The Case of President McKinley

     Now that the authorized detailed account of the history of the late President’s case, with report of pathologist, has been given to the medical public, criticism should give way to words of commendation for the zeal and labors of the attending physicians and surgeons. The operator, Dr. Matthew D. Mann, summoned to the Exposition grounds without a hint as to the purpose, was totally unprepared for such an emergency. The patient was quickly etherized in the small emergency hospital, which was only equipped for minor surgical work, and with such instruments as they happened to have, supplemented by Dr. Herman Mynter’s pocket case, undertook an abdominal section under tremendous physical difficulties, to say nothing of the enormous element of personal responsibility. Every abdominal surgeon will appreciate the obstacles in the way of the operator attempting to suture a wound in the posterior wall of the stomach through a very thick abdominal wall without retractors, and in the failing light of half past five o’clock on a September afternoon. While the sun shone through the awning-covered windows, light was only admitted to the abdominal cavity by the reflection of a hand mirror held by Dr. Rixey; subsequently a movable electric light was arranged before the completion of the operation. The only question of technique that might arise was the subject of drainage. Before the wound was closed each of the surgeons was asked by the operator if he were perfectly satisfied with what had been done, and they all answered in the affirmative. Dr. Herman Mynter suggested drainage, but was outvoted, for in the judgment of the other surgeons they could see no indication for a “Mikuliz.” It would, in the light of subsequent developments, be very interesting to know how the case would have terminated had Dr. Mynter’s suggestion prevailed. Blood examination shortly before death showed no evidences of sepsis, and, aside from a suspiciously high pulse [571][572] rate and considerable prostration, it certainly did seem as though the distinguished patient would recover, and the public should then note the radical advance of present-day surgery over that of President Garfield’s time. As has been stated before, the coolly calculating scientific mind must carefully weigh conditions and from them carefully make deductions that are not to be dominated by emotion or desire. Diagnosis is indeed a great factor in the minds of the laity. Diagnosis may be frequently changed without comment, but an error in prognosis, sanguine or otherwise, dwells longest in the minds of the interested watchers, and comes back upon the heads of the devoted attendants with great force, forgetting even the real good and great effort that has been made.