Gunshot Wound

[wsanto]

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.