The Indianapolis journal. [volume] (Indianapolis [Ind.]) 1867-1904, 1901-09-24
WHAT WAS CAUSE OF DEATH?
Medical Theories Accounting for the
Fatal Result Of McI<inIey's Wound.
American Medicine.

American Medicine.
At the autopsy there were found no signs
of Inflammation, no peritonitis, no pus.
There was simply nonhealing. and a necrosis
Of all the tissues in the neighborhood of the
track of the bullet. This nonhealing eX-
tended to the operative incision in the alb
dominal wall, around the bullet wounds
in the stomach-wall for a space of about
the size of a silver dollar. and for a larger
area about the head of the pancreas and
adjacent tissues beneath and beyond. The
attempt to account for this extensive gan
grenous process brings one face to face
with the mystery which no theory seems
adequately to clear UP. So far as We are
able at present to set these theories forth
we may classify them somewhat as follows:
- was due to an absorption
into the circulation of the morbid products
of the extensive necrosis, the intOXication
finally overcoming the vitality of the heart,
naturally weak, and further lessened by
disease.
Second-Death was the result of a kind of
shock through the injured solar pleXus SUI
perinduced by the injury and subsequent
necrosis of the tissues in its neighbOrhOOd.
Either theory is simply a method of push
ing the mystery a step further back and
of asking the question, what was the cause
of the extensive necrosis? To this there
are several answers:
First--lt was due to septic matter carried
in with the bullet, either from the clothing
or from some other accidental source. The
absence of Inflammation or Of pus makes it
ulIICulI 10 understand now the result cOul0
have been thus brought about.
Second-It was due to a cunningly poi
soned bullet, but no substance is known
which could produce such a widespread ne
crosis.
Third-It was due to a strange and rare,
but by no means unknown, absence of heal
ing power in sone diseases and persons.
DR.. Phelps, of Buffalo, recently had a SINH
lar case. The extension of the gangrenous
process TO tissues but distantly and slightly
lnterferred with as to nutrition, might be
n NJ nc gro ~ trnF 1nn. - nYYaI
healing power. This LIBERALIZATION of the
structures, it might be added, would be
very natural in a man who, at the Presi-
dents age, had long led a Sedentary life.
and who had borne the heavy burdens Of
power and responsibility.
Fourth-It is possible that the necrosis or
lowered healing power WAS due to injury to
the solar pleXus whereby the trophic power
was inhibited or deranged, partially by di-
rect trauma, or partially by the action of
the pancreatic eXudate, reaching is COM
plete effect only after two or three DAYS.
Fifth-The necrosis was indirectly due to
q concussion of the pancreas, which was not
perforated by the bullet. but which was
''grazed' and slightly injured. or confused
by it, and which within two or three days
began to pour out its natural or morbid
secretion; and this. extending along the
track of the wound, induced the necrosis
by its strong and positive digestive power,
or because of the natural or acquired lack
of healing power in the tissues.
There is a whole science yet to be re-
vealed concerning the pancreas, but from
many published cases it is clear that this
organ is easily injured; that fat-necrOSiS
and other kinds of morbid results soon
ensue; that fatal results follow from slight
injuries TO it; that its secretiOns, normal
and morbid, rapidly pass through its en-
veloping membrane. and soon work ire
parable injury to other structures.
Until further light may be shed upon the
pathology, either by cultures made from
the tissues secured at the autopsy, or by
some discovery, we hold that dogmatic
opinion is not justified. We frankly say,
however. that the theory last suggested
above seems 10 be the best working hypOth-
esis. a rigid analysis of all the cases of
pancreatic disease and injury might tend
to confirm it. In this case the pancreatic
exudate, causing the necrosis, might posi-
bly, have co-operated with a minor bullet
injury TO the solar plexus. and the absorp-
ton of necrotic products thus added 20 the
trauma, to create both intOXicatiOn and
nervous shock; or possibly also. as we nave
said. troph.c loss may nave been in part
or wholly due TO direct or cumu-
lative degenerative injury Of the solar
| nIa~rrn