The Condition of the President’s Heart Once More

     Since the President’s death we have had [500][501] a surfeit of theorizing regarding its cause. Now that the poisoned bullet has been eliminated we are presented with such fine-spun speculations as the possibility of injury to the solar plexus, a peculiar idiosyncrasy of the tissues preventing their healing, although their vitality was otherwise unimpaired; or the injury of the pancreas producing a general gangrene of the impaired tissues. It is hardly worth while [sic] to talk about the solar plexus as the cause of death. Deaths ascribed to injury of this structure follow immediately upon the wound and are not long drawn out, as in the President’s case. It is useless to attempt to discuss an idiosyncrasy of the tissues, when we did not know certainly that it existed at all, and the assumption that it did in this particular case is purely gratuitous. As for the pancreas, as far as we can discover from personal communication from the attending physicians, glycosuria or other symptom of pancreatic disease was never present.
     On May of last year a discussion was held before the College of Physicians of Philadelphia upon the effect of anesthesia in heart disease. It was shown then that in valvular disease of the heart without muscular degeneration an anesthetic has little or no injurious effect (Finney). On the other hand, there is reason to believe that in myocardial disease the anesthesia may cause a fatal termination either by producing sudden heart failure (Mayo) or by causing a sudden exacerbation of the morbid condition (Stengel), and attention was particularly called to the fact that in these cases the patient might continue in apparently good health for several days after the operation and then go into a state of sudden collapse exactly as in the case of the President.
     We do not believe that enough attention has been paid clinically to myocardial disease. Whatever the actual cause of death there is no doubt, however, that the President’s pulse was a just cause for anxiety from the very beginning of the case, and that the terminal manifestations of the case were collapse and heart failure. Whether these were produced by the anesthetic acting upon an already weakened heart or whether the condition of the myocardium was such that the shock of the injury was capable of causing it ultimately to become insufficient, we do not know, but at least we shall await with keen interest the histological report upon the condition of the heart muscle.