Robert E. Lee's Last Stand: His Dying Words and the Stroke That Killed Him. (P1.294)

Abstract

OBJECTIVE: To review historical details of the stroke preceding the death of Robert E. Lee, and offer perspective on the understanding and management of cerebrovascular disease in the late 19^th century. BACKGROUND: On the evening of September 28, 1870, Robert Edward Lee suffered a stroke. He died two weeks later at the age of 63 ending one of the most storied lives in American history, yet little has attended to his death and the nature of his stroke. DESIGN/METHODS: Investigation of Lee’s medical history and death from Lee - The Last Years by C.B. Flood; including accounts by his physicians, Drs. H.T. Barton and R.L. Madison, close friend Col. W.P. Johnston, and family. RESULTS: In the autumn of 1870, while serving as president of Washington College, Lee regularly experienced fatigue, shortness of breath with exertion, and chest pains. Previous diagnoses included “rheumatism” and “pericardial inflammation” - Fredericksburg (1863). On September 28, Lee stood to say grace over supper, “opened his mouth but no words came out.” Sitting back in his chair, he “bowed down, looking very strange and speaking incoherently.” His physicians found no paralysis or “apoplexy” but diagnosed “venous congestion of the brain” secondary to “cerebral exhaustion.” In following days, observers noted “⋯his lips never uttered a sound!” and “for the most part communicated with nodding or shaking his head.” Therapy included bed rest, turpentine, strychnine, and morphine. The morning of October 12, he developed a “feeble, rapid pulse” and “shallow breathing.” Lee’s reported last words were, “Tell Hill he must come up!” “Strike the tent!” Yet, his daughter at the bedside recalled only “struggling” with “long, hard breathes,” and “in a moment he was dead.” CONCLUSIONS: Lee suffered chronic angina and congestive heart failure, with a probable myocardial infarction during the war. His death stemmed from an acute, possibly cardioembolic stroke manifesting as expressive aphasia, and subsequent respiratory complications. Given his aphasia, Lee’s famous last words are questionable.

Disclosure: Dr. Southerland has received personal compensation in an editorial capacity for Neurology Podcast.