Traumatisms and Surgical Notes [excerpt]

     It was the generally accepted belief among the members of the profession, that had President McKinley (at the time of the wound and operation which proved so disastrous) been in the prime and vigor of health, with organs of secretion and excretion equal to the full performance of their duty, the wound and operation might not have proven fatal. It is believed that the impairment of the metabolic functions and gradual accumulation of toxic waste products within the system served to paralyze reparative energy when the occasion demanded. The necessity of immediate operation rendered it impossible in this instance to rid the organism of purin waste in the manner recommended in such cases.
     The local irritation of tissue observed in the diabetic patient, when injured or operated upon, is well known to the surgeon. The frequent association of gout and diabetes has caused much speculation as to the probable similarity of origin of these two complaints—though one represents faulty metabolism of nitrogenous products and the other of the carbo-hydrates; and much food for reflection is afforded the thoughtful physician in such cases as [194][195] that of the lamented McKinley. Was he suffering from purin excess (or the so-called “gouty diathesis”), and were retrograde tissue products present in such quantity as to serve as a disturbing factor?