The Official Report of the Case of President McKinley

THE 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.