Could Modern Doctors Have Saved Alexander Hamilton? Weehawken Needed a Helipad and a Better Sense of Humour
A dawn duel on a New Jersey ledge, a rowing boat across the Hudson and an argument about who fired first that has outlived everyone involved


WEEHAWKEN, NEW JERSEY, 11 July 1804 - Alexander Hamilton, the first Treasury Secretary of the United States and a man who wrote more words before breakfast than most of his rivals managed in a year, was shot by the sitting Vice President on a rocky ledge above the Hudson. He died the following afternoon. It was a bitter, pointless and thoroughly American way to settle a quarrel, and no Briton can read about it without feeling a modest glow of superiority. We, after all, would have written to The Times.


How Did the Duel Between Hamilton and Burr Go Wrong?


The rivalry between Hamilton and Aaron Burr had been simmering for years. In 1804 Hamilton helped sink Burr's bid to become governor of New York, and a newspaper printed a remark about Hamilton's "despicable opinion" of the Vice President. Burr demanded an apology and, when none came, a duel. The article on the Burr-Hamilton duel explains the rest. They crossed the river at dawn to New Jersey, where dueling was less strictly policed. Pistols were drawn, two shots rang out, and Hamilton fell with a ball in his abdomen. To this day nobody can agree who fired first.


The Wound


The bullet struck Hamilton in the lower right side of the abdomen, glanced off a rib, passed through the liver and diaphragm and lodged near his spine. He knew at once that it was serious, telling the doctor who attended him that it was a mortal wound and that he had lost the feeling in his legs. The attending physician, Dr David Hosack, was a respected surgeon who had been waiting in a boat on the river. Hosack did what he could, administering stimulants and having Hamilton rowed back across the Hudson to Manhattan, where he was carried into the house of a friend, William Bayard. He survived about thirty hours, in considerable pain, receiving visits from his wife and children.


What Modern Medicine Could Have Done


A gunshot to the abdomen is an emergency that modern surgeons treat many times a week. Paramedics would have arrived in minutes, set up lines, given fluids, and taken Hamilton to a trauma centre, where a CT scan would have mapped the bullet's path. Surgeons would have repaired the liver, stopped the bleeding and checked the spine for damage, and powerful antibiotics would have headed off infection. Hamilton had a decent chance of surviving, perhaps a good one. The spinal damage was the real worry, since it might have left him paralysed. He'd have lived, but possibly in a wheelchair, in which case he'd have kept writing, because nobody could have stopped him.


The Difficulty of Doing It on a Cliff


Now consider the logistics. The duel took place on a narrow, rocky ledge twenty feet above the river, reachable only by climbing down from the heights or by boat. The nearest hospital was across the water. A modern ambulance would have needed a helicopter, and a helicopter would have needed somewhere to land. The only flat surface was the dueling ground itself, which was about the size of a modern dining room. You can imagine the paramedics landing in a hurry, only to find two grown men with pistols, a handful of seconds, a doctor and a boatman, and no clear idea who was responsible. "Which of you is the patient?" "I am." "And which of you did it?" "That is the controversy."


The British Take on American Dueling


It's worth pausing to notice the cultural difference. In Britain, by 1804, dueling was already on the way out among the educated classes, and when gentlemen disagreed, they were more likely to write each other very rude letters. The last famous British duel involving a prime minister was the Duke of Wellington's in 1829, and he missed on purpose, which is the most British thing you could do with a pistol. The Americans, with their tradition of taking affairs of honour seriously, went on shooting each other for another half-century. The Britannica biography of Alexander Hamilton documents the end of the man who, by any measure, had better things to do.


What If Hamilton Had Survived?


American history would be a little different. Burr, who was already notorious, might have been spared his later disgrace over a plot to break away part of the western territories, though we shouldn't count on it. Hamilton, still in his late forties, would have gone on writing, lobbying and annoying everyone he met. The Federalist Party might have limped on for longer, and his plan for a strong central bank would have been defended by its author rather than by his admirers. The Library of Congress holds the surviving letters, which you can browse at the Library of Congress. There are plenty. He was not short of opinions.


The Verdict: Probably Survivable, Provided You Could Find Him


With modern medicine and a helicopter standing by, Hamilton very probably lives. It's a more difficult question whether he'd have got his political career back, because the one thing medicine can't cure is a damaged reputation. Still, the lesson for any aspiring statesman is plain: when you receive a letter demanding satisfaction, reply with a strongly worded memo, and make sure your doctor has a boat.


Humorous Observations

- A man who wrote fifty-one Federalist essays in under a year could not write his way out of a dawn appointment.


- Dueling in New Jersey is the only recorded case of anyone choosing New Jersey on purpose.


- The Vice President shooting the Treasury Secretary is the least efficient form of government reform ever devised.


- The pistols were later displayed in a bank, which seems like a very Hamiltonian thing to do.


- A modern trauma team would have asked for his insurance details, and Hamilton would have written them a pamphlet.


- Nobody can agree who fired first, which makes it the best argument in American history that nobody has ever won.


- The Brits, who invented the stiff upper lip, would have settled this with a sniffy letter and a boycott.


- If Hamilton had survived, the musical would have been about a banking reform, and nobody would have bought a ticket. https://prat.uk/?p=51085

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