Lincoln Assassination

[LincolnAbraham]

I've been doing some research on the events of Lincoln's assassination and came across this first-hand account of Dr. Charles A. Leale, an army surgeon who had been in attendance on April 14, 1865 when Lincoln was shot. He was the first doctor to tend to the president after he had been shot and before the Surgeon General arrived at Ford's Theater. He was also the first to pronounce Lincoln's wound mortal. Here is an excerpt of Leale's account of the events:

"I placed my finger on the President's right radial pulse but could perceive no movement of the artery. For the purpose of reviving him, if possible, we removed him from his chair to a recumbent position on the floor of the box, and as I held his head and shoulders while doing this, my hand came in contact with a clot of blood near his left shoulder. Remembering the flashing dagger in the hand of the assassin, and the severely bleeding wound of Major Rathbone, I supposed the President had been stabbed, and while kneeling on the floor over his head, with my eyes continuously watching the President's face, I asked a gentleman to cut the coat and shirt open from the neck to the elbow to enable me, if possible, to check the hemorrhage that I thought might take place from the subclavian artery or some other blood vessel. This was done with a dirk knife, but no wound was found there. I lifted his eyelids and saw evidence of a brain injury. I quickly passed the separated fingers of both hands through his blood matted hair to examine his head, and I discovered his mortal wound. The President had been shot in the back part of the head, behind the left ear. I easily removed the obstructing clot of blood from the wound, and this relieved the pressure on the brain.

The assassin of President Lincoln had evidently carefully planned to shoot to produce instant death, as the wound he made was situated within two inches of the physiological point of selection, when instant death is desired. A Derringer pistol had been used, which had sent a large round ball on its awful mission through one of the thickest, hardest parts of the skull and into the brain. The history of surgery fails to record a recovery from such a fearful wound and I have never seen or heard of any other person with such a wound, and injury to the sinus of the brain and to the brain itself, who lived even for an hour.

As the President did not then revive, I thought of the other mode of death, apnoea, and assumed my preferred position to revive by artificial respiration. I knelt on the floor over the President, with a knee on each side of his pelvis and facing him. I leaned forward, opened his mouth and introduced two extended fingers of my right hand as far back as possible, and by pressing the base of his paralyzed [Pg 6]tongue downward and outward, opened his larynx and made a free passage for air to enter the lungs. I placed an assistant at each of his arms to manipulate them in order to expand his thorax, then slowly to press the arms down by the side of the body, while I pressed the diaphragm upward: methods which caused air to be drawn in and forced out of his lungs.

During the intermissions I also with the strong thumb and fingers of my right hand by intermittent sliding pressure under and beneath the ribs, stimulated the apex of the heart, and resorted to several other physiological methods. We repeated these motions a number of times before signs of recovery from the profound shock were attained; then a feeble action of the heart and irregular breathing followed.

The effects of the shock were still manifest by such great prostration, that I was fearful of any extra agitation of the President's body, and became convinced that something more must be done to retain life. I leaned forcibly forward directly over his body, thorax to thorax, face to face, and several times drew in a long breath, then forcibly breathed directly into his mouth and nostrils, which expanded his lungs and improved his respirations. After waiting a moment I placed my ear over his thorax and found the action of the heart improving. I arose to the erect kneeling posture, then watched for a short time, and saw that the President could continue independent breathing and that instant death would not occur.

I then pronounced my diagnosis and prognosis: "His wound is mortal; it is impossible for him to recover." This message was telegraphed all over the country."

This is from Leale's book, Lincoln's Last Hours, which can be found for free at Gutenberg.org.

What do you think?

 

[Mrs. V]

Interesting that he is describing mouth to mouth resuscitaion. I had no idea that the technique was known so long ago. I wonder if he did more harm than good by removing the clot though. Then again, I'm not a doctor!

 

[LincolnAbraham]

Hi Mrs. V,

That part struck me, too! Apparently, though, by putting his finger in the bullet hole, Leale was able to remove several clots, each time helping the president breathe a little more easily. Interesting, too, that mouth-to-mouth dates back at least to the 1700s: http://cpr.heart.org/AHAECC/CPRAndECC/AboutCPRFirstAid/HistoryofCPR/UCM_475751_History-of-CPR.jsp. I just learned something, too!

 

[huskerblitz]

Dr. Leale has been highlighted in a number of documentaries about the assassination. Giving the time period, it sounds as if Leale did the best he could for Lincoln. Doctors are divided on whether or not Lincoln could have survived the wound even with modern day techniques.

 

[Aussie Billy Sherman]

I wonder if Lincoln could be helped with today's medicine.

 

[WJC]

I've been doing some research on the events of Lincoln's assassination and came across this first-hand account of Dr. Charles A. Leale, an army surgeon who had been in attendance on April 14, 1865 when Lincoln was shot. He was the first doctor to tend to the president after he had been shot and before the Surgeon General arrived at Ford's Theater. He was also the first to pronounce Lincoln's wound mortal. Here is an excerpt of Leale's account of the events:

"I placed my finger on the President's right radial pulse but could perceive no movement of the artery. For the purpose of reviving him, if possible, we removed him from his chair to a recumbent position on the floor of the box, and as I held his head and shoulders while doing this, my hand came in contact with a clot of blood near his left shoulder. Remembering the flashing dagger in the hand of the assassin, and the severely bleeding wound of Major Rathbone, I supposed the President had been stabbed, and while kneeling on the floor over his head, with my eyes continuously watching the President's face, I asked a gentleman to cut the coat and shirt open from the neck to the elbow to enable me, if possible, to check the hemorrhage that I thought might take place from the subclavian artery or some other blood vessel. This was done with a dirk knife, but no wound was found there. I lifted his eyelids and saw evidence of a brain injury. I quickly passed the separated fingers of both hands through his blood matted hair to examine his head, and I discovered his mortal wound. The President had been shot in the back part of the head, behind the left ear. I easily removed the obstructing clot of blood from the wound, and this relieved the pressure on the brain.

The assassin of President Lincoln had evidently carefully planned to shoot to produce instant death, as the wound he made was situated within two inches of the physiological point of selection, when instant death is desired. A Derringer pistol had been used, which had sent a large round ball on its awful mission through one of the thickest, hardest parts of the skull and into the brain. The history of surgery fails to record a recovery from such a fearful wound and I have never seen or heard of any other person with such a wound, and injury to the sinus of the brain and to the brain itself, who lived even for an hour.

As the President did not then revive, I thought of the other mode of death, apnoea, and assumed my preferred position to revive by artificial respiration. I knelt on the floor over the President, with a knee on each side of his pelvis and facing him. I leaned forward, opened his mouth and introduced two extended fingers of my right hand as far back as possible, and by pressing the base of his paralyzed [Pg 6]tongue downward and outward, opened his larynx and made a free passage for air to enter the lungs. I placed an assistant at each of his arms to manipulate them in order to expand his thorax, then slowly to press the arms down by the side of the body, while I pressed the diaphragm upward: methods which caused air to be drawn in and forced out of his lungs.

During the intermissions I also with the strong thumb and fingers of my right hand by intermittent sliding pressure under and beneath the ribs, stimulated the apex of the heart, and resorted to several other physiological methods. We repeated these motions a number of times before signs of recovery from the profound shock were attained; then a feeble action of the heart and irregular breathing followed.

The effects of the shock were still manifest by such great prostration, that I was fearful of any extra agitation of the President's body, and became convinced that something more must be done to retain life. I leaned forcibly forward directly over his body, thorax to thorax, face to face, and several times drew in a long breath, then forcibly breathed directly into his mouth and nostrils, which expanded his lungs and improved his respirations. After waiting a moment I placed my ear over his thorax and found the action of the heart improving. I arose to the erect kneeling posture, then watched for a short time, and saw that the President could continue independent breathing and that instant death would not occur.

I then pronounced my diagnosis and prognosis: "His wound is mortal; it is impossible for him to recover." This message was telegraphed all over the country."

This is from Leale's book, Lincoln's Last Hours, which can be found for free at Gutenberg.org.

What do you think?

I look forward to the comments on this from any medical professionals among our colleagues.

 

[LincolnAbraham]

Thank you, Aussie Billy Sherman. I wondered, too, if Lincoln would have been helped by modern medicine. Maybe his life could have been saved, but if he had lived, he would probably not have been the same man.

 

[DixieRifles]

I placed an assistant at each of his arms to manipulate them in order to expand his thorax, then slowly to press the arms down by the side of the body, while I pressed the diaphragm upward: methods which caused air to be drawn in and forced out of his lungs.

This is another form of resuscitation that I learned for my Boy Scout Life Saving merit badge. I don't think the Boy Scouts knew about mount-to-mouth in 1965.

 

[kholland]

Hi Mrs. V,

That part struck me, too! Apparently, though, by putting his finger in the bullet hole, Leale was able to remove several clots, each time helping the president breathe a little more easily. Interesting, too, that mouth-to-mouth dates back at least to the 1700s: http://cpr.heart.org/AHAECC/CPRAndECC/AboutCPRFirstAid/HistoryofCPR/UCM_475751_History-of-CPR.jsp. I just learned something, too!

In reading his book he mentions that while he was kneeling next to Lincoln, two doctors arrived on the scene, Charles Taft and Albert F. A. King. And even though Leale was in his early twenties they followed medical protocol and considered him the "lead physician" as he had been initially involved. And even when they decided to carry him to the Peterson House they stopped a few tines so Leale could clean out the clots in the wound.

Below is a link to a very detailed explanation from the Atlantic.com website about how he may have been saved using modern medical tools.

https://www.theatlantic.com/health/...ln-have-survived-if-he-was-shot-today/281680/

 

[LincolnAbraham]

Thank you for the link to that excellent article, kholland!

 

[amweiner]

Interesting stuff, thank you for posting! From what I've read, Lincoln wasn't breathing until Leale removed the clot, so I don't imagine it was harming anything.

As for whether or not he might have been saved, that would be an interesting discussion. I'd be curious to hear from medical folks here about this.

 

[Cavalry Charger]

Off the top of my head, haven't read that article yet, an injury to the brain often involves swelling which has to be relieved as soon as possible to prevent permanent brain damage. Surgeons will sometimes drill a hole into the skull to help relieve the pressure of internal bleeding, or even remove a portion of the skull temporarily to allow for the swelling until it goes down. These are important measures in relation to brain injuries, and I'm guessing removing those clots was beneficial in the circumstances. Usually you want to stop bleeding, but internal bleeding with regard to a brain injury is deadly business.

 

[JPK Huson 1863]

It's all beyond what I could conjecture. The brain is such a mystery? Even in those days of rudimentary medicine we read of the most shocking head wounds- bullets passing through the skull and men living to father children. Crazy stuff. It doesn't sound like Lincoln could have gotten better care than the men who were coincidentally there.

Can't imagine just going to see a show, all of sudden you're immersed in one of the most famous murders of all time.

 

[huskerblitz]

As for whether or not he might have been saved, that would be an interesting discussion. I'd be curious to hear from medical folks here about this

I can't recall which one, but it was a television documentary that explored whether or not he could have survived given today's technology. One who did say he might have survived did also say he would have been in a vegetative state and concluded perhaps the original outcome might be better.

If I remember which documentary it was I'll post it here.