“‘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 exertion 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 followed 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 present 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 apparent 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 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 following 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 delicate 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 was now 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 fearful 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, debility and exhaustion of life was manifestly the clearest phenomenon visible.
“‘This was accompanied with an interrupted action of the muscles of voluntary motion, great weakness of the loins, inability to protract beyond a few minutes any mental effort without pain, weight and uneasiness in the head, together with soreness in the region of the cervical vertebræ; 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 condition of parts. All the symptoms being of a depressed order, exhaustion and weakness predominating in all the functions, the clear indication in the case was to reënergize 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 efforts of the diseased parts, and a gradual stringing up and intonation of the whole body under the influence of mountain air, mountain water, and change of climate. Within five weeks, the effects of this treatment were marked and clearly visible to all. So emphatic 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, with 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 Senator’s health greatly facilitated.
“‘Yours truly,
“‘R. M. Jackson.
“‘Cresson, Nov. 12, 1856.’
“Since Mr. Sumner’s return to Boston, he has been gradually improving. 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 time, 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 assumed the external appearance of health. Time and mental repose 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 I am inclined to the opinion of Dr. Jackson, ‘that the brain, as well as the spinal cord, has been the seat of some serious lesion.’ The 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 conclusion. 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.”
This diagnosis does not extend beyond December, 1856. Subsequent newspapers contain notices of the case. The diagnosis, at a later day, by Dr. Brown-Séquard, has never been published.