The Death of President McKinley

     For the third time in the history of our free country the Chief Executive has died at the hands of an assassin. The remarkable hopefulness and buoyancy of the American people was reflected by the official bulletins, which were in the face of statistics extremely optimistic. If those in attendance are to be blamed at all it should be for this extreme optimism.
     The most reliable statistics give a very high rate of mortality. We recognize the value of hopefulness and would encourage it, but in this case as in many others the hope is not justified, and the disappointment seems intensified. A case came under our observation a year or so ago. A young man had been shot, the ball passing through the stomach. The patient was seen in a neighboring town twenty-four hours after the injury. He had reacted [sic] and his condition was so favorable that operation was deferred. The patient recovered [141][142] without any untoward symptoms. Such cases occasionally occur and are a stimulus to our hopefulness.
     The question of removing the ball seems to occupy the minds of many. Very frequently the efforts at the removal of a ball cause more damage than the presence of the missile if left alone. The great damage is done by the ball in motion and it continues a menace by pressure and by carrying infection.
     It has been suggested that the wound made by the ball entering the posterior abdominal wall should have been drained. This was not feasible, as the ball could not be located. The condition of gangrene found at post-mortem was surprising, and the cause of this local death is not at all clear.
     It is not known positively whether the President was a diabetic or not. Many reasons have been put forward explaining the cause of the gangrene; among them, injury to the pancreas, but the operator and the pathologist neither mentioned such a wound. Injury to the solar plexus has been urged—and the wound of the kidney with its adrenal gland has been discussed.
     Is it not possible to explain the local death in the stomach wall as in other tissues? Could not the effects of the laceration and contusion have been more extensive than was apparent to the eye? And again, how much of this gangrene was due to post mortem changes. A full report of the case is promised in the near future and we hope some of those questions will be cleared up.
     Looking at the case as a whole we feel assured that the surgeons did their full duty and their great mistake was their extreme hopefulness, unfortunate, especially for the profession—since it exposes, in the most glaring manner, our weakness.