The Cause of the Death of the President

     As medical men we are profoundly interested in the cause which led to the death of President McKinley. The post-mortem revealed gangrene along the entire track of the bullet, from the skin wound to and including its track through the edge of the kidney. The pancreas was also gangrenous. The post-mortem report says nothing about a wound of this latter organ, though Dr. Roswell Park intimates that it was injured. Here we have the injured abdominal wall, wounded stomach anterior and posterior walls, wounded kidney, and possibly injured pancreas. We know the men who operated on the president and believe they took every precaution to save the life of their illustrious patient.
     As surgeons we meet with gangrene where there is mechanical obstruction to the blood current, as in an improperly applied bandage or splint. We see it again in cases of violent inflammation which by the swelling interference with the venous circulation of a part. In this case, so far as we know, there were neither of these agencies at work, and the examination of the [304][305] bullets showed they were not poisoned. Then what produced the gangrene and death of the president? Dr. Roswell Park, in an interview, intimates the possibility of an undetected injury to the pancreas, and that the flow of the pancreatic fluid into the abdominal cavity produced the disastrous results. The post-mortem furnishes no evidence of injury to the pancreas, though it was gangrenous. If it had been injured would its secretion produce the gangrene? If it has such disastrous results why did it confine its action to the tract of the bullet, and its surrounding tissues? Why did it not involve other tissues and organs in the abdominal cavity? The pancreatic juice will liquify fat when that fatty material comes to it as food—dead tissue, but it is not known to attack and destroy living organs and tissues, as the peritoneum and stomach walls, composed of living muscle, fibrous material and muscus [sic] membrane.
     We know that inflammation cannot hide itself anywhere in the body without its presence being detected by the use of the microscope; the blood count in this case, 48 hours before the end, showed that there was no increase of the white blood corpuscles. Unquestionably, then, the surgeons were justified in saying there was no inflammation; and this finding of the microscopist was confirmed at the autopsy. There had been no attempt whatever at repair of the wound in the stomach or elsewhere along the tract of the bullet. We know that two peritoneal surfaces sutured together will unite in a few hours—and here there was no union at the end of 7 days. What was the etiological factor in the gangrene and death of the president? We confess we do not know.