October 17, 2012 by EmerJencyWEBB
The World’s a Stage
Throngs of citizens filled the Temple of Music, pushing closer towards the main attraction at the 1901 Pan American Exposition. The President stood in formal dress at the height of the mass, shaking hands with the men, women, and children of Buffalo, NY at a feverish rate. It had been a warm afternoon, and although the shade of the Temple offered some reprieve, the faces of many were marked with beads of perspiration. It was good to have a handkerchief in hand, at times like these, to wipe the brow and hands of sweat before meeting the leader of the Country.
Therefore, it was not alarming to the President or the available security detail to see a man step forward, shortly after 4:00 pm, with his right hand wrapped in a cloth. As McKinley offered his left to shake, two gunshots rang out in rapid succession. The would be assassin, and self proclaimed anarchist Leon Czolgosz was quickly tackled to the ground, and barely escaped death by a mob of onlookers.
The President recoiled, clutched his abdomen. “Am I shot?”.
Dr. Matthew D. Mann arrived at the Exposition emergency hospital at 5:10pm, walking briskly, uncertain of the full extent of the patient’s injuries. As an obstetrician by trade, it seems peculiar his attendance at this moment in history, to the abdominal injuries of the Chief Executive. However, Buffalo’s most highly regarded surgeon Dr. Roswell Park was out of town in the midst of a complicated neck dissection at the time of the shooting. The time it would take for him to travel by train to Buffalo from Niagra Falls could be the difference of life and death for McKinley.
Mann was summoned by Dr. Herman Mynter, the first physician to arrive at the President’s side. Mann, he knew, was a skilled surgeon trained in Medicine at Columbia, and in advanced European technique in Vienna, Paris, and London. He had almost 30 years experience operating on the abdomen. He was the McKinley’s best bet.
A brief discussion about the risks and benefits of surgery was made between surgeons and with the patient, and the decision to operate, before nightfall, was solidified.
Surgery to Save a President
The Exposition Hospital was not fully equipped to handle an emergency operation at this time of day. There were no electric lights in the operating theater, so the surgeons would have to work quickly against the fading sunlight. Also, surgical instruments were difficult to find, so Dr. Mynter offered up his pocket set. Both the surgeons’ hands and the patient’s abdomen were prepped with soap, water, and mercuric chloride to achieve the new standard of antisepsis. Ether anesthesia commenced at 5:20 pm. Nine minutes later, only an hour and twenty minutes after the President was shot, Mann picked up a scalpel and made his first incision.
There were two obvious wounds. The first, a contusion noted between the 2nd and 3rd ribs just right of the sternum, with no penetration of the skin. The bullet must have been deflected by a button or piece of clothing. The second bullet wound penetrated the abdomen “five inches below the left nipple and one and one-half inches to the left of the median line”. This is where the surgeon’s turned their attention.
An incision was made parallel to the midline from the edge of the ribcage, through the bullet wound, to a length of 8 cm. The anterior wall of the stomach was delivered up into the operating field, where a hole was found and repaired with a double row of silk suture. Mann enlarged his incision to a total of 15 cm, to access the posterior stomach. Omentum and transverse colon “were pulled well out of the abdomen” to achieve a satisfactory view. It was now 6:05 pm. With sunset approaching, hand held mirrors were utilized to deflect the remaining ambient light into the depths of this deep wound. Another hole was found in the back of the stomach and repaired.
Dr. Roswell Parks finally arrived from Niagra Falls by train at 6:20 pm, able to provide additional consultation while the abdomen was still open. The surgeons concluded that as the bullet was too deeply embedded to be found, and as the patient’s vital signs were becoming more tenuous, it was best to stop here and close. The peritoneal cavity was irrigated with a warm salt solution and with no extraneous bleeding or gastric leakage, Mann decided a drain was not necessary. Seven silkworm gut sutures cinched the abdomen closed with catgut between. The patient was prepped for transport and at 7:32 pm was placed in an ambulance (still under anesthesia) driven by two medical students to the the home of John Milburn, President of the Pan American Exposition, for recovery.
The first post-surgical bulletin was released later that night:
“The President is rallying satisfactorily and is resting comfortably. 10:15 P. M. temperature, 100.4 degrees; pulse, 124; respiration 24.
Convalescence and Death
Although the operation utilized more advanced skill and technique not available to prior Presidential assassinations, the post-operative course of McKinley was characterized by the same rudimentary and pre-modern treatments that plagued the prolonged death of President Garfield. Subcutaneous injections of fluid, brandy, digitalis, strychnine, nitroglycerin, camphor, adrenalin were utilized in conjunction with nutrient enemas of egg and whiskey. Decisions regarding the administration of these treatments were made on the inspection of vital signs, fecal contents, and spot urinalysis on a day to day basis.
President McKinley had a temperature of 102.2 by the second morning after the operation, and continued to spike daily fevers and waves of tachycardia until the day of this death a week later.
At 2:15 AM on September 14th, 1901, preceded by several hours of restlessness, and two hours of unconsciousness, the President was pronounced dead.
The Autopsy of a President
On the day of his death, President McKinley’s autopsy was carried out. On examination of the body the cause of death was attributed to gangrene. There was extensive necrosis of the pancreas and surrounding tissues, necrosis along margins of the stomach wounds, a left superior kidney injury, and left adrenal injury. The prolonged dissection was terminated before the bullet could be found due to a request by the President’s family, and could only be assumed to lie in the tissues posterior to the pancreas. Extensive microscopic and microbiological studies supplemented the autopsy post-mortem, and it was concluded at the time that no bacteriologic source was deemed significant enough to cause the death of the President.
The medicine and science surrounding the death of President McKinley reveals the advancements made in a short time, even since the assassination of Garfield: ambulance retrieval, emergency surgery, advanced surgical technique, antisepsis, and post-mortem, the battery of microscopic and microbiological testing of the President’s tissues in aid to autopsy.
However, we also see how limited pre-modern post-operative, nutritional, and medical treatments were in resuscitating their patient. Would McKinley have survived if treated in the modern era? Most authors would agree, yes it is possible. More importantly, what would America look like today if he had? Food for thought.