The Case of President McKinley

     After a careful perusal of the brief report of the autopsy in the late President’s case, and a diligent study of the mass of professional opinions given out both in the lay and medical press, we are forced to arrive at two principal conclusions. Of these the first and most important is that every shred of evidence distinctly points to the fact that, within the limitations of the surgical art and science, the distinguished surgeons in attendance did everything that technical skill, diagnostic ability, and courage could possibly have accomplished. The second point is the simple fact that, until exhaustive microscopical and bacteriological investigations shall have been completed, we will be in doubt in regard to some pathological points which, hidden as they still are from us, constitute an atmosphere of mystery beyond which we seek in vain for a clear light.
     In regard to the operation itself we must declare our firm belief that nowhere could the work have been better done. Any further search for injuries would have been unjustifiable, and would in all likelihood have resulted in death upon the operating table, or at least in a condition of shock that would very soon have carried away the distinguished patient. The fact that no peritonitis was discovered after death testifies to the care that was taken in the closure of the gastric wounds, and in the cleansing of the abdominal cavity, and the good condition of the patient after the operation testifies to the rapidity with which it was done and the skill with which shock was met and avoided.
     The mysterious element to which we have referred may or may not be entirely cleared up by the findings of the pathologists. That some valuable information will be given us is unquestionable, yet we fear that every doubtful point may not be elucidated. It is more than likely that we are confronting one or two problems which physiology has not yet reached an eminence great enough to solve. It does not appear absolutely clear whether or not the pancreas was actually wounded, or whether the gangrene affecting it was an extension by contiguity of the same process occurring in the posterior wall of the stomach. That the absorption of the pancreatic juices by the tissues is followed by necrotic processes, chiefly affecting adipose tissue, is known. Again, there is a possibility that lesions of the central sympathetic system may have had an important bearing upon the peculiar and unexpected lack of reparative power evidently manifested by the patient. Failing any proof that these may have been the true causes of the necrotic changes revealed after death, and leaving aside any theory implying a toxic action due to a poisoned missile, there remains the fact that President McKinley’s surgeons dealt with a patient beyond middle age, stout, of sedentary habits, who had not only for nearly five years borne the burdens of a great nation and the responsibilities of a war, but had also known the carking care of severe and prolonged illness affecting one very dear to him. His heart walls were thin, we are told; hence we are well justified in believing that his vitality was considerably impaired.
     Some have ventured to attach blame to the surgeons for the hopeful tenor of the bulletins daily issued by them. They would unquestionably have preferred to indulge in no prognostications. But the whole country was hungering for news, and they had to give their opinions. Why should they not have spoken hopefully? It is an invariable rule that, some time after the third day, when the chances of general infection have passed by, laparotomy patients are considered as making great progress on the road to ultimate recovery. Until near the very end the symptoms shown by the President were never serious enough to justify anything but the most favorable outlook.