The age-herald., 1901-10-06
MIR. M'kiNLEYs SURGEONS.
High English Authority Shows Treat
 ment Was Without Fault.

From the London Lancet.
 In considering the reason or reasons of the fatal issue of the case we may leave out of consideration the bullet itself; where it was lodged it could do no harm. and time and the patients strength would have been wasted in searching for it. The injury to the kidney aiso appears to have been of but little moment and need not be further considered. The dam age to the pancreas was probably unim- portant, though 1t has been suggested that the escape of pancreastic juice may have caused or assisted in causing the .gangrene" of the bullet track described in the account of thenecropsy. This is hardly likely, as the "gangrene" was found also in the wounds of the stomach wall. The peritoneum and the wounds of the stomach remain to be considered. There seems to be no evidence that at any time was there any peritonitis, and this was confirmed by the absence of the leucocytosis, the blood having been ex- amined several times during the patients life It does not appear from the account of the necropsy that any meteorological examination was made of the peritoneal wall or fluid Still, we shall not be prob ably wrong in assuming that no perito- nitis was present. The empty condition of the st omach prevented eXtravasatton occurring, at least to any great extent. The wounds in the stomach wall were sutured with a minimum of delay, and apparently no leaking occurred.
 How shall we account for the gan grene' of the margins of the wound? There is no need to suspect any poisoned bullet, and the suppostion that such bullet was used was probably due to the fervid imagination of reporter, not un- willing to pile horror upon horror. It is ct vAIxy wounds of the stomach wall that but lit tie att empt at repair Is made. This is to be attributed in part to the local action of the gastric juice and in part to the patients general state. The pathological condition has been met with before and will doubtlessly often occur again. Sur gerry does all of which it Is at present capable. The wound Is carefully sutured and the peritoneal cavity is asceptic, and yet healing does not occur. The bruised gastric wall has not sufficient vitality to recover and it makes no effort.
 The favorable prognosis which was put | forth at first was so far justified that in some cases recovery might have followed, but the issue hardly comes as a surprise. 1 The injuries were terrible. the patient was no longer young, and the circum-
 stances were such as to produce, even | in man of iron courage, the maximum l of shock If we may venture to criticiSe
 any portion of the treatment we feel in 1 clined to suggest that the feeding by the | mouth was somewhat in excess of that | which is usually considered advisable
 But while we say this we know that to
 the brilliant surgeons and experienced
 physicians around President Mckinley s | bed there may have been indication for I the bolder treatment impossible to be dis regarded. In short. on a careful review | of the whole case, we feel justified in
 saying that surgery did it's best the sad
 result is to be ascribed to the lack in vi- tality of the tissues themselves.