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 stated:
     “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 egg.
     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 almost pulseless.

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.