the country and the economy. So he decided that he would have the tumor removed, but in secret.

INSKEEP: You've explained why it's a big deal that the president would be seen as being ill at this time of crisis. The very nature of the disease, I wonder if that's worth talking about. It would be a big deal today to have a sitting president diagnosed with cancer.

Mr. ALGEO: It would be a big deal today. It was an ever bigger deal then, because at the time, there was a stigma attached to cancer. Newspapers would call it the dread disease.

INSKEEP: How do you take a president of the United States, who is in such a public position, and perform an operation on him without anybody knowing? How do they go about trying to keep this a secret?

Mr. ALGEO: This was a matter of much discussion. They came up with an interesting plan. Cleveland had a friend who owned a yacht. The yacht was called the Oneida. And so they decided what we'll do is we'll say we're going on a fishing trip. And so they boarded this yacht. It was late June, in 1893. They boarded the yacht in New York and took four days to sail up to Buzzard's Bay on Cape Cod, where Cleveland had a summer home. And it was on that yacht this operation was performed.

They assembled a team of six surgeons. It took about 90 minutes. They used ether as the anesthesia, and they removed the tumor, along with about five teeth and a large part of the president's upper left jawbone.

INSKEEP: But it was all inside the mouth.

Mr. ALGEO: Yes. There were no external scars, because they were able to pull the mouth open wide enough to get to the tumor. Cleveland also had a very distinctive mustache. And he was very afraid that if anything happened to the mustache, people would know right away that something was up. So it was very important to Cleveland that, A, there be no external scars and, B, save the mustache.

INSKEEP: Isn't this an incredible risk? I mean, the president - I mean, even the most basic nature of this, if there's a sudden squall, you're trying to operate on a man, and suddenly there's choppy seas. Or if there's some complication, you are far away from a hospital. I mean, this is a big risk.

Mr. ALGEO: The doctors took incredible risks. I mean, it was really foolhardy. I talked to a couple of oral surgeons researching the book, and they still marvel at this operation, that they were able to do this on a moving boat. They did it very quickly - a similar operation today would take several hours. They did it in 90 minutes. So it was really an extraordinary achievement in American medicine, but it was a complete secret. Nobody ever knew it happened. Nobody knew what happened at the time, anyway.

INSKEEP: How did the secret get out?

Mr. ALGEO: Even in 1893, for the president to disappear for four days was rather unusual. So rumors began spreading that he was in bad health, and maybe there had been some sort of operation on the boat. It wasn't until about two months after the operation that a reporter for the Philadelphia Press found out about it through a friend of a friend, and he confirmed it with one of the doctors. And this reporter, E.J. Edwards, published a story about this.

But Cleveland denied it, and so nobody believed E.J. Edwards. He was dismissed as a disgrace to journalism.

INSKEEP: It wasn't just a matter of saying, oh, this isn't true. There was a whole campaign against the reporter.

Mr. ALGEO: To discredit the reporter.

INSKEEP: Well, how did the secret finally get confirmed? There was this report, but it was knocked down and denied. Nobody believed it at the time. How, ultimately, did it become a part of history that it definitely did happen...

Mr. ALGEO: Well, we wouldn't...

INSKEEP: ...that this president had cancer and was operated on?

Mr. ALGEO: We wouldn't know about it at all if it wasn't for one of the doctors. There was a doctor who took part in the operation. His name was Keen, William Williams Keen, and he was from Philadelphia. Twenty-four years after the operation, when all of the other principles were dead - there were only three witnesses left to the operation - and he decided it would be the right thing to do, to publish an article to explain what really happened and to vindicate E.J. Edwards.

INSKEEP: It is really interesting, though. You do uncover a letter here in which President Grover Cleveland wrote privately to a friend and essentially confesses to the fact that he lied. I wonder if I could get you to read a couple of paragraphs from that letter.

Mr. ALGEO: Yeah. Cleveland we don't know a lot about, but he was an inveterate letter writer. And this is the only letter I was able to find that talked about the operation. He wrote it to his friend, Thomas Bayard. He was the American ambassador to Britain at the time.

And Cleveland writes: The report you saw regarding my health resulted from a most astounding breach of professional duty on the part of a medical man -that's the doctor who admitted that the operation had taken place. I tell you this in strict confidence, for the policy here has been to deny and discredit this story. And he ends the letter and says: You have now more of the story than anyone else outside of the medical circle.

INSKEEP: Well, now, what does this story from 1893 make you think when you read about modern White Houses?

Mr. ALGEO: There's an interesting history of presidents and health. Woodrow Wilson suffered a stroke in his second term and was more or less completely incapacitated for the last 18 months.

INSKEEP: Covered that up.

Mr. ALGEO: Yes. Warren Harding had a terrible heart disease that was covered up, Kennedy with Addison's Disease. And it was interesting: I was researching Ronald Reagan. He had a couple operations for cancer. But Nancy Reagan insisted that the spokesperson, Larry Speaks, not mention the word cancer in any release or any statement anywhere. And this was a matter of great debate within the White House at the time. So even as late as the 1980s, this idea of the president having cancer carried some sort of stigma with it.

The other thing that's interesting is you think, wow, it would be impossible for a president to just go away and have a major operation like that and nobody know about it. And I did a little research, and apparently there is a fully-equipped operating room on Air Force One. So if a president did want to disappear for a little bit and have an operation, it actually might be easier to do today than it was in 1893.

INSKEEP: Air Force One might be a little smoother than being out on a boat.

Mr. ALGEO: I guess you would want to avoid turbulence, definitely, if you were doing a sensitive operation on Air Force One.

INSKEEP: Matthew Algeo is the author of "The President is a Sick Man." Thanks very much.

Mr. ALGEO: You're welcome.

(Soundbite of music)

INSKEEP: Of course, the secret was a little bit easier to keep before the 24-hour news cycle and the minute-by-minute, even second-by-second updates of social media.

MONTAGNE: President Obama takes on that reality today in his very first Twitter town hall meeting. Twitter founder Jack Dorsey will moderate the event, turning tweets into questions for the president.

(Soundbite of music)

MONTAGNE: And this is NPR News.

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