Criticism of the Medical Attendants of President McKinley

     As an aftermath to the lamented death of President McKinley, there have appeared, unfortunately but perhaps inevitably, in various journals and from various sources considerable criticism on the conduct of the case on the part of the attending physicians, which has not been confined to the lay press that is supposed to be more or less uninstructed and therefore not quite so capable of judiciously criticising, but also is apparent in some of the medical journals.
     The chief features that have met with criticism are three; and only these three are really worthy of notice. These are, first, that a physician presumedly more thoroughly familiar with the cardiac conditions than any attendant upon President McKinley should have been called in consultation from the beginning of the case. It seems to be forgotten by these critics that in addition to Drs. Mann, McBurney, Wasdin and others, Dr. Rixey, a man who has not devoted himself exclusively to surgery, and who was probably more familiar with the physical condition of the President than any other physician, was in attendance, and we believe he was not only thoroughly competent to manage the President’s case, but that he did everything that possibly could have been done. Surely no treatment that is familiar to us could have altered the fatal result; and we are not aware of any medicine that could have been employed which was better than that given.
     The second point is that food, and particularly solid food, should not have been administered by mouth as early as it was. Upon this point there is no doubt that a certain amount of discussion is justifiable. The medical profession has not reached any degree of unity regarding the proper time to begin feeding after operations upon the stomach. We can conceive that the feeding may have been injurious in two ways: either by hemorrhage from or by perforation through the stomach wall at the site of the injury. As a matter of fact neither of these occurred, and there is no reason to believe from the results of the autopsy that the feeding was harmful in any way. The physicians had the choice of two risks, either of allowing the patient to become too weak from lack of nourishment or of injuring the wall of the stomach by the administration of food. They choose the latter, and who shall say unwisely?
     Finally, there is much comment upon the very favorable character of the bulletins issued during the first days after the wounding. At that time the patient was doing well undoubtedly. There were no unfavorable symptoms, excepting, perhaps, the undue rapidity of the heart’s action. The physicians believed that recovery was possible, and believing this, it was their duty to the public to state the case favorably. Perhaps our knowledge that gun shot wounds of the stomach are exceedingly fatal in elderly persons might have caused them to have been a little more cautious, but that is all.
     It is not too much to say that adverse criticism is premature before the appearance of the final report, and such adverse criticism from a medical journal is especially indelicate and contrary to the best recognized standards. One of our contemporaries, in its haste to record its adverse judgment, has been guilty of a remarkable solecism. Thus, the Medical Record, in its criticism of the case, publishes two sentences, one immediately following the other, which we reproduce in parallel columns for the sake of a more graphic effect:

     It will puzzle the ignorant to understand how any favorable result whatever could be expected in the case of an injury which every one knows is uniformly fatal. The truth is that such cases are not uniformly fatal. Alexis St. Martin recovered from a severe gastric wound more than three quarters of a century ago, and Dr. William Beaumont made the case classical.