The assassin ascends the steps to the private balcony where his unsuspecting prey delays.
The prey watches the performance below him, oblivious to his own approaching doom. He knows nothing until he hears the firing of a derringer, and by then it\’s past too far.
The shot rings out. The crowd screams. The assassin flees.
And by the next morning, obama is dead.
Abraham Lincoln, 16th President of the us, was shot in the back of the top by John Wilkes Booth on April 14th, 1865, mere days following the end from the long and bloody Civil War.
As the 150th anniversary of Lincoln\’s death nears (April 15th), one can\’t help but wonder: Would the President have survived if he\’d had access to today\’s medical technologies? Would modern science have any effect on his chances for survival?
Almost immediately after being shot, Lincoln was rushed from Ford\’s Theatre to a nearby house and treated for his injury.
However, in 1865 there was little when it comes to medicine, technology or trauma care for something as severe as Lincoln\’s fatal wound, said Dr. Allen Sills, a neurosurgeon at Vanderbilt Hospital in Nashville, Tennessee.
\”There was no way to monitor intracranial pressure, there was no way to image the mind and also the variety of medications which were available were extremely limited,\” Sills said. \”I think that traumatic injuries towards the brain were treated probably treated similar to traumatic injuries to other areas of the body where physicians and surgeons attempted to steer clear of the bleeding and provide general supportive care and hope all went well.\”
Based on Lincoln\’s autopsy report, the bullet entered Lincoln\’s skull through his occipital bone \”about one inch to the left from the median line and merely above the left lateral sinus, which it opened.\”
Currier & Ives depiction from the Lincoln assassination.
From there, the bullet tore into Lincoln\’s dura mater, worked its way with the cerebrum\’s left posterior lobe and entered the left lateral ventricle.
The bullet finally came to rest within the white matter of the cerebrum above the anterior area of the left corpus striatum.
This caused Lincoln\’s brain to compress against the inside of his skull. Like tissue anywhere else in the body, the brain naturally swells after sustaining a traumatic injury.
However, while an injured branch can freely expand without restriction, the brain are only able to swell so much because of the skull surrounding it.
“You need to think of the brain as existing inside a closed box, that is what the skull is really,\” Sills said. \”The skull really can\’t expand, it\’s not elastic at all and it\’s very rigid. So, once the mental abilities are injured and it starts to swell, it causes a dramatic increase in the pressure inside the skull.\”
To ease this pressure, the doctors treating Lincoln repeatedly probed his wound to get rid of the blood and thereby keep your pressure down. This only prolonged the inevitable and didn\’t affect his long-term opportunity for survival, Sills said.
The bleeding finally stopped because of the very high pressure in Lincoln\’s brain tissue, which in turn caused his brain to fail entirely and eventually resulted in his death.
If Lincoln were alive in 2015, he would find himself aware of numerous developments in medicine and science.
Within the last many years alone there has been multiple breakthroughs just in the field of neurosurgery and just how the mind is treated, from CAT scans to metabolic suppression, Sills said.
\”Probably the biggest innovations in the last two to three decades have been our capability to measure intracranial pressure continuously,\” he said. \”Additionally there exists a much greater selection of medications we are able to use to decrease pressure within the brain and also to reduce the amount of energy the brain is requiring at any given time.\”
Besides having the ability to medicate and image the brain to look for structural damage, Sills said the understanding of the variables affecting each patient\’s survival has also evolved in the past few years.
So, with all that in mind, what can happen if Lincoln were shot today in the identical way as on that fateful night in 1865?
The initial step, said Sills, is always to secure Lincoln\’s airway by putting a breathing tube directly down his windpipe.
\”When the mind has a severe injury, respiration and charge of respirations may become very irregular, which actually contributes to a worsening from the injury,\” he explained.
The second reason for this is so doctors can help reduce the pressure in the brain by governing the ratio of oxygen and co2 in the body, which helps ease the swelling of brain tissue.
Once it was done, doctors would stabilize and continuously monitor Lincoln\’s blood pressure level even though in the same making sure enough blood was flowing to the brain despite the injury.
Lincoln would then be given medicine and treatment to ease the intracranial pressure, then undergo the cat scan to find out if surgery was needed \”immediately, on the delayed basis or otherwise at all,\” Sills said.
However, Sills noted that surgery isn\’t very common in most cases of penetrating brain injuries from gunshot wounds.
\”Surgery is not extremely common because the nature from the injury doesn\’t lend itself to the need for surgery, but that\’s obviously selected a case-by-case basis,\” he said.
Even if patients survive such injuries, Sills said many of those patients will suffer from disabilities. These may vary from lack of vision to loss of speech or movement, but the deficiencies, if any, are determined by how much of the mental abilities are damaged by the incoming bullet.
Despite the benefits of today\’s technology and medicine, Sills asserted Lincoln probably still wouldn\’t have survived his traumatic gunshot wound.
Lincoln was shot at close range in the back of the top having a .44 caliber bullet. This fact, coupled with the path carved through the bullet through his brain, implies that not really modern science might have saved Lincoln\’s life.
And even if he\’d lived, Lincoln certainly wouldn\’t have resumed his duties as president.
\”I think in line with the descriptions we have, that even if he had been literally across the street from the modern major trauma center, this would have likely been a fatal injury. But, if he had survived, there would have been significant disability that he would have incurred,\” Sills said.