The Case of President McKinley
following report has received the
approval of, and is issued by, the undersigned, the medical staff
attending the late President, William McKinley.
||P. M. R
M D. M .
H M .
R P .
E W .
C M B .
C G. S .
October 12, 1901.
Surgical History.—President William
McKinley was shot, by Leon F. Czolgosz, in the Temple of Music,
at the Pan-American Exposition, Buffalo, N. Y., at about 7 minutes
past 4 on the afternoon of Friday, September 6, 1901. Two shots
were fired. One bullet struck near the upper part of the sternum,
and the other in the left hypochondriac region. The President was
immediately conveyed to the Emergency Hospital on the Exposition
grounds by the motor ambulance, where he arrived at 4.18. Dr. G.
McK. Hall and Mr. Edward C. Mann, medical student, of the house
staff were in charge of the ambulance, Medical Student T. F. Ellis
being the driver.
On arriving at the hospital, President
McKinley was at once placed upon the table in the operating room
and undressed. During the removal of his clothing a bullet fell
out and was picked up by Mr. Ellis. Dr. Hall placed a temporary
antiseptic dressing over the wounds, and Mr. Mann ordered a nurse
to administer 0.01 gm. of morphine and 0.002 gm. of strychnine hypodermically.
Dr. Herman Mynter, who had been telephoned
from police headquarters to report immediately at the Exposition
Hospital, was the first surgeon to arrive, at 4.45 o’clock. At that
time Drs. P. W. Van Peyma and Joseph Fowler of Buffalo and Dr. Edward
Wallace Lee of St. Louis were present. Dr. Mynter brought with him
Dr. Eugene Wasdin of the United States Marine Hospital Service.
Dr. Mynter inspected the President’s
wounds, and immediately saw their serious nature. He told the President
that it would be necessary to operate, and at once set about making
preparations, aided by the house staff and nurses and Dr. Nelson
W. Wilson, Sanitary Officer of the Exposition, who at that time
assumed charge of the hospital in the absence of Dr. Roswell Park,
the Medical Director of the Exposition. The President’s pulse on
the arrival of Dr. Mynter was 84; he had no particular pain in the
abdomen, and no apparent loss of liver dulness [sic]. He
was evidently slightly under the influence of the morphine.
Dr. Matthew D. Mann arrived at the
hospital at 5.10 P.M., having been telephoned for by Mr. John C.
Milburn. He was followed, five minutes later, by Dr. John Parmenter.
An examination was at once made, followed
by a short consultation between Drs. Mann, Mynter, and Wasdin, which
resulted in the decision to operate at once. The necessity for the
operation was explained to President McKinley, and he gave his full
consent. Immediate operation was decided upon because of the danger
of possible continued internal hemorrhage and of the escape of gastric
or intestinal contents into the peritoneal cavity, and because the
President’s pulse was getting weaker. Moreover, the daylight was
rapidly failing. Dr. Roswell Park, who, by virtue of his office,
had he been present would have performed the operation, was at Niagara
Falls, and although a special train had been sent for him, it was
uncertain when he would arrive.
Dr. Mann was selected to do the operation,
with Dr. Mynter as his associate, by the common consent of the physicians
present and at the request of Mr. Milburn, President of the Pan-American
Exposition, who stated that he had been requested by President McKinley
to select his medical attendants. Dr. Mann selected Drs. Lee and
Parmenter as assistants.
At 5.20 Dr. Mann directed the administration
of ether to President McKinley, and requested Dr. Wasdin to administer
it. Ether was chosen as being, on the whole, the safer anæsthetic.
While the anæsthetic was being given, the surgeons who were to take
part in the operation prepared their hands and arms by thoroughly
scrubbing with soap and water and immersing them in a solution of
bichloride of mercury.
The operation began at 5.29. Dr. Mann
stood upon the right-hand side of the patient, with Dr. Parmenter
on his right-hand side. Dr. Mynter stood upon the left-hand side
of the patient, and on his right was Dr. Lee. To Drs. Parmenter
and Lee were assigned the duties of sponging and the care of the
instruments. Dr. P. M. Rixey, U. S. N., President McKinley’s family
physician, having been detailed by the President to accompany Mrs.
McKinley to the Milburn home, did not arrive until 5.30, when he
gave very efficient service by guiding the rays of the sun to the
seat of the operation by aid of a hand mirror, and later by arranging
an electric light. Dr. Roswell Park arrived just as the operation
on the stomach was completed, and gave his aid as consultant. Mr.
E. C. Mann had charge of the needles, sutures, and ligatures. Mr.
Simpson, medical student, was at the instrument tray.
The nurses, under the charge of Miss
A. C. Walters, superintendent of the hospital, were Miss M. E. Morris
and Miss A. D. Barnes, with hands sterilized; Miss Rose Baron, Miss
M. A. Shannon, and Miss L. C. Dorchester, assistants, and Miss Katharine
Simmons attending the anæsthetizer.
Besides those immediately engaged
in the operation, there were present Drs. P. W. Van Peyma, Joseph
Fowler, D. W. Harrington, and Charles G. Stockton of Buffalo, and
Dr. W. D. Storer of Chicago.
The Operation.—President McKinley
took the ether well, and was entirely under its influence in nine
minutes after the beginning of the anæsthetization. The abdomen
was carefully shaved and scrubbed with green soap, and then washed
with alcohol and ether and the bichloride solution.
Inspection showed two wounds made
by the bul-  lets. The upper
one was between the second and third ribs, a little to the right
of the sternum. The use of a probe showed that the skin had not
been penetrated, but that the bullet had probably struck a button
or some object in the clothing which had deflected it. The lower
wound made by the other bullet—a 32 caliber—was on a line drawn
from the nipple to the umbilicus. It was about half way between
these points, and about 5 cm. to the left of the median line. A
probe showed that this wound extended deeply into the abdominal
walls, and that the direction was somewhat downward and outward.
An incision was made from the edge
of the ribs downward, passing through the bullet wound and nearly
parallel with the long axis of the body. A deep layer of fat was
opened, and followed by incision of the fascia and muscles to the
peritoneum. After cutting through the skin, a piece of cloth, undoubtedly
a bit of the President’s clothing, was removed from the track of
the bullet, a short distance below the skin.
On opening the peritoneum, the finger
was introduced and the anterior wall of the stomach palpated. An
opening was discovered which would not quite admit the index finger.
This opening was located near the greater curvature of the stomach,
and about 2 cm. from the attachment of the omentum; its edges were
clean cut and did not appear to be much injured.
The stomach was drawn up into the
operation wound, and the perforation very slightly enlarged. The
finger was then introduced and the contents of the stomach palpated.
This was done to see if the stomach contained food, and also with
the hope that possibly the bullet might be in the stomach. The stomach
was found to be half-full of liquid food, but no evidence of the
ball was discovered. In pulling up the stomach a small amount of
liquid contents escaped, together with a good deal of gas. The tissues
around the wound were carefully irrigated with hot salt solution
and dried with gauze pads. The perforation in the anterior stomach
wall was then closed with a double row of silk suture (Czerny-Lembert).
The sutures were not interrupted with each stitch, but four stitches
were introduced before the ends were tied. The loop was then cut
off and the suture continued. About eight stitches were used in
each row. The silk used was fine black silk, the needle being a
straight, round sewing needle.
In order to examine the posterior
wall of the stomach it was necessary to enlarge the incision, which
now reached about 15 cm. in length. The omentum and transverse colon
were pulled well out of the abdomen. The omentum was enormously
thickened with fat and very rigid. In order to reach the back wall
of the stomach, it was necessary to divide about 4 inches of the
gastrocolic omentum, the cut ends being tied with strong black silk
in two masses on each side. In this way the stomach could be drawn
up into the operation wound, and the bullet wound in its posterior
wall reached. This opening was somewhat larger than that in the
anterior wall of the stomach, and had frayed and blood-infiltrated
edges. Its exact location was impossible to determine, but it appeared
to be near the larger curvature.
This opening was closed in the same
way as the anterior wound, but with great difficulty, as the opening
was down at the bottom of a deep pocket. A short curved surgical
needle was necessary here. Little or no gastric contents appeared
around this opening, but after it had been closed the parts were
carefully irrigated with hot salt solution.
The operation on the stomach being
now finished, Dr. Mann introduced his arm so as to palpate carefully
all the deep structures behind the stomach. No trace of the bullet
or of the further track of the bullet could be found. As the introduction
of the hand in this way seemed to have a bad influence on the President’s
pulse, prolonged search for further injury done by the bullet or
for the bullet itself was desisted from. The folds of the intestine
which had been below the stomach were inspected for injury, but
none was found. The entire gut was not removed from the abdomen
for inspection, as the location of the wound seemed to exclude its
injury. To have made a satisfactory search for wounds in the President’s
back, it would have been necessary to have entirely eviscerated
him. As he was already suffering from shock, this was not considered
justifiable, and might have caused his death on the operating table.
Before closing the abdominal wound,
Dr. Mann asked each of the surgeons present, whether he was entirely
satisfied that everything had been done which should be done, and
whether he had any further suggestions to make. Each replied that
he was satisfied. The question of drainage was also discussed. Dr.
Mynter was in favor of a Mikulicz drain being placed down behind
the stomach-wall. Dr. Mann, with the concurrence of the other surgeons,
decided against this, as being unnecessary.
As the last step in the operation,
the tissues around the bullet track in the abdominal wall were trimmed
in order to remove any tissue which might be infected. The abdominal
wound was then closed with seven through-and-through silkwormgut
sutures drawn only moderately tight, the superior layer of the fascia
of the rectus muscle being joined with buried catgut. The edges
of the skin were brought together by fine catgut sutures. Where
the bullet had entered there was slight gaping of the tissues, but
it was not thought advisable to close this tightly, as it might
allow of some drainage. The wound was then washed with hydrogen
dioxid and covered with aristol powder and dressed with sterilized
gauze and cotton, which were held in place with adhesive straps.
Over all was put an abdominal bandage.
The President bore the operation very
well. The time from the beginning of the administration of the anæsthetic
until its discontinuance was exactly an hour and thirty-one minutes;
the operation was completed at 6.50 P.M., having lasted from the
time of the first incision, an hour and twenty-one minutes. At the
beginning of the operation, President McKinley’s pulse was 84. At
5.38, 0.002 gm. of strychnine was administered hypodermically. At
5.55 the respiration was 32 and the pulse 84—both good in character.
At 6.09 the pulse was 88. At 6.20 it was 102, fair in character;
respiration 39. At 6.22, 1.50 gm. of brandy was administered hypodermically.
At 6.48 the pulse was 124, the tension good but quick, respiration
36. At 7.01, after the bandage was applied, the pulse was 122 and
the respiration 32. At 7.17, 0.004 gm. of morphine was administered
At 7.32 the patient was removed from
the hospital in the ambulance. Dr. Rixey asked Drs. Park and Wasdin
to go in the ambulance, as his duty called him to go at once to
inform Mrs. McKinley of her husband’s condition and to prepare a
room for his reception. Drs. Mann and Mynter, with friends of the
President, followed in carriages immediately after. President McKinley
had not then recovered from the anæsthetic. He bore the journey
to Mr. Milburn’s house exceedingly well, but it was found necessary
to give him a small hypodermic injection of morphine during the
transit, as he was becoming very restless. On arrival at the house
of Mr. Milburn, 1168 Delaware Avenue, he was removed from 
the ambulance on the stretcher and carried to a room in the northwest
corner of the house, where a hospital bed had been prepared for
Remarks on the Operation by Matthew
D. Mann, M.D. The difficulties of the operation were very
great, owing partly to the want of retractors and to the failing
light. The setting sun shone directly into the room, but not into
the wound. The windows were low and covered with awnings. After
Dr. Rixey aided us with a hand mirror, the light was better. Toward
the end of the time a movable electric light with reflector was
put in use. The greatest difficulty was the great size of President
McKinley’s abdomen and the amount of fat present. This necessitated
working at the bottom of a deep hole, especially when suturing the
posterior wall of the stomach.
The operation was rendered possible
and greatly facilitated by a good operating table and the other
appliances of a hospital, and by the presence of many trained nurses
and assistants. Still, the hospital was only equipped for minor
emergency work, and had but a moderate supply of instruments. Unfortunately,
when called I was not told what I was wanted for, and went to the
Exposition grounds entirely unprepared. Dr. Mynter had his large
pocket-case, the contents of which were of great use.
As has already been noted, further
search for the bullet was rendered inadvisable by the President’s
condition. The autopsy shows that it could not have been found,
and that the injuries inflicted by the bullet after it passed through
the stomach were of such a nature as to render impossible and unnecessary
any further surgical procedure. A bullet after it ceases to move
does little harm. We were often asked why, after the operation,
we did not use the x-ray to find the bullet. There were several
reasons for this. In the first place, there were at no time any
signs that the bullet was doing harm. To have used the x-ray
simply to have satisfied our curiosity would not have been warrantable,
as it would have greatly disturbed and annoyed the patient, and
would have subjected him also to a certain risk. Had there been
signs of abscess-formation, then the rays could and would have been
My reason for not draining was that
there was nothing to drain. There had been no bleeding nor oozing;
there was nothing to make any discharge or secretion; the parts
were presumably free from infection, and were carefully washed with
salt solution. As there was no peritonitis and the abdomen was found
post mortem to be sterile, we may safely conclude that no drainage
could have been provided which would have accomplished anything.
My experience teaches me never to drain unless there is a very decided
indication for it, as a drain may do harm as well as good.
In conclusion, I wish to thank all
the gentlemen who so kindly and skilfully assisted me. They were
all surgeons of large experience in abdominal surgery, and their
aid and advice were most valuable. Especially I wish to acknowledge
my great obligation to my associate, Dr. Mynter. Not only was he
an assistant, but he was much more, and helped me greatly by his
skill and, as a consultant, with his good judgment and extensive
knowledge of abdominal work. Although called first, he waived his
claim, and generously placed the case in my hands, willingly assuming
his share of the responsibility.
The anæsthetic was most carefully
administered by Dr. Wasdin, and the knowledge that he had charge
of this very important duty relieved me of any anxiety on that score.
In the eventful week that followed
the operation, Dr. Park and Dr. McBurney were towers of strength
in helping to decide the many difficult questions which came up.
Dr. Rixey was in constant charge of
the sick-room, aided later by Dr. Wasdin, who was detailed for this
special duty. Both were unremitting in their care, and faithful
to the end.
Dr. Stockton helped us in the last
three days with the highest skill and best judgment.
Never, I am sure, under like circumstances,
was there a more harmonious or better-agreed band of consultants.
That our best endeavors failed was, I believe, no fault of ours;
but it must be an ever-living and keen regret to each one of us,
that we were not allowed the privilege of saving so noble a man,
so attractive a patient, and so useful a life.
The After-Treatment.—When put to bed
the President was in fair condition: Pulse, 127; temperature, 100.6°;
respiration, 30. The nurses on duty were Miss K. R. Simmons and
Miss A. D. Barnes from the Emergency Hospital. Soon after his arrival,
at 8.25, he was given morphine, 0.016 gm., hypodermically. There
was slight nausea. The pulse soon improved. During the evening the
patient slept at intervals, vomiting occasionally, but rallied satisfactorily.
A slight discoloration of the dressings was noted at 10.45. There
was occasional and slight pain. Ninety c.c. of urine was voided,
and an enema of salt solution given and retained.
Second Day, Saturday, September
After midnight the patient slept
a good deal; he was free from pain and quite comfortable.
At 6 A.M., the temperature was 102°;
pulse, 110; respiration, 24.
Gas in large quantities was expelled
from the bowels. A saline enema was given as before. Miss Simmons
and Miss Barnes were replaced by Miss Maud Mohan and Miss Jane Connolly.
Miss E. Hunt of San Francisco, Cal., Mrs. McKinley’s nurse, also
rendered assistance, and Miss Grace Mackenzie of Baltimore, Md.,
arrived September 9, and was detailed for regular duty. P. A. Eliot,
J. Hodgins, and Ernest Vollmeyer of the U. S. A. Hospital Corps
were detailed as orderlies.
During the forenoon, 0.01 gm. of morphine
was administered hypodermically.
At 1.15 P.M., a saline enema of 500
c.c. was given. As the pulse was rising, 0.06 gm. of fluid extract
of digitalis was injected hypodermically.
The President rested quietly until
6.30 P.M., when he complained of intense pain in the pit of the
stomach, and was given 0.008 gm. morphine sulphate hypodermically.
He was very restless, but after being sponged, rested again.
At 6.30 P.M., the pulse was 130; temperature,
102.5°; respiration, 29.
During the day the digitalis, morphine,
and saline enemas were kept up at regular intervals; 4 gm. of somatose
was added to the water at 10.30 P.M. At 11.15 P.M. the President
passed from the bowels 240 c.c. of a greenish colored fluid and
some particles of fecal matter.
The total amount of urine for 24 hours
was 270 c.c.
First Uranalysis, by Dr. H.
sediment obtained by centrifuge shows a great amount of large
and small epithelial cells with some leukocytes and occasional
red cells. There is a comparatively large number of hyaline
casts, principally small, with some finely granular ones; also
an  occasional fibrinous
one. The amount of sediment is large for the quantity of urine
submitted. There were no crystals in the sediment.
Third Day, Sunday, September 8.
During the early morning the President
slept a good deal, but was restless, and at times confused and a
little chilly. On the whole, he passed a fairly good night.
He expelled a little gas and brown
fluid from the rectum. The digitalis was continued, and at 7.45
A.M. 0.002 gm. of strychnine was given hypodermically. At 8.20 A.M.
he was clear and bright, with the pulse strong and of good character.
The wound was dressed at 8.30, and
found in a very satisfactory condition. There was no indication
of peritonitis. Pulse, 132; temperature, 102.8°; respiration, 24.
The dressing on the wound was changed
because there was some exudation. The bullet track was syringed
out with hydrogen dioxide. There was very little foaming, and there
were no signs of pus.
At 10.40 A.M., following an enema
of Epsom salts, glycerin, and water, he had a small stool with gas,
and another at noon. He was less restless and slept a good deal.
At noon Dr. Charles McBurney joined
the medical staff in consultation, having been summoned by Dr. Rixey.
Bulletin 14, 12 m.—The
improvement in the President’s condition has continued since
the last bulletin. Pulse, 128; temperature, 101°; respiration,
During the day he continued to improve;
he slept four or five hours and his condition was satisfactory.
At 4.45 P.M., he was given a teaspoonful
of water by the mouth; also an enema of sweet oil, soap, and water.
He passed slightly colored fluid with some little fecal matter and
mucus. After this he had a small quantity of water by the mouth,
and at 6.20 P.M. a nutritive enema of egg, whiskey, and water, which
was partly retained. Digitalis and strychnine were both given during
At 9 P.M., the President was resting
comfortably. The pulse was 130; temperature, 101.6°; respiration,
Four hundred and twenty c.c. of urine
was passed during the day.
examination of sediment obtained by centrifuge shows fewer organic
elements. Some large and small epithelial cells and some leukocytes.
Casts are not so abundant as yesterday and are principally
of the small finely granular variety. There is a marked diminution
in small renal epithelial cells.
Quite a quantity of large crystals
of uric acid and bacteria are present.
Fourth Day, Monday, September
The bulletin tells the story of
the fourth day.
Bulletin 17, 6 a.m.—The
President passed a somewhat restless night, sleeping fairly
well. General condition unchanged. Pulse, 120; temperature,
101°; respiration, 28.
Bulletin 18, 9.20 a.m.—The
President’s condition is becoming more and more satisfactory.
Untoward incidents are less likely to occur. Pulse, 122; temperature,
100.8°; respiration, 28.
Bulletin 19, 3 p.m.—The
President’s condition steadily improves and he is comfortable,
without pain or unfavorable symptoms. Bowel and kidney functions
normally performed. Pulse, 113; temperature, 101°; respiration,
Bulletin 20, 9.30 p.m.—The
President’s condition continues favorable. Pulse, 112; temperature,
101°; respiration, 27.
Codeine was substituted for morphine,
as the pain was less. Digitalis and strychnine were stopped. Nutritive
enemas were given at 3.20 A.M., at 4.30 and 10 P.M. Hot water was
taken quite freely by the mouth.
Attempts to get a good movement of
the bowels were successful at noon, when he had a large light-brown,
partly formed stool. This followed a small dose of calomel and a
high enema of oxgall.
On the whole, the President’s condition
improved steadily during the day. He slept a good deal and was fairly
comfortable. There was no pain on pressure over the abdomen.
examination of sediment obtained by centrifuge shows a decrease
in the amount of organic elements and an increase of amorphous
urates, but fewer crystals of uric acid. Casts are fewer and
only the small granular and large hyaline varieties. The proportion
of casts is greater. There are very few epithelial cells, mostly
of renal type. A large number of cylindroids are found.
Fifth Day, Tuesday, September
Soon after midnight the President
had a high enema of soap and water, which was expelled, together
with some fecal matter. He took hot water frequently, and slept
a good deal.
Bulletin 21, 5.20 a.m.—The
President has passed the most comfortable night since the attempt
on his life. Pulse, 118; temperature, 100.4°; respiration, 28.
On awaking he felt very comfortable,
and his mind was clear and cheerful. The nutritive enemas were kept
up, and water given by the mouth. Had two small stools during the
day. The only medicine given was one hypodermic of codeine phosphate,
In the evening the dressings were
examined, and as there was considerable staining from the discharge,
it was thought best to remove four stitches and separate the edges
of the wound. A little slough was observed near the bullet track,
covering a space nearly an inch wide, the thickness of the flaps.
The separation seemed to extend down to the muscle. The surfaces,
except those mentioned, looked healthy, but not granulating. It
was supposed that the infection of the wound occurred either from
the bullet or from the piece of clothing carried into the wound
at the time of the shooting. The parts were thoroughly washed with
hydrogen dioxide and packed lightly with gauze, and held together
with adhesive straps.
Sixth Day, Wednesday, September
Bulletin 26, 9 a.m.—The
President rested comfortably during the night. Decided benefit
has followed the dressing of the wound made last night. His
stomach tolerates the beef juice well, and it is taken with
great satisfaction. His condition this morning is excellent.
Pulse, 116; temperature, 100.2°.
Bulletin 27, 3.30 p.m.—The
President continues to gain, and the wound is becoming more
healthy. The nourishment taken into the stomach is being gradually
increased. Pulse, 120; temperature, 100.2°.
Bulletin 28, 10 p.m.—The
President’s condition continues favorable. Blood count corroborates
clinical evidence of the absence of any blood poisoning. He
is able  to take more
nourishment and relish it. Pulse, 120; temperature, 100.4°.
The blood count made by Dr. Wasdin
in the evening was as follows:
A little after midnight Wednesday
morning, the patient was given 4 c.c. of beef juice, the first food
taken by the stomach. It seemed to be very acceptable. Nutritive
enema was given at 2 A.M.; later there was a yellow stool.
From 4 to 8 c.c. of beef juice was
given every one to two hours during the day. The rectum was becoming
irritable, and did not retain the nutritive enemas well.
At 10 A.M. the remaining stitches
were removed, the wound separated and dressed. It seemed to be doing
well. Most of the sloughing tissue had separated.
The patient slept much during the
day, and expressed himself as feeling very comfortable. The only
medicine administered was one hypodermic of strychnine.
In the evening he was changed to a
fresh bed. Nutritive enemas were continued.
Urine was passed much more freely—750
c.c. in twenty-four hours.
examination of sediment obtained by centrifuge shows a marked
diminution in amount of organic elements, but a great increase
in uric-acid crystals.
There are very few epithelial
cells—mostly of renal type.
There are fewer casts—small and
large hyaline—some finely granular.
Cylindroids are more abundant.
Seventh Day, Thursday, September
The President slept a good deal
during the night, and awoke in the morning feeling better. The beef
juice was continued and increased, and a little chicken broth added
to the dietary. He also had a little whiskey and water.
At 8.30 A.M. he had chicken broth,
a very small piece of toast and a small cup of coffee. He did not
care for the toast, and ate scarcely any of it.
The wound was dressed and washed with
a weak solution of iodine and then with hydrogen dioxide. He was
given 30 c.c. of castor oil at 9.20 A.M.
The President now seemed at his best
and his condition to warrant the favorable prognosis given out.
The time for peritonitis and sepsis had passed. The bowels had moved
and gas passed freely, showing that there was no obstruction. The
tongue was clear, and the appetite increasing; and he seemed to
be able to digest food. There was no pain nor tenderness in the
abdomen, and he was able to turn easily and to sleep on his side.
The urine was steadily increasing. His spirits were good and his
mind clear, while his pulse, though frequent, was strong and of
good quality, and the temperature low.
The analysis of the urine gave no
uneasiness, as the amount of urea was fair; there was no albumin
worth considering, and the casts were rapidly diminishing. There
were no more of them than are found in a large percentage of cases
following a long operation under ether. The excess of indican was
taken to mean merely some intestinal indigestion, and to be of no
serious import. The only symptom to cause any uneasiness was the
frequency of the pulse. Still, anxiety on this score was relieved
by knowing that the President had naturally a rapid pulse, and that
it was easily excited. The open wound was not considered important.
It looked healthy, and, although it would take a long time to heal,
in itself it was evidently causing no harm, nor was it likely to.
Dr. McBurney left Buffalo for his
home in the morning, having arranged to return at once if his presence
Toward noon it was noticed that the
character of the pulse was not quite so good. Infusion of digitalis,
8 c.c., was ordered, and strychnine, 0.002 gm.
It was thought probable that there
was some intestinal toxæmia, as there had been no free movement
from the bowel since food had been begun, the oil having failed
to act. Gradually the pulse went to 130, and grew weaker.
Dr. Charles G. Stockton was added
to the medical staff in consultation. At 7 P.M. the President was
given 0.20 gm. of calomel.
Bulletin 32, 8.30 p.m.—The
President’s condition this evening is not quite so good. His
food has not agreed with him, and has been stopped. Excretion
has not yet been properly established. The kidneys are acting
well. His pulse is not satisfactory, but has improved in the
last two hours. The wound is doing well. He is resting quietly.
Temperature, 100.2°; pulse, 128.
At 9.30 P.M. a second dose of 30
c.c. of castor oil was given, followed by a high enema of oxgall.
This resulted in a large, dark semifluid stool, which seemed to
exhaust him somewhat. Stimulants were given freely. No more beef
juice or food was given. The pulse grew rapidly worse, but at midnight
there seemed some improvement, as bulletin 3 [sic] shows.
At 11 P.M. 420 c.c. of normal salt solution was given subcutaneously.
Bulletin 33, 12 m.—All
unfavorable symptoms in the President’s condition have improved
since the last bulletin. Pulse, 120; temperature, 100.2°.
examination of sediment obtained by centrifuge shows fewer organic
elements than the last examination. There is less uric acid
and a large amount of amorphous phosphates. Renal casts, about
as in the last examination, with very few cylindroids.
Eighth Day, Friday, September
At midnight the pulse was fairly
good, 132. Strychnine and whiskey were given at intervals, and hypodermics
of camphorated oil.
Bulletin 34, 2.50 a.m.—The
President’s condition is very serious, and gives rise to the
gravest apprehension. His bowels have moved well, but his heart
does not respond properly to stimulation. He is conscious. The
skin is warm, and the pulse small, regular, easily compressible,
126; respiration, 30; temperature, 100°.
The wound had been dressed regularly
in the manner described three times a day. At 9 A.M. the dressing
was changed, and a mixture of balsam of Peru and glycerin put in
on gauze after the douching.
Stimulants were continued as before,
but more freely. Coffee, 45 c.c., and clam broth, 60 c.c., were
given; also liquid peptonoids.
At 8.30, 1.50 gm. of adrenalin was
given hypodermically, and repeated at 9.40.
At 10 A.M., nearly two pints of normal
salt solu-  tion was given
under the skin, and one pint containing adrenalin at 6 P.M. Nitroglycerin
and camphor were also injected, at various times, together with
brandy and strychnine.
Stimulants as detailed above were
used freely all day.
3.30 P.M. Pulse growing weaker.
5.00 P.M. Oxygen given and continued
for some hours.
6.30 P.M. Last bulletin, No. 39.
Bulletin 39, 6.30 p.m.—The
President’s physicians report that his condition is most serious
in spite of vigorous stimulation. The depression continues and
is profound. Unless it can be relieved, the end is only a question
At 6.35 P.M., and again at 7.40,
morphine was given hypodermically, as he was very restless and seemed
to be suffering.
9.00 P.M. Heart sounds very feeble.
The President continued to sink,
becoming weaker and weaker.
At 10:00 P.M., the oxygen was discontinued.
The heart sounds were very feeble and consciousness lost.
The President died at 2.15 A.M., September
Drs. E. J. Janeway and W. W. Johnston,
who, at the request of Dr. Rixey, had been summoned in consultation,
arrived too late, but were present at the autopsy. Dr. McBurney
also returned on Friday afternoon.
examination of sediment obtained by centrifuge, before and after
clearing, shows no change from yesterday’s sample. Casts, hyaline
and granular, both large and small, comparatively few. Cylindroids,
a few. Crystals, large amount of uric acid, some sodium urate,
and in the untreated specimen a large amount of amorphous deposit,
principally of phosphates. There are a few epithelial cells,
small, granular. Occasional red cells and leukocytes.