The Case of the Sick Statesman With a Bullet in His Belly

Albert B. Lowenfels, MD


March 23, 2010

Brief Biography

Alexander Hamilton (Fig. 1) was born in 1755 on the island of Nevis in the Caribbean. His parents divorced and he was orphaned in 1767 at age 13, when his mother, at age 38, died of fever and his father abandoned him. He then supported himself by working for a shipping company. Within a few years he became responsible for a thriving commercial export enterprise. At age 17, he sailed to America where he remained for the duration of his life. While still a teenager, he entered King's College (now Columbia College), where he was initially interested in becoming a physician. At age 19, he made his first political speech supporting the action of the Boston patriots against British taxation policies.

Figure 1. Alexander Hamilton (1755-1804).

When the Revolutionary war broke out, Hamilton, then in his early 20s, became George Washington's aide-to-camp, where he met most of the revolutionary leaders who became important in his subsequent political career. Hamilton's administrative ability and decisiveness added greatly to Washington's inherent leadership qualities. When the French sent officers and troops to aid the Americans, Hamilton's French -- his first language -- was another invaluable asset. Hamilton contributed numerous essays to the federalist papers -- important documents that helped ensure the adoption of the new Constitution of the United States. He fulfilled the post of secretary of the treasury -- a vital position -- in George Washington's first cabinet.

Hamilton resigned as the secretary of the treasury in 1795 and returned to the practice of law in New York. He remained politically active, however, and highly influential, including affecting major elections, which eventually led to his duel with Aaron Burr. Hamilton had been a long-standing political enemy of Burr. The two men had similar backgrounds. Both lost their parents when they were young, both fought courageously in the Revolutionary War, and both became lawyers and practiced in New York. However, their careers in the nascent government took off in opposite directions. Hamilton belonged to the political group who favored Washington and eventually formed the federalist party, whereas Burr was a jeffersonian. In spite of Hamilton's political opposition to Jefferson, he believed Burr was dangerous. In the 1800 presidential election, Hamilton helped to break an electoral college tie between Burr and Jefferson to ensure the latter's presidency. In accordance with the electoral rules at the time, Burr then became the vice president. In 1804, Burr sought to run for governor of New York, but was defeated, in part because of Hamilton's opposition. After the gubernatorial election, letters were published citing disparaging remarks by Hamilton concerning Burr, who sought an apology. Hamilton refused, and Burr challenged him to a duel.

Hamilton had close personal experience with dueling. As a young boy growing up on Nevis he would have heard about a fatal duel that took place on the island shortly before he was born. Hamilton was also knowledgeable about dueling practice, having served as a second in a duel concerning Washington's honor. Even more important and tragic, 3 years before his own fatal duel, Hamilton's son Philip died in a duel.

Early in the morning of Wednesday, July 11, 1804, after 3 weeks of attempted settlement of the dispute by their seconds, Hamilton and Burr were rowed separately across the Hudson River and met in Weehawken, New Jersey (Fig. 2). Hamilton chose the weapons -- dueling pistols previously used for his son's duel. The men separated by 10 paces, and at the agreed upon signal, fired, nearly simultaneously. There is still disagreement about who fired first and about the extent to which Burr had practiced before the duel, but there is complete agreement that Hamilton's bullet strayed far from the target, perhaps because Hamilton purposely decided to aim away from his opponent. Burr's deadly bullet struck Hamilton's torso, entering the abdomen above the hip, causing Hamilton to immediately fall to the ground. His friend and physician, David Hosack, supervised Hamilton's return home by boat.

Figure 2. Hamilton-Burr duel.

Although Burr was still vice president of the United States, the state of New Jersey indicted him for murder. To the surprise of many congressmen, a few months after the duel Burr returned to Washington, was warmly received by President Jefferson, and resumed his senatorial duties. However, by the time the term ended, Burr's colleagues had little further interest in him. With his political career over, Burr traveled widely in Europe and the United States. Burr never exhibited any remorse for having killed a political rival and one of America's most powerful, effective statesman, nor did he ever exhibit any signs of sympathy for Hamilton's wife and 7 fatherless children. Although Burr lived to be 77, the duel essentially ended his career.

Could Hamilton Have Become President?

Whether Hamilton could have become president has been much discussed, and has led to considerable confusion and controversy, because the constitution clearly states that to be president a candidate must be a natural-born citizen, age 35 or older, and must have lived in the United States for 14 or more years. Not having been a natural-born citizen would appear to disqualify Hamilton and several other early presidents who were not natural-born citizens. To avoid this problem, the constitution included an additional clause: "or citizen of the United States, at the time of the adoption of this constitution." Hamilton, along with all the early presidents, was a citizen of the United States at the time of the adoption of the constitution, so he would have been eligible to be president. This same issue surfaced again during the 2008 presidential election with respect to McCain, born in the Panama Canal Zone, and Obama, born in Hawaii 2 years after the island attained statehood.

With his strong administrative abilities, legal and financial knowledge, abundant energy, courage, and military background, Hamilton would have made a powerful president who favored a strong central government. It is likely that if president during the War of 1812 with England, he would have defended the capitol rather than allow it to fall into the hands of the British.

History of Dueling

Dueling has a rich history, with the custom possibly arising from the code of chivalry adopted by the nobility during the late Middle Ages. It only applied to "gentlemen," and not to laborers or common people. Initially swords were the weapon of choice, which were gradually supplanted by pistols. There were elaborate rules to be followed so that gentlemen understood just how and under what circumstances they must defend their honor. Samuel Johnson wrote in response to a question from his biographer, Boswell: "Sir, it is never unlawful to fight in avert the stigma of the prevent himself from being driven out of society." Throughout most of the 18th and early 19th century, dueling was an accepted way of settling quarrels and defending one's honor. Dueling with pistols carried an appreciable mortality: 10 of 16 duels (32 combatants) carried out in American between 1777 and 1859 ended fatally, yielding a mortality rate of 31%. An additional 19% of the combatants sustained wounds.[1] Despite the real possibility of death or injury, fighting a duel was considered more acceptable than losing one's honor or being thought a coward.

Dueling continued in Europe and in America well into the 19th century, although in America formal duels became much less frequent after the Civil War, perhaps because after so many bloody battles, the country had lost it's appetite for additional personal battles. In addition, dueling was illegal in most states, and challenging an opponent to a duel could lead to a fine, prison, or both. In fact, the Hamilton-Burr duel took place in New Jersey because, in 1804, dueling was illegal in New York state. One of the last famous duels in the United States took place in Springfield, Missouri, in 1865, when "Wild Bill" Hickok killed his former friend Dave Tutt over the outcome of a poker game. Hickok, charged with murder, was eventually acquitted.


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