With today's tools, doctors could have saved Lincoln's life

Abraham Lincoln probably would have had trouble expressing ideas, struggled with dyslexia and experienced vision problems. But the nation's 16th president might have survived an assassin's bullet to the head if today's medical technology had been available.

"He would have had a long recovery," said Thomas M. Scalea, MD, physician in chief at the R. Adams Cowley Shock Trauma Center at the University of Maryland Medical Center in Baltimore. "Could he have been president again? Maybe."

Dr. Scalea spoke about Lincoln last month at the university during the 13th annual Historical Clinicopathological Conference. The gathering attracted more than 300 alumni, faculty, students and history buffs.

Past conferences explored medical mysteries of prominent figures such as Alexander the Great and Edgar Allan Poe.

On April 14, 1865, Lincoln was shot in the back of the head by John Wilkes Booth at Ford's Theatre in Washington, D.C. The bullet from Booth's derringer stopped behind Lincoln's left eye. Army assistant surgeon Charles Leale, who was at the theater, cared for Lincoln and found a blood clot at the back of the president's head.

Physicians used brain decompression, but within 10 hours, Lincoln was dead.

"The state of the art that they offered him was brandy, water and probing the wound," said Dr. Scalea, who reviewed medical records from Lincoln's physicians.

If the shooting happened now, Lincoln would be airlifted to the Baltimore trauma center for a CT scan and medications to reduce effects of brain swelling. Surgery would be done to lessen pressure and remove accumulated blood. Doctors also would work to prevent additional brain damage.

"If [Lincoln] came in here tonight and lived, we wouldn't be amazed," Dr. Scalea said.

He said Lincoln's frontal lobes were spared, preserving sections that handle emotions, language and problem-solving. With rehabilitation, the president would have improved and may have been able to communicate.

Steven Lee Carson, a U.S. presidential historian who spoke at the conference, said he believes Lincoln would have had a difficult time returning to a normal presidency.

"If Lincoln had survived, he would have been in such bad shape that there would have been a long, long rehabilitation," Carson said. He noted that at the time, there was no provision for replacing a disabled president. It wasn't until 1967 that the 25th Amendment was ratified to address transfer of power from the president.

Philip Mackowiak, MD, founder of the annual conference, said Dr. Scalea made a good case that Lincoln might have survived but been limited in his abilities.

"He's probably the leading authority in the world. He deals with cases like this every week," said Dr. Mackowiak, chief of medical care at the VA Maryland Health Care System and author of Post Mortem: Solving History's Great Medical Mysteries, a book about cases addressed at past conferences.