Medical Minute – The Assassination of a President.

By: Dr. James Lee

One hundred and twenty-one years ago this month, the President of the United States was assassinated. One is quick to think of Kennedy and Lincoln, but few remember Garfield and McKinley. On September 6, 1901, in Buffalo, New York, William McKinley became our third President to be assassinated. A look into this assassination is intriguing, compelling, and full of irony in addition to having far reaching implications.

William McKinley was the 25th President of the United States. He was born in Niles, Ohio the proverbial small-town boy who made good, and he was loved by all. On the way to becoming President he had taught school, studied law, served in Congress, and was the last President to have fought in the Civil war. He had just begun his second term in 1901, which he won by a great majority. It has been said that in no other period in our history has there been so much empathy and rapport between the man in the White House and the people outside.

When one is asked about Buffalo, New York, most would think of nearby Niagara Falls, or perhaps the Buffalo Bills and their four straight losses in the Super Bowl (wide right). Others may think of Buffalo as the place where buffalo wings originated. Most would think of it as a blue-collar working-class city, few would call it sophisticated or a center of culture. However, it was exactly that at the end of the 19 and first of the 20th Century.

In 1901, Buffalo was the 8th Largest City in the United States (currently 79th in2022). It was growing and thriving with its population doubling every 10 years for the last 6 decades It was the center of business and industry as well as society. Over 60 millionaires called Buffalo home ($1.00 in 1901 would be almost $35.00 today). It was known as the Queen City and the City of Lights. It was the first city to have electricity widely available and had been so since 1896, largely due to the availability of hydroelectric power from nearby Niagara River and Falls.

It is no surprise that Buffalo was chosen to be the location of the 1901 Pan-American Exposition and was to highlight the cooperation and relationship between North and South America. 40 million people lived within a day’s travel of Buffalo (think horses and train, not cars and planes). The Expo grounds and buildings were impressive. A 400-foot Electric Tower was constructed. It had 35,000 light bulbs and electric search lights at the top that could be seen from Niagara Falls 20 miles away. All the buildings had lights for display for the nighttime light show. Remember, this was a time when most cities relied on gas lights and had little electricity. Rural communities had never seen electric lights. These buildings were constructed for the Expo alone and within 6 months after, were torn down as planned. The only surviving building from the exposition is the Buffalo History Museum which was constructed as part of the New York State Pavilion and planned as the future home of the museum.

The Pan-American Expo was a six-month event from May-to November. There were numerous special days to honor different groups and citizens. September 6th 1901 was President’s Day and the day that McKinley was to visit, tour, and address the Exposition. After a full day of travel, which included a train trip to Niagara Falls and the Power House (hydroelectric power station), he arrived back to Buffalo for a public reception at the Temple of Music on the exposition grounds at 4:00 pm. McKinley was famous for his 50 handshakes a minute reception lines and he insisted on greeting the public despite the concerns raised by his secretary, George Cortelyou. McKinley was only supposed to shake hands for ten minutes. He was seven minutes into the reception line, when 28-year-old Anarchist Leon Czolgosz approached the President and shot him twice at point blank range with a .32 caliber Iver Johnson revolver. The first bullet ricocheted off McKinley’s vest button and the second entered his stomach. McKinley’s first thoughts were of his wife, who was in poor health after losing her mother and two daughters in a 3-year period and had suffered a nervous breakdown. McKinley told his secretary to “be careful how you tell her, oh be careful.” His next thought was of his assassin, telling his guards to “be easy on him boys,” and later, “Don’t let them hurt him.” The events that followed are interesting, intriguing, and shaped the future.

First, the Secret Service men were not next to the President. They and the 60-odd guards were present, but the security was below par, even by the standards of the day. In fact, the next man in line to shake the President’s hand, that was behind Leon Czolgosz, immediately reacted and struck him on the neck and wrestled him to the floor and disarmed him even as Czolgosz tried for a third shot third shot which would have been immediately fatal. McKinley’s guards and secret service then joined in the apprehension and subdued Czolgosz. The man behind Czolgosz was James Benjamin Parker, a black man from Savannah, Georgia who was 6 foot-six inches and 250 pounds. He had been a Constable in Savannah and had a reputation for never returning with an unserved warrant. He was known as a man of few words and his command to submit for arrest was always quietly obeyed. He had arrived at the Exposition only days before to work for a catering company at the Expo.

There has been much discussion and debate surrounding the decisions and care of McKinley after the assassination. He did not die outright but lived for eight days before he passed on September 14. McKinley was removed from the Temple of Music at 4:18 pm and taken to the Exposition hospital. Although it had an operating room, this facility was not a full hospital and mainly dealt with minor injuries; the operating room was designed for anything but major surgery. McKinley was deemed to be too unstable to travel the five miles to nearby Buffalo General Hospital.

Upon arrival to the “hospital,” the President’s personal secretary, George Cortelyou determined that no one would cut presidential flesh until he was satisfied of the person’s credentials. He relied upon John Milburn, local attorney, and President of the Pan-American Exposition, to tell him when the right man arrived.

The obvious choice was Roswell Park. Dr. Roswell Park was the preeminent surgeon in the area. He had extensive experience in treating trauma and abdominal wounds, had done research on treating gunshot wounds, and specifically stressed the importance of removing all foreign material and devitalized tissue along the bullet track and drainage of the wound. He was also a proponent of sterile technique and a sterile surgical environment. He was the clear choice to perform surgery on the President. However, he was in Niagara Falls performing delicate neck surgery on a lymphoma patient. In fact, when a messenger ran into Dr. Park’s operating room in Niagara Falls to announce that Dr. Park was needed urgently in Buffalo, Dr. Park was said to say, “Don’t you see I can’t leave this case, even if it were for the President of the United States?” To which the messenger replied, “Doctor, it is for the President of the United States.”

Dr. Park did send a fellow surgeon to hurry ahead to the railway station to make arrangements for a special engine to speed him to Buffalo, but when Roswell Park arrived at the station, he found everything in confusion and had to wait 15-20 minutes for the regularly scheduled train to come through.

Meanwhile, back at the Exposition, the first surgeon to arrive to the hospital at 4:45 pm was Herman Mynter, an especially competent surgeon with experience in gunshot wounds to the abdomen. He counselled McKinley that it would be necessary to operate at once. Several other doctors arrived after Mynter, but it wasn’t until 5:10 pm that Dr. Matthew Man arrived, and Millburn whispered to Cortelyou that he was the man for the operation. Dr. Mann was a gynecologist with no surgical experience in the upper abdomen, where McKinley was shot, and there is good reason to believe that he had never operated on a gunshot wound. Mann was the quintessential society doctor—well-known, wealthy, distinguished, and supremely self-confident. Cortelyou’s reliance on an attorney for advice on the best surgeon, while well meaning, likely contributed to the outcome.

Despite being known as the city of lights, and the tremendous light shows at night, there were no electric lights to guide the operation and it was done in the fading light of the setting sun. The operation started at 5:29, McKinley’s personal physician, Presley Rixey, arrived at 5:30 pm and using a hand mirror to guide the rays of the setting sun into the wound to allow the surgeons to see. The only instruments available were from Dr. Mynter’s pocket case. There were no retractors, used to hold the operative wound open, particularly important when operating on a patient the size of McKinely. No one noticed Dr. Park’s complete surgical set of surgical instruments in the anteroom. Mann opened the abdomen and removed some foreign material from the bullet tract. He found a hole in the front and back of the stomach that he closed. Attempts to find the bullet were unsuccessful and stopped due to the effect it was having on the President’s pulse. The operation was completed, and Dr. Roswell Park arrived just in time for the final closure. Dr. Park noticed none of the surgeons wore gloves, caps, or gowns. Dr. Mann asked the other doctors if they were satisfied with what had been done. Dr. Mynter alone expressed the only contrary view and favored placing a drain behind the stomach (the right thing to do) but was overruled by Mann and others who felt there was nothing to drain.

McKinley’s post-operative course and recovery was at John Milburn’s house. As you can imagine, the course is meticulously documented. In fact, interestingly, the account of his progress was detailed in the newspaper three times a day. Although it appeared that he may survive the ordeal initially, he succumbed to his wounds and dies at 2:15 am the morning of September 14. At autopsy gangrene was cited as the cause of death. Dr. Park had an overwhelming disappointment, one that he suffered the rest of his life from his inability to save the president, according to those close to him.

Theodore Roosevelt, McKinley’s Vice President left for the Adirondack Forest after it appeared that McKinley would survive. He had to be located by a park ranger on September 13, when it became clear that McKinley would not survive. He left at midnight to travel by wagon five hours to the nearest train station. He would take the Oath of office 13 hours after McKinley’s passing at the Wilcox’s house in Buffalo, which still stands.

It is out of the scope of this article, but interesting to ponder the differences in policy between McKinley and his Vice President Theodore Roosevelt, that may have changed the course of our country if McKinley survived. There has been a lot of debate regarding what would have happened if Roswell Park had been available to operate on President McKinley. This is even more compelling when it is notes that several weeks after the assassination, a woman, distraught over McKinley’s assassination, inflicted the same wound on herself with the same caliber gun. Roswell Park operated and saved this woman.

With regards to Leon Czolgosz, a grand jury was convened on September 16th and met only once before indicting Czolgosz. His trial began on September 23, 1901, a mere 9 days after McKinley’s death, or 17 days from the shooting. Many believe he did not receive a fair trial. His court appointed defense consisted of two aging former judges who had not argued in court for years. They requested only four-hour days in court due to their health, they did not challenge the jury who all admitted from the start of the trial they were inclined to find Czolgosz guilty, they made no effort to communicate with their client, called no defense witnesses, and consistently apologized to the court for their clients “dastardly act”. If that is not bad enough, they did not raise any issue regarding Czolgosz’s sanity. Three days later the jury found him guilty and sentenced him to death after less than a half hour of deliberation. On October 29, 1901, Czolgosz was executed in Auburn Prison. Another irony, given the Pan American Exposition dazzling display of electricity and electric lights, Czolgosz was executed in the electric chair.

Finally, a word about the Secret Service. Ironically, it was Abraham Lincoln that commissioned the Secret Service on July 5, 1865, to combat counterfeiting after learning that one third to one half of the circulating currency was counterfeit. Even more ironic, Lincoln signed the legislation to create the Secret Service on the evening he was assassinated. The Secret Service began investigating a wide range of crimes that today are done by the FBI, including bank robberies and illegal gambling. In 1894, the Secret Service informally began protecting the President Grover Cleveland. However, it was not until after William McKinley was assassinated that Congress requested presidential protection by the Secret Service, which they assumed full-time in 1902. This begs the question why this was not done after Lincoln’s or Garfield’s assassination.

In US history, there have been 4 presidents assassinated, 2 presidents wounded, 15 presidential assassination attempts, and 2 presidential deaths rumored to have been assassinations. The Secret Service continues to evolve and improve in Presidential protection and learn from previous incidents. Today part of the advancement teams’ job is identifying hospitals available where they travel and even identifying locations in the hospital where the President can be isolated and protected. The President is never more than 10 minutes away from a trauma center. Blood that is the Presidents blood type is even refrigerated on board all vehicles in which he is transported. These advancements in presidential protection mitigate the chance of another assassination.

In addition to the question of how history would have changed if Roswell Park, MD was available to care for McKinley, we can add the question as to whether McKinley would have even been shot if the Presidential Protection Detail of the Secret Service had been implemented, more than on an informal basis after the assassination of James Garfield twenty years before, not to mention Abraham Lincoln in 1865.

Dr. James Lee serves as the Coroner of Winn Parish. He is a General Surgeon and Surgical Oncologist who has been practicing in Winnfield for over ten years. Dr. Lee attended the University of Colorado for his medical degree. He completed his residency in Surgery at the University of Oklahoma before completing a fellowship in Surgical Oncology and Endoscopy at Roswell Park Cancer Institute in Buffalo, NY. Dr. Lee and his wife Scarlett live in Winnfield with their son and are active in the community.