The age-herald., 1901-10-18
Cause of Gangrene Remains a Mystery to the AtteRd-
 ing Physicians
DETAILED STORY OF CASE
The Presidents Heart Was Diseased, Which Accounts for Its Failure to Respond to stimuIants,
 and His Rapid Pulse.

New York. October 1.-The New York Medical Journal for October 19 will con tain the full official report of the sur geons who attended the late President Mckinley in Buffalo
 The report lays emphasis on the com plete harmony that existed among the physicians. It says of the operation that the utmost care was used to prevent in- lection of the abdominal cavity and of the wound. The wounds in the stomach were sutured with silk, using double rows of stitches so arranged that the greatest possible security was given to the sutured spots. The application of anaes- thetics were accompanied by great diff faculties and especially the suturing of the opening in the posterior wall of the stomach The chief trouble was the depth of the abdominal cavity, the lack of instruments to draw the edges of the wound apart during the sewing and the lack of good light. Speaking of the search for the bullet during the operation the report says:
 No Trace of Bullet.
 "The operation on the stomach now being finished, Dr. Mann introduced his arm so as to palpitate carefully all the deep structures behind the stomach. No trace of the bullet or of the further track of the bullet could be found As the introduction of the hand in this way seemed to have a bad influence on the Presidents pulse, prolonged search for further injury done by the bullet or for the bullet itself, was desisted from"
 It was decided not to introduce any gauge or tubes into the abdomen for drainage.
 On the fifth day, September 10. took place the much discussed removal of stitches from the wound in the abdominal wall The report says:
 Tn the evening the dressings were ex- amined, and as there was considerable staining from the discharges 1t was thought best to remove four stitches and to separate the edges of the wound. A little slough was observed near the bullet track covering space nearly an inch wide, the thickness of the flap. The sup puration seemed to extend down to the muscle.
 The remainder of the wound looked healthy and 1t was thought the infection was due to the. bullet or to a piece of clothing which had been carried into the wound at the time of the shooting. The wound was then dressed, and on the fol- lowing day the patients condition was very much improved.
 Not f1uTr py Solid Foo0.
 The findings at the autopsy as we'll as the developments of the case during the last days, exclude all possibility of abso- lute injury to the stomach by premature giving of solid food. as was alleged at the time when unfavorable symptoms came on after the change to solid food On the fifth day the President slipped hot water On the sixth he had beef juice, the first food taken by mouth since the opera tion.
 In the meantime nutritive enemas were given but were not we'll retained. At S:3O in the morning of the seventh day he was allowed chicken broth, a very small piece of toast and small cup of coffee. He did not care for the toast and ate scarce ly any of it. The wound had in the meantime been doing very well and had been dressed daily after the removal of the stitches and the sloughing tissue. The President seemed at his best and favorable result was now confidently pre- dicted. There was no sign of blood poi soning or of inflammation of the peritoneum The only alarming symptom was his rapid pulse and as it had been of fairly good quality right along the surgeons did not attribute very great importance to this sign. On the seventh day, towards noon, the pulse began to grow weaker and grew rapidly worse. Stimulants were given and the food was discontinued while castor oil and an anema were given to move the bowels. At midnight there was some improve mept in the pulse after an injection or lsat solution into the subcutaneous tissue. On the eighth day the condition of the President was described as very serious, as he did not respond to stimulation. Stimulants and injections of salt solu- ton, coffee and broth were given, but without much effect.
 At 5 clock oxygen was given and con- inn
 At 6:30 o'clock the President was rest less, at 10 p. m. he lost consciousness and continued to sink until he died at 2:15 a. m. on September IA.
 In speaking of the criticism that Roet- gen rays should have been used to locate the bullet, Dr. Mann says in his report:
 We were often asked why, after the operation, we did not use the x-ray to find the bullet. In the first place there were at no time any signs that the bullet was doing harm. To have used the x-ray simply to have satisfied our curiosity would not have been warrantable, as it would have greatly disturbed and an- moved the patient. and would have sub jected him also to a certain risk Had there been signs of abscess formation, then the x-ray could and would have been used"
 Pathooglst Report.
 The report of pr. Harvey R. Gaylord. pathologist to the New York State Path ological Laboratory, on the autopsy is lengthy and detailed. The abdominal wound showed no evidences of necrosis or sloughing No inflammation of the per- itoneum was found. The wound in the front wall of the stomach was found held intact by silk sutures." but the area of stomach wall around it was dis colored. grayish green, and easily torn. The area around the wound on the pos- terior wall of the stomach was also of a dull gray color but the sutures held the wound intact. Behind the latter wound there was spot of discoloration which showed that the sloughing process had gone backward in the track of the bullet The gangrenous cavity found behind the stomach involved the pancreas and the surrounding loose tissues. the bottom of the blind pocket being formed by the up- per end of the leaking wound, which was to bnI t.1 hot Al