The Blood Count in President McKinley’s Case

     Before closing this series of articles, we feel that attention should be called to the blood count in the case of President McKinley.
     The President was shot on Sept. 7, and died on Sept. 14. The temperature rose for two days but fell on the third day from 102°8 [sic] to 101° in a few hours. From this date on there was a steady decline to the end, the temperature being higher mornings than evenings; this latter fact is worthy of note.
     The pulse reached 145 on the second day, Sept. 8th. It dropped in an irregular fashion to 106 on Sept. 10th, and then rose irregularly until the Presidents [sic] death, reaching 128 on Sept. 12th and 13th.
     The President complained of fatigue in the latter days of his illness and his rapid irregular pulse led to anxiety on the part of the attending surgeons, before it was communicated to the public. The question of injury to the solar plexus was set aside because of the regression and later acceleration of the pulse rate. As regards the question of sepsis, there was no abdominal tenderness, no gaseous distention, no muscular retraction, and the temperature was continually falling. Dr. Wasdin then made a blood count, and reported that there was no leucocytosis; and in consequence of this sepsis was excluded.
     Just here in regard to the blood count a false conclusion was reached, [293][294] and it is especially worth noting in connection with the subject of these papers. We have repeatedly called attention to the fact that in pneumonia, an absence of leucocytosis is an omen of a fatal issue of the case. We also note that in sepsis an absence of leucocytosis meant a speedy death.
     In our article in the June number of The Medicus we quoted Dr. Deaver of Philadelphia, as saying:
     “Leucocytosis is the most significant fact which a blood examination will give a surgeon. High leucocytosis is in general a favorable sign as it usually foreshadows a reaction and may express the fact that nature is able to cope with the inflammation.”
     The condition of affairs was simply this in President McKinley’s case: His general health and strength was really at a low ebb, so low that he only gave the slightest evidence of reaction against the invasion of septicaemia on the third day when the temperature rose to 102.°8 [sic]. It is likely that a slightly increased white blood count would have been found at this time. But nature was physically unequal to the task, the few extra white cells soon fell victims to the bacterial invasion, and general sepsis followed. The lack of leucocytosis was a sign of impending death.
     But who thought of President McKinley as in such poor general health. An old drunkard takes phenmonia and dies without reaction in a few days. There is no leucocytosis in his case, and we easily explain the results by saying exposure and debauching had so exhausted his vital powers that no reaction would take place. We are now warned that hard mental affliction, great stress of brain work, great care and great responsibility, not to mention the care of a sickly wife to pull at the heart strings, many [sic] so debilitate an apparently healthy man that no reaction may take place in opposition to septic invasion.
     The giving of a little solid food may have hastened the end slightly. It seems ill advised, but it in no way aided to determine the final result. The case was otherwise well handled, but nature was incompetent to accomplish the desired results.