Source: American Practitioner and News
Source type: journal
Document type: editorial
Document title: “The Death of President McKinley”
Date of publication: 15 September 1901
Volume number: 32
Issue number: 6
|“The Death of President McKinley.” American Practitioner and News 15 Sept. 1901 v32n6: pp. 232-34.|
|McKinley assassination (personal response); anarchism (personal response); William McKinley (medical care: personal response); William McKinley (surgery); William McKinley (autopsy); William McKinley (death, cause of); William McKinley (medical condition).|
|Simon Flexner; George H. F. Nuttall; William Henry Welch.|
The Death of President McKinley
The lesson taught by the death of our beloved
President will be remembered for all time by the American people. While there
is no land under the sun where freedom and liberty are so equally shared by
all classes as in America, yet it is evident that this freedom certainly had
something to do with and led to the destruction of this great man. No man or
woman should be permitted in this country to promulgate any doctrine which is
opposed to the best interests of its citizens. The man who preaches anarchy
should be banished. Anarchists should not only not be permitted to promulgate
their doctrines, but they should not be allowed to live in this country and
enjoy its freedom and its privileges, when their whole lives are devoted to
the destruction of its very best principles and its leaders.
All Praise to the Doctors who had Charge of the President’s Case. We have the pleasure of a personal acquaintance with some of the physicians interested in the case, and there can be no question that every thing known to the art and science of surgery was applied in this case. It has now become a settled fact, and should have been long ago, that in all cases of gunshot wounds of the abdomen, where the cavity  has been entered, laparotomy should be done at the very earliest possible moment. It was done in the President’s case and in the most skillful manner and by trained, experienced men—the best that the nation could afford, or the world, either, for that matter. While the final result was far from what was expected in the earlier days after the operation, it was no fault of the operators or any one concerned in the operation.
The Autopsy. The autopsy showed a very remarkable condition of affairs to exist in the track of the wound. The stitches were intact. There had been no leak from the stomach, but there was a large necrotic area surrounding each wound in the stomach. A similar condition of affairs existed along the whole line of the track of the bullet. This condition is so unusual that something more than passing notice of it is demanded. The wound in the kidney and the wound of the pancreas of themselves were not necessarily fatal, but of course contributed their share to shock.
The Bacillus Aerogenes. It may have been the work of the bacillus aerogenes, which was described by Welsh and Nuttall in 1891-2. “Later studies of Welsh and Flexner and many others have confirmed the original belief that the bacillus is a frequent excitant in man of a serious infectious disease, characterized by a local or widespread serous and emphysematous, phlegmonous inflammation, frequently associated with gangrene and general symptoms of a profound toxemia.
“The bacillus aerogenes is rather large, on certain media spore-forming, is often capsulated, and occasionally forms chains. It retains the stain by Gram’s method. It is anaerobic, growing readily in a variety of artificial culture media.
“Rabbits are not susceptible to even large intravenous injections of pure cultures. But if they be killed soon after such inoculation, within a few hours, at room temperatures, an abundant development of gas occurs throughout the body. On the other hand, the subcutaneous injection of a very small quantity of the fresh edematous exudate is followed by the typical local and general marks of infection. Guinea-pigs are more susceptible than rabbits to inoculation, either with cultures or fresh material, and develop characteristic lesions.
“While infection may occur without gas, in most cases before death, and especially after, there is an abundant formation of gas in the tissues. This is largely hydrogen, formed through the splitting by the bacillus of either sugar or proteids. While the gas may be present in  any of the tissues, in the body cavities, and in the blood-vessels, it is especially in the liver after death that the marks of gas accumulation are most striking. This organ may be riddled with small holes, presenting an appearance which has been characterized as ‘foamy liver.’
“Infection may occur through wounds or injuries in any part of the body. It has been frequently observed in pregnant and puerperal women. Ulcers of the stomach and intestine or the urinary tract may be portals of entry. One of the more common forms of local infection is the so-called gaseous phlegmon or emphysematous gangrene. Pulmonary and pleural lesions, appendicitis, and peritonitis are described as well as gaseous abscesses and purulent meningitis, while the usual action upon the tissues is the induction of bloody edema and necrosis. This bacillus is also occasionally pyogenic.
“The natural habitat of the organism is the soil and the intestinal canal. This accounts for the relative frequency of infection through the intestinal and genito-urinary tracts and through wounds contaminated with dirt.
“Infection, especially from the intestinal canal, may apparently occur during the later hours of life, with or without symptoms, and with a post-mortem formation of gas. It is often difficult to determine, since gas formation occurs so early and so extensively after death, whether the entrance has or has not been effected during life. It seems fair to infer, as the result of animal experiments, that when the gas formation, even after death, is widespread, ante-mortem infection had occurred. Concurrent infection with other organisms, especially the pyogenic cocci, is frequent.
“Welsh and Nuttall early called attention to the importance of recognizing the possibility of infection with this bacillus in judging of a certain class of cases of alleged air embolism.”
Small Kidney. A significant fact connected with the post-mortem was that the kidney was rather small. We take it for granted that the kidney was contracted, and if this was true, it meant that the President had interstitial nephritis. This, if it existed, can fully account for the condition of the wound, as it is a well-known fact that tissue reparation does not occur, and particularly would it be the case in this instance, as the President’s vitality was at a low ebb, notwithstanding he was apparently in good health.