Source: Alienist and Neurologist
Source type: journal
Document type: editorial
Document title: none
Author(s): Hughes, Charles Hamilton
Date of publication: October 1901
Volume number: 22
Issue number: 4
|Hughes, Charles Hamilton. [untitled]. Alienist and Neurologist Oct. 1901 v22n4: pp. 722-24.|
|William McKinley (medical care: personal response); William McKinley (medical condition).|
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 Presidentís. 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 back.
Up to the time of the tragedy the Presidentís 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.