Death of President McKinley

     KINGS and queens and men of note, in former days, have died because their exalted position paralyzed the arms that would have gladly aided one of lower degree, but in recent times surgical skill has been more ready to disregard the rank of the sufferer and to do its best, alike for prince and pauper. We in America have had our share of such emergencies, and the last one—the wounding of President McKinley while visiting the Pan-American Exposition at Buffalo, on September 9, 1901—will linger long in the memory of the public and be recalled by the profession as a celebrated case of prompt, brave surgery that deserved, it would seem, a better reward.
     The only wound of the President that needed any special care was the one made by the ball which penetrated the left hypochondriac region; the other was trivial. This wound showing no point of exit of the ball, it was determined, after a necessarily brief consultation among the surgeons who could be immediately obtained, that it should be followed, and that the proceedings proper in penetrating wounds of the abdomen should be carried out as soon as possible.
     In about an hour after the shot was fired (Dr. Wasden giving ether, for the President’s heart was known to be weak), Drs. Mann and Mynter, assisted by Drs. Lee and Parmenter, opened the peritoneal cavity and discovered a bullet wound of the anterior wall of the stomach, near the greater curvature; the edges were clean-cut, and were approximated by the Czerny-Lembert suture. The abdominal incision was slightly enlarged and about four inches of the gastro-colic omentum divided to reach the posterior wall of the stomach. Here a second somewhat larger wound was found, with frayed and infiltrated edges; these were united by a double row of sutures, but further search for the bullet was discontinued on account of the condition of the patient’s pulse. The operation lasted an hour and a half, and the President was then carried to a private house in Buffalo and put in charge of Dr. Rixey, U. S. N., who was later assisted by Dr. Wasden. For a while the [300][301] President’s condition seemed to improve, and daily and favorable bulletins were in consequence issued by general consent of the attending physicians; these often expressing great hope of his recovery. Dr. McBurney and Dr. Stockton were later added to the staff of consultants (Dr. Janeway and Dr. Johnson, who were summoned still later, did not arrive until after the President’s death). The patient’s temperature during the days following the injury ranged from 100 to 102 degrees, but his pulse (thin most of the time) was disproportionately high, ranging between 140 and 145. The urine was scant, with a trace of albumin, some casts, and much indican. Nutritive and saline enemata were employed to sustain him, and on the seventh day the patient was given nourishment by the mouth. The intense pain was controlled by morphine and such cardiac tonics and stimulants as met the needs of the hour; but the President’s heart began to fail on the evening of the eighth day, and, stimulants no longer availing, he died in the early morning of September 14.
     The autopsy was performed by Drs. Gaylord and Matzinger, nine hours after death. Rigor mortis was marked; sternal wound superficial, cultures from it showing Staphylococcus epidermides albus of Welsh. Abdominal fat well developed and normal in color; ventral wound showed little effort at repair; cultures showed Staphylococcus albus, and a short encapsulated bacillus thought to belong to the proteus group, but no streptococci here or elsewhere. The stitches uniting the wounds of the stomach were intact, surrounded by discolored friable areas, and each had been reinforced by adhesions.
     Behind the stomach was a large necrotic cavity, fibrin-lined, involving the pancreas and extending downward and backward towards the left kidney, where it ended in a cul-de-sac. Tissue elements from it were unrecognizable. Neither leucocytes [sic] nor pus-corpuscles were found, but an abundance of fat-like crystals. The left kidney was congested and lacerated, and the adrenal gland seemed injured; but there was no sign of peritonitis. The heart-walls were thin and surrounded by much adipose tissue; other organs normal.
     Bacterial examination of the weapon (a 32-calibre revolver) from which the fatal shot had been fired showed simply the presence of staphylococci. Dr. Hill, by chemical analysis, disproved the current suspicion that the cartridges had been poisoned.
     That the autopsy was abruptly concluded and the bullet left undiscovered was owing to the wishes of the family of the deceased President. It is to be regretted that the autopsy was not thoroughly completed and material allowed to be taken as a basis for further scientific study.
     The assassin of the President (Leon F. Czolgosz, aged twenty-eight, [301][302] and an American by birth), after speedy trial, was executed at Auburn Prison in the electric chair. The autopsy was immediately thereafter made by Drs. McDonald, Spitzka, and Guerin, but neither abnormality nor lesion was found; his brain was slightly above the average, and the conclusion reached was that his intellect was not impaired, confirming the opinion of Fowler, Crego, and Putnam, who examined him prior to his trial.
     C. K. Mills believes from the evidence that he was mentally sound at the time of the assassination, but that had he lived longer he would probably have developed tendencies to insanity.