[208]
Leech wrote:

It is difficult to interpret the optimism with which the President's physicians looked for his recovery. There was obviously the most serious danger that his wounds would become septic. In that case, he would almost certainly die, since drugs to control infection did not exist ... [Prominent New York City physician] Dr. McBurney was by far the worst offender in showering sanguine assurances on the correspondents. As the only big-city surgeon on the case, he was eagerly questioned and quoted, and his rosy prognostications largely contributed to the delusion of the American public.[209]

On the morning of September 13, McKinley's condition deteriorated. Specialists were summoned; although at first some doctors hoped that McKinley might survive with a weakened heart, by afternoon they knew that the case was hopeless. Unknown to the doctors, gangrene was growing on the walls of McKinley's stomach and slowly poisoning his blood. McKinley drifted in and out of consciousness all day, but when awake he was a model patient. By evening, McKinley too knew he was dying, "It is useless, gentlemen. I think we ought to have prayer."[210][211] Relatives and friends gathered around the death bed. 