The Attempted Assassination of President McKinley

AT seven minutes past four o’clock on the afternoon of September 6th, President McKinley, while receiving the people in the Temple of Music at the Pan-American Exposition, in Buffalo, was shot twice by an anarchist. The man had a pistol in his right hand, concealed by a handkerchief so arranged as to give the appearance of a bandage. He was in line with others passing before the President, and just as the latter was extending his hand, raised the pistol and fired two shots.
     One bullet struck the sternum, and glanced off, producing simply a contusion, and was found in the clothing. The other one, which is thought to have been the first fired, penetrated the abdomen five inches below the nipple, and an inch and a half to the left of the median line.
     Word was at once sent to the Emergency Hospital in the Exposition grounds, and Drs. Ellis, Mann, Jr., and Hall of the hospital staff bore the wounded President to the ambulance, and hurried with him to the hospital. This was at 4.14. On arrival at the hospital, the President was fully conscious. He was placed in one of the private rooms, but, on the arrival of Drs. Mann and Rixey, was transferred to the small operating room to the right of the entrance. At 5.07, just one hour after the shot, Dr. Matthew D. Mann arrived at the hospital, and Drs. Mynter and Parmenter arrived almost immediately. At half past five o’clock, Dr. Rixey of the U. S. Navy, the President’s personal physician, arrived, and then the operation was begun by Dr. Mann, assisted by Drs. Mynter, Parmenter, and Lee. There were present also Drs. Wardin, Van Peyma, and C. G. Stockton. Dr. Charles McBurney of this city became subsequently associated with the case as consulting surgeon.
     The abdomen was opened by an incision including the point of entrance of the bullet. It was found that the missile had penetrated the anterior wall of the stomach. This hole was immediately closed by a Lembert suture of fine silk, and then the organ was turned over, and a search was made for the point of exit in the posterior wall. This was quickly found, and sutured in the same way.
     A careful examination showed that the intestine and other abdominal organs had not been injured. After a toilet of the peritoneum, the abdominal wound was closed without drainage. The further course of the bullet could not be traced, and the bullet itself was not found.
     Shortly before the close of the operation, Dr. Roswell Park, who had been summoned from Niagara Falls, arrived at the hospital.
     The illustrious patient stood the ether and the operation well, his pulse at its termination being 130, and of good quality. At half past seven he was removed in the ambulance to the residence of Mr. Milburn, where he is at the present writing.
     For about twelve hours after the operation the temperature was in the neighborhood of 100°, and slowly rising; it then fluctuated between 101° and 102° for thirty-six hours, after which it very gradually declined. The pulse was 120 to 130, and the respiration about 25.
     There have been at no time any symptoms of peritonitis or of septic poisoning.
     The pistol used was, fortunately, one of slight penetrating power, and the bullet was of small caliber, otherwise the ball which struck the sternum would almost certainly have done far greater damage than that which perforated the stomach, even had it not caused instant death.
     The great public interest manifested in the case made it necessary for the MEDICAL RECORD to send a member of its editorial staff to Buffalo to study it from its strictly scientific aspect. The data furnished by this gentleman can be considered, therefore, as thoroughly trustworthy, and based on authoritative statements of the different surgical attendants on the case. The idea was to obtain all the points of real interest from a surgical standpoint, and such as have been furnished can be considered strictly accurate.
     A very remarkable feature of the operation was its performance so soon after the infliction of the injury, and in this respect it may be looked upon as unique. The details of the procedure could not have been better arranged if they had been planned beforehand. In fact, the ultimate success of the operation was largely due to this fortunate circumstance. This by no means detracts from the well-acknowledged skill of the operator and the perfection of all his details of modern technique. Fortunately, in consequence mainly of careful handling of the patient before the operation, only a very small amount of stomach contents escaped into the peritoneal cavity. Viewed by itself as a surgical procedure, it may be considered beyond criticism. No chances were taken for any failure of most minute details. In fact, it was the opportunity appropriately met of demonstrating to the public one of the many triumphs of modern surgery.
     It is most gratifying to state that at the present writing the distinguished patient is on a fair way to complete recovery. The elevated temperature which for the first few days occasioned so much anxiety to the daily newspapers was largely due to the ordinary effects of secondary shock. Although general peritonitis was quite naturally feared, there was at no time any distinct evidence of such a complication.
     During the first few days the stomach was kept quiet by rectal alimentation, and at no time was any nausea, tympanitis, or gaseous retention manifest. There was so little pain that no anodyne was required after the third day. Except for the fact that a portion of the bullet track in the course of the abdominal incision failed to unite—a trifling matter in itself—the case would not have had a [417][418] single drawback from a public, sensational, or spectacular standpoint. The only trouble now from the latter view centers in the present uncertainty as to the location of the bullet. Although believed to be lodged in the muscles of the back somewhere in the lower dorsal or upper lumbar region, there has been no means as yet of proving such a point. Of course every hope now rests in the probability of the muscle becoming safely encysted and consequently harmless. It is somewhat difficult to understand why, up to this writing, the x-ray, so easily and effectually applied, has not been brought into service. It would hardly be so much a matter of gratifying curiosity—as remarked by one of the eminent surgeons in the case—as of being absolutely sure of the terminal track of the missile. It is to be hoped that the bullet course behind and beyond the stomach is in a safely closed and aseptic condition. This would seemingly be the only absolute guarantee against any future trouble from secondary suppurating processes.
     In calculating the naturally direct course of the missile from before backward to its supposed designation, it may be fair to assume that the only serious damage that was done was the double perforation of the stomach wall. Taking the chances of a shot in any other direction would have been more than hazardous. It seems quite evident, in the absence of any positive data to the contrary, that the general direction of the missile must have been in the mid-epigastric plane obliquely backward and to the left.
     Such a course would explain the missing of the pancreas, and the splenic artery below, the cœliac axis internally, the spleen to the left, and the left suprarenal capsule and left kidney below. The escape of the liver was easily explained by the track of the ball being just external to the shelving top of the left lobe.
     But whatever theories may be offered as to the precise nature of the injury, they can be very harmlessly ventilated in the face of the gratifying fact that the patient seems destined to recover and valiantly defy them all.