WHEN THE PRESIDENT IS THE PATIENT

 

EMERGING INFECTIOUS DISEASES

 


The President Has Been Shot

Five times during our nation's history, Americans have been stunned by the news that their president had been shot. Many Americans can recall where they were the day President Kennedy was shot. The picture of a wounded President Reagan being pushed into the back seat of the White House limousine reminded many of us how vulnerable our presidents are to would-be assassins.

Presidents Abraham Lincoln, James A. Garfield, William McKinley, and John F. Kennedy were killed by assassins' bullets. Questions have been raised by historians about the quality of the medical care received by these presidents after they were shot. Criticisms of the management of Garfield's and McKinley's cases, for example, arose almost immediately. Whether these presidents could have been saved with better medical care is an issue that is still being debated by historians and physicians.

Andrew Jackson
1829 - 1837

Assasination Attempt of President Andrew Jackson

On 30 January 1835, President Andrew Jackson went to the Capitol to attend the funeral of Congressman Warren Davis of Mississippi. When the President walked along the Capitol's east portico after the service, he was approached by an unemployed house painter named Richard Lawrence. When Lawrence was within eight feet of the President, he drew a pistol and attempted to shoot Jackson. The pistol misfired. Lawrence then drew a second pistol, which also misfired. The ever-feisty Jackson raised his walking stick and went after his assailant, who was arrested and later declared insane. The first assassination attempt of an American president had failed.

 

Abraham Lincoln
1861 - 1865

Portrait of President Abraham Lincoln

This photograph, taken on 10 April 1865, shows a president wearied by the Civil War. Four days later, President Lincoln was assassinated.

On the evening of 14 April 1865, President Lincoln and first Lady Mary Todd Lincoln attended Washington's Ford's Theater to see the comedy "Our American Cousin." Shortly before 10:30 that evening, John Wilkes Booth, an actor and a southern sympathizer, entered the presidential box and shot Lincoln in the back of the head with a derringer. Two Army doctors rushed to the wounded Lincoln and tried to revive him with artificial respiration and brandy. Once the President's breathing was restored, he was moved to a nearby boarding house.

 

After the President was carried to the boarding house, a number of government officials and physicians arrived on the scene. The doctors used a probe to locate the bullet. The bullet traveled about seven inches into Lincoln's brain and lodged behind his left eye. The physicians felt that here was nothing they could do to save the President.

It has since been questioned whether Lincoln could have been saved if the physicians on the scene had decided to operate, and had removed the bullet. Even if the doctors had modern techniques of surgery available, it would not have made a difference. The bullet had caused a severe hemorrhage and damaged vital brain tissue.

Lincoln died at 7:22 a.m. on 15 April. He was the first American president to be killed by an assassin's bullet. Vice President Andrew Johnson took over Lincoln's duties as Chief Executive.

James Abram Garfield
1881

On 2 July 1881, two months after he was sworn in as the 20th President of the United States, James Abram Garfield was shot in Washington's Baltimore and Potomac railroad station as he was boarding a train for Williamstown, Massachusetts. Garfield was the second American president to die by assassination. Vice President Chester Alan Arthur took over as president.

Assassination of James Abram Garfield

Garfield was shot by Charles J. Guiteau, a mentally disturbed, unsuccessful office seeker. He was struck by two bullets from Guiteau's English bulldog .44 caliber pistol. One bullet grazed the President's right arm. The second bullet entered the right side of Garfield's back, breaking a rib, piercing the spine (but not the spinal cord) and lodging within inches of the backbone below the pancreas. As he was shot, the President cried out "My God! What is this?"

 

Surgeons in Charge of President Garfield

The wounded Garfield was moved to the White House, where he was placed under the care of a team of prominent physicians. The team was directed by Dr. D. Willard Bliss (top). Dr. Bliss and other members of the team inspected the wound with their fingers and a long silver probe to determine the track and location of the bullet. The doctors decided not to remove the bullet, believing the attempt would kill Garfield.

 

Portrait of David Hayes Agnew, M.D.

Dr. David Hayes Agnew was one of the members of the impressive medical team assembled to manage the case of President Garfield. At the time, Dr. Agnew was professor of surgery at the University of Pennsylvania. A leading American surgeon, Dr. Agnew served as the president of the American Surgical Association and of the College of Physicians of Philadelphia.

 

At first, Dr. Bliss believed that Garfield would not survive the first night. As it turned out, the President lingered for 80 days. As Garfield seemingly recovered, Dr. Bliss and the other doctors closely watched his breathing, pulse, and temperature. They also drained the wound and incised any abscesses that developed.

During the weeks following the assassination of Garfield, his physicians made numerous unsuccessful attempts to locate the bullet. Alexander Graham Bell tried out his new electromagnetic Induction Balance, but he too failed.

President Garfield Dying in the White House

Garfield was moved from the White House in early September to his summer home in Elberon, New Jersey to escape the capital's intense heat and humidity. The change seemed to help at first, but whatever hopes the doctors had of the President's recovery were dashed. Garfield's splenic artery burst, which caused internal hemorrhaging. He died on 19 September. Garfield's doctors were criticized for hastening his death by introducing infection in to the wound because of their probing with unwashed fingers and instruments.

 

William McKinley
1897 - 1901

Assassination of President McKinley

On 6 September 1901, William McKinley, 25th President of the United States, was shot while visiting the Pan American Exposition in Buffalo, New York. He was standing in a receiving line in the Temple of Music when a mentally deranged man named Leon Czolgosz approached him. The assassin had hidden a .32 caliber revolver under a handkerchief wrapped around his hand. He fired two shots and McKinley crumpled to the ground. In severe shock, the President was moved to the small Exposition Hospital.

 

Dr. Matthew D. Mann

The first physicians to arrive on the scene decided to remove the bullet. Dr. Roswell Park, the most qualified local surgeon, was out of town, so Dr. Matthew Mann, another leading surgeon who specialized in gynecology, was chosen to operate. The Exposition Hospital was ill equipped for such an operation, but Dr. Mann and his three assistants decided to proceed because they feared that McKinley was bleeding internally.

 

The lighting in the hospital was inadequate. One of the physicians used a hand mirror to reflect the rays of the setting sun into the President's opened stomach. Dr. Mann was unable to find the bullet and decided to give up the search. After his assistants repaired the tears in McKinley's stomach and cleaned out the wounds, Dr. Mann closed the incision. He did not drain the wound.

Chart of Pulse, Temperature and Respiration of President McKinley

 

 

After the operation McKinley was moved to the home of the Exposition's president, where he seemed to get better. The President's doctors thought he had a fair chance of recovering. Early news bulletins to the American people were optimistic enough to convince Vice President Roosevelt to leave town for a vacation in the Adirondacks. On the 13th however, the President's condition began to deteriorate. McKinley died in the early morning hours of 14 September. Vice President Theodore Roosevelt assumed McKinley's presidential duties.

President McKinley's Casket Arriving in Canton, Ohio

 

 

Dr. Mann created a scrapbook of newspaper clippings on McKinley's assassination. Dr. Mann and his assistants, like President Garfield's doctors years before, were criticized for their handling of McKinley's case. Dr. Mann's decision not to drain the President's wound was questioned by many of his colleagues. While the autopsy was inconclusive concerning the cause of death, Dr. Mann's decision may have played a significant role in the President's demise.

John Fitzgerald Kennedy
1961 - 1963

No assassination of an American president, except that of Abraham Lincoln, has caused so much controversy as that of President John F. Kennedy's on 22 November 1963. The American people were at first shocked and later mourned the death of the young and popular president. A commission appointed to investigate the events surrounding the assassination in Dallas, Texas, reported that Kennedy was killed by a lone gunman, Lee Harvey Oswald. The commission's report has been questioned by many since its release in 1964. Numerous conspiracy theories have been advanced in the wake of Kennedy's death. Few would argue, however, that Kennedy could have survived the massive head wounds inflicted by the two bullets.

Ronald Wilson Reagan
1981 - 1989

On 30 March 1981, two months after he was inaugurated as the 40th President of the United States, Ronald Reagan was shot by John Hinckley, Jr. after giving a speech at the Washington Hilton, Hinckley fired a number of shots and one hit Reagan in the chest. The President was rushed to George Washington Hospital, where he underwent three hours of surgery to remove the bullet that had entered his lung. While Reagan's wound appeared to be more serious than those suffered earlier by presidents Garfield and McKinley, he survived the surgery and made a good recovery.