Medical Treatment of President McKinley
The President was of a nervo bilious
temperament and took on fat (fatty infiltration), becoming quite
obese. This condition of the body tells of a forceful, if not rapid,
heart that sooner or later causes cardiac hypertrophy, dilation
and fatty degeneration as well as infiltration. We are told that
when nervous he had a very rapid heart.
Such a body was wounded at short range
and he fell, or would have fallen had he not been supported. That
tells us that the heart’s action was arrested. He was shot [a]t
4:07 p. m. and the pulse record at 4:45 p. m. was 84. (We quote
from the official record). The ball entered the abdomen at the left
of the median line about half way between the left nipple and the
umbilicus, taking a downward, backward and outward direction. At
4:30 p. m. he was given hypodermically .01 gm of morphine and .002
gm of strychnine. He had no particular pain and soon was under the
influence of the opiate. (Why was it given)? At 5:29 the operation
began under ether. The incision began at the ribs and was nearly
parallel with the median line of the body. The stomach was wounded
twice, the ball passing through the great curvature, [s]lightly
wounding the kidney and, it is thought, the pancreas. At 5:38 p.
m. .002 gm strychnine was again given. At 5:55 the respiration was
32, pulse 84, both of good character. At 6:09 the pulse was 88;
at 6:20 it was 102, fair, respiration 39. At 6:22 was administered
1.50 gm of brandy. At 6:48 the pulse was 124, the tension good,
but quick; respiration 36. At 6:50 the operation was completed.
At 7:01 the pulse was 122 and the respiration 32. At 7:17 there
was given .04 of morphine. At 7:32 the patient was removed to the
private residence of Mr. Milburn. In suturing the stomach, part
of its contents escaped into the abdomen, but was carefully mopped
out. We are told that introducing the arm into the cavity had a
bad effect upon the pulse. The pulse at this time was 127, temperature
100.6 and respiration 30. At 8:28 he was given .016 gm of morphine.
There was slight nausea. During the night he slept at intervals,
vomited occasionally, but rallied satisfactorily; occasional slight
pain. An enema of salt solution was given and retained; slept free
Second day, 6:00 a. m., temperature
102, pulse 110, respiration 24; expelled gas in large amount; saline
enema.  During forenoon .01
gm morphine was given. At 1:15 p. m. saline enema 500 c. c. As the
pulse was rising .06 gm fl. ext. digitalis was given hypodermically.
At 6:30 p. m. the patient complained of intense pain in the epig[?]stric
region, and .08 gm morph. sulph. was given. He was very restless,
after sponging rested again. Now pulse 130, temperature 102[.]5,
respiration 29. During the day the digitalis, morphine and saline
enemas were kept up at regular intervals. (How much and how often
record does not tell). At 10:3 comatose [sic] 4 gm was
given with enema. At 11:15 p. m. stool, greenish colored fluid,
Third day, restless, confused, a little
chilly. Digitalis was continued. (How much and how often record
does not state). At 7:45 strychnine, .002 gm was given. At 8:20
pulse strong and of good character; at 8:30 the record states that
the pulse was 132, temperature 102.8, respiration 24. There was
some oozing and the bullet track was syringed with peroxide of hydrogen.
At 10:4 enema of Epsom salts, glycerine [sic] and water
brought away some gas and small stool; at noon another. Pulse 128,
temperature 101, respiration 27. At 4:45 he was given a teaspoonful
of water and an enema of sweet oil, soap and water. That
produced a slightly colored fluid, some fecal matter and mucus[.]
After this he had a small quantity of water and at 6:2 a nutritive
enema of egg, whiskey and water, which was partly retained.
Digitalis and strychnine were both given during the evening. At
9:00 p. m. pulse was 130, temperature 101.6, respiration 30. During
the day 42[0?] c. c. of urine was passed. The urinalysis showed
[a] specific gravity of 1.26, with strongly acid reaction, with
but a mere trace of albumin and no sugar. Indican, however, was
abundant. The other constituents were normal. Microscopic examination
showed a few small, finely granular casts and many large crystals
of uric acid and bacteria.
Fourth day, Monday, Sept. 9, the bulletins
at 6:00 and 9:30 [a]. m., 3:00 and 9:30 p. m. recited that the President’s
condition steadily improved throughout the day. His pulse dropped
from 120 to 112 and his respiration rose from 26 to 28, temperature
remaining practically constant at 101, varying but .2 of a degree.
Codeine was substituted for morphine, and the digitalis and strychnine
were stopped. Nutritive enemas were given at 3:20 a. m. and 4:30
and 10:00 p. m. Following a small dose of calomel and a high enema
of oxgall he had a large, partly formed stool. The third urinalysis
showed a decrease in indican and uric acid crystals and no other
Fifth day, Tuesday, Sept. 10. The
President passed the most restful night since he was shot. On awakening
his mind was clear and he was cheerful. The nutritive enemas were
kept up and water was given by the mouth. The only medicine was
one dose of cod. phos. .015 gm. In the evening the dressings of
the wound were examined and it was thought best to remove four stitches
and separate the edges of the wound. There was a little slough near
the bullet track an inch wide. The separation extended down to the
muscle. Otherwise the surfaces were healthy but not granulating.
The parts were packed with iodofom [sic] gauze and closed
with adhesive straps.
Sixth day, Wednesday, Sept. 11. The
President rested well and took beef juice with great satisfaction.
His temperature stood at 100.2 all day, pulse was regular at 116,
but rose to 120 at night. The blood count was, leucocytes [sic]
9752; red cells 3,920,000. At 10:00 a. m. the wound was redressed
and  seemed to be doing well.
The patient slept much during the day and seemed comfortable. The
rectum would not contain the enemas. The fourth urinalysis showed
a larger quantity (750 c. c.), an increase in albumin, indican and
cylindroid cells, but no other change.
Seventh day. The President now seemed
at his best and his condition appeared to justify the most favorable
prognosis. The beef juice was continued with the addition of a little
chicken broth. He also had some whiskey and water. At 8:30 a. m.
he was given chicken broth, a very small piece of toast; and a small
cup of coffee. He ate but a little of the toast. The only unfavorable
symptom was the rapid pulse, but it was known that it was naturally
high and easily excited. [Nervous tobacco heart]. At noon the pulse
weakened and an infusion of digitalis, 8 c. c, and strychnine, .002
gm, was given. In spite of this the pulse went to 130 and grew weaker.
At midnight, however, the unfavorable condition was improved. The
fifth urinalysis showed the indican to be decreased and the earthy
phosphates to be much increased.
Eighth day. At midnight the pulse
was fairly good, 132. Strychnine and whiskey were given at intervals
and hypodermics of camphorated oil. At 2:50 a. m. his condition
gave rise to the gravest apprehension, and his heart did not respond
to stimulation. At 10:00 a. m. two pints normal salt solution were
given under the skin and one pint containing adrenalin [sic].
At 3:00 p. m. nitroglycerin and camphor were injected at various
times, together with brandy and strychine [sic]. At 3:30
p. m. his pulse grew weaker and at 5:00 oxygen was administered.
At 6:30 p. m. the last bulletin was issued, saying that unless the
profound depression could be relieved his death must sh[o]rtly supervene.
At 10:00 the President lost conciousness [sic] and the oxygen
was discontinued. He became weaker and weaker and died at 2:15 a.
m., September 14, 1901.
The post mortem showed necrosed tissue
along the track of the bullet and at the top of the left kidney.
In this region was a large, irregular cavity, “the walls of which
were covered with a grey, shiny material, in which were found fragments
of nercrotic [sic] tissue.” The heart “was covered with a
well developed panniculus.” It was soft and flabby. The mitral valve
admitted three fingers. [Two fingers only can be admitted through
the normal mitral valve. This shows dilation]. The muscular tissue
was infiltrated with fat, also showing fatty degeneration and brown
In reading the above abstract of the
official record, the inquiry arises, why an enema was not given
before the operation, and also why morphine and strychnine were
given before the operation. These are anti-dotal drugs and if one
was indicated the other was not. The old idea of digitalis
was followed, and the case did better when its use was stopped.
The frequent enemas must have annoyed and weakened the patient.
He did not need nourishment. The gases could have been drawn off
with a catheter. The giving of calomel was a sad mistake; the same
can be said of the food by mouth and the castor oil on the seventh
day and at noon of the eighth.
The medical treatment of this case
savored of the old, old school. We have wondered what would have
been the result had he been given staphisagria after the
operation, and small amounts of water, leaving the bowels alone.
What have our surgeons to say?
This case is a striking illustration
of the fact that the most brilliant operation 
may fail when the medical management is not equal to the surgical.
We cannot overlook the fact that the weakened tobacco heart made
the subject a bad one.
The small doses of medicine given
show a progress in old school therapeutics, but they are still guided
by contraria. It is to be regretted that modern scientific medicine
(Homœopathy) could not have been summoned to help save the life
of such a great and good man.