The Savannah morning news., 1901-09-22
NOT OPEN TO CRITICISM.
Philadelphia Medical Jour,.r
View of Presidents Case.


From the Philadelphia Record
The Philadelphia Medical Journal -
its issue of this week, comments =.
some length on the death of Presidan.
Mckinley and the surgical aspects 90
the case. On the latter point it save,
"All that human skill, knowled,.
promptness, daring and an overrnas+ou
ing sense of duty could accomnlisb
were devoted to the case of the Pr,
ident. There is nothing to retrac+
explain or to apologize for in all +ho.
has been said or done by the bravo 49,
devoted staff who gave their host
knowledge and skill to the SAVING =,
that valuable life. An unforeseen co,,
tingency such as may happen in am,
surgical case; an unavoidable coy
tutional defect, such as may annea,.
In any man we'll passed middle iifa
these We're the undoing of the he's
planned and best executed opera flo,
of which the case permitted. FL
the technical standpoint we HELM
that the case is not open to adverse
criticism.
THE gravity of the wound, arising
from the important and vital strnot
ures in it's close proximity, was rac
ognized by abdominal surgeons ana
1t was the general belief that forty
eight to seventy-two hours must elansa
before a reasonable hope for recover,
could be entertained. 1t was. there.
fore, source of intense satisfaction
not only to the medical attendants
but to the whole medical profession
that this limit was reached with ali
the symptomS-save one-pointing To-
ward rapid and uncomplicated recov.
cry. The rapidity of the hearts action
was not accounted for.
THE steady improvement in every
other respect justified the hopefnI
view of the case that was taken nv
those in charge. The fact that, in sniff
of wound of the pancreas, the patient
lived for a week, is one of the most
noteworthy in the case The wound
of the kidney was so light as to he
insignificant. The fatel collapse which
dashed expectations to the ground So
abruptly and so irretrievably could
meet with no adequate explanation.
Late sepsis, heart failure, homorrhage
indiscretion in feeding-all were sug
gested, but none was satisfactory to
those who by long experience knew
what to expect and how to recognize
the nature of the complication when
1t came.
No Mistake Made.
Nov that the track of the wound
has been laid bare an exclamation of
surprise has swept over the land. Can
creme, the result of intense devitaliza-
ton of tissues, or, possibly of the irri-
tating action of some unrecognized
germ or virus, had destroyed the pa
tient. The unexpected had happened
The proper course had been pursued,
the dreaded complications that were
common had been averted, and the
medical and surgical men who had la
bored so Loyalty and conscientiously in
behalf of their patient had the salts
faction of knowing that no mistake had
been made. The unusual sequel, against
which no precautions could have been
taken, had only revealed itself in its
latent stage by rapidity of the pulse a
symptom which might have been pure
ly functional, and one common to many
conditions. We as medical men may
point with satisfaction to the surgical
records of the two great national pa
tients-President Garfield and Presi-
dent Mckinley-as an exemplification
of the vast strides that have been made
In the technique of surgery during the
last two decades. iarll9
I'm a man of the late lamented Pres
ident's age there are number of fac
tors to be considered by way of ac-
counting for the heart failure, or weak
ness, which was a source of continued
anxiety to his attending physicians.
There were, 1t appears, no signs indi-
eating the lesion of the pancreas or
the gangrene which followed the
course of the assassin's bullet.
Bad Effects of Tobacco.
1.-THE blood counts which were made
revealed nothing, and the important
index in the lack of correlation be-
tween the pulse and the temperature
was not regarded seriously, owing to
the fact that the President was known
to have a most erratic pulse. In a
man of Mr.. McKinley's obese frame
and full, sedentary habit, fatty degen-
GRAFTON of the organ was to be expect
ed. This would naturally have fol-
lowed the hypertrophy succeeding his
active army life.
Granting the absence of organic val
Vular disease, as medical men we are
interested in specializing as to what
might have produced the asthenic con-
dition. In addition to the cause Of
the original hypertrophy, present, the
arduous life of the Presidents younger
manhood, he is said to have been an
habitual user of tobacco. The effect
OF tobacco is to cause nervous over
action. which will in time lead to
hypertrophic condition of the heart,
owing to the extra work it throws on
the organ. This hypertrophy in time
naturally underwent changes of fatty
inf1ltration and degeneration and con-
sequently dilatation. These may be
accounted for by the increased obesity
of the distinguished patient and the
condition of arterioselerosis, to be
expected in man of his years, and
affecting to some extent the coronary
arteries.
Long Continued Anesthesia.
This effect of the long continued,
general anesthesia is not to be over
looked. 1t has been shown quite con-
clusively that blood inspissation,
condition of anhydremia, is present
after etherization. The hemoglobin
is reduced absolutely and a general
hemolysis of varying degrees occurs.
These conditions would throw in
creased work on the already weakened
muscular structure, oxygenation re-
curing so much more effort. If we
add to this the effect of the shock,
and the toxemia indicated by the path
illogical processes within the abdominal
cavity it is easy to understand how
tired nature was beaten in the heroic
battle and how one of Gods noblemen
was lost to a sorrowing people,"
---s-e-
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