Results of the Autopsy in President McKinley’s Case

     From the standpoint of pathological anatomy, the report of the autopsy performed on the body of our late president fails to entirely account for the production of the necrotic changes observed in the track of the missile. In the report of the bacteriological examination made by Dr. Matzinger, the bacteriologist to the New York State Pathological Laboratory, of whose high competence in such matters there is no question, it is shown that there were no known pathogenic bacteria in the necrotic cavity, warranting the statement of Dr. Matzinger to the effect that “bacterial infection was not a factor in the production of the conditions found at the autopsy.” The bacteriological and chemical examinations of the chambers and barrel of the revolver, as well as of the empty shells and cartridges, ordered by the district attorney, was entirely negative, excepting that from a loaded cartridge there was grown an ordinary staphylococcus and a mold. The chemical examination made by Dr. Hill, the chemist, was also negative. This goes very far to prove that the theory of a poisoned bullet may now be entirely discarded. We are, therefore, in a position to state that from the bacteriological and chemical standpoint there were no factors to be found that might have served to explain the presence of the peculiar necrotic area observed at the autopsy, and that we must seek further for an explanation of the occurrence of this unusual phenomenon. Such an explanation must evidently be at best but an unsatisfactory one from the point of view of a rigorous scientific accuracy, since we are thrown back more or less upon theoretical notions derived in part from the appearance of the lesions directly caused by the bullet, and in part from the observation of the other organs of the body. In the first place the report makes it evident that there was no general infection of a pyemic or septicemic nature. The blood taken from the heart was sterile, and cultures from the peritoneal surfaces showed that no peritonitis existed. Neither was there, in any part of the track of the bullet, any collection of pus. The heart was rather small, its walls thin and flaccid, and in a condition of fatty degeneration, infiltration and brown atrophy. The kidneys were in a condition of partial parenchymatous degeneration. These organs were, therefore, affected in a manner such as to very distinctly diminish the force of resistance to injury possessed by the patient, and to sufficiently explain the lack of reparative action manifested by the findings of the autopsy. Experiments by Flexner and Chiari, mentioned in the report, have shown that animals seem to have died as a result of not very extensive lesions inflicted upon the pancreas, and that concussions and slight injuries of this organ may be a factor in the development of necrosis. The latter writer observed, although it is a comparatively rare condition, extensive areas of softening and necrosis of the pancreas, especially of the posterior central portion which lies directly over the bodies of the vertebræ, where the organ is most exposed to pressure or the effects of concussion. Since the injury inflicted upon the left kidney was of a comparatively slight extent, we must believe that the lesion of the pancreas, assisted by the impaired condition of the heart and kidneys, was the chief and determining cause of the lamentable end of the distinguished patient. While it is unfortunate that our knowledge of the lesions of the pancreas should be so slight, this case seems to prove that injuries of this organ, especially in patients already somewhat debilitated by other pathological conditions, are an additional source of danger in the chapter of abdominal traumatisms.
     The reading of the exhaustive report upon the late president’s case leaves the reader under the firm impression that nothing that might have been achieved by the most painstaking care and the application of the most thorough scientific knowledge was neglected in any manner whatsoever.