Abraham Lincoln didn?t have to die. That was the conclusion of Maryland?s miracle worker, Dr. Thomas Scalea, after considering how today?s shock trauma responders would have treated America?s 16th president.
“President Lincoln did not have a uniformly fatal injury,” Scalea said Friday. “He probably would have had substantial disability, but you never really know.”
At the University of Maryland Baltimore?s 13th annual Historical Clinicopathological Conference, Scalea and historian Steven Lee Carson discussed what might have happened if Lincoln received modern medical care in the minutes and hours after John Wilkes Booth assassinated him and what the nation might have looked like.
“The United States certainly would have been a more just nation, particularly in matters of race, and quicker,” Carson said.
The constitutional issues of succession weren?t fully resolved until 1967, he said. In Lincoln?s case, while Andrew Johnson officially took the helm, Lincoln?s secretary of war Edward M. Stanton ran matters immediately after the assassination.
The possibility of speech defect following Lincoln?s brain injury may have deepened the president?s well-documented melancholy.
As for survival, Scalea said several modern and innovative procedures could have relieved pressure on his damaged brain, and reduced or eliminated secondary damage from hemorrhaging.
“There is some we could do to prevent additional damage,” he said. “There?s nothing we can do to treat brain injury.”
It would be critical that the president get into the trauma center in about six or seven minutes, he said. The primary care in the ambulance would be to give him IV fluids and “drive really fast.”
Once there, they would insert a breathing tube, remove damaged tissue and get him into a CT scan within minutes.
Pressure in the cranium can be dramatically reduced by opening the thoracic cavity, Scalea said.
“There?s a clear relationship between intercranial, interabdominal and interthoracic pressure,” he said. “It?s become a common and powerful tool we would use in the case of the president.”
Other procedures pioneered at the R. Adams Cowley Shock Trauma Center include operating on brain trauma patients in an upright position to further relieve pressure and bleeding, and leaving the skull plate open for up to three months to ease healing.
Following surgery, Lincoln would require intensive occupational and speech therapy, and would probably have trouble focusing, reading, speaking and swallowing, he said.
“His frontal lobes were spared, so his cognition would probably still be intact,” Scalea said.
