Official Report of the Case of President William McKinley

512 AMERICAN JOURNAL OF THE MEDICAL SCIENCES. CASE OF PRESIDENT MCKINLEY 513 Codeia was substituted for morphine, as the pain was less. Digitalis day, Wednesday, September 11.-Bulletin 26, 9 A.M. The President and strychnine were stopped. Nutritive enemas were given at 3.20 rested comfortably during the night. Decided benefit has followed the dress- A.M., 4.30 and 10 P.M. Hot water was taken quite freely by the mouth. ing of the wound made last night. His stomach tolerates the beef juice Attempts to get a good movement of the bowels were successful at well, and it is taken with great satisfaction. His condition this morning is noon, when he had a large light-brown, partly-formed stool. This fol- excellent. Pulse, 116; temperature, 100.2°. lowed a small dose of calomel and a high enema of oxgall. Bulletin 27, 3.30 P.M. The President continues to gain, and the wound is On the whole the President's condition improved steadily during the becoming more healthy. The nourishment taken into the stomach is being gradually increased. Pulse, 120; temperature, 100.2°. day. He slept a good deal and was fairly comfortable. There was no Bulletin 28, 10 P.M. The President's condition continues favorable. Blood pain on pressure over the abdomen. count corroborates clinical evidence of the absence of any blood poisoning Third Urinalysis. He is able to take more nourishment and relish it. Pulse, 120; tempera- Quantity received 540 c. ture, 100.4°. Color amber, slightly turbid. The blood count made by Dr. Wasdin in the evening was as follows: Specific gravity 1.026. Albumin a .trace. Leucocytes 6,752 Indican not so abundant as yesterday. Red cells 3,920,000 Urea 0.047 gm. per 1 c. c. of urine. A little after midnight Wednesday morning the patient was given 4 Chlorides and phosphates about normal. c. c. of beef juice, the first food taken by the stomach. It seemed to Sulphates still somewhat high. be very acceptable. Nutritive enema was given at 2 A.M.; later there Sugar none. was a yellow stool. Microscopical Examination. Microscopical examination of sediment ob- From 4 to 8 c. c. of beef juice was given every one to two hours dur- tained by centrifuge shows a decrease in the amount of organic elements and ing the day. The rectum was becoming irritable, and did not retain an increase of amorphous urates, but fewer crystals of uric acid. Casts are the nutritive enemas well. fewer and only the small granular and large hyaline varieties. The pro- portion of casts is greater. There are very few epithelial cells, mostly of At 10 A.M. the remaining stitches were removed, the wound separated renal type. A large number of cylindroids are found. and dressed. It seemed to be doing well. Most of the sloughing tissue had separated. Fifth day, Tuesday, September 10. Soon after midnight the President The patient slept much during the day, and expressed himself as had a high enema of soap and water, which was expelled, together with feeling very comfortable. The only medicine administered was one some fecal matter. He took hot water frequently and slept a good deal. hypodermic of strychnine. Bulletin 21, 5.20 A.M. The President has passed the most comfortable In the evening he was changed to a fresh bed. Nutritive enemas night since the attempt on his life. Pulse, 118; temperature, 100.4°; respi- were continued. ration, 28. Urine was passed much more freely-750 c. c. in twenty-four hours. On awaking he felt very comfortable, and his mind was clear and cheerful. The nutritive enemas were kept up and water given by the Fourth Urinalysis. mouth. Had two small stools during the day. The only medicine Quantity 82 c.c. given was one hypodermic of codeia phosphate, 0.015 gramme. Color amber, clear. In the evening the dressings were examined, and as there was consid- Specific gravity 1.027. erable staining from the discharge it was thought best to remove four Reaction strongly acid. stitches and separate the edges of the wound. A little slough was ob- Albumin a trace. Indican abundant. served near the bullet track, covering a space nearly an inch wide, the Urea 0.04 gm. per 1 c.c. of urine. thickness of the flaps. The separation seemed to extend down to the E. phosphates and chlorides normal. muscle. The surfaces, except those mentioned, looked healthy, but not Sulphates still a little high. granulating. It was supposed that the infection of the wound occurred either from the bullet or from the piece of clothing carried into the Microscopical Examination. Microscopical examination of sediment obtained wound at the time of the shooting. The parts were thoroughly washed by centrifuge shows a marked diminution in amount of organic elements, with hydrogen dioxide and packed lightly with gauze, and held together but a great increase in uric acid crystals. There are a few epithelial cells-mostly of renal type. with adhesive straps.