Lincoln and Medicine

6. The Assassination of Lincoln

74 c h a p t e r s i x The Assassination of Lincoln The theater had been a means of relaxation and escape for Abraham Lincoln throughout the Civil War. When he and Mary went to see the silly play Our American Cousin at Ford’s Theatre one April evening, they did not expect anything different. Tragically, the night of April 14, 1865, was very different indeed. Shortly after 10:00 p.m., Southern-sympathizing actor John Wilkes Booth entered the presidential box and shot Lincoln in the back of the head at point-blank range before jumping to the stage and making his escape. As the audience came to realize that this was not a part of the play, chaos ensued. When someone called frantically for a doctor, the first to respond was Charles A. Leale, who was seated in the dress circle about forty feet from Lincoln’s box. It might not have inspired much confidence if people had realized that Leale was twenty-three and had received his medical degree from Bellevue Hospital Medical College in New York only six weeks earlier. In fact, that very day, April 14, Leale had been promoted from acting assistant surgeon to the commissioned post of assistant surgeon, to date from April 8. He was in charge of a wounded officers ’ ward at the Armory Square Hospital in Washington. However, despite his recent acquisition of credentials, Leale had had a great deal of appropriate experience during the war. He had studied gunshot wounds and surgery privately with the noted Dr. Frank H. Hamilton. Leale had also been part of the Union army’s medical cadet program from February 17, 1864, to February 17, 1865. This involved a year of The Assassination of Lincoln | 75 very practical training, experience, and increasing responsibility, most likely for Leale in a ward of the Armory Square Hospital. As a result, Leale was an appropriate person to care for the wounded president.1 Leale left two accounts of his treatment of Lincoln: a letter written to Benjamin F. Butler on July 21, 1867, for the House Special Committee on Lincoln’s Assassination, and a recollection, Lincoln’s Last Hours, printed after it was delivered as a talk to the New York Commandery of the Military Order of the Loyal Legion of the United States in honor of Lincoln’s one hundredth birthday in 1909. Both of these accounts were based on notes written soon after the event. Many of Leale’s memories are confirmed in the journal and memoir of Dr. Charles Sabin Taft, who arrived at the presidential box in Ford’s Theatre shortly after Leale.2 When Leale entered the box, he found Lincoln with his eyes closed and his head leaning to the right, being held upright in his chair by the weeping Mary. In all the confusion, Leale could feel no pulse and realized Lincoln was “almost dead.” “His breathing was exceedingly stertorious [harsh snoring and gasping], there being intervals between each inspiration and he was in a most profoundly comatozed condition.” Two men helped Leale lay Lincoln on the floor. Noticing some blood near Lincoln’s left shoulder, Leale remembered seeing Booth’s knife and initially looked without success for an arterial stab wound. When Leale lifted Lincoln’s eyelids, he saw that the pupil of one eye was dilated, a sign of brain injury. Feeling through Lincoln’s hair, Leale found the gunshot wound “in the back part of the head, behind the left ear.” A blood clot with matted hair blocked the opening . Leale removed this with his fingers, gently probing the wound with his little finger. As the wound began to bleed a bit, Lincoln’s vital signs improved. Leale and the other doctors had to periodically remove blood clots throughout the night, relieving the pressure on his brain, to keep Lincoln alive.3 Some people have suggested that because the doctors probed Lincoln’s wound with their fingers, infection was introduced and was the cause of Lincoln’s death. While it is no question that wound infections were a cause of serious illness and death during the war, this was not the problem in Lincoln’s case. Had Leale not poked 76 | The Assassination of Lincoln around in Lincoln’s wound, the president would have died within a few minutes on the floor of the theater box. Probing the wound and removing blood...