The daily morning journal and courier., 1901-09-20
PHYSICIANS NOT BLAMED.
REVIEW OF PRES. M'KINLEY,S
 CASE BY THE MEDICAL NEVIS,
Drs. Mann and Mynter Comm n ded for
 Their Prompt tOperation-Usual Causes of Death After Such an Injury and Operation Escaped, Removed or Pre- vsnted-Death Due to Complication So Rare That it Could Not Reasonably Have Been Anticipated and Could Not
Iiaue Been Averted.

Haue Been Averted.
 New York, Sept. 19.--The Medica News in its issue of September 21 will
 print review of President Mckinley $
 case from medical point of view. The
 article recites the circumstances of the
 shooting and reprints the official report
 of the autopsy and certain unofficial
 statements credited by the press to the
 doctors in attendance. It then takes
 up the subject of the gangrenous con- dition of the wound, and in this connec- | ton says:
 The gangrene, extensive as it was, seems to us not so different from oth- CTS observed under analogous circum- stances as to require the assumption | of exceptional causes for its explana- tion. Necrosis of tissue in a thinner or thicker cylinder along the track of a
 bullet is thought to be the rule, and or dinarily it is easily taken care of by liquefaction and absorption. And ne- crosis, even of a considerable extent, in feeble patients about a sutured wound,
 
 and is explained by interference with the local circulation either by tension or by the spread of coagulation within the blood vessels.
 The spread of the process in a pa tient of low recuperative power would not be so very exceptional or surpris- ing. Was the present such patient? Apparently he was. According to Dr. Wasdin, when the incision was reopen ed toward the end of the fifth day no effort was required to open it through out its entire length, although only the track of the bullet was affected. That expression would hardly have been used unless he had intended to indicate that the amount of repair usual after that lapse of time had not taken place. Then, the president was fifty-eight years of age, had led a sedentary, laborious and anxious life, and had complexion and appearance which for some years had been commented upon as indicative of impaired vitality.
 ''It is evident that the surgeons, not ably Drs. Mann and Mynter, with whom the first decision lay, acted with com mendable promptitude and courage in undertaking the operation, and showed excellent judgment in it's course and skill in it's execution. They did all that could properly have been done and nothing that should have been left un- done. The usual causes of death after such injury and operation were escaped or removed or prevented, and their pa- tient succumbed to complication which is so rare that 1t could not req have been anticipated and could not have been averted. The pres ident died because he could not carry on the processes of repair and because the effort to do so was more than the of the tissues involved could support. This, of course, excluded the possible presence of poison brought by the bullet or of destructive action by the pancreatic juices. If either of those was factor 1t needs only to substitute 1t in the statements of the assumed de- fective vitality of the patient. What ever cause acted, 1t was unrecognizable at the operation and uncomfortable then or subsequently,.
 "There has been some criticism of the confident assurances of recovery made by those in attendance after the fifth day. To us the progress of the case up to that time appears fully to have justified those assurances and the pub- lie anxiety to have required them"
 The review of the case closes with the following reference to the doctors: They did their work successfully and their behavior was digni- fed. restrained and worthy of the best | traditions of the profession, and they nad the misfortune, when success seem- ed to have been secured, of seeing it | 1verthrown by a complication which | could not have been foreseen nor avoid | sd They deserve our admiration and | sympathy, not our criticism