/j^eAAM. fwt- • S• ) CASE OF HON. CHARLES SUMN'E'fc. BY MARSHALL S. PERRY, M.D., OF BOSTON^VW O Communicated to the Boston Society for Medical Improvement, Dec. 8th, 1856. The assault was made upon Mr. Sumner in the Senate of the United States, on Thursday, May 22d. The first blow produced insensibility. It is not certain how many blows he received ; they were many. He bled profusely, and fell insensible on the floor. When he was removed to the ante-room, it was thought he could not survive. His wounds were dressed by Dr. Boyle. He had two gashes on the back of the head, one above each ear, about two, or two and a half inches in length. These gashes went through the scalp to the bone, which was laid bare, but it is supposed not fractured. Besides these, he had bruises on the face, on the back of each hand and on the arms. From the time of the attack until the Monday following, no seri- ous symptoms manifested themselves, except some pain and sore- ness in the head, and nervousness. Tuesday morning he had more pain, and in the afternoon he was quite feverish. During the night the pain became very violent, and when 1 saw him early on Wednesday, for the first time, professionally, he had a high fever, pulse 104, intense pain in the head, eyes suffused, and extreme ner- vousness. The scalp above the right ear was inflamed, having the appearance of erysipelas. This inflammation extended to the glands of the neck, which were swollen and tender Jo the touch. On examination, it was found that pus had formed under the scalp, which escaped readily on opening the wound, which had been •2 closed over with collodion by Dr. Boyle. Mr. S. had suffered so much during the last ten hours, that he had become very much exhausted. He was put under the influence of opium ; the wound was poulticed, and perfect rest enjoined. For three days he was in a critical situation. The local inflammation, the danger of poison from the absorption of pus, and the extreme nervous ex- haustion, made it a formidable case. At the end, however, of this time, he appeared to be out of immediate danger. The wound on the left side of the head healed by first intention. It was several weeks before that on the right side closed over. During this time he was very weak, had some fever, especially when excited, and was confined mostly to his bed. He did not at that time complain of much pain in his head, but as the wound healed after several weeks, he had neuralgic pain in the back of the head, coming on in paroxysms. As these passed away, he had a feeling of oppressive weight or pressure of the brain, which was increased when excited or engaged in conversation. He described it as " a 56-pounds weight " upon his head. At the same time he lost flesh and strength, his appetite was irregular, and his nights wakeful—sometimes lying awake all night, or when sleeping, dis- turbed. He had also increased sensibility of the spinal cord, and a sense of weakness in the small of the back. These were developed by walking, and every step he took seemed to produce a shock upon the brain. His walk was irregular and uncertain, and after slight efforts he would lose almost entire control of the lower extremities. In this condition he was advised by Dr. Lindsly, of Washington, to remove from that place to some more quiet spot. He accordingly came to Philadelphia, and there called upon Dr. Wister for advice. Mountain air and complete seclusion were recommended ; but Mr. Sumner undertook first to try the sea air, and went to Cape May. Here he was very weak, so that he was unable to bathe, and he finally left without any sensible improvement. On the recommen- dation of Dr. Wister, he went to Cresson, in the Alleghany Moun- tains. While there he was in the family of Dr. R. M. Jackson, and under his medical direction. 3 The following letters, received from Drs. Wister and Jackson, describe Mr. Sumner's condition while under their care. Philadelphia, Oct. Will, 1856. Dr. M. S. Perry,—Dear Sir,—It gives me much pleasure to reply to your note of inquiry concerning the health of Mr. Sumner. You are perfectly aware of the condition of Mr. S. when he reached this city on the 9th of July ; a condition of extreme ner- vous exhaustion, his circulation feeble, and in fact every vital power alarmingly sunken. At that lime his steps were feeble and totter- ing, as in extreme old age ; he complained of constant pain in the back and lower extremities; in the latter, it was a tired and weary sensation, and he had a sense of constriction and pressure about the head. At that time his pulse was quick and small, ap- petite languid, and his sleep broken, disturbed and unrefreshing. All the above conditions were heightened by exertion, either mental or physical. I could find no evidence of organic disease. 1 understood Mr. Sumner to be in that state of extreme nervous exhaustion from which men are months, and, at times, even years, in being fully restored. Mr. Sumner has done eminently well. His present state is but a shadow of that above described ; and although none of the features of the past are lost, they are only evident when imprudent exertion, mental or physical, shall call them up. Within the limits of exer- tion of an ordinary retired gentleman, Mr. Sumner improves daily, and all his powers improve, with a steady progress towards perfect health. Indiscretion brings on morbid wakefulness, and in the re- curring outline of his former condition, admonishes him that though recovering, he is still in risk. With much respect, truly yours, Caspar Wister. LETTER FROM DR. JACKSON.* You ask for a brief report of the case of the Hon. Charles Sumner, as it came under my observation during his visit and stay * This letter was addressed to Hon. H. Wilson. 4 on the Alleghany Mountain in Pennsylvania. Mr. Sumner came to Cresson on the 3d of August last. On his arrival, he had the appearance of a man who had been sick for a long time, and was still extremely unwell. Careful observations and examinations of the case, for some time, revealed the following appearances and symptoms. The lips were pale, showing a watery condition of the blood, evinced also by general pallor of the countenance and flabbiness of the solids. The action of the heart and arteries was weak, the pulse being slow and languid. On the surface of the head the integuments showed a slight redness around the cicatrices of the recently-healed cuts; also some morbid sensibility on pressure. Efforts at walking gave a tottering and uncertain gait, as if from partial paralysis (say threatened paraplegia), the steps being short and unsteady, the muscles evidently not under the complete control of the will, the limbs even giving way partially. The slightest exer- tion was followed by lassitude, quite disproportioned to the efforts. His nights were frequently passed in a state of morbid wakefulness, and general uneasiness. The action of the brain was always fol- lowed by a sense of weight and dull throbbing pain in the head. This result invariably followed even the slightest mental effort of writing a common letter of business. The entire chain of symptoms soon pointed to the head and spine as the seat of a highly morbid condition. The contents of the other cavities of the body seemed normal. As no regular medical report had been given me of the case before its arrival at the Mountain, its original condition after the assault had to be inferred from pre- sent inspection, without the history of its progress. From this it was clearly evident that the brain and spinal cord had been the seat of a grave and formidable lesion. As the first violent symptoms had passed off, the consequences of which, veiled and obscure, were the only evidence by which the case could be read, it was clearly appa- rent that its present pathological condition was of a most serious character, and had been preceded by impending danger to life. From all the facts, it was evident that from the blows upon the skull, 5 there must have been either congestion, or concussion followed by congestion, or positive inflammation of the brain or its investing membranes in this case. Actual fracture is not at all necessary to this result. In Hope's Pathological Anatomy, we have the follow- ing statement: " In several cases of fracture of the skull, and in some of injury of the scalp alone (!), I have found pus, either liquid or of a pasty consistence, between the bone and the dura mater, and adhering to both." Thus inflammation and its products on the interior of the skull proceed from " injuries of the scalp alone." The injury occurring in a subject of a highly impressible and deli- cate nervous temperament, at a time in which the central organ of the nervous system was exhausted by excessive mental tension for days and nights of severe effort, carried with it impending destruction. The insidious danger of the first injury wasnow only to be estimated by its threatening consequences at the stage of progress of the case when it arrived at the Mountain. All too plainly marked by fear- ful features the true character of the effects of the assault in the Senate, and plainly showed their fatal tendencies in the condition of the man. At this stage of the case, whatever might have been, or might now be the condition of the suffering internal organs, de- bility and exhaustion of life was manifestly the clearest phenomenon visible. This was accompanied wilh an interrupted action of the muscles of voluntary motion, great weakness of the loins, inability to pro- tract beyond a few minutes any mental effort without pain, weight and uneasiness in the head, together wilh soreness in the region of the cervical vertebras ; all of which symptoms, taken together, demonstrate a case ravaged by severe disease in the great nervous centre, and showing in that region still a highly pathological condi- tion of parts. All the symptoms being of a depressed order, ex- haustion and weakness predominating in all the functions, the clear indication in the case was to reenergize the man in every way,and by every influence. This, it seemed, would be most effectually secured by a judicious diet, mild tonic agents, constant exercise in the open air on horseback, or in a carriage, and by cessation of all active 6 efforts of the diseased parts, and a gradual stringing up and intona- tion of the whole body under the influence of mountain air, moun- tain water, and change of climate. Within five weeks, the effects of this treatment were marked and clearly visible to all. So em- phatic were they in the consciousness of Mr. Sumner, that he could not be persuaded he was still an invalid, and not almost well and ready for the field of active operations. He left the Mountain prematurely, before he was hardened and his body restored to its normal tone. This was done contrary to my urgent advice and entreaties. It was clearly apparent, that wilh one more month of the bracing influences of the Mountain, he would have been much better than at present, and the perfect final restoration of the Sena- tor's health greatly facilitated. Yours truly, Cresson, Nov. 12th, 1856. R. M. Jackson. Since Mr. Sumner's return to Boston, he has been gradually im- proving. He has followed a rigid system of exercise in the open air, and carefully avoided all intellectual excitement. The pressure in his head, or sensation of weight, which formerly came on after the slightest mental or physical exertion, and which was very oppressive, is now felt only after great fatigue, or considerable effort of the mind. He still complains, after sitting up for a long lime, of pain in his back ; and when he rises from his bed or chair, he finds at first some difficulty in using the muscles of the lower extremities, but after walking a short time they become quite flexible and under the complete control of the will. His appetite is good, he sleeps much better than he did, and is gaining flesh and strength. I see no reason why he may not entirely recover, unless he allows himself too soon to enter upon his senatorial duties. He has already as- sumed the external appearance of health. Time and mental re- pose will do the rest. I think it is impossible to decide, with absolute certainty, what the pathological condition of Mr. Sumner's brain has been ; but 1 am in- clined to the opinion of Dr. Jackson, that the base of the brain, as well as the spinal cord, has been the seat of some serious lesion. The 7 long-continued sense of weight in his head, the pain along the spine, the partial loss of power in the lower extremities, the loss of flesh during the first three months after the attack, and the wakefulness without any affection of the mind, would lead, I think, to this con- clusion. Had the patient died, a post-mortem examination would have determined conclusively the character of the injury; but we can only make an approximation to a true appreciation of the case by a cautious interpretation of the symptoms,