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Blaine Houmes, M.D.
Dr. Blaine Houmes
© Abraham Lincoln Online

A Doctor's View of the Lincoln Assassination

Ever since President Abraham Lincoln's assassination in 1865, questions, rumors and speculation have surrounded the medical aspects of his death and those connected with it.

If the president had been rushed to a modern-day emergency room, would he have survived? Why wasn't he returned to the White House to die in his own bed? Did he bleed to death after being shot? Even if he hadn't been killed, would some hidden medical problem have cut short his second term? Did his assassin escape his pursuers to live a long life? Did he commit suicide in the Virginia tobacco barn where he was apprehended?

To address these and other questons, we turned to Blaine Houmes, M.D., from Cedar Rapids, Iowa, who has many years of experience in emergency medicine and has studied the Lincoln assassination from a medical viewpoint.

ALO: How did you get started in the Lincoln field?

Dr. Houmes: Two experiences each gave me an epiphany. The first was a book, a Christmas gift that I received during my youth. It was Stefan Lorant's Lincoln: A Picture Story of His Life and in it there was a marvelous image of Lincoln in death taken in New York City, and the story behind it, which was of the young schoolboy from Des Moines who had found it in the John Nicolay papers at the State Historical Library of Illinois. That had a great influence on me since I was a similar age, and it sparked an interest which has continued.

The other main event was discovering a book that I chuckle at and shake my head at now, which I saw during my sophomore year at Iowa State University. I spent a summer in school there and should have been studying for a quantitative analysis chemistry course, but I was in the library and found a book on the shelf by Otto Eisenschiml, Why Was Lincoln Murdered? The accusations and suggestions in it just astounded me, and years later when I had the time and resources, I began investigating the Lincoln assassination. Through my medical career I was interested in Lincoln's medical history and my interest flourished from there.

ALO: How does your background in trauma care relate to your Lincoln interest?

Dr. Houmes: By training I'm an emergency physician. I did my internship and residency at Cook County Hospital in Chicago and after returning to Iowa for about ten years I was a deputy medical examiner in Linn County, so most of the focus of my career has been on trauma and forensic medicine. That's probably how I've been able to delve into a lot of the medical mysteries and attempt to clear up some things about what people believe and shouldn't.

ALO: President Lincoln was shot on April 14, 1865. If he was brought to your attention today, how would you regard his condition?

Dr. Houmes: I've seen several cases like this, most of them in Chicago. You have to take into account that medicine in 1865 was a great deal different than it is today. The training back then was very limited, not only in medical education but surgical care. There really were no surgical training programs then. The first one was at Johns Hopkins in 1889. A gunshot wound in the head like Lincoln had in 1865 was 100 percent fatal.

There are some people today who believe that he could have survived. There were cases of survival in the medical and surgical histories of the Civil War. A multi-volume edition was put out, coincidentally, by Dr. Joseph K. Barnes, who took care of Lincoln after his injury. There were people who survived their injuries from gunshot wounds but you have to read the cases carefully -- their wounds were not as major or traumatic as Lincoln's.

Today if you treat someone with an injury like Lincoln had, despite all of our advances, despite all of our equipment, despite all the drugs we're able to give, and the procedures available, if you look in the medical literature, the fatality rate is still 100 percent.

ALO: Do speculations about Lincoln's possible survival seem reasonable?

Dr. Houmes: I think they're unfounded, although in many cases, not intentionally. Some of these opinions are stated for their sensationalistic value. However, the problem also lies in the different accounts written by the physicians at the autopsy of President Lincoln performed on April 15 at the White House.

Unfortunately, depending on which account you read, you'll find that there could have been a different path of the bullet. If you only read one or two of the reports, in theory Lincoln could have survived, particularly today with our medical care. But if you read all the others, there's no way he could have survived, due to the severity of the injury. In a couple of the accounts they claimed that the bullet went straight forward; if you read other accounts, it went diagonally and ended up somewhere above or behind the right eye.

ALO: Which bullet path do you think is most accurate?

Dr. Houmes: What's interesting is that in the accounts of the physicians at his bedside in the Petersen House there is a wonderful, almost minute-by-minute account of what Lincoln looked like, what his vital signs were like, and how he was acting even though he was unconscious -- he would have some movements, some twitching, things like that, and it's a foregone conclusion that he was brain-dead by about 1:00 a.m.

This was recorded by Dr. A.F. Stone, noting that President Lincoln suddenly had spasmodic contractions of his arms, he stopped breathing for a few seconds, and then both pupils became widely dilated -- and they stayed that way until he was pronounced dead. When Lincoln exhibited these signs, the increasing pressure from the gunshot wound had herniated part of his brain, pushing it down into the opening of the spinal canal and he could no longer be saved, even by medical standards today.

The area beneath the brain is called the brain stem, and it controls breathing and heart rate. When there is pressure on the brain stem like this, whether by trauma or any other process, the vital signs begin to deteriorate and the breathing slows, becomes irregular and gasping, and the blood pressure eventually starts to fall. This is what the doctors observed and recorded. I believe from the neurologic signs and the later autopsy notes that the bullet ended behind or above the right eye.

Incidentally, this is also the strongest argument against the critics who claim that the doctors "killed" Mr. Lincoln by probing his brain with a silver probe and then a Nelaton probe. He was already brain dead when the physicians attempted these procedures at about 2:00 a.m. If anything, they may have prolonged his life by relieving the pressure on his brain by reopening the bullet hole in his skull.

The bullet that killed Lincoln
Assassination Bullet
© Abraham Lincoln Online

ALO: What changed the bullet's shape? Did the impact on the skull flatten it?

Dr. Houmes: Yes. The question is: was all the flattening effect from where it first entered the skull in the back of his head, or when it was slowed by passing through the brain and then struck the front of his skull? There wasn't enough energy for it to go through the front of his face. A 41-caliber derringer had a muzzle velocity of about 400 feet per second. The Civil War muskets had a muzzle velocity of about 1,400 feet per second. The rifle used to kill President John F. Kennedy had a muzzle velocity of 2,500 feet per second.

In the laws of physics it's not the mass of the bullet, it's the velocity that counts. There was an experiment done with gelatin blocks by the U.S. Army in the 1930s which showed that when you pass a bullet through a gelatin block or through a brain or through any soft tissue, there are different types of cavities formed briefly by the path of that missile. There's an early instantaneous one, there is one that ends up being the final track itself, but there's one in between where it just mushrooms out for a few milliseconds, so the cavity can be several times larger than the original track of the bullet -- that's the energy from the velocity being expended.

So a lot of people think it's the bleeding or the initial track of the bullet or the size of the bullet that causes all the damage. No, actually it's the cavity being instantaneously formed and then collapsing back in on itself from the energy. That's where you get a lot of the damage, so even though it's only a 41-caliber bullet, there was more than enough trauma to cause Lincoln's death.

ALO: Was the shooting done at almost point-blank range?

Dr. Houmes: Correct.

ALO: What does that mean in terms of inches or feet?

Dr. Houmes: When you look in the literature, a lot of people say that Booth fired from two or three feet away and others say that it was point-blank. We do know from a few accounts that there was a powder burn around the bullet entrance wound in the back of Lincoln's head. If that's the case, it would have had to have been at the most about a foot away and more likely a few inches away.

ALO: After doctors arrived in Lincoln's theatre box and assessed the situation, they ruled against taking him back to the White House. What were the problems they anticipated?

Dr. Houmes: Actually, there would have been several concerns. I don't know if Dr. Taft or Dr. Leale would have had the medical training to appreciate it, since medical education then was different from today, but right away you have to worry about the airway being compromised. When Dr. Leale, the first physician to arrive, gained entrance into the president's box, Lincoln was dead. He had no respiratory rate, he had no pulse. Mary Lincoln was sitting beside him, holding him up with his head propped forward.

The first thing Dr. Leale did was to put him on the floor and open up his airway, so that would have been a major concern. The other concern is that with the jostling in the street going back to the White House, they could have made the injuries far worse because the bullet was still in the brain, potentially bouncing around.

Then a final consideration would have been whether the carriage trip would have made the brain swell even more. Lincoln didn't bleed to death, he died because of the swelling which caused the brain stem to herniate down the spinal canal opening at the base of his skull. We know that the president didn't bleed to death because a later record by Dr. Charles Taft, who was also in constant attendance at the bedside, notes that all bleeding from the head wound stopped at 5:30 a.m., although death was not pronounced until 7:22 a.m.

ALO: If a doctor saw a person in this situation today would the assumption be the case is hopeless?

Dr. Houmes: There's a caveat in that question because sometimes circumstances aren't what you expect or have been led to believe. Until you get an X-ray, a CT-scan of the head, you don't know where the missile is and you don't know what damage has been done. It's not uncommon to find that an injury is either more or less serious than first suspected. There is a remarkable case history in one of the major forensic medical texts which describes a fellow who died from a 22-caliber wound to the back of the head, and the bullet never even penetrated the skull. It was the shock wave which killed him.

ALO: After Booth shot Lincoln, he broke his leg, either when he jumped to the stage or later. Do you have an opinion on this?

Dr. Houmes: Mike Kauffman has done the most work on that issue and he has a very convincing argument that Booth broke his ankle later. From my medical experience, I've known people to walk a mile or two with a broken ankle, which you would not think would be possible. I've seen people come into the emergency room days later with a broken ankle somewhat similar to Booth's.

But what is known is that the recollections and the accounts given by people who were in Ford's Theatre are all over the road. There were some who claimed that Booth limped, or that he ran, or that he was doing amazing things before leaving the theater, and many of these observations, unfortunately, were written years and years later; their recall was not ideal. One woman said she saw Booth leap from the president's box, dangle from a rope, and swing Tarzan-like down to the floor on the other side of the stage. I think Mr. Kauffman's theory is more logical than others.

ALO: After Booth fled the theatre that night, he sought medical help from Dr. Mudd. How would you rate the treatment he received?

Dr. Houmes: Actually, Dr. Mudd did a very fine job. It was state-of-the-art for 1865. Booth had a closed fracture of the left fibula, and at that time the treatment of choice for a simple bone fracture, which this was (it did not penetrate the skin) was splinting it in as close to normal anatomical position as possible. Casting material wasn't available in a sophisticated form like we know it today. Dr. Mudd made Booth a fine splint and some crutches. Rest and elevation also would have been the treatment of choice in 1865. Even today, broken bones like Booth's take about six to eight weeks to heal.

ALO: It seems like the fracture bothered Booth immensely during his flight.

Dr. Houmes: True, but you have to consider the privations he underwent. He was bouncing along on a horse, he was out in the swamps under horrendous conditions. It's not surprising that after he died people claimed that they didn't recognize him as the John Wilkes Booth that they knew. When you consider what he went through and the stress of the manhunt, it's a safe bet he was miserable.

John Wilkes Booth in the Garrrett Barn
Booth in the Barn
Harper's Weekely

ALO: When Booth is finally confronted, he resists arrest and invites the bullet that took his life. Why do you call this "suicide by cop"?

Dr. Houmes: This situation goes by different names: assisted suicide, victim-precipitated homicide, police-assisted suicide, or suicide by cop, and has been recognized for years. It only started appearing in the police and medical literature in the past 30 years or so. What it means is that under the right conditions, when people are under the influence of drugs or medicines or are psychologically disturbed, they provoke a law enforcement officer to shoot them. It usually happens when someone confronts the officer, who in turn must act to protect his or her own life or others nearby.

We know that John Wilkes Booth did not shoot himself from the work of the late Dr. John Lattimer. His studies compared the autopsy report on Booth with the neck vertebrae removed during the examination. These bones are now in the collection of the National Museum of Health and Medicine, in Washington, D.C. From the angle of the bullet path and the direction of entrance and exit through his neck, it's quite clear that someone else shot him.

Booth fits this profile well, especially if you consider his alcohol intake in the last year of his life. He was drinking the night of the assassination in Taltavul's tavern next to Ford's Theatre, just before he went up and shot President Lincoln. If you consider that, and his previous, almost histrionic outbursts with his family and others, as well as how upset he was with the Southern cause and the statements he made to the soldiers at Garrett's farm, it's entirely reasonable to consider this as being probably what happened.

ALO: Are there any assassination myths you would like to address?

Dr. Houmes: One of the greatest myths or misunderstandings is that John Wilkes Booth actually escaped and lived and died years later. He was supposedly spotted in multiple countries and multiple parts of the United States. The most notable example was the alcoholic housepainter in Enid, Oklahoma, by the name of David E. George, who committed suicide by strychnine poisoning in 1903.

Luckily I was able to bring some light on that case by discovering the X-rays of his ankle taken during a supposed autopsy of his body in 1931 in Chicago. The X-rays clearly showed that he had no healed fracture of the ankle, and without a broken ankle, it couldn't have been John Wilkes Booth.

ALO: What about possible medical conditions that Lincoln had at the time of his death?

Dr. Houmes: Postmortem autopsies are very difficult to perform without what medical examiners call the corpus delicti. If you don't have the body or very good evidence otherwise, it's hard to do anything other than speculate. Lincoln had an incredibly good constitution despite everything he'd been through in the White House -- the stress of the Civil War, death of a child, family and friends fighting on both sides, along with the usual diet, hygiene, and medical care available in 1865. The doctors at his bedside in the Petersen house were just amazed when they undressed him to find that his physique was that of a man much younger. Unless you can do DNA testing, which may have its limitations for many syndromes, we'll just never know.

ALO: Do you know anyone who thinks that Lincoln had Marfan's syndrome?

Dr. Houmes: Personally, no, and professionally no, and I don't believe it either. I've taken care of several Marfan's patients and they did not look like Abraham Lincoln. They have so many medical challenges that Lincoln did not exhibit. The idea that Lincoln had Marfan's came from an article in the Journal of the American Medical Association in 1964. A physician reported that a distant relative of Lincoln's father (a third cousin four times removed) was diagnosed in 1959.

Marfan's is inherited in an autosomal dominant pattern, meaning if a person is affected with the syndrome, there's a 50 percent chance of passing on the disease. In genetics, however, it's also considered a "fully penetrant" disorder, which means that unaffected relatives will not pass Marfan's syndrome on to their children. With a lapse of several generations without many more relatives affected, the Lincoln cousin probably inherited a spontaneous genetic mutation occurring in one of his parents (who had no symptoms), and this caused the cousin's disorder. Unfortunately, many (including physicians) have heard of this journal article and continue to believe it.

Related Information
Assassination Links
Assassination Books

Selected Articles by Blaine Houmes
"The Death of John Wilkes Booth: Suicide by Cop?" American Journal of Forensic Psychiatry, Vol. XXV, Issue 2, 2004.
"John Wilkes Booth and the Enid Mummy." Lincoln Herald, Vol. 106, No. 1, Spring 2004.
"Robert Todd Lincoln, John Wilkes Booth, & Lucy Lambert Hale." Manuscripts, Vol. LIX, No. 1, Winter 2007.
"The Wound of Abraham Lincoln." Surratt Courier, Vol. 20, No. 8, August 1995.

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