Atlantic article on Lincoln's survival

[Rob Wick]

This article was posted Friday on the Atlantic's website. Hopefully Blaine will weigh in.

http://www.theatlantic.com/health/archiv...ay/281680/

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

http://quod.lib.umich.edu/a/alajournals/...5&size=100

Best
Rob

[RJNorton]

Rob, in addition to Blaine, I also hope wsanto (Dr. Bill Carnevali) chimes in.

Here's what Dr. Lattimer wrote about this topic: "There seems to be no reason to disagree with those who have stated that Lincoln could not possibly have survived this wound, even in modern times, and that, indeed, it is remarkable that he survived for nine hours, as he did, after the shooting. Even if he had survived, he most certainly would have been a decerebrate 'vegetable'; a cruel transformation from the sensitive, compassionate, and thoughtful chief of state which he had been."

Last year Blaine 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."

[Rob Wick]

It seems one of those things that could be debated endlessly, Roger. When I was going through Eisenschiml's papers in Springfield, I saw the letters Eisenschiml wrote to various doctors, including Dr. Loyal Davis, who was the father of Nancy Reagan, and all said it would have been impossible to save Lincoln. Of course, the medical knowledge the doctors were working with in 1944 when Eisenschiml wrote the article and the situation now are worlds apart, and I obviously don't have any medical background other than being sick occasionally, but my gut tells me being kept alive, possibly. Living a functional life, doubtful.

Best
Rob

[RJNorton]

(12-01-2013 09:18 AM)Rob Wick Wrote:  but my gut tells me being kept alive, possibly. Living a functional life, doubtful.
Best
Rob

I agree, Rob.

A lot depends on whether the bullet crossed the centerline of the brain. I think this is crucial to know. The Atlantic article, if I am interpreting it correctly, seems to take the position the bullet didn't cross the centerline. But Lincoln's doctors disagreed on the path of the bullet. Ed Steers writes:

In Dr. Lattimer's book the author writes that Drs. Woodward and Curtis said left eye, and Drs. Barnes and Taft said right eye. (In another description Taft contradicted himself and said left eye.)

Diagram from Dr. Lattimer's book

[LincolnMan]

The brain damage was massive, wasn't it? If he had survived, there wouldn't have been much or any quality to his life.

[J. Beckert]

I'm not a Doctor, but due to the reports of Lincoln's position as he was shot and the fact so much bruising and discoloration was noted on the right side of his face, I tend to believe the rather large bullet damaged both sides of his brain.

A question I have is if Lincoln had lived more than the 9 hours he did, what would the effects have been of the Doctors putting their unsanitized fingers and probes into his head have been? Infection, or something worse?

[LincolnMan]

Sounds correct. That is what happened to Garfield.

[RJNorton]

(12-01-2013 08:13 PM)J. Beckert Wrote:  I'm not a Doctor, but due to the reports of Lincoln's position as he was shot and the fact so much bruising and discoloration was noted on the right side of his face, I tend to believe the rather large bullet damaged both sides of his brain.

I agree, Joe. However, the most well-known doctor to argue Lincoln could have survived is Dr. Thomas Scalea. If one googles 'Thomas Scalea Abraham Lincoln' there are numerous articles on the web describing Dr. Scalea's thoughts on why he feels Lincoln could have been saved. Last year I wrote Dr. Scalea an email inviting him to join the forum, but I received no reply.

"We probably see a dozen gunshot wounds to the head each year where people survive. He (Lincoln) had a non-fatal injury by 2007 standards," said Thomas M. Scalea, a surgeon and the director of the Shock Trauma Center."

[J. Beckert]

I saw a gunshot wound once in which both sides of the brain were damaged and the Doctor told me if the man wasn't dying of cancer, he'd have made a full recovery. His weak condition allowed pneumonia to set in. But that was a small caliber round and it fragmented into very small pieces. I'm wondering if Lincoln's wound was concentrated to one side or maybe if it wasn't so deep, if the Doctor's unsanitary methods would have killed him.

[BettyO]

Good point, Joe.

I've often wondered the same thing - if the bullet wound didn't kill him, the unsanitary conditions utilized with probes and fingers could more or less have resulted in an infection within the brain which would have killed him. The vast majority of amputations and deaths from wounds in the Civil War were the result of unsanitary medical conditions and poor treatment.

[Gene C]

According to 20 Days, "The President was stuck in the back of his head, yet the orbital plates of both eye sockets had been cracked by "contre-coup", or transmitted force, the phenomenon which causes breakage at points opposite the point of impact" The photo on p.94 shows a severely cracked skull. Hard to believe any one could survive that, even with modern medical care.

[RJNorton]

(12-02-2013 09:02 AM)Gene C Wrote:  According to 20 Days, "The President was stuck in the back of his head, yet the orbital plates of both eye sockets had been cracked by "contre-coup", or transmitted force, the phenomenon which causes breakage at points opposite the point of impact" The photo on p.94 shows a severely cracked skull. Hard to believe any one could survive that, even with modern medical care.

We discussed what Gene is referring to once before, and I made a scan of the photo he is talking about here. From what I have read there are many in the medical community who do not agree with Dr. Scalea.

[Eva Elisabeth]

(12-02-2013 08:27 AM)BettyO Wrote:  Good point, Joe.

I've often wondered the same thing - if the bullet wound didn't kill him, the unsanitary conditions utilized with probes and fingers could more or less have resulted in an infection within the brain which would have killed him. The vast majority of amputations and deaths from wounds in the Civil War were the result of unsanitary medical conditions and poor treatment.

I personally doubt this. AFAIK, the most likely causative organisms for posttraumatic infections are straphylococci, streptococci or clostridiae. Incubation period for
staphylococcus is usually 4-10 days, for streptococcus it can be 18 hours.
Clostridium perfringens can cause gas gangrene after 5-8 hours, this would go along with myonecrosis (muscle tissue death), gas production, sepsis and then progress to toxic shock (which would be the fastest fatal reaction in the case of straphylococcus and streptococcus infection, too).
A. Lincoln showed no signs of a toxic shock syndrome.

[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.

[wsanto]

The autopsy report dated April 15, 1965 is quite clear as to the path of the bullet. The bullet entered the left occiput near the mid-line and traveled through the lateral sinus, cerebrum, lateral ventrical, and lodged above the left corpus striatum. The autopsy does note that both the left and right orbital plates were fractured, bloodied and swollen.

The autopsy report was based on the autosy which is the best evidence of the bullet's path. It was completely visualized by the doctors rpeforming the autopsy and writing the report.

I am not sure why there is a controversy.

It is now 2013 and advancemnets are made every year, especially in the care of trauma patients, making it even more likely Lincoln could have survived and regained a fair amount of function.