Evening star., 1901-09-19
Cause of4Death, Toxeimia.

ing on the result. Other causes. which are
described in detail in the accompanying ar
ticle, sapped the life Of the President.
Cause of0Death, Toxeimia.
DR.. Shrady says toxeimia, which Is as
signed as the immediate cause Of President
McKinley's death, Is a distinctly chemical
process due to bthe introduction into the
blood Of toxine poison, derived from gan
grenous tissues. Death was not due to
blood poisoningf ras 1t, is generally under
stood. Blood poisoning is a archaeological
process as distinguished from toxeim1a,
but is also accompanied with high tempera-
ture and accelerated pulse-symptoms
which excited the anxiety of the Presi-
dents physicians from the first.
The medical profession will deeply deplore
any public controversy over the strictly
medical aspects of Mr., McKinley's case. OF
course, every one Is deeply interested In the
actual cause ofodeath, but 1t Is always
very undesirable, thing for any one party in
a professional consultation to speak inde-
pendently to the public. AS 1T is each gen
tleman In the present instance seems called
upon to defend his reputation. There is
really no necessity for this, as all OF the
gentlemen who were called to attend the
President had gained an enviabie position
in their chosen profession years before, and
some even before Mr.. Mckinley himself
came prominently before the public The
fact that they should place themselves on
the defensive at all would seem to indicate
sary.
Whenever large number Of consultants
are concerned in a celebrated case there is
always occasion for honest differences of
opinion. Usually, as in this instance, these
differences are on comparatively trivial
points. No one doubts that everything
was done to save the life of President Nc
Kinley that experience could suggest or
skill execute. The operation by DR.. Mann.
assisted by DR.. Mynter and several other
physicians Of established reputation, was
according to the highest rules Of advanced
surgery and was promptly and brilliantly
ultimate result Is unfortunately true in
view of the revelations Of the autopsy.
There Is certainly no fault to be found
with what was done in the crisis following
the shooting. On the contrary, the con-
duct Of the physicians shows that they had
the true surgical courage Of facing fearful
odds in dreadful and most responsible
emergency. Whatever else might have
been done. the ultimate result. based upon
the condition Of the President on Friday
last, would have been inevitably fatal.
Personally, was impressed from the first
that the President could not recover, and
as the case progressed / am free to say
that my surprise increased with the ex-
treme optimism Of some of the surgeons
In attendance.
Fatality of Stomach Wounds.
Gunshot wounds Of the stomach are al
most always fatal, especially when the bull
let traverses the entire area Of the abdomi-
nal cavity and penetrates both walls OF the
organ. This is explained by the fact that
such wound is in nearly every case COM
plicated by injuries to other organs along
the track Of the missile. In fact every sur
geon who has had experience In the treat
ment of such wounds is deeply concerned
as to the condition of the bullet track be-
yond the stomach. voiced such an opin-
Ion in the Medical Record of last week and
in a statement to the Herald emphasized
the great desirability Of being sure Of this
condition OF the track of the ball. At that
time / said!
TT is to be hoped that the bullet course
behind and beyond the stomach is in
safely closed and asceptic condition. This
would seemingly be the only absolute guar
antee against any future trouble from Sec
ondary suppurating processes"
1t Is unfortunate that the track of the
bullet could not be traced beyond the pos
terror wall OF the stomach when the parts
were exposed at the time OF the operation
by Dr. Mann There was no chance for the
DETECTION OF the missile unless it struck
rib or some portion of the spinal column,
and then it might have been DETECTED in
any direction. This was shown in the case
of President Garfield when the bullet
striking the eleventh rib, was supposed to
have taken a downward course and lodged
in the right groan when In reality 1t took
q rectangular course penetrating the yerte-
bral column andssstfangely enough, lodging
behind the panoreaE and wounding the
splenic artery.
In the case Of President Mckinley the cir
cumstances indicate that there was nothing
to check the progress of the bullet the In
tervening organs from the point of entrance
to the muscles 6f the back, in which the
ball presumably lodged, being composed OF
soft tissues y
To shorten Period of Shock.
Knowing Dr. Manns skill as a surgeon.
I am prepared to believe that 1t was impos-
sibie at the time of the operation more
thoroughly to examine the posterior region
of the stomach. He certainly appreciated
the necessity for such examination, and did
all he dared do to assure himself on that
point. Every surgeon of experience in abb
dominal operations knows how important 1t
IL to shorten the period of shock in such
cases and close up the wound as speedily
as possible. Dr. Mann's explorations car
ried him into very dangerous region. ana
he could not probe around indiscriminately
without running the risk OF inf1ictinp more
serious damage than that which had been
done by the bullet
The precise stages of the operation cam
not be positively known except by the
operator and his assistants There are al