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April 15, 1865

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

Autograph Manuscript
7 pages
SMC 1844
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 the bullet from a single-shot 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.
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