The Case of President McKinley

     William McKinley, twenty-fourth President of the United States, died at Buffalo, New York, on September 14th, 1901, from the effects of a pistol shot wound of the abdomen at the hand of an assassin. Few rulers, crowned or uncrowned, have ever been the objects of such respect, affection and solicitude as were displayed for him during the week he lay battling with death.
     With these facts in mind, with a consciousness of the fierce glare of public opinion concentrated on them, the distinguished patient’s surgeons accepted their tremendous task. They saw their plain duty and met it, irrespective of the immeasurable enormity of the responsibility they shouldered. It was not the difficulty of the operation, but the fact that the censure of a nation would fall on him who made the slightest mistake in judgment or technique that required the nerve to perform it. There was no delay to share responsibility, and no fastidious red tape. Within an hour of the reception of his wounds the illustrious patient was operated upon in the Emergency Hospital in the Exposition grounds. That this was possible can but reflect great credit on the medical management of the Exposition. Dr. Matthew D. Mann, Professor of Obstetrics and Gynecology, University of Buffalo, performed the operation. His first assistant was Dr. Herman Mynter, Professor of Operative Surgery, University of Buffalo. Dr. John Parmenter, Professor of Anatomy and Clinical Surgery, University of Buffalo, acted as second assistant, and Dr. E. Wallace Lee, of St. Louis, Mo., served as third assistant. Dr. Eugene Wasdin, of the Marine Hospital Service, administered the ether. Dr. Prestley M. Rixey did not reach the scene until after the operation had been started. Dr. Roswell Park, Professor of Surgery, University of Buffalo, had gone to Niagara to operate. He was summoned to the hospital and arrived on a special train in time to assist in the completion of the operation.
     The bullets were fired from a revolver held in front of the President by a vile thing having the appearance of a man, a Frankenstein monster whose bread and salt came from the country he so sorrowfully afflicted. One ball struck the sternum on the left side, between the second and third ribs. It was abstracted without difficulty and caused no serious injury. The fatal bullet penetrated the abdomen at a point two and a half inches to the left of the median line and at a level of about one-half inch above the umbilicus. An incision, five inches in length, was carried into the abdomen and the trajectory of the bullet followed. A perforation in the anterior wall of the stomach was found and sutured with fine black silk. The intestines were then inspected, but no injury was found. The perforation in the posterior wall was over an inch in diameter, with irregular lacerated and contused edges. This also was sutured with fine silk. The fact that food had not been ingested for a [sic] least three hours before the injury, together with the promptness, celerity and dexterity of the surgeons, accounts for the little peritoneal contamination present. A copious irrigation of surgical salt solution was next employed and the abdomen closed without drainage. Through and through sutures of silk-worm gut were used and the fascia brought together with catgut. During the anesthetic sleep an ambulance conveyed the august patient to the house of Mr. John Milburn, President of the Pan-American Eposition [sic]. Three male nurses from the United States Army Corps and three female nurses were selected to administer to the President’s wants. The male nurses were selected from those on duty with the Field Hospital Exhibit of the Army Medical Department at the Exposition. They were Acting Hospital Steward Palmer A. Eliot, Private Ernest Vollmeyer and John Hodgkins, all of whom graduated from the School for Hospital Corps men at the Army General Hospital, Washington, D. C. Eliot is also a graduate of the Bellevue Hospital Training School, and Vollmeyer a graduate of the Presbyterian Hospital of New York. Hodgkins has had a long experience of nine years in military hospitals. “The efficiency of these men is such as to have elicited much favorable comment from the staff of attending surgeons.” We are glad to note the marked competency of the Army Hospital Corps in meeting the great duty which devolved upon it, and also the rare common-sense displayed in not excluding male nurses. The female nurses were Miss Helen Mohan, a graduate of the Buffalo General Hospital Training School; Miss Conley, a graduate of the Buffalo Hospital Training School; Miss Hunter, Mrs. McKinley’s nurse, and Miss Grace McCullough, of Baltimore, all of whom deserve the highest praise for their part in the unsuccessful campaign against the Grim Reaper.
     The President’s faithful physician, Dr. Rixey, and one of the surgeons remained in the house each night, and all the physicians and surgeons consulted three times each day. Dr. Charles McBurney, of New York, was sent for as a consultant; he arrived the next day.
     There was apparently no profound shock following the operation. The pulse, however, always remained above the normal, but as the period for peritonitis slowly dragged by without any evidence of this dreaded complication, anxiety and doubt dissolved and crystallized themselves into the conviction that recovery was assured.
     At frequent intervals bulletins, brief, plain and simple, telling the progress of the case, were issued, signed by Drs. Rixey, Mann, Park, Mynter, Wasdin and McBurney, and by Mr. George B. Cortelyou, Secretary to the President. They contained no opinion, nor made any prognostication. The phantom of tetanus, injury to the pancreas, kidney or thoracic duct, and necrosis around the bullet tract, as is sometimes seen in diabetes and in other debilitating diseases, and indeed in individuals otherwise healthy, skulked in the background and must have haunted the brains of the surgeons. Retroperitoneal abscess, uremia and the condition of the heart we heard mentioned frequently. There was scarcely room in one’s mind, nor time, to consider the remoter possibilies [sic]. And here the newspapers come in for honorable mention. With a few yellow exceptions they told the whole truth, and nothing but [480][481] the truth. It was suggested that the bullets might have been poisoned, but there seems to be little probability of this.
     At the end of the fourth day two stitches were removed because of some wound irritation. Nutritive enemata and stimulants hypodermically had been administered, but now some liquid nourishment was cautiously given by mouth. Convalescence was believed to have begun. On Thursday, the sixth day, a piece of toast, some weak coffee, beef juice and a cup of chicken broth were given by mouth. The surgeons were confident that the gastric wounds had been securely sutured. There was nothing to indicate food would not be assimilated; indeed, food had been absorbed, and the patient’s condition demanded nourishment. Then, like a bolt from the blue sky, came the tiding that the patient was fatigued, that there were evidences of toxemia. Many thought of perforation. Questions as to the propriety of allowing food by mouth were raised by some, as if small fragments of broth-soaked toast could tear asunder the careful stitching that had been done.
     Dr. Charles D. Stockton was asked as a medical expert to see the weakening patient. The morning of the next, the seventh day, hope grew stronger, but towards evening fear assumed supremacy, and when night fell hope was abandoned, and the situation resolved itself into a watching and waiting for the inevitable. Early in the morning Dr. Edward Janeway, of New York, and Dr. W. W. Johnston, of Washington, were summoned, but nothing mortal brain could evolve, nor mortal hand do, was sufficient to stay the ebbing vital tide. As the last words of the dying President expressed it, “God’s will, not ours, be done.”
     Few adverse criticisms concerning the treatment have been made. The country is convinced that nothing was left undone, and everything was done to save its leader, and that the accursed bullet, together with the weakened resistance of its victim, engendered by long and onerous public service, was the direct cause of death, and that this was destined to be so from the first. All the surgical skill and good judgment of the world’s surgeons could have done no more than was done.
     The following report of the autopsy silences all critcism [sic]. It was made on the day of death and signed by representatives of the government, the faimly [sic] and the profession.

REPORT OF AUTOPSY.

     The bullet which struck over the breastbone did not pass through the skin, and did little harm. The other bullet passed through both walls of the stomach near its lower border. Both holes were found to be perfectly closed by the stitches, but the tissues around each hole had become gangrenous. After passing through the stomach, the bullet passed into the back walls of the abdomen, hitting and tearing the upper end of the kidney. This portion of the bullet track was also gangrenous, the gangrene involving the pancreas. The bullet has not yet been found. There was no sign of peritonitis or disease of other organs. The heart walls were very thin. There was no evidence of any attempt at repair on the part of nature, and death resulted from the gangrene which affected the stomach around the bullet wounds, as well as the tissues around the further course of the bullet. Death was unavoidable by any surgical or medical treament [sic], and was the direct result of the bullet wound.

     In the certificate issued by the coroner the cause of death is given as gangrene of both walls of the stomach and pancreas following gunshot wound. It is signed by H. R. Gaylord, H. Z. Matzinger and James F. Wilson, coroner.