The daily morning journal and courier., 1901-10-18
REPORT ON M'KINLEY CASE
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 '"The operation on the stomach being finished Dr. Mann inserted his arm to palpatate carefully all the deep struct-
 ures behind the stomach. No trace or S the bullet or of the further track or the bullet could be found. As the ln- Production of the hand in this way seemed to have a bad influence on the presidents pulse prolonged search for' further injury done by the bullet, or for the bullet itself was desisted from. Further search might have caused the death of the patient upon the operating table. At the close of the opertaion the surgeons present unanimously assured Dr. Mann in answer to his questions that they were perfectly satisfied that everything that was possible had been done and that they had no further sug- gestions to make. It was also decided not to introduce any gauge or tubes into the abdomen for drainage and this was not necessary, but the wound was not sewed up so tightly that no drain age could take place naturally.
 The report then continues in the his X. tory of the case after the operation, The progress of the illness is given day by day and the bulletins as given out by the attending physicians are incor- porated in the report.
 On the fifth day, September 10th, took place the much discussed removal of stitches from the wound in the ab- dominal wall The report says;
 Tn the evening the dressings were examined, and, as there was consider able staining from the discharges It was thought best to remove four stitches and to separate the edges ot Atne wound A little slough was Qb- served near the bullet track, covering a space nearly an inch wide, the thick ness of the flaps. The separation seem
 ad to extend down to the muscle"
 The remainder of the wound looked healthy and it was thought that the in lection was due to the bullet and to piece of clothing which had been car ried into the wound at the time of the shooting. The wound was then dressed and on the following day the patient condition was very much improved
 The findings at the autopsy as well as the developments of the case durlng the last days, exclude all possibility or absolute injury to the stomach py pre- mature giving of solid food as was al leged, at the time the unfaVoraple symptoms came on after change to solid diet. On the fifth day the president sipped hot water, on the sixth he had beef juice, the first food taken by mouth since the operation. In the meantime n1,tritiye enemas were continued, but were not well retained. At S:30 in the morning of the seventh day he was al- lowed chicken broth, a. very small piece Of toast and small cup of coffee. lie did not care for the toast and at scarce |aIy any of 1t. The wound in the mean time had been doing very well and had been dressed daily after the removal of the stitches and the sloughing tissue. The president seemed at his best and Favorable result was now confidently expected There was no sign Of blood poisoning or of inflammation of the per sitoneum. The only alarming symptom was his rapid pulse, and as it had been of a fairly good quality right along the nz1Irgeons did not attribute very great ili.Iortance to this sign On the sev- senth day. towards noon, the pulse be- gan to grow weaker and grew rapidly worse. Stimulants were given and the food was discontinued, while castor oil and an enema. of OK gall were given to move the bowels. At midnight there was some improvement in the pulse af- fer an infection of salt solution into the stlbcutaneous tissues. On the eighth day the condition of the president was described as very serious, as he did not respond to stimulation. Stimulants and infections of salt solution, coffee and broth were given, but without much effect. At o'clock oxygen was given and continued for some hours. At 6:9o the president was restless; at 10 o'clock he lost consciousness and continued to sink until he died at 2:15 a. m. on Sep tember 14
 In speaking of the criticism that Roentgen rays should have been used to locate the bullet, Dr. Mann says in his report:
 I've were often asked why, after the operation we did not use the X-rays to find the bullet In the first place. there were at no time any signs that the bull let was doing harm. To have used the K ray simply to have satisfied our cu- srfosity would not have been warranta- |ble. as it would have greatly disturbed and annoyed the patient and would have subjected him also to certain risk. Had there been signs of abscess- formation then the. X-rays could and would have been used"
 Dr. Gaylord's report of the autopsy is lengthy and detailed. Nothing of importance was noticed about the wound on the chest caused by the first shot, except that the area of skin affect ed was found to be discolored, greenish' yellow and mottled, and that there was a hemorrhage into the fat under the skin beneath this area. The abdominal wound showed no evidences of necrosis