I just started reading the report from Dr. Charles Leale, the 23 year old physician who was the first to arrive when President Abraham Lincoln was shot at Ford's Theater.
It's a fascinating account of the first moments after Lincoln's assassination. I am especially intrigued by the doc ordering brandy and water. I wondered at first who the brandy was for.
"Quick man, fetch water for the president and bring me a stiff drink to calm my nervous condition!"
They talked like that back then, right?
Anyway, the brandy (and the water, but who really cares about that) came at some point and Leale gave a little to Lincoln. The Prez didn't puke it up and that was significant enough to Leale for him to include it in the report. There is no mention of whether Leale took a swig or two for himself (one for you, Mr. President, and one for me).
My money's on Leale getting hammered before this thing was over.
As paramedic, I got a big kick out of reading what amounts to a very clinical account of Lincoln's last moments. Abe was unconscious after he was shot and never recovered.There's no mention of blood pressure (which at first would probably have been very high) but the pulse was slow and erratic, common for a brain injury.
Leale knew more about brain injuries than I would have expected a doctor to know in 1865. Leale describes in detail what would happen when pressure (he called it "compression") built up in the brain:
"After this second exploration nothing further was done with the wound except to keep the opening free from coagula, which if allowed to form and remain for a very short time, would produce signs of increased compression the breathing becoming profoundly stertorous and intermittent and the pulse to be more feeble and irregular."
I have to give credit to these Civil War docs props for knowing that pressure inside the skull (intracranial pressure) was responsible for the changes they saw in Lincoln's breathing. On the other hand, they weren't perfect. The "second exploration" Leale mentions was an attempt to find the bullet:
"About 2 A.M. the Hospital Steward who had been sent for a Nelatons probe arrived and an examination was made by the Surgeon General, who introduced it to a distance of about 2½ inches, when it came in contact with a foreign substance, which laid across the tract of the ball."
2½ inches! Really?! So here's where the ignorance of a group of physicians from 1865 shows through. They just poked the president's brain with a stick to see if they could find the bullet. That far into the skull, they're now digging into state secrets for sure. But alas, they're not done:
"This being easily passed the probe was introduced several inches further, when it again touched a hard substance, which was at first supposed to be the ball, but as the bulb of the probe on its withdrawal did not indicate the mark of lead, it was generally thought to be another piece of loose bone."
Several inches further! I've seen Lincoln's top hat, he didn't have a very big head. Where is this thing going? Hey guys, the hard thing you hit was the other side of the skull!
"The probe was introduced a second time and the ball was supposed to be distinctly felt by the Surgeon General, Surgeon Crane and Dr. Stone."
One jab at presidential gray matter wasn't enough, so these guys thought the best thing was to poke around in there some more. The idea of a probe makes sense for a gunshot wound if you can do something about it. If you're going to cut into somebody's chest or belly to take out a bullet, you gotta know where the bullet is. This was cutting edge technology -- the Civil War equivalent of a CT scan.
But why did they care where it was? Were they planning on cutting open Abe's melon and retrieving the offending ball of lead? I think even 1865 docs knew they couldn't go slicing through the brain to extract the bullet. Maybe they thought it wasn't inside the Prez's skull. How would they have changed the treatment if they convinced themselves the bullet wasn't there?
Anyone who watched House M.D. knows that docs love to figure out what's going on with their patients. Often -- even today -- it doesn't really matter what they're going to do with the information. The more important thing is to understand what's going on, despite what happens to the patient in pursuit of that understanding.
The ignorance of these four physicians is evident when they ran the risk of creating more damage to a patient's brain just to find out whether the bullet that was shot into Lincoln's head was still there. I suppose the bullet could have bounced out, but the very first probe went in over 2 inches. The bullet clearly made it past the skull. As soon as they knew that, did it matter how far the bullet actually went?
The hard truth is that in 1865, a gunshot wound to the brain was either going to be fatal or not and doctors wouldn't have much affect one way or the other. Whatever happened after Boothe pulled that trigger was between him and Lincoln. Everyone else was just a spectator.
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