BECAUSE A PRESIDENT is assumed to have access to the best physicians, hospitals and medical technology, the dispute over whether President Reagan received the proper tests early enough might seem surprising -- but the problem is not new. In earlier days, physicians did not have the quantity of detailed medical information about the president's treatment about which they could speculate. Questionable practices were buried from public view.
President James A. Garfield is the first example of inappropriate medical care that comes to mind, but he is hardly alone. To one degree or another, Presidents Grover Cleveland, Woodrow Wilson, Warren G. Harding, Franklin D. Roosevelt and John F. Kennedy each received inappropriate medical treatment.
After Garfield fell wounded from an assassin's bullet in the back, one of the first physicians on the scene took control of the treatment and fired every doctor critical of his practices. Dr. Willard Bliss violated the antiseptic standards even of 1881 by inserting his bare finger into Garfield's wound, introducing infection, and then compounded his error by irrigating the wound with a catheter that ultimately was inserted to a length of 14 inches in the wrong direction.
As far away as Germany, eminent surgeons denounced this treatment and argued that without it Garfield would probably have survived. These opinions were confirmed when the pathologist in his autopsy found the bullet harmlessly encysted.
Cleveland needlessly underwent radical surgery to remove what his doctors incorrectly believed was a jaw cancer. Because of an inadequate biopsy, the doctors assumed the worst, pulled two healthy teeth and sawed off a substantial portion of Cleveland's jaw. The suspected cancer turned out to be a benign mouth wart caused by heavy smoking and poor oral hugiene.
Unlike Garfield and Cleveland, Wilson suffered from a paucity of medical care rather than excess. His doctor's training consisted of nine months of medical school which left him unprepared to diagnose and treat Wilson's first stroke at the Paris peace conference in April 1919.
The doctor believed Wilson's stroke was influenza, although others in the presidential party recognized that Wilson was suffering from an illness more serious than flu. Only when Wilson became paralyzed in the White House six months later did the doctor seek consultation with qualified specialists.
Harding's physician, who had even less training than Wilson's doctor, failed to recognize Harding's worsening heart condition, as evidenced by blue lips and progressive shortening of breath. When Harding suffered his fatal heart attack, the doctor diagnosed his illness as indigestion from eating bad crab meat.
Roosevelt's inactivity from polio and heavy smoking made him a candidate for high blood pressure and arteriosclerosis, well-known even then. But Roosevelt's physician for his 12 years in the White House was an ear, nose and throat specialist who continually treated with nose drops the symptoms he did not recognize.
When FDR's family expressed concern about his sitting for long periods with a glassy-eyed expression and his mouth open, the doctor dismissed their apprehensions. At the 1945 inauguration, during which Roosevelt suffered an angina attack, Woodrow Wilson's widow remarked that FDR resembled her husband before his paralyzing stroke. The doctor said he was the picture of health.
After the president's death caught the public by surprise, the medical profession attacked the White House doctor for being incompetent, a liar or both.
Kennedy received treatment from a doctor who later lost his medical license because of patient deaths from intravenous injections of amphetamines and cortisone. Among those killed was a Kennedy family photographer.
As the public demand for information about presidential health increases, controversy over medical treatment of the president is likely to intensify.
Reagan, who contends his health problems are private matters between himself and his doctor, is fighting a losing battle for privacy. Although he has disclosed more health information than any previous president, such disclosure is not the problem that the president perceives because it can only improve the quality of the care he receives.