The Cause of the President’s Death

IT is needless to retrace all the steps of the history of the injury and death of the President. There can be no valid criticism but only praise for the promptness and courage with which the Buffalo surgeons applied the best resources of modern surgery to the care of the President. Everything was done to save his life that could have been done, and it was all done as skilfully [sic] as it could have been anywhere in the world. Tremendous respon- [436][437] sibility fell suddenly upon the surgeons called to care for the President, and it is a matter of no little pride that these men worked together manfully and without friction. This is frankly conceded by physicians everywhere and, with one exception to be noted, by the medical press. With characteristic promptness and thoroughness American Medicine for September 21 publishes the best information in regard to the exact cause of death that has yet appeared. Dr [sic] Gould holds also that there was a slight mistake in the conduct of the case in that the surgeons did not at once after the operation call in counsel a physician of good training in general medicine. He writes: “Every surgical case at once presents problems of medical import, and ones with which the surgical mind is unfitted to deal. The expert in internal medicine should be summoned the first day. The principle holds perfectly, although, as we now know, the fatal result in this instance was inevitable.” Our own remarks on this head were written before this issue of American Medicine reached Cleveland, but we are especially glad to have this view upheld by so powerful an advocate.
     The oversanguine prognosis is greatly reprehended by American Medicine, as indeed it is by most physicians. Having noted the lack of reparative energy in the tissues indicated by the gaping of the external wound, our excellent contemporary goes on to say: “That this fact, together with the high pulse-rate, did not give the flooding optimism of some a chill, is at present only a proof to us that the scientific mind must not allow itself to be dominated by feeling or desire.” Referring to the feeding by the mouth, which has been condemned by some, the fact is pointed out that when this was begun the rectum had absolutely refused to retain the enemas, while the administration of some nourishment was absolutely necessary. The injury to the kidney was trivial, and took no part in the fatal issue. The injury of the pancreas was one of shock, concussion, and probably contusion, and naturally was not found at the operation.
     There was no gangrene of the external wound, and yet the process of repair had barely begun, if at all, when death ensued. This clearly demonstrates that the prime factor in the fatal issue was some systemic defect, and that coupled with this was the fact of the escape into the track of the bullet of pancreatic juice, which promptly produced necrosis in the tissues that had been bruised. Injury of the solar plexus may have reduced trophic power in the abdominal organs and tissues, while absorption of the fluid products of necrosis produced toxemia. The necropsy showed that there was not the least evidence of peritonitis. The thin-walled heart clearly indicated some old-standing vascular and muscular degeneration, which of course very greatly impaired the power of recuperation. The bullet of low velocity, unsteady motion, and short range produced vastly more contusion of the tissues about its track than would a modern rifle bullet. So far as can at present be told, this sums up the reason that death followed the bullet-wound.