Arizona republican., 1901-09-26
The Medical News !" Dis-
 cusses McKinIey's Case
It Does Not Wholly Agree With the Finding of the Autopsy-Ipjury to Solar Plexus and Kidney Pos sibly Fatal Cause.

a surgical and pathological point of view. are discussed at length in this { weeks issue of the Medical News. The conclusion reached is that MT. McKin- | ley's death from the first was inevit- | able. but the exact cause of death is | not determined. After quoting from the official report of the autopsy, the | Medical News says:
 This indicates that death was due ; to the eangrenous process. but gave very little clue to the cause of the gangrcne.( Internal tissues injured by bullet wounds do not become gangren- GUS unless there is some circumstance in addition to the mere passage of :, bullet What this accessory factor could have been has occupied general attention during the week.
 The paper is skeptical as regards the 1, theory that the bullet was poisoned. | The question can be settled, it says. | only by a chemical and bacteriologicaI examination of the bullets remaining in the assassin's revolver. The reasons for regarding the hypothesis of a pol soned bullet as unlikely are given us follows:
 The poison could scarcely be a chem ical irritant. since a .32 caliber buller could not carry on it's outer surface enough of any chemical that is ordi- narily known even to medical men to produce such a fulminant death of tis- ] sues. It must be remembered scarcely 1 more than one-half the surface of tile bullet in a cartridge is exposed for coating with foreign material. and any such material would be removed in a great degree during the course of .lIe bullet through the revolver barrel, tue clothing and external tissues of the vic ] tim. There are popular traditions or Virulent poisors that act in minutest quantities. but medicine knows or none that would act this one is said ,oi have done.
 Was the poison used a bacterioiogi- cal agent and not chemical com pound? This is more possible. but there is no known culture of bacteria that will produce gangrene locally l without giving signs of general septic i condition. IL has been suggested that ] If the bullet were dipped previous to insertion in the revolver in putrid meat. yr.,S-ere would result wherever q came in contact with the tissues. This would not produce reaction Such d procedure might cause sepsis. but not gangrene, unless the vitality of the parts wounded had been very much e. ducei. Gangrene is not putrefaction, which Is an active biological process due to the presence of living germs. but , is death of the tissues involved" As to the theory that the pancreas was wounded. and that its secretions flowed into the track of the bullet and produced the gangrene. the News has this to say:
 'Agaipst this theory there are a good many objections. The first and most important one is that the track of the bullet seems to have been such that the | pancreas was not wounded. The bullet passed through the walls of the stom- ach near it's lower border. and so it's course would carry it, several inches below a normally situated pancreas. Besides this, supposing there was d ' : wound of that organ, pancreatic secre- tion might easily have reached tho, wound in the posterior wall of the stomach. but it is hard to understand how it could have found it's way to the anterior gastric wall. since the sur geons declare that the presidents stomach was found nearly half full of food at the time of the operation. A wound of the pancreas. supposing :. prolapse of that organ to account for such an accident, would have taken place near its tail, where the pancre- attic ducts are small, and there would be very limited discharge of it's secra- ton.
 ! With regard to the effect of the pan creatic juice, while it produces necro-s sis of fatty tissue. it does not produce gangrene. The characteristic appears ance of the peritoneum where a dis charge of pancreatic juice has taken place Is well known to those who havt. seen many autopses. and would have | been recognized at once by the experi-
 enced pathologists who made the au- topsy
 This much Is certain, however that
 wounds of the pancreas are by no
 means necessarily fatal. The escape of | pancreatic fluid produces characteris- , tic foei of fat necrosis, but does not produce the lowering of vital resist ance. which would lead to local death
 of all tissues with which it happened | to come in contact. number of re- ooveries from wounds and operations
 on the pancreas are reported and gan
 Srene Is not one of the complications or | sequelae usually anticipated"
 Two other theories as to the cause of death are discussed; first, injury of the
 solar plexus, and, second. Injury of the
 suprarenal capsule. As to the first the | News says: "The disturbance of the presidents pulse during the first few days after
 the operation was attributed by one of | the most prominent surgeons in charge l of the case to irritation of this extreme 1 ly sensitive organ. the abdominal brain as it has been not inaptly called. Un- fortunately our knowledge of the func- 1 tions of the various parts of the ner-
 vous system and especially of the ab- dominal sympathetic nervous system :s
 not sufficient to enable us to say with
 any degree of assurance what would be the effect of direct injury or serious ! irritation of this organ. The manipu-
 lations necessary for the suturing Of the wounds in the stomach had to be 1 carried out In the immediate neighbor- hood of this delicate organ This is