What Caused the Death of President McKinley?

To the Editor of The Post,
     Bryan, Texas, September 25.—Was it wholly to the nature of the wound? Might death have been prevented under a different line of treatment?
     It may appear somewhat rash for a comparatively obscure physician at this distance to call in question the wisdom of the distinguished physicians who attended President McKinley; but a graduated physician, having some valuable experience to his credit, having, moreover, a brain to think with, and a habit of doing some thinking on his own account, may be allowed, without apologies to anybody, to draw some deductions from this celebrated case as reported in the newspapers.
     From time to time, during the fateful week, bulletins were issued reporting the temperature, respiration and pulse beat. While the temperature record was never above 102.5 the respiration was sometimes as high as thirty and the pulse beat as high as 144. There was at all times, too, great divergence between the degree of temperature registered and the rate of the pulse. An increase of ten pulse beats usually indicates a rise of one degree of temperature. A pulse beat of 128-144 should therefore indicate a temperature of 103.5 to 105.4. The president’s temperature was never above 102.5; his pulse beat should never have been above 112; but on the very days when it was repeatedly said “The president is responding well to medication; his condition is satisfactory; the temperature is steady; not an unfavorable symptom,” the temperature was 102, while the pulse beat sounded a steady alarm at 130 to 144 to the minute! On the 10th, the very day that it was so confidently asserted “the president is out of danger,” his temperature had gone down to 100.8 while his pulse beat had ran up to 144! What meant this great divergence or lack of correspondence between the temperature and the pulse rate? What meant the rapid breathing—from six to twelve respirations per minute above normal? The lowering of temperature without a corresponding decrease in the pulse rate and respiration is always an unfavorable symptom. Accompanied, on the other hand, by an increase of pulse rate and respiration, it forebodes danger. The lowering temperature, under such accompanying conditions, meant a loss of vitality. The increase of pulse beats and respiratory efforts simply meant a frantic effort of nature to repair the loss. The loss of vitality indicated a deficiency of iron, the oxygen carrier of the circulation, to produce the combustion necessary to support the vital functions.
     It is well known to all students of physiology that without iron in the circulation there can be no oxygenation of the tissue and non-oxygenized tissue must die. The red disks of the blood carry the oxygen to the farthest extremities of the body, purify, sweeten and save the tissues. Iron is necessary to the manufacture of the red disks.
     It is said that at every respiration twenty thousand (20,000) of these red disks are destroyed. Normal respiration then destroys 360,000 per minute. Think of the enormous destruction of these oxygen carriers going on in the case of a person breathing from twenty-four to thirty times per minute!
     Such was the case of our great and good and greatly lamented president. The rapid breathing and rapid pulsation was a call for oxygen. It is true that in the act of breathing oxygen was taken into the lungs to furnish aeration for the blood in the lungs. Yes, but the red disks were not there to appropriate it and carry it to the tissues.
     It is also true that oxygen was administered on the last day, but it was not in a form in which it could be appropriated and carried by the circulation to the suffering tissues. Had iron been given in the form of foods known to be rich in iron and by medication artificial oxygenation would have been unnecessary. If the tract of the wound was gangrenous, that is further proof that the tissues needed oxygen, for it is well known that oxygen prevents gangrene or pathological changes. President McKinley being a man of sedentary habits, and general anaemic condition, needed the iron to build him up to a health level. The records do not show that he received such food or such medication. Bovinine is an ideal food, because it contains all the blood corpuscles in their original state and the stomach readily absorbs it without the necessity of action of the intestines, in a manner approximating the transfusion of blood. This could have been taken through the stomach from the first, because it is so readily absorbed by the irritable stomach that it can be retained with benefit even when the stomach rejects water. Even if it had come within the wounded tract it wound have done no harm, in fact, being antiseptic and aseptic. Bovinine is a very good dressing for wounds.
     Digitalis and strychnia were given to support the heart, but this would not have been necessary if the cause of the heart’s weakness had been recognized and removed. Veratrum veride would have been far better in any case, because it would have had a good effect in reducing the frequency and increasing the strength of the heart’s action and circulation. A few doses will reduce the pulse, even when greatly accelerated, to the healthy standard at which it can be easily retained until the cause subsides.
     Now, briefly to recapitulate: There must be a sufficient amount of oxygen in the system to produce combustion for the repair and purification of the tissues. As an antiseptic and an aseptic oxygen stands at the head of the list. Therefore I hold that had President McKinley’s physicians rightly divined the significance of his low temperature compared to his rapid heart beat and quickened respiration and had given him iron in suitable form and quantity there would have been no unnatural divergence of temperature and pulse beat, no unnatural breathing. All these unnatural and unfavorable symptoms called for eight long days for oxygen. The oxygen given to him went no further than the lungs. Iron would have prepared his blood for receiving, appropriating and carrying the oxygen to the tissues. Had iron been given him the air cells of the blood would have been laden with this precious, indispensable element and it would have been carried to the wounded tissues and would there have performed its God-given work.
     In the face of these facts, based upon physiological data that can not be questioned, is it not wonderful that President McKinley lived as long as he did? And are not my deductions reasonable that he died simply for the want of a properly oxygenated tissue, and that this want could have been supplied by proper nourishment and medication, and his life, possibly, nay probably, saved? To no man nor set of men is it given to know the issues of life and death; but, while it may be true that anything that could have been done might not have saved him, I do not concur in the opinion that nothing that could have been done would have saved him. As it was, nothing that was done saved him, because virtually nothing was done that was indicated.

Thomas J. Pugh, M. D.