Some Lessons from the President’s Case

IN the death under tragic circumstances of a prominent man the medical profession often is compelled to face tremendous responsibility, and frequently the lessons learned from every case under such conditions are brought much more forcibly to the attention of physicians. So we find that there is something to be learned from this unfortunate case.
     Under present customs the surgeon expects the general physician to call him in consultation in every surgical case; the surgeon when first consulted usually forgets to call a general physician. In the first case the surgeon assumes that the internist can know nothing of surgery, while in the second he credits himself with a full knowledge of internal medicine in addition to his surgical skill. The surgeon’s experience does not lead him to the acquirement of facility in the finer methods of physical diagnosis, and in what appears to him a purely operative case he not infrequently overlooks slight morbid changes in heart, bloodvessels [sic], lungs, kidneys, or other organs. The time has now come when the surgeon, in asking the consulting support of the general physician on the ground of his especial surgical training and skill, must no longer assume to be a specialist in internal medicine. In addition to being distinctly unfair, this attitude is illogical in the extreme and is at times productive of results much less happy than might be obtained by the hearty cooperation of both parties. The calling in, early in the history of the President’s case, of a physician especially trained in the methods of modern internal medicine would certainly not have saved the life of the illustrious patient; but it would, almost beyond question, have resulted in sparing the country the unreasonable sense of security in the favorable outcome of the case that was indulged in on the fifth and sixth days. The medical profession also would in that case not now feel under the necessity to condone the want of care in prognosis that was shown by some at least of the President’s surgeons. The thin-walled heart, accompanied by a disproportionately rapid and irregular pulse, could not have failed very early in the case to have unfavorably impressed the physician skilled in estimating the reserve power of a cardiac muscle. His counsel would certainly have acted as a check upon the rosy prognostic interviews of one of the attending surgeons, for it must be remembered that in the official bulletins, with one exception, prognosis was left to the readers, the surgeons usually confining the bulletin to a bare statement of the actual condition. The one exception is the more noteworthy that it occurred in the bulletin of 2:30 p. m. on September 13, just twelve hours before death. This read: “The President has more than held his own since morning, and his condition justifies the expectation of further improvement.” This was not signed by the surgeon whose expressions of his belief in the ultimate and prompt recovery of the President had been received so joyfully by the public. It is therefore a little difficult to explain. [438][439]
     The two chief lessons then to be learned from this infinitely sad case in regard to the conduct of grave surgical cases are, first, the great advantage of early seeking the counsel of a physician thoroughly experienced in internal medicine; and, second, the very evident disadvantage of venturing any form of prognosis.