The report of the autopsy
in President McKinley’s case is admirably brief, clear and free
from technicalities. This is most fortunate, as it is desirable
on every account that the public should fully understand it. From
the medical standpoint it perhaps leaves some things to be desired.
For the pathologist it is not exhaustive, and some queries are bound
to arise; some speculation is sure to occur in an attempt fully
to interpret it.
The essential point in the case was
the occurrence of gangrene. This process had occurred not only in
and around the wounds in the stomach, but also along the track of
the penetrating bullet. Even the superficial wound made by the first
bullet was, according to one observer, not in a healthy condition,
but was also the seat of beginning gangrenous change. With all this
there was no formation of pus nor any evidence of a distinct septic
or pyemic infection. Contrary to what had been thought, two of the
viscera beside the stomach were found to have been wounded. One
of these, the kidney, was only slightly abraded, and its injury
does not seem to have been responsible in any way for the fatal
result. The other viscus involved was the pancreas, and this injury
was probably of far greater significance. In our review of the case
last week we spoke of a possible wound of the pancreas, and pointed
out the fatal consequence of such a wound.
In the light of the autopsy the determination
of the cause of such an unusual sequela as widely disseminated gangrene,
must be largely a matter of speculation. As such we do not intend
to enter fully into its discussion, and yet there are a few considerations
that suggest themselves in this connection.
The escape of the pancreatic fluid
and its constant bathing of the wounded parts are not to be ignored.
In disease of the pancreas, with formation of pus, gangrene has
been observed (Starr, Pepper’s System of Medicine, Vol. II).
Again, the occurrence of gangrene,
following upon wounds and some suppurative lesions, such as boils
and carbuncles, has been observed in diabetes. We have no evidence
that such a complication existed in the President’s case. The only
suggestion of it has come from newspaper reports and other unauthor-
 ized statements. Hence we
are not entitled to adopt such an interpretation, and must put it
The heart muscle was thin, a condition
in which there is always the suggestion of some muscular degeneration
in the case of a man almost 60 years of age. The state of the coronary
arteries, a thickening of which would induce beginning muscular
degeneration and dilatation, is not recorded. The state of the pulse
from the first was suggestive of shock, acting upon a somewhat weakened
From the autopsy it is evident that
the best directed surgical skill was doomed from the beginning to