The Shooting of James King
At five o'clock on the same afternoon, as was his custom, King left his office at Merchant and Montgomery Streets to go home for dinner. As he approached the corner of Washington and Montgomery, Casey stepped into the street from behind a horse and wagon standing in front of the Pacific Express Company and confronted him. According to his own testimony, King was taken utterly by surprise. He heard someone cry out "Come on!" Then, looking up, he saw Casey, only a few paces away, throwing off his short cloak and aiming a revolver. The weapon was fired instantly. King staggered under the impact of the bullet as it drove completely through his left chest, entering in front just below the outer third of the clavicle and exiting from the back. At the same moment a certain Edward (Ned) McGowan, a judge of the Police Court and a good friend of Casey's, was seen hurriedly leaving the vicinity.
Bleeding profusely from his wounds, King was assisted into the Pacific Express Office nearby where the first medical man to arrive and examine his wounds was Dr. R. K. Nuttall, (MD Aberdeen, 1847; Licentiate of the Royal College of Surgeons, Ireland) who had arrived in San Francisco from Australia in 1850. King was by this time unconscious due to shock from loss of blood. The wound was explored with the finger and found to course upwards, inwards and backward through the chest wall. The bleeding was thought to be venous because of the dark color of the blood. There was no pulse at the left wrist and only a weak one at the right. The great question then and later was whether the subclavian artery had been severed.
Dr. Nuttall had hardly completed his examination when Dr. Beverly Cole arrived to find King pulseless. Although bleeding was by this time only slight, the patient was still in shock. Cole applied mustard plasters and heat to his extremities to reinstate the circulation and King rallied sufficiently to grasp his hand and plead: "Oh Cole, in the name of God stay by me!"   
Meanwhile, news of the tragedy spread rapidly among the medical community. Cole and Nuttall were soon joined by Dr. H. M. Gray. Dr. William Hammond was next to arrive. Since he had previously been King's personal physician, he officiously took over control of the patient who had now been laid on a counter in the Pacific Express Office. Although hemorrhage had essentially stopped and Nuttall on making another examination could feel a clot in the wound, it was felt that movement might start bleeding again. Therefore, Gray and Nuttall suggested putting a plug into the wound. The only thing available was a large piece of white sponge. Cole objected to anything being put into the wound. In any case he would use lint rather than sponge which he thought would become adherent in the wound during the healing process and, by blocking drainage, worsen the infection that was bound to occur in such a wound. He was overridden by the others, however, and a piece of sponge the size of a goose egg, too big for the wound on the anterior chest wall, was soaked in water and shoved into the wound with considerable pressure, then secured in place with wet compresses and bandages. There was, of course, no conception of antisepsis in that day and Gray and Nuttal lacked Cole's conviction, based on his surgical experience, that tight closure of a deep and contaminated wound is a recipe for fulminant infection.
At eight o'clock that night King's condition was so poor that Dr. Hugh Toland, popularly considered the foremost surgeon of San Francisco, was called in consultation. He arrived to find an immense crowd within and without the Pacific Express Building. He had to fight his way through the emotional bystanders to the semiconscious patient who was surrounded by fifteen or twenty physicians taking his pulse, making suggestions and filling the air with tobacco smoke. On account of the confusion, Toland did not examine the wound but concluded from general observation and the accounts of Nuttall and others that the subclavian artery might be severed. He feared more bleeding if King were moved and advised that a surgeon be in attendance throughout the night. Hammond agreed to stay until 1 A. M. and Cole volunteered to watch until dawn.
When the morning of the first day, Thursday May fifteenth, came with no improvement in King's condition, Hammond summoned Drs. Gray, C. Bertody and Toland to an urgent consultation at seven A. M. Cole and Nuttall were still there but were pointedly excluded from the conference. Nevertheless, Cole offered the unsolicited advice that the sponge should be removed from the wound and, if the subclavian artery bled, it should be ligated. Nuttall added that the sponge had been inserted only as a temporary measure and also advised that it be removed. The comments of Cole and Nuttall were coldly ignored except for Hammond's haughty remark that: "Well, I guess I have some crude notions on the subject myself."
It was at this point that Elias Cooper entered the sickroom. During the past year he and Cole had become friends and colleagues, Cole frequently attending operations, anatomical dissections and animal experiments at Cooper's Infirmary. He had learned to respect Cooper's knowledge of anatomy and skill as a surgeon, particularly with respect to vascular procedures. Therefore Cole, before he found the King case taken out of his hands by Hammond, sent word to Cooper asking that he come to examine King and give his opinion on management. Cole's invitation was reinforced by a personal request to Cooper from the patient's brother, Thomas King. Nevertheless, when Cooper arrived at the Pacific Express Office on the morning of the fifteenth and sought to speak with Cole, he was not allowed to do so. Cooper was deeply offended by the rude reception he received and gave this account of the incident: 
(Dr. William Hammond was one of the medical attendants of James King of William after he was shot by James Casey on 14 May 1856.) It is to Hammond, as I afterwards learned, that I am indebted for the very civil treatment of being forced out of Mr. King's room by a Police Officer under threats of being arrested if I attempted to enter again. It is true I was not invited there by Dr. Hammond, but I was invited by Dr. R. Beverly Cole who was with Dr. Hammond and both facing me and within five steps distant, when the Officer forced me out in the most unceremonious manner which I submitted to without the least resistance rather than make a disturbance that might prove injurious to the patient though I had been specially invited by Mr. Thomas King to examine his brother's wound. Dr. Hammond was personally a stranger to me at the time but Dr. Cole witnessed my treatment and assured me afterwards that he would have had it otherwise if he could.
By this time, Cole was thoroughly outraged by the treatment he had received from Hammond, especially since he had preceded Hammond on the scene and the patient had pled with him to stay. Furthermore, his advice to remove the sponge was being ignored. There was nothing more he could do. Renouncing all responsibility for King's care, Cole withdrew from the case.
The bulletin at the end of the first day, Thursday May fifteenth, announced that the left arm was entirely paralyzed, cold, blue and swollen; that it was pulseless and without sensation or motion; that hemorrhage had stopped;. . . that it was feared the subclavian artery was cut, but that Mr. King's condition was too precarious to permit operation.
During the second day, Friday May sixteenth, there was no improvement and as the day dragged on King's attendants sought to make him more comfortable by moving him to the Montgomery Block, a large office building across the street where a sick room had been made ready for him.
In the days that followed the course was one of mounting sepsis and continuing unwillingness of the doctors to remove the sponge that was plugging the wound for fear of hemorrhage from a severed subclavian artery. On the fourth day, Sunday May eighteenth, a former army surgeon, Dr. John S. Griffin, arrived from Los Angeles as a consultant and advised against removing the sponge, again for fear of hemorrhage from the subclavian artery. By this time the Infection had become so severe that it was necessary on this day to drain considerable pus by an incision in the left armpit under chloroform anesthesia. There was still no improvement.
At the dawning of the sixth day following the wounding, Tuesday May twentieth, King's condition was worse. Following a restless night, his right pulse was now faint and rapid, his breathing labored. At thirty minutes past one o'clock in the afternoon, the last bulletin was posted - James King of William was dead. He left a wife and six young children.
According to the report of the post mortem examination on James King, the subclavian artery was not injured; there was some damage to and considerable phlebitis of the subclavian vein; the nerves of the brachial plexus were torn apart; caseous (tuberculous) masses were found in the lungs; and there was inflammation of the pleura and over a pint of bloody serum in the left chest cavity. By implication, the cause of death was infection.
The momentous consequences of King's death imparted historic significance to the treatment he received. Was his wound by its nature a lethal one, or was its management responsible for the fatal sepsis? Simply put: did the sponge packed into the wound to prevent subclavian artery hemorrhage serve instead to block drainage of the sepsis raging in its depths, with fatal results?
Why was the sponge not removed? The answer is that the doctors responsible for the patient's care feared bleeding from a severed subclavian artery which they had not the anatomical knowledge and technical ability to expose surgically and ligate. Both Elias Cooper and Beverly Cole accused King's treating physicians of incompetence and malpractice but before returning to their outspoken criticisms, we will provide further information about King's physicians, and report on the civic unrest precipitated by his death.
Dr. William Hammond (1824-1905), who summarily usurped the care of the patient from Drs. Cole and Nuttall on the day of the injury, was born in Hagerstown, Maryland. His father, an army doctor, was transferred in 1843 with his family to Jefferson Barracks in St. Louis where William began the study of medicine by taking courses in chemistry and anatomy at St. Louis University. In the fall of 1844 he continued his medical studies in Baltimore at the Faculty of Physic of the University of Maryland and was granted the MD degree in 1845. In 1847 we find him in Galena, Illinois. He was engaged in general practice but it proved uncongenial and in 1848 he followed his father into the U. S. Army. Under commission as an army surgeon he was posted to the general hospitals in Mexico City and Hualapa until the army evacuated Mexico in 1848. After serving in several army posts around the United States he was ordered to report for duty in Oregon in 1853, but on reaching California he sent in his resignation from the army and remained in San Francisco. There he was successful in a practice devoted principally to medical conditions. It is not evident that he ever had significant practice in the field of surgery. Like Dr. Gray, whom we previously introduced, he was a member of the Pathological Society.  
Regarding Dr. Charles Bertody we know little beyond the facts that he graduated from Harvard Medical School in 1838 and was elected Corresponding Secretary of the Second San Francisco Medical Society in 1853. Whatever his accomplishments, they were not such as to leave an imprint on the medical literature of his day. Specifically, there is nothing to suggest that he brought to the King deliberations any special knowledge or experience relevant to the management of gunshot wounds. As for Dr. Toland, we have already sketched his background and remarked on his prominence as a surgeon and his aloofness from medical societies.
Finally, there was the consultant, Dr. John Strother Griffin (1816-1898), a Virginian by birth and fellow Southerner of Toland. Unable to make up his own mind regarding the treatment of King, whose condition was growing worse by the day, Toland requested that Griffin be brought up from Los Angeles to consult and, not incidentally, share the onus for a disaster that Toland was astute enough to suspect was in the offing. Griffin arrived on Sunday May eighteenth, the fourth day after the injury. Specifically, Toland asked him to advise whether to remove the sponge from King's wound as Cole and Nuttall had so unequivocally recommended three days previously.
Griffin was the best known surgeon in the Los Angeles area and because of his prestige was an excellent choice as a consultant. He received his MD degree from the University of Pennsylvania in 1837 and practiced medicine in Louisville, Kentucky, for the next three years. In 1840 he was commissioned as a surgeon in the U.S. Army, a post he held until 1854 when he resigned to settle in Los Angeles.
Griffin's fourteen-year career in the army was distinguished by his service as a medical officer during the occupation of California by U.S. Forces in 1846-47. At that time he was attached to the expeditionary force of General Stephen W. Kearny who set out overland on 25 September 1846 from Santa Fe (New Mexico) with a force of 121 men, including Assistant Surgeon Griffin. Kearny's orders were to join in the pacification of California at this most turbulent and confusing juncture in the State's history.
After a punishing journey across over a thousand miles of mountainous and desert wasteland, guided by Kit Carson, the exhausted troops of General Kearny attacked a cavalry force of rebellious Californians at the Indian village of San Pasqual near San Diego. The encounter took place in the chilling rain and fog on the early morning of December 6th 1846. Although the Californians retreated and the Americans remained in possession of the battlefield, their victory was a pyrrhic one for their attack was ill-conceived and many American lives were recklessly and needlessly sacrificed. A report of American battle casualties is found in the communications of Assistant Surgeon Griffin who listed eighteen killed and eighteen wounded. The Californians were led by Captain Pico. As far as can be determined, none of the Californians were killed and Pico claimed that only 11 were wounded, none seriously. Nevertheless, the battle of San Pasqual was a decisive one and has since been described as the most famous and deadly in California history.
Dr. Griffin's conspicuous army service in Southern California combined with his sterling personal qualities no doubt contributed to his rapid rise to leadership in civic and business affairs in Los Angeles, and to his acquisition of a large surgical practice within a few years. Although memorial statements about his career say that he sought new treatments and was not hesitant to discard old methods, we have no specifics as to the meaning of these generalities and we have no information about his experience with vascular surgery. In any case, we know that he sided with Toland's timid colleagues and advised against removing the sponge. Assuming that it was not already too late to make a difference, we must conclude that it was Griffin's opinion that sealed the fate of James King of William.