One Discordant Note

EVERYWHERE in the medical press, with one notable exception, there has been found most hearty approval of the course pursued by the President’s physicians, together with genuine commendation for their courage in most trying circumstances. Criticism has been only upon minor points, and has been kindly in tone, recognizing that no suggested alteration in the treatment pursued would have in any way affected the final outcome. In the President’s case, as in all similar cases, it is a mistake for surgeons to assume the entire medical as well as the surgical treatment. For their own protection, if for no other reason, the surgeons should early in the case have called for the opinion of a skilled internist as to the condition of the patient’s vital organs. The only other mistake was due to some of the surgeons, one particularly, giving unofficially to the representatives of the press a prognosis much more favorable than that to be drawn from the official bulletins signed by themselves. Neither of these errors in conduct was serious in its effects upon the outcome of the case. Their complete correction would not have changed the issue, but it must be admitted that it would have resulted in the surgeons standing just a little better before the public.
     These little points however furnish no adequate excuse for the scorching that the surgeons received in the Medical Record of September 21. Some quotations will show the character of this very unfortunate editorial. “Taken in connection with the clinical history of the case, and the extremely optimistic views of some of the consultants, the discovery of some of the lesions named is both a surprise and a disappointment. It is a pity indeed that such an evident failure in diagnosis should have been so conspicuously demonstrated to the general public. It has proved in fact, the lost opportunity for an entirely contrary exhibition of judgment, skill, and tact.” Where in the records of the case and of the necropsy the Record can find the least justification for these unkind and impolitic strictures upon the conduct of the case we are unable to say. It is to be feared that this is the old story of an editor in his closet caring for a surgical case at a range of some 400 miles. The best surgeons in Buffalo cared for President McKinley. The medical profession of the entire country knows that they are honest and thoroughly capable men, who would do the very best that human skill could do under the circumstances.
     The Record, in denying confidence in the ability and good judgment of the surgeons involved, is running counter to the sentiment of the medical profession, is substituting closet lucubration for clinical skill and action, is [439][440] once more endeavoring to delude the public into the belief that the old régime of internal professional warfare is not yet dead (as it is), and is laying itself open to the charge of a willingness to belittle the surgical skill, diagnostic care, and prognostic ability of others than the editor of the Medical Record. It is certainly to be hoped that the entire profession will set the seal of its disapproval most emphatically upon this damaging course of the Record.
     A most extraordinary feature of the Record’s [sic] editorial lies in the fact that it contains some eight or ten exactly self-contradictory statements. In evidence of this American Medicine of September 28 effectually makes use of the “deadly parallel column.” What must the profession conclude as to the attitude toward the medical profession of a medical editor who in bitterly and publicly criticising some of his fellow-physicians specifically contradicts many of his own points?
     A few more extracts from this untimely editorial will be given in order more completely to set forth its character, which reminds one vividly of the squabbles of a past medical generation. Its tone has no place in modern medicine. It is a voice from the past, and even then not one pointing out the correct way for the future. Really it is impossible to review the Record’s [sic] position, because there is little or nothing in common between the conclusions of modern surgery and the views advanced by the Record. The criticisms advanced are so irrelevant, and savor so strongly of the scintillating afterthought, that the only conclusion to be drawn from the Record’s [sic] assertions is the old one that (in the light of postmortem findings) diagnosis, prognosis, and treatment might occasionally be different from that which had been found necessary in the antemortem conduct of the case.
     The Record says that the surgeons’ “judgment was in error,” and that the operation was “necessarily incomplete.” “It was announced that the external wound was found to be infected.” As the exact opposite of this was stated in the bulletins published here, one is forced to the conclusion that the Record has been drawing its information from the New York World and Journal. “A most startling error of diagnosis was flauntingly accentuated by an indignant and astonished press.” This renders quite certain the part played by the “yellow” press in forming the opinions of the Record. “Everyone knows that such an injury as existed in the President’s case is uniformly fatal!” This is based on the supposition of a wound of the pancreas and of the kidney. There was no wound of the pancreas, and only a slight one of the kidney. It is true that at the necropsy pancreatic fluid was found in the gangrenous cavity just behind the posterior wall of the stomach, but it is a known fact that under certain conditions the limiting membrane of the pancreas permits the transudation of pancreatic fluid—notably concussion of the pancreas. The operation disclosed no wound of the pancreas, and there is no known means of determining or remedying the leaky condition of its capsule produced by concussion or contusion. The Record first [440][441] and last finds especial fault with the surgeons for not finding the bullet. At the time of the operation, after the stomach wounds had been closed and the pancreas and kidneys examined, the President’s pulse and temperature emphatically forbad any farther manipulation for fear of death on the table under anesthesia, for which the criticism would have been widespread. The ball was not found at the necropsy because the President’s family and friends refused to allow the making of any further incisions, and it is not easy to extract a ball from the muscles of the back through an abdominal opening in a fat subject. Taken all in all, the Record’s [sic] comments upon the President’s assassination constitute in every respect one of the most unfortunate contributions to medical literature that has appeared for a generation. Even with the clearer light of the necropsy the Record does not suggest better methods of treatment than those employed. Criticism should have a higher motive.
     Already the sensational press, as might be expected (and as was intended?), is printing extracts under “scare” headlines—“Grave Errors,” etc. The Record has done the medical profession incalculable harm. For what purpose?