Abraham Lincoln and Aortic Insufficiency. The Declining Health of the President.

According to many observers and subsequent scholars, the health of Abraham Lincoln in his last year of life was such as to preclude completion of his second term of office even if he had not been assassinated. Understandably, in the absence of a known organic basis for that unfavorable prognosis, the decline in the physical well-being of the President has been attributed to emotional factors attendant upon the burdens of office and tragic war, an impression that only positive evidence, the subject of this report, can perhaps obviate. 

Background and Hypothesis

Several years ago, a case of the Marfan syndrome in a young boy under my care was presented and a pedigree given indicating his descent from Mordecai Lincoln II, a great-great-grandfather of Abraham Lincoln. The descriptive and genetic evidence was also submitted, demonstrating that the striking morphologic characteristics of the 16th president were likewise those of the Marfan syndrome as derived from the ancestor held in common with the patient-reported. While in the original communication, only involvement of the skeletal and visual apparatus was documented for the President, material by which to infer in his case a cardiovascular lesion typical of arachnodactyly (a condition in which the fingers are long, slender, and curved) has long been available. Before this observation was reported, however, it was felt desirable to find a way to make this impression objective because of the indirect nature of the data. Only recently has a method of accomplishing this been found. Evidence is, therefore, now offered to suggest that President Lincoln, two years before his assassination, had physical findings consistent with aortic insufficiency as a complication of Marfan syndrome.

The Evidence

The evidence suggesting a cardiovascular lesion in Abraham Lincoln actually evolves from certain observations and remarks of the president himself, together with those of Noah Brooks, a newspaperman, as they reviewed a photograph for which Mr. Lincoln had posed a short time previously. In the episode, as reported by Hamilton and Ostendorf, the president was speaking: 

"I can understand why that foot should be so enormous," he said to Brooks "It's a big foot anyway, and it is near the focus of the instrument. But why is the outline of it so indistinct and blurred? I am confident I did not move it." 

Brooks suggested that the throbbing of the arteries may have caused an imperceptible motion. 

The President crossed his legs and watched his foot. 'That's it! That's it!" he exclaimed. "Now that's very curious, isn't it?" 

Aortic insufficiency (AI) being a common lesion in the Marfan syndrome, the clinician will recognize in the President's suspended throbbing and pulsating foot, a phenomenon entirely compatible with the hemodynamic effects of aortic regurgitation.

Fundamentally, such visible pulsations result from the sudden filling of the large collapsed arteries accompanying aortic regurgitation. Corrigan in 1832 described this effect in the carotid, temporal and other like vessels, while similar pulsations have since been described in the uvula, the liver, and the capillaries. Even more applicable, cardiologist Luisada emphasizes, as a manifestation of the "vascular dance" accompanying Aortic insufficiency, the abrupt "rhythmic extension of one leg when crossed over the other coincident with systole." Further, the eminent Sir Thomas Lewis states specifically that the jerking water-hammer quality of the pulse-wave of aortic incompetence "is extreme in the dorsum of the foot." 

Other studies reveal that in Aortic insufficiency, the blood pressure in the femoral artery is greatly exaggerated over that of the brachial, and since the femoral artery is in a direct line with the aortic stream while the brachial issues from the aorta at a right angle, the femoral receives both the pressure and the very considerable velocity head of the aortic stream. This increased pressure and velocity head is precisely the mechanism that may produce pulsatile motion in a suspended leg and foot in Aortic insufficiency, a lesion that in the Marfan syndrome is the direct result pathologically of dilatation of the aortic ring or myxomatous change of the aortic valve. 

Independent objectifying evidence supporting the plausibility of the hypothesis offered is available in an analogous situation recently documented by a young journalist who himself had the Marfan syndrome. This man, in a recent book describing his personal medical experiences with ectopia lentis, loose-jointedness, and aortic insufficiency, noted most perceptively: 

"My heart had its work cut out ... There was no need to feel my pulse. Its heavings were all too readily discernible in my neck, at my wrist, and even on the back of my hand. And when I crossed my legs and Iet my muscles relax, the upper leg jumped up and down like a spring, keeping perfect rhythm with the beat of my heart muscle."

A non-physician with the same condition that affected Abraham Lincoln made this observation in himself would appear to lend considerable reliability and validity to the similar observation and analysis made 107 years ago (from 1972) by the laymen Lincoln and Brooks.

The pulsating suspended leg and foot phenomenon, which may be called the Lincoln-Brooks sign of aortic insufficiency, is made possible by the hinge-like arrangement of the related body parts. From this arises the possibility that laxness with hyperextensibility of the joints, as commonly seen in arachnodactyly, may facilitate pulsatile motion of a suspended extremity even in the presence of lesser degrees of regurgitation than otherwise required for this phenomenon in cases of aortic insufficiency without hyperextensibility. While Lincoln was many times described by his contemporaries as "loose-jointed," further evidence specifically for the laxness of his ankle joint, which may have made his foot, in addition to his leg, more responsive to minor degrees of regurgitation, is found in a description by Lincoln's law associate William Henry Herndon: 'In walking, Mr. Lincoln put the whole foot flat down on the ground at once, not landing on the heel. He lifted his foot all at once-not lifting himself from the toes and hence had no spring or snap ... to his ... walk."

While undoubtedly a mere coincidence, the fact remains that the pose assumed for the photograph under consideration had Lincoln's lower extremities crossed, with the overhanging foot close to the lens where its arc, increased first by the rhythmically extended leg and then by the still oncoming steep pulse-wave reaching the foot, was optimal for producing "photokymographic" documentation of the President's "altered" circulatory dynamics.

Abraham Lincoln's Blurred Left Foot,  Alexander Gardner, November 8, 1863.

As to other findings in aortic insufficiency, no blood pressure apparatus was clinically available in Lincoln's time by which to establish that there was a wide pulse pressure. Regarding also the usual aortic diastolic decrescendo murmur: it may in any given case be absent or extremely difficult to elicit or localize, particularly in the presence of an altered configuration of the chest. Significantly, Mr. Lincoln has been shown to have, as a skeletal component of the Marfan syndrome, a pectus excavatum that shifts the heart well into the left hemithorax, thereby rendering many of the cardiac findings less than typical. Furthermore, when detected, this murmur reflects diagnostically only the same pathologic condition that produces a bounding pulse. In that sense, the murmur is only one of many cardiovascular signs of aortic incompetence. The absence, therefore, of evidence for a diastolic aortic murmur in the President does not detract from the present diagnostic impression.

Discussion

Considering, then, the presence of the Marfan syndrome as previously established in Mr. Lincoln; the frequency of aortic valvular incompetency in that condition; the hemodynamics of aortic regurgitation; the graphic data of the Gardner photograph (above) as detected by the President himself; the hypothesis of Brooks and its clinical confirmation by Lincoln; the leg and foot signs in the medical literature; the analogous clinical findings by a non-physician with arachnodactyly and the diagnostic criteria quoted, the evidence in the case of the President becomes highly consistent with aortic insufficiency and regurgitation. 

Adding a cardiovascular lesion consistent with arachnodactyly to the previously documented skeletal and visual findings in the case of the President reinforces the original diagnosis of the Marfan syndrome considerably as already authoritatively accepted elsewhere by completing involvement in all three major body systems, any one or more of which may participate in the total spectrum of arachnodactyly as a heritable disorder of connective tissue. 

Further, from the perspective of the present diagnostic impression, the course of the President's declining health can be shown to be consistent with the late slow form of cardiac decompensation highly characteristic of Aortic insufficiency. In relation to this, the period preceding Mr. Lincoln's violent death was one of easing burdens, lessening anxiety and lightening of spirit as the War Between the States drew to its long-awaited close. However, the health of the President continued to deteriorate ever more rapidly, a paradox inconsistent with psychic stress as the one responsible factor. More compatible with the physical decline of Mr. Lincoln is a progressive decrease in cardiac reserve after long-standing aortic insufficiency, the course of which was abruptly terminated by his death on April 15, 1865. 

In conclusion, if the diagnosis of the Marfan syndrome has resolved to any extent some of the enigma long surrounding President Lincoln, it also highlights one of the foremost problems of the era-genetic control. As expressed by one authority citing by way of example the Marfan syndrome and Abraham Lincoln: "... who would dare wish him eugenically suppressed (the production of good offspring)?"

By Dr. Harold Schwartz, M.D., Lynwood, California. May 1972.

Edited by Dr. Neil Gale, Ph.D.

ADDITIONAL READING:

Is There Proof That Abraham Lincoln Had Marfan Syndrome? 

Lincoln in Despair—A Time When He Was Tempted To Commit Suicide.

An Instance When he Was More Serious Than the Case Warranted

Story Told by Secretary of War, Edwin Stanton.

President Lincoln during the war was very sensitive of the criticisms on his administration by the newspaper press, believing it to be, as he asserted, the true voice of the people. The failures of McDowell, McClellan, Burnside, and Poe with the Army of the Potomac and the criticisms made thereon by the newspapers almost crazed him. Time and again he would free himself from the Executive Mansion and seek my little office, the only place in Washington, he often said, where he could be absolutely free from interruption. When he became closeted with me on these visits Mr. Lincoln would unbosom himself and talk of his cares and woes. Several times he insisted that he ought to resign, and thus give the country an opportunity to secure someone better fitted to accomplish the great task expected of the President. Or, if he did not resign, he thought he ought to impress upon Congress the propriety of giving the absolute control of the army to some purely military man. It was during one of these moods that he conceived the idea of placing Joseph Hooker in command of the Army of the Potomac, and of vesting him with such power that, in his opinion, he could not fail of success.

Brigadier General Joseph "Fighting Joe" Hooker of The Army of the Potomac. It was the principal Union Army in the Eastern Theater of the Civil War. It was created in July 1861 shortly after the First Battle of Bull Run and was disbanded in June 1865 following the surrender of the Confederate Army of Northern Virginia in April.

He had a great idea of Hooker's ability as a soldier, and in addition, he believed him to be an honest man and a sincere patriot. He wanted him to fight what he intended should be and what he felt would be, the closing battle of the war. Accordingly, when Hooker got underway, and the news came that at Chancellorsville he would make his fight, Mr. Lincoln was in the greatest state of mental excitement. From the time that Hooker's army began its march until the smoke of battle had cleared from the fatal field of Chancellorsville, he scarcely knew what it was to sleep.

It will be remembered that the fight lasted three days. During the first two days it looked as if Hooker was about to accomplish what so many generals before him had failed to do; but, early on the third day, the usual half-hour dispatches began to make matters look dark and ominous of defeat. The whole day Mr. Lincoln was miserable. He ate nothing and would see no one but me. As it grew dark the dispatches ceased coming at all. 

White House, 1865

Mr. Lincoln would walk from the White House to my apartment and anxiously inquire for news from Hooker. With the going down of the sun a cold and drenching rain set in, which lasted through the night. At about 7 o'clock Mr. Lincoln ceased his visits to my apartment and gave orders at the Executive Mansion that he, would see no one before morning. An hour afterward a dispatch of indefinite character was received from Hooker, and I hurried with it to Mr. Lincoln's apartments. When I entered I found him walking the floor, and his agonized appearance so terrified me that it was with difficulty that I could speak. Mr. Lincoln approached me like a man wild with excitement, seized the dispatch from my hand, read it, and, his face slightly brightening, remarked: "Stanton, there is hope yet!" At my solicitation, Mr. Lincoln accompanied me to the War Department, where he agreed to spend the night, or until something definite was heard from Hooker. For five hours, the longest and most wearisome of my life, I waited before a dispatch announcing the retreat of Hooker was received. When Mr. Lincoln read it he threw up his hands and exclaimed, "My God, Stanton, our cause is lost! We are ruined—we are ruined; and such a fearful loss of life! My God! this is more than I can endure!" He stood, trembling visibly, his face of a ghastly hue, the perspiration standing out in big spots on his brow. He put on his hat and coat and began to pace the floor. For five or ten minutes he was silent and then, turning to me, he said: "If I am not around early tomorrow, do not send for me, nor allow anyone to disturb me. Defeated again, and so many of our noble countrymen killed! What will the people say?"

As he finished he started for the door. I was alarmed. There was something indescribable about the President's face and manner that made me feel that my chief should not be left alone. How to approach him without creating suspicion was the thought of a second. Going up to him and laying my hand on his shoulder I said: "Mr. President, I, too, am feeling that I would rather be dead than alive; but is it manly—It is brave—that we should be the first to succumb? I have an idea: "You remain here with me tonight. Lie down on yonder lounge, and by the time you have had a few hours' sleep, I will have a vessel at the wharf, and we will go to the front and see for ourselves the condition of the army."

The idea of visiting the army in person acted like a tonic. Mr. Lincoln immediately adopted the suggestion. The next morning we left Washington on a gunboat for Hooker's command. On our return trip Mr, Lincoln told me that when he started to leave the War Department on that evening he had fully made up his mind to go immediately to the Potomac River and there end his life, as many a poor creature—but none half so miserable as he was at that time. 

Compiled by Dr. Neil Gale, Ph.D.

The Great Epizootic; an equine influenza in 1872-1873 starting in Canada, and killed horses all over North America.

Bloomington, Illinois' streets were eerily quiet for several weeks in late November and early December 1872. Horses were missing from the normally bustling downtown and surrounding neighborhoods. In the age before the internal combustion engine and the automobile, it was challenging to get from here to there without flesh-and-blood horsepower.

The Great Epizootic, which had already ravaged the East Coast and major inland cities such as Chicago, had finally reached Bloomington. Nearly every horse, mule, or donkey for miles around was sick or dying, relegated to barn or stable until the highly virulent strain of equine influenza burned through the area.

It was over, and it was challenging to shuttle passengers and goods from railroad depot to factory, store, or home since dray and omnibus lines (respectively, delivery trucks and taxis of the day) had no healthy animals. Public transportation also halted, given that horses in Bloomington-Normal and hundreds of other communities were needed to pull street railway cars. (This was before the electric era.)

The equine influenza was known as the horse flu or, more popularly, the horse epizootic (a word for a non-human epidemic). Symptoms included fever and shivering, a nasty cough, and a yellowish discharge dripping from their nostrils and mouths. For several days or more, infected horses would be listless, with heads cast down and little interest in either food or water, unable to pull or carry loads.

The 1872 North American epizootic was its most recorded outbreak in history.

Equine influenza first appeared in late September in horses pastured outside of Toronto. Within days most animals in the city's crowded stables caught the virus. The U.S. government tried to ban Canadian horses but acted too late. Within a month, border towns were infected, and the "Canadian horse disease" became a North American epidemic. By December, the virus reached the U.S. Gulf Coast, and in early 1873 outbreaks occurred in West Coast cities. It was still sweeping through Arizona Territory settlements as late as March 1873. The epizootic eventually reached Cuba, Mexico, and Central America.

At this time, the germ theory of disease was still controversial, and scientists were 20 years away from identifying viruses. Horse owners had few good options for staving off infection, and they disinfected their stables, improved the animals' feed, and covered them in new blankets. One wag wrote in the Chicago Tribune that the nation's many abused and overworked horses were bound to die of shock from this sudden outpouring of kindness. At a time when veterinary care was still primitive, others promoted more dubious remedies: gin and ginger, tinctures of arsenic, and even a bit of faith healing.

The percentage of horses infected in the continental U.S. is placed anywhere from 80 percent to the high 90s. Mortality rates were highest in urban environments, reaching 10 percent in some cities. However, more often than not, the 1872 outbreak killed between 1 and 2 percent of the horse population in any given community.

In the absence of horses and vehicles, the streets of Chicago were saved from utter desertion by vehicles drawn by hardy humans or oxen.

Every aspect of life was disrupted. Saloons ran dry without beer deliveries, and postmen relied on "wheelbarrow express" to carry the mail. Forced to travel on foot, fewer people attended weddings and funerals. Desperate companies hired human crews to pull their wagons to market. Worst of all, firemen could no longer rely on horses to pull their heavy pump wagons.

Post-fire, Field, Leiter & Co. Store in the Singer Building, Northeast Corner of State and Washington Streets, Chicago, 1873.

When equine influenza decimated Chicago's horses in 1872, Field, Leiter & Co. (Marshall Field and Levi Ziegler Leiter) used oxen. "All orders filled promptly and shipped the same day!" they boasted.

The epizootic reached Bloomington the third full week of November. The Daily Leader, a long-defunct Bloomington newspaper, reported on November 22nd that nearly all the horses in the downtown Ashley House stable had a "suspicious cough." There were other ominous signs as well. "One of General [Asahel] Gridley's horses is down and is pronounced a clear case [of the epizootic]," added the paper. "Dr. [Asa P.] Tenney also has a horse that is not expected to live."

The Pantagraph agreed with its competitor that the epizootic was here. "It is now estimated that about 200 horses have been attacked in this city within three days," announced the paper's November 23rd edition.

Oxen unaffected by the epizootic were drafted into service, and human muscle often supplanted horsepower for two long weeks. "Many of the grocery merchants are delivering groceries with wheelbarrows and handcarts," commented the November 29th Leader, "and in some instances, wagons are hauled through the streets by men." Marion Chuse, the chief engineer of the Bloomington Fire Department, announced that horses of engine company No. 1 were out of commission, and in the event of a fire, he called for volunteers to "man the ropes."

Clover Lawn, the residence of David and Sarah Davis on the city's east side (now the David Davis Mansion state historic site), was completed in the year of the Great Epizootic. On November 29th, Sarah Davis mentioned the outbreak in a letter to her husband David, then a U.S. Supreme Court justice. "The sickness of the horses makes it inconvenient to get coal hauled — and to save the coal we have on hand — we burn large logs in the furnace," she wrote.

Yet within a week of that letter, influenza's grip on the local horse population began to loosen. Street railway service was up and running by December 7th, and once again, the horse enjoyed dominion over Bloomington's thoroughfares. Thankfully, local fatalities were few, probably numbering fewer than a few dozen in the city.

During the early days of the outbreak, the Daily Leader Newspaper commented on the prospect of life — if only for a week or two — without horses. "The people of this city," the paper stated, "will have an opportunity to learn the value of the noble horse and how much we depend upon 'man's best friend' among the brute creation for comfort and convenience."

MARSHALL FIELD AND COMPANY ARTICLES

Compiled by Dr. Neil Gale, Ph.D.

The Slow Death of Chicago's Edgewater Hospital and the Scandals that Caused its Closing.

Edgewater Hospital founder, Doctor Maurice Mazel, was a resident of the Edgewater Beach Apartments, in 1929 when the hospital was started. The funds came from Edgewater developer John Lewis Cochran’s Real Estate firm at the outset of the Great Depression. 

Doctor Maurice Mazel

Dr. Mazel personally oversaw hospital operations until he died in 1980. During his tenure, notable births included former US Secretary of State Hillary Rodham Clinton and serial killer, John Wayne Gacy. Mazel's wife, Circus Hall of Fame performer Harriet Mazel-Szanto, functioned as chairman and CEO from 1980 to 1984. She later shed the CEO title but remained on as chairman until 1988. After her passing, the hospital sought new ownership under the Mazel family.

Edgewater Hospital as it appeared in the 50-60s.

Medical staff is ethically obligated to provide the best possible quality of care for patients, no matter the affliction. For some executives and doctors at Chicago’s Edgewater Medical Center, personal profits came before those ethical standards. The unnecessary suffering and premature deaths they caused resulted in the shuttering of a historic Chicago neighborhood hospital. It was shut down abruptly after years of controversy involving Medicare fraud, mismanagement, and bankruptcy.

Edgewater Hospital's vintage patient rooms.

TVs were added to patient rooms in the 1950s.

Businessman Peter Rogan acquired Edgewater Medical Center in 1989 for $1 million cash and assumed its $10 million in liabilities through the Edgewater Operating Company (EOC) he created. In 1994 Rogan sold EOC and real estate to the Edgewater Property Company (EPC), which he also controlled. In the deal, Edgewater Medical Center paid an exorbitant monthly rent of $79,500 to EPC. At the helm of both entities, Rogan funneled profits directly into his own pockets.

Corruption rooted itself deep into Edgewater’s staff. Rogan orchestrated a complex system of kickbacks for doctors and staff complicit with committing fraud against Medicare, Medicaid, and private insurance companies. Vice president Roger Ehmen and medical director Dr. Ravi Barnabas were able to turn the nearly bankrupt hospital into a lucrative profit center. The pair tapped Dr. Sheshiqiri Rao Vavilikolanu and Dr. Kumar Kaliana to recruit potential patients. For years the doctors sent hospital employees into the Chicago community to find potential patients. It did not matter if they did not have heart conditions, were drug addicts, unable to speak English, or had no health insurance coverage. Recruiters instructed the potential patients on how to feign symptoms to mandate services rendered by Edgewater Medical Center. In return, the patients were offered money, food, cigarettes, and other amenities for their cooperation.

Edgewater Hospital's Hollywood Building rooftop solarium 1949.

Rooftop deck accessible through the solarium on the Hollywood Building.

Another complicit Edgewater physician participated in the massive fraud scheme. Dr. Andrew Cubbria tapped into the recruited patient pool for unnecessary angiogram and angioplasty operations. Albert Okaro, 42, underwent an invasive and unnecessary cardiac surgery that ultimately killed him. The patient’s death was regarded as collateral damage for Dr. Cubria. Tax-payer-funded healthcare programs and private insurers reimbursed the hospital for more than 750 invasive, and expensive, cardiac surgeries performed by Dr. Cubria alone.

One Edgewater physician, Dr. Krishnaswami Sriram, a cardiologist, billed the government for seemingly impossible human feats. According to Dr. Sriram’s billing records on November 12, 1997, he saw 187 patients… all of whom coincidently had congestive heart failure. In January 1999 a severe snowstorm brought Chicago to a standstill. Despite the hazardous weather conditions, Dr. Sriram was apparently able to visit 31 elderly patients at their homes and 18 more in medical facilities. Thirty-two of Dr. Sriram’s patients also managed to incur new medical costs long after their deaths. On paper, it appeared as though Dr. Sriram was indefatigable. His records indicate that he met with patients every single day in 1997 and 1998 while missing only two days of work in 1999.

Dr. Sriram’s apparent superhuman ability to visit patients did not go by unnoticed. Some of the elderly patients he targeted began to grow suspicious after noticing over-inflated billings on Explanation of Benefits forms. At least 15 patients contacted the Wisconsin Physicians Service, which handles claims in the Illinois area. Wisconsin Physicians Service alerted the FBI and they immediately began an investigation.

Things began to unravel in 1999 when the hospital paid out over $1 million to stave off an impending federal lawsuit over Medicare billing irregularities. The ambitious Dr. Sriram was taken into custody in 2000. Feds exposed the rest of the fraud operation in 2001.

Edgewater Hospital flooded Nurses’ station.

The upheaval brought on by the charges cut the hospital’s day-to-day operations off at the knees. In November 2001 the US government, which accounted for 90% of Edgewater Medical Center's income, ceased Medicare payments indefinitely. Unable to find a suitable financier the hospital shut down in December 2001. The remaining 450 staff were suddenly out of a job or had to transfer to other area healthcare facilities. In addition to the displaced staff, 52 patients were transferred to other facilities for ongoing care.

Peter Rogan, former Chief Executive Officer of Edgewater Medical Center in Chicago.

In a 2006 trial, U.S. District Judge John Darrah in Chicago found Peter Rogan had lied on the stand and destroyed documents to obstruct justice and entered a $64.2 million judgment against him. There was also a whopping $188 million more in civil judgments against him. Rogan fled to Canada in the fall of 2006 when FBI agents searched his abandoned business offices in northwest Indiana. Among the discarded furniture and empty folders, agents found something astonishing: An invoice to Rogan from a company he hired to destroy 47 boxes of financial records. In addition to the federal charges, French Bank "Dexia Credit Local" was working with the Justice Department to recover assets scattered throughout various bank accounts and front companies in the Caribbean. One of the trusts found was set up in the Bahamas and was entitled the "Peter Rogan Irrevocable Trust." Rogan insisted that he maintained no control whatsoever over the assets and could not access it. In October of 2015, Rogan, 69, was sentenced to 21 months in prison for lying in his 2006 sworn affidavit that he had no control over a multimillion-dollar trust account in the Bahamas when he was actually using the money to support his lavish lifestyle. Rogan had been renting a $5,000-a-month penthouse condominium in Vancouver. He had engaged the government and others he owed money in a yearslong, expensive game of "catch me if you can," shredding a total of 67 boxes of documents and lying about his assets as authorities tried to trace accounts all over the world. The sentencing marked the end of nearly seven years of criminal proceedings against Rogan.

Senior vice president Roger Ehmen and Dr. Ravi T. Barnabas were convicted for their roles in the fraud operation. Ehmen received 6½ years of prison time and was ordered to pay $5 million in restitution. Ehmen was quoted at sentencing saying; ”Words alone cannot describe the deep sorrow and regret I have. I will have to live with this guilt for the rest of my life.” Medical director Dr. Barnabas was sentenced to 4 years and 4 months prison time and ordered to pay $1.1 million in restitution. Dr. Barnabas’s physician license is still active in Illinois and expires on July 31, 2023.

Dr. Sheshiqiri Rao Vavilikolanu confessed that he unnecessarily admitted over 900 patients. He was sentenced to 3 years and 11 months of prison time and ordered to repay $6 million to Medicare and Medicaid. Dr. Vavilikolanu’s license not active anywhere nationwide. Dr. Kumar M. Kaliana admitted to mail and healthcare fraud. He received a 1 year and 4 months sentence and forced to return $156,000, along with $1.1 million in restitution. Dr. Kaliana’s physician license has not been renewed since September 30, 2020.

The courts came down most heavily upon Dr. Andrew Cubria. In addition to Albert Okaro’s untimely death in 2000, the feds discovered that at least one more unnecessary cardiac operation resulted in the death of another patient in 1999. Dr. Cubria was sentenced to 12½ years in prison for his wrongdoing. He was also ordered to return $2 million of his profits and pay $14.4 million in restitution. His physician license was suspended thereafter.

The man whose superhuman feats caught the eyes of the FBI was also brought to justice. A teary-eyed Dr. Sriram cried as he apologized for what he called "my foolishness." He pleads guilty to mail fraud, healthcare, and tax fraud. He faces up to 18 years in prison, but he has been appealing that ruling. As part of his plea, the doctor has agreed not to practice medicine. 

Sriram had faced as much as 18 years in prison if U.S. District Judge John Darrah had found that the losses from the fraud totaled the government's original claim of $15 million. A federal judge spared the doctor prison and sentenced him Thursday, April 28 2005 to 5 years of probation for Medicare fraud. Federal prosecutors had originally contended that the fraud scheme by Dr. Krishnaswami Sriram exceeded $15 million in losses, but Judge Darrah concluded the loss came to just $1,258. Dr. Sriram's physician license is active but on probation until July 31, 2023.

After a decade of abandonment, Edgewater residents are aiming to rid themselves of the abandoned hospital. According to The New York Times, the property is in the hands of the Edgewater Medical Center Bankruptcy Estate, which is comprised of 250 creditors who are still owed more than $110 million. Of the creditors, French Bank Dexia is owed over $55 million. Unable to recoup their costs creditors would like to see the hospital razed in favor of business development. Edgewater community members would rather have the real estate transformed into parkland. According to an official city-authorized assessment the hospital is valued at $5.9 million. The cost to demolish the hospital is estimated to be $6.5 million alone.

One of the intensive care units in the abandoned hospital.

What will happen to that hollowed-out shell that was once Edgewater Medical Center? What sets this building apart from other failed urbex locations is that it was created by criminal acts over an extended period of time. Even though the hospital was dated, they were still operating in a capacity that for the most part benefitted patients. By the time the FBI discovered the corruption it had already metastasized and killed the Edgewater Medical Center.

Like most hospitals with chronologically staggered additions, it is a winding labyrinth. Some of the floors look practically identical and it is easy to lose one's bearings. Yet each section of the hospital was still unique in its own way. 

Biohazard containers, alcohol swabs, diabetic supplies, and other pharmaceutical supplies were littered throughout some of the rooms. Medical records, tissue samples, autopsy records, and medical images were found in one of the labs. 

Patient records stacked on the floor almost reach the ceiling.

Tissue sample slides.

An x-ray photo of the human heart with arteries highlighted.

Heavy equipment such as a hyperbaric chamber and x-ray machines were tucked away behind closed doors. Above the Kadin Memorial Nurses’ Residence was a filthy empty pool under a skylight. Vintage furniture from the 1970s occupied some of the rooms even though eviction notices from 2002 were found on the floor.

Abandoned Hyperbaric Chamber.

A massive x-ray machine still residing within the hospital.

One of the laboratories with numerous patient records and equipment. Note the orange, avocado green, and harvest gold (not seen in this picture) colors popular in the 1970s.

Vintage furniture still occupied some of the nurses’ apartments.

The administration building was, perhaps poetically, completely devoid of mementos of life. It is quite unsettling to see a once intentionally sterile hospital environment ravaged by the uninhibited destructive elements of nature.

Edgewater Hospital view from Ashland and Hollywood, 2014.

Edgewater Medical Center Demolition.

Edgewater Medical Center Campus.

The story of the Edgewater Medical Center foreshadowed many of the problems that plague the American healthcare industry today. Profit-focused healthcare endangered the lives of those who could not or were unable to protect themselves. Patients at Edgewater Medical Center were exploited by the greed of administrators and doctors to the tune of millions of dollars. The system failed thus taking vital healthcare services away from one Chicago community.

Rendering of the Anderson Point Apartments.

Compiled by Dr. Neil Gale, Ph.D.

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

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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, Mary Lincoln exclaimed 'Oh 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 primarily 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 on 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 Theatre and the night that followed after the assassination of the President. The letter is dated November 3, 1866. It is in response to a request by General John Harrison Littlefield (a personal friend of Abraham Lincoln who 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 the 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 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. 

At night, 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 were present. 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. At the same time, the Rev. Dr. Gurley earnestly supplicated to God on behalf of the distracted family and our afflicted and sorrowful 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 (March 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 was 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 – December 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 audience members 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 (January 18, 1841- December 13, 1914); M.D., Columbia Medical College, 1861; University of Pennsylvania, 1865; Acting Assistant Surgeon, United States Army. The third physician to reach Lincoln (often placed as the 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- October 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). He was together with his brother Capt. Oliver Cross Gatch (in uniform), in the dress circle of Ford's. According to Oliver's statements, they were asked to the State Box, where Charles concluded 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 undoubtedly absent in the state box since they are discussed 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 (April 30, 1834 – September 20, 1874); M. D. served at the War's end on the Monitor "Montauk" and was at Ford's Theatre on April 14, 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 (September 20, 1830 – April 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 Theatre 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 arrived, I found everything was confusing, some calling for one thing, others for another. As soon as I saw the wound, I saw 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, dreading being called as a witness when there should be an investigation."

PHYSICIANS IN ATTENDANCE AT THE PETERSEN HOUSE

(in addition to Leale, Taft, and King)

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It took approximately 25 minutes to move the mortally wounded President from Ford's Theatre at 448 (511 today) Tenth Street northwest 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 theatergoers 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 to 50 feet from Ford's Theatre door to Petersen's door.

William Morrow Notson (Feb 1836 – June 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 Theatre 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 Abraham Lincoln's boots off and opened the back window for fresh air. Dr. Norton ordered the room to be cleared of everyone under the rank of major. Dr. Notson also treated Seward and wounded members in Seward's chamber during the night. After Abraham Lincoln's passing, Dr. Notson attended the autopsy, but his participation was interrupted to again attend Seward.

Charles Henry L. Liebermann (September 15, 1813 – March 27, 1886) came to the U.S. early in 1840; M.D., University of Berlin, 1838. Washington physician (practicing at Pennsylvania Avenue ); professor of Surgery University of Georgetown 1849-1853 and 1857-1861, President of the Medical Society of the District of Columbia. He 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 (June 15, 1840 - February 15, 1884); M.D., University of Pennsylvania, 1861. Arrived at Petersen's House after Dr. Liebermann and before Dr. Stone. During the more significant part of the night, the pulsations were counted by Dr. Ford and noted by Dr. King.

Robert King Stone (December 11, 1822 – April 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 – April 5, 1883); M.D., University of Pennsylvania, 1838; 12th United States Army Surgeon General (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 whether Barnes took charge over Stone (discrepancies between Dr. Leale's two accounts and between the accounts of Taft and Dr. Leale).

Charles Henry Crane (July 19, 1825 – October 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 (April 28, 1819 – March 21, 1884); M.D.; homeopathic physician of Concord, N.H. At generally five-minute intervals (from 11:00 pm to 7:20 am), he made a detailed record of Lincoln's condition and other events that 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 and cut away in search of the fatal bullet wound. He was said to be 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 actual 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 caused by his scalpel when he removed two years earlier a fibroid tumor from the back of J.W.B.'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 President Lincoln's deathbed, but no further details are known.

Ashbel Woodward (June 26, 1804 - December 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 at Abraham Lincoln's bedside.

Mary was at Abraham's side, weeping uncontrollably.

PHYSICIANS PRESENT AT LINCOLN'S AUTOPSY

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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 (October 30, 1833 – August 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 (June 4, 1838 - November 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 (August 18, 1825 – February 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 (April 7, 1837 – December 29, 1913), M.D.; Toronto School of Medicine, 1861; first Canadian person of color to be a licensed physician; participated in the C.W. 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 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 to soak up Lincoln's blood, and other items. The deathbed is now owned by and displayed at the Chicago History Museum. However, replicas have taken their place. 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 exist 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 formed in 1847, but it initially only concerned itself with ethical issues, not medical procedures. There were no licensing requirements or 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 more senior 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 was 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, 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 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 other doctors who treated Lincoln, was not to repair Lincoln's brain damage—well beyond medicine's ability for more than a century. He aimed to relieve the pressure inside Lincoln's brain 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 two main procedures. One was to scrape away any blood clots over a head wound and, if necessary, to push out any piece of bone that might be acting as a valve, which 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 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 Army handbook were from the 1863 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 Handbook of Surgical Operations; Charles StuartHandbooker and George Curtis Blackman's 1861 Handbook for the Military Surgeon; or the textboHandbooken 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 examining a gunshot 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 to cause 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 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 utilizing a finger to remove foreign objects from injuries. Dr. Frank Hamilton, Dr. Leale's professor, suggested 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 the additional damage ultimately killed Lincoln. Fraser believed 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, the 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 investigations 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 bullet's path. 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 Stone, Barnes, or anyone else in the room had ever trephined someone with a headshot wound.

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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In the course of his duties in the White House, John Hay developed a close relationship with Robert Todd Lincoln, just a few years his junior. The two were at the White House together on the evening when Lincoln was shot and rushed to Lincoln’s side at the Petersen house, where they remained by Lincoln's side through the night and was present when he died.

CLICK TO READ IN FULL-SIZE

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Is there any truth to the statement that shortly after the death of President Lincoln the Jewelers' Association of America met in a convention and decided that all clock faces used for advertising purposes should be set at the hour of Lincoln's death?

No, there is no truth to that statement. This story is a myth that has been circulating online for many years, but there is no evidence to support it. In fact, there is no record of any such convention ever taking place.

All Original, Working, 1891 Seth Thomas, Quarter Hour Chime, Adamantine Marble (rarest) Finish Mantel Clock. From the Private Collection of Neil Gale.

The story likely originated from a 1922 article in The Jewelers' Circular, which mentioned that some jewelers were setting their clocks to 7:22 (am), the time of Lincoln's death. However, the article did not say that this was a decision made by the Jewelers' Association of America, and it is likely that this practice was simply a spontaneous act of tribute by individual jewelers.

The myth of the Jewelers' Association of America convention is a reminder of the power of stories, even when they are not based in reality. This story has been repeated so often that many people believe it to be true, even though there is no evidence to support it. It is important to be critical of the information we encounter online and to verify the facts before we share them.

Compiled by Dr. Neil Gale, Ph.D.

ADDITIONAL READING:

Lincoln's Last Hours, by Charles Augustus Leale M.D. Published in 1909 (pdf)

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