Loving President Lincoln
by Caitlin Dolan
The death of Abraham Lincoln marked a gruesome end to a presidency devoted to unification and reform, and it remains unclear how his strong leadership could have healed a divided nation. But if John Wilkes Booth had shot Lincoln in 2007, and if the president had the benefit of being treated by the world’s first trauma center at the University of Maryland, would the outcome have been any different? According to Thomas M. Scalea, MD, physician-in-chief for the R Adams Cowley Shock Trauma Center since 1997, the president sustained a recoverable injury with a reasonable expectation to survive. “We see dozens of head wounds from gunshots every year, and many survive,” said Scalea.
Thomas Scalea, MD |
The 1865 assassination and the theoretical impact of Lincoln’s potential survival were the subject matter for the 13th annual Historical Clinicopatholgical Conference, sponsored by the MAA, medical school, and VA Maryland Healthcare System. In his presentation to nearly 350 medical students, faculty, and alumni, Scalea demonstrated how the president’s bullet wound was not necessarily fatal. Medical records from April 1865, found in the National Archives, were scrutinized by Scalea and his team. They found the frontal lobes of the brain, which control cognition, were not compromised. Thus, Scalea concluded that if Lincoln had survived the attack, he might have been capable of limited speech and possessing reasonable memory after a long recovery. But he added that the president would have faced partial blindness, unsteadiness of gait, numbness of key extremities, and impaired speech due to severe damage done by the ball of a derringer pistol fired by John Wilkes Booth.
According to official reports of the assassination, an initial examination by Dr. Charles A. Leale that took place moments after the attack found Lincoln in a comatose condition with stertorous breathing. After finding an absent right radial pulse, Leale placed the president in a recumbent position and examined the head wound. He discovered a blood clot located approximately one inch below the superior curved line of the occipital bone, removed the coagula, and eventually resuscitated Lincoln.
Once Lincoln was transferred across the street to the Peterson House, the president’s medical team used a silver probe to keep the bullet wound open and attempted to prevent the further formation of coagula. Those at Lincoln’s bedside noticed a slight ecchymosis on the left eyelid, while doctors attempted to reduce the intracerebral pressure that damaged the president’s brainstem. As the night continued, Lincoln’s respiration and pulse rate diminished as the swelling and bleeding of the brain became more severe. Nine hours after the attack at Ford’s Theater, the president “breathed his last, and the spirit fled to God, who gave it.”
Throughout the conference, Scalea described the tactics the trauma team at Maryland would have performed to save the president’s life. “He needed surgery, modern-day life support, and the appropriate level of intensive care,” Scalea said. The cause of death, according to Scalea, was due to the staggering amount of brain swelling and blood loss caused by the fatal shot.
Dr. Samuel Mudd as portrayed by Wayne Millan
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If the assassination had occurred in 2007 with access to current medical technology, an endotracheal tube would have been inserted. In addition, intravenous fluid (containing a higher salt concentration than blood) would have been administered to reduce edema of the brain. Within ten minutes, a CAT scan of the president’s head would be performed, and a physical examination would take place. The CAT scan results would show large blood pools that could quickly be addressed by today’s specialists. Scalea noted that one side of the skull would be removed, opened, and covered. Then, two procedures developed at Maryland would be performed by surgeons to further reduce brain swelling and blood loss: the president’s abdominal cavity would be opened and the bed would be placed in a vertical position. Then, it would be crucial for medical staff to protect the president from complications such as infection, kidney failure, and bleeding. With a positive outcome, Scalea suggested that it is likely Lincoln could return to office after extensive physical therapy. “For him to have lived today would not be an extraordinary thing,” he concluded.
Historian
Steven Lee Carson
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Had Lincoln survived, Secretary of War Edwin Stanton, who made a number of critical decisions directly after the assassination, would likely have played a greater role, according to Stephen Lee Carson. The presidential historian reminded the audience that Vice President Andrew Johnson would not automatically have taken charge because the 25th Amendment, which deals with the transfer of power when a president is incapacitated, was not in place until after the Kennedy assassination. “The decision as to who took charge was handled on a case-by-case basis until then,” Carson added.
This year’s conference included a cameo appearance by Samuel Alexander Mudd, class of 1856, portrayed by Wayne Millan. Mudd gained notoriety for setting the broken left fibula of Booth on the morning of Lincoln’s death. He was convicted of aiding and abetting Lincoln conspirators and received a life sentence to be served at Fort Jefferson, Florida, but was later pardoned. Nikki Southall, ’02, and Heather M. Luper, MSW, performed a rendition of Farewell Father, Friend and Guardian, a song written after Lincoln’s death. |