Abraham Verghese: Was Lincoln Dying Before He Was Shot?

John Sotos is a physician well known in medical circles for his book, ZEBRA CARDS: AN AID TO OBSCURE DIAGNOSIS. We tell our medical students,"When you hear hoofbeats think horses, not zebras," or, common things occur commonly. But John has had a lifelong interest in rare diseases--zebras.  (He is also a medical consultant for the TV show HOUSE.)

Recently, I heard John make the case in a lecture that Abraham Lincoln suffered from a rare endocrine disorder called MEN2b (Multiple Endocrine Neoplasia Type 2b)  in which most patients will die of cancer of the thyroid if the thyroid is not removed. John argues that at the time of his death, Lincoln was dying.  Indeed, if one looks at Lincolns pictures and then a few months later in February 1865, it does appear that he has lost weight and reports from that time suggest he was greatly fatigued. One characteristic of this syndrome is the presence of mucosal neuromas--little bumps on the lips. Close examination of photographs such as the one below suggests that he did have these.lincoln2.JPG John's talk provoked some heated debate. For  more details see John's book THE PHYSICAL LINCOLN. Photographs are courtesy of John Sotos. 

The Grand Army of the Republic museum in Philadelphia has a pillowcase with Lincoln's blood on it, and DNA from that could conceivably prove or disprove this hypothesis. (It could also prove or disprove another hypothesis that states Lincoln had another condition, namely Marfan's syndrome.)  For now, the museum has decided to wait on DNA testing.

There have been hundreds of books about Lincoln. In fact, the Library of Congress catalog suggests that a new book about Lincoln comes out every 5 days or so.  If indeed Lincoln had a disease whose manifestations had much to do with his behavior, and which might explain the early deaths of his mother and of his son--seminal events in any life--then in a sense, all  previous biographies are inaccurate.

But is this a slippery slope? Are historians to become forensic anthropologists?

Would Abe have wanted the DNA testing done?

One day there might be a test that could tell us what he would have decided. 

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Donald Wolberg - 5/22/2009

At times we seem almost as interested in the illnesses of famous folks, real or imagined, as we are in who they were and what they did. At times of course, what they did might also reflect their illnesses. Mr. Lincoln has forever been a favorite subject of inquiry. Scholars have looked to his physical appearance as evidence of various ailments, to his depressions and even his bowel habits and use of purgatives throughout his life as indicating "serious" ailments of one kind or another. The significance of illness and physical issues can certainly have importance, one would think, in the outcomes of lives for better or worse. Mr. Darwin, born the same day as Mr. Lincoln, was chronically ill after his Beagle voyage of discovery, and this illness variously interpreted by Darwin scholars as either psychosomatic or with a physiacal basis (Chagas disease) did rpovide Darwin the opportunity to live a quiet and controlled life filled with time to ponder and write, that yielded a series of one of the the most, if not the most, significant life time accomplishmets in science.
One can ponder the high arsenic content of Napoleon's hair and wonder who slipped the guy dangerous cocktails at the end of his life, or the massive amounts of "treatments" Hitler received from his odd assortment of Physicians, or, indeed, the "tonics" President Kennedy received in office. Robert E. Lee apparently had chronic heart disease before the war began, and this was clearly exacerbated by the physical and mental stresses of the war. We can only speculate what impact this had on Mr. Lee's seeming determination and courage in the face of amazing odds through the war. To what extent the illnesses and the treatments shaped the elite cast of characters and how that influenced their impacts on events, makes for very interesting opportunities for scholars to ponder.

I would suggest that the obvious changes in Mr. Lincoln's appearance seen in his photographs--and Mr. Lincoln has left us a remarkable recod of images through his life--may just as easily be the result of the enormous stresses that he dealt with during the war. That Mr. Lincoln internalized so much of the anguish of the entire nation during the war, that horrific slaughter and the permanently injured veterans that must have confronted him every day, all day and night, is well documented by his own writings, speeches and those of others. That confilct that cost more American lives than all the conflicts before and since combined, did take a tremendous toll on the man.
Much of the effect seen in his photographic images through the war, can easily be attributed to those impacts.

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