19 Assasinations

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<div class="storyhead">Famous assassinations: Who could doctors save today?<div

class="subhead"></div></div>
<p class="byline"><b>By DONNA HEALY<br>Of The Gazette Staff</b></p>
Would Julius Caesar or John F. Kennedy have survived if they were attacked in
Billings today?<BR /><BR />Dr. Terry Housinger, a general surgeon at the Billings
Clinic, tackled the topic of famous assassinations at a meeting of the History of
Medicine Club, offering his audience of medical students and doctors a chance to
reflect on the evolution of trauma care.<BR /><BR />After describing the
circumstances surrounding each famous assassination, Housinger offered his opinion
on whether modern medicine could have saved those high-profile victims if the
attack had occurred in Billings today.<BR /><BR />Here's the gist of what
Housinger gleaned from the historical record:
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<h3>Julius Caesar</h3>• The circumstances: As a military leader, Caesar
transformed Rome into an empire that stretched across Europe. But political
opponents feared his power as a statesman.<BR /><BR />On March 15, the Ides of
March, in 44 B.C., Caesar was lured to the Senate by Roman aristocrats who hid
knives under their togas.<BR /><BR />William Shakespeare's play "Julius Caesar"
helped make his murder one of the most talked-about assassinations in history,
Housinger said.<BR /><BR />"The first blow went into his shoulder and his neck, so
it may have gotten a major artery there," Housinger said. Caesar started spurting
blood all over, according to historical accounts.<BR /><BR />"And then everybody
just had at it."<BR /><BR />Caesar was stabbed many times - some accounts say more
than 20 times while others claim 75 to 100 times - and left to bleed to death.<BR
/><BR />• Today's outcome: No chance. If he had been stabbed in an alley in
Billings that many times and left to bleed, he wouldn't have survived today,
Housinger said. Caesar had too many big wounds and lost too much blood.<BR /><BR
/><h3>Abraham Lincoln</h3>• The circumstances: The first assassination of an
American president came on the night of April 14, 1865, when Lincoln attended a
performance of the comic melodrama "Our American Cousin" at Ford's Theater in
Washington, D.C.<BR /><BR />As part of a conspiracy plot, John Wilkes Booth, an
actor, shot the president from the rear of the presidential box, leapt to the
stage and cried, "Sic semper tyrannis" ("Thus always to tyrants"), Virginia's
motto.<BR /><BR />• The weapon: Booth's single shot, at a distance of less
than 5 feet, came from a .44-caliber derringer, a short stubby weapon. The
derringer had a medium muzzle velocity, a measure of the speed of a bullet as it
leaves the barrel, of 900 feet per second. It also had a relatively low muzzle
energy of 350 foot-pounds.<BR /><BR />In comparison, today's high-powered rifles
get into the 3,000 range for muzzle energy.<BR /><BR />• The wound: The
bullet entered from behind the left ear and penetrated deep into Lincoln's
skull.<BR /><BR />• Medical attention: "At the scene, they did a form of
CPR," Housinger said.<BR /><BR />Because Lincoln stopped breathing shortly after
he was shot, a couple of medical students tried to do an early form of
cardiopulmonary resuscitation. "CPR, the way they did it, was basically where they
were pushing on his diaphragm from below and they were pulling up his arms,"
Housinger said. "They actually got some respirations."<BR /><BR />One of the
physicians who was there kept pulling the clot out to minimize the damage caused
by swelling.<BR /><BR />"Their thought at the time, maybe one of the things they
learned from Civil War trauma, was they wanted to keep pressure off the brain.
They would pull the clot off so he could freely bleed."<BR /><BR />Lincoln moaned
frequently and moved a little bit in his upper extremities but showed few other
signs of life. He was carried to a nearby house.<BR /><BR />"There was a lot of
hand wringing done in the next portion of his care. About 10 hours later, he
died," Housinger said.<BR /><BR />In addition to the bleeding and tissue damage
from the gunshot, the injury probably caused the brain to swell severely enough to
cause the brain to herniate, or bulge downward, pushing the brain stem down toward
the spinal column, which can cause death by stopping the body's control of basic
functions such as breathing or heartbeat.<BR /><BR />• Today's outcome: In
Billings, with good neurological care, Lincoln might have survived. He probably
could have been decompressed, relieving the swelling by using drugs or opening a
portion of the skull to relieve pressure. The operation might have required
removing a portion of the brain.<BR /><BR />If he survived, he would have been in
a minimal vegetative state at best, Housinger said.<BR /><BR /><h3>James A.
Garfield</h3>• The circumstances: Four months after taking office, Garfield
was assassinated by a disappointed job seeker. Garfield was the fourth president
to die in office and the second to be assassinated.<BR /><BR />He was shot on July
2, 1881, as he stood in a railroad station waiting to take a train to his 25th
class reunion at Williams College. The assassin, Charles J. Guiteau, stepped out
of the crowd and fired two shots.<BR /><BR />• The weapon: Garfield was shot
from a distance of less than 5 feet with a .44 caliber pistol.<BR /><BR />•
The wound: The bullet passed within 3 to 4 inches of the president's spinal
column. It broke through the 11th rib of Garfield's back on the right side,
causing injuries to the liver and soft tissues.<BR /><BR />• Medical
attention: Wound probing.<BR /><BR />Despite horrendous casualties during the
Civil War, surgeons learned very little about trauma care from the war because
there was no systematic method of evaluating the results of specific
procedures.<BR /><BR />"We didn't learn diddly squat from the Civil War. People
weren't of a mode to study how you could better take care of somebody who is badly
injured. They just did stuff," Housinger said.<BR /><BR />Every doctor had his own
ideas about treatment.<BR /><BR />"One of the things these guys all did was they
wanted to probe the wound. I don't have any idea of what they thought they were
going to do by probing the wound, but, by God, they did it. They stuck their
fingers in it and probed for the bullet. Everybody was hung up on finding the
bullet," he said.<BR /><BR />Today, a bullet is often allowed to remain in place
because digging around for it can cause more damage.<BR /><BR />"They closed his
wounds. That was about it," Housinger said.<BR /><BR />Garfield was tachycardic,
having a very rapid heartbeat, and tachypneic, having abnormally rapid
breathing.<BR /><BR />On Sept. 19, 80 days after he was shot, Garfield died of
sepsis, a widespread inflammation that happens when the body's normal reaction to
an infection goes into overdrive. The inflammation can cause dramatic changes in
body temperature, blood pressure, breathing and heart rate, and it can spiral into
multiple organ failure.<BR /><BR />Garfield had abscesses, pockets of infection,
throughout his abdomen, where his body had tried to wall off the infection in an
attempt to contain it.<BR /><BR />As Garfield struggled against death, he also
became severely malnourished, dropping from 220 pounds to 130 pounds.<BR /><BR
/>"He had any number of wound probings, not just that first night, but on down the
way. Everybody needed to stick their finger in," Housinger said.<BR /><BR />At the
time, there were no surgical gloves or antibacterial soaps.<BR /><BR />•
Today's outcome: Doctors would have been able to treat his injuries and infection
and been able to offer nourishment intravenously or through tube feedings.<BR
/><BR />"This was a no-brainer. It would have been an unreasonable death by
today's standard," Housinger said.<BR /><BR /><h3>William McKinley</h3>• The
circumstances: McKinley was six months into the start of his second term when he
was shot by an assassin and Theodore Roosevelt assumed the presidency.<BR /><BR
/>On Sept. 5, 1901, McKinley was shaking hands with people in a receiving line at
the Pan-American Exposition in Buffalo, N.Y., when he was shot twice by Leon F.
Czolgosz, a deranged anarchist.<BR /><BR />• The weapon: McKinley was shot at
point-blank range with a .32-caliber revolver. The revolver had a muzzle velocity
of 780 feet per second. The bullet had a fairly low energy of 130 foot-pounds.<BR
/><BR />• The wound: The bullet hit McKinley's left upper abdomen and passed
through his stomach.<BR /><BR />• Medical attention: At first, McKinley was
taken to a clinic on the exposition grounds, then to a hospital in Buffalo, where
they operated to close his stomach wounds.<BR /><BR />Although the surgeon had
some experience with trauma, his primary doctor, an obstetrician-gynecologist,
knew nothing about gunshot wounds, Housinger said. McKinley also had two other
doctors, famous cronies who were friends of the exposition's director.<BR /><BR
/>Although they closed the holes in his stomach, they failed to debride him. After
a gunshot wound, surgeons debride soft-tissue wounds, removing dead or dying
tissue, metal or bone fragments and other contaminants such as pieces of clothing,
hair or skin.<BR /><BR />As high-velocity projectiles penetrate the body, they
cause shock waves that disrupt and destroy tissues as far as several inches from
the bullet's path. Failing to debride a wound increases the risk of infection and
likelihood of complications including gangrene and death.<BR /><BR />The doctors
tried to look around to find the bullet, but, when McKinley's pulse became feeble,
they quickly finished up the operation. In their haste, they probably missed a
number of injuries, Housinger said.<BR /><BR />McKinley died nine days after the
shooting, probably from sepsis and pancreatitis, an inflammation of the pancreas
caused by injuries to the pancreas that the doctors overlooked. The pancreas
secretes digestive enzymes and produces several important hormones that regulate
blood glucose levels.<BR /><BR />McKinley also leaked digestive acids from the
stomach into his abdomen and probably leaked pancreatic enzymes, which can digest
the surrounding body tissue.<BR /><BR />"Throughout the whole time he was trying
to get over his illness, they gave him whiskey, and they gave him cognac and more
whiskey and they gave him strychnine and then they gave him digitalis and quinine
and they gave him more whiskey.<BR /><BR />"That was pretty much it. I don't know
where people came up with the idea this was going to help him. There was
absolutely no science here, whatsoever, that I could see," Housinger said.<BR
/><BR
/>• Today's outcome: "We would have had him out of the hospital in a week,
10 days max," Housinger said.<BR /><BR />Surgeons would have treated his wound,
recognized which organs were injured and debrided his abdomen and pancreas.<BR
/><BR /><h3>Archduke Franz Ferdinand</h3>• The circumstances: The
assassination of the archduke touched off World War I, one of the bloodiest and
costliest wars in modern history.<BR /><BR />On June 28, 1914, crowds had gathered
in Sarajevo, the capital of the Austrian province of Bosnia, to see Archduke
Francis Ferdinand, heir to the Austria-Hungary throne. A man jumped on the running
board of the royal touring car and fired a pistol.<BR /><BR />Two shots hit
Ferdinand, and one hit his wife, Sophie, duchess of Hohenberg. The assassin was
Gavrilo Princip, a Serb nationalist.<BR /><BR />When Austria-Hungary declared war
on Serbia a month later, military alliances drew the rest of Europe into the
fight.<BR /><BR />• The weapon: Princip fired a .22-caliber handgun from a
distance of several feet. It had a muzzle velocity of 700 feet per second and
energy of 75 foot-pounds.<BR /><BR />• The wound: A bullet entered the side
of the archduke's neck and nicked his jugular vein, which drains blood from the
head and brain back to the heart. The archduke bled profusely.<BR /><BR />•
Medical attention: "His treatment at the scene - various and sundry screams and
exhortations," Housinger said.<BR /><BR />"Nobody did just the simplest thing on
the planet. Nobody put a finger on it. He basically bled to death right at the
scene."<BR /><BR />• Today's outcome: "Most of us now would have enough
sense, I don't care if you're Joe Civilian or the finest trauma surgeon on the
planet, you know you can stop bleeding by putting direct pressure on it,"
Housinger said.<BR /><BR /><h3>John F. Kennedy </h3>• The circumstances:
Kennedy, the youngest man ever to be elected president, was barely past his first
1,000 days in office when he was shot as he rode in an open limousine during a
motorcade through Dallas on Nov. 22, 1963.<BR /><BR />The limousine raced to the
nearby Parkland Hospital. Kennedy never regained consciousness, and within two
hours of his death Vice President Lyndon B. Johnson was sworn in as the 36th
president. Lee Harvey Oswald, who was charged with the murder, was shot two days
later by Jack Ruby, a Dallas nightclub owner.<BR /><BR />• The weapon: The
6.5 mm rifle had a muzzle velocity of 2,200 feet per second and energy of 2,800
foot-pounds. Kennedy was shot at a distance of about 200 yards.<BR /><BR />•
The wound: One shot entered the back of JFK's head. Another shot passed through
his larynx.<BR /><BR />• Medical attention: He arrived at Parkland Hospital
after a 15-minute limousine ride. At the time, the program of Advanced Trauma Life
Support training for emergency resuscitation and stabilization of seriously
injured or ill patients did not exist. But Kennedy was given full ATLS-style
trauma care.<BR /><BR />The ATLS training program, developed by the American
College of Surgeons, simplified and standardized the treatment approach to trauma
patients. The premise of ATLS is to treat the greatest threat to life first.<BR
/><BR />The memory aid, or mnemonic, ABCDE, sets the order of handling injuries. A
stands for airway; B for breathing; C for circulation and bleeding control; D for
disability or a neurological evaluation of brain function; and E for exposure and
environment, meaning the patient is safe from environmental hazards.<BR /><BR
/>Doctors intubated Kennedy through the wound the bullet had caused in his trachea
by placing a tube into the trachea to protect his airway and provide a means for
mechanical ventilation. There was no heart or respiratory activity.<BR /><BR
/>• Today's outcome: "The bullet tore his skull apart completely," Housinger
said, noting that JFK would have no chance of surviving today.<BR /><BR /><h3>The
Rev. Martin Luther King Jr.</h3>• The circumstances: In spite of King's
emphasis on the use of nonviolent resistance to achieve racial justice, the
Baptist minister and Nobel Peace Prize winner often became the target of
violence.<BR /><BR />He was stabbed in New York City and stoned in Chicago, and
his home in Montgomery, Ala., was bombed. On April 4, 1968, at the age of 39, King
was shot by James Earl Ray, an escaped convict, as King stood on a motel balcony
in Memphis, Tenn.<BR /><BR />• The weapon: King was killed with a single shot
from a distance of 100 yards with a .30-06, a high-powered rifle with a muzzle
velocity of 2,500 feet per second and energy of 2,900 foot-pounds.<BR /><BR
/>• The wound: The bullet entered from the right side at an angle and took
out King's jaw along with his jugular vein, which drains blood from the head, and
carotid artery, which supplies blood to the head.<BR /><BR />• Today's
outcome: "If someone had shot him on the operating table, we couldn't have saved
him," Housinger said.<BR /><BR /><h3>Robert F. Kennedy</h3>• The
circumstances: After his brother John F. Kennedy's assassination in 1963, Robert
Kennedy served as a U.S. senator from New York from 1965 to 1968. He was
assassinated in Los Angeles in June 1968 while campaigning for the Democratic
nomination for president.<BR /><BR />His assassin, Sirhan Sirhan, is serving a
life sentence in California.<BR /><BR />• The weapon: RFK was shot three
times from just inches away with a .22-caliber handgun, a very low-energy weapon
that had a muzzle velocity of 1,095 feet per second and an energy of 77 foot-
pounds.<BR /><BR />• The wound: The main bullet wound was behind his ear.<BR
/><BR />• Medical attention: RFK was still breathing at the scene, where he
was given comfort measures. At the first hospital, which was nearby, there was no
neurosurgeon, so Kennedy was transported to another hospital 20 minutes away.<BR
/><BR />Shortly after he got there - about one to 1½ hours after the shooting -
surgeons did a craniotomy on him and decompressed him, opening a portion of his
skull to relieve pressure and control bleeding. They found significant brain
injury from the slug and bone fragments. The swelling caused Kennedy's brain to
herniate.<BR /><BR />• Today's outcome: With no delay in treatment, doctors
today might have saved Kennedy, but he would have had poor quality of life.<BR
/><BR />"He probably would have lost a lot of motor function and may have had
trouble breathing," Housinger said.<BR /><BR />Doctors would have had to deal
quickly with the swelling and would probably have left parts of his skull open to
relieve pressure.<BR /><BR /><i>Contact Donna Healy at <a
href="mailto:dhealy@billingsgazette.com">dhealy@billingsgazette.com</a> or at 657-
1292.</i>
<br />
<br />
<p class=date>Published on Saturday, March 01, 2008.<br />Last modified on
3/1/2008 at 1:38 am</p>
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style='width: 400px; '><a name='89190'></a>
<span class='simpleblog-name'>CarsonCityKid</span>
<span class='simpleblog-date'> said 1 day ago</span></div><div

class='ratingWrapper'><div id='displayBox0' class='ratingDisplayBox'>MUST HAVE
BEEN A REALLY SLOW NEWS DAY!</div><div id='permalinkdiv0'
class='permalinkDiv'><span class='tiny'><a
href='http://billingsgazette.net/h/forms/commentreport.php?id=89190' >Report as
offensive</a> | <a
href='http://www.billingsgazette.net/articles/2008/03/01/features/life/19-
assasinations.txt#89190'>Permalink</a></span></div></div><br /><br /><br /><br
/><div class='simpleblog-results-2' style='width: 400px; '><a name='89268'></a>
<span class='simpleblog-name'>Hmmmmm</span>
<span class='simpleblog-date'> said 1 day ago</span></div><div

class='ratingWrapper'><div id='displayBox1' class='ratingDisplayBox'>No matter
WHAT you say, it was interesting reading.</div><div id='permalinkdiv1'
class='permalinkDiv'><span class='tiny'><a
offensive</a> | <a
<span class='simpleblog-name'>Cynthia</span>
<span class='simpleblog-date'> said 21 hours ago</span></div><div

class='ratingWrapper'><div id='displayBox2' class='ratingDisplayBox'>I thought it
beat the heck out of most of the other stories and this is from ther LIFE section
not the NEWS section.</div><div id='permalinkdiv2' class='permalinkDiv'><span
class='tiny'><a
offensive</a> | <a
<span class='simpleblog-name'>Milkseat</span>

class='ratingWrapper'><div id='displayBox3' class='ratingDisplayBox'>This reminds
me of those Star Trek episodes where Bone's would complain about the barbarity fo
21st century medicine!</div><div id='permalinkdiv3' class='permalinkDiv'><span
class='tiny'><a
offensive</a> | <a
<span class='simpleblog-name'>fossilman</span>

class='ratingWrapper'><div id='displayBox4' class='ratingDisplayBox'>Its all still
just theory....They will never know...Its the past,deal with what the future
holds...</div><div id='permalinkdiv4' class='permalinkDiv'><span class='tiny'><a
offensive</a> | <a
assasinations.txt#89469'>Permalink</a></span></div></div><br /><br /></div>
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