Hektoen International

A Journal of Medical Humanities

Mark Hanna’s knees and the Panama Canal

Michael Ellman
Chicago, Illinois, USA


Aficionados of the history of the Panama Canal know that at the end of the 19th century and the beginning of the 20th century, Nicaragua was to be the site for the “American” inter-oceanic canal. A Nicaraguan canal would be hundreds of miles closer to ports in the Gulf of Mexico and would bypass the need to purchase the Panama railroad and the French rights to build the canal in Panama, which at that time was a district of Colombia. The Walker Commission (also known as the Isthmian Canal Commission), was established by President McKinley to determine the most favorable canal route. After two years of field work it determined that Nicaragua was the “most practicable and favorable route” for the American canal.1,2 In 1902, the House of Representatives voted overwhelmingly to proceed with the Hepburn Bill, authorizing the construction of a canal in Nicaragua. Both the Republican Party platform in 1896 and the Democratic Party platform in 1900 insisted on a Nicaraguan canal, and the Nicaraguan government was eager to accommodate the Americans.1-3

How then did we come to build our canal in Panama, who was Mark Hanna, and what about his knees?

Marcus Alonzo Hanna (1837-1904) was a U.S. Senator from Ohio and a Republican Party powerhouse who believed that government existed primarily to help business. He became one of the first and most successful political fundraisers, bringing business leaders into the political arena and organizing them as a force for the Republican Party as no one had done before.3-5 Hanna was also credited with “making” McKinley President.4 He provided McKinley with money, advice, friendship, organization, and loyalty; in turn, the newly elected McKinley appointed Hanna senator, promoting the then current Ohio Senator, John Sherman, to Secretary of State.3

Hanna was a successful businessman with holdings in such varied enterprises as coal, iron, Great Lakes shipping, urban (Cleveland) railway, newspapers, opera house, and banks. His influence was such that that he was labeled the “Red Boss of Cleveland” (a reference to the colored smoke of his factories) by his adversaries. Cartoons of “Dollar Mark, the fat brother of the Trusts” were commonplace and in one cartoon he was depicted as a fat turkey.*

Hanna was a robust youth, briefly serving in the Union Army, but he contracted typhoid fever in 1867 when he was 30 years old that permanently affected his health. He developed heart disease and arthritis linked temporally with the bout of typhoid. Biographers talked about “a limping (sic) trip to Europe for Hanna’s rheumatism; his ailing legs; being a wheezy and rheumatic Senator; bent with rheumatism,” etc.3,5 But in spite of his infirmities, he was an active politician and energetic politician for McKinley, himself, and the Republican Party, even undertaking the chairmanship of the Republican National Committee in 1900.2,3-5

It was unclear how Senator Hanna became interested in the location of the American inter-oceanic canal. Philippe Bunau-Varilla, a past chief engineer of the French Panama canal effort, and self-appointed protagonist for the construction of the American canal in Panama, took credit for Hanna’s interest in Panama. Bunau-Varilla toured the United States touting the geographic and engineering advantages that Panama possessed. He received an invitation to meet Hanna in Washington and after several visits wrote that he had “completed his (Hanna’s) conversion to Panama.”3,5,7 Other forces were at work to further the Panama site, including the efforts of the effective lobbyist for the Panama Canal Company, William Cromwell.** Nevertheless, the House of Representatives passed the Hepburn Bill, 224 to 361 to proceed with a canal built in Nicaragua and the bill was rushed to the Senate for final approval.

Hanna was an infrequent and mediocre speaker, but was technically well-prepared for his Senate speech (June 5, 1902) favoring the Panama route. His leadership role in his party and in the Senate, even to the extent of being widely considered as a presidential candidate by the anti-Theodore Roosevelt political faction for 1904, attracted an excited crowd to hear his oration. His plain but forceful speech for Panama enumerated the engineering advantages such as the shorter transit time (33 hours versus 12 hours6), fewer turns, and the natural harbors that Panama possessed.8 In addition, Hanna (as did Cromwell and Bunau-Varilla), emphasized the worrisome presence of active volcanoes in Nicaragua (there were no volcanoes in Panama).1

It was a difficult time for Hanna as he was in poor health. He had spoken for an hour, but his legs were stiff, his face damp with effort until finally “his knees sagged” and he told the Senate President that “I am not able to continue longer . . . and (will) continue my remarks tomorrow.”2,3,5,8

Hanna finished his speech the next day and was interrupted so frequently that he finally told the Senate President: “I do not want to be interrupted, for I am very tired and I want to get through.” Hanna’s message did get “through.” His speech changed Senate votes, although it was supplemented by intense private lobbying that also drained his health—(Mrs. Hanna “fretted . . . and weeped and said Hanna was killing himself with this effort”3,5). Hanna warned that if the United States built the canal in Nicaragua, another power would complete the canal in Panama and usurp the dominant role of the United States in the Americas.3,7 The Senate vote was 42 to 34 in favor of Panama, contingent upon the purchase of the prior French construction and the future building rights for $40 million. The French Company later agreed to accept that sum. If there had been a difference in five Senate votes the Panama Canal would have been built in Nicaragua.


Herbert Croly, a contemporary journalist and political commentator, wrote that it was in 1899 that Hanna’s knees began to cause severe trouble. Chalky deposits were present in Hanna’s knees and fingers (this is one of the few clues as to the cause of Hanna’s arthritis except for the typhoid fever episode, but the source of the information was not provided by Croly). Croly stated, “No political leader of similar prominence in modern times has left such a skim (sic) public record.”3

The diagnosis of chalky deposits in the joints seemed likely made by X-ray. Wilhelm Roentgen had received the Nobel Prize in 1901 for his 1895 discovery of X-ray photography, and X-ray clinics were proliferating everywhere.9,10 Hanna was in Europe in 1899 at Aix-les-Bains for the baths, and possibly roentgenograms were obtained there, although X-ray clinics were already present in the United States.10

Calcific (chalky) articular deposits could be a result of chronic renal failure (calcific periarthritis), or due to an illness that was not to be formally described for almost another 60 years: pseudogout, or calcium pyrophosphate deposition disease.11 The latter illness is frequently encountered in the elderly (Hanna was 62 years old when the severity of the arthritis was mentioned), and is associated with several other disorders, especially hyperparathyroidism and hemochromatosis, both of which are associated with chronic ill health including fatigue and heart failure. The arthritis of pseudogout can be quite severe and episodic.

Typhoid fever can affect the joints causing septic arthritis and joint destruction (usually monoarticular arthritis), but chalky deposits would be an unusual sequela. True gout (sodium urate crystal deposition) may present with tophaceous deposits that are chalky on gross appearance, but gout was never mentioned by Hanna’s biographers. Furthermore, gout was well known to the physicians of his era, and Hanna was attended by such stalwarts as Sir William Osler.3,5

Hanna’s effective Senate speech made in the face of infirmity was instrumental in determining the site of the canal, which will mark the Centennial of its opening in 2014. The final treaty to build the canal in Panama was ratified by the Senate eight days after Hanna’s death from heart failure, but not before it was necessary for Panama to break away from Columbia. It was Philippe Bunau-Varilla, now representing the new Republic of Panama, who signed the treaty that granted the United States a zone in which to build the canal.1,2



*Mark Hanna still takes it on the chin. In a tongue-in-cheek article about the popular movie The Wizard of Oz, (Frank Morgan playing the Wizard), conceived as a political allegory on the monetary system of the late 1890s, Morowitz imagines the Wizard to be . . . not William McKinley, the President, but Mark Hanna, the chairman of the Republican National Committee, “who speaks through various figureheads and adheres to a purely Republican world view.” (Morowitz, HJ:Wizardry. Hospital Practice.1992;27:11:83-84)

**William Cromwell, the lobbyist for the Panama Canal Company, was aware that Nicaragua depicted active volcanoes on several of its postage stamps (the active volcano Momotombo was on the route of the proposed canal); but Philippe Bunau-Varilla took credit for sending one of these volcano-bearing stamps to every Senate member.6



  1. Mack G. The Land Divided. A History of the Panama Canal. New York, NY: Alfred A. Knopf: 1944.
  2. McCullough D. The Path Between the Seas. The Creation of the Panama Canal 1870-1914. New York, NY: Simon and Schuster; 1977.
  3. Croly H. Marcus Alonzo Hanna: His Life and Work. New York, NY: The MacMillan Co; 1912.
  4. Russell F. The President Makers. From Mark Hanna to Joseph P. Kennedy. Boston, MA: Little, Brown and Company: 1976.
  5. Beer T. Hanna. New York, NY: Alfred A. Knopf; 1929.
  6. Anguizola G. Philippe Bunau-Varilla. The Man Behind the Panama Canal. Chicago, IL: Nelson Hall; 1980.
  7. Bunau-Varilla P. The Great Adventure of Panama. New York, NY: Doubleday, Page and Co; 1920.
  8. U.S. Congressional Record-Senate Volume 35, June 5&6, 1902. Senate speeches by Senator Mark Hanna.
  9. Brecher E, Brecher R. The Rays. A History of Radiology in the United States and Canada. Baltimore, MD: The Williams and Wilkins Co; 1969.
  10. Grigg ERN. The Trail of the Invisible Light. Springfield, IL: Charles C. Thomas; 1965.
  11. McCarty DJ, Kohn NN, Faires JS. The significance of calcium phosphate crystals in the synovial fluid of arthritic patients: The “pseudogout syndrome.” I. Clinical aspects. Ann Intern Med 1962:56;711-737.



MICHAEL ELLMAN, MD, MACR, is a retired physician, formerly professor of medicine and rheumatology at the University of Chicago. His military service was spent as a preventive medicine officer in the Canal Zone between 1965-1967. Ellman has also written several works of fiction, which have appeared in Front Porch Review, Hektoen International, Third Wednesday, and Black Heart Magazine. His Great American Novel about a third-year medical resident during the early 1960s is in search of a publisher.


Highlighted in Frontispiece Summer 2013 – Volume 5, Issue 3

Summer 2013  |  Sections  |  History Essays

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