How Did Lincoln Die?


In none of these cases did the doctors report using their fingers or any other device to “relieve the pressure” on the brain. In fact, there were many doctors who explicitly warned against the practices that were administered to Lincoln. When Leale first probed Lincoln’s wound with his unsterile finger, he was inviting sepsis, and had the President lived long enough, his wound would have become infected. Then, as now, infection was an issue. Around 1860 the discoverer of chloroform anesthesia, Sir James Y. Simpson, issued a survey to surgeons and found that of 2,098 amputations in hospital practice, 855 (40 percent) died, while only 226, or 10 percent, of the same number of patients died from amputations performed outside hospitals. Simpson concluded that “a man laid on the operating table in one of our surgical hospitals is exposed to more chances of death than was the English soldier on the battle of Waterloo.” During the Civil War 110,000 Union soldiers died from wounds or were killed in action, while 224,000 died from disease; the figures for Confederates were roughly proportionate.

It was clear to almost everyone that something was flagrantly wrong with the hospitals and medical practices of the time. Ignaz Semmelweis, a Hungarian doctor working in Viennese maternity wards, attempted to address the problem. Everyone knew about the high incidences of fatal puerperal fever among postpartum women in maternity wards and that the lyingin wards attended by medical students and doctors had higher fatality rates than those attended by nurses.

Semmelweis observed that the doctors came straight from dissecting tables to these wards, and around 1846 he began to insist that all who came from the dissecting rooms wash their hands in chlorinated lime. Incidences of puerperal fever fell dramatically.

Most doctors did not heed Semmelweis’s warnings, but there were medical men in this country who supported his assertions. Oliver Wendell Holmes in fact had already published an article advising physicians to wash their hands in calcium chloride after attending women with puerperal fever. At around the same time, Louis Pasteur, studying fermentation, had discovered that it could not take place without germs. Eventually he drew the first clear analogy between fermentation and septicemia. But Pasteur was not a doctor, and his principles were not applied to medicine and surgery until Dr. Joseph Lister read them and formulated a technique for performing antiseptic surgery.

The importance of antiseptic measures had been realized by many doctors by the time of Lincoln’s assassination. Still, this was a minor concern and not a contributing factor in Lincoln’s demise. Tissue damage incurred by the probe was likely much more harmful, and it, too, was an imprudent procedure given the standards of the time. Some doctors had known this as early as the 1820s. Dominique Jean Larrey, the surgeon-in-chief of the imperial armies of France under Napoleon, was emphatically opposed to this type of probe: “And I repeat this,” he wrote, “if foreign bodies pass beyond the inner table of the skull into the substance of the brain, it is better to leave the patient to the results of expectant treatment than to attempt to explore the interior of this pulpy organ, as we have seen some practitioners do.”

John K. Lattimer, the author of the 1980 study Kennedy and Lincoln: Medical and Ballistic Comparisons of Their Assassinations , wrote extensively on the topic of Lincoln’s murder, and his is the most detailed account of the President’s medical treatment. There are several points in Lattimer’s book that I would question. Most important, he asserts that “there seems to be no reason to disagree with those who have stated that Lincoln could not possibly have survived this wound, even in modern times. . . .” He argues that “the principles of aseptic techniques and the concept of germs as the cause of wound infections were unknown in Lincoln’s day; while occasional Civil War soldiers were reported to have recovered from bullet wounds of the brain, these were rare exceptions.”

As we have seen, the role of germs in wound infections certainly was known in Lincoln’s day. Lister did not publish his first papers until two years after the President’s assassination, but his theories on the spread of infection by germs had been established two decades earlier. As for Lattimer’s other assertion, research indicates that during the Civil War many soldiers as well as civilians did survive gunshot wounds to the brain. Among the cases I reviewed at New York Hospital, more patients survived these wounds than did not!

Another point Lattimer uses to support his case is that the autopsy “does not take into account the further damage which is now known to result from the momentary creation of a large cavity in the brain when it is traversed by a missile traveling at the speed of a bullet.” This is true for many of today’s high-velocity bullets but not of the slow-moving lead ball that killed Lincoln. Evidence for the derringer’s extremely low muzzle velocity is shown in that the ball “lodged in the white matter of the cerebrum,” a fact uncontested in all of Lincoln’s autopsy reports; the brain’s gelatinous consistency can impede only the very slowest missiles. The ball’s kinetic energy would have been too low to form much, if any, of a cavity.