Some of the Surgical Aspects of the Assassination
of President McKinley
Within the past thirty-five years,
three presidents of the United States have been stricken down by
the murderous weapon of an assassin.
In each instance there were several
features of striking surgical interest. In all three, the resources
of science and art were impotent; we may say, that their wounds
were from the beginning mortal.
In the case of the illustrious Lincoln,
the missile entered the skull just posterior to the right ear, about
an inch from the torcular, tore widely open the lateral sinus and
lodged in the brain substance. The commotion transmitted through
the emcephalon was so great that the anterior fossa of the base
of the skull was widely fissured and the supra orbital plates shivered
Consciousness was lost and mortal
symptoms immediately supervened, death following in six hours.
In President Garfield’s case, the
missile entered from behind, tearing through the thick lumbar muscles
and the body of the ninth dorsal vertebra, in transit wounding the
spinal cord. During life the position of the bullet could not be
Immediately on being shot, the President
fell to the ground, was soon in deep shock with signs of paralysis
of both lower extremities. The President lingered nearly four months
before the end came.
In this case, for several weeks after
the murderous assault, there were some very good reasons for expecting
an ultimate recovery. He survived the immediate danger of mortal
hemorrhage, the paralysis improved, there was no evidence of perforation
of the hollow viscera, he had fair digestive power, besides, he
was a person of good habits, with a robust constitution. But, as
time sped on, it was obvious that the unfortunate man was doomed,
the effects of shock lingered, infection set in, metastatic suppuration
followed, with a steady rise of temperature; increasing exhaustion
and final loss of digestive power; added to this continued pain
and loss of rest. The patient had made a brave fight for his life,
but the odds were against him.
It was thought at that time—20 years
ago—that could the missile be only located and extracted, the patient’s
life might have been saved.
Laparotomy at that time for penetrating
wounds of the abdomen, was yet untried, and of the floroscope or
the Roentgent Rays nothing was known. Lister was then working out
his system of antiseptics, and many had adopted it, but it was only
in its trial stages, and was by no means generally employed. On
autopsy, after the viscera of the abdomen were removed, the bullet
was found, well encysted in the pancreas. At that time, all that
the resources of the healing-art could accomplish was to aid the
processes of nature and alleviate symptoms.
Since that epoch, very considerable
advances have been made in operative medicine, but let no one delude
himself with an impression that they are of as widespread a character
as some would have us believe. We have no means yet which will enable
us to overcome the effects of age, nor to prevent the death of tissues,
after what Cowan well describes as “the local shock to parts after
a traumatism.” We cannot well mend a shattered spine, nor restore
tissues which have been destroyed.
The Third Assassination.
The medical aspects of the late President
McKinley’s case in many respects are the most extraordinary and
unique on record. No doubt, but for years to come, they will occupy
an important place in the annals of surgery, and serve as an object
to the rising generation of practitioners.
Too much haste and too much optimism
seemed to be the conspicuous features here. About four hours after
eating a mid-day lunch, while standing in an erect position, the
President was shot twice, at very short range, not more than one
or two feet—the cartridge being 32 calibre. One ball struck the
sternum and glanced, the other pierced the abdomen one inch above
and to the left of the umbilicus—immediately over the hypogastrium—a
highly vital area. For the moment, the President was dazed rather
than shocked; he gazed for a moment on the assassin and sat down.
It does not appear from the bulletins, that immediately after the
assault the President showed any signs of grave constitutional disturbance,
of large hemorrhage or great shock. Almost immediately he was removed
in an ambulance to the Emergency Hospital, and within one hour after
the shooting he  was on the
The active participators in the laparotomy
consisted in one gynaecologist, a member of the medical staff of
the Navy, a professor of surgery, and a visiting surgeon on the
grounds. The chief surgeon of the hospital, Dr. Roswell Park, was
not present when the operation began but was there soon after.
Now, why this haste till Park arrived,
or until a larger number of experienced general surgeons could be
called, that deliberate council could be had?
But why, may be enquired, a moment’s
delay when there are good grounds of suspecting the penetration
of a hollow viscus?
To such we must answer that the lessons
of Stimpson’s statistics on “Results after interference, and non-interference
in penetrating gun-shot wounds of the abdomen,” the writings of
Reclus, the records of the Cuban war, and those up to date in the
Transvaal, have been lost, as all of these clearly demonstrate that
few escape a mortal end, after laparotomy for gun-shot wounds, while
a large number recover under expectant treatment.
Rarely, or perhaps, it may be said,
never do we find a double perforation of the gastric walls without
co-incident damage to other important organs, the liver, spleen,
the pancreas, kidney or lungs; in one such case in the writer’s
hands, mortal hemorrhage came from the left kidney, in another the
internal iliac artery was opened and a fatal secondary hemorrhage
into the left pleural cavity occurred.
In the case of Mr. McKinley, it is
said that one and one-half hours were consumed in the operative
procedure. This seems a long time, but to one who has ever encountered
the difficulties of suturing a posterior perforation in the mobile,
living stomach, it certainly implies no lack of skill, but to employ
what prophylactic we may, the immediate or ultimate shock succeeding
is invariably very great. This following immediately on the shock
of the assault, tries the vital powers to their utmost, and certainly
enfeebles the reparative processes of the system. There is no case
of recovery yet recorded after laparotomy for gun-shot wound of
the stomach in one over 50 years old.
The optimistic bulletins, the sanguine
expectations, the “absence of sepsis and of peritonitis,” “the normal
blood count,” the certainty of recovery while tissue asphyxia, decomposition
and sphacelus were slowly but steadily undermining life, seem indeed
quite incomprehensible. In a case of this character of world-wide
notoriety, the effect of the laity must certainly tend to discredit
the prognosis, the opinion of physicians and the boast of the profession
that medicine is approaching an exact science.
Far better for the prestige and honor
of the profession had it been if the medical staff had taken a determined
stand and firmly resisted the importunities of friends and the press,
and stubbornly refused to commit themselves until all chances of
error in prognosis were impossible.