Friday, March 4, 2011

Could modern medicine have saved Lincoln?

February 12 marked the bicentennial of the birth of Abraham Lincoln, the 16th and greatest president of the United States.  Most people know that on the night of April 14, 1865, Lincoln was assassinated by John Wilkes Booth while viewing a play at Ford’s theatre in Washington. Shortly after being shot by Booth, Lincoln was attended to by two young physicians, one of whom had graduated from medical school just a month earlier. The doctors did what they could for Lincoln, but the medical techniques available at the time could do little to save the president. The question arises: could modern medical techniques have made a difference in Lincoln’s prognosis?

I recently found an article that featured comments from Thomas A Scalea, M.D., who is associated with the nation’s oldest trauma center, the R.Adams Cowley Shock Trauma Center in Baltimore. In the article, the precise nature of Lincoln’s wounds are described, along with how he would be treated today.

Booth’s bullet entered the left side of Lincoln’s skull, and the two attending physicians soon probed the open wound with their fingers, which certainly isn’t advisable due to possible exposure to sepsis. They noted that at age 56, Lincoln still had the “chest and arms of an athlete.” Lincoln’s robust physique led the doctors to believe that if he hadn’t been in such strong condition, he would have died in 10 minutes.

The force of the bullet caused Lincoln to have an intracerebral hemorrhage and a subdural hematoma (blood clot) in the brain. If it happened today, Lincoln would have been rushed to a local trauma center, where he would have immediately been intubated to assist his breathing. The treatment would next have focused on relieving Lincoln’s intracranial pressure. This would involve providing a blood expansion effect by administering hypertonic saline (salt solution), along with modest hyperventilation. He would be given a chest X-ray, along with a CT scan of his head to observe the full extent of his injury.

To relieve the blood clot in his brain, Lincoln would have undergone surgery within 15 minutes of his arrival at the trauma center. The main thrust of Lincoln’s treatment would have involved relieving his elevated intracranial pressure. After the surgery, Lincoln would have been given antibiotics to prevent infection, along with a drug to prevent post-operative seizures.

Since brain injury is a highly catabolic event, Lincoln would have also been provided with parenteral nutrition or “tube feeding.” To prevent deep vein thrombosis, he would have been given blood thinners.

Lincoln’s injury would have resulted in some permanent deficits. He would have been paralyzed on his right side, suffer partial blindness, and would have been unable to read, write, or speak. But since the frontal lobe of his brain was uninjured, he would have retained his intellectual capacity. In short, he may have survived Booth’s bullet, but his quality of life would have been quite low.

Several other physicians have remarked that even if he had not been shot by Booth, Lincoln would not have lived long anyway. Based on Lincoln’s body structure, some doctors have suggested that Lincoln suffered from Marfan’s disease, which often results in a premature death from heart failure. Another physician, Dr.John G.Sotes, a cardiologist who has studied the health of American presidents, published a book last year based on years of research into the state of Lincoln’s health. In his book, The Physical Lincoln, Sotes says that Lincoln  had a rare (one person in a million) genetic disorder called multiple endocrine neoplasia, type 2B. Having this genetic defect results in cancers of endocrine organs, especially the thyroid and adrenal glands. Sotes suggests that Lincoln already showed signs of advanced cancer at the time of his death, and wouldn’t have survived much longer, since there was no treatment of cancer at the time.

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