The Late President McKinley

MERCK’S ARCHIVES:
     In the President’s case the surgeons were remarkably expert and the operation was most complete and thoroughly scientific; but no doubt the injury was fatal from the beginning. As one prominent pathologist stated, “the President’s nervous system was constantly toned up to the highest pitch, and in receiving this severe injury there was a lack of nerve force to carry the patient through the crisis.” The constantly rapid and feeble pulse was a sure indication of severe nervous prostration, and judging from what we have seen, the patient never fully recovered from the “shock” attending the injury. It is well known that gangrene is not idiopathic, but an effect which may be produced by various causes, and is not necessarily produced by gunshot wounds. During the war, as we have seen, gangrene was quite common where the men were exhausted from long marches, poor food, and exposure, and it is well known, that a gunshot wound or any kind of wound, is liable to produce gangrene in any case of severe prostration or extreme debility. How well we see this principle illustrated in old, debilitated subjects: if an operation be performed in such a case, as a rule, the wound shows no disposition to heal, gangrene ensues, and the patient dies, not from gangrene, but from “shock” and nerve exhaustion.  .  .  .  In the President’s case we had, first, the severe shock, then the feeble pulse with other impaired physiological action, and then gangrene and collapse, following complete nerve exhaustion. May we not, then, regard “shock” as the true cause of death in this case? Inasmuch as we are all anxious for truth and enlightenment, the writer will be pardoned for not allowing this case to pass unnoticed, without some comment.

GEORGE A. WILLIAMS, M.D.,          
Bay City, Mich.