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
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 
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
resu[l]t of the bullet wound.
HARVEY D. GAYLORD, M. D.
HERMAN G. MATZINGER, M. D.
P. M. RIXEY, M. D.
MATTHEW D. MANN, M. D.
HERMAN MYNTER, M. D.
ROSWELL PARK, M. D.
EUGENE WASDIN, M. D.
CHARLES D. STOCKTON, M. D.
EDWARD G. JANEWAY, M. D.
W. W. JOHNSTON, M. D.
W. P. KENDALL, Surgeon, U. S. A.
CHARLES CARY, M. D.
EDWARD L. MUNSON,
Surgeon, U. S. A.
HERMANUS L. BAER, M. D.
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.