The Revelations of the Autopsy
revelations of the autopsy on the
body of President McKinley are deeply significant from many pathological
and surgical points. While the report of the physicians is meant
to be merely a preliminary one, the main facts thus far presented
are sufficiently explicit to anticipate in all essential particulars
the fuller account which is promised later.
Taken in connection with the clinical
history of the case, and the extremely optimistic views of some
of the consultants, the discovery of certain of the lesions named
is both a surprise and a disappointment. It is a pity indeed that
such an evident failure in diagnosis should have been so conspicuously
demonstrated to the general public. It has proved, in fact, the
lost opportunity for an entirely contrary exhibition of judgment,
skill, and tact.
In reconciling the findings after
death with the symptoms during life, there are many relations between
causes and effects, which, although hidden before, are now very
painfully apparent. We may comfort ourselves by saying that, under
the circumstances, events were uncontrollable and results unavoidable,
but the public, alas! view the real situation in a very matter-of-fact
The operation of suturing the stomach
wounds was timely, proper, and, so far as it went, brilliant. Medical
men the world over were proud to hear that it had been done so promptly
and so well upon a person of such importance.
But now, in the light of the autopsy,
we know that the operation, carefully conducted as it was, was necessarily
an incomplete one. This is speaking of the procedure from a strictly
surgical standpoint, irrespective of the ultimate doom of the patient
in any event. Time was precious, and prolonged search for the ball
was impossible, consequently the condition and course of the wound
beyond the stomach could not be positively ascertained at the time.
The surgeons satisfied themselves, therefore, that it was safe to
leave this terminal wound to itself and close up the abdomen. They
used their best judgment under trying conditions; but, unfortunately,
that judgment was in error.
Then came the bulletins and interviews
so eagerly read by an anxious nation. It was stated at first that
the stomach wounds were the only causes for anxiety, that the ball
having lodged in the muscles of the back would become safely encysted,
and that septic peritonitis from possible leakage of the stomach
contents was the only thing to be feared. When the latter danger
was over, there came the surprising intelligence that the patient
would certainly recover. This in face of a continued high temperature
and rapid pulse! Then it was announced that all the wounds had healed
perfectly, and the only real danger was centered in a weak heart.
Hardly had this bulletin been issued when it was announced that
the external wound was found to be infected, necessitating the removal
of some stitches. Still it was said that the distinguished patient
was doing excellently well—in fact, even better than before. Next
was the report of an attack of indigestion, claimed to be due to
food given too soon, and last of all and without warning came the
appalling accounts of his rapid collapse and surprisingly quick
Worst of all, however, were the actual
facts of the autopsy which seemed to prove to the public that the
doctors had been wrong in their conception of the case from the
beginning to the end.
Sadly enough, not one of the principal
lesions gave any evidence of its existence during life. The good
condition of the wound behind the stomach, of which all the surgeons
were so pronouncedly confident, was an illusion and a snare. What
was considered to be a most insignificant factor became the most
important of all. Instead of the terminal track of the bullet being
healed and the ball encysted, it was found, at the autopsy, to be
gangrenous throughout. Thus a most startling error of diagnosis
was flauntingly accentuated by an indignant and astonished press.
The practical surgeon very properly
asks himself why the condition and the direction of the track behind
the stomach was not discovered at the time the parts were exposed
during the operation? That the problem was not solved then and there
was certainly not due to any want of forethought on the part of
the operator, whose skill in his line no one can question. The only
answer must be that such a thorough examination of the parts was
impossible at the time. Still it seems hard to explain why all the
gentlemen on the case were so satisfied with the real nature of
a wound that they, obviously, knew nothing about.
R was exceedingly anxious on this
point and earnestly called attention to the possibility of there
being a wound of the pancreas or kidney or both. Unfortunately,
as the sequel too well shows, we were right in at least one particular.
Another matter is that which referred
to the desirability of an x-ray examination to locate the
ball. The R urged this as of the
greatest importance, and yet, with the apparatus at hand, it was
repeatedly and publicly stated that such an examination was not
at all necessary. In fact, it seemed safer to guess than to be sure.
What comment suggests itself in this connection when even at the
autopsy, so far as can be ascertained at present, it was not considered
worth the trouble to search for the ball beyond a certain point!
What excuse must be offered to the public for the utter inability
to find the bullet even in the dead body! All these matters may,
however, be properly explained when the fuller account of the post
mortem is given to the medical and lay public.
Many different theories have been
offered by the medical attendants concerning the cause of gangrene
of the bullet track. By some the condition is charged to a poisoned
bullet, by others to the leakage of pancreatic juice into the bullet
sinus, and  by still others
to mere lack of recuperative energy in the tissues involved.
On these points, however, the profession
is willing to suspend judgment, pending the completion and publication
of the official reports of the post-mortem examiners.
Viewing the strictly surgical aspects
of the case in the light of the autopsical demonstrations, certain
points of treatment might naturally suggest themselves. Everyone
knows that such an injury as existed in the President’s case is
uniformly fatal. The most favorable result that could have been
expected was the healing of the wound and the possible establishment
of a fistula. This would certainly be infinitely better even as
a tentative measure than accidentally leaving a leaking kidney or
pancreas in a closed cavity to work such mischief as was manifested
in the gangrenous condition of the surrounding tissues of the case
Allowing that the bullet had actually
lodged in the muscles of the back, also that the missile was within
easy reach, it would be following a good surgical rule to establish
drainage by the most direct route posteriorly. This course, however,
could not be followed, as the bullet, on account of the unfortunate
conditions already noted, was not accurately located. Under the
circumstances, therefore, and taking everything into consideration,
it is comforting to note that all was done for the distinguished
patient that was possible. In fact, as was repeatedly stated by
the operator, “the case was a fatal one from the start.”
In thus remarking upon the public
aspects of the case it is only for the purpose of getting at the
truth and learning perhaps a useful lesson. In the same spirit we
can afford to view the strictly professional side. To err is human,
but wisdom comes from experience. It is safe to say that under like
circumstances in future the gentlemen concerned would act somewhat
differently. We sincerely trust that they at least would not then
be asked to explain why they allowed a lost ball to be buried with
the victim’s body.