Lost report of Lincoln assassination physician found after 147 years

[firetender]

The Doc did a good job of describing symptoms, like;

At 6.40 A.M. his pulse could not be counted, it being very intermittent, two or three pulsations being felt and followed by an intermission, when not the slightest movement of the artery could be felt.

Which gives a pretty accurate description of PVC's, so when he describes the respiritory change as;

6.50 A.M. The respirations cease for some time and all eagerly look at their watches until the profound silence is disturbed by a prolonged inspiration, which was soon followed by a sonorous expiration.

I'm NOT hearing Cheynne-Stokes. The Doc would have likely accurately described a "stair-step" pattern (not just once) that - - when breathing resumes -- starts with short in-breaths which progressively increase in length and depth until another period of apnea begins.

This is an extremely notable pattern.

My vote is this falls into the agonal category, especially since a Cheynne--Stokes pattern would have been noted for the last 1/2 hour of Lincoln's life.

 

[VFlutter]

Very cool story! The doctor did an amazing job describing everything

 

[AnthonyM83]

While approaching the President I sent a gentleman for brandy and another for water.

If I was there in that time period, I probably would have done the same...water for the President, but the brandy for myself to get through the next few moments...

 

[bigbaldguy]

The Doc did a good job of describing symptoms, like;



Which gives a pretty accurate description of PVC's, so when he describes the respiritory change as;



I'm NOT hearing Cheynne-Stokes. The Doc would have likely accurately described a "stair-step" pattern (not just once) that - - when breathing resumes -- starts with short in-breaths which progressively increase in length and depth until another period of apnea begins.

This is an extremely notable pattern.

My vote is this falls into the agonal category, especially since a Cheynne--Stokes pattern would have been noted for the last 1/2 hour of Lincoln's life.

Agonal gasps for 30 minutes? I just got done doing a bit more research on this and I did find one paper that talks about it possibly lasting for several hours. I definitely could be mistaken on this one. The doctor does a great job of describing everything else in careful detail so I think you're right if the president had exhibited signs of Cheynne-Stokes he probably would have described the building/falling pattern.

Anyone else have thoughts on this?

Here is the article that describes two cases that in some ways resemble the account by the doctor with Lincoln.

http://jme.bmj.com/content/28/3/164.full

 

[bigbaldguy]

If I was there in that time period, I probably would have done the same...water for the President, but the brandy for myself to get through the next few moments...

The brandy may have been for Mrs Lincoln. I'm sure she needed it.

 

[AnthonyM83]

The brandy may have been for Mrs Lincoln. I'm sure she needed it.

I think I needed it just from reading the report...that was intense...

 

[mycrofft]

Basic first aid used to be no dressing to a deep head wound that would stop all drainage/bleeding. Now they just ignore it.

Occipital GSW could cause odd stuff since it was both a cause of increased intracranial pressure (from bleed) and affect of resp and pulse (mechanical trauma to that area).

The facial mechanical s/s of ICP were interesting.
Note: no stethoscopes back then.

 

[Veneficus]

Basic first aid used to be no dressing to a deep head wound that would stop all drainage/bleeding. Now they just ignore it.

Occipital GSW could cause odd stuff since it was both a cause of increased intracranial pressure (from bleed) and affect of resp and pulse (mechanical trauma to that area).

The facial mechanical s/s of ICP were interesting.
Note: no stethoscopes back then.

More note:

The stethoscope was invented by a surgeon and primarily used by such.

How many surgeons do you actually see even carry a stethoscope today, much less actually use one?

 

[baonerges]

"The coagula I easily removed and passed the little finger of my left hand through the perfectly smooth opening made by the ball, and found that it had entered the encephalon.

As soon as I removed my finger a slight oozing of blood followed and his breathing became more regular and less stertorous."

i just recently passed my NREMT and so this might be completely obvious to anybody with actual experience, but is it appropriate to stick a finger into this kind of wound?

 

[bigbaldguy]

"The coagula I easily removed and passed the little finger of my left hand through the perfectly smooth opening made by the ball, and found that it had entered the encephalon.

As soon as I removed my finger a slight oozing of blood followed and his breathing became more regular and less stertorous."

i just recently passed my NREMT and so this might be completely obvious to anybody with actual experience, but is it appropriate to stick a finger into this kind of wound?

Not by today's standards no.