Dr. Robert Stone Describes Abraham Lincoln's Final Hours and Death in His Postmortem and Autopsy Report

April 15, 1865

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Dr. Robert Stone Describes Abraham Lincoln's Final Hours and Death in His Postmortem and Autopsy Report
Autograph Manuscript
7 pages | SMC 1844

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      Background

      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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      Page 1 transcript
      Peter [...] --
      (1.
      On the evening of Friday, April 14th, /65, I was summoned in haste to the late Prest [sic] of the US -- to whom I had the honor to be family physician. I was called for, at, or very near
      , a quarter past ten oclock [sic] PM the [sic] carriage which was sent for me, having been driven at top speed, in coming for me & returning to the scene of blood – The least possible time was spent in the passage to the house. I then found, that the president had been carried to the residence of Mr Petersen, who resided on 10th St, opp the scene of the deplored slaughter --

      The Prests [sic] body had been conveyed to a small room in the back bedroom of the house as the easiest of access & most convenient - a plain but comfortable apartment. The Prest [sic] was laid upon the occupants [sic] bed & so great was his stature, that his body had to be placed obliquely across it & while 
      his head reached the lefthand top of the bed -- his feet [text is crossed out] extended to the right hand bottom of the couch 

      I found him surrounded by sympathizing fellow citizens - whose very hands seem wrung with love – but who, in spite of the exasperating ugliness of the act – still controlled the longing of their aroused passions & maintained a discreet silence around his humble couch -- I found my fellow Assistant Surgn [sic] Taft supporting the sufferers [sic] head -- Dr Leale, also of the army [word obliterated by stain] every way -- my old friend Dr Lieberman, Dr King, with Dr Ford Surgeon of the old Capitol Prison, making every attempt to render the President [text is crossed out] air & afford him every comfort, in the power of man to bestow -- As soon as I was recognized by my friends, the case was surrendered to my care & 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 feature - tho' at times, his [text is crossed out] respiration was somewhat stertorous [.] Examination showed that he had recd [sic] a gun shot wound on the posterior aspect of the head - not far from the median line & about 3 inches from the Left Auditory meatus in an oblique line – a clean, well defined entrance wound thro the bone being remarkably clean cut as if punched tho gun used [text is crossed out].  It was remarked that the Prest [sic] Left eye was blackened - the Periphery -- or orbitar [sic] surface was ecchymosed presenting the ordinary appearance of “blackeye”. This, the gentlemen around, he said, had been produced by the fall -- Having by this time seen the wound in the Cranium, I begged leave to differ & expressed the opinion that it was the result of the direct violence of the ball --  that I had several times seen such a [text is crossed out] condition following a wound on the back of the head (all or part) in which, fractures of the base of the Cranium, another nearer [...] -- This was also noticed, that the pupil of the Right Eye was 

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      Page 2 transcript
      2
      very much dilated & immobile. The left pupil was unchanged, or if anything was rather myotic or diminished. This is perhaps a point, not only of detail; [text is crossed out] for I am certain, this pupillar aperture of the President, was rather small - - While engaged about him, rending all the aid, in our 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 [text is crossed out] in size, invading the whole orbitar [sic] perephiry [sic] until the Right Eye was surrounded by a Zone of the most intense Ecchymosis. This, gradually increased; the Effusion was poured 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 & then the protrusion reached [text is crossed out] its greatest point, until the ball, (covered by palpebrum [sic]) seemed to protrude one inch at least from its socket -- After a short time, [text is crossed out] when the intensity of the Left orbitar [sic] ecchymosis had reached its intensity - we noticed that the Left pupil began to quite slowly dilate, until the dilatation [sic] of both pupils was equal --

      When I first reached the unfortunate president, he was breathing quietly & calmly & I had hoped, he had received a less fatal injury; but in a few moments, his breathing became difficult or stertorous. - On Examining the wound, it was found,  that the orifice was plugged by coagula & debris of Brain tissue [.] On cleaning this away, the wound bled steadilytho' not severely & instantly almost the [text is crossed out] Stertor was removed & 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 on scalp was not in the least burn[t] – the edges of the wound were sharp & distinct -- On probing the wound, with the finger, the projectile was found to have cut a distinct & perfectly round aperture, the edges of which, were peculiarly sharp & distinct & totally devoid of spiculae of fragments of either tatters of the injured occipital bone --

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      Page 3 transcript
      3
      About at this time, several other Medical Gentlemen reached the house among whom I might enumerate Drs Hall & May -- who examined the wound, recognized its fatal character & despairing of life had nothing to consult & soon retreated --

      About the same time the Surg. Genl [sic] of the Army reached the spot, with Dr Crane of the Same Corps. These gentlemen examined the injury & the Presidents [sic] condition & 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 [text is crossed out] or fragt [sic] of ball, it was impossible to determine.-- Some inches further on, a larger body of the same character, was touched/passed & the probe passed its full length without giving the satisfactory sensation of striking a metallic body -- A longer inst[rument] [sic] or Nelaton probe was procured by my friend Dr Taft & with this, I proceeded to re"explore [sic] the [text is crossed out] track of the wound-- The course of the wound, with this proper inst [sic] was found to be forwards, upwards, with a decided inclination inwards -- The two foreign bodies already alluded to, were noticed & passed & the probe went in, to its full length, leaving me only a line & a half of its length, to hold by--   This, carried to its full length (about 7 in') to its porcelain tip, struck against what, at first seemed to be the ball--  But farther exploration 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 & 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 & laid over his abdomen & extremities & as in a little time, the mustard found to have been useless, [...] – A new set of strong, fresh Sinapisms were prepared & his body & limbs enveloped in them. Bottles & jugs of hot water were placed [sic] him & 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 ago, had promised [text is crossed out] so many years yet to come of happy life & goodness to all men.--    

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      Page 4 transcript
      4.
      As remarked before, the Presidents [sic] condition, was very much dependent upon the State of flow from his wound--  As long as the discharge of blood was free & steady – tho' in [a] small stream, his respiration & sleep were composed but in a few moments, after the orifice of the wound was plugged, or [text is crossed out] impeded the difficulty of respiration began & increased, until it was of the most stertorous, purging character-- If I made slight pressure on the scalp & occiput below the orifice of the wound, there would spring from the aperture a coaglum [sic] of blood, or a fragment of disorganized Brain tissue-- per saltum-- The flow would [text is crossed out] then, be steady & gentle & almost instantly, the Stertor would yield in intensity. Still more decline & pass away, melting into the gentlest & most calming kind of sleep. His pulse, which was, ^until then, small & [text is crossed out] weak [text is crossed out] -- would then gradually improve & become excellent, again. Notes taken by Dr King, at the Prests [sic] bedside, during the progress of the Case A L
      11 o'clk [sic] his pulse was 41.
      11.5 -- [text is crossed out] 45 & growing weaker
      11.10 mi [sic] 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 [sic] 21. Ecchymosis of both eyes
      12.30-’            54
      12.32-             60
      12.35’--          66        
      12.40’--          69. R Eye much [...], ecchymosis very marked
      12.45’             70  Respr [sic] 27.
      12.55.’            80. [text is crossed out] Convulsive Motsn [sic] of arms, from shoulders as if promotion was performed with [...]
      1.PM.             86. Respir- [sic] 30
      1.30’               95. appearing easier --- Blood & Brain fragts [sic] had been allowed to flow from him
      1.45.’              Very quietRespirt: [sic] irregular 
      2.10’               pulse & Respiration gradually fell & [...]
      2.30’               Prest [sic] very quiet Pulse 54. Respr 28.
      2.52:               Pulse 48 -- Respr 30.
      3.25’               Respr 24- & regular
      4 AM.             Respr 26. regular

      (Turn to other side)

      Case A L
      4.15’              Pulse 60. Respr: 25
      5.50’                 “              “      28
      6.30               State failing & labored breathing
      at this time the least touch of his body surface, would
      cause an electric jerk thru body

      7.                   Pulse & Respiration failing much 
      7.22               Death closed the scene-- He slept



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      Page 5 transcript
      The amt [sic] of Brain tissue broken up & discharged, from receipt of the wound, to the [text is crossed out] dying moment, must have been considerable [.] Those gentlemen, who were present, & aided to remove the Prest [sic] to Mr Petersen’s house have stated to me-- that much brain was lost in transporting the body across the street--  During my presence, the lost [sic] of brain substance was considerable for the ball [...] was large & evidently produced by a large projectile -- At times when seated by, counting the pulse, I noticed that the stertorous breathing became very disturbing & the flow from the wound was almost null --  Suddenly, there burst forth from the wound, on several occasions, small pieces of brain & coagula of blood-- followed by a gentle, steady trickling of blood --  This [text is crossed out] phenomenon was always productive of the greatest improvement - the respiration & pulse were instantaneously improved - It is impossible to say how much cerebral substance was lost - but at the least all that which had been broken up in the track of ball from occiput, to its resting 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 & brain debris arrested the flow -- & then the stertor & labored breathing were disturbingly painful, to witness & its flow was at once [...], as prolonging life & depriving [text is crossed out] death of the same attendant horrors, which would need [...] have honored the souls of the [text is crossed out] relatives & friends who with throbbing hearts witnessed the passing away of this great man in Israel;

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      5.)
      The next day, previous to the process of Embalment [sic], I proceeded to the autopsy of our late President, having requested my friends Asst Surgeons J Javier Woodward & Curtis USA, to be present & as [text is crossed out] skilful [sic] [...] Anatomists to conduct the examination--  There were present, Surgeon Genl Barnes USA, Dr Crane USA, & Dr Taft USA. It was my intention, [text is crossed out] ^ after the permission was accorded me to make this PM exam[ina]tion, to have invited a limited number of my professional brothers to be present & more particularly these gentlemen, who had been so kind & unintermitting in their attentions to the victim--  But to my great surprise I found, that every thing had been advanced -- that it was absolutely necessary to proceed at once to the Embalmment [sic] of the body, which Dr Brown the Embalmer told me, would immediately follow our necropsy. -- I was thus unavoidably deprived of the [text is crossed out] privilege I should have indulged -- of inviting members of this Society to be present--  Having heard this statement, my brethren & especially those, like Dr Lieberman[,] Ford & others who so kindly aided & counselled me this [sic] that long & painfully trying night-- I am sure will hold me acquitted of any want of courtesy to themselves thereby -- I could not have altered things.
       
      Before proceeding to the autopsy, we noticed that the ecchymosis of the orbits of eyes, was very intense & had passed on to the temples & [...] surface --The Right Eye, had lost its protrusion, as hitherto described & 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 oedema [sic] about the wound & some extravasation of [text is crossed out] blood around the [text is crossed out]. The wound itself, seemed a clean cut gaping slit thro the scalp --  In the occipital bone itself, the ball infire was a clean cut, circular opening -- singularly free from all [text is crossed out] splinters or roughnesses & appeared as it had been cut thro the bone, with a sharp punch -- between the scalp [text is crossed out] & the bone orifices, we removed a little shaving of lead, which had evidently been passed from the ball, as it drove thro the harder tissue --
       
      We proceeded to the Examin[tn] [sic] by dividing scalp from ear to ear & sawing off the Calvarium -- When the scalp was removed, we found 

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      Page 7 transcript
      6. that the ball pierced the occipital bone, one inch to the left of the median line & had traversed the upper edge of the Left lateral Sinus, a little to the left of the Torcular Herophilii [sic]. This wound in the occipital bone was remarkably smooth & as particularly noted by Dr Woodward, spherical in shape & bevelled off, from without inwards, so that the aperture of the internal table of Cranium, was decidedly larger than that of the outer table.  Thence passing forward ^ almost in the horizontal plane the ball pierced the Dura Mater & reached the posterior lobe of the Left hemisphere of the brain. There piercing thru cerebral substance, it entered the left Lateral ventricle of the Brain behind & following the course of that cavity, very accurately, inclining upwards & inwards it ploughed the upper part of the Thalamus Nerve Opticum & lodged in the white cerebral substance, just above the Corpus Striatum of the left side [.]
       
      In the track of the ball, the brain was in a pulpy disorganized state & around the track, was pultaceous & livid from capillary hemorrhage [.] About 2½ inches, in the track, within the orifice of wound, the 1st piece of occipital bone, driven in by the ball was discovered -- A 2d [sic] & larger fragment of the Same was discovered further forwards about 4 inches within [text is crossed out] orifice & the ball, still further in -- The track of the ball was filled with coagulated blood. -- Indeed the whole brain seemed engorged with blood [...]