Lincoln`s Medical Mystery - Healthcare Professionals

7/10/2013
Michael Ready, MD
Medical History Selective
 By the Historical Method Alone Can Many of the
Problems in Medicine be approached profitably.
Sir William Osler
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 It is better to be silent and thought a fool
 Than to open your mouth and remove all doubt
A. Lincoln
 How did he get the name Honest Abe?
 A man of his time or today?
 Lessons for today
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 "I have within the last few days, been making a
most discreditable exhibition of myself in the way
of hypochondria and thereby got an impression
that Dr. Henry is necessary for my existence.
Abraham Lincoln to his law partner
Congressman John Stuart
January 20, 1841.
 Lincoln had close association /c physicians
 Friends & and providers
 Doctors often were community leaders and the best
educated citizens.
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 Association with doctors kept him aware of public
health issues.
 He was a member of a committee largely made up
of doctors who were attempting to promote proper
care of privies, removal of putrefying garbage, and
general cleanliness in a successful effort to forestall
an epidemic of Cholera in the 1830's.
 Very concerned /c medical inadequacies for troops
 Encouraged reorganization of the medical
department.
 Played an important role in establishment the
foundation for state supported medical and health
education by signing the Land Grant Act
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 A syndrome of congenital changes in the
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mesodermal & ectodermal tissues.
Autosomal dominant inheritance.
Skeletal changes (arachnodactyly, long limbs,
laxness of joints)
Vascular defects (particularly aneurysm of the
aorta, dissecting or diffuse);
Ectopia lentis
Iris transillumination is marked due to a deficiency
of posterior epithelium pigment
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 Myopia
 Lens Displacement
 Dolichocephaly - Head longer than expected
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 Pectus carinatum--the outward displacement of the
sternum
 Pectus excavatum--the inward displacement of the
sternum
 “I was simply astonished at the showing of the nude
remains were well rounded muscles built upon strong
bones told the powerful athlete. Now did I
understand the deeds of prowess recorded of the
President’s early days”
Dr. Edward Curtis
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 Sculptors & anthropologists examined & measured
these casts of Lincoln's hands commented
Long hands & fingers in keeping with his elongated
frame
Hey Lincoln was HWP !
 Any connective tissue deficiency of Marfan’s
Syndrome, his opponents could have bent his
fingers, wrists, and even elbows back and escaped
his grasp with the greatest of ease
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 Before his death, Lincoln put on a display of
woodchopping
 Using a heavy axe, making the chips fly in all
directions,
 Soldier’s home audience were amazed amazed
 Finished by standing up and holding the heavy axe out
at arm's length by the tip of the handle.
 American Heritage Feb
/ Mar 1995
 Richard Frazier, MD
professor of
Neurosurgery
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 56 yo WM GSW L occiput.
 Marked edema Post scalp
 Stat CT Head demonstrated entry 1" L of med line
sup to L Lat sinus. Missle transversed thru L post
cerebrum lobe & L lat Ventricle lodging in
cerebrum white matter above the ant portion L
corpus striatum,
 Bilat Orbits ecchymosed.
 Exopthalous present
 What are the chances for survival?
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 Charles A. Leale, MD
 Battlefield Surgeon
 Out of School 2m
 Didn’t speak about it til
1909
 Upon exam apneic / pulseless
 Moved to the floor and started resusitation
 Doctor Leale started CPR
 Discovered a clot on Shoulder
 Remembered Booth had a knife, orders Lincoln’s
collar cut off
 Discoordinate pupils = TBI
 Examined the scalp & found the bullet hole in
occiput
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 Dislodged the clot -- respirations resumed & faint
pulse present
 The President was then moved across the street to
Petersen's rooming house
 Placed in the large, back bedroom on the first
floor. Bed was too short for his frame, he was
placed diagonally across it.
 A wedge of pillows was placed under his head and
shoulders.
 At this time my knowledge of physiology,
pathology and psychology told me that the
President was totally blind as a result of blood
pressure on the brain, as indicated by the paralysis,
dilated pupils, protruding and bloodshot eyes, but
all the time I acted on the belief that if his sense of
hearing or feeling remained, he could possibly
hear me when I sent for his son, the voice of his
wile when she spoke to him and that the last
sound he heard may have been his pastor's prayer,
as he finally committed his soul to God.
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 A replica .41caliber derringer of modern steel was obtained
 Fired .41-caliber 95-grain lead ball
 Determined that powder charges that would penetrate the skull
 Fresh skulls, packed with animal brains in plastic bags
 Ballistic screens were used to demonstrate whether the 1' & 2'
missiles were rotating , tumbling , or precessing.
 Labs, X-Ray & AV departs of the Columbia Presbyterian MC
were also used.
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 Knowledge that frequently just before departure
recognition and reason return to those who have been
unconscious caused me for several hours to hold his
right hand firmly within my grasp to let him in his
blindness know, if possible, that he was in touch with
humanity and had a friend.
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 The future of the practice of medicine directly depends
upon what members of society do regarding it now.
 The relevance of Dr. Leale is that there are still
physicians as sensitive and caring to their patients, a
concept referred to as the physician/patient
relationship.
 Its importance must not be dismissed or diminished.
 "To search for middle ground between the right and
the wrong would be as vain as the search for a man
who should be neither a living man nor a dead man.
Let us have faith that right makes might, and in that
faith, let us, to the end, dare to do our duty as we
understand.”
A. Lincoln
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James A Garfield
Fascinating man
Last president to be born in
a log cabin
Civil War General
Write one hand in Latin the
other in Greek
Last Congressman to be
elected President
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 Stalked Garfield
 Choose the railway station
 Prayed for 2 wks
 44 caliber pd $1 extra
 Shot Garfield in the back
 2 shots from 6 ft away
 Tried to escape
 Sent Letter to Gen Sherman
Letter to Sherman
To General Sherman:
I have just shot the President. I
shot him several times as I
wished him to go as easily as
possible. His death was a political
necessity.
I am a lawyer, theologian, and
politician. I am a Stalwart of the
Stalwarts. I was with General
Grant and the rest of our men, in
New York during the canvass.
I am going to the Jail. Please order
out your troops, and take
possession of the jail at once.
Very respectfully,
Charles Guiteau.
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 Went down, emetic fainted -- Administered NH4/Brandy
 C/o pain in R leg / foot described as a prickling sensation
 Thank you Dr. but I am a dead man
 Believed bullet was lodged on Right side
 Robert Todd Lincoln –Sec. of War
 Dr Willard Bliss – At Lincoln’s death bed
 Dr Susan Edson Mrs Garfield’s physician
 Roscoe Conkling –former Senator from NY
 Chester A. Arthur – VP & protégée of
Conkling
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 Lister -- 16 Years before Garfield Assassination
 The whole theory od antisepsis is not only absurd but a positive injury.
 (Lister’s)… methods would be a return to the darkest days of ancient
surgery
 Little if any faith, is placed by any enlightened or experienced surgeon
on this side of the Atlantic in the so called carbolic acid treatment of
Professor Lister -- Samuel Gross, MD
 A. G. Bell – Why was telephone invented?
 Pallid expressionless face covered in sweat weak pulse
tachycardic ~120 shallow respirations
 Demanded to be taken to the White House
 AG Bell brought in to find the bullet –frantically developed
a working metal decteror
 Pyrema, Pressure Sores, Pustules, Congested Lungs
 Lived for 80 days wt from 200 to 120#
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 4 hours to complete
 Bullet was on the Left
 Lodged beneath the
pancreas –encysted
 Right side had track from
repeated probing
 Evidence of profound
sepsis
 Immediate cause of
death –Splenic AA.
rupture
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 1901 Pan American Expo
 Leon Czolgosz Shot
twice 4:18p
 James Parker jumped
Czolgosz
 “Don’t let them hurt
him”
 Dr George Hall transported to the Exposition Hall Hospital
 Lifted on the OR Table a bullet fell out –other never found
 Strychnine given
 Dr Herman Mynter -- 1st surgeon on the scene
 Dr. Matthew Mann (Gyn) well socially connected was selected
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Rosewell Parks
Parks Prof of Surgery Buffalo Medical
School
Medical director of the Exposition
Stressed complete removal of
devitalized tissue & foreign material
Cancer Center named after Parks in
Buffalo
 Not thought he could survive the transfer to a hospital
 Vital at the time of the shooting P 84 Resp nl
 “Gentleman I am in your hands”
 Chloroform was given instead of ether (gas light)
 Irony -- Incandescent lights min away, x-ray machine
in the hall
 Used a hand mirror to direct light
 Shock set in procedure had to be stopped
 No surgical in the equipment -- Parks equipment was
in the anteroom
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Reagan
Assassination
Wash. Hilton & Towers –
Reagan Hilton
Didn’t think he was shot.
Secret Service pushed into
the limo
Immediate dyspnea &
coughing up frothy blood
Insisted on walking into
the ED
CC– Chest hurts & can’t
catch my breath
Who’s holding my hand
When Nancy arrived
Mr. President today we’re
all Republicans
Emergency
Department
C/o Pain in Ribs
My chest hurts and I’m
having trouble breathing
BP 80/palp
Normal Heart Sounds
No Breath Sounds over over
Left chest
1.5cm wound over L posterior
Axillary line
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 Chest tube inserted
 1200ml bloody drainage
 200 to 300mL Q 15min
 2275 mL in ED
 BP improved 160/100
 Peritoneal Lavage clear
 EBL 3000-3500mL
 Infused 8 units PRBC
 3 Units of fresh frozen
plasma
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