A British comedy on stage, a twenty-three-year-old army surgeon in the audience, and a bed too short for the patient
WASHINGTON, 15 April 1865 - Abraham Lincoln died at twenty-two minutes past seven in the morning in a rented bedroom across the road from Ford's Theatre. He had been shot the night before while watching a play, and he lingered for nine hours without regaining consciousness. A modern reader wants to know one thing above all: with a trauma team, a scanner and an ambulance, could they have got him to the other side of the night? The answer is complicated, and rather less cheering than you'd like.
The Play and the Shot
Lincoln and his wife Mary had gone to Ford's Theatre on Good Friday to see Our American Cousin, a comedy by the English playwright Tom Taylor. It was, ironically, a British farce full of fortune-hunting aristocrats and mistaken identities, and the audience was laughing at one of the biggest gags when John Wilkes Booth slipped into the presidential box and fired a single shot from a .44-calibre derringer into the back of Lincoln's head. Booth leapt to the stage, shouted something in Latin, caught his spur on a flag and broke his leg, and escaped through the back door. The article on the assassination of Abraham Lincoln covers the hunt that followed. For the surgeons, the clock had begun.
The Twenty-Three-Year-Old Who Saved the Night
The first doctor to reach Lincoln was Charles Leale, an army surgeon who had been in the audience and who was, remarkably, only twenty-three years old. He had qualified only recently. Leale pushed through the panicking crowd, found the president slumped in his chair, and cut away his collar. He found the wound behind the left ear, removed a blood clot with his finger, and in doing so restored Lincoln's breathing. He then performed a kind of mouth-to-mouth resuscitation. It was a remarkable piece of improvised emergency care, and it may have given Lincoln a few extra hours. It is a story that every modern paramedic ought to read.
Why They Didn't Take Him to a Hospital
Here we come to the ambulance problem. Leale and the other doctors decided the president couldn't survive a bumpy carriage ride to the White House, a mile or so away. Instead, soldiers carried him across Tenth Street to a boarding house owned by a tailor named William Petersen. Because Lincoln was six feet four, they had to lay him diagonally across a bed that was too short. There was no ambulance, no stretcher, no trauma centre and, by today's standards, no hope of getting the right equipment. Ford's Theatre today runs a museum on the site, and you can read about the night and see the bed's replica on the Ford's Theatre website.
The Probe That Did More Harm
The other doctors who arrived at the Petersen house, including the Surgeon General, made one critical mistake. They probed the wound with a long, unwashed metal probe and then a doctor's finger, looking for the bullet. Modern medicine would call this an infection risk of the first order. Lister's antiseptic methods had been published in 1867, two years after Lincoln's death, and no one in Washington had heard of sterilising instruments. So they poked around in the president's brain with whatever came to hand. It probably didn't change the result, since the bullet had passed through the brain and lodged behind his right eye, but it makes a surgeon's blood run cold.
Would Modern Medicine Have Saved Him?
This is where honesty comes in. The wound was devastating. The ball had crossed the brain, tearing through both hemispheres, and it's very hard to see how even a modern neurosurgical team could have saved him. Patients with gunshot wounds that cross the midline of the brain have a very low survival rate even today, and those who survive are often left with severe disabilities. A helicopter, a CT scan, an immediate operation and intensive care would have given him a chance, a slim one, but not a good one. Doctors in 1865 didn't believe he'd live through the night, and he lived for nine hours, which is more than most would have managed. The Britannica biography of Abraham Lincoln paints a picture of a nation too stunned to speak.
Stanton, the Doctors and the Famous Words
Secretary of War Edwin Stanton, who was a force of nature, took charge at the Petersen house. He ordered the investigation, summoned witnesses, dictated telegrams and kept an eye on the dying president. When Lincoln breathed his last, Stanton is supposed to have said, "Now he belongs to the ages," or possibly "Now he belongs to the angels", since nobody present could agree. It's a perfect bit of political theatre, and the disagreement over the exact words makes it better. A modern press officer would have issued a statement, three clarifications and a hashtag.
What Would America Have Looked Like?
This is the question that dominates the history books. Lincoln had just won the Civil War, and he was planning a gentle Reconstruction that would bring the South back into the Union with minimal vengeance. His successor, Andrew Johnson, was a very different character, and the harsh, chaotic period that followed owed a lot to his stubbornness. A living Lincoln might have managed the peace more skilfully, though he'd have faced fierce opposition from Radical Republicans. We'll never know. What we do know is that a country which had just emerged from a bloody war was left leaderless on the very week the war ended.
The Verdict: A Brave Attempt, A Very Long Shot
Modern medicine could have given Lincoln a better chance, but not a good one. The wound was too severe. The true lessons of the night lie elsewhere: in the quick thinking of a twenty-three-year-old surgeon, in the courage of the men who carried him across the street, and in the sad fact that for all our technology, there are injuries from which no one recovers. If you ever find yourself in an emergency, think of Leale, and learn first aid.
Humorous Observations
- He was shot during a British comedy, which is the cruellest review of an English play ever recorded.
- The Petersen house bed was too short, which makes it the only time a president has been literally cut down to size.
- A twenty-three-year-old surgeon outperformed the Surgeon General, which proves that newly qualified doctors have always been braver than their elders.
- Dr Leale was barely old enough to hire a car, and still did exactly the right thing.
- Stanton's famous last line has been argued over for 160 years, and nobody has apologised for the confusion.
- Booth broke his leg jumping onto the stage, which is the only point in the story where a modern A&E might have managed something.
- The probe and the finger are exhibits that every infection control nurse would like to see destroyed.
- Every presidential motorcade today has an ambulance in it, and for that, at least, we can be grateful. https://prat.uk/?p=51091
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