Doctors Discuss Autopsy

GENERAL AGREEMENT THAT THE PRESIDENT’S SURGEONS
FOUGHT AGAINST INEVITABLE DEATH.

     The report of the autopsy performed on President McKinley was thoroughly discussed by many leading physicians in this city yesterday. To these men the autopsy revealed the fact that the physicians who attended the President were trying to conquer inevitable death, for in the tract of the bullet gangrene developed, and this gangrene involved the pancreas. In the opinion of some of these men the formation of gangrenous processes in the stomach following gunshot wounds is an unusual thing. These processes gave rise to no symptoms which would cause alarm or give warning that they were doing deadly work. Some thought the theory that the bullet was poisoned might prove to be well founded. Dr. George G. Van Schaick, visiting surgeon to the French Hospital, said:

     The injuries to the pancreas and kidney were such as it was practically impossible to recognize at the time of the operation. It is evident that the President’s general condition was rather below par, and that his system made little or no effort toward repairing processes. The President did well for a time, because the early operation prevented peritonitis and general sepsis. Death was due to the same lack of vital power which precluded repair and allowed the formation of gangrenous processes, together with the effusion of pancreatic juices within the neighboring parts.

POISONED BULLET THEORY.

     If there be any truth in the poisoned bullet theory, this would of course have a most important bearing on the case.
     There is very little, however, in the report of the autopsy to indicate that the bullet was poisoned, excepting the fact that the tract of the bullet seemed to have undergone a gangrenous transformation. The case altogether presents most puzzling features. Gangrene of the stomach is a very unusual thing. I have never known it to occur without the presence of some severe injury, excepting in cases of ulcers, in which there is a death of a certain area of the stomach tissues.
     It is impossible to tell how soon this gangrene began to develop. It probably began to develop very early. The wound of the pancreas and the wound of the kidney are also very important factors contributory to the fatal end. We don’t know much about wounds of the pancreas. The pancreas is a small organ, and it is one of the most important concerned in digestion. It gives out the pancreatic juice, which is important in intestinal digestion. Wounds of the pancreas are not necessarily fatal. There are no parts of the body that cannot be injured by a bullet and recover.

MORE DETAILS NEEDED.

     Dr. Edward J. Donlin, who is said to have had as large an experience in autopsical work as any physician or surgeon in this city, said:

     I am of the opinion that the report of the autopsy is incomplete, and that a fuller one will probably be issued in a few days. I do not incline to the theory that the bullet was poisoned. This theory is not well founded, to my mind. In fact, I can see nothing on which to base such a theory. I believe the bullet caused the gangrenous processes, but that the bullet carried no poisonous matter. It caused the gangrenous or sloughing condition primarily by its impact on live tissues. Nature, in her endeavor to repair the diseased or injured tissues, caused a sloughing, which presented that appearance of the body as shown by the autopsy. This appearance of the body in no sense resulted from any poisonous matter on the bullet, but was simply a result of the passage of the bullet into the body.

THE PROCESS OF SLOUGHING.

     Sloughing is a process of throwing off dead tissue. When a bullet enters the body it kills all tissues which it touches, and within an area of about a quarter of an inch of the tract of the bullet there is caused a hemorrhage. Nature in trying to repair such injury to tissues first causes a sloughing or disintegration of the injured or diseased parts in its efforts to bring about a healing process. If the vitality of the patient is at par, nature will heal the wound kindly and quickly, but if the patient’s system is impaired from any cause, nature is slow to bring about a union of healthy tissues, and gangrene is liable to occur, as it did evidently occur in the President’s case.
     The report says that both holes were found to be perfectly closed by the stitches, but the tissues around each hole had become gangrenous. I interpret this to mean that the sutures closed those holes in the stomach, but complete union did not take place, as evidenced by the gangrenous condition around those holes. This condition about the area of the holes made by the bullet leads me to think that President McKinley was in impaired health at the time of the shooting; but there is no doubt, judged from the report of the autopsy as printed, that everything was done for the President that could possibly have been done, and that his death was only a question of time.

HEART WALL WEAK.

     The report of the autopsy plainly shows that the wall of the heart was thin and weak, and could not bear for a long time a severe strain of sickness. The only organs shown by the report to have been injured are the stomach and the upper end of one of the kidneys. The pancreas showed evidences of gangrene, but no signs, according to the report, of having been struck by a bullet. The pancreas is a small organ back of the stomach, and its purpose is the emulsification of fats. As a rule, injuries to the pancreas are fatal.
     The gangrenous condition involving the pancreas impaired its functions, but I do not think that symptoms of such impairment could have been determined. Few cases of diseased pancreas are recognized in life.
     If the bullet had been poisoned the poison would have manifested itself, I think, early in the case. The injury to the kidney was not fatal.