Rixey Files His Report
M’KINLEY CASE DESCRIBED FROM DOCTOR’S NOTES.
Surgeon Makes Written Transcript to Navy Department—Details of the
Late President’s Condition from Time of Operation to His Dying Hour
Given with Strict Fidelity—Action of Medicine Described—Cause of
Death Is Gangrene.
Washington, D. C., Oct. 26.—“In the
line of duty, while receiving the people, was shot by Leon F. Czolgosz,”
is the official statement filed with the Surgeon General of the
navy by Dr. Presley M. Rixey, medical inspector, United States navy,
as the introduction for his report upon the wounding, illness, and
death of the late President McKinley. The cause of death is thus
“Gangrene of both walls of stomach
and pancreas, following gunshot wound.”
The report itself is remarkable for
its exhibition in the closest possible detail of the exact state
of the patient during his mortal illness. It is in the shape of
a ship’s log almost, showing at intervals of a few minutes, sometimes
a single minute, rarely more than an hour, the patient’s progress
towards the end.
Perhaps the most valuable data contained
from a medical point of view is the accurate registering of the
medication of the case—not a single morsel of food, nor a dose of
medicine, nor bath is omitted in this account. Included in the running
story at the proper intervals are the bulletins which were given
to the public as the case progressed.
Describes First Operation.
The report begins with an account
of the first operation at the emergency hospital on Sept. 6, the
two wounds being described exactly as they have been treated in
the preceding medical reports. Dr. Rixey, stating that all the physicians
present agreed to immediate laparotomy, makes his first entry at
5:30 p. m., when Dr. Mann made a vertical incision, passing through
the wound, and found at the beginning a piece of cloth carried in
by the bullet. Eight minutes later strychnine was administered hypodermically.
Some time after that brandy was administered in the same manner,
and then morphine likewise was administered. This same application
became necessary five minutes after the patient arrived at the Milburn
house, the result being an improved pulse, but slight nausea.
The first bulletin issued to the public
was dated at 7 p. m. It described the character of the wound, the
general outline of the operation, and spoke of the condition of
the patient as gratifying, and justifying hopes of recovery. The
next entry, at 8:43, declares that he rested quietly for eight minutes,
but at 9:15 the patient vomited a small quantity of partly digested
food and a blood clot. Vomiting followed at 9:40 also.
At 10:40 the bulletin was issued stating
that the President was rallying satisfactorily and resting comfortably.
At 10:45 p. m. there were occasional twinges of pain and slight
discoloration of dressings. At 12 o’clock midnight a saline enema
was retained. At 1 a. m., an hour later, the bulletin described
the President as free from pain and resting well.
Sleeping on Second Day.
The notes follow at intervals of
less than an hour until 4:55 the second day, Sept. 7. The patient
was sleeping, but at the latter hour a large amount of gas was expelled,
and ten minutes later, at 5:05 a. m., the entry reads: “Pain severe
on deep inspiration.” At 5:20 the patient is said to be restless
after retaining one pint of saline enema. At 6 a. m. the official
bulletin announced, “The President has passed a good night.” Fifteen
minutes later an injection of morphine was given, and at 9 a. m.
it was announced that the President had passed a fairly comfortable
night and no serious symptoms had developed.
At noon on the second day more morphine
was administered hypodermically, at 1:15 there was a saline enema,
and at 4:30 there was a hypodermic injection of digitalis, the patient
passing much gas by the mouth. The first alcohol bath was given
at 5:30 of this day, while the patient was sleeping, but passing
gas by the mouth. At 6:30 the patient complained of intense pain
in the pit of the stomach. He was given a hypodermic injection of
morphine. No pain, but restless. Sponged with alcohol and rested
quietly for half an hour. The official bulletin announced no change
for the worse.
Responds to Medication.
At 7:40 p. m. digitalis was administered
hypodermically, and the bulletin at 9:30 declared that the conditions
continued much the same, the President responding well to medication.
He had fifteen minutes’ quiet sleep, when a saline enema with somatose
was administered, part of which was rejected. Then there was another
hypodermic injection of digitalis at 10:40, and fifteen minutes
later of morphia, the patient being quite restless.
Restless on Third Day.
The third day, Sept. 8, began with
the entry at 12:30. “Restless during sleep. Limbs sponged with alcohol.
Quiet and slept from 2 to 3 o’clock.” The 3:20 a. m. bulletin said
the President had passed a fairly good night. At 3:30 there was
another enema of salt and somatose. From 4 to 4:30 the patient was
said to be “confused and restless.” At 5 a. m., “Complains of feeling
chilly, but it passed in a moment.” The patient was restless and
talkative from 5 to 6 o’clock a. m., expelling brown fluid and gas.
There are frequent entries of these eructations, and before 9 o’clock
there were two hypodermic injections of morphia and digitalis. A
hypodermic of strychnine was followed at 12:30 p. m. by a saline
enema with somatose, which was not retained, and an alcohol rub.
At 4:45 p. m. the patient was restless
and talkative, and for the first time was given water by the mouth.
At 4:55 an enema of sweet oil, soap, and water brought away some
slightly colored fluid and a little mucus. A 8 a. m. there was a
discharge of the bowels and the patient was set down as “very restless.”
At 8:20 a great deal of gas was passed and some fluid.
Mental Distress on Fourth Day.
On the fourth day, Sept. 9, the patient
is recorded as “restless from 1 to 1:20 o’clock.” At 3:15 p. m.
as “very restless and mind much disturbed.” Codei phos was administered
hypodermically. After an hour’s sleep the record is made at 7:10
a. m., “mind clear, feels chilly.” The patient drank water frequently
in small quantities. At 9:20 the bulletin was issued:
“The President’s condition is becoming
more and more satisfactory,” etc. At 10 o’clock on this morning
the doctors began to administer hourly doses of calomel. Meanwhile,
following a nutritive enema of egg, whisky, and water, there were
two high enemas, one with soap, water, and ox gall, which brought
away a copious discharge, with gas. At 3 p. m. the bulletin said:
“The President’s condition steadily
improves and he is comfortable, without pain or unfavorable symptoms.
Bowels and kidney functions normally performed.”
At 4:20 of this day, following a dressing
of the wound of about an hour, the patient spit up greenish, bitter
fluid. Hot water was given at 5:50, and half an hour later the patient
complained of nausea.
Short Sleep on Fifth Day.
The fifth day, Sept. 10, began at
1:46 a. m., after a short sleep, with this entry: “Uncomfortable,
turning frequently.” There are three entries of “sleeping,” and
then the 5:20 bulletin stating that the President had passed the
most comfortable night since the attempt on his life. The 9 a. m.
bulletin predicted a rapid convalescence, failing complications.
The bulletin at 10:30 said the President’s condition was unchanged
and described the removal of the stitches and the cause therefor.
First Food Is Eaten.
The sixth day’s treatment was marked
by the administration of the first food into the stomach, beef juice,
which the note says “tasted good.” There were seven administrations
of this beef juice between midnight and 9 o’clock the next morning.
The patient complained of feeling chilly, but is recorded as sleeping
more than usual, and the bulletin at 9 o’clock said that he rested
comfortably and his condition was excellent. The patient complained
of headache at 2:15, and camphor was applied to the head. The bulletin
at 3:30 stated that the President continued to gain, and the wound
was becoming healthy.
Given Beef Juice and Whisky.
The seventh day began with the administration
of beef juice, and the diet was varied this time (the patient complaining
of pain in the abdomen) by whisky and water and chicken broth. At
1:30 p. m., digitalis and strychnine having been injected hypodermically
meantime, the patient was given the second piece of toast and one
The entry reads: “Did not relish it,
and ate little. Quieter and more cheerful since having last strychnine.”
At 4:45 it is said: “Mind wandering
and restless.” Calomel, whisky, and water, and digitalis were again
administered. The skin was moist and cold, and the 8:30 bulletin
reported that the President’s condition was not quite so favorable
and his food had been stopped. At 9:35 Dr. Rixey writes: “Whole
body moist and cold. Pulse weak and thready. Slept quietly twenty
minutes.” At 11 o’clock of that night normal salt solution was injected
beneath the skin. At midnight whisky and water was given, with an
infusion of digitalis.
Oxygen Resorted To.
For the first time resort was had
to inhalations of oxygen. The bulletin issued at that time read:
“All unfavorable symptoms in the President’s condition have improved
since the last bulletin,” etc.
The eighth and last day of the President’s
life, Sept., 13, opened with this entry at 12:30 a. m.: “Restless,
and complains of headache.” Whisky and water was given, and a perspiration
was induced, but at 1 a. m. is this entry: “Very restless and wants
to get up; tired.”
The same medical treatment was continued,
involving a plentiful use of oxygen, digitalis, strychnine, and
morphia, and peptonoids. Still at 4:55 the patient’s condition is
reported as grave. The oxygen was continued. There was no response
to stimulants. Atropine and morphia were injected; the patient was
Last Entry Tells of Death.
The last entry was made at 9 a. m.,
and there was a gap of five hours between that and the end. It read:
“Heart sounds very feeble. Oxygen continued. Slight reflex movements,
and at 2:15 a. m., Sept. 14, 1901, the President died.”
Attached to the report are the results
of the autopsies and the chemical and bacteriological examinations
which already have been published in the medical journals.