The Assassination of President McKinley

     The whole world stood aghast when the wires flashed the news that the hand of the assassin had been raised against so estimable and amirable [sic] a man as Mr. McKinley. The wounds did not prove fatal until a little more than a week, and from the hour of his injury until death closed the scene, bulletins were issued at short intervals from Mr. McKinley’s sick room, and were eagerly read by a sorrowing and sympathetic people the world over.
     We gather the following facts from the Medical News, a member of whose staff was sent to Buffalo and interviewed directly the medical men connected with the case. The President was wounded shortly after 4 o’clock on the afternoon of Sept. 6, 1901, while holding a public reception in the Temple of Music on the grounds of the Pan-American Exposition. Czolgosz, the assassin, carried his pistol (a short, 32 calibre, “bull dog”) in his right hand, his right arm being carried across his chest as though in a sling. In straightening the arm to fire its general direction was downward. The President was immediately conveyed to the Emergency Hospital on the Exposition Grounds and placed upon the operating table, where he remained awaiting the arrival of Dr. Matthew D. Mann, who was summoned in the absence of Dr. Roswell Park, who was absent at [377][378] Niagara Falls, but who arrived before the operation was completed. On seeing that the first shot penetrated the abdominal cavity, (the second struck the sternum and did not penetrate the skin) Dr. Mann at once ordered ether administered and prepared himself to do a laparatomy [sic]. An incision was made (just an hour and a quarter from the time the wound was inflicted) through the bullet wound, when it was found that the stomach had been perforated in the neighborhood of the greater curvature, the anterior opening being small with sharp inverted edges. The posterior opening was large and more irregular, but its edges were also inverted, and the amount of leakage was not great, although the stomach was about half full. Both openings were closed with Lembert sutures, to reach the posterior wound the stomach being turned upward and backward to avoid contact with the intestines. No other visceral wounds could be found. There was practically no hemorrhage. The abdomin [sic] was thoroughly flushed out with normal salt solution and closed up without drainage. The patient was under ether about an hour and a half. The bullet was not found and was supposed to have lodged in some of the muscles of the back.
     The President’s condition gradually improved, the temperature reaching 103° F., but gradually reducing until it reached 100° F. on Sept. 10th. On the night of this date, as there was increasing tenderness in the wound, the dressings were removed and there was found a small collection of pus along the edge of the wound. The pus was evacuated and found to be due to a small piece of clothing which had been carried into the wound. After this dressing the President became more comfortable, and the bulletins were very encouraging.
     These did not continue long, however, for on the 13th the word was sent out that the patient’s heart action was very unsatisfactory. Each bulletin brought more unfavorable news until the end came at 2:15 a. m. of September the 14th. The autopsy showed the wounds in the stomach wall had healed, but the tissues about them had become gangrenous. There was found also a wound of the pancreas and of the kidney. These tissues were likewise gangrenous. The bullet was not found.
     The distressing outcome of this case is greatly to be deplored, and will doubtless give rise to much discussion if not criticism. There was nothing but praise, and deserved praised [sic], of the surgeon who so promptly realized the importance of entering the abdominal cavity in the presence of a penetrating wound, and who so boldly proceeded to act upon his judgment. No one, probably, will deny that it is the surgeon’s duty, in all cases of penetrating wounds of the abdomin [sic], to enlarge the [378][379] opening already made and determine the presence or absence of injury to the viscera, and to do this promptly before the absorption of poisons and the onset of peritonitis. To await the development of symptoms is to lose precious time and allow the enemy to fortify itself. It is extremely unfortunate, however, that the serious lesions of the pancreas and kidney should have been overlooked. The time spent in the operation, one hour and a half, is evidence that search was made for further injury, for so much time could not have been consummed [sic] in repairing the two small wounds of the stomach. It is very difficult to thoroughly inspect the deep organs in the upper abdomen, especially through a small opening, and considering the importance of the personage upon whom he was operating, one can readily understand the hesitation of the surgeon in making the opening sufficiently large to permit a more through [sic] investigation, and yet this very fact made the necessity for thoroughness the more urgent. Whether or not it would have been possible to repair the injuries to the pancreas and kidney so as to have averted the fatal termination we cannot say, but it would have reflected more credit upon surgery if the diagnosis had been made anti-mortem [sic] and less sanguine views regarding the outcome of the case expressed. More impressive teaching oftimes [sic] comes from failure than from success, and that brought out in this instance is the importance of knowing that organs are intact, and not to surmise that they are because of the absence, at the time, of symptoms. As to the cause of the gangrene along the route of the bullet, further investigation will be necessary to determine it, but we cannot accept the theory of one of the surgeons that it was due to poisoned bullets, but think a more plausible reason would be the destruction of vitality in the tissues immediately about the track, owing to the slow progress of the missile followed by the disturbance of the nervous system, due to what Dr. Mann calls “solar plexus irritation.”