The Official Report of President McKinley’s Case

     The final report by the medical staff attending the late President leaves no hiatus. A study of the brief but very clear notes on all the details of the case from the beginning to the end gives a perfect retrospect, and no one can find grounds upon which to base ex post facto objections. A clinical retrospect may often furnish most convincing evidence of errors in judgment in the conduct of a case, but with the surgeons’ and pathologists’ reports before us we are unable to see how the President could have been more scientifically treated.
     From the moment he was taken in charge by the ambulance surgeon until the fatal termination one week later the best surgical judgment was shown. That the sanguine anticipations of the attending staff were not justified is now self-evident, but in view of the favorable clinical notes, with the one exception of the pulse rate, which continued until the hour of the sudden change for the worse, a favorable prognosis was justified. No time was lost in beginning the operation. The assassin’s bullet was fired at 4.07 in the afternoon. At 4.18 the distinguished patient was placed upon the operating table and undressed. The President’s wounds were inspected by Dr. Mynter at 4.45 who at once recognized the urgent necessity for operation, and upon the arrival of Dr. Mann, who was chosen to do the operation, the administration of the anesthetic was begun. The operation was commenced at 5.29 and the seats of injury in the stomach walls were expeditiously located. With the exception of the deficient illumination and the difficulties incident to the lack of abdominal retractors, the operation was conducted without complications and with the greatest celerity and precision. The only point which furnished ground for possible criticism was the closure of the wound without drainage. Without question the great majority of surgeons are in full accord with the course pursued by Dr. Mann, for, as stated by him at the time of the operation, and concurred in by his associates with one exception, drainage appeared to be unnecessary. Again, the results of the autopsy would appear to justify this decision, for notwithstanding there were a few spoonfuls of greenish, gray, thick fluid beneath the mesocolon, the most efficient drain would probably not have reached this spot. In the final criticism of the operation we, therefore, are in entire concurrence with the great majority of European and American surgeons in giving to Dr. Mann and his associates unquestioned credit for the skilful [sic] way in which the operation was conducted. This endorsement is fully justified by the autopsy notes, for they reveal nothing which in any way casts reflection upon the surgical treatment of the case.
     As to the conduct of the autopsy, criticism might be offered were it not that the pathologists were forced to curtail a fully detailed examination. The failure to locate the bullet was of little moment, but a careful microscopic examination of all organs and involved tissues might have thrown light upon some of the questions which now must remain dark. The notes bearing upon the macroscopic changes in the pancreas appear to be of vital importance. While our knowledge of surgical diseases and injuries to the pancreas is very deficient, we nevertheless know that in certain acute infections there are symptoms of great depression characterized by rapidity of the pulse and rapidly increasing lethal symptoms. The slight traumatism of the kidney was of little importance in the case. It would appear possible that the impaired condition of the kidneys, as demonstrated by the urinary examination and pathological report, taken in conjunction with a greatly weakened heart, rendered the President especially vulnerable to a terminal toxemia. Such toxemias are usually of bacterial origin, but as the bacteriological report fails to demonstrate any serious infection we are forced to fall back upon the theory that the toxic products incident to the necrosis of the pancreas and surrounding tissues through their absorption, may have been sufficient to have contributed to the fatal termination.
     This, however, is a matter of speculation, for we have no well defined basis for this theory. That the final symptoms were not due to the usual complications of abdominal section is certain. It is to [663][664] be hoped that carefully conducted experiments bearing upon the surgical lesions of the pancreas will be carried out.