Atlantic article on Lincoln's survival

[Houmes]

Interestingly, Otto Eisenschiml posed the same question, but came up with a different answer, in [i]The Case of A.L --, Aged 56.[/i]

The Atlantic article is based in large part on a conference presentation by Dr. Thomas Scalea at the University of Maryland in 2007. Dr. Scalea has reiterated his beliefs in different media for some time, including the fact that the trauma unit he leads could have saved Lincoln's life. The Atlantic article is composed of various sections which are misleading and contradict known facts. It also has a tendancy to waffle, although giving most support to Dr. Scalea's ideas, not surprising since it was written by one of his University of Maryland colleagues.

Scalea's entire premise is based on the bullet ending up on the left side of Lincoln's brain. Because there are differing accounts from participants at the autopsy, there is still debate today about which reports are accurate. This is further complicated by earlier clinical signs, observed and recorded by the doctors during Lincoln's decline, which are compatible with either a left or right bullet path. To completely disregard that the bullet didn't end up somewhere other than on the left side--and then present this as fact at a major scientific conference--is (ahem) risky, if not outrageous.

What is astonishing is why Dr. Scalea puts so much faith in what modern medicine and his team could have accomplished, believing that his care "would not only have saved Lincoln's life, but would also have restored much of the President's...function," according to the article. The path of the bullet may actually have been more midline, than on either side. It tore a large laceration in the left frontal lobe (which sits above the left eye and behind the left forehead) and passed through the vital inner part of the brain: the left portion of the ventricles (which produce spinal fluid surrounding the brain and spinal cord) before stopping above the left corpus striatum (which controls fine muscle movements, especially in relation to emotions and body responses). Mortality from gunshot wounds to the head like this one in 1865 was essentially 100%. There was the rare miracle then as there is today, depending upon several factors, but despite all the abuse Dr. Leale has taken over the years, he was correct when he said the president's wound was mortal. Today the same gun shot wound (again, depending upon several factors) has a mortality of between 90-100%. And most of those who survive end up in a vegetative state.

In the Atlantic article, comparison was made to U.S. Representative Gabby Giffords, after she was shot in the back of the head at an Arizona public function in 2011. It was near the same anatomical location as Mr. Lincoln's wound. It did not, however, "travel the same path as Booth's bullet" as mentioned in the article. The single bullet went in a straight line, continuing forward at a more lateral, oblique angle and exited through her left forehead, above and to the left of her eye. The bullet passed through only one half of her brain, missing the complex central area affected in Lincoln's brain.

The most important predictors of how well a victim will recover from a gunshot wound to the head include: the path of the bullet through the brain, the type of bullet (Gifford's was a 9-millimeter high energy missile which didn't deform, while Lincoln's was low energy which ended up irregularly blunted, sending out more irratic shock waves trailing along its path), if the victim is in an immediate coma (calculated from the universal Glascow coma scale), and if there is a unilateral dilated pupil (which Lincoln had). Any bullet involving vital midline structures of the brain and/or transecting both hemispheres of the brain is a recipe for disaster.

It's nice to know Otto and I could agree.