⬅ William McKinley: Post-Shooting Medical Course
BY Dr. PRESLEY M. RIXEY, Medical Inspector, U. S. Navy
FIRST DAY -- September 6, from 4:07 p.m. to midnight.
Report made to Dr. Dr. Roswell Park, medical director, Pan-American Exposition, fixes the time of shooting at 4:07 p.m., and the President's arrival at the Emergency Hospital 4:18 p.m. Immediately upon being undressed an examination revealed upon the surface of the body two wounds, the one to the right of the sternal line being an abrasion 1 cm. in diameter. Measuring from the suprasternal notch the distance was 5 1/2 cm., from the right nipple 10 cm. and from the line of the right nipple 8 1/4 cm. The second wound was a penetrating wound of the abdomen 15 1/2 cm. from the left nipple and 16 1/2 cm. from the umbilicus, being 1 cm. from the right of a line drawn from the umbilicus to the nipple and made by a .32 caliber bullet.
All those present agreed that an immediate laparotomy was demanded, and preparations were made accordingly. Dr. Eugene Wasden [sic], of the Marine Hospital Service, administered the anesthetic. The administration of the ether was begun at 5:20 p.m., and the President was under its influence at 5:29 p.m. Dr. M. D. Mann was the operator, Dr. Herman Mynter first assistant, Drs. » Parmenter and » Lee sponging, Dr. E. C. Mann at sutures, and Drs. » Hall and » Rixey assisting with the lights. Miss Walters was in charge of the nurses -- Miss Morris, Miss Barnes, Miss Baron, Miss Shannon, Miss Dorchester, and Miss Simmons.
5:30 p.m. Dr. Mann made a vertical incision 8 cm. in length, passing through a bullet wound, and in a few minutes enlarged it to 10 cm. A piece of cloth, carried in by the bullet, was found and removed.
5:38 p.m. 0.002 grams strychnine administered hypodermically.
5:41 p.m. The stomach was exposed and a perforating bullet wound found in the anterior wall midway between the orifices of the stomach about 1 cm. in diameter and about 1 1/2 cm. from the line of the omental attachment. The wound was examined and enlarged so as to admit the finger.
5:43 p.m. The wound of the stomach was secured with a double row of silk sutures.
5:55 p.m. Respiration, 33; pulse, 84; both of good character.
5:58 p.m. Incision increased to 14 1/2 cm. Abdominal cavity carefully explored and all bleeding points tied off.
6:05 p.m. Respiration, 36. Intestines examined; omentum ligated and divided after which perforation in posterior wall of stomach was readily found. It was about 1 1/2 cm. in diameter. The wound was carefully sutured. Pulse 88, and of good character.
6:20 p.m. Pulse, 107; only fair in character; respiration, 39; 1.6 c. c. of brandy given hypodermically.
6:23 p.m. » Roswell Park, medical director Pan-American Exposition, arrived in the operating room.
6:31 p.m. Abdominal cavity irrigated with sterile salt solution and abdominal opening sutured.
6:40 p.m. Pulse, 120; fair; respiration, 36.
6:48 p.m. Pulse, 124; tension good; respiration, 36.
6:50 p.m. Abdominal sutures in place; 7 silk-worm gut sutures, with catgut between.
6:51 p.m. Anesthetic stopped.
7:01 p.m. Bandaging completed. Pulse, 122; respiration, 32.
7:17 p.m. Hypodermic of morphine, 0.004 gram administered.
7:32 p.m. Removed from the hospital to the ambulance, Drs. Park and Wasden accompanying the President. At this time his condition was good, but he was still under the influence of the anesthetic.
SECOND DAY -- September 7, 1901
12:40 a.m. Passed urine, 60 c.c.
1:00 a.m. The following bulletin was issued:
"The President is free from pain and resting well. Temperature, 100.2; pulse, 120; respiration, 24."2:00 a.m. Pulse, 126. Passed urine, 30 c.c.
3:00 a.m. Pulse, 110; temperature, 101.6; respiration, 24. The President continued to rest well. 3:20 a.m. Passed 15 c. c. urine.
4:10 a.m. Pulse, 100. Sleeping.
4:55 a.m. Pulse, 108; temperature, 101.8; respiration, 24. Large amount of gas expelled.
5:05 a.m. Pulse 104. Pain severe on deep inspiration.
5:20 a.m. Saline enema, 1 pint; retained. Restless.
6:00 a.m. The following bulletin was issued:
"The President has passed a good night. Temperature, 102; pulse, 110; respiration, 24."6:15 a.m. Morph. sulph., gm. 0.016, administered hypodermically.
6:50 a.m. Pulse, 125. Passed urine, 60 c.c.
8:00 a.m. Pulse, 123, temperature, 102.2; respiration, 24. The nurses, Miss Simmons and Miss Barnes, returned to the Emergency Hospital, having been relieved by Miss Maud Mohun and Miss Jane Connollv.
9:00 a.m. The following bulletin was issued:
"The President passed a fairly comfortable night, and no serious symptoms have developed. Pulse, 146; temperature, 102; respiration, 24."Acting Steward P. A. Eliot and Private Jack Hodgins and Ernest Vollmeyer, all of the Hospital Corps, United States Army, have been detailed as orderlies.
12:00 noon. Pulse, 136; temperature, 102.2; respiration, 28. Hypodermic of morph. sulph. gm. 0.01 administered.
1:15 p.m. Saline enema 500 c.c.
3:30 p.m. Pulse, 140; temperature, 102.2; respiration, 24.
4:30 p.m. Pulse, 127. Hypodermic digitalis. Passing much gas by the mouth.
5:30 p.m. Pulse, 124. Passed urine, 60 c.c; Sponged with alcohol. Sleeping. Passed gas by mouth.
6:30 p.m. Complains of intense pain in pit of stomach. Gave morp., 0.008 gm. hypodermically. No pain but restless. Sponged with alcohol, and rested quietly for half an hour. The following bulletin was issued:
"There is no change for the worse since last bulletin. Pulse, 130; temperature, 102.6 degrees; respiration, 29."7:35 p.m. Pulse, 133. Saline enema, 500 c.c., retained.
7:40 p.m. Hvpodermic digitalis. Passed urine, 45 c.c.
8:50 p.m. Pulse, 132; temperature, 102.5; respiration, 28.
9:30 p.m. The following bulletin was issued:
"Conditions continue much the same. The President responds well to medication. Pulse, 132; temperature, 102.5; respiration, 25. All temperatures reported are taken in the rectum."10:30 p.m. Has slept quietly for 15 minutes. Saline enema, 500 c.c., with 4 gm. somatose. Rejected 60 c.c.
10:40 p.m. Gave hypodermic digitalis.
10:55 p.m. Pulse, 140. Very restless.. Gave morph. 0.008 gm., hvpodermicallv.
11:15 p.m. Passed from the bowels 240 c.c. greenish-colored fluid and two particles of fecal substance. Passed gas by the mouth.
Quantity _________________________________________ 30 c.c.
Color _________________________________________ dark amber
Reaction ___________________________________ strongly acid
Urea _______________________ 0.028 gm. per 1 c.c. of urine
Albumin __________________________________________ a trace
Phosphates and chlorides __________________________ normal
Sugar _______________________________________________ none
Indican ________________________________ very small amount
The sediment obtained by centrifuge shows a large amount of large and small epithelial cells, with some leucocytes and occasional red cells. There is a comparativelv large number of hyaline casts principally small, with some finely granular ones; also an occasional fibrinous one. The amount of sediment is large for the quantity of urine submitted. There were no crystals in the sediment.
THIRD DAY -- September 8, 1901.
12:30 a.m. Pulse, 138; temperature, 102.6; respiration, 28. Restless during sleep. Limbs sponged with alcohol. Voided urine 60 c.c. Quiet, and slept from 2 to 3 o'clock.
3:20 a.m. The following bulletin was issued:
"The President has passed a fairly good night. Pulse, 122; temperature, 102.4 degrees; respiration, 24."3:30 a.m. Saline enema, 500 c.c. Somatose, 4 gm.
4:00 to 4:30 a.m. Confused and very restless.
5:00 a.m. Pulse, 120; temperature, 102.2; respiration, 26. Complains of feeling chilly, but it passed in a moment.
5:35 a.m. Voided urine, 45 c.c. Restless and talkative from 5 to 6 o'clock.
5:50 a.m. Expelled a small quantity of brown fluid and gas by rectum.
6:00 a.m. Expelled small quantity of brown fluid. Gas by mouth. Sleeping.
6:55 a.m. Hypodermic digitalis. Passed gas by mouth.
7:45 a.m. Pulse, 132; temperature, 102.8; respiration, 24. Hypodermic of strychnine 0.001 gm.
8:20 a.m. Wound dressed. Urine voided, 90 c.c.
9:00 a.m. The following bulletin was issued:
"The President passed a good night and his condition this morning is quite encouraging. His mind is clear and he is resting well. Wound dressed at 8:30 and found in a very satisfactory condition. There is no indication of peritonitis. Pulse, 132; temperature, 102.8; respiration, 24."9:30 a.m. Sleeping.
10:15 a.m. Pulse, 132. Hypodermic digitalis.
10:25 a.m. High enema; epsom salts, glycerine, and water.
10:40 a.m. Small dark-brown fluid stool with gas.
11:00 a.m. Voided urine, 90 c.c.
12 noon. The following bulletin was issued:
"The improvement in the President's condition has continued since last bulletin. Pulse, 128; temperature, 101; respiration, 27."Hypodermic strychnine. Small dark-brown fluid stool.
12:30 p.m. Saline enema with somatose; not retained. Alcohol rub. Sleeping. Dr. Charles McBirney [sic] of New York, joined the surgeons.
3:00 p.m. Voided urine, 90 c.c. Pulse, 130; temperature, 101; respiration, 30.
4:00 p.m. The following bulletin was issued:
"The President since the last bulletin, has slept quietly, four hours altogether since 9 o'clock. His condition is satisfactory to all the physicians present. Pulse, 128; temperature, 101; respiration, 28."Hypodermic strychnine. Sleeping.
4:45 p.m. Restless and talkative. Water, 4 c. c., by mouth; first taken by mouth.
4:55 p.m. Water, 4 c.c., by mouth. Enema of sweet oil, soap and water. Passed some gas and 270 c.c. slightly colored fluid with a few particles of fecal substance and a verv little mucus.
5:10 p.m. Water, 4 c.c. Sponged with alcohol. Mouth washed with peroxide solution.
5:35 p.m. Water, 8 c.c. Gas passed by mouth.
5:50 p.m. Gas and water discharged by rectum.
6:10 p.m. Water, 8 c.c.
6:20 p.m. Water, 8 c.c. Nutritive enema of egg, whisky [sic], and water, partly rejected.
7:15 p.m. Hypodermic digitalis.
7:30 p.m. Hypodermic strychnine.
7:40 p.m. Pulse, 130; temperature 101.6; respiration, 28.
8:00 p.m. Water discharged from the bowels. Very restless.
8:20 p.m. Passed a great deal of gas and some fluid with particles of fecal substance.
9:00 p.m. The following bulletin was issued:
"The President is resting comfortably and there is no special change since last bulletin. Pulse, 130; temperature, 101.6; respiration, 30."Restless. Voided urine, 45 c.c.
9:45 p.m. Gas by rectum. Quiet only a few minutes at a time.
10:00 p.m. Pulse, 128; respiration, 28.
Quantity _____________________________________ 450 c.c.
Color ________________________ amber -- slightly turbid
Reaction ________________________________ strongly acid
Specific gravity ________________________________ 1.026
Urea ____________________ 0.038 gm. per 1 c.c. of urine
Albumin ____________________________________ mere trace
Sugar ____________________________________________ none
Indican ______________________________________ abundant
Sulphates ___________________________________ increased
Phosphates _________________________ somewhat increased
Chlorides __________________________ somewhat increased
Microscopical examination of sediment obtained by centrifuge shows fewer organic elements. Some large and small epithelial cells and some leucocytes. Casts are not so abundant as yesterday and are principally of the small finelv granular variety. There is a marked diminution in small renal epithelial cells.Quite a quantity of large crystals of uric acid and bacteria are present.
FOURTH DAY -- September 9, 1901.
12:01 a.m. Pulse, 124; temperature, 101.4; respiration, 28. Gas by mouth. S1eeping.
1:25 a.m. Water, 8 c.c. Restless from 1 to 1:30 o'c]ock.
2:00 a.m. Quiet and sleeping. Gas by mouth and by rectum
2:20 a.m. Took water, 12 c.c. Voided urine, 120 c.c.
3:15 a.m. Very restless and mind much disturbed. Codeia phos. 0.015 gm. hypodermically.
3:20 a.m. Nutritive enema. Sponged legs and arms with alcohol.
4:10 a.m. Quiet and resting. Pulse, 120; temperature, 101; respiration, 28.
5:15 a.m. Water, 12 c.c. Expelled small quantity of fluid, faecal odor, with particles of faecal substances and gas.
6:00 a.m. The following bulletin was issued:
"The President passed a somewhat restless night, sleeping fairly well. General condition unchanged. Pulse, 120; temperature, 101 degrees; respiration, 28."Slept at intervals from 5 to 6 o'clock. Water, 12 c.c.
7:09 a.m. Water, 15 c.c. Gas by rectum. Voided urine, 150 c.c. Mind clear. Feels chilly. Water, 24 c.c.
8:00 a.m. Water, 24 c.c.
9:00 a.m. Pulse, 112; temperature, 100.8; respiration, 28. Restless from 8 to 9 o'clock. Passing gas by mouth and rectum.
9:20 a.m. The following bulletin was issued:
"The President's condition is becoming more and more satisfactory. Untoward incidents are less likely to occur. Pulse, 112; temperature, 100.8 degrees; respiration, 28."
The following memorandum was issued to the nurses:
Nurses' Hours
Miss Mohun __________ 8 a.m. to 4 p.m.
Miss Connolly __________________ 4 p.m. to midnight
Miss McKenzie ________________ 12 midnight to 8 a.m.The nurse going off duty must not leave the sick quarters until she has satisfied her relief that all dressings are prepared and the relief understands the instructions of the physicians. The instructions will be in writing. Nurses on tour duty must not leave the sick room without proper relief (some one of the staff at the bedside of the patient), and then only for five minutes, unless relieved by a trained nurse.
Miss Hunt will be in the house and will be the relief for meals and also the special nursing of Mrs. McKinley.
Dr. Rixey will write out the instructions of the physicians and be accessible at all times. Any change demanded must be reported to him at once.
9:35 a.m. Water, 30 c.c.
10:00 a.m. Calomel, 0.015 gm., dry on the tongue. Nutritive enema of egg, whiskey, and water.
11:00 a.m. High enema, olive oil and castor oil.
11:15 a.m. Calomel, 0.015 gm., dry on the tongue. Water, 30 c.c. More quiet.
12 noon. High enema, 2,000 c.c. soap and water with 8 c.c. or gall. This was foliowed by a large, light brown, partly formed stool with gas.
12:15 p.m. Calomel, 0.015 gm. Water, 60 c.c. Voided 240 c.c. urine. Sleeping.
1:15 p.m. Calomel, 0.015 gm., dry on the tongue. Alcohol rub. Sleeping.
2:15 p.m. Calomel, 0.015 gm. Water, 24 c.c. Sleeping.
3:00 p.m. The following bulletin was issued:
"The President's condition steadily improves and he is comfortable, without pain or unfavorable symptoms. Bowel and kidney functions normally performed. Pulse, 113; temperature, 101; respiration, 26."Wound dressed.
3:20 p.m. Calomel, 0.015 gm. Dry on the tongue.
4:20 p.m. Spit up 15 c.c. greenish bitter fluid.
4:30 p.m. Voided urine, 120 c.c. Nutritive enema given; part rejected.
5:50 p.m. Hot water, 16 c.c.
6:15 p.m. Pulse, 112. Considerable gas by mouth, and feels nauseated.
7:10 p.m. Hot water, 16 c.c. Slept 15 and 20 minutes.
8:00 p.m. Slept 20 minutes. Pulse, 112; temperature 101; respiration, 27
9:30 p.m. The following bulletin was issued:
"The President's condition continues favorable. Pulse, 112; temperature, 101; respiration, 27."Voided urine, 180 c.c. Gave codeia, 0.015 gm.
10:00 p.m. Nutritive enema. Complains of feeling full and very uncomfortable.
11:30 p.m. Hot water, 16 c.c.
Quantity received _________________________ ____ 540 c.c.
Color _________________________ amber -- slightly turbid
Specific gravity __________________________________ 1.026
Albumin _________________________________________ a trace
Indican ____________________ not so abundant as yesterday
Urea ______________________ 0.047 gm. per 1 c.c. of urine
Chlorides and phosphates ___________________ about normal
Sulphates ___________________________ still somewhat high
Sugar ______________________________________________ none
Microscopical examination of sediment obtained by centrifuge shows a decrease in the amount of organic elements and an increase of amorphous urates, but fewer crystals of uric acid. Casts are fewer and only the small granular and large hyaline varieties. The proportion of large casts is greater. There are very few epithelial cells, mostly of renal type. A large number of cylindroids are found.
FIFTH DAY -- September 10, 1901.
12:05 a.m. High enema of soap and water. Expelled part of the enema with light-brown stained fluid with dissolved fecal substances. Slept quietly for 25 minutes.
1:46 a.m. Uncomfortable; turning frequently.
1:50 a.m. Very quiet and slept 35 minutes.
2:30 a.m. Pulse, 108; temperature, 100.4; respiration, 26. Voided urine, 180 c.c. Gave hot water, 24 c.c.
3:00 to 4:00 a.m. Sleeping. Hot water, 30 c.c.
4:10 to 5:05 a.m. Sleeping.
5:20 a.m. The following bulletin was issued:
"The President has passed the most comfortable night since the attempt on his life. Pulse, 118; temperature, 100.4; respiration, 28."Has passed much gas by mouth and rectum.
6:00 a.m. Wakened and feels very comfortable. Water, 60 c.c.
7:05 a.m. Nutritive enema. Alcohol rub. All previous temperatures by rectum; all following by mouth unless otherwise noted.
8:40 a.m. Pulse, 109; temperature, 99.8; respiration, 25.
9:00 a.m. The following bulletin was issued:
"The President's condition this morning is eminently satisfactory to his physicians. If no complications arise a rapid convalescence may be expected. Pulse, 104; temperature, 99.8; respiration, 26. The temperature is taken by mouth and should be read about 1 degree higher bv rectum."9:20 a.m. Water, 60 c.c. Voided urine, 60 c.c. Sleeping.
10:45 a.m. Nutritive enema; expelled a portion.
11:40 a.m. Pulse, 112; temperature, 100.3; respiration, 26. Water, 60 c.c. Complains of some distress in abdomen.
12 noon. Expelled a quantity of light yellow fluid, fecal odor.
12:30 p.m. Hypodermic codeia phos., 0.015 gm. Resting more quietly; sleeping. Voided urine, 150 c.c.
2:00 p.m. Lime juice for the mouth. Water, 30 c.c. Oozing visible on bandage.
2:45 p.m. Pulse, 120; temperature, 100; respiration, 28. Gas by mouth.
3:20 p.m. The following bulletin was issued:
"There is no change since this morning's favorable bulletin. Pulse, 110; temperature, 100; respiration, 28."3:35 p.m. Wound dressed. Water, 24 c.c. Voided urine, 150 c.c. Sleeping.
4:15 p.m. Resting. Alcohol rub. Sleeping. Water, 90 c.c.
6:10 p.m. Nutritive enema. Slept half an hour and expelled 180 c.c. light yellow fluid, fecal odor, with gas.
9:20 p.m. Pulse, 114; temperature, 100.6; respiration, 28. Some of the stitches removed from the abdominal wound and dressing done by Dr. Mann. Much exhausted, tired, and very restless.
10:30 p.m. The following bulletin was issued:
"The condition of the President is unchanged in all important particulars. His temperature is 100.6; pulse, 114; respiration, 28."When the operation was done on Friday last it was noted that the bullet had carried with it a short distance beneath the skin a fragment of the President's coat. This foreign material was of course removed, but a slight irritation of the tissues was produced, the evidence of which has appeared only tonight. It has been necessary on account of this slight disturbance to remove a few stitches and partially open the skin wound. This incident cannot give rise to other complications, but it is communicated to the public as the surgeons in attendance wish to make their bulletins entirely frank. In consequence of this separation of the edges of the surface wound, healing of the same will be somewhat delayed. The President is now well enough to begin to take nourishment by the mouth in the form of pure beef juice."
SIXTH DAY -- September 11, 1901.
12:05 a.m. Beef juice, 4 c.c. First food taken into the stomach since the operation. Tasted good.
1:15 a.m. Beef juice, 4 c.c. Water, 90 c.c. Urine voided, 240 c.c.
2:00 a.m. Starch and laudanum enema followed by nutritive enema. Alcohol rub.
3:00 a.m. Wound dressed by Dr. Rixey. Expelled from rectum 90 c.c. light yellow fluid, fecal odor.
4:50 a.m. Has slept about 40 minutes. Beef juice, 4 c.c. Water, 90 c.c.
5 :15 a.m. Gas by rectum. Feels chilly. Voided urine, 150 c.c.
6:00 a.m. The following bulletin was issued:
"The President has passed a very comfortable night. Pulse, 120; temperature, 100.2; respiration, 26."Beef juice, 6 c.c. Sleeping.
7:00 a.m. Beef juice, 8 c.c. taken with a relish.
8:00 a.m. Beef juice, 8 c.c. Resting comfortable since 12 o'clock. Sleeping more than usual.
8:30 a.m. Pulse, 116; temperature, 100.2; respiration, 28. Voided urine, 180 c.c. Took beef juice, 12 c.c.
9:00 a.m. The following bulletin was issued:
"The President rested comfortable [sic] during the night. Decided benefit has followed the dressing of the wound made last night. His stomach tolerates the beef juice well, and it is taken with great satisfaction. His condition this morning is excellent. Pulse, 116 ; temperature, 100.2."10:10 a.m. Wound dressed. Remaining stitches removed. Starch enema followed by nutritive enema. Beef juice by mouth, 12 c.c.
1 1:00 a.m. Water, 120 c.c. Expelled small amount light yellow fluid, fecal odor. Sleeping.
12 noon. Sleeping.
12:40 p.m. Beef juice, 16 c.c. High enema soap and water.
12:50 p.m. Hypodermic strychnine. Restiess.
1:15 p.m. Albumin water, 16 c.c. Alcohol rub. Slept quietly for 1 hour.
2:1 5 p.m. Pulse, 120; temperature, 100.2; respiration, 26. Complains of headache.
2:30 p.m. Beef juice, 16 c.c. Voided urine, 240 c.c.
3:00 p.m. Camphor applied to head. Albumin water, 16 c.c.
3:30 p.m. Wound dressed by Dr. McBirney. The following bulletin was issued:
"The President continues to gain and the wound is becoming more healthy. The nourishment taken into the stomach is being gradually increased. Pulse, 120; temperature, 100.2."4:00 p.m. Beef juice, 16 c.c.
4:50 p.m. Water, 180 c.c. Voided urine, 120 c.c.
5:00 p.m. Starch and laudanum enema.
5:20 p.m. Nutritive enema of egg, whiskey, and water. Sleeping.
6:15 p.m. Albumin water, 16 c.c.
7:30 p.m. Slept three-quarters of an hour. Complains of bandage being too tight.
7:35 p.m. Beef juice, 16 c.c. Pulse, 120; temperature, 100.4; respiration, 30.
8:00 p.m. Lower strap loosened by Dr. Rixey. Sleeping.
8:45 p.m. Albumin water, 16 c.c. Rubbed with alcohol. Complains of bandage being uncomfortably tight and it is loosened by Dr. Rixey. Blood count by Dr. Warden shows absence of blood poisoning.
9:40 p.m. Beef juice, 16 c.c. Wound dressed by Dr. McBurney [sic].
10:00 p.m. The following bulletin was issued:
"The President's condition continues favorable. Blood count corroborates clinical evidence of absence of blood poisoning. He is able to take more nourishment and relishes it. Pulse, 120; temperature, 100.4."10:40 p.m. Beef juice, 16 c.c. Changed to fresh bed.
11:00 p.m. Starch and laudanum enema.
11:20 p.m. Nutritive enema of whiskey, egg, and water.
11:40 p.m. Beef juice, 30 c.c. Strychnine hypodermically, 0.002 gm. Pulse, 126; temperature, 100.4; respiration, 32. Sleeping.
12 midnight. Beef juice, 30 c.c. Voided urine, 240 c.c.
Quantity___________________________________________ 82 c.c.
Color _______________________________________ amber - clear
Specific gravity ____________________________________ 1.027
Reaction ____________________________________ strongly acid
Albumin ___________________________________________ a trace
Indican __________________________________________ abundant
Urea _________________________ 0.04 gm. per 1 c.c. of urine
E. phosphates and chlorides ________________________ normal
Sulphates _____________________________ still a little high
Microscopical examination of sediment obtained by centrifuge shows a marked diminution in amount of organic elements, but a great increase in uric acid crystals.There are very few epithelial cells -- mostly of renal type.
There are fewer casts -- small and large hyaline -- some finely granular.
Cylindroids are more abundant.
SEVENTH DAY -- September 12, 1901.
1:00 a.m. Beef juice, 30 c.c. Very restless. Alcohol rub.
1:45 a.m. Has been sleeping. Water, 90 c.c. Complains of pain in the abdomen.
2:00 a.m. Beef juice, 30 c.c. Whiskey, 8 c.c. Water, 60 c.c.
3:10 a.m. Chicken broth, 60 c.c. Water, 120 c.c.
4:00 a.m. Beef juice, 30 c.c. Sleeping.
4:35 a.m. Water, 16 c.c.
5:00 a.m. Pulse, 122; whiskey and water; chicken broth. Voided urine, 270 c.c.
6:00 a.m. Beef juice, 30 c.c. Upper part of body quite moist from 5:30 to 6 o'clock. Sleeping.
6:20 a.m. The following bulletin was issued:
"The President has had a comfortable night. Pulse, 122; temperature, 100.2."7:00 a.m. Whiskey and water. Sleeping.
7:35 a.m. Hypodermic strychnine.
8:00 a.m. Voided urine, 150 c.c. Whiskey and water. Comfortable night; sleeping more than usual.
8:30 a.m. Chicken broth, piece of toast, and small cup of coffee.
9:15 a.m. Wound dressed and doing well. Washed with iodine solution and peroxide.
9:20 a.m. Castor oil, 30 c.c.
9:30 a.m. The following bulletin was issued:
"The President has spent a quiet and restful night and has taken much nourishment. He feels better this morning than at any time. He has taken a little solid food and relished it. Pulse, 120; temperature, 100.2 degrees."10:00 a.m. Pulse, 122; temperature, 100.2; respiration, 29. Whiskey and water.
10:30 a.m. Beef juice, 45 c.c. Slept at intervals. Bathed head and hands with camphor. Passing much gas by rectum and mouth.
11:30 a.m. Pulse, 124. Infusion of digitalis, 8 c.c. Restless and depressed. Alcohol rub and sponge.
12:05 p.m. Hypodermic strychnine, 0.002 gm.
Dr. McBirney returned home.
12:30 p.m. Whiskey and water. Chicken broth. Sleeping.
1:15 p.m. Voided urine, 240 c.c.
1:30 p.m. Small piece of toast and one soft-boiled egg. Did not relish it and ate very little. Quieter and more cheerful since having last strychnine.
2:00 p.m. Pulse, 128; temperature, 100.2; respiration, 28. Water, 90 c.c. Infusion of digitalis, 8 c.c. Skin moist and cold.
2:30 p.m. Complains of headache and nausea. Whiskey and water. Beef juice, 45 c.c. Drowsy; feels very tired.
3:05 p.m. Pulse, 134; temperature, rectum, 101; respiration, 32. Hypodermic strychnine, 0.003 gm. Dr. Stockton called in consultation.
3:00 p.m. The following bulletin was issued:
4:45 p.m. Pulse, 128; respiration, 28. Mind wandering and restless.
5:00 p.m. Infusion digitalis, 15 c.c. Chicken broth, 90 c.c. Skin
moist and cold.
6:00 p.m. Pulse, 130; respiration, 31. Sleeps at intervals. Complains of feeling very tired and headache.
6:30 p.m. Voided urine, 210 c.c. Whiskey and water. Sleeping.
7:00 p.m. Hypodermic strychnine, 0.003 gm. Calomel, 0.18 gm. Dry on tongue.
7:30 p.m. Whiskey and water. Quiet and sleeping at intervals.
8:00 p.m. Pulse, 130; temperature, rectum, 101; respiration, 28. Wound dressed by Dr. Mann.
p.m. 8:30 p.m. Resting very quietly. Upper part of body quite moist; cold. The following bulletin was issued:
9:35 p.m. High enema, soap and water and ox gall. Water, 120 c.c. A large, dark, semifluid stool. Urine voided, 180 c.c.
10:00 p.m. Whiskey and water. Hypodermic strychnine, 0.002 gm.
10:30 p.m. Seems much exhausted after the enema. Whole body moist and cold. Pulse weak and thready. Slept quietly 20 minutes.
11:00 p.m. Whiskey and water. Normal salt solution, 420 c.c. subcutaneously.
12 midnight. Whiskey and water. Infusion digitalis. Oxygen inhaled. The following bulletin was issued:
EIGHTH DAY -- September 13, 1901.
12:20 a.m. Voided urine, 240 c.c. Restiess and complains of headache. Pulse fairly good.
1:00 a.m. Pulse, 132. Whiskey and water. Perspiring; body warmer. Very restless and wants to get up; tired.
1:45 a.m. Hypodermic strychnine, 0.002 gm.
2:00 a.m. Whiskey and water, camphorated oil hypodermically.
2:15 a.m. Clam broth, 45 c.c.
2:45 a.m. Hypodermic camphorated oil.
2:50 a.m. The following bulletin was issued:
3:30 a.m. Quiet. Pulse, 124, volume fair; respiration, 32. Water 16 c.c. Hypodermic camphorated oil. Condition of skin better. Sleeping.
4:00 a.m. Whiskey and water. Essential oil of camphor hypodermically.
4:30 a.m. Chicken broth, 60 c.c.
5:00 a.m. Whiskey and water.
5:20 a.m. Pulse, 122, volume not good. Infusion digitalis, 15 c.c. Whiskey and water. Mind clear. Sleeps for 5 to 10 minutes at a time.
5:55 a.m. Hypodermic strychnine, 0.003 gm. Skin slightly better.
6:30 a.m. Liquid peptonoids; whiskey and water.
7:00 a.m. Coffee, 45 c.c. Clam broth, 60 c.c.
7:40 a.m. Pulse, 128; temperature, 100.8; respiration, 32.
8:00 a.m. Whiskey and water. Passed urine, 270 c.c.
8:30 a.m. Hypodermic of adrenalin. Chicken broth.
8:45 a.m. Hypodermic camphorated oil.
9:00 a.m. Wound dressed with balsam of Peru. Whiskey and water. Liquid peptonoid, 15 c.c. The following bulletin was issued:
10:00 a.m. Salt solution subcutaneously. Whiskey and water.
10:20 a.m. Clam broth, 60 c.c.; refused one half.
11:00 a.m. Whiskey and water.
12 noon. Whiskey and water. Sleeping at intervals; slept 15 minutes.
12:30 p.m. Chicken broth, 60 c.c.; took only half of it. The following bulletin was issued:
1:45 p.m. Pulse, 123, not good; temperature, 100.4; respiration, 26. Liquid peptonoids 15 c.c. A little difficulty for the first time in swallowing. Hypodermic strychnine, 0.002 gm. Hypodermic brandy, 2 c.c.
2:00 p.m. Whiskey and water.
2:15 p.m. Clam broth, 30 c.c.; refused more. Wound dressed and doing well.
2:30 p.m. Voided urine, 240 c.c. The following bulletin was issued:
3:30 p.m. Hypodermic brandy. Pulse very weak. Hypodermic camphorated oil.
4:00 p.m. Whiskey and water. The following bulletin was issued:
4:36 p.m. Hypodermic essential oil camphorated.
4:40 p.m. Hypodermic strychnine, 0.002 gm.
4:55 p.m. Adrenalin hypodermically. Brandy and water.
5:00 p.m. Oxygen. Urinated involuntarily.
5:15 p.m. The following bulletin was issued:
6:15 p.m. The following bulletin was issued:
7:40 p.m. Oxygen continued; almost pulseless. Morphia hypodermically, 0.015 gm.
9:00 p.m. Heart sounds very feeble. Oxygen continued. Slight reflex movements, and at 2:15 a.m., September 14, 1901, the President died.
In addition to those already mentioned, there were present in the operating room, Emergency Hospital, at the time of the operation:
5:00 p.m., September 14, 1901, the following bulletin was issued:
## End ##
"The President's condition is not quite so favorable. His food has not agreed with him and has been stopped. Excretion has not been properly established. The kidneys are acting well. His pulse is not satisfactory, but has improved in the last two hours. The wound is doing well. He is resting quietly. Temperature, 100.2; pulse, 128."
9:30 p.m. Castor oil. 30 c.c.
"All unfavorable symptoms in the President's condition have improved since the last bulletin. Pulse, 120; temperature, 100.2."
Color _______________________ light amber, very turbid
Specific gravity _______________________________ 1.025
Reaction ________________________________________ acid
Albumin ___________________________ mere trace, if any
Indican _________________________________________ less
Urea ___________________ 0.044 gm. per 1 c.c. of urine
Sulphates _______________________________ about normal
E. phosphates _________________________ much increased
Chlorides _____________________________________ normal
Microscopical Examination
Microscopical examination of sediment obtained by centrifuge shows fewer organic elements than the last examination. There is less uric acid and a large amount of amorphous phosphates. Renal casts, about as in the last examination, with very few cylindroids.
"The President's condition is very serious, and gives rise to the gravest apprehension. His bowels have moved well, but his heart does not respond properly to stimulation. He is conscious. The skin is warm and the pulse small, regular, easily compressible, and 126; respiration, 30; temperature, 100."
3:00 a.m. Hypodermic of camphorated oil. Whiskey and water. Clam broth.
"The President's condition has somewhat improved during the past few hours. There is a better response to stimulation. He is conscious and free from pain. Pulse, 128; temperature, 99.8."
Quantity ____________________________________ 252 c.c.
Reaction ________________________________________ acid
Specific gravity _______________________________ 1.023
Albumin ___________________________ mere trace, if any
Urea ______________________ 0.047 gm. per l c.c. urine
Indican ______________________________________ a trace
E. phosphates ______________________________ increased
Chlorides _____________________________________ normal
Sulphates ______________________________ a little high
Microscopical Examination
Microscopical examination of sediment obtained by centrifuge before and after clearing shows no change from yesterday's sample. Casts, hyaline and granular, both large and small, comparatively few. Cylindroids, a few. Crystals, large amount of uric acid, some sodium urate, and in the untreated specimen a large amount of amorphous deposit, principally of phosphates. There are a few epithelial cells, small granular. Occasional red cells and leucocytes. Spermatozoa.
9:40 a.m. Hypodermic of strychnine, 0.002 gm. Hypodermic adrenalin, 1.4 c.c.
"The President's physicians report that his condition is practically unchanged since the 9 o'clock bulletin. He is sleeping quietly."
1:00 p.m. Whiskey and water. Called for bedpan but bowels did not move. Quiet and sleeping.
"The President has more than held his own since morning, and his condition justifies the expectation of further improvement. Pulse, 123; temperature, 99.4."
Hypodermic of brandy, whiskey, and water. Liquid peptonoids.
"The President's physicians report that he is only slightly improved since the last bulletin. The pulse and temperature remain the same as at that hour."
4:30 p.m. Hypodermic of brandy. Chicken broth, 60 c.c.
"The President's physicians report that his condition is grave at this hour. He is suffering from extreme prostration. Oxygen is being given. He responds to stimulation but poorly. Pulse, 125; respiration, 40."
6:00 p.m. Oxygen continued. Normal salt solution subcutaneously. Whiskey and water. Hypodermic nitroglycerine; hypodermic brandy.
"The President's physicians report that his condition is most serious in spite of vigorous stimulation. The depression continues and is profound. Unless it can be relieved the end is only a question of time."
6:25 p.m. No response to stimulants. Very restless. Hypodermic morphia, 0.015 gm., and atropine, 0.00045 gm.
P. M. RIXEY,
Medical Inspector, United States Navy.
"The bullet which struck over the breastbone did not pass through the skin, and did little harm. The other bullet passed through both walls of the stomach near its lower border. Both holes were found to be perfectly closed by stitches, but the tissue around each hole had become gangrenous. After passing through the stomach the bullet passed into the back walls of the abdomen, hitting and tearing the upper end of the kidney. This portion of the bullet track was also gangrenous, the ganrene involving the pancreas. The bullet has not yet been found. There was no sign of peritonitis or disease of other organs. The heart walls were very thin. There was no evidence of any attempt at repair on the part of nature, and death resulted from the gangrene, which affected the stomach around the bullet wounds as well as the tissues around the further course of the bullet. Death was unavoidable by any surgical or medical treatment and was the direct result of the bullet wound."
The physicians and surgeons present at the autopsy and signing the above 5 o'clock report of September 14, were:
- Fisher, Jack. Stolen Glory: The McKinley Assassination. Alamar Books, 2001.
a p. xii b p.77
- Braisted, William C.; Bell, William Hemphill; Rixey, Presley Marion. The Life Story of Presley Marion Rixey: Surgeon General, U. S. Navy 1902-1910: Biography and Autobiography. Strasburg, VA: Shenandoah Publishing House, Inc., 1930.
a pp.51-70 b pp.71-82Comment: Dr. Rixey was the White House physician for both William McKinley and Theodore Roosevelt.
- Rixey, PM; Mann, MD; Mynter, H; Park, R; Wasdin, E; McBurney, C; Stockton, CG. Death of President McKinley. J.A.M.A. 1901;37:779.
- Rixey, PM; Mann, MD; Mynter, H; Park, R; Wasdin, E; McBurney, C; Stockton, CG. The official report on the case of President McKinley. J.A.M.A. 1901;37:1029.