The President’s Case
Life is Short, the Art is Long, the Time is Urgent;
Experience Fallacious, and Judgment difficult.
The triumphant life, the tragic
death of William McKinley, the twenty-fifth President of the United
States has passed into history.
During the fateful days which followed
the cruel blow of an assassin, all the world stood still and centered
their vision upon that hospital couch where science struggled mightily
In spite of every resource death won.
But though nations come and go, republics
flourish or wither, rulers pass away, the healing art moves on,
and the surgeon will turn from the keen disappointment as to the
outcome of this illustrious case to a study of its scientific aspects.
It is therefore not out of place to
devote several pages of this issue to the correct official records
of the case of President McKinley, in a form which many readers
will undoubtedly find worthy of preservation for future reference.
From a technical standpoint it is
admitted that the case is beyond adverse criticism. All that human
skill, knowledge, promptness, daring and an overmastering sense
of duty could accomplish were devoted to the President’s case. The
most brave and skillful of modern surgeons gave their best knowledge
to the saving of that valuable life. From the autopsy it is evident
that the best directed medical skill was doomed from the beginning
to be frustrated—the unexpected happened.
To ascertain the cause of the results
in this case, and if possible to provide against its recurring,
many able men will bend their energy. The future treatment of wounds
of the abdomen will be placed upon a firmer basis and a better footing
than ever before. Because this life was lost many lives will be
Grand and noble in his life, in dying
William McKinley will have advanced the cause of surgery, and in
so doing he has not suffered and died in vain.
President McKinley was wounded at
about 4:30 p. m. Sept. 6th. In less than a half hour he was removed
to the Emergency Hospital on the Exhibition Grounds. He was received
by the son of Dr. Mann, the acting house surgeon, hypodermic injections
were at once administered and preparations made for the operation.
In less than an hour after the bullet was fired the operation was
It was found that two bullets of 32-calibre
had struck the President from the front, at close range. One ball
struck the sternum on the left side, between the second and third
ribs, but did not penetrate. The second bullet penetrated the abdomen
at a point two and one-half inches to the left of the median line,
and at a level of about one and one-half inches above the umbilicus.
An incision five inches in length
was carried into the abdomen following the trajectory of the bullet.
The anterior wall of the stomach was found to be perforated. This
was satured [sic] with fine black silk. The intestines were
inspected but no injury found. A perforation over one inch in diameter
was found in the posterior wall of the stomach. This was lacerated
irregularly, and with contused edges. This wound was also suured
[sic] with fine silk.
The course of the bullet after passing
through the stomach could not be traced. But little peritoneal contamination
was present. The abdominal cavity was thoroughly irrigated with
normal surgical salt solution and closed without drainage. In this
latter procedure through and through-sutures of silk worm gut were
used, and the facia brought together with catgut. The wound was
finally covered with aseptic gauze held in place by “Z O” Adhesive
plaster and bandages.
While yet under the influence of the
anesthetic, the patient was conveyed to the residence of Mr. Milburn,
the President of the Exposition. Dr. Rixey re- 
mained at the house continuously. Consultations of all the physicians
were held three times each day. No profound shock followed the operation.
From the time of the operation to the end, the pulse was rapid and
erratic, and gave great concern to the attendants. The temperature,
however, fell. There was no abdominal tenderness, no meteorism,
no muscular contraction. Examination of the blood showed no leucocytosis,
and the fear of peritoneal sepsis gradually disappeared.
Nutritive enemata were given, but
were not retained. Broths given by the mouth were retained. The
only solid food given was a bit of toast well soaked in broth, administered
the fifth day. Indican was present in the urine, but this disappeared
after evacuation of the bowels was secured. On the sixth and seventh
day heart stimulants, digitalis, adrenalin [sic], oxygen
inhalation, etc., were resorted to, but there was no reaction from
the stimulation. The urine examinations were negative. The President
suffered no pain, and in the absence of positive indications, hope
was not abandoned until the seventh day.
The following is the official report
of the 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 closed by the stitches, but
the tissue 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 s [sic]
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 treatment, and was the direct result of the bullet wound.”
Friday, Sept. 6.—7 p.m.—The
operation successfully performed. The President stood the operation
well. Condition in general gratifying; justifies hope of recovery.
p.m.—Is rallying satisfactorily and resting comfortably.
Saturday, Sept. 7.—1
a.m.—Free from pain and resting well.
3 a.m.—Continues to rest well.
5 a.m.—Has passed a good night.
9 a.m.—No serious symptoms have
3:30 p.m.—Continues to rest quietly;
no change for the worse.
much the same. Responds well to medicine.
Sunday, Sept. 8.—3:20
a.m.—Has passed a fairly good night.
9 a.m.—Has passed a good night
and condition is quite encouraging. Mind is clear and he is
resting well; wound dressed at 8:30 and found in a very satisfactory
condition. There is no indication of peritonitis.
12 m.—The improvement in the President’s
condition has continued since last bulletin.
4 p.m.—Since the last bulletin
has slept quietly, four hours together since 9 o’clock. Condition
satisfactory to all physicians present.
p.m.—Is resting comfortably and there is no special change since
Monday, Sept. 9.—6 a.m.—The
President passed a somewhat restless night, sleeping fairly
well. General condition unchanged.
9:20 a.m.—Condition becoming more
and more satisfactory. Untoward incidents are less likely to
3 p.m.—The President’s condition
steadily improves and he is comfortable, without pain or unfavorable
symptoms. Bowel and kidney functions normally performed.
p.m.—Condition continues favorable.
Tuesday, Sept. 10.—7
a.m.—The President has passed the most comfortable night since
the attempt on his life.
9 a.m.—Condition this morning
is eminently satisfactory to physicians. If no complications
arise, a rapid convalescence may be expected.
3:20 p.m.—There is no change since
this morning’s favorable bulletin.
p.m.—The condition of the President is unchanged in all important
particulars. When the operation was done on Friday last it was
noted that the bullet had carried with it a short distance beneath
the skin a fragment of the President’s coat. This foreign material
was, of course, removed, but a slight irritation of the tissues
was produced, the evidence of which appeared only to-night.
It has been necessary on account of this slight disturbance
to remove a few stitches and partially open the skin wound.
This incident cannot give rise to other complications. In consequence
of this separation of the edges of the surface wound the healing
of the same will be somewhat delayed. The President is now well
enough to begin to take nourishment by the mouth in the form
of pure beef juice.
Wednesday, Sept. 11.—6
a.m.—Passed a very comfortable night.
9 a.m.—Rested comfortably during
the night. Decided benefit has followed the dressing of the
wound made last night. Stomach tolerates beef juice well, and
it is taken with great satisfaction. Condition this morning
is excellent. 
3:30 p.m.—Continues to gain and
the wound is becoming more healthy. The nourishment taken into
the stomach is being gradually increased.
p.m.—Condition continues favorable. Blood count corroborates
clinical evidence of absence of any blood poisoning. Is able
to take more nourishment and relish it.
Thursday, Sept. 12.—6:20
a.m.—Has had a comfortable night.
9:30 a.m.—The President has spent
a quiet and restful night, and has taken much nourishment. He
feels better this morning than at any time. He has taken a little
solid food this morning and relished it.
3 p.m.—Condition very much the
same as this morning. His only complaint is of fatigue. He continues
to take a sufficient amount of food.
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.
unfavorable symptoms have improved since last bulletin.
Friday, Sept. 13.—1:50
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 and easily compressible.
9 a.m.—Condition has somewhat
improved during the past few hours. There is a better response
to stimulation. He is conscious and free from pain.
2:30 p.m.—Has more than held his
own since morning, and his condition justifies the expectation
of further improvement. Is better than yesterday at this time.
4 p.m.—Only slightly improved
since last bulletin.
5:35 p.m.—The President’s condition
is grave at this hour. He is suffering from extreme prostration.
Oxygen is being given. He responds to stimulants but poorly.
6:30 p.m.—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 of time.
President is dying.
Saturday, Sept. 14.—2:15
a.m.—The President is dead.
ROLL OF HONOR.
The medical and surgical attendants
of President McKinley who so well performed a grave public duty
under most trying circumstances, will ever be honored by an appreciative
public. Conscious of the fierce glare of public opinion, the distinguished
patient’s surgeons accepted their tremendous task.
The operation was not a difficult
one, but it was the fact that the censure of the nation and the
criticism of the surgical world would fall with tremendous force
upon the slightest mistake in judgment or technique, that required
the fortitude. To their credit let it be recorded that there was
no hesitancy, no delay, no shrinking from responsibility, no red
tape. Their consistent and dignified action, the celerity and skill
with which they performed their duties will ever be regarded with
pride by their professional brethren.
In less than an hour after the illustrious
patient was wounded, he was operated upon in the Emergency Hospital
in the Exposition Grounds. Dr. Matthew D. Mann, Professor of Obstetrics
and Gynecology, University of Buffalo, performed the operation.
He was assisted by Dr. Herman Mynter, Professor of Operative Surgery,
University of Buffalo, Dr. John Parmenter, Professor of Anatomy
and Clinical Surgery, University of Buffalo, and Dr. E. Wallace
Lee of St. Louis. Dr. Eugene Wasdin of the Marine Hospital Service
administered the anesthetic (ether). Dr. Presley M. Rixey, the President’s
physician, and Dr. Roswell Park, Professor of [S]urgery, University
of Buffalo, arrived before the operation was complete. Dr. Charles
McBurney of New York was sent for as consultant and arrived the
following day. On the sixth day Dr. Charles G. Stockton of Buffalo,
Dr. Edward G. Janeway of New York and Dr. W. W. Johnson of Washington
were summoned as medical experts.
The male nurses in attendance were
Palmer A. Elliott, Ernest Vollmeyer and John Hodgins of the Army
The female nurses were Miss Helen
Mohan, Miss Conley, Miss Hunter and Miss Grace McCullogh.
THE HOSPITAL AND THE DRESSINGS.
No small amount of credit is due
to the medical management of the Pan-American Exposition, in that
through their foresight they had established a completely equipped
Emergency Hospital on the Exposition Grounds. Thus it was possible
to give to the nation’s illustrious patient without delay, the advantages
of all the appliances known in the technique of modern surgery.
The equipment of this hospital was faultless for emergency service,
and without ostentation, delay or confusion its staff responded
to this most unexpected draft upon its resources. 
The surgical dressings used in this
Hospital are those of Johnson & Johnson’s manufacture exclusively.
These dressings were used in the first instance of the operation
upon the President, and afterward during the entire course of the
The makers of these dressings and
the surgeons in attendance, while realizing the great responsibility
with the eyes of the world focused upon that wound, never for one
moment doubted the reliability of the dressings used. So far as
the dressings were concerned all was perfect. There was no inflammation,
no pus, no irritation. Probably no greater compliment could be paid
to the integrity of the dressings used in this remarkable case,
than the final report of the surgeons at the autopsy: “Death was
unavoidable by any medical or surgical treatment.”
On opening the abdomen, the wall
of which was two and one-half or three inches in thickness, the
omentum was found adherent all around the wound of operation. This
wound was five inches long, extended down to the muscle and was
healthy in appearance, no gangrene being present. The omentum was
healthy and no signs of peritonitis were evident. The intestines
were smooth and shiny without adhesions or exudate. The mesentery
of the transverse colon was adherent to the stomach wound. On loosening
these adhesions, the sutures of the wounds of the anterior and posterior
walls of the stomach were found tight and in place, allowing no
Around the sutures, however, there
was a zone of total gangrene of the wall of the stomach about two
inches in diameter and ready to slough.
From the wound in the posterior wall
of the stomach it was found that the bullet passed through the transverse
mesocolon near its attachment, thence through the posterior layer
of peritoneum cutting a groove into the upper end of the left kidney,
and entering into the retro-renal fatty tissue. The whole track
of the bullet presented the appearance of a gangrenous hole, the
gangrene in the retro-renal tissue being of the size of a fist.
From this point the bullet passed into the posterior muscular tissue
and could not be found, although careful search was made for four