have lead [sic] to some controversy which we do not wish
now to discuss at length.
Bullet wounds of the abdominal viscera
followed by gangrene, as was the case of the unfortunate President,
are necessarily fatal, even though the stomach escapes wounding.
The President had the benefit of good and prompt surgical skill
and the fatal sequel could not have been averted.
Our only comment would be on the great
proneness of surgeons to exclude essential medical counsel in such
cases as the President’s. In all grave wounds the man, as well as
the wounded part should be considered, and in a multitude of medical
counsel, even in a surgical case, there is 
safety, as well as in the mere technical skill of the surgeon. In
the brilliant light of modern medical illumination upon the processes
of disease and diagnostic discernment, surgical cases cannot longer
be regarded as exclusively alone for the surgeon. Haematology, urinology,
cytology, neurololy [sic] and psychiatry, as well as especially
skilled knowledge of the viscera and all inner medicine, should
hold worthy place in all counsel as to surgical after management,
and oftentimes in pre-surgical treatment. Medicine now marches on
as a whole as well as in sections.
Good surgical reasons are given by
the surgeons for promptly closing the abdominal cavity after the
suturing of the perforated stomach, an operation well and skillfully
and timely done. Family objections are said to have also embarrassed
the surgeons some in extensive search for the bullet and the X-ray
examination was not brought into use for reasons satisfactory to
those in attendance who had located the ball in the muscles of the
Up to the time of the tragedy the
President’s vitality had been overtaxed. His nerve centers were
strained by the combined fatigue of the California trip, his domestic
anxiety and watching over his wife and his excessive smoking, added
to the prolonged exceptionally severe official burden he had so
long previously borne. Under these circumstances the counsel and
prescriptions of skilled neurologists accustomed to the care of
brain-burdened, brain-fagged and nerve-tired organisms might have
been of service to the surgery of the President though they could
not have saved the doomed life. This sort of service is not esteemed
as it should be by many mere wielders of the knife. Gangrene makes
its destructive way to do its worst when nerve center resistance
is broken and reconstructive blood disintegrates.
There is a neuro-psychic aspect to
every case of major surgery worthy of more consideration than most
surgeons by force of restrictive thought, give to the subject. McKinley
went into the fight for his life handicapped by fatigued nerve centers,
that lowered resistance, made dissolution, by gangrene a possibility.
When the nerve center senti- 
nels are not on active duty and the neurones are exhausted the issue
of a vital conflict in traumatism is never hopeful.