Cleopatra’s nose, Wood’s brain tumor

Blaise Pascal, in his posthumously published work “Pensees” (Thoughts), said of Cleopatra’s nose: “Had it been shorter, the whole face of the world would have been changed.” Historians who order the universe in a linear fashion and consider only the deeds of great men may disagree with the musings of the 17th-century French mathematician, but then how different would Western history be if Julius Caesar and Marc Antony were not charmed by Cleopatra? How different would Philippine history be if Manuel Luis Quezon was not killed by TB and Leonard Wood by a brain tumor?

I made reference to Leonard Wood’s brain now preserved in Yale University as a teaser for a follow-up on medicine and history, and was elated to receive an e-mail from Dr. Jose A. Aguilar, vice president of the Academy of Filipino Neurosurgeons, whose expert opinion reads:

“My interest in General Leonard Wood concerns his medical or neurosurgical condition. Wood was a patient of the greatest neurosurgeon of the 20th century, Dr. Harvey Cushing. The collection of about 400 preserved brains at Yale Medical School was a legacy of Dr. Cushing, who undertook to collect the brains of his patients who died of various brain tumors, including the brain of the famous General Wood [who] suffered from a benign brain tumor (meningioma), and was operated on three times, the last two by Dr. Cushing.

“It is interesting to note that Wood’s brain tumor started to manifest itself when he was governor of the Moro province in the Philippines in 1902 and when he was conducting one of the most brutal American military pacification campaigns to subdue the Filipino Muslims, resulting in more than 1,500 Moro casualties including women and children. One can only speculate now whether Wood’s brain tumor had a role in affecting his aggressive intolerant behavior or controversial military decisions in [the Battle of Bud Dajo in March 1906.]

“In October 1904, while still in the Philippines, Wood had a seizure and when examined by a divisional surgeon, was noted to have a left-sided weakness and a protuberance at the right side of his head near the vertex, prompting his return to the United States for medical evaluation and treatment. In 1905, Dr. Arthur Cabot of Boston did a limited excision of his brain tumor, mainly involving the skull and without opening the dura, the brain’s tough external membrane covering. Dr. Cabot decided not to go after all of Wood’s brain tumor because of the very high mortality rate for brain surgery at that time. Wood returned to the Philippines but in 1909, had a recurrence of his left-sided weakness and had to go back to the U.S. to consult Dr. Cabot who then referred him to Dr. Cushing.

“The second surgery (in two stages) was done in 1910 at the Johns Hopkins Hospital by Dr. Cushing who reluctantly agreed to do an exploratory brain surgery (craniotomy) on his already famous patient. The surgery was a success and Dr. Cushing removed the general’s brain tumor with the patient recovering completely from the operation. This was the first time that such a dangerous brain surgery for this type of brain tumor had been performed successfully and Dr. Cushing’s fame as the foremost brain surgeon in the world was ensured.

“Unfortunately, Dr. Cushing had no way of knowing that the tumor had also infiltrated the bone which he had put back after the surgery and that the tumor (meningioma) originated from the dura which he also failed to excise after removing the visible tumor. The tumor recurred years later leading to a third and fatal surgery [resulting in] Dr. Cushing blaming himself for Wood’s death. However, before the tumor recurred, Wood was able to return to his political work and even attempted (and failed) to become the Republican presidential candidate in 1920. The US president, Warren Harding, his co-Republican, asked Wood to return to the Philippines as Governor-General to address the corruption and anti-American sentiment prevailing in the American colony. Wood then spent six years in the Philippines (1921-1927), during which his disability gradually returned due to brain tumor recurrence. Wood’s physical and mental deterioration was obvious to his close subordinates, and the previously physically powerful man became fat and unable to exercise. He became very difficult to get along with and was ‘overbearing, tactless, and intensely jealous of the prerogatives of office.’ He also became paranoid and refused to meet with any Filipino without a white man present. This illustrates the possible behavioral effects of his recurrent brain tumor.

“Wood returned to the US in 1927 when his physical and mental faculties had markedly deteriorated. When Dr. Cushing saw him before his final surgery, he observed that Wood was ‘bloated in body and face … crumpled up on a couch with face distorted, eyes almost closed, a grotesque and pitiful figure.’ His third and last brain surgery done in August 6, 1927, by Dr. Cushing at Boston’s Peter Bent Brigham Hospital was fatal. Cushing warned his surgical team that they were in for a ‘desperate procedure’ and true enough, he struggled for several hours trying to stem torrential bleeding in trying to excise a large recurrent tumor which had become adherent to critical brain structures. Although Dr. Cushing, by sheer skill and heroic effort, was able to remove the tumor and control the bleeding, Wood eventually succumbed to a recurrent hemorrhage several hours later.” To be concluded

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