April 15, 1865

Abraham Lincoln’s Family Physician Describes the President’s Final Hours

  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
enlarge

On the evening of April 14, 1865, President Abraham Lincoln attended a play at Ford’s Theatre in Washington, D.C.  Sometime between ten and ten-thirty, John Wilkes Booth - one of the most popular actors in the country - slipped unnoticed into the Presidential box and, standing four feet away from the President, discharged a single bullet from a derringer into the back of Lincoln’s head. The short-barreled pocket pistol shot a round lead ball at a very low muzzle velocity — about that, say, of today’s air guns. It was enough, however, to render Lincoln unconscious and paralyzed. As Booth escaped from the theater, a young Army surgeon, Charles Leale, made his way through the audience to Lincoln’s side. He determined that the wound was mortal, and ordered the stricken President carried across the street to a neighboring boarding house. There, because he was too tall to fit lengthwise, Lincoln was laid diagonally across a small bed - which, on previous occasions, had been slept in by his assassin, Booth.
 
The narrative presented here is that of Lincoln’s personal physician, Dr. Robert King Stone, who was summoned immediately to the cramped back bedroom where Lincoln lay and, upon his arrival, became the chief attending physician. It is written on pages stained with human blood – although whose blood it is, is impossible to determine at this remove. Stone did attend, though, at both the death-bed and the autopsy: each was held in close spaces wherein Lincoln’s blood was spilled and present.
 
“On the evening of Friday, April 14,” Stone begins, “I was summoned in haste to the late President of the United States, to whom I had the honor to be family physician. I was called … a quarter past ten o'clock p.m… I then found, that the president had been carried to the residence of Mr. Peterson, who resided on 10th Street, opp[osite] the scene of the deplored slaughter. The president’s body had been conveyed to a small room in the back… The president was laid upon the occupant's bed and so great was his stature that his body had to be placed obliquely across it…” Stone found a large number of “sympathizing fellow citizens” and physicians already present: “Assistant Surgeon Taft supporting the sufferer's head, Dr. Leale also of the Army… my very old friend Dr. Lieberman, Dr. King, with Dr. Ford, surgeon of the old Capitol Prison…” 
 
“As soon as I was recognized by my friends,” Stone continues, “the case was surrendered to my care and I proceeded to the exploration of the wound. The president, then lay, perfectly passive on his back as if quietly asleep, without any distortion of features though at times his respiration was somewhat stertorous. Examination showed that he had rec'd a gun shot wound on the posterior aspect of the head - not far from the median line & about three inches from the left auditory of the head… It was remarked that the president's left eye was blackened - the periphery or orbital surface was ecchymosed…” Stone “expressed the opinion that it was the result of the direct violence of the ball… the pupil of the right eye was very much dilated and immobile. The left pupil was unchanged…”   
 
Stone then details, in dispassionate forensic terms, the alarming changes in Lincoln’s physiology: “I noticed the appearance of a black or purple spot at the internal angle of the right eye. This, occupying the position of the… ophthalmic sinus, gradually increased in size, invading the whole orbital periphery until the right eye was surrounded by a zone of the most intense ecchymosis…  After a short time… we noticed that the left pupil began to quite slowly dilate, until the dilation of both pupils was equal.” Stone relates that “when I first reached the unfortunate president, he was breathing quietly and calmly and I had hopes he had received a less fatal injury; but in a few moments, his breathing became difficult and stertorous. On examining the wound, it was found that the orifice was plugged by coagula and debris of brain tissue. On cleaning this away, the wound bled steadily though not severely and instantly almost the stertor was removed and respiration became instantly as sweet and regular as an infant. The wound… gave the appearance of having been produced by a larger ball, than that, used in ordinary revolver pistol.  The hair or scalp was not in the least burn[t] – the edges of the wound were sharp and distinct. On probing the wound, with the finger, the projectilewas found to have cut a distinct and perfectly round aperture…”
 
“With a small silver probe, I attempted to follow the ball & recognized the presence of a rough foreign body, whether bone or fragment of ball, it was impossible to determine. Some inches further on, a larger body of the same character was touched and passed, and the probe passed its full length without giving the satisfactory sensation of striking a metallic body. A longer instrument or Nelaton probe was procured by my friend Dr. Taft & with this I proceeded to re-explore the track of the wound.” Stone’s unsuccessful probing for the bullet, modern commentators have suggested, probably did more harm than good - the argument being that when a low-velocity missile enters the brain, the tissue behind the ball swells and closes up the track of the ball. A probe then, such as the sort used by Stone, would have, at the least, caused an increase in intracranial pressure: the best thing to have done, it now seems, was nothing.   
 
In recounting his bedside ministrations, Stone details the whole of Lincoln’s treatment. Mustard poultices were applied to Lincoln’s “abdomen and extremities”; “bottles and jugs of hot water were placed near him and his extremities” as well. “Of course,” Stone concludes, “all aid was useless in a wound of this character. We had to wait for the slow exhaustion of that vital energy, which a few short hours before ago, had promised so many years yet to come of happy life and goodness to all men.”       
 
As Lincoln’s life gradually ebbs, Stone quotes from notes, no longer extant, no longer extant, “taken by Dr. King at the president’s bedside during the progress of the case,” which document the President’s increasingly labored respiration and irregular heartbeat. At 12:40 a.m., the blackening of the President’s right eye is “very marked”; at 12:55 a.m., there is a “convulsive motion of arms, from shoulders”; at 1:45 a.m., he “lay quiet. Resp[iration] irregular.” By 6:00 a.m. Stone notes that Lincoln’s pulse is failing; by 6:30, breathing is labored and “the least touch of his body surface, would cause an electric jerk through body”; by 7:00, “pulse and respiration failing much.” Then, at 7:30, “Death closed the scene. He slept.” 
 
Four and half hours later, at noon, April 15th, Stone is at the White House to autopsy the President in the “Prince of Wales” bedroom (the same room in which, just two years before, his beloved son Willie had died). He notes those present – Surgeon General Barnes, Dr. Crane, and Dr. Taft - and expresses his “great surprise” that the embalmer, Dr. Brown, insists that “the embalmment of the body… would immediately follow our necropsy.” He then devotes the last two pages to his narrative to an explicit description of the autopsy procedure, and the precise nature of the President’s wound. To this end he charts the exact course of the fatal projectile fired by Booth: “the ball pierced the Dura Matter and through posterior lobe of the Left hemisphere of the brain… it entered the left lateral ventricle of the brain… inclining upwards and inwards… and lodged in the white cerebral substance, just above the Corpus striatum of the left side.” Stone’s exhaustion is evident as he closes the account, with his handwriting, or note taking, becoming less and less legible until suddenly the manuscript ends, seemingly mid-sentence. Those last words, however, like the first, have to do with blood: not of the external scene, but the intimate, intrinsic fact. Capillary hemorrhage; coagulation; “the whole brain,” he writes, “engorged with blood.”  
   
What the doctor reports, ultimately, is what the poet also saw: “the debris and debris,” Walt Whitman said, “of all the slain soldiers of the war.” Now Lincoln too, was fully at rest, and suffered not, five days after the end of the bloodiest war in American history. 

[LINCOLN ASSASSINATION: DR. ROBERT K. STONE] Autograph Manuscript (unsigned), being a first-hand account of Lincoln’s medical condition, death and autopsy; 7 blood-stained pages, recto with one page verso, quarto, no place or date [Washington, D.C, April 14-15, 1865]. Apparently draft notes for Stone’s lecture on May 3, 1865, to the Medical Society of the District of Columbia.

You may also be interested in:

  • On His Last Day Alive, Abraham Lincoln Writes a Pass to Richmond for the Wife of the Doctor Who Would Attend His Death-Bed
    On His Last Day Alive, Abraham Lincoln Writes a Pass to...
  • Portentous John Wilkes Booth Letter, Written Just Eight Weeks Before Abraham Lincoln’s Assassination, Mentions Ford's Theatre
    Portentous John Wilkes Booth Letter, Written Just Eight...
  • Unused Ticket for Ford's Theatre April 14, 1865 - The Night Lincoln Was Assassinated There
    Unused Ticket for Ford's Theatre April 14, 1865 - The...
  • First Responder Leale: The Eyewitness Account of Abraham Lincoln’s Assassination By The Doctor Who Treated Him at the Scene
    First Responder Leale: The Eyewitness Account of Abraham...
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
enlarge

Transcript

On the evening of Friday, April 14, I was summoned in haste to the late President of the United States, to whom I had the honor to be family physician. I was called for, at, or very near, a quarter past ten o'clock p.m.  The carriage which was sent for me, having been driven at top speed, in coming for me and returning to the scene of blood – The least possible time was spent in the passageto thehouse. I then found, that the president had been carried to the residence of Mr. Peterson, who resided on 10th Street, opp. the scene of the deplored slaughter. The president’s body had been conveyed to a small room in the back building [?] of the house as the easiest of access and most convenient - a plain but comfortable apartment.  The president was laid upon the occupant's bed and so great was his stature that his body had to be placed obliquely across it and while his head reached the left-hand top of the bed, his feet extended to the right hand bottom of the couch [?] I found him surrounded by sympathizing fellow citizens whose very hands seems wrung with love – but who, in spite of the exasperating ugliness [?] of the act – still controlled the longing of their aroused passions and maintained a discreet silence around his humble couch. I found my fellow Assistant Surgeon Taft supporting the sufferer's head, Dr. Leale also of the Army [word obliterated by stain] every way - my very old friend Dr. Lieberman, Dr. King, with Dr. Ford, surgeon of the old Capitol Prison making every attempt to render the President air and afford him every comfort, in the power of man and… As soon as I was recognized by my friends, the case was surrendered to my care and I proceeded to the exploration of the wound. The president, then lay, perfectly passive on his back as if quietly asleep, without any distortion of features though at times his respiration was somewhat stertorous. Examination showed that he had rec'd a gun shot wound on the posterior aspect of the head - not far from the median line & about three inches from the left auditory [ear] of the head… in an oblique line – a clean, well defined [illegible] thro the bone being remarkably clean cut as if punched …It was remarked that the president's left eye was blackened - the periphery or orbital surface was ecchymosed presenting the ordinary appearance of “blackeye.” This, the gentlemen around said had been produced by the fall.  Having by this time seen the wound in the cranium, I begged here to differ and expressed the opinion that it was the result of the direct violence of the ball.  That I had sometimes seen such a condition following a wound on the back of the head… in which fracture of the base of the cranium... This was also noted, that the pupil of the right eye was very much dilated and immobile. The left pupil was unchanged, or if anything was rather myopic or diminished.  This is probably a [indiscernible], not only of detail; for I am certain, this… aperture of the president, was rather small.  While engaged about him, rending all the aid, in my power, I noticed the appearance of a black or purple spot at the internal angle of the right eye. This, occupying the position of the circle of ophthalmic sinus, gradually increased [?] in size, invading the whole orbital periphery until the right eye was surrounded by a zone of the most intense ecchymosis.  This, gradually increased, the effusion was formed into the subconjunctival cellular tissue of this lately affected eye.  The ball of the eye became prominent by slow degrees until the zone around the eye orbit, was complete and then the protrusion reached its greatest point, until the ball, covered by… seemed to protrude one inch at least from its socket.  After a short time, when the intensity of the left orbiture ecchymosis had reached its intensity - we noticed that the left pupil began to quite slowly dilate, until the dilation of both pupils was equal.

When I first reached the unfortunate president, he was breathing quietly and calmly and I had hopes he had received a less fatal injury; but in a few moments, his breathing became difficult and stertorous. On examining the wound, it was found that the orifice was plugged by coagula and debris of brain tissue. On cleaning this away, the wound bled steadily though not severely and instantly almost the stertor was removed and respiration became instantly as sweet and regular as an infant. The wound, external gave the appearance of having been produced by a larger ball, than that, used in ordinary revolver pistol.  The hair or scalp was not in the least burn[t] – the edges of the wound were sharp and distinct. On probing the wound, with the finger, the projectilewas found to have cut a distinct and perfectly round aperture, the edges of which, were peculiarly sharp and distinct and totally devoid of spiculae of fragments of either tatters of the  injured occipital bone.


About at this time, several other medical gentlemen reached the house among whom I might enumerate Drs. Hall and May who examined the wound, recognized its fatal character and despairing of life had nothing to consult and soon retreated.

About the same time the surgeon general of the army reached the spot, with Dr. Crane of the same Dept. These gentlemen examined the injury of the President’s condition and confirmed the fatal prognosis.  With a small silver probe, I attempted to follow the ball & recognized the presence of a rough foreign body, whether bone or fragment of ball, it was impossible to determine. Some inches further on, a larger body of the same character was touched and passed, and the probe passed its full length without giving the satisfactory sensation of striking a metallic body. A longer instrument or Nelaton probe was procured by my friend Dr. Taft & with this I proceeded to re-explore the track of the wound.  The course of the wound, with this proper instrument was found to be forwards, upwards, with a decided inclination inwards.  The two foreign bodies already alluded to, were noticed and passed as the probe went in, to its full length, leaving me only a line and a half of its length to hold by.  This, carried to its full length (about 7 inches) to its porcelain tip, struck against what, at first seemed to be the ball.  But further explorations convinced me that I was thinking a fracture bone - the rough fractured surface, being perfectly appreciated, by means of probe.  
 
The surgeons around seemed to be convinced, that the last point noticed and explored was fractured bone. I thought myself, that it had been one of the clinoid processes, or lesser Ala [?] of the sphenoid bone. During the evening, the President‘s state varied - when I reached there we soon had large sinapisms made and laid on his abdomen and extremities & as in a little time, the mustard formed to have been useless, [indiscernible] – A new set of strong, fresh sinapisms were prepared and his body and limbs enveloped in them. Bottles and jugs of hot water were placed near him and his extremities, to regulate the temperature. Of course, all aid was useless in a wound of this character.  We had to wait for the slow exhaustion of that vital energy, which a few short hours before ago, had promised so many years yet to come of happy life and goodness to all men.    

As remarked before, the President’s condition, was very much dependent upon the state of flow from his wound.  As long as the discharge of blood was free and steady – though in a small stream, his respiration and sleep were composed, but in a few moments, after the orifice of the wound was plugged, it impeded the difficulty of respiration began and increased, until it was of the most purging stertorous character. If I made slight pressure on the scalp and occipital below the orifice of the wound, there would spring from the aperture a coagulum of blood, or a fragment of disengorged brain tissue per saltum. The flow would then be steady and gentle and almost instantly, the stertor would yield in intensity. Still more decline and pass away, melting into the gentlest and most calming kind of sleep.  His pulse, which was until then, small and weak would then gradually improve and become excellent, again. Notes taken by Dr. King at the president's bedside during the progress of the case.

11 ---    his pulse was 41

11.5     45 & growing weaker

11.10 mi 45

11.15’     42

11.20’  45 respiration 27 to 29

11.25’  42

11.32’  48 & full

11.40  45. Resp. 22

12 -  48  “        22

12.15’  48  Respirat. 21. ecchymose of both eyes   ----

12.30’  54

12.32  60

12.35’  66

12.40’  69.  R. eye much refused ecchymosis very marked

12.45’  70 Resp. 27

12.55’ 80 Convulsive motion of arms, from shoulders…

1 PM 86 Resp. 30

1.30’ 95 appearing  --- blood and brain parts had been allowed to flow from him

1.45’ lay quiet. Resp. irregular

2.10’ pulse & respiration gradually fell ---

2.30’ Presd very quiet Pulse 54. Respr 28

2.52’ pulse 48 = Respr 30

3.25’ Respr 24 & regular

4AM Respr 26 regular

4.15’  Pulse 60. Respr 25

5.50’ “  “     28

6.30   State failing and labored breathing at this time the least touch of his body surface, would cause an electric jerk through body;

7. Pulse and respiration failing much

7.22.  Death closed the scene. He slept."
The amount of brain tissue broken up and discharged, from receipt of the wound, to the dying moment must have been considerable.  Those gentlemen, who were present and aided to remove the President to Mr. Peterson’s house have stated to me that much brain was lost in transporting the body up the street.  During my presence, the loss of brain substance was consistent for the ball was large and evidently produced by a large projectile.  At times, when seated by, counting the pulse, I noticed that the stertorous breathing became very disturbing and the flow from the wound was almost null.  Suddenly, there burst forth from the wound, on several occasions, small pieces of brain and coagula of blood followed by a gentle, steady trickling of blood.  This phenomena was productive of the greatest improvement - the respiration and pulse were instantaneously improved.  It is impossible to say how much cerebral substance was lost, but at least all which had been broken up in the track of the ball from occipital to its recovery in the front part of cerebrum.  The loss of blood was not very great at any one time; but was steadily continued in a gentle drain - unless when coagula and brain debris arrested the flow and then the stertor and labored breathing were disturbingly painful to witness and its flow was at once [illegible] as prolonging life and deferring death of some attendant horrors, which would not… have honored [?] the souls of the relatives and friends who with throbbing [?] hearts witnessed the passing away of this great man…

The next day, previous to the  process of embalmment, I proceeded to the autopsy of our late president, having requested my friends Asst Surgeons J. Javier Woodward and Curtis USA, to be present as they are skilful anatomists to conduct the examination.  There were present, Surgeon General Barnes USA, Dr. Crane USA, and Dr. Taft USA.  It was my intention, after the permission was accorded me to make this full [?] examination and had invited a limited number of my professional brothers to be present and more particularly these gentlemen, who had been so kind and unstinting in their attentions to the victim.  But to my great surprise, I found that everything had been advanced, that it was absolutely necessary to proceed at once to the embalmment of the body, which Dr. Brown the embalmer told me, would immediately follow our necropsy.  I was thus unavoidably deprived of the privilege I should have indulged of inviting members of this Society to be present.  Having heard this statement, my brethren and especially those, like Dr. Lieberman, Ford and others who so kindly aided and counseled me that long and painfully trying night.  I am sure will hold me acquitted of any want of courtesy to themselves & [this] body [?]. I could not have altered things.
 
Before proceeding to the autopsy, we noticed that the ecchymosis of the orbits of eyes was intense and had passed on to the temples and mastoid [?] surface. The right eye had lost its protrusion, as hitherto discolored and again, fell back to its normal position nearly.  No other marks upon the face. On the occipital portion of the head, we noticed that there was great serum edema about the wound and some expansion of blood around the wound.  The wound, itself, seemed a clean cut gaping slit thro the scalp.  In the occipital bone itself, the ball… was a clean cut, circular opening singularly free from all… and appeared as it had been cut thru the bone, with a sharp punch between the scalp and the bone orifice, we recovered a little shaving of lead, which had evidently been passed from the ball, as it drove thru the harder tissue.
 
 We proceeded to the examination by dividing scalp from ear to ear and sawing off the Calvarium. When the scalp was removed we found that the ball pierced the occipital bone, one inch to the left of the median line and had traversed the upper edge of the left lateral sinus, a little to the left of the Facular Hemophilic [?].  This wound in the occipital bone was remarkably smooth and was particularly noted by Dr. Woodward, spherical in shape and beveled off, from without inwards, so that the aperture of the internal table [?]of cranium, and decidedly layered then that of the outer table [?].  Thence passing forward, almost in the horizontal plane the ball pierced the Dura Matter and through posterior lobe of the Left hemisphere of the brain.  Thence passing  thru cerebral substance, it entered the left lateral ventricle of the brain behind and following the course of that cavity, very accurately inclining upwards and inwards it ploughed the upper part of the Thalamus nerve opticum and lodged in the white cerebral substance, just above the Corpus striatum of the left side.
 
In the track of the ball, brain was in a pulpy… state and around the track, was pultaceous and livid from capillary hemorrhage. About 2 ½ inches, in the… orifice… the 1st piece of occipital bone, driven in by the ball was discovered. A 2nd larger fragment of the same was discovered further inwards about 4 inches within orifice and the ball, still further in. The track of the ball was filled with coagulated blood. Indeed the whole brain seemed engorged with blood…