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 condi[t]ions,
meant a loss of vital[i]ty. 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 function[s].
It is well known to all students of
physiology that without iron in the circulation there can be no
oxygenation o[f] 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
respirat[i]on 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 su[f]fering 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 change[s]. President McKinley being a man
of sedentary habits, and g[e]neral 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 i[t] 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 b[ee]n 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 no[r] 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 save[d] him, because
virtually nothing was done that was indicated.
Thomas J. Pugh, M. D.