The Official Report of the Case of President
official report of the case of President
McKinley, containing, as it does, detailed accounts of the operation,
treatment, and autopsical findings, will be read with becoming interest
by all who have so eagerly awaited the final expressions of opinion
of the gentlemen in attendance. Much of what appears has already
been anticipated by the full reports which came from time to time
from the sick-room, either in the shape of bulletins and personal
statements, and which were so widely published by the medical and
secular press. Still, it is now a matter of history to print the
story in its present connected and authoritative form. As a description
of a now famous case, it lacks nothing in completeness of detail,
accuracy of statement, or frankness of opinion. As such it will
stand on its merits as a notable contribution to medical literature.
While, doubtless, the account will
be read from beginning to end with varying interest in the points
discussed, it is safe to say that the elaborate and carefully prepared
autopsical report will receive the greatest attention. There have
been very many different opinions expressed among medical men generally
as to the real cause of death, and it will be with great satisfaction
that the accurately described details of the post-mortem examination
can be studied with becoming thoroughness.
All discussion has, of course, centered
on the cause of the gangrene in the bullet track. The suspicion
that it might have been due to a poisoned ball was very quickly
and properly dispelled. In fact, we now have bacteriological proof
that the wound was not at all infected primarily, but that a necrotic
process developed later, and steadily progressed until the end.
It cannot be positively demonstrated that the lesion of the pancreas
had anything directly to do with the induction or continuance of
this tissue change.
Doubtless, the theory that gangrene
was induced by a lack of vital resistance in tissues involved will
appeal to the greater number as being the most reasonable one. There
were certainly many contributory causes to such an end. The patient
was of sedentary habits, given to obesity, had a feeble heart action,
and was aged beyond his years, with the usually deficient oxidation
of his tissues.
We know that whenever a bullet passes
through the living body it leaves a track of contusion, more or
less well marked, according to the size or velocity of the projectile
and the nature of the tissue which it traverses. If the patient
survives the immediate injury, and recovery is a physiological possibility,
the contused tissue undergoes one of two processes: If the bruise
is not too severe and the patient’s circulation is active, the tissue
recovers. If not, it undergoes putrefaction or necrobiosis. Naturally,
what in one patient with a good heart action and active vital processes
would be a practically harmless contusion, in another with a weak
and thin-walled organ would be exactly the opposite.
It is therefore not unreasonable to
suppose that the necrosis tissue in the case of the President represented
originally the contused tissue into which the enfeebled heart was
unable to force the blood current so as to overcome the stagnation.
This condition of affairs, associated with the feeble heart, again
would explain the rapid pulse which was such a marked and ominous
feature of the case, and which so sadly and effectually set at naught
the optimistic predictions of some of the medical attendants.