President McKinley’s Death

IN no country in the world, outside the United States itself, was President McKinley’s assassination viewed with greater horror, his hopeless struggle for life followed with more sympathetic interest nor his death more deeply deplored than throughout the Dominion of Canada. The bulletins issued from the sick room on the days following the assault were of such a hopeful character that people generally had begun to think his ultimate recovery was assured. The prompt and courageous measures undertaken by the surgeons who were first called to see him and their apparently brilliant results, were made the text for many laudatory comments in the public press on present day surgery. Unforttunately [sic] some of those connected with the case, if newspaper reports are to be credited, indulged too early in rather fulsome self-congratulation. It is therefore scarcely a matter for surprise that the news of the unfavorable turn the case had taken should have come as a shock to the public, who were quite unprepared for it, and that the keenest, almost angry disappointment should have been shown at the unfavorable termination. Immediately the medical attendants were subjected to the most caustic criticism and medical science incidentally, was made to share in the odium. Looked at in its most favorable light and in the knowledge subsequently gained from the autopsy, it must be candidly admitted that the whole case has not tended to raise the medical profession in the public esteem. The fatal termination was at first attributed to the too early admistration [sic] of solid food, a hasty and wholly unwarranted conclusion which any thoughtful practitioner appreciated at the time and which the autopsy afterwards conclusively demonstrated. The post mortem examination revealed the fact that the case was absolutely hopeless from the first and nothing known to the therapeutist could have warded off the fatal result. All within the power of modern surgery and medicine was done. At the President’s age [101][102] and in his physical condition, the resisting and restorative power of nature were unequal to the task laid upon them. The tissues along the course of the wound through the abdominal walls, stomach, pancreas and kidney became gangrenous—a failure of the vis medicatrix naturae which no human power could obviate. It seems to us that much useless discussion has taken place as to the cause of the gangrene, some attributing it to a poisoning of the bullet, others to the digestive action of the pancreatic juice. Sloughing along the course of a bullet-wound, from direct injury to the tissues and the opportunity for microbic infection, especially in an elderly patient with lowered vitality, is certainly neither a rare nor unexpected result. Why attribute the gangrenous condition in the pancreas to the action of the digestive fluid, when the same reason does not explain the condition in the walls of the stomach and elsewhere?
     While the autopsy has absolved the doctors from blame from a therapeutic point of view, it does not equally satisfy for the failure in diagnosis and prognosis. To the medical profession, with bulletins recording an unexplained increase in temperature and a rapid pulse, in [102][103] such a necessarily serious case of injury to the peritoneum and abdominal viscera, the absolutely roseate reports from the sick room were quite inexplicable. Only the excellent reputations of the specialists in attendance and the thorough confidence in their ability to do all that medical art allowed, and to appreciate as nearly as might be the gravity of the condition with which they had to deal, caused the profession more readily to accept their opinions, though at variance with general experience. For the failure in exact diagnosis only those ignorant of the difficulties in the way, would attempt to blame the doctors in attendance. In the face of the facts before them, however, the general verdict of the profession will accord with that of the public, that the surgeons were over-sanguine in their prognosis. No doubt, as often happens, the eagerness for the recovery of their illustrious patient and a desire to give as much hope and comfort as possible to anxious friends and to the people at large, caused them to unduly magnify favorable symptoms. Personal feelings for the patient obscured their judgment. The apparent failure to fully grasp the seriousness of the condition, appears to us to be the only thing for which the medical attendants can be justly criticised.
     There are those, speaking in the light of the experience of Senn during the campaign in Cuba, and of Sir William McCormack, Sir Frederick Treves and Watson Cheyne, in South Africa, who will question the advisability of an operation having been undertaken at all, but this is still an unsettled point in surgery, and certain it is, public criticism would have been absolutely unrelenting, had death occurred without any operative attempt to give relief. The New York Sun from a lay standpoint we believe, sums the matter up fairly in concluding that “the necropsy shows that the most skilful medical diagnostician or therapeutist could not, by his advice, have changed the progress or the result of the conditions following the injury.”
     The failure of the pathologist to locate the bullet at the autopsy is another matter which, with the information at present at hand, is difficult to understand.
     The following extract from the official report of the post mortem examination will assist in a clearer understanding of the whole case:
     “The bullet which struck over the breast-bone did not pass through the skin and did little harm. The other bullet passed through both walls of the stomach near its lower border. Both holes were found to be perfectly closed by the stitches, but the tissue around each hole had become gangrenous. After passing through the stomach the bullet passed into the back walls of the abdomen, hitting and tearing the upper end of the kidney. This portion of the bullet track was also [103][104] gangrenous, the gangrene involving the pancreas. The bullet has not yet been found. There was no sign of peritonitis or disease of other organs. The heart walls were very thin. There was no evidence of any attempt at repair on the part of nature, and death resulted from the gangrene, which affected the stomach around the bullet wounds, as well as the tissues around the further course of the bullet. Death was unavoidable by any surgical or medical treatment, and was the direct result of the bullet wound.”