Dangers Peculiar to the Invalid of Exalted Station

     Now that fearful suspense and vacillating hopefulness have given way to the calmness of settled sorrow at the sad results of the assassin’s deed, we can give utterance to some of the thoughts suggested by the case.
     It would be a most interesting subject for thought to endeavor to determine the mental constitution of those who style themselves anarchists, and to trace out the line of reasoning by which, starting out with the demand for absolute personal liberty of thought, word and deed for every one as their fundamental principle, they come to regard it as a duty to remove by death those who merely represent views differing from their own. Surely this is in itself enough to prove an obliquity of mental vision incompatible with a sound mind. But insanity which prompts to murder should, according to our view, be ended surely and speedily by death,—not as a punishment, but as a means of self-protection on the part of the community. Why burden society with the charge for years, perhaps, of a useless and dangerous individual? His reformation, if possible, is only possible through death.
     The thoughtless demand for freedom, or rather license, of speech and of the press, leaves out of sight entirely the fact that those who talk and write are not generally the ones who act. On a little higher mental plane than their degenerate dupes, these instigators of foul deeds, while arousing the worst passions of their followers to overt acts, and sheltering themselves under the guaranteed freedom of speech, are none the less responsible for the acts which follow their teachings, but which they are too prudent and too cowardly to commit.
     But the thought which has most forcibly suggested itself to us while reading the history of this lamentable case, and which has more interest for us as physicians, is the increased danger incurred by any one high in station, by reason of his exalted position, in the event of illness of any kind. [645][646]
     However glibly we may be inclined to repeat that all men are born free and equal, in our inner consciousness we feel that this is not so, and that, besides the inequalities of birth, reflected in the mental and moral natures, there are certain inequalities of fortune and position which render one life of more value than another. In most cases, to the individual his life is the most valuable; but in the eyes of the community, the state, and the world, the life of him is the most valuable in whom the most interests center, and upon whom the greatest responsibilities rest. With this higher valuation of a life comes an increase of responsibility to those who may be called upon to protect it or to seek to preserve it. From this, in some cases, almost overwhelming sense of responsibility arise the dangers which threaten one occupying an exalted position if he should be unfortunate enough to require medical or surgical treatment.
     In the first place, the feeling of apprehension on the part of the attendant is enhanced in proportion to the valuation set upon the life of the sufferer, and with this comes, too, the desire to divide the responsibility, and one or more consultants are summoned. Now, although it is true that in a multitude of counsellors [sic] there is (a sum total of) wisdom, it does not necessarily follow that all of this is directly available for the benefit of the one most needing it. Although the numerous satires written on medical consultations of former years are no longer as true to nature now as then, can we conscientiously maintain that consultations are invariably resultant in good for the patient? Is the good accomplished proportioned to the number of consultants? We think not; and the common satirical remark that “So and so got well in spite of having had two doctors” reflects a similar popular distrust. With the increase in the number of consultants increases also the danger of irreconcilable differences of opinion, leading to delayed action or compromise measures. Aside from the depressing effect upon the patient of this increase of attendants, the actual result may, as we see, only increase the danger.
     If it be kept in mind that these remarks are not to be taken as applying to the present case specifically, but as only suggested by it, we will not be misunderstood when we quote various correspondents of one of the daily newspapers, show- [646][647] ing that the dangers here referred to are not imaginary. We read, “The rumors of coldness between Dr. —— and the other doctors should not detain us. It is easy to give a dark interpretation to a really harmless episode, and —— is not a man to sulk like a schoolboy; moreover, the situation is too grave for professional jealousies.” Unfortunately human nature, and even professional human nature, has the property of generally remaining a pretty constant factor in all our actions.
     In another and almost diametrically opposite direction, the number of advisors may prove an element of danger. It is a danger which depends upon suggestion, that word which is so much in evidence at the present day, and the full import of which is but imperfectly comprehended. Who of us has not found himself at times influenced in his diagnosis or treatment by the report or discussion of some case which has had points of resemblance to our own? Or who has not, even in consultations, in spite of the most determined independence of thought, found himself liable at least to be biased in his opinion by the statement of the case given and the point of view taken? The greater the number of those thus gradually brought under the influence of suggestion, the more firmly does each become convinced of the correctness of the general view, and the less likely are other possibilities to meet with the consideration and study which their importance may demand. In the case before us, and with the intention only of proving the existence of this danger, we point to the generally expressed view that sepsis and peritonitis were the dangers to be feared. All the attendants were agreed upon this point; all looked for signs of these conditions; no one found them, and all were hopeful. But, according to the statement of one of the physicians, “The breastbone showed a big impact. Still, the area of infiltration of subcutaneous tissues was entirely too extensive to be accounted for from contusion or the force of the bullet. The subcutaneous tissues were in a partially gangrenous condition. . . . . The skin wound on the point of entrance was livid and gangrenous, and this process extended to the entire line of invasion made by the surgeons through the abdominal wall.” Here was a condition of the external wound which surely could have been seen at the repeated re-dressings, and [647][648] which, to a mind uninfluenced by cumulative suggestion, might have pointed to a similar condition within, such as was found at the autopsy. While nothing could have been done to change the final result, the prognosis would have been a different one, and the terrible shock of disappointed hopes spared us all.
     Again, the tremendous responsibility to be incurred often prevents that immediate energetic action which determines the difference between fatality and recovery. In the case of an obscure individual chances are taken, and there is no delay. Fortunately this danger was in the present case avoided; but that it is a real danger can be seen from the following quotation: “This avoidance of delay, if I may be pardoned for saying it, was due to the fact that within a few minutes after the shooting there were at the President’s side two surgeons with the ‘audacity’ to go ahead with the operation, which they knew was essential, without waiting for the consent of cabinet officials, for a general consultation of surgeons, or for anything else.”
     Further, on account of remote possibilities, any slight departure from the regularly reported routine assumes a more serious aspect, more or less detrimental to that calmness and self-confidence on the part of the attendants which react so favorably on the patient. We quote again a reference to the reopening of the wound: “If it had happened in an ordinary hospital patient, not a word would have been said about it. . . . . If anything happens, we’ll tell you when the time comes. You can depend upon that, no matter how rattled we may be.”
     Finally, the frequent issuing of bulletins, demanded by the anxious public, has a tendency to divert the minds of the attendants from the general course of the trouble by limiting their attention to the conditions found just at the moment of making their observations upon which each bulletin is based. Of course, taken by themselves, such observations are an index of the apparent condition at the time, but it is only by a rigid comparison of observations taken at longer intervals that a judgment as to the progress towards recovery or its opposite can be arrived at. Naturally, such comparisons are supposed to be made, and no doubt are made; but the tendency is to place too great reliance upon the isolated observations. The [648][649] frequent examinations are apt to allow slight and apparently insignificant changes to occur, whereby the mental picture of the progress of the disease is gradually altered, whereas these differences observed at longer intervals would become more marked and significant. Only in exceptional cases, according to our view, are the frequent examinations and visits necessary, which we hear of so often as proof of a physician’s interest in a case.
     Although, as is now evident, the fate of our lamented President could, under the circumstances, have been none other than it was, the fact remains that, when sick, the one of exalted rank or position is exposed, by reason of his eminence, to dangers at the hands of his friends which do not threaten one of humbler station.