Sunday, May 19, 2013

Even if he Survived, Lincoln was Likely to Fall Victim to Another Cause

While standing over the death bed of President Abraham Lincoln in the morning of April 15, 1865, Secretary of State Edwin Stanton helplessly said, “Now He Belongs to the Ages.” Stanton uttered these grisly words following hours of intense medical care provided by the most reputable physicians in the nation’s capital. Although the trauma workup patients receive in the 21st century is much more encompassing and competent than 19th century care, it is almost certain that Lincoln still would have fallen victim to his wound in the current era. However, if the president had managed to pull through, he still would have likely suffered from impairments like speech difficulty and problems with locomotion that are typically associated with brain injuries. If a hypothetical Lincoln had survived though, he probably would not have had that much longer to live. Lincoln was known to have other health problems that were taking a significant effect on his body. Before these ailments are covered though, it is necessary to first discuss the events of the evening of April 14, 1865.

Shortly after ten o’ clock on April 14, 1865, an unsuspecting Lincoln was shot in the head by John Wilkes Booth. The bullet first penetrated the occipital bone, passed through the left posterior cerebrum, entered the left lateral ventricle, and ultimately came to rest just before reaching the frontal lobe. Prior to Lincoln’s death, one of the attending physicians documented Lincoln’s behavior and noted that “Lincoln suddenly had spasmodic contractions of his arms, stopped breathing for a few seconds, and then both pupils became widely dilated.”

Emergency medicine physician and Lincoln enthusiast, Dr. Blaine Humes of Cedar Rapids, Iowa noted that Lincoln exhibited these symptoms, because the wound had caused his brain to herniate into the spinal canal. Since impingement of the spinal cord has such deleterious consequences on vital functions, it makes sense to conclude that even with today’s standard of care, the survival rate for Lincoln would have been pretty low. However, there are always cases in which gunshot wound victims miraculously pull through. A recent example occurred in Arizona when House representative, Gabrielle Giffords was wounded in the head. Although she was given the best standard of trauma care available today, the American Academy of Neurological Surgeons would consider her survival to be a miracle as, “Gunshot wound head trauma is fatal about 90 percent of the time, with many victims dying before arriving at the hospital.” If an individual is lucky enough to survive a gunshot wound, he or she is still likely to suffer from certain neurological and physical impairments such as ataxia, aphasia and gait/balance problems. If Lincoln had miraculously survived his wound, he too would have suffered from some type of physical or cognitive difficulty. However recent research on Lincoln’s blood indicates that even if Lincoln survived, he may have not had that much longer to live.

During his lifetime, president Lincoln had a few defining characteristics, that separated him from the rest of the general population. The one attribute known to most individuals was his unusually tall height. However, he was also known to have interesting lumps on his lips and he frequently suffered from gastrointestinal problems, such as constipation. He was also noted to have lost a significant amount of weight before his death. Evidence of Lincoln’s ailments were made public in 2007 after Dr. John Sotos, professor of Medicine at the University of North Carolina School of Medicine, set out to investigate why Lincoln seemed to be in poor health prior to his assassination. Due to the characteristic symptoms Lincoln displayed, Sotos zeroed in on multiple endocrine neoplasia, type 2B(MEN 2B), a rare and fatal type of thyroid cancer. To explain his proposal, Sotos first looked at Lincoln’s weight loss. This idea makes sense, as the increased metabolic activity of the thyroid gland would stimulate metabolic activities. He then looked at Lincoln’s height and lip hematomas, which are also characteristic of the disease. Finally, Sotos examined various photographs of a young president Lincoln and those of an elder Lincoln. The younger president kept a relatively short beard that was well trimmed. However, the elder Lincoln had a much longer beard and often had his neck covered by a higher collar. Sotos and historians elsewhere suggested that Lincoln may have been trying to hide a visible tumor on his neck. htttp:// Instead of being permitted to test DNA from Lincoln’s remains, Sotos was allowed to perform genomic tests on a specimen of Lincoln’s blood. The blood specimen was on a dress and was made available by the relatives of an actress, who held Lincoln’s head in her lap. Although no definitive evidence was found, the lab results did show mutations that were classified as minor contributors to MEN 2B. Currently, Sotos hopes that other family heirlooms harboring Lincoln’s blood are made available so that further testing can be performed.

Unfortunately for Lincoln, individuals with MEN 2B do not live long. When he was shot, Lincoln was fifty-six years old, thus, if he really had the disease, Lincoln may not have had long to live. It will be interesting to see if more biological specimens are made available so that it can be concluded if Lincoln really had MEN 2B. With the stress of disease and the mental and emotional fatigue incurred by the war, Lincoln truly was a walking miracle and deserves a special place in history as the enduring individual who helped to unite these states.

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