Tuesday, November 17, 2020

A Comprehensive Account of President Lincoln's Doctors' Beginning from the Assassin's Gunshot on April 14, 1865 through Abe's Death on April 15th.

The First Doctor At Ford's Theatre To Treat Lincoln
"When I entered the box the ladies were very much excited. Mr. Lincoln was seated in a high-backed arm-chair with his head leaning towards his right side supported by Mrs. Lincoln who was weeping bitterly. Miss Harris was near her left and behind the President." While approaching the President I sent a gentleman for brandy and water.

Those are the words of Charles Augustus Leale, M.D. who was a 23-year-old Union Army Surgeon in the Civil War, who was in attendance at Ford's Theatre on April 14, 1865, when John Wilkes Booth entered the presidential box and shot Lincoln in the head days after the conclusion of the War.


NOTE: Noyes W. Miner, pastor of the First Baptist Church in Springfield, Illinois, who wrote of his conversations with Mary Todd Lincoln in 1882, and several other references, that these were Abraham Lincoln’s last words in the Ford's Theatre state box: “We will visit the Holy Land, and see those places hallowed by the footsteps of the Savior. There is no city on earth I so much desire to see as Jerus[alem].” With that last half spoken word, the bullet fired from John Wilkes Booth's pistol entered Lincoln's brain.
Charles Augustus Leale, M.D. (1842-1932)
The young doctor was sitting just 25 feet away from the Lincoln box, giving him a front-row seat to the tragedy. He then became the first doctor to treat Lincoln, supervising his care until the president's own doctor arrived.

Dr. Leale's long-lost report of what happened that evening, and his actions, are now online thanks to Papers of Abraham Lincoln, a group that searches for documents written by, to, or about the nation's 16th president.

In his account, Dr. Leale wrote that he was in the audience at Ford's Theatre that night.
"The theatre was well filled and the play of 'Our American Cousin' progressed very pleasantly until about half-past ten," he reported, "when the report of a pistol was distinctly heard and about a minute after a man of low stature with black hair and eyes was seen leaping to the stage beneath, holding in his hand a drawn dagger. 
I then heard cries that the 'President had been murdered,' which were followed by those of 'Kill the murderer' 'Shoot him' etc. which came from different parts of the audience.

I immediately ran to the President's box and as soon as the door was opened 'O Doctor, do what you can for him, do what you can!' I told her we would do all that we possibly could."
Dr. Leale began examining Lincoln, quickly discovering the gunshot wound to the president's head. "As soon as I removed my finger," he wrote, "a slight oozing of blood followed and his breathing became more regular and less stertorous. The brandy and water now arrived and a small quantity was placed in his mouth, which passed into his stomach where it was retained."

Other physicians arrived moments later. It was then decided to move Lincoln across the street to the nearest house of William and Anna Petersen's House, 453 (516 today) Tenth Street Northwest, Washington, D.C.

From there, Dr. Leale's account is mostly one of the physicians' efforts to make the president comfortable and to monitor his breathing. There's no indication they thought there was anything they could do to save Lincoln.

It was at 6:50 AM, Dr. Leale reported, when:
"The respirations cease for some time and all eagerly look at their watches until the profound silence is disturbed by a prolonged inspiration, which was soon followed by a sonorous expiration.

The Surgeon General now held his finger to the carotid artery. Col. Crane held his head, Dr Stone who was sitting on the bed, held his left pulse, and his right pulse was held by myself.

At 7.20 AM. he breathed his last and 'the spirit fled to God who gave it.' "
Dr. Leale ends with this: "Immediately after death had taken place, we all bowed and the Rev. Dr. Gurley supplicated to God in behalf of the bereaved family and our afflicted country."

Dr. Charles A. Leale's letter dated November 3, 1866, requested by General John Harrison Littlefield.
Below is the original handwritten four-page manuscript on onionskin paper from Dr. Leale describing the events of April 14-15, 1865 at Ford's Theater and the night that followed after the assassination of the President. The letter is dated Nov. 3, 1866, and is in response to a request by General John Harrison Littlefield (a personal friend of Abraham Lincoln, and studied law with him in Springfield, Illinois) for details of those two days. He apparently used this information in engraving "Deathbed of Lincoln," published in 1868.
CLICK TO SEE THE COMPLETE HANDWRITTEN LETTER
THE LETTER:
Hon. John H. Littlefield,
670 Fulton Street
Brooklyn, New York

Dear Mr. Littlefield,

In accordance with your request, please find a brief statement of the last hours of President Lincoln. I sincerely hope that you will meet with perfect success.

Very Truly Yours,
Charles A. Leale

November 30, 1865

"After President Lincoln had been fatally wounded, it was fortunate for the nation that Mrs. Lincoln was able so soon to secure the services of an experienced young Army surgeon, who by his prompt and efficient action prevented the immediate death of the president, and prolonged his life for eight hours at a time when the sympathy for the dying martyr overcame much of the malice of the enemies of our country.

These eight hours gave the Cabinet Officers time to carefully consider the duties they so faithfully performed in continuing in office, unbroken by a single day as president of the United States. I allude to Dr. Charles A. Leale, who was then stationed in Washington in charge of the ward containing the wounded officers and was executive officer of Armory Square Hospital. He was the first surgeon to reach the President after he was shot, and at the special request of Mrs. Lincoln took charge of him. Explained the fatal extent of his injury and did all possible to restore the feeble heart’s action and by the immediate application of his knowledge of gunshot wounds soon overcame the shock and relieved the brain pressure, thereby preventing the death of the President in the theatre. In response to many inquiries, Dr. Leale then said that the wound was mortal and that recovery was impossible. As soon as Mr. Lincoln had partially recovered from the shock, Dr. Leale began his removal from the scene of the tragedy to a place of safety. Dr. Leale carried the head and shoulders of the President, and with the assistance of others, reached the streets, where the surging excited populace crowded forward and obstructed the exit from the theatre. He called out three times, “Guards, clear the passage!” and with the assistance of a captain present who reported for duty. Almost immediately two lines of soldiers, with drawn swords, bayonets, pistols and other weapons, stood in the position of present arms and cleared a space about five feet wide across the street, through which the bleeding form of the prostrate president was carried, amid the most profound and solemn silence.

Not a voice was heard, or a shout from the soldiers as their beloved Commander in Chief who so often had visited and comforted them in weary camp life and hospital sickness, was now borne, insensible and dying, to a place of quiet, to a bed in the nearest house [Petersen's home]. 

Dr. Leale was several times asked if he would take Mr. Lincoln to the White House, and each time said “no," inasmuch as death would probably occur before reaching it. After placing the President in bed, Dr. Leale again found it necessary to remove the coagulation from the opening in the cranium, where oozing of blood relieved the brain pressure and breathing was re-established, this is repeated on several occasions and when Dr. Stone and the Surgeon General arrived Dr. Leale explained the good effects which followed these reliefs from brain pressure, and the operation was continued at intervals during the night. 

During the course of the night, there were present Dr. R.K. Stone, Surgeon General J.K. Barnes, Assistant Surgeon General C. Crane, Dr. C.S. Taft, Dr. A.F.A. King, and others. Mrs. Lincoln was attended by Mrs. Senator Dixon who on her last visit to her husband was carried from the room in a fainting condition. The protracted death struggle lasted until twenty minutes past seven o’clock on the morning of April 15, 1865. At the moment of dissolution, Dr. Leale held the right hand of the martyr and closed his eyelids in death, after which the few remaining knelt down around the lifeless form of the patriot and hero, while the Rev. Dr. Gurley earnestly supplicated to God in behalf of the distracted family and our afflicted and sorrowing country.

What a scene for memory and history."

The Doctors' Present at Lincoln's Side
PHYSICIANS PRESENT IN THE STATE BOX AT FORD’S THEATRE

Charles Augustus Leale (Mar 26, 1842 – June 13, 1932); M.D., Bellevue Hospital Medical College, 1865; appointed Assistant Surgeon, U. S. Volunteers, April 8, 1865. The first physician to reach Lincoln and in charge until the arrival of Lincoln's family physician Dr. Stone. Dr. Leale remained with Lincoln until the president’s death. Restored Abraham Lincoln’s airway, breathing, and circulation, to improve Abraham Lincoln’s life chance and assisted in carrying Abraham Lincoln across the street to the Petersen House (held Lincoln’s head).

Charles Sabin Taft (Aug 1835 – Dec 18, 1900); M.D., a surgeon in charge at the Signal Corps Camp of Instruction at Red Hill, Georgetown; Acting Assistant Surgeon, United States Army. The second physician to reach Lincoln (is often placed third because his personal account intimates so). He climbed on the stage and was assisted by members of the audience up to the box, which he entered by climbing over the rail. Taft was active in the artificial respiration measures of Abraham Lincoln. Assisted carrying Abraham Lincoln across the street to the Petersen House (held Lincoln’s right shoulder).

Albert Freeman Africanus King (Jan 18, 1841- Dec 13, 1914); M.D., Columbia Medical College, 1861; University of Pennsylvania, 1865; Acting Assistant Surgeon, United States Army. The third physician to reach Lincoln (is often placed second); was active in the artificial respiration measures of Abraham Lincoln. Observations of the pulse and respiration were noted down by Dr. King at Abraham Lincoln’s bedside. Assisted carrying Abraham Lincoln across the street to the Petersen House (held Lincoln’s left shoulder).

PHYSICIANS PRESENT AT FORD’S THEATRE
(it's doubtful they were in the State Box)

Charles Davenport Gatch (1841- Oct 27, 1870); M.D., served through the war with the armies of General Rosecrans. The fourth physician to reach Lincoln's box (following his own account the third). Was together with his brother Capt. Oliver Cross Gatch (in uniform) in the dress circle of Ford’s. According to Oliver’s own statements, they were asked to the State Box, where Charles came to the conclusion that Abraham Lincoln’s injury was fatal. According to Oliver he helped carry the president to the Petersen House, but this is doubtful because this is not mentioned in any other accounts. The brother's Gatch was almost certainly also not present in the state box since they are mentioned neither by Dr. Leale nor by Taft. Dr. Gatch certainly had no active role in treating president Lincoln. The Gatch brothers’ story (if true) ended when Lincoln was removed from Ford's Theatre.

George Brainard Todd (Apr 30, 1834 – Sep 20, 1874); M. D., served at the end of the war on the Monitor "Montauk” and was at Ford's Theater on the 14th of April, 1865. In a letter addressed to his brother he describes what happened that night and was given a note by an unknown general and told to go to the nearest telegraph office to inform the nation. Dr. Todd had no active role in treating president Lincoln.

Samuel A. Sabin (Sep 20, 1830 – Apr 3, 1871); M.D.; medical division Michigan University, 1857, first surgeon of the Ninth New York Heavy Artillery (Aug 1862 – Jan 1865); practicing in Palmyra, N.Y.; was present in Ford’s and witnessed the assassination. He wrote a letter to his wife Florence the following day, describing what he saw in Ford's Theater. Someone said, "The president is shot," and, thinking there would be no surgeon at hand I might be of service, I ran immediately to the president's box. When I got there, of course, I found everything in the utmost confusion, some calling, for one thing, some for another. As soon as I saw the wound, I saw there was no hope, and another surgeon [Dr. Leale] had stated the same previously... I did not accompany the body across the street as I might have done, dreading to be called as a witness when there should be an investigation.”

PHYSICIANS IN ATTENDANCE AT THE PETERSEN HOUSE
(in addition to Leale, Taft, and King)
NOTE: It took approximately 25 minutes to move the mortally wounded president from Ford's Theatre at 448 (511 today) Tenth Street, across the street to William and Anna Petersen’s boarding house at 453 (516 today) Tenth Street. William T. Clark, a 23-year-old army clerk, rented the back bedroom on the first floor. When theatre goers carried President Lincoln from Ford's Theatre across the street to the boarding house, they brought him to the first floor rear bedroom which Clark, rented. It was only about 40 feet, door to door.
William Morrow Notson (Feb 1836 – Jun 23, 1882); M.D.; Jefferson Medical College, 1861. Medical Officer, Maj. Surg. 1876; U. S. Army, 1862-1882; Brev. Capt. 1863 for gallantry and meritorious service at Gettysburg; Dr. Notson left service after the battle of Fairfield and resided in Washington, D.C. “The 6th United States Cavalry in the Civil War,” says: “He was one of the officers who attended the president from the theater across the street to Mr. Petersen’s house”. Lt. MacLermont of the 11th New York Cavalry recalled that Notson sent for brandy to "revive" Abraham Lincoln. MacLermont pulled off Abraham Lincoln’s boots and opened the back window for some fresh air. Dr. Norton ordered the room to be cleared of everyone under the rank of major. During the night Dr. Notson treated also Seward and wounded members in Seward's chamber. After Abraham Lincoln’s passing Dr. Notson attended the autopsy, but his participation was interrupted to again attend Seward.

Charles Henry L. Liebermann (Sep 15, 1813 – Mar 27, 1886), came to the U.S. early in 1840; M.D., University of Berlin, 1838. Washington physician (practicing at Pennsylvania Ave.); professor of Surgery University of Georgetown 1849-1853 and 1857-1861, President of the Medical Society of the District of Columbia. Was (one of) the first physicians who arrived at the Petersen House. He removed a lock of hair from the area of Lincoln's head near the wound.

Charles Mason Ford (Jun 15, 1840 - Feb 15, 1884); M.D., University of Pennsylvania, 1861. Arrived at Petersen’s House after Dr. Liebermann and before Dr. Stone. During the greater part of the night, the pulsations were counted by Dr. Ford and noted by Dr. King.

Robert King Stone (Dec 11, 1822 – Apr 23, 1872); M.D., University of Pennsylvania, 1845. Family physician of the Lincolns (from their arrival in Washington in 1861) and in charge at Abraham Lincoln’s deathbed from the time of his arrival at the Petersen House (when Dr.  Leale gave control over). He arrived according to Dr. Leale “about 20 minutes after we had placed him [Abraham Lincoln] in bed in the House of Mr. Peterson" (according to Stone himself, he arrived at about 10:15 pm, but this can’t be true; Lieberman and Ford arrived earlier, possibly also Notson).

Joseph K. Barnes (July 21, 1817 – Apr 5, 1883); M.D., University of Pennsylvania, 1838; 12th Surgeon General of the United States Army (1864–1882). Barnes arrived much later than Stone; he was first in attendance on Secretary Seward (until a few minutes after 11:00 pm). It’s unclear Barnes took charge over from Stone (discrepancies between Dr. Leale's two accounts as well as between the accounts of Taft and Dr. Leale).

Charles Henry Crane (Jul 19, 1825 – Oct 10, 1883); M.D.; Harvard, 1847, assistant to Dr. Barnes, medical inspector of prisoners-of-war (Crane was Surgeon General, U. S. Army, 1882-1883) and arrived with him; Col. Crane had charge of Abraham Lincoln’s head "during a great part of the time”.

Ezra W. Abbott (Apr 28, 1819 – Mar 21, 1884); M.D.; homeopathic physician of Concord, N.H. He made a detailed record, at generally five-minute intervals (from 11:00 pm to 7:20 am) of Lincoln's condition and some other events which took place during the last hours (not to be confused with the pulse and respiration table of Ford and King). He preserved a section of the sleeve from Lincoln’s coat, cut away in search of the fatal bullet wound. It was said that he was one of the men who carried the mortally wounded president from Ford’s Theatre.

James Crowdhill Hall (1805 -1880 – in some accounts “Neal Hall” or "J.C. Hall"); M.D.; University of Pennsylvania, 1827; he was at Abraham Lincoln’s deathbed for only a (very) short moment, but in his opinion, Abraham Lincoln’s true condition was that “the president was dead to all intents, although he might live three hours or perhaps longer".

John Frederick May (May 19, 1812 – May 1, 1891); M.D., Columbian Medical College, 1834; Washington physician. Dr. May made a positive identification of the body of John Wilkes Booth when a formal inquest was held aboard the U.S.S. Montauk, based upon the recognition of the scar made by his scalpel, when he removed two years earlier a fibroid tumor from the back of JWB’s neck. Reports say that he was a short moment at the bedside of Abraham Lincoln. No further info is known.

Lyman Beecher Todd (Apr 1832 – May 1902); M.D., Jefferson Medical School, Philadelphia,1854. A (half) cousin (of Lexington, Ky.) and close friend of Mary Todd Lincoln. He was at the deathbed of President Lincoln, but there are no further details known.

Ashbel Woodward (Jun. 26, 1804 - Dec. 20, 1885); M.D.; for many years president of Connecticut Medical Society; no further identification known. Immediately after the removal of Lincoln’s body (from Petersen’s House), Hermann Faber, a medical artist on duty at the Army Medical Museum, entered the room where the president had died and made a sketch, which he showed to Dr. Woodward who provided details of the position of those present at the time of Lincoln’s demise, so “a Dr. Woodward” was there. Drs. Woodward and Barnes approved the accuracy of Faber’s sketch, but was this Ashbel Woodward or Janvier Woodward, who, along with Dr. Edward Curtis, performed the autopsy on President Lincoln? Faber and Janvier Woodward were no strangers to each other... However, there is no supporting evidence that Janvier Woodward was actually at Abraham Lincoln’s bedside.
Mary at Abraham's side weeping uncontrollably.
PHYSICIANS PRESENT AT LINCOLN’S AUTOPSY
NOTE: Nine men were present for the autopsy: Barnes, Crane, Stone, Taft, and Notson, Gen. Rucker of the Army’s Quartermaster Dept., Lincoln’s friend Orville H. Browning and these two doctors:
Joseph Janvier Woodward (Oct 30, 1833 – Aug. 17, 1884); M.D.; University of Pennsylvania, 1853; Woodward performed -and wrote reports on- the autopsies of both Abraham Lincoln and John Wilkes Booth (he also attended to President Garfield after he was shot). Was one of the two doctors/pathologists who performed the autopsy, together with:

Edward George Curtis (Jun. 4, 1838 - Nov. 28, 1912); M.D.; College of Physicians and Surgeons, New York, 1864; Army Surgeon, 1863-1870. He was Woodward's assistant at the Army Medical Museum from 1864 to 1870. Aided Woodward at Abraham Lincoln’s autopsy.

PHYSICIANS CERTAINLY NOT IN ATTENDANCE
(however, still mentioned in some documentation)

Doctor Willard Bliss (Aug 18, 1825 – Feb 21, 1889); M.D.; Cleveland Medical College, 1849; commander of the Armory Square Hospital in 1865. From Dr. Charles A. Leale’s Report (1867) on the Assassination of Abraham Lincoln: “I asked again to have the Surgeon General and Dr. Stone sent for, also sent a special messenger for Surgeon D. W. Bliss then in command of Armory Square Hospital”. Dr. Bliss never attended Lincoln. Dr. Bliss was the M.D. who treated president James A. Garfield after his mortal wounding from a gunshot in July 1881 (now seen as a “mistreatment”).

Anderson Ruffin Abbott (Apr. 7, 1837 – Dec 29, 1913), M.D.; Toronto School of Medicine, 1861; first Canadian person of color to be a licensed physician; participated in the CW as a civilian assistant surgeon (one of eight) in the Union army. Later, he acted as a civilian surgeon in several Washington, DC, hospitals that served Union forces. Became popular in Washington society, resulting in a “friendly relationship between him and the president”. Some claimed that he was at Abraham Lincoln’s deathbed when he accompanied Elizabeth Keckley to the Petersen House. (true or untrue?) Anderson Abbott was never at Abraham Lincoln’s bedside. People who say he was, have confused him with Dr. Ezra W. Abbott. Following Lincoln's assassination, Mary Todd Lincoln gave Abbott the plaid shawl Lincoln wore to his first inauguration.

The Medical Treatment of President Lincoln on his Deathbed at the Petersen House.
In the medical debate over what killed Abraham Lincoln, the most contentious issue is whether sticking fingers and probes into Lincoln’s brain violated a standard of medical care. Standard of care is a loose criterion that refers to how similar one doctor’s treatment of a patient is to the way other qualified doctors would treat the same patient.
The Petersen House is a 19th-century federal style row house located at 453 (516 today)Tenth Street NW, Washington, D.C., circa 1890. On April 15, 1865, President Abraham Lincoln died there. The house was built in 1849 by William A. Petersen, a German tailor. Future Vice-President John C. Breckinridge, a friend of the Lincoln family, once rented this house in 1852. In 1865, it served as a boarding house. In 1877, the bed that Lincoln occupied and other items from the bedroom had been bought by Chicago collector Charles F. Gunther, "The Candy Man." He set up Lincoln's deathbed in his Downtown Chicago candy store to draw customers in. Gunther's collection also included Lincoln's carriage, Lincoln's piano, a towel used to soak up Lincoln's blood, and other items. The deathbed is now owned by and on display at the Chicago History Museum. However, replicas have taken their places. Since 1933, the National Park Service has maintained Petersen House as a historical museum, recreating the scene at the time of Lincoln's death. The bloodstained pillow and pillowcases are the original ones used by Lincoln.


Official medical standards of care did not come into existence until 1907 when the American College of Surgeons created such standards for surgery. The American Medical Association, the oldest medical society in the United States, was created in 1847, but it initially only concerned itself with ethical issues, not medical procedures. There were no licensing requirements and no official standard of care during the Civil War. For the most part, doctors learned doctoring on the job. Most of the medical training older doctors had received had been gained as apprentices to even older doctors. Young doctors such as Charles Leale and Charles Taft, two of the physicians who treated Lincoln after he was shot, received formal training for two years (compared to four years in Europe), and the second year was typically a repetition of the first.

Such modern-day critics as Dr. Richard Fraser, a neuroscientist, accused all of the doctors who treated Lincoln by probing his brain with their fingers and surgical instruments of violating the standard of care for their time, thereby dooming Lincoln. All of them were at fault, opined Fraser, but as the first doctor to treat Lincoln, and the doctor whose description of what went on being the most detailed, Fraser directed the blunt force of his accusations at Dr. Leale. Fraser claimed Dr. Leale ought to have known better. In Fraser’s opinion, it was the direct damage that came from this probing that ultimately killed Lincoln.
Lincoln's deathbed at the Petersen's house.

Fraser was right on two counts, but his implication that Dr. Leale and the other doctors who treated Lincoln had violated standard medical care for that time was not. Even if the gunshot wound had not been fatal, placing fingers and other foreign objects into Lincoln would inevitably have resulted in blood poisoning, and so Lincoln still would have died. There is no question Lincoln’s wounds would have become infected from the unsterile fingers and probes, but at the time, no one knew about germs. Dr. Leale and the other doctors should not be faulted for not knowing something that no one else at the time knew. Doctors would not come to understand and appreciate the importance of sterile conditions until several years after the war. Even so, Lincoln did not die of septicemia. He would have had to have lived much longer than the nine hours after he was shot for septicemia to have been a factor in his death.


However, Fraser was not completely mistaken when he said Dr. Leale and the other doctors doomed Lincoln. Even without septicemia, the additional internal tissue damage and bleeding from their intrusion destroyed whatever chance of survival he might have had. But Fraser was mistaken when he also contended that the doctors should have known better. Lincoln’s loss of consciousness, slow pulse, decreased breathing, and dilation of only one eye in response to light (a condition called anisocoria) are all signs of brain damage. Dr. Leale could not have known the details of that damage, but those symptoms are classic signs of a herniation in the brain in which one part of the brain protrudes into other parts, causing damaging pressure.



Dr. Leale’s goal, and the goal of the other doctors who treated Lincoln, was not to repair Lincoln’s brain damage—that was well beyond medicine’s ability for more than a century. His goal was to relieve the pressure inside Lincoln’s brain that was being caused by collateral internal bleeding from broken blood vessels leaking cerebrospinal fluid from the damaged ventricle in Lincoln’s brain.

Modern medicine has very sophisticated techniques for determining and relieving intracranial pressure, but in Dr. Leale’s day, there were basically two main procedures. One was to scrape away any blood clots over a head wound and, if necessary, to push away any piece of bone that might be acting as a valve, which is what Dr. Leale did. The other technique for relieving intracranial pressure, which Dr. Leale could not have performed because he did not have the requisite equipment and which was even then frowned upon but resorted to in dire emergencies, was trephining—cutting a hole in Lincoln’s skull to remove any foreign objects and to allow fluid to drain out.

Dr. Fraser did not fault Dr. Leale for allowing the fluid inside Lincoln’s brain to drain off, but he did fault him and the other doctors for sticking their fingers into Lincoln’s brain, which he contended violated the medical standard of care. At the time of the Civil War, however, there were no formal guidelines for the standard of care. In the absence of any such formal standardization, the informal standard of care for treating gunshot wounds can be inferred from the military field medical handbooks of the time. The main texts used in the Confederate Army were the 1863 A Manual of Military Surgery Prepared for the Use of the Confederate States Army, written under the direction of Confederate surgeon general Samuel Preston Moore, and Confederate army surgeon Edward Warren’s An Epitome of Practical Surgery. Union surgeons could draw upon Samuel David Gross’s 1859 two volume Systems of Surgery, which was issued to all Union Army surgeons during the war; Union surgeon Stephen Smith’s Hand-Book of Surgical Operations; Charles Stuart S. Tripler and George Curtis Blackman’s 1861 Handbook for the Military Surgeon; or the textbook written by Dr. Leale’s teacher at Bellevue Hospital, Frank Hastings Hamilton’s 1863 A Treatise on Military Surgery and Hygiene.

The Confederate Manual of Military Surgery advises that “of all the instruments for conducting an examination of a gun-shot wound, the finger of the surgeon is the most appropriate.” The manual stated that the goal was to remove pieces of bone or foreign matter. To that end, it recommended using a finger as causing the least damage. Dr. Stephen Smith similarly advises if any probing is necessary, it should be performed with the finger. Tripler and Blackman also recommend that only the finger should be used for the examination and probing and that the wound should not be enlarged, except to remove the loose bone. Warren’s text likewise advises using a finger to remove foreign objects from wounds. Dr. Frank Hamilton, Dr. Leale’s professor, advised using the finger to remove bone fragments but was adamantly against the use of metal probes to locate and remove bullets.

In censuring Dr. Leale and Lincoln’s other doctors, Fraser contended their fingers and probes would have easily ruptured blood vessels that had not been hit by the bullet and that it was that additional damage that ultimately killed Lincoln. Fraser’s opinion was that the bleeding and oozing that occurred when those fingers were removed came from a broken clot or a broken blood vessel, which was inevitably true.

When Dr. Leale and the other doctors probed Lincoln's brain with their fingers and instruments, they were not violating any consensus about doing so because there was no consensus. Even though Dr. Leale’s actions did not violate the standard of care when Drs. Taft, Crane, and Stone each put their fingers into Lincoln’s brain, their actions bordered on medical malfeasance. And equally, if not more, egregious were the two times Drs. Stone and Barnes stuck a metal probe into Lincoln’s brain when once would have been more than enough. When Surgeon General Barnes and Dr. Stone probed Lincoln’s brain, those probes were not merely inserted into the channel left by the bullet. When bone fragments were encountered, force had to be applied to maneuver the probe around them, tearing more tissues and blood vessels and hastening, if not causing, Lincoln’s death. The probes may also have created tracks of their own, which is why there was some disagreement during the later autopsy of Lincoln’s brain regarding the path of the bullet. Manipulating those probes around bone fragments caused extensive additional damage.

Dr. Blaine Houmes, an emergency medicine specialist, notes that when Lincoln’s doctors probed his brain they were “trying to alleviate this (increased intracranial pressure) with the only methods available,” which meant trephining—cutting a “hole in the skull about the size of many small gunshot wounds.” But trephining had rarely saved anyone and inevitably resulted in death from infection. It was only used as a last resort. However, there is no evidence that either Stone or Barnes or anyone else in the room had ever trephined someone with a gunshot wound to the head.

Despite their good intention, Fraser was right in maintaining that Lincoln’s surgeons did more harm than good through their treatment. But in doing so, they did not violate the core common ground standard of care indicated by the surgical manuals of that era. That being said, there was also no reason for everyone to have a turn sticking a finger or probe into Lincoln’s brain.

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Compiled by Neil Gale, Ph.D.
Contributor; Loetar44, "The Doctors' Present at Lincoln's Side," Lincoln Discussion Symposium.

ADDITIONAL READING:
In observance of the 100th Anniversary of the Birth of President Abraham Lincoln. 

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