The Probable Course of the Ball in President
view of the great professional interest
in the case of President McKinley, and in the absence, up to the
present writing, of any definite demonstration of the exact course
of the bullet, the M R
presents a study of probabilities which, from anatomical and surgical
standpoints, may prove interesting to our readers. The accompanying
illustrations have been made with great care, and with special reference
to their particular adaptability to the purposes of the article.
Figs. 1 and 2 indicate the points of entrance of the missile from
the front, and Fig. 3 shows, in a schematic way, the relation of
the important internal organs in an anteroposterior section of the
At best, no absolute theory can be
to the direction of the ball, as the latter has not been traced
beyond its point of exit from the posterior wall of the stomach.
Nor can any positive information be obtained as to the relative
positions of the would-be assassin and his victim. It was evidently
intended that the pistol should be fired point blank, the parties
nearly facing each other, and that the heart should be struck. In
the absence of any proof to the contrary, it must be assumed that
the aim was really in a direction from before backward, slightly
to the left, and on a horizontal plane.
In the present aspect of the case,
considering the important organs in the region of the wound tract,
the great wonder is that so many of them escaped mortal injury.
The opinion of the surgeons in attendance
on the President is to the effect that the foreign body is lodged
in the muscles of the back somewhere in the region of the eleventh
intercostal space and possibly in the substance of erector spinæ
muscles. This would give the ball almost a horizontal direction
from before backward. It is impossible to believe that it took a
more internal course toward the vertebral column, as the cœliac
axis  or even the aorta itself
would undoubtedly have been wounded. It has been quite clearly demonstrated
by the operation that the stomach was the only important organ injured.
The left edge of the liver escaped harm by the merest chance of
its position and thus a most formidable if not a fatal complication
was averted. There was no injury to the adjacent cartilage of the
In placing the point of exit of the
ball on a line with that of its entrance as in Fig. 2, the relative
positions of the internal organs in the neighborhood can be easily
studied. The only apparent reason why all these important parts
escaped injury is on the supposition that the real course of the
missile is thus properly placed in the diagram mentioned. Toward
the median line are the important blood vessels already named. Inferiorly
are the splenic vein and artery, the pancreas, and the left suprarenal
capsule and kidney, and posteriorly and externally the spleen. The
only point for the safe transit of a bullet would be seemingly in
a very limited space within these boundaries.
The operator has given the best of
reasons for not probing too much for the lost bullet, as such a
course, considering the proximity of important blood vessels,
would have been extremely hazardous. Considering also the necessity
of shortening the period of shock as much as possible, there was
no time for deliberate dissection or prolonged search. Besides it
is quite usual under the circumstances for the course of a ball
to be lost when it is continued through the loose areolar and fatty
tissue usually found in the neighborhood of the parts involved in
the operation. It was not impossible for the missile after its escape
through the posterior wall of the stomach to drop into the peritoneal
If such had been the case, however, the ball would have been easily
found by the surgeons during their careful toilet of the peritoneum.
If by any chance the ball had escaped detection in that situation
there would have been a very prompt clinical evidence of the fact.
If the ball be actually lodged in
the muscles of the back it could not be more favorably situated
for fulfilling the conditions of encystment nor be more out of the
way for resisting the effects of ordinary pressure irritation.