The President’s Case

     We present below the result of the autopsy on the president and opinions of his surgeons. We have great faith in the surgeons, and believe they did all that could have been done for his ultimate recovery. They have our profound sympathy in that they did not succeed. Who could have done any better? The great advances in surgery during the last 20 years led us to hope President McKinley would be spared to us, as a result of the application of modern methods. No one could have foretold that no effort whatever at repair would be made and that gangrene would supervene. The surgeons in charge of the case, Drs. Park, Mann, Mynter, Wasdin and Stockton, say positively [305][306] that there was no disagreement among themselves and that any publication to the contrary is false:
     “The bullet which struck over the breast bone did not pass through the skin and did little harm. The other bullet passed through both walls of the stomach near its lower border. Both holes were found to be perfectly closed, but the tissue around each hole had become gangrenous. After passing through the stomach, the bullet passed into the back walls of the abdomen, hitting and tearing the upper end of the kidney. This portion of the bullet’s track was also gangreous [sic], the gangrene involving the pancreas. The bullet has not yet been found. There was no sign of peritonitis or disease of other organs. The heart walls were very thin. There was no evidence of any attempt at repair on the part of nature and death resulted from the gangrene which affected the stomach around the bullet wounds as well as the tissues around the further course of the bullet. Death was unavoidable by any surgical or medical treatment and was the direct result of the bullet wound.

                                                                                        HARVEY D. GAYLORD, M. D.,
                                                                                        HERMAN G. MATSINGER, M. D.,
                                                                                        P. M. RIXEY, M. D.,
                                                                                        MATHEW D. MANN, M. D.,
                                                                                        HERMAN MYNTER, M. D.,
                                                                                        ROSWELL PARK, M. D.,
                                                                                        EUGENE WASDIN, M. D.,
                                                                                        CHAS. G. STOCKTON, M. D.,
                                                                                        EDWARD G. JANEWAY, M. D.,
                                                                                        W. W. JOHNSTON, M. D.,
                                                                                        W. P. KENDALL, Surgeon, U. S. A.,
                                                                                        CHARLES CAREY, M. D.,
                                                                                        EDWARD L. MUNSON,
                                                                                                     Assistant Surgeon U. S. A.,
                                                                                        HERMANUS L. BAER, M. D.

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     Dr. Matthew D. Mann, the surgeon upon whom fell the responsibility of operating upon the President immediately after he was shot, in the course of a cursory talk said:
     “First of all, there was never any contention or unseemly discussion among the physicians as to the method of treatment of a case similar to the present one in importance. In no case was there ever a better understanding as to what should be done. We worked together as one man. There were honest differences of opinion among us sometimes as to which was the [306][307] better mode of procedure under certain conditions, but the minority always were convinced.”
     About the criticisms that were made as to the insufficiency of the original examination and the failure to locate the bullet at the time of operation, the doctor was asked, “were they justified?”
     “I think the report made to-day,” Dr. Mann replied, “is a sufficient answer to your question. It shows very plainly that the location of the bullet had nothing to do with the final outcome of the case. That resulted from gangrene which appeared in the path of the bullet. Even our efforts to-day to locate it, as stated in the report, were unsuccessful. I believe it went into the muscle at the small of the back. We followed the hole made by the bullet until it went into the muscle. We searched one and a half hours for the missile of death. The X-ray instrument was not used, as the appliances were not handy. This serious damage was done to the organs through which it passed—not to the locality where it now rests.”
     “Your report says the first bullet striking in the breast did no harm.”

FIRST BULLET STRUCK BUTTON.

     “Yes, that is correct. That bullet evidently struck a button and then shied off without doing any damage. Had it not met some obstruction it surely would have killed the President immediately. Below the locality where it struck the flesh was quite flabby and contused.
     “To-day’s investigation developed the fact that the first bullet struck the President on the right side of the breast bone, near the edge, and between the second and third ribs. In our original examination we said it was to the left of the breast bone. The mistake in the first announcement was due to the very hasty examination we made at the time of the shooting, when the question was not so much as to the exact locality of the wounds as to that of getting to work to save the President’s life.”
     “The report speaks of a lack of evidence of repair work on the part of nature. Won’t you explain just what bearing this had on the case at issue?” the doctor was asked.
     “By that statement we mean that the general system of the patient failed to respond to the demand upon it for a revival from the shock suffered by the shooting. It was due, probably, to a low state of vitality; not to poor health, mind you, but to [307][308] a system that was considerably run down and needed rest and recuperation.”
     “The report says the heart walls were very thin. Was this condition peculiar to the President, or is it a common complaint? Did the use of smoking tobacco by the President have any important bearing on the case?”
     “A man whose heart walls are very thin is usually one who leads a sedentary life and whose heart gets no great amount of exercise. This organ, like any other, requires active exercise to keep it in proper condition. No doubt the President’s heart was sufficient for him in his ordinary business affairs of life, when no strain was required. When extraordinary efforts were necessary, the heart was unable to meet them.
     “No, I don’t think the smoking habit affected the President’s heart to the extent of making it figure in the result of his case.”
     Doctors Roswell Park, Matthew Mann and Eugene Wasdin, three of the most prominent surgeons in the case, were asked to explain this situation to-night, and their statements follow:
     Dr. Eugene Wasdin, an expert in fever cases, who is familiar with the poisons in the human body, said:
     “The breastbone wound showed a big impact. Still the area of inflammation of subcutaneous tissues was entirely too extensive to be accounted for from contusion or the force of the bullet. The subcutaneous tissues were in a partially gangrenous condition. The bullet that went into the abdomen and penetrated the stomach also was followed by extensive necrosis of tissue, or gangrene, wherever it passed. The skin wound on the point of entrance was livid, gangrenous, and this process extended to the entire line of invasion made by the surgeons through the abdominal wall. The point of entrance into the stomach was necrotic, or gangrenous. The sutures made by the surgeons were still intact at the autopsy, but the line of sutures were surrounded by a decrotic area through the entire thickness of the stomach wall, and extending on all sides about 1½ to 2 inches. The same is true of the wounds of exit of the bullet on the posterior wall of the stomach, which was also still closed by sutures in the center of an extensive area of necrosis. The further passage of the bullet through the soft tissues of the back, where it became imbedded, was also surrounded by necrotic tissue. These different necrotic areas all had the same appearance as to time of duration—that is, they were due to the same influence acting about the same time. All these conditions lead me to believe that there has been an influence exerted by the passing bullet [308][309] through these tissues entirely dissimilar to that influence exerted by an ordinary missile. In this case there was not the appearance of a single effort of natural repair at any point along the track of the ball.
     “Bacteriological tests are in progress, and possibly a germ capable of giving rise to this gangrenous condition of tissues may be found. But the presence of gangrene only at points of the passage of the bullet and the length of time—seven days—required for the necrotic or gangrenous changes rather convince me that it is not a bacterial influence, but must be due to some organic poison.
     “Tests were made of gangrenous material when the stitches in the President’s wound were removed and the wound redressed. They have not show [sic] as yet the presence of a gangrene producing organism—leading inferentially to the opinion that the bullet was coated with some poisonous substance.”
     Dr. Herman Mynter said: “If”—and great emphasis was laid on the word—“if a bullet could be poisoned, it is safe, perhaps, to say that it might produce conditions similar to those found in the case of the President. Doesn’t that make my position clear?”
     Dr. Roswell Park, when asked as to the likelihood of the now much talked of bullet being poisoned before it crashed into the body of the President, was somewhat categorical in declaring his position. In response to questions put by a reporter, he said: “I do not think that the bullet was poisoned.”