How Did Lincoln Die?

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The damage done by the ball was significant but not devastating; many people have survived greater wounds.

With all the speculation as to the correct path of the ball, I assert that regardless of whether it lodged above the right or left orbit, Lincoln’s wound was not necessarily fatal. There are two errors in Lattimer’s comment that “it is surprising that, if the bullet had indeed traversed the central part of the brain [stem] damaging it directly as it would if it crossed the midline, respirations could be maintained at all.” First, if the bullet had damaged the brainstem directly, it would have been impossible for Lincoln to have lasted nine hours; he would have died instantly. Second, if the ball crossed the midline of the brain, it didn’t traverse the brain stem. If the ball entered just above the left lateral sinus (a fact uncontested in Woodward’s autopsy report) and traveled across the brain to lodge above the right orbit, it would have passed above the brainstem.

It would, of course, be unfair to hold Lincoln’s doctors completely responsible for his death. It was at the time very difficult to understand the extent of this type of injury and devise a procedure to treat it. Although excessive probing did probably have a negative effect on the President’s condition, there was still the problem of raised intracranial pressure, for which there was no known treatment in 1865.

Nevertheless, there were doctors in Lincoln’s day who knew better. If the principles of Larrey and others had been heeded, the doctors would never have probed as they did. There are reasons to believe that today Lincoln’s life could have been saved. The damage incurred by the ball was significant but not devastating, and many people have survived wounds of a greater force.

When defending the constitutionality of the Emancipation Proclamation, Lincoln used a metaphor that is both ironic and relevant to this article: “Often a limb must be amputated to save a life. The surgeon is solemnly bound to try to save both life and limb; but when the crisis comes, and the limb must be sacrificed as the only chance of saving the life, no honest man will hesitate.... In our case, the moment came when I felt that slavery must die that the nation might live.”

In the days before antiseptic surgery, Lincoln had foreshadowed his own demise; his efforts to preserve the life of the nation had been successful at the cost of its strongest limb.