Gunshot Wound

[Gene C]

I have read (can't remember where) that when President Lincoln was shot, his body pitched foreward, and Mary kept him from falling out of the rocking chair.

[BettyO]

Quote:I have read (can't remember where) that when President Lincoln was shot, his body pitched foreward, and Mary kept him from falling out of the rocking chair.

I've read that too, Gene -

[wsanto]

(08-19-2013 01:34 PM)J. Beckert Wrote:  I'm at work, but I'll check when I get home. I believe it stated it was a common occurrance in battlefield fatalities when the shot entered the rear of the head. I believe they stated it was due to a sudden surge of pressure in the brain.

I've never heard Lincoln's head hit the rail.

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That's the one I was thinking of Roger. Thanks.

After further study, I believe Joe and Roger are correct that the orbital plate fractures were caused by the shockwave of the bullet and not, as I have speculated, by a frontal force on the brow.

The frontal bone forms the brow and then reflects backward to form the top of the eye sockets. The orbital plate is basically the top portion of the eye socket and is wafer thin with relation to other bones of the skull . According to Dr. Woodward, they were fractured and the broken bone fragments were pushed upward toward the frontal lobe of the brain.

It now makes sense to me that the shockwave of the penetrating bullet was travelling cephalad (upward) from the occipital entry wound below the ear line and would have exerted an upward force on the orbital plates, fracturing them, in this case, and pushing the fragments toward the frontal lobe.

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(08-19-2013 09:04 PM)JMadonna Wrote:  

(08-19-2013 08:21 AM)L Verge Wrote:  I don't remember anyone ever mentioning the very plausible idea that Lincoln's head pitched forward at the moment of impact and hit the box's railing. Good point to consider.

I recall from the Kennedy shooting that the head naturally goes backward after being hit by a bullet from the rear not forward.

I believe you are correct about Kennedy. Although the initial force of the bullet hitting the skull would force the head forward, the high speed nature of the bullet travelling though the soft tissue of the brain would overcome that intial force with the equal and opposite force of the brain's soft tissue recoiling backward from the momentum of the bullet.

Lincoln's case is different as this was not a high-speed gunshot wound and so the recoiling would be less by my guess. Lincoln's wound was also penetrating (no exit wound) as opposed to Kennedy's perforating wound.

[JMadonna]

I've often wondered if the doctors had drilled a hole in Lincoln's head to relieve the pressure, would that have made a difference?

[RJNorton]

(08-20-2013 07:15 AM)JMadonna Wrote:  I've often wondered if the doctors had drilled a hole in Lincoln's head to relieve the pressure, would that have made a difference?

I believe the most well-known doctor to make a case for Lincoln's (present-day) survival is Dr. Thomas Scalea.

[L Verge]

How far into the wound were they able to insert the Nelaton probe? Would it have been far enough to determine which way the bullet was headed?

[brtmchl]

Take from Dr. Leale's account: ( He has the most amazing handwriting I have ever seen )

About 11PM the right eye began to protrude which was rapidly followed by an increase of the ecchymosis until it encircled the orbit extending above the supra orbital ridge and below the infra orbital foramen.

The wound was kept open by the Surgeon General by means of a silver probe…..who introduced it to a distance of about 2 1/2 inches when it came in contact with a foreign substance which laid across the track of the ball.

This being easily passed the probe was introduced several inches further, when it again touched a hard substance, which was at first supposed to be the ball, but as the bulb of the probe on its withdrawal did not indicate the mark of lead, it was generally though to be another piece of loose bone.
http://www.impactednurse.com/?p=4495

http://www.papersofabrahamlincoln.org/ne...il-15-1865

[wsanto]

(08-20-2013 07:49 AM)RJNorton Wrote:  

(08-20-2013 07:15 AM)JMadonna Wrote:  I've often wondered if the doctors had drilled a hole in Lincoln's head to relieve the pressure, would that have made a difference?

I believe the most well-known doctor to make a case for Lincoln's (present-day) survival is Dr. Thomas Scalea.

Thanks for the article Roger. I fully agree that he would have survived if taken to a modern trauma hospital.

A great point in the article is the fact that Lincoln did survive for so long thanks to his abundent stregnth and the great care he received from Dr. Leale and others. That's the best evidence that he would have survived long-term with modern day decompressive strategies, as described in the article.

We have a modern day example with Rep. Gabby Giffords. Her wound was similar to Lincoln's as it did not cross the midline which is uniformly fatal. She has survived and is in rehabilitation and doing quite well. She even addressed Congress since the shooting.

[Gene C]

IMO there was to much brain damage for President Lincoln to survive, even with today's medical technology and advancements.

[L Verge]

I think the crux of the whole debate is "survival" vs. "useful life."

[JMadonna]

Thanks for the article Roger, very interesting.

Did doctors at the time have the tools needed to drill a hole in the head or cut open the skull even if they chose such an option?

[RJNorton]

Jerry, I do not know. Much of this stuff is all Greek to me. Last year Dr. Houmes was kind enough to send me information on a 2009 University of Maryland Shock Trauma conference in which doctors discussed/debated Lincoln's condition. One doctor said, "If Dr. Scalea's team had had access to Lincoln at the time of the assassination, the President might well have survived, albeit with right-sided hemiplegia and homonymous hemianopsia, along with persistent dyslexia, dysgraphia, and dysphasia." Huh?

Years ago, when students wrote me through my website asking if Lincoln might have survived with modern techniques, I would always answer "no." But over the last several years I've been more open to the possibility of what Bill said above, and I simply tell the students that doctors themselves discuss/debate this issue.

[Eva Elisabeth]

(08-20-2013 11:37 AM)JMadonna Wrote:  Thanks for the article Roger, very interesting.

Did doctors at the time have the tools needed to drill a hole in the head or cut open the skull even if they chose such an option?

Such tools and methods are pretty old:

http://en.m.wikipedia.org/wiki/Trepanning

[wsanto]

(08-20-2013 11:37 AM)JMadonna Wrote:  Thanks for the article Roger, very interesting.

Did doctors at the time have the tools needed to drill a hole in the head or cut open the skull even if they chose such an option?

Jerry,

It would have taken more than a hole or two to decrompress that type of injury. Burr holes are typically used today to drain hematomas or relieve hydrocephalus (increased pressure of cerebrospinal fluid) due to blockage.

The increased pressure in Lincoln's case was due to the massive injury to his brain swellling and from the bleeding inside his skull adding to the intracranial pressure. Dr. Leale was able to temporarily relieve some of the pressure due to the bleeding but I suppose Lincoln died from the swelling and the bleeding causing increased intracranial pressure. As intracranial pressure gets too high it can overcome blood pressure and this starts to decrease blood flow to the brain. The increased pressure allso causes herniation of parts of his brainstem into the spinal canal through the base of the skull. The brainstem controls breathing, heart rate, blood pressure and other rudimentery functions. When it herniates all those functions are threatened, then fail, and death ensues.

A burr hole in this case would probably cause herniation into the burr hole. Today he would have had most of his left temporal bone removed which allows the swelling to occur and the brain to expand freely without herniation. Also his blood pressure would remain greater than intracranial pressure and allow for adequate perfusion.

[JMadonna]

(08-20-2013 02:16 PM)wsanto Wrote:  A burr hole in this case would probably cause herniation into the burr hole. Today he would have had most of his left temporal bone removed which allows the swelling to occur and the brain to expand freely without herniation. Also his blood pressure would remain greater than intracranial pressure and allow for adequate perfusion.

So could a trephine as shown here:
http://en.m.wikipedia.org/wiki/Trephine
depending on the size could have done the job?

Thanks for the link Eva.