The Autopsy

     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- [461][462] ized statements. Hence we are not entitled to adopt such an interpretation, and must put it aside.
     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 heart.
     From the autopsy it is evident that the best directed surgical skill was doomed from the beginning to be frustrated.