The Washington times., 1901-09-23
Mr.. McKinIey's Surgeons.

Mr. McKinIey's Surgeons.
In contradistinction from former arti-
cles on the subject of the surgical his
tory of the great case at Buffalo, which
have appeared in medical journals since
the death OF Mr.. Mckinley, and which
have seemed to laymen to be rather
whitewashy in character. the New
York Medical Record in it's current is
sue comes out boldly and criticises the
physicians and surgeons in attendance
with considerable severity The editor
of the Medical Record" DR.. Shrady,
admits that his professional brethren
did what they thought best in the cir
cumstances. but thinks that neither
that fact nor the other, that, whatever
might have been done, the wounds were
necessarily fatal, cannot alter the truth
that they were greatly in error in their
diagnosis, and in fault in not providing
against dangers which they assumed to
be non-existent, but which proved to
be otherwise and fatally so. Discussing
the first operation at the Exposition
grounds. Dr. Shrady says:
''The operation of suturing the stomach wounds
timely proper and, so far as it went bril-
liant. Medical men the world proud
to near that it had been done 50 promptly and 50
we'll upon a person OF such Importance
But now. in the light of the autopsy, we
know that the operation, carefully conducted as
it was, was necessarily an incomplete one.
This Is speaking of the procedure from j
strictly surgical standpoint irrespective of the
ultimate doom OF the patient in any event Time
precious. and prolonged search for the ball
was impossible; consequently the condition and
,f t.pu md haran rba II. nntli
not be positively ascertained al the time. The
surgeons satisfied themselves. therefore. that it
safe TO leave this terminal wound TO itself
and close up the abdomen
They used their best Judgment under trying
conditions; but. unfortunately, that judgment
was in error
''The good condition of the wound behind the
stomach of which al the surgeons were so pro-
nouncediy confident, illusion and a
What was considered TO be most insignificant
factor, became the most important of all. In
stead of the terminal track of the bullet being
healed and the ball eneysted il found. at
the autopsy, TO be gangrenous throughout. Thus
most startling error of diagnosis was Haunt
ingly accentuated.
THE practical surgeon very properly asks him
self why the condition and the direction Of the
track behind the stomach was not discovered az
the time the parts were exposed during the op-
Grafton?
That the problem was not solved then and
there was certainly not due to any want of fore
thought the part OF the operator, whose skill
in his line no one can question The only answer
must be that such a thorough examination of
the parts impossible at the time
-'Still it seems hard to explain Why all the
gentlemen on the case were so satisfied with
the real nature Of wound that they, obvious
ly knew nothing about
The Medical Record critique pro-
ceeds to call attention to the apparent
ly strange course of the surgeons, in
not attempting to locate the bullet by
the aid of the Roentgen ray appara tus
which they had at hand, and suggests
that the reason may have been that it
seemed safer to guess than to be sure. !"
And DR.. Shrady asks: What excuse
must be offered to the public for the
the dead body?" In conclusion, he says:
"All these matters may. however, be properly
explained when the fuller account OF the post
morteIn is given to the medical and lay public
'-Many different theories have been offered by
the medical attendants concerning the cause Of
gangrene Of the bullet track. BY the con-
dition is charged to pioS0ned bullet. by Others
to the leakage Of panereatie juice into the bull
let sinus and by still others TO mere lack of
recuperative energy in the tissues involved.
"On these points however, the professor is
willing 20 suspend Judgment. pending the com
pletion and publication OF the official reports Of
the post-u0rtcrn examiners.
'-yiewing the strictly surgical aspects Of the
IN the light of the aGtopsical demonstra-
tions certain points of treatment might naturally
suggest themselves.
Everyone knows that such an injury as exist
ed in the Presidents case is uniformly fatal.
The most favorable result that could have
been expected the healing of the wound and
the possible establishment of a fstu!a-in this
case permanent, narrow duct opening the
surface Of the body
nj he. iufi bett ter
as a tentative measure than accidentally leav-
ing a leaking kidney or pancreas in closed
cavity to work such mischief manifested
in the gangrepous condition Of the surrounding
tissues in the in question.
Allowing that the bullet had actually lodged
in the muscles Of the back, also that the muscle
within easy reach. 1t would be following
a good surgical rule to establish drainage by
the most direct route posteri0rily.
This course, however, could not be followed,
as the bullet account OF the unfortunate con-
ditions already noted. was not accurately located
''Under tine circumstances, therefore, and tax
ing everything into consideration, it Is comfort
ing TO note that all done for the distn-
suished patient that possible. In fact, as
Uas repeatedly stated by the operator, the case
was 4 fatal from the start
''In thus remarking upon the public aspect
Of the case 1t IS only for the purpose of getting
at the truth and learning. perhaps, useful les
son. In the spirit afford TO view
the strictly professional side To err is human,
but wisdom comes from experience.
"It is safe TO say that under like circumstance,
| in future the gentlemen concerned would act
| somewhat differently.
''we sincerely trust that they, at least. would
| not then be asked TO explain why they allowed
lost ball to be buried with the victims body. .
Perhaps, as the editor of the -Medi-
| cal Record observes, the official re-
| port of the autopsy may shed light upon
| what now seems very like a mystery.
As will be seen from the language of
| the above excerpts there is every indi-
| cation of a spirited professional con-
troversy to come. That will interest
| the general public to the extent that IT
may serve to show whether or not the
1 nj, Cd af lra