Health and Medical History of President
Abraham LincolnLived 1809-1865
Health and Medical History of President
Abraham LincolnLived 1809-1865
Lived 1809-1865
2023
1776
Revolutionary War1776-1783
War of 18121812-1815
Mexican-American War1846-1848
Civil War1861-1865
Spanish-American War1898-1899
World War 11917-1918
World War 21941-1945
Korean War1950-1953
Viet Nam War1964-1975
Desert Storm1990-1991
Bush's Wars2001-2021
Plainly stated, much of what appears in print about Lincoln -- and much of what people believe about his medical status -- is incorrect. For example:
- There is no evidence that Lincoln was color blind.
- There is no evidence that Lincoln had sore feet.
- There is essentially no evidence that Lincoln was depressed, and strong evidence against it.
- The claims that Lincoln had end-stage valvular heart disease are not tenable.
- There is no evidence that Lincoln or his father had type 5 spinocerebellar ataxia (SCA5), with strong evidence against it.
- The evidence that Lincoln had Marfan syndrome is weak.
- The conclusion that Lincoln had hemifacial microsomia is wrong.
- and, slightly off-topic, Photographs clearly show that Tad Lincoln did not have a cleft lip.
Many of these errors occurred because authors failed to examine the primary literature in depth. Instead, authors would see, in a superficial examination, what they wanted to see, and go from there. This was particularly egregious in the case of SCA5. It is an especially bad practice among physicians.
Worst of all is the case of Lincoln's depression, which has achieved great currency in the public's mind. Proponents of this theory have failed to distinguish between depression as a pathological condition, and completely separate states such as bereavement, simple sadness, and love-sickness that are a part of normal human life. They also downplay the fact that Lincoln passed the greatest mental stress test ever visited on an American public servant. If an organ (in this case, the brain) does not break under the heaviest imaginable stress, then, by definition, there can be no disease present.
Dr. Zebra now believes that it is impossible to write accurately about any President's medical history unless the primary documentation is examined. Secondary sources are simply not trustworthy, unless the author has made extraordinary efforts to examine primary sources. On Lincoln and on Taft, Dr. Zebra has made extraordinary efforts. For VP Cheney, the effort has been 80% extraordinary, but the sources are scant.
The diagnosis strongly suggests that Lincoln was dying of cancer in his last months, and also explains many previously mysterious Lincolnian characteristics:
- Lincoln's body shape, i.e. his height, long limbs, big feet, leanness, high voice, flat feet, sunken chest.
- Lincoln's sagging face, that witnesses mistakenly thought was sadness or depression.
- Lincoln's bumpy lips and big lower lip.
- The large bump on Lincoln's right cheek.
- Lincoln's fatigue, headaches, fainting, and cold hands & feet in his last months.
- Lincoln's intermittently drooping eyelids.
- Lincoln's constipation.
- Lincoln's high voice.
- Lincoln's propensity to lie on the floor when reading, and rest his feet on a table when sitting.
- Lincoln's asymmetric face and homeliness.
- Lincoln's loose-jointedness.
- The death of three of Lincoln's sons before age 20, and, probably, his mother's death at 34.
Austin Gollaher ... claims to have saved Lincoln from drowning one day as they were trying to 'coon it' across Knob Creek on a log. The boys were in pursuit of birds, when young Lincoln fell into the water, and his vigilant companion ... fished him out with a sycamore branch. 5a
This does not mean Lincoln had Marfan syndrome, however. More than a dozen different medical conditions cause this same type of body shape; Lincoln had one of these other disorders (MEN 2B). Still, it is proper to say that Lincoln was "marfanoid," meaning he was shaped like a person with Marfan syndrome.
For his time, Lincoln was about 7.5 inches taller than average 2d. His height came from his legs. Sitting, he was no taller than the average man 2e. (See photo.)
It has been said that a cast of Lincoln's hands show them to be muscular and powerful, not the slender hands of Marfan syndrome 10 11. This is not correct. True, the casts show that Lincoln did not have the classic long, graceful hands and fingers of Marfan syndrome. But they also show that his hands were longer than normal and that his fingers were longer than normal. It is important to remember that Lincoln used an axe more or less all day every day from the time he was about 8 years old until he was 23. No physician practicing today knows what that level of hand exertion does to the hands of someone with Marfan syndrome 2f.
Evidence for other features of Marfan syndrome (ocular, cardiovascular, familial) in Lincoln has been presented, but found weak 2g 12a. In 1959, Marfan syndrome was diagnosed in a distant relative of Lincoln's (a third cousin four times removed) on his father's side 13. Sharing 1/4096th of Lincoln's genetic material, it is difficult to ascribe much significance to this fact 12b. Although the world's greatest authority on Marfan syndrome thinks it's "50-50" that Lincoln had the condition 3h, other geneticists (and Dr. Zebra) think it unlikely 12c 14 2h.
(None of the several physicians who saw Lincoln's naked body at autopsy remarked on a sunken chest 12e. It is difficult to attach much significance to the effusive, hyperbolic, nonspecific statements of these physicians 2i.)
Much of the evidence for Lincoln's depression derives from observations of his facial expression. This is unreliable, however. Lincoln's low muscle tone (a consequence of MEN 2B) made his face sag whenever he was disengaged from his surroundings. This gave him a profoundly sad appearance, regardless of his internal mood. Dr. Zebra calls this phenomenon "pseudo-depression" 2j.
The intermittent drooping in his right eyelid may actually have resulted from hyper-elevation of his *left* eyelid, i.e. had he allowed his left eyelid to droop, it would have blocked his vision in that eye.
This is a type of craniosynostosis caused by the early fusion of the left frontal and parietal bones during growth of the skull. Abnormal skull shapes are part of the MEN2B syndrome.
New York Republicans had written Lincoln about the same time also urging a beard, to disguise his long neck 2p.
Did Lincoln have cancer? If he had MEN2B, the answer is certain: yes. The historical record also suggests he had cancer.
Lincoln began losing weight in 1860. There is no quantitative data about his weight after becoming President, but many people wrote of his declining appearance and increasing thinness. Casts of his face in 1860 and 1865 show a striking loss of soft tissue. Temporal wasting is present on the 1865 cast.
In his last months, Lincoln had headaches, cold feet & hands, exercise intolerance & sweating, pervasive fatigue that a work respite did not ease, fainting, and nausea. These findings are compatible with a pheochromocytoma 2s.
MEN 2B is rare -- perhaps about one in a million people have it -- and there are no large studies on survival statistics. Lincoln lived to be quite old for someone with MEN2B. This topic is discussed in great detail in 2 and in 3.
"[It] wellnigh broke the President's heart, and certainly an affliction more crushing never fell to the lot of man. ... Strong as he was in the matter of self-control, he gave way to an overmastering grief, which became at length a serious menace to his health. ... A deep and settled despondency took possession of Mr. Lincoln; and when it is remembered that his calamity -- for such it surely was -- befell him at a critical period of the war, just when the resources of his mighty intellect were in most demand, it will be understood how his affliction became a matter of the gravest concern to the whole country."In fact, Lincoln went only four days without writing official documents 19.
Comment: Aortic regurgitation is caused by a leaky heart valve. When severe, large swings in blood pressure occur with every heartbeat, causing structures in the body to pulsate. Diagnosing aortic regurgitation from photographic blurriness is a clever idea, but, in this case, wrong. First, other photographs demonstrate that Lincoln's foot was simply out of focus 2v. Second, such pulsatile foot movement is normal (even Dr. Zebra has it). Third, Lincoln was incubating smallpox when the photograph was taken, so possibly he was vasodilated for that reason and more prone to foot movement.
With some difficulty, smallpox was eventually diagnosed. It was reported to the public as "varioloid," which is the mildest of the four clinical syndromes of smallpox. Clearly, however, Lincoln had full-blown smallpox, not varioloid. Although the acute crisis had passed by early December, he is described as still recovering through the entire month. Only on January 1, 1864 does someone observe: "he has a hue of health to which he has long been a stranger" 3l.
During the whole of his presidency, Lincoln was beset by people asking for jobs, commissions, pardons, and other favors. When informed that his disease was highly contagious, Lincoln remarked "There is one good thing about this. Now I have something I can give everybody" 24a 3m.
While visiting troops in the field, days before his death, Lincoln picked up a heavy axe, chopped wood for several minutes, then held the axe straight out, horizontally, "without its even quivering." Several strong soldiers, tried to duplicate this feat, but could not 3n.
Yet, just two years before, he was described as "cadaverous and emaciated" in appearance 18c.
Lincoln performed the "horizontal" feat several times, e.g. at Milwaukee, WI on Sept. 30, 1859 18d. Comment: I accept some stories of Lincoln's strength in youth, but I have been unable to find the primary reference for the 1865 wood-chopping performance.
Eyewitness accounts of the shooting and its immediate aftermath are available from Dr. Leale MORE and from Dr. Charles Taft MORE.
An autopsy was performed in the White House (restricted to the head only), as was the embalming 3p.
- In reference to discussions of Lincoln's health, one Lincoln scholar writes: "Lincoln
was not a sufferer from much of anything, and students should be thinking what an edge his
fabulous health gave him in the quest for success as politician and president"
19.
Comment: This is a common misconception. Lincoln illnesses were acute and self-limited until about 1860, at which time he began losing weight. From there, he went continuously downhill. In his last three months, he was sick more than he was well -- if he was ever well at all. - In declining a job offer in Chicago (about 1849) Lincoln gave as a reason
that he tended to consumption, and, if removed to a city like Chicago, he would have to sit down and study harder than ever. The close application required of him and the confinement in the office, he contended, would soon kill him. 5b
It is hard to know if Lincoln was being diplomatic or was referring to his leanness. - His eyes were gray 5c.
- At his second inaugural, Lincoln shook so many hands, "the perspiration ... rolling down his face as he grasped the hands of the passing throng, as though he had been splitting rails as of yore" 27a, that he got blisters on his hand.
- "Lincoln never forgot anybody" 28a.
- Stephen Douglas called Lincoln "two-faced." Lincoln responded: "I leave it to my audience. If I had another face, do you think I would wear this one?" 24b.
- Walking barefoot through Dixon, IL in 1832, Lincoln complained that his feet were cold. Someone told him: "No wonder, there's so much of you on the ground" 18e. The same story is told about him in the post-1839 time frame 18f.
- Lincoln was "devoid of any natural ability as a singer" 5d. After being serenaded by a quartet of singers in 1860, Lincoln said he wished he could sing like that, "but he knew only two tunes; one is 'Old One Hundred' and the other isn't'" 18g. Essentially the same anecdote is told about Ulysses Grant.
- In January 1862 Lincoln braved the sickroom of General George McClellan, who was ill with typhoid fever 29.
- Lincoln tales:
- Lincoln once used his knowledge of medicine to get rid of someone who often encroached upon his time. The encroacher was bald. In one of their meetings, Lincoln got up, walked over to the wardrobe, picked up a bottle, and asked "Did you ever try this for your hair?" The man answered no, so Lincoln said "Well, I advise you to try it and I will give you this bottle. If at first you don't succeed, try, try, again. Keep it up. They say it will make hair grow on a pumpkin. Now take it and come back in eight or ten months and tell me how it works." The man left with the bottle, and Lincoln was still convulsed with laughter when the next visitor entered the room 24a.
- A delegation "called on Mr. Lincoln to ask the appointment of a gentleman as commissioner to the Sandwich Islands. They presented their case as earnestly as possible and besides their candidate's fitness for the place they urged that he was in bad health, and that a residence in that balmy climate would be of great benefit to him. The President closed the interview with this discouraging remark: 'Gentlemen, I am sorry to say that there are eight other applicants for that place, and they are all sicker than your man.'" 21b
- During his 1860 campaign speeches, Lincoln would tell of seeing a man nearby with a sore on his neck. The man, he said was like the slavery question: it was dangerous to cut out because the man might bleed to death, but if he did not have it removed, it would shorten the man's life. 18h
- Soon after the fall of Richmond, Lincoln walked through the city. He was immediately recognized. Black citizens crowded around him and knelt before him. Lincoln, famously, told them "Don't kneel to me. That is not right." Less famously, but equally telling of the status in which Lincoln was held, one black woman was later heard to tell her child that "a touch of Lincoln's garment would cure his pain" 18i.
- In 1842 Lincoln admitted writing letters to the newspaper in Springfield, IL satirizing the state auditor, James Shields. (Whether Lincoln wrote one, some, or all of the letters is unclear.) To uphold his honor, Shields, a crack shot, challenged Lincoln to a duel. As the challengee, Lincoln was to make the choice of weapons. He chose cow pies. Shields would not be deterred, however, and eventually Lincoln chose to duel with cavalry broadswords. When Lincoln and Shields met at the appointed place, Lincoln picked out a sword and, with his remarkable height and long arms, began slashing at tree branches that the shorter Shields could not reach. After this, an accomodation was reached and the duel never took place. Although humorous in retrospect, the affair was deadly serious. (Shields later became a Brigadier General and a U.S. Senator from Illinois, Missouri, and Minnesota.) 18j 30
- Some family history (fully discussed in
2y
3q):
- Many Lincolns died young: his mother Nancy (age 34), his son Eddie (age 3), his son Willie (age 11), and his son Tad (age 18).
- Nancy Hanks Lincoln died during an epidemic of "milk sickness," caused by drinking the milk of cows feeding on poisonous plants. It is not clear, however, that she died of milk sickness. Some of the people who told Herndon about Nancy's death had other opinions, and it can be seen that Herndon told absolutely nothing about her signs and symptoms MORE . Fear of the milk sickness' return seems to have been a factor in the surviving Lincolns' decision to move from Indiana to Illinois in 1830 5e.
- Eddie died after a 52-day illness that the 1850 census recorded as "chronic consumption." This old-fashioned term is compatible with both tuberculosis and cancer. Eddie was tall, and had the type of lips seen in MEN2B.
- Willie died in the White House from an acute infection, probably typhoid fever. He had survived scarlet fever in 1860. He had long legs, and had the type of lips seen in MEN2B.
- Tad died of progressive respiratory distress, caused by fluid around his lungs and possibly his heart. This was most likely a malignant effusion that arose from medullary thyroid cancer that had spread into his chest. Tad had the type of lips seen in MEN2B. Earlier, Tad had contracted, but survived, the illness that killed his brother Willie in 1862
- Lincoln's oldest son, Robert, lived to age 82. His lips were normal. There is a tradition in Terre Haute, IN that Lincoln brought young Robert there to be treated with a "mad stone" after a dog bite, possibly in September 1859.
- Abraham Lincoln's last direct descendent died in 1985.
- In a weird twist of fate, Edwin Booth saved the life of Robert Lincoln. Edwin Booth was the older brother of Lincoln's assassin, and Robert Lincoln was the son of Abraham Lincoln. Robert had slipped onto the train track at Jersey City, NJ train station while travelling to Washington from New York City. He fell into an open space and was helpless until Booth "vigorously seized" him to safety. The incident occurred while Lincoln was President. 18k
- During the time Lincoln lived in Kentucky and Indiana, the family name was pronounced "Linkhorn" 18l.
- A genetic neurological disorder, spinocerebellar ataxia type 5 (SCA5) OMIM 600224 has been found in decendents of Lincoln's paternal grandparents. This disease impairs the ability to walk and coordination of various other muscles. Some researchers have tried to make a case that Lincoln could have had the disease, and they want to test his DNA. Unfortunately, their historical analysis is embarrassingly superficial. There is not a shred of evidence that either Lincoln or his father had SCA5. (If Lincoln's father did not have the disease, then Lincoln is at no greater risk for the disease than you or me. Lincoln's father lived to age 73, with no record of invalidism.) Full discussion in: 3r.
- Seldes, George. Witness to a Century. New York: Ballantine Books, 1987.
a p.245. In 1927 Katherine Medill McCormick recalled to a group of people that her mother used to say this -- and several other disparaging things about the President -- before sending her to play with the Lincoln children. McCormick's father, Joseph Medill, was a friend of Lincoln's. Lincoln was not alone in being an object of Mrs. Medill's scorn. Seldes makes it clear that she hated just about everyone and everything.
- Sotos, John G. The Physical Lincoln: Finding the Genetic Cause of Abraham Lincoln's Height, Homeliness, Pseudo-Depression, and Imminent Cancer Death. Mt. Vernon, VA: Mt. Vernon Book Systems, 2008.
a p.57 (Volk's memory is known as not entirely trustworthy) b pp.223-227 c pp.44-81 d p.44 e p.45-48 f pp.52-63 g pp.84-115 h pp.117-121 i pp.77-80 j pp.206-233 k pp.87-89 l pp.80-81 m pp.194-205 n p.167 o pp.164-173 p pp.252-257 q pp.67-68 r p.138-139 s pp.158-163 t p.102 u pp.96-105 v p.102-103 w p.157 x pp.49, 122, 187 y pp.106-115, 140-145Comment: More information at: http://www.physical-lincoln.com/
- Sotos, John G. The Physical Lincoln Sourcebook. Mt. Vernon, VA: Mt. Vernon Book Systems, 2008.
a pp.66-67 b pp.190-191, 313 c p.191 quoting primary sources d p.118 e p.71 f pp.118, 313-315 g pp.318-326 h p.26 (¶73) i pp.195-198 j pp.191-192 quoting all sources k p.56, quoting Elizabeth Todd Grimsley l pp.335-351 m p.340 n pp.88-89 o pp.57-58, 86-87 (633, 635, 1199-1216) p p.177-179 q pp.206-310 r pp.364-370Comment: More information at: http://www.physical-lincoln.com/
- Bumgarner, John R. The Health of the Presidents: The 41 United States Presidents Through 1993 from a Physician's Point of View. Jefferson, NC: MacFarland & Company, 1994.
a p.89 b pp.91-94 c p.95
Comment: Devotes one chapter to each President, through Clinton. Written for the layperson, well-referenced, with areas of speculation clearly identified, Dr. Zebra depends heavily on this book. Dr. Bumgarner survived the Bataan Death March and has written an unforgettable book casting a physician's eye on that experience.
- Herndon, William H. and Weik, Jesse W. Herndon's Life of Lincoln. Cleveland: World Publishing, 1942 (originally published 1888).
a p.18 b p.247 c p.250 d p.48 e p.56
- Shutes, Milton H. Lincoln and the Doctors: A Medical Narrative of the Life of Abraham Lincoln. New York: Pioneer Press, 1933.
a pp.7-8
- Shenk, Joshua Wolf. Lincoln's Melancholy. Boston: Houghton Mifflin, 2005.
- Davidson, Glen W. Abraham Lincoln and the DNA controversy. Journal of the Abraham Lincoln Association. 1996;17(1):1-26.
- Gordon AM. Abraham Lincoln: a medical appraisal. Journal of the Kentucky Medical Association. 1962;60:249-253. Pubmed: 13900423.
Comment: A brilliant work of historical research and medical deduction. MEN2B was unknown in 1962, so Gordon got as close as he could.
- Lattimer JK. Lincoln did not have Marfan syndrome; documented evidence. N Y State J Med. 1981;81:1805-1813. Pubmed: 7036022.
Comment: A failed challenge to the idea that Lincoln was marfanoid.
- Pyeritz RE, McKusick VA. The Marfan syndrome: diagnosis and management. N Engl J Med. 1979;300:772-777. Pubmed: 370588.
- Marion, Robert. Was George Washington Really the Father of our Country?. Reading, MA: Addison-Wesley, 1994.
a pp.88-124 b p.100 c pp.108, 110. Marion believes Lincoln had mitral valve prolapse syndrome, which shares some of the skeletal features of Marfan syndrome. d p.93 e p.104
- Schwartz H. Abraham Lincoln and the Marfan syndrome. Journal of the American Medical Association. 1964;187:473-479. Pubmed: 14084818.
- Ready T. Access to Presidential DNA denied. Nature Medicine. 1999;5:859. Pubmed: 11645164.
- MacMahon, Edward B. and Curry, Leonard. Medical Cover-Ups in the White House. Washington, DC: Farragut, 1987.
a p.19
- Goldstein JH. Lincoln's vertical strabismus. J Pediatr Ophthalmol Strabismus. 1997 Mar-Apr;34(2):118-20.
- Fishman RS; Da Silveira A. Lincoln's craniofacial microsomia. Arch Ophthalmol. 2007; 125: 1126-1130.
- Gary, Ralph. Following Lincoln's Footsteps. New York: Carroll & Graf, 2001.
a p.227 b p.58 c p.313 this comment was from soldiers in Fredericksburg, VA, April 1863 d p.397 e pp.66, 398 f p.177 g p.68 h p.4 i pp.322, 323-324 j pp.9-10 k pp.238, 261 l pp.209, 318
- Neely, Mark E. Jr. Rattling Lincoln's bones. Lincoln Lore: Bulletin of the Louis A. Warren Lincoln Library and Museum. August 1990; nbr 1818:1-4.
- Hirschhorn N, Feldman RG, Greaves IA. Abraham Lincoln's blue pills: did our 16th President suffer from mercury poisoning?. Perspect Biol Med. 2001;44:315-332. Pubmed: 11482002.
- Lamon, Ward Hill. Recollections of Abraham Lincoln. Washington, DC: Dorothy Lamon Teillard, 1911.
a p.161 b p.136
- Schwartz H. Abraham Lincoln and aortic insufficiency. The declining health of the President. California Medicine. 1972;166(5):82-84. Pubmed: 4565398.
- Schwartz H. Abraham Lincoln and cardiac decompensation: a preliminary report. West J Med. 1978:128(2):174-177. Pubmed: 343393.
- Boller, Paul F. Jr. Presidential Anecdotes. New York: Oxford University Press, 1981.
a p.133 b p.125
- Available on the web: http://www.mrlincolnswhitehouse.org/content_inside.asp?ID=217&subjectID=3
- Kunhardt, Philip B, et al. Lincoln: An Illustrated Biography. NY: Alfred A. Knopf, 1992.
a p.356
- Pendel, Thomas F. Thirty-Six Years in the White House. Washington: Neale Publishing Company, 1902.
a pp.35-37
Comment: Pendel was door-keeper at the White House from the time of Lincoln to the time of Theodore Roosevelt. Full text is available on-line at loc.gov. It is a rather dry book, and reads as if it were written by an old man. http://memory.loc.gov/cgi-bin/query/D?lhbcbbib:1:./temp/~~ammem_rEou::
- Tarbell, Ida. Abraham Lincoln and His Ancestors. Lincoln, NE: University of Nebraska, 1997.
a p.185
Comment: Originally published 1924 as In the Footsteps of the Lincolns.
- Rafuse, Ethan S. Typhoid and turmoil: Lincoln's response to General McClellan's bout with typhoid fever during the winter of 1861-62. Journal of the Abraham Lincoln Association. 1997;18(2):1-16.
- Myers, James E. The Astonishing Saber Duel of Abraham Lincoln. Lincoln-Herndon Building, 1968.
Comment: Cited by Gary.