Publication: ADVANCE for Occupational Therapists Issue Date: 7/17/2000
Search String: Civil War
-----------------------------------------------------------July 17, 2000 *
Vol 16 * No.14 Page 29
evaluating famous fatalities from the Civil War
If Abe Lincoln, John Wilkes Booth and Stonewall Jackson were shot or injured
today, they might have survived
By Cynthia Blank-Reid
If Abraham Lincoln, John Wilkes Booth and Gen. Stonewall Jackson were injured
today, would they have lived? Has modern medicine progressed that far? In
this article, through case studies of these three famous trauma patients of
the Civil War years, 1861-1865, we'll learn more about their fatal injuries.
Listed below are some of the highlights of their injuries and the medical
care they received.
Case Study 1: Lincoln
(Feb. 12, 1809- April 15, 1865)
The Civil War had been over for about a week, and the 16th president had
turned his attention to rebuilding the South. On Good Friday, April 14, 1865,
the 56-year-old president and Mrs. Lincoln went to Ford's Theatre to see the
play "Our American Cousin." At approximately 10:15 p.m. a shot rang out, and
Abraham Lincoln sustained a gunshot wound (GSW) to his left occipital area.
Lincoln was carried across the street to the Petersen house, examined and
given brandy to drink, despite the fact that he was unconscious. In an effort
to keep him warm, hot water bottles were placed around him, heavy blankets
were put on top of him and mustard plaster packs were applied.
Lincoln's head wound was probed almost non-stop during the last hours of his
life.
When the probe being used was not long enough, soldiers went to local
physicians' homes to obtain a longer one. In the end with each probing, blood
and brain matter would ooze out and the President's vital signs would
temporarily improve. What Lincoln was experiencing was Cushing's Triad from
increased intracranial pressure (ICP). The physicians were able to lleviate
Cushing's Triad several times, but Lincoln died several hours after he was
shot.
Would Lincoln have survived today?
Experts argue "yes" and "no" to this question. Those who feel Lincoln's
injuries would be survivable argue that the continuous blind probing of his
wound only aggravated his injury. His treatment today would have started at
the scene with intubation and IV access. He would have been taken to the
closest trauma center, had a CT scan, surgical decompression and medical
management of his ICP.
The experts do agree, though, that if Lincoln could survive his injuries, he
would have significant neurologic deficits, possibly be blind in his left eye
and be in some type of comatose state. This type of living outcome raises the
question of what President and Mrs. Lincoln would have thought about the
withdrawal of life support, were they living in our world.
The experts who feel that Lincoln had insurvivable injuries conclude that the
bullet in the left ventricle and the secondary brain damage would have been
too much. They agree the continuous wound probing did not help the situation
but do not think it changed the outcome.
These individuals feel that the question Mrs. Lincoln would have to think
about today would be whether the president would want to be an organ donor.
Case Study 2: Booth
(May 20, 1838 - April 26, 1865)
It was documented that Booth displayed pathologic personality traits similar
to schizophrenia and suffered from alcoholism, which ran in his family. After
shooting President Lincoln, the 27-year-old Booth jumped from the balcony
level to the stage and broke his leg. He escaped to southern Maryland and
eluded federal troops for almost two weeks.
On April 26, 1865, the troops found Booth and one of his accomplices hiding
in a barn on the Garrett Farm in northern Virginia. With orders to bring
Booth back alive, a decision was made to set the barn on fire and drive the
men out. The accomplice ran out and was apprehended. Booth could be seen
pacing on a crutch.
Despite orders not to shoot, Sgt. Boston Corbett aimed his rifle and shot
Booth in the neck. He fell to the ground and was dragged from the burning
barn and placed underneath a locust tree. Booth could speak, but he could not
move his arms or legs. When the heat from the barn fire became unbearable,
Booth was moved to the front porch of the Garrett home. He would occasionally
ask for water, his mother and to be killed. He also asked that his hands be
raised up to his face so that he could see them.
Would Booth have survived today?
The experts all agree that Booth would have survived. He would have been
immobilized at the scene and taken to a trauma center. Ultimately he would
have been referred to a regional spinal cord center and would have faced all
of the complications and issues that spinal cord injury patients face.
Booth would have been a quadriplegic and possibly ventilator dependent, but
he would have survived his initial injury.
Case Study 3: "Stonewall" Jackson
(Jan. 21, 1824 - May 10, 1863)
During the battle of Chancellorsville, on Saturday evening, May 2, 1863, at
approximately 9 p.m., the 39-year-old Confederate general sustained three GSW
hen he was accidentally fired upon by his own troops. One shot went through
the left upper arm just beneath the shoulder. The humerus was fractured and
his brachial artery was injured.
The second bullet entered the lateral left upper forearm and exited
diagonally from the medial lower third of the forearm. A third bullet struck
his right hand and fractured the second and third metacarpal bones and lodged
beneath the skin on the back of his hand.
The military surgeons kept a detailed record of his condition and the care he
received.
Would Jackson have survived today?
The experts say, "yes." In fact, he would probably not even have had to have
his arm amputated.
There is considerable discussion though as to what exactly caused Jackson's
death. His wound by all accounts was not contaminated.
Some argue he had pneumonia, a pulmonary embolus from the vein at the
amputation site lodged in his lung or some intra-abdominal pathology as a
result of his fall from the litter.
No matter what the actual cause of his demise was, antibiotics, oxygen,
heparin, an abdominal CT scan, a pulmonary angiogram, etc. were not therapies
available at that time.
Conclusions
History is forever changed when key figures die.
The outcome of the Civil War might have been different had Jackson survived.
No other Confederate or Northern general could match him. Lincoln never lived
to put down on paper his strategy for reconstruction of the South, and
therefore other plans were utilized. Assassination conspiracy theories are
still discussed concerning Lincoln's cabinet members; and due to the death of
Booth, who was the mastermind of the plan, we will never know who was
involved.
There have been tremendous advancements in technology, health care and
medicine in the past 125 years. Today's health care providers might wonder
how any patients survived the Civil War, but many did. They received the best
care that was available to them at that time. Remember that 125 years from
now, someone will be looking back at our patients. *
Resources available on request.
Cynthia Blank-Reid has been the trauma nurse coordinator at The Medical
College of Pennsylvania Hospital, Philadelphia, for the last 11 years.
Table 1: Synopsis of President
Abraham Lincoln's Care
APRIL 14, 1865
2215: Shot in Ford's theater
2220: Wound finger-probed; blood oozes from it
2230: Moved across the street to the Petersen House
2250: Given brandy to drink, one pupil dilated, both unresponsive
2255: Pulse is slow
2300: Right eye significantly protruding, due to massive ecchymosis and
bleeding, P 45
APRIL 15, 1865
0100: Spasmodic contractions of muscles, pronation of both forearms; both
pupils widely dilated, has occasional apnea, P 100
0200: Silver probe only able to be placed three inches into the skull and is
too short to follow the length of the bullet track. Nelaton probe utilized
and could go approximately five inches into the skull and it strikes the left
orbital plate (verified at autopsy)
0232: P 54
0530: Oozing of blood, fluid and cerebral contents stops, P 64 and thready,
R 27
0721 and 55 seconds: Breathing ceases
0722 and 10 seconds: Pulse stops
1210: Autopsy begins at the White House in Lincoln's bedroom
AUTOPSY RESULTS--The bullet entered through the occipital bone about one inch
to the left and just above the left lateral sinus, which it opened. The
bullet then penetrated the dura mater, passed through the left posterior lobe
of the cerebrum, entered the left lateral ventricle and lodged in the white
matter of the cerebrum just above the anterior portion of the left corpus
striatum, where it was found at autopsy. In addition, both orbital plates of
the frontal bone were fractured due to the tremendous force from the gun
firing at such close range.
Table 2: Synopsis of John Wilkes Booth's Care
APRIL 26, 1865
0300-0330: shots rang out on the Garrett Farm
* Dragged from barn to tree
* Moved to the front porch
* Mumbles and speaks occasionally
* Asked for water and other things, including to be killed
* Town physician arrives, says he will not live another hour
Approximately 0530: Booth is pronounced dead
AUTOPSY RESULTS--Autopsy was done on a boat in the middle of the Potomac
River at approximately 12 p.m. under an awning. Cause of death was a GSW to
the neck with the ball entering just behind the sterno-cleido muscle--2.5
inches above the clavicle. It passed through the bony bridge of the 4th and
5th cervical vertebrae, severing the spinal cord and passing out through
the body of the sterno-cleido of right side, three inches above the clavicle.
Paralysis of the entire body was immediate, and all the horrors of
consciousness of suffering and death must have been present to the assassin
during the two hours he lingered, according to the official autopsy report.
Table 3: Synopsis of Gen. Thomas J. Jackson's Care
SATURDAY, MAY 2, 1863
2100: Sustained initial injury. While Jackson is carried from scene, a
stretcher-bearer is shot, and Jackson falls 3-4 ft. from the stretcher onto
the ground. He is picked up and taken to a field hospital, where a tourniquet
is applied.
SUNDAY, MAY 3, 1863
0300: Given anesthesia and operation started. Left arm amputated.
0900: Awakens 12 hours after being wounded and seven hours after amputation.
Pain free, cheerful and doing well. Eats a little; mind functioning quickly.
1000: Eight hours after amputation, right side begins to hurt. No bruising,
abrasions or external injuries noted. Lungs appear OK. Cold cloths applied to
right side. Dr. McGuire feels pain is from falling off stretcher.
2000: Left side pain is gone.
MONDAY, MAY 4, 1863--FIRST DAY AFTER AMPUTATION
0800: Gen. Robert E. Lee orders Jackson to be moved to safety, as fighting is
very close. Leaves field hospital in a wagon on a mattress and travels 27
miles on rough roads. Is talkative and feels well.
2000: Arrives at new location (the Chandler House). Has tea and bread and
goes to bed.
TUESDAY, MAY 5, 1863--SECOND DAY AFTER AMPUTATION
Wound healing by first intention to some extent in the stump and rest has
healthy granulation. Hand wound not painful and discharge from it healthy. A
short, light splint placed on right hand. Ate heartily and was cheerful.
Asked how long he would be kept from the battlefield.
WEDNESDAY, MAY 6, 1863--THIRD DAY AFTER AMPUTATION
No change
THURSDAY, MAY 7, 1863--FOURTH DAY AFTER AMPUTATION
0100: Awakened with nausea and pain. Warm, wet towels placed on abdomen. At
daybreak, Dr. McGuire awakened (Jackson had forbidden his aides from waking
him during the night). Diagnosis was pleuro- pneumonia of his right side. Dr.
Morrison agreed and attributed it to the fall from the litter.
1100: Mrs. Jackson and their 5-month-old daughter arrive. She notes Jackson's
cheeks are flushed and that he has a fever and oppressed breathing, which
benumbs his senses. He was not under opiates and did not recognize her. Had
to be roused to speak to wife and soon nodded off. Condition has changed
rapidly and approaching a toxic crisis.
1400: Awoke and seemed better. Recognized those around him and spoke to his
wife. Hoping for a full recovery.
FRIDAY, MAY 8, 1863--FIFTH DAY AFTER AMPUTATION
Stump redressed and wound discharge had lessened. Pain in right side has
disappeared but breathing with great difficulty and complains of exhaustion
and labored inspiration. Fever and restlessness increased, growing weaker and
becoming delirious at times.
SATURDAY, MAY 9, 1863--SIXTH DAY AFTER AMPUTATION
Marked deterioration of strength. Told nothing else can be done. Has a few
lucid moments. In afternoon, could barely talk as breathing was so labored.
In the evening, breathing less difficult, obviously weakening hourly and
becoming more toxic. Asked wife to read from the Bible and sing to him.
SUNDAY, MAY 10, 1863--SEVENTH DAY AFTER AMPUTATION
All night tossed feverishly and could not sleep. Requested continuous wet
cloths on forehead. Was delirious and weaker and he whimpered commands to
officers as if in battle. Most of time remained unconscious.
1300: He awoke and said, "It is the Lord's Day, ... have always desired to
die on Sunday."
1330: Momentary consciousness again
1500: Delirious again; ordering generals and men into battle. Stopped
suddenly, smiled and said, "Let us cross over the river, and rest under the
shade of the trees." He dies.
AUTOPSY RESULTS--Was not performed.
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