The Surgical Aspects of President McKinley’s Case

     So world-wide is the interest felt in every phase of the case of the late President McKinley, and so much at variance are many of the statements regarding it which have appeared in the lay as well as the medical press, that an epitome of the facts, in so far as up to the present writing they have been determined, is herewith given.
     The extent of the injury inflicted by the two shots fired by the assassin is stated in the following report of the autopsy issued by the attending physician:
     “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 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.”
     A full official report of the whole history of the case is in course of preparation, and will be made public at an early day. In the mean time [sic] the following facts appear to have been established with a reasonable degree of certainty:
     First.   As regards injury to the viscera, other than the stomach, the wound of the kidney was not sufficiently severe to cause any appreciable functional disturbance; there was no appearance of pus or blood in the urine. The pancreas was probably perforated, although there is some obscurity upon that point, but certainly was so injured as to result in the formation of a slough through which the pancreatic [594][595] secretion ultimately escaped, following the track of the bullet back of the stomach.
     Second.   Although the injury to the kidney and pancreas was not discovered by the attending surgeons at the time when the abdominal cavity was opened and the stomach perforations sutured, it is not probable that the fatal issue would have been averted even had the course and effect of the bullet been fully ascertained and more extended surgical interference effected.
     Third.   The successful and skilful [sic] suturing of the bullet wounds of the stomach and the increasingly favorable symptoms which day after day followed that operation justified the hopeful prognosis of the physicians in charge, and this notwithstanding the fact that pulse, temperature, and respiration, although showing progressive improvement, were at no time thoroughly satisfactory, and even in the most hopeful stage of the case remained as symptoms of possibly ominous significance.
     Fourth.   That if a mistake was made in too early imposing a digestive task upon the injured stomach, the risk may have been warranted by the failing strength of the patient and the apparent necessity for sustaining the vital forces, and that in any case the resultant indigestion did not materially influence the ultimate result of the case.
     Fifth.   That the true reason for the failure of modern surgical science to save a life so precious to the nation was not faulty operative technique or mistaken medical treatment, but was inherent in the nature of the injury and the systemic condition of the patient. President McKinley had a small heart with thin walls showing fatty degenerative changes; his pulse was erratic, possibly from organic lesions, as well as from functional disturbances, to which a somewhat excessive use of tobacco may have contributed. Like many other overworked men in public as well as private life, he had for many years been living upon his vital capital, and had no reserve force upon which to call in the hour of need. Hence there was enfeebled recuperative power in the injured tissues. There was no inflammation and no pus; but nearly the whole track traversed by the bullet became necrotic.
     Sixth.   The reason for the development of gangrene in this unforeseen and unusual form has not been fully determined, and may long remain a mystery. The theory that the bullets were poisoned has not been sustained by the results of chemical and bacteriological examination. Indeed, no poison, organic or inorganic, is at present known to toxicology capable of producing the exact line of effects which followed the course of the missile. Another theory is that the necrosis was due to the action of the escaped pancreatic secretion upon the tissues [595][596] which it permeated; and there are recorded cases of gangrene directly or indirectly following injuries of the pancreas which give some degree of plausibility to the suggestion. In the absence of much more definite knowledge regarding the physiology and pathology of the pancreas than we at present possess this theory must, however, be regarded as simply a possible hypothesis.
     The one supreme fact is that one who will perhaps go down in history as the best beloved of Presidents, because his gentle and yet manly nature invited love as well as trust, was stricken down in an hour when the arm of every fellow-citizen should have been his defence and every breast his shield, and that all the resources of modern medical and surgical science were powerless to save to the American people the ruler whom their suffrages had twice raised to the chief magistracy of the nation.
     If science thus disillusioned, her brightest expectations blasted, and her most hopeful auguries set at naught, can from this cruel failure gain one added truth helpful to others in time to come, it will be as he would have wished. And if we as a people awaken to a stern realization of the fact that cancerous sores infect the body politic for which the nation’s safety demands the swift, sharp sweep of the surgeon’s knife rather than the laissez-faire of the social optimist or the nostrum of the political quack, McKinley will not have died wholly in vain.