How Did Lincoln Die?

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When the surgeon reached Lincoln, he found him paralyzed, with his eyes closed. Leale placed his finger on the right radial pulse but felt no movement. With assistance Leale immediately placed the President in a recumbent position, and in the process his hand came in contact with blood on Lincoln’s left shoulder. He thought that perhaps the President had been stabbed with the dagger, but found no wound. Continuing to examine the patient, Leale noticed that the pupils were dilated, and he discovered a large clot of blood about one inch below the superior curved line and an inch and a half to the left of the median line of the occipital bone in the back of the skull. He passed the little finger of his left hand through the hole made by the ball. Lincoln “was then apparently dead,” Leale wrote in his report, but when he removed his finger, blood oozed out, and the President “soon commenced to show signs of improvement.”

There is some question about what occurred next. Leale’s account of the assassination submitted in 1867 made no mention of resuscitation, but in 1909 he delivered an address in New York giving a detailed description of practicing mouth-to-mouth resuscitation on Lincoln after he probed the wound. It is strange that Leale did not include this in his first account, which omitted no other important details of the President’s treatment. I am more inclined to give credence to this earlier version, recorded in Leale’s own hand the day Lincoln died.

In any event, this resuscitation, if it actually occurred, was directly followed by the arrival of an Army surgeon, Dr. Charles S. Taft, and Dr. A. F. A. King of Washington, at which point the three doctors agreed to remove the stricken President. Leale was asked to put Lincoln in a carriage to take him to the White House, but he refused for fear that the President would die if placed upright. Instead Lincoln was taken across the street to the nearest house, which belonged to a Mr. William Petersen, and was placed on a bed—diagonally because he was too tall to fit lengthwise. Leale asked that everyone leave the room with the exception of “the medical gentlemen.” After undressing the patient, Leale found that the President’s lower extremities were quite cold “to a distance several inches above his knees.” He sent for the surgeon general, J. K. Barnes, the family physician, Robert K. Stone, and the commander of the Armory Square Hospital, D. W. Bliss. The moment Dr. Stone arrived, Leale gave control of the President’s care over to him. (Dr. Bliss is unique in being the only surgeon to participate in the care of two assassinated Presidents; he helped preside over President Garfield’s post-assault care sixteen years later. The quality of his conduct in that case and that of his colleague Dr. Weiss, an anatomist, prompted one reporter’s acid comment: “If ignorance is Bliss, ’tis folly to be Weiss.”

When Lincoln was first laid in bed, a “slight ecchymosis of blood” (a spot from a rupture) was noticed on his left eyelid, and the pupil of that eye was dilated. At 11:00 P.M. the right eye began to protrude, and this was followed by an increase of the ecchymosis, until it encircled the right orbit. The wound was kept open by the surgeon general with a silver probe. Dr. Taft remarked that at 11:30 a twitching of the facial muscles of the left side set in and continued for about fifteen to twenty minutes, and “there was artificial heat to the extremities.” At 1:00 A.M. “spasmodic contractions of the muscles came on,” and “at about the same time both pupils became widely dilated and remained so until death.” Presumably at this moment Lincoln became decerebrate—brain dead.

The probe hit a foreign substance and kept going until it felt another one, at first thought to be the ball.

At 2:00 A.M. a doctor’s aide arrived with a Nekton’s probe, and an examination of the wound was made by the surgeon general. The probe was driven about two and a half inches when it hit a foreign substance. This was passed, and then the probe felt another hard substance, which was at first thought to be the ball. However, when the probe was removed without a lead stain, the obstacle was thought to be another piece of bone. The probe was introduced a second time, and the ball “was supposed to be distinctly felt by the Surgeon General.” Taft accounts for the ball’s not making any mark on the probe by explaining that it “was afterwards found to be of exceedingly hard lead.” Following the probes, “Nothing further was done except to keep the wound free from coagula.” Taft remarks on the “great difference in character of the pulse whenever the orifice of the wound was freed from coagulum” and adds that “while the wound was discharging freely, the respiration was easy, but the moment the discharge was arrested from any cause, it became at once labored.”

During the night doctors counted pulsations, and at 6:50 A.M. respirations ceased for some time. Lincoln lived about thirty minutes longer, during which time Rev. Phineas Gurley said, “Let us pray,” and everyone knelt beside the bed. At 7:22 A.M. , Lincoln “breathed his last.”