Could Modern Medicine Have Saved Lincoln?

By David Brown
Washington Post Staff Writer
Monday, May 21, 2007

If Ford's Theatre had been in Baltimore, if the patient had been taken to the state Shock Trauma Center and if 1865 were 2007 . . . Abraham Lincoln might have survived the gunshot wound to his head.

If he had lived, he would at the very least have been partially blind, unsteady on his feet, numb in certain regions of his body and inarticulate. Nevertheless, he might have been able to think and, after much rehabilitation, communicate.

What that might have meant to the United States at the dawn of reunification after the Civil War -- well, the string of imaginary events can be unspooled forever.

In their annual examination with the flexible retrospectoscope, medical experts last week took on the case of Abraham Lincoln at the 13th Historical Clinicopathological Conference, sponsored by the University of Maryland School of Medicine and the Veterans Affairs hospital.

Previous exercises have sought to diagnose illness or determine cause of death of famous people with incomplete medical records. They include Alexander the Great (typhoid fever complicated by Guillain-Barre syndrome), Ludwig van Beethoven (syphilis) and Edgar Allan Poe (rabies, a diagnosis now generally discredited). This year's attempted not to solve a mystery but rather to address an extreme hypothetical -- what might have happened to one of the country's greatest presidents if time travel were possible.

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

Though almost all previous analyses have called Lincoln's wound unsurvivable under any circumstance, Scalea believes evidence to the contrary is in plain view. Lincoln survived for nine hours.

Lincoln was shot about 10:25 p.m. on April 14, 1865. He lived long past the "golden hour" when stabilization of vital functions -- principally, respiration and blood pressure -- is essential. Throughout the night his condition waxed and waned, until brain swelling and blood loss tipped him inevitably toward death, which occurred at 7:22 a.m. the next day.

During that night, which ended with Secretary of War Edwin Stanton's memorable comment "Now he belongs to the ages," definitive medical care would have been possible if Lincoln had lived in another age.

"For him to have lived today would not be an extraordinary thing," Scalea said.

John Wilkes Booth, the assassin, shot the 16th president with a muzzle-loading derringer pistol. The bullet -- apparently a .41-caliber slug fired from the .44-caliber weapon -- pierced the lower rear part of the skull, called the occipital bone, and traveled roughly straight forward.

It tore a path through the left side of the brain, including through the fluid-filled lateral ventricle. But it did not hit the brainstem, which controls such essential functions as breathing, did not cross the midline, and stopped before entering the frontal lobes, the seat of reason and emotional control.

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