Part 2

I instantly arose and in response to cries for help and for a surgeon, I crossed the aisle and vaulted over the seats in a direct line to the President's box, forcing my way through the excited crowd. The door of the box had been securely fastened on the inside to prevent anyone following the assassin before he had accomplished his cruel object and made his escape. The obstruction was with difficulty removed and I was the first to be admitted to the box.

The usher having been told that I was an army surgeon, had lifted up his arm and had permitted me alone to enter.

I passed in, not in the slightest degree knowing what I had to encounter. At this moment, while in self-communion, the military command: "Halt!" came to me, and in obedience to it I stood still in the box, having a full view of the four other occupants. Then came the advice: "Be calm!" and with the calmest deliberation and force of will I brought all my senses to their greatest activity and walked forward to my duty.

Major Rathbone had bravely fought the assassin; his arm had been severely wounded and was bleeding. He came to me holding his wounded arm in the hand of the other, beseeching me to attend to his wound. I placed my hand under his chin, looking into his eyes an almost instantaneous glance revealed the fact that he was in no immediate danger, and in response to appeals from Mrs. Lincoln and Miss Harris, who were standing by the high-backed armchair in which President Lincoln sat, I went immediately to their assistance, saying I was a United States army surgeon. I grasped Mrs. Lincoln's outstretched hand in mine, while she cried piteously to me, "Oh, Doctor! Is he dead? Can he recover? Will you take charge of him? Do what you can for him. Oh, my dear husband!" etc., etc. I soothingly answered that we would do all that possibly could be done. While approaching the President, I asked a gentleman, who was at the door of the box, to procure some brandy and another to get some water.

As I looked at the President, he appeared to be dead. His eyes were closed and his head had fallen forward. He was being held upright in his chair by Mrs. Lincoln, who was weeping bitterly. From his crouched down sitting posture it was evident that Mrs. Lincoln had instantly sprung to his aid after he had been wounded and had kept him from tumbling to the floor. By Mrs. Lincoln's courage, strength and energy the President was maintained in this upright position during all the time that elapsed while Major Rathbone had bravely fought the assassin and removed the obstruction from the door of the box.

I placed my finger on the President's right radial pulse but could perceive no movement of the artery. For the purpose of reviving him, if possible, we removed him from his chair to a recumbent position on the floor of the box, and as I held his head and shoulders while doing this, my hand came in contact with a clot of blood near his left shoulder. Remembering the flashing dagger in the hand of the assassin, and the severely bleeding wound of Major Rathbone, I supposed the President had been stabbed, and while kneeling on the floor over his head, with my eyes continuously watching the President's face, I asked a gentleman to cut the coat and shirt open from the neck to the elbow to enable me, if possible, to check the hemorrhage that I thought might take place from the subclavian artery or some other blood vessel. This was done with a dirk knife, but no wound was found there. I lifted his eyelids and saw evidence of a brain injury. I quickly passed the separated fingers of both hands through his blood matted hair to examine his head, and I discovered his mortal wound. The President had been shot in the back part of the head, behind the left ear. I easily removed the obstructing clot of blood from the wound, and this relieved the pressure on the brain.

The assassin of President Lincoln had evidently carefully planned to shoot to produce instant death, as the wound he made was situated within two inches of the physiological point of selection, when instant death is desired. A Derringer pistol had been used, which had sent a large round ball on its awful mission through one of the thickest, hardest parts of the skull and into the brain. The history of surgery fails to record a recovery from such a fearful wound and I have never seen or heard of any other person with such a wound, and injury to the sinus of the brain and to the brain itself, who lived even for an hour.

As the President did not then revive, I thought of the other mode of death, apnoea, and assumed my preferred position to revive by artificial respiration. I knelt on the floor over the President, with a knee on each side of his pelvis and facing him. I leaned forward, opened his mouth and introduced two extended fingers of my right hand as far back as possible, and by pressing the base of his paralyzed tongue downward and outward, opened his larynx and made a free passage for air to enter the lungs. I placed an assistant at each of his arms to manipulate them in order to expand his thorax, then slowly to press the arms down by the side of the body, while I pressed the diaphragm upward: methods which caused air to be drawn in and forced out of his lungs.

During the intermissions I also with the strong thumb and fingers of my right hand by intermittent sliding pressure under and beneath the ribs, stimulated the apex of the heart, and resorted to several other physiological methods. We repeated these motions a number of times before signs of recovery from the profound shock were attained; then a feeble action of the heart and irregular breathing followed.

The effects of the shock were still manifest by such great prostration, that I was fearful of any extra agitation of the President's body, and became convinced that something more must be done to retain life. I leaned forcibly forward directly over his body, thorax to thorax, face to face, and several times drew in a long breath, then forcibly breathed directly into his mouth and nostrils, which expanded his lungs and improved his respirations. After waiting a moment I placed my ear over his thorax and found the action of the heart improving. I arose to the erect kneeling posture, then watched for a short time, and saw that the President could continue independent breathing and that instant death would not occur.

I then pronounced my diagnosis and prognosis: "His wound is mortal; it is impossible for him to recover." This message was telegraphed all over the country.

When the brandy and water arrived, I very slowly poured a small quantity into the President's mouth, this was swallowed and retained.

Many looked on during these earnest efforts to revive the President, but not once did any one suggest a word or in any way interfere with my actions. Mrs. Lincoln had thrown the burden on me and sat nearby looking on.

In the dimly lighted box of the theatre, so beautifully decorated with American flags, a scene of historic importance was being enacted. On the carpeted floor lay prostrate the President of the United States. His long, outstretched, athletic body of six feet four inches appeared unusually heroic. His bleeding head rested on my white linen handkerchief. His clothing was arranged as nicely as possible. He was irregularly breathing, his heart was feebly beating, his face was pale and in solemn repose, his eyelids were closed, his countenance made him appear to be in prayerful communion with the Universal God he always loved. I looked down upon him and waited for the next inspiration, which soon came: "Remove to safety." From the time Mrs. Lincoln had placed the President in my charge, I had not permitted my attention to be diverted. Again I was asked the nature of his wound and replied in these exact words: "His wound is mortal; it is impossible for him to recover."

While I was kneeling over the President on the floor Dr. Charles S. Taft and Dr. Albert F. A. King had come and offered to render any assistance. I expressed the desire to have the President taken, as soon as he had gained sufficient strength, to the nearest house on the opposite side of the street. I was asked by several if he could not be taken to the White House, but I responded that if that were attempted the President would die long before we reached there. While we were waiting for Mr. Lincoln to gain strength Laura Keene, who had been taking part in the play, appealed to me to allow her to hold the President's head. I granted this request and she sat on the floor of the box and held his head on her lap.

We decided that the President could now be moved from the possibility of danger in the theatre to a house where we might place him on a bed in safety. To assist in this duty I assigned Dr. Taft to carry his right shoulder, Dr. King to carry his left shoulder and detailed a sufficient number of others, whose names I have never discovered, to assist in carrying the body, while I carried his head, going first. We reached the door of the box and saw the long passage leading to the exit crowded with people. I called out twice: "Guards, clear the passage! Guards, clear the passage!" A free space was quickly cleared by an officer and protected by a line of soldiers in the position of present arms with swords, pistols and bayonets. When we reached the stairs, I turned so that those holding the President's feet would descend first. At the door of the theatre, I was again asked if the President could be taken to the White House. I answered: "No, the President would die on the way."

The crowd in the street completely obstructed the doorway and a captain, whose services proved invaluable all through the night, came to me, saying: "Surgeon, give me your commands and I will see that they are obeyed." I asked him to clear a passage to the nearest house opposite. He had on side arms and drew his sword. With the sword and word of command he cleared the way. We slowly crossed the street. It was necessary to stop several times to give me the opportunity to remove the clot of blood from the opening to the wound. A barrier of men had been formed to keep back the crowds on each side of an open space leading to the house. Those who went ahead reported that the house directly opposite the theatre was closed. I saw a man standing at the door of Mr. Petersen's house, diagonally opposite, holding a lighted candle in his hand and beckoning us to enter. This we did, not having been interrupted in the slightest by the throngs in the street, but a number of the excited populace followed us into the house.

The great difficulty of retaining life during this brief time occupied in moving the President from the theatre to Mr. Petersen's house, conclusively proved that the President would have died in the street if I had granted the request to take him such a long distance as to the White House. I asked for the best room and we soon had the President placed in bed. He was lifted to the longitudinal center of the bed and placed on his back. While holding his face upward and keeping his head from rolling to either side, I looked at his elevated knees caused by his great height. This uncomfortable position grieved me and I ordered the foot of the bed to be removed. Dr. Taft and Dr. King reported that it was a fixture. Then I requested that it be broken off; as I found this could not satisfactorily be done, I had the President placed diagonally on the bed and called for extra pillows, and with them formed a gentle inclined plane on which to rest his head and shoulders. His position was then one of repose.

The room soon filled with anxious people. I called the officer and asked him to open a window and order all except the medical gentlemen and friends to leave the room. After we had given the President a short rest I decided to make a thorough physical examination, as I wished to see if he had been wounded in any other part of the body. I requested all except the surgeons to leave the room. The Captain reported that my order had been carried out with the exception of Mrs. Lincoln, to whom he said he did not like to speak. I addressed Mrs. Lincoln, explaining my desire, and she immediately left the room. I examined the President's entire body from his head to his feet and found no other injury. His lower extremities were very cold and I sent the Hospital Steward, who had been of great assistance to us in removing the President from the theatre, to procure bottles of hot water and hot blankets, which were applied. I also sent for a large sinapism and in a short time one very nicely made was brought. This I applied over the solar-plexus and to the anterior surface of his body. We arranged the bed clothes nicely and I assigned Dr. Taft and Dr. King to keep his head upon the pillows in the most comfortable position, relieving each other in this duty, after which I sent an officer to notify Mrs. Lincoln that she might return to her husband; she came in and sat on a chair placed for her at the head of the bed.

As the symptoms indicated renewed brain compression, I again cleared the opening of clotted blood and pushed forward the button of bone, which acted as a valve, permitted an oozing of blood and relieved pressure on the brain. I again saw good results from this action.

After doing all that was professionally necessary, I stood aside for a general view and to think what to do next. While thus watching several army officers anxiously asked if they could in any way assist. I told them my greatest desire then was to send messengers to the White House for the President's son, Captain Robert T. Lincoln, also for the Surgeon General, Joseph K. Barnes, Surgeon D. Willard Bliss, in charge of Armory Square General Hospital, the President's family physician, Dr. Robert K. Stone, and to each member of the President's Cabinet. All these desires of mine were fulfilled.

Having been taught in early youth to pay great respect to all religious denominations in regard to their rules concerning the sick or dying, it became my duty as surgeon in charge of the dying President to summon a clergyman to his bedside. Therefore after inquiring and being informed that the Rev. Dr. Gurley was Mrs. Lincoln's pastor, I immediately sent for him.

Then I sent the Hospital Steward for a Nelaton probe. No drug or medicine in any form was administered to the President, but the artificial heat and mustard plaster that I had applied warmed his cold body and stimulated his nerves. Only a few were at any time admitted to the room by the officer, whom I had stationed at the door, and at all times I had maintained perfect discipline and order.

While we were watching and letting Nature do her part, Dr. Taft came to me with brandy and water and asked permission to give some to the President. I objected, stating as my reason that it would produce strangulation. Dr. Taft left the room, and again came to me stating that it was the opinion of others also that it might do good. I replied: "I will grant the request, if you will please at first try by pouring only a very small quantity into the President's mouth." This Dr. Taft very carefully did, the liquid ran into the President's larynx producing laryngeal obstruction and unpleasant symptoms, which took me about half a minute to overcome, but no lasting harm was done. My physiological and practical experiences had led to correct conclusions.

On the arrival of Dr. Robert K. Stone, who had been the President's family physician during his residence in Washington, I was presented to him as the one who had been in charge since the President was shot. I described the wound and told him all that had been done. He said he approved of my treatment.

Surgeon General Joseph K. Barnes' long delay in arriving was due to his going first to the White House, where he expected to find the assassinated President, then to the residence of Secretary Seward and his son, both of whom he found requiring immediate attention, as they had been severely wounded by the attempts of another assassin to kill them.

On the arrival of the Surgeon General and Assistant Surgeon General, Charles H. Crane, I reported what we had done and officially detailed to the Surgeon General my diagnosis, stating that whenever the clot was allowed to form over the opening to the wound the President's breathing became greatly embarrassed. The Surgeon General approved the treatment and my original plan of treatment was continued in every respect until the President's death.

The Hospital Steward arrived with the Nelaton probe and an examination was made by the Surgeon General and myself, who introduced the probe to a distance of about two and a half inches, where it came in contact with a foreign substance, which lay across the track of the ball; this was easily passed and the probe was introduced several inches further where it again touched a hard substance at first supposed to be the ball, but as the white porcelain 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. The probe was introduced the second time and the ball was supposed to be distinctly felt. 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 short time, produced signs of increased compression, the breathing becoming profoundly stertorous and intermittent, the pulse more feeble and irregular. After I had resigned my charge all that was professionally done for the President was to repeat occasionally my original expedient of relieving the brain pressure by freeing the opening to the wound and to count the pulse and respirations. The President's position on the bed remained exactly as I had first placed him with the assistance of Dr. Taft and Dr. King.