Source: Diagnosis by Means of the Blood
Source type: book
Document type: book chapter
Document title: “The Examination of the Blood in President M’Kinley’s Case”
Author(s): Watkins, Robert Lincoln
Publisher: Physicians Book Publishing Co.
Place of publication: New York, New York
Year of publication: 1902
|Watkins, Robert Lincoln. “The Examination of the Blood in President M’Kinley’s Case.” Diagnosis by Means of the Blood. New York: Physicians Book Publishing, 1902: pp. 227-32.|
|full text of chapter; excerpt of book|
|William McKinley (medical condition); William McKinley (death, cause of); William McKinley (death: personal response).|
|James G. Blaine; James A. Garfield; Abraham Lincoln; William McKinley; Phocion; Plutarch; Henry Van Hoevenberg.|
Figures 81 and 93 (referred to below) appear on pages 233 and 269 (respectively).
The chapter (below) includes the two following footnotes. Click on the superscripted number preceding each footnote to navigate to the respective locations in the text.
Footnotes 2 and 3 refer to the following citations (respectively):
In the book’s table of contents the chapter’s title is given as “McKinley’s Case.”
From title page: Illustrated by 154 Photo-Micrographs of Specimens of Blood, as Observed in General Practice, Showing Products That Are Found in Definite Diseases.
From title page: By Robert Lincoln Watkins, M.D.
The Examination of the Blood in President M’Kinley’s Case
By the death of President McKinley,
on September 14th last, the nation has lost a man whose inner life was little
understood or appreciated by the vast majority, even of those who respected
him and thought that he never erred.
While it may seem strange to many that his name should be mentioned in a work of this kind, on reconsidering, it will be remembered that the consulting physicians submitted his blood to a miscroscopic [sic] examination.
At the time of Garfield’s assassination, the examination of blood was not much thought of. In the past few years, however, this line of work has made great strides; and blood examination to-day is carried on systematically in every large hospital.
The question naturally arises: What could have been indicated by the blood in the President’s case that would in any way have been of value?
Theoretically, everything should be told, while practically a blood examination is of more service than would be imagined by those who are not familiar with this line of work.
The statement made in another part of this work is applicable here, that when one part of the body is “sick” the whole suffers with it. An experienced diagnostician, by means of the blood alone, can often tell when parts of the body are “sick.” The condition may be recent, or it may have been coming on for years.
I say the blood will often tell the inner story; as the old quotation says: “Every action of our lives touches on some chord that will vibrate in eternity.”
So, to a greater or less degree, every action makes some change in the body. There may be no practical way of determining the finer effects; but if a definite action of mind or  body is kept up, in time the change is perceptible to the eye. And so, for health or disease, this change takes place, and sometimes it is years in showing evidence. This evidence to-day can be seen by one experienced in blood diagnosis. For example, gangrene will show changes in the blood, and the physicians resorted to a blood examination in the President’s case.
Both a fresh and a dry blood examination should always be made if everything is expected to be found that is determinable by this diagnostic method.
William McKinley, like all public men, was cartooned, criticised and misrepresented for years, even by many who now see their mistake. All men who have a conscience are aware that much criticism on a sensitive man is not only wearing, but when joined with the great weight that falls on our Chief Executive, from such sources, would rip the very nervous tissue—say nothing of the nervous energy—in a man of McKinley’s sensitive parts.
And such changes can be seen in a fresh or living blood examination. The poikilocytes and the microcytes, either one or both together, might be present in the blood. When such changes take place in the nerve elements, the blood corpuscles have not their proper form; they should all be round and elastic, but instead they are elongated, angular and flabby, and often the number of dwarf cells are increased because the system does not have time to manufacture strong, full-sized cells.
The nervous energy is used up too fast, and this latter condition is especially perceptible to the diagnostician when the crenated red cells are abundant. These cells can be seen easily in the fresh blood, and that there be no mistake as to what is meant by fresh or living blood, we refer the reader to the introduction. Of course, if the blood stands half an hour or so, all the cells get more or less crenated. But they should be  seen floating around in the serum as soon as the drop is placed on the slide (see Fig. 93). That then indicates the condition of the system. Fig. 81 illustrates it well.
These things that have been pointed out are seldom thought of by the majority of blood examiners. More often, an increase in the number of white cells is what is looked for. Normally, there is one to about every four hundred red ones; but, as a rule, these are counted by the dry method of examination¹. One examination by this latter method is often of no avail. In the President’s case there were found, according to the physicians’ report, 6,752 white and 3,920,000 to the cubic millimetre of the red cells, which is below normal. In each it was expected that there would be an increase in these white cells, or more than normal. The only way for the dry method to be of any definite value would be by reference to a previous examination.
If the President six months before, or even a month before, had had his blood cells counted, a comparison of that condition with the one at the time of his sickness would have been of some value one way or another. There will be a time when people will have their blood examined as regularly as they go, or ought to go, to their dentist. If a photograph is taken, there is a defienite [sic] record to look back to.
Therefore, as it happened, the blood examination of the President threw no light on the case.
The fresh blood examination, however, in the hands of a diagnostician—and every physician should be his own—should have at least revealed his weak condition—this lack of vitality.
In President Garfield’s case, if blood examinations had then been in vogue, it would have told much, but not without a previous record (or a photograph) to compare. It was found at  the autopsy that he had an abscess² cavity, which had nothing to do with the wound caused by the bullet. This, in itself, would show leucocytosis, or increase in the white cells.
The pyemia, which afterward developed in Garfield’s case, from the destruction of tissue, would have shown marked increase in the white blood cells, and probably much tubercular matter.
This statement on McKinley’s case from a blood standpoint is simply to show some things that all do not think of, and to indicate what often can be told from a fresh blood examination, in contradistinction to the dry.
It is not in any sense intended as a criticism.
According to the report of the physicians, the President died directly as a result of the gunshot wound.
When the nervous energy in a man is exhausted, the result is just as bad as though his blood vessels were empty. The preservation of the vitality in the human economy is to-day not appreciated by the majority of men and women. This energy can leak from its channels in the body in many ways, the same as steam can leak from the boiler or cylinder of the steam engine. If you shoot a boiler full of holes there will be no steam left to make the engine go; and so McKinley was shot, and his already weak vital system was drained still more (of energy).
The fact that the bullet affected the pneumogastric-nerve and, perhaps, passed close to the solar plexus, is what did the damage. This, in itself, often kills. Pugilists are aware of this, and use a belt to guard this location. Attention enough is not given in our post-mortem examinations to the nervous tissues that are affected by shocks, due to either wounds or surgical operations. For when the nervous energy is low, or there is a great loss of blood, which is often dangerous; poikilo-  cytes or flabby red cells are often present in proportion to the weakness, and these cells would always be of great aid in diagnosing this condition.
The shock in this case dissipated what nervous force the President had left, by shutting off one of the main channels through which this energy travels in going from the head to the feet. This shock can be compared to the breaking or short-circuiting of the main wire of a dynamo-electric machine under full load. The result here would be the stopping of the machine. In the body, the only thing that could happen would be death of tissue, mortification or death of the man as a direct result of the shock. Again, often in connection with the nervous shock, the dwarf cells make their appearance in the blood and we have nerve weakness, indicated especially when these dwarf cells are mixed with the poikilocytes. In order to see these latter well, a large drop of blood must be had and the cover glass must be laid on gently, for the ability to perceive and judge this condition cannot be gained in a night; it cannot be learned in the laboratory; but the ability to see these peculiar red cells slowly floating about in the watery portion of the blood can only be learned at the bedside of the patient.
When these two kinds of cells described are present in abundance, the blood supply is distributed slowly to any part because the heart action is weak. Death of tissue in this state of the system must result somewhere. When gangrene sets in, even in a moderate degree, there will generally be found an increase in the white blood cells. Germs of various kinds, then begin their work; if present, bacillus coli communis and gas germs, in connection with the others, call for more fuel; the continual lowering of the vitality allows the fuel to be supplied; and so the germs multiply and gangrene goes on.
President McKinley’s death was due primarily to the gunshot wound, and, secondarily, to the low state of his nervous energy. 
There have been only a few recoveries from similar wounds—such is never expected. Dr. Van Hoevenberg³ reported since McKinley’s death one such in a man aged 33. The young man was strong and vigorous, his vitality or nervous energy was high; he withstood the operation well, but possibly the ball did not strike in as vital a part as in the case of McKinley. Still, it is generally considered that bowel wounds, such as that reported by Dr. Van Hoevenberg, are the more dangerous.
Still more plainly does this lack of vitality stamp its fatal mark when it is remembered that the President’s whole body began to mortify in a very few days. This, again, will confirm the opinion that there was lack of vitality, due to the wound, and the long strain under which McKinley had been laboring.
To some it will appear out of place, nevertheless medical periodicals throughout the country have been eulogizing President McKinley more or less. We therefore say, without fear of controversy, that William McKinley was one of the few modern public men that had lived and knew how to die.
He probably, for the time, saved the life of the man who slew him. “Be easy with him, boys.”
Plutarch says, when speaking of the personality of Phocion, the great Greek general: “That a word or a gesture from a truly good man carries more weight than ten thousand eloquently argued speeches.”
And so in the President’s last hours upon earth—just as natural as though he were going to live for twenty years to come—McKinley (as James G. Blaine said of Lincoln in his debates) said: “The things that would stand the test of time and square themselves with eternal justice,” more truly and more as he lived, than any public man of whom we have record in modern days.