President McKinley greeted each person with a warm smile and a handshake, pausing briefly to exchange words with any children who had accompanied their parents. The line moved quickly. Many in attendance held cloths to dab the sweat from their foreheads on the warm, humid day. As the waiting people shuffled forward, Foster noticed one man in line who had his right hand wrapped in a handkerchief. Foster wondered if it covered an embarrassing injury.

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McKinley saw the man’s apparent disability, and he reached to shake his left hand. Suddenly, Leon Czolgosz thrust his bandaged right hand into the president’s chest. Onlookers heard two sharp popping sounds, like small firecrackers, and a thin veil of gray smoke rose up in front of the president. McKinley looked confused and rose up on his toes, clutched his chest, and leaned forward. Members of his entourage moved to support the slumping president and help him to a nearby chair as the blood spread across his white vest. ‘Be careful how you tell my wife,’ McKinley said, his strength already waning.

Foster and others pounced on the assailant, knocking him roughly to the floor as he tried to aim his revolver for a third shot. McKinley managed a weak, ‘Don’t let them hurt him,’ when he saw Czolgosz being pummeled beneath a mass of angry guards. As the pandemonium continued, aides rushed the president to a hospital on the exposition grounds. One bullet had struck his sternum a glancing blow, causing only a superficial wound, but the other had penetrated his abdomen, a potentially fatal injury.

Dr. Roswell Park, the exposition’s medical director and a surgeon with an international reputation, was performing a cancer operation in nearby Niagara Falls. Rather than wait for his return, the doctors present believed it imperative to act immediately, and they decided to operate as soon as prominent Buffalo surgeon Dr. Matthew Mann arrived.

At 5:20 p.m., an hour and 13 minutes after the shooting, President McKinley went under the knife. As he slipped into an ether-induced sleep, he murmured the Lord’s Prayer. Operating conditions were far from ideal, and professional lapses occurred that in retrospect probably raised an eyebrow or two, but the grave emergency required snap judgment. At one time doctors had to reflect the waning sun’s rays onto the patient with a mirror because of inadequate lighting.

An anxious crowd awaited word of the president’s condition. At 7:00 p.m. the physicians released a statement detailing the extent of McKinley’s injuries and describing the surgery, during which they had searched for but could not find the second bullet. Summing up, they said the president’s ‘condition at the conclusion of the operation was gratifying. The result cannot be foretold. His condition at present justifies hope of recovery.’

While initial reports were optimistic, as they would be for the next six days, one presidential adviser felt an uneasy foreboding. Secretary of State John Hay had already experienced the assassinations of two presidents — the first as a personal secretary to Abraham Lincoln and the second as a personal friend and confidant of James Garfield. Called to Buffalo from Washington, Hay reportedly told his escort that the president would surely die. But the secretary of state’s fear was an exception. The optimism of other reports prompted cabinet officials to return to their duties elsewhere. Vice President Theodore Roosevelt, who had rushed to the president’s bedside when he received news of the shooting, left Buffalo ‘with a light heart’ and joined his family on vacation in the Adirondacks.

The president improved daily, and he felt strong enough on the morning of September 12 to receive his first food orally — toast and coffee. McKinley’s spirits were good, but by afternoon he began to experience discomfort, and his condition rapidly worsened. Within 36 hours Hay’s prediction came true. Gangrene, unseen, had been forming along the path of the bullet for nearly a week. Some 40 years before penicillin became generally available, McKinley had been doomed the moment Czolgosz fired his revolver. The president died in the early morning hours of September 14, surrounded by a small group of family and friends. That afternoon Theodore Roosevelt was sworn in as president of the United States.

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