"He may be President of the United States, but he has dirty fingernails." 1a

Maladies and Conditions

This style... ... means the event occurred while President.



Introduction Dr. Zebra has written two books about the medical history of President Lincoln and his family 2 3 . In the process, he examined several hundred primary source documents which, surprisingly, turned out to be a highly disturbing experience, when it became clear that both historians and physicians had deeply corrupted this material in their writings over the years. 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. Plainly stated, much of what appears in print about Lincoln -- and much of what people believe about his medical status -- is incorrect. For example: 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. 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. 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 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.



MEN 2B multiple endocrine neoplasia, type 2B (MEN2B) A 2008 book by Dr. Zebra proposes that Lincoln and several of his family members had a hereditary cancer syndrome called(MEN2B) 2 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. These topics are explored in more detail below. The diagnosis strongly suggests that Lincoln was dying of cancer in his last months, and also explains many previously mysterious Lincolnian characteristics:These topics are explored in more detail below.



not color blind The Nation) and found it completely worthless. There is no good reason to believe Lincoln had defective color vision For many years Dr. Zebra reported, as have several others, that Lincoln was color blind. Recently, however, he reviewed the original evidence behind this assertion (Thomas Shastid's 1929 article in) and found it completely worthless. There is no good reason to believe Lincoln had defective color vision 3a



near-drowning 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 As a child Lincoln almost drowned in Knob's Creek, Kentucky. A neighbor boy saved him. 4a



concussion 3b. At age 9, Lincoln was driving an old horse in a grist mill. Impatiently, he applied the whip and was rewarded with a kick square to the forehead. He was unconscious for several hours, and there were fears for his life. The kick came at a moment when Lincoln was halfway through speaking a sentence. Remarkably, his first words upon regaining consciousness were the completion of the sentence 5



clubbed in head Returning from New Orleans in 1828 by boat, Lincoln and a companion were attacked in their sleep by seven men, "with intent to kill and rob them." As Lincoln emerged from a hatchway, an attacker "struck him a blow with a heavy stick ... making a scar which he wore always" 3c



axe cut Lincoln almost took off his thumb with an axe, according to a 20-year-old memory from sculptor Leonard Volk. However, a high resolution print of a photograph shows a wide linear scar over Lincoln's left forefinger 2a



malaria - 1830 Lincoln's father moved the family to Macon County, Illinois in 1830. All of the family members developed "ague and fever" that autumn -- probably vivax malaria. They treated it with Peruvian bark and whiskey, and resolved to leave the area 3d . (Peruvian bark contains quinine, which is an effective anti-malarial.) Lincoln, having reached the age of 21, settled in New Salem, IL.



frostbitten feet 3e. During the famous "deep snow" winter of 1830-1831, still remembered even 100 years later, Lincoln's feet were badly frozen while crossing the Sangamon River. He was marooned for weeks in the cabin belong to the Warnick family. Mrs. Warnick treated Lincoln by putting his feet in the snow, "to take out the frost-bite" 6a



malaria - 1835 3f. The hot summer of 1835 in New Salem, IL followed a wet spring -- perfect conditions for malaria. Lincoln had chills and fever on alternate days (i.e. malaria) for at least a month, and took "heroic doses" of quinine and cathartics, but irregularly 2b 3f . Then his near-fiancee Ann Rutledge died of "brain fever" (perhaps typhoid). Claims that this triggered an episode of major depression in Lincoln 7 rest on incomplete analysis of the historical record. A neighbor couple treated the bereaved Lincoln, who returned to work no later than three weeks after Rutledge's death 2b



syphilis Lincoln's law partner, William Herndon, wrote that Lincoln had syphilis about 1835-1836. Herndon said Lincoln told him this. Long known to Lincoln scholars, this topic erupted into public debate in the 1980s because many historians did not believe Herndon, while the writer Gore Vidal did. Dr. Zebra's full discussion 3g finds no reason to disbelieve Herndon, and finds many reasons to believe him.



blood type A Analysis of a bloodstain on the cuff of Dr. Woodward showed that Lincoln had type A blood 8 . [I am not sure the cuffs are Woodward's. More is written about the cuffs of Dr. Edward Curtis.]



marfanoid habitus Lincoln was 6 feet 3.75 inches tall, had long legs, long arms, long thin feet, long hands, a long thin face, a long thin neck, flat feet, and a "sunken breast" (in the words of his law partner William Herndon) 2c . All of these characteristics are typical of persons with Marfan syndrome 9 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. 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 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 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 14 2h. 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



pectus excavatum Lincoln's chest was, according to his law partner, thin and had a "sunken breast" 12d (None of the several physicians who saw Lincoln's naked body at autopsy remarked on a sunken chest (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 .)



pseudo-depression Much has been written about Lincoln's "melancholy" 7 , but the evidence is not convincing 15a . (Full discussion in 2j .) Advocates of the theory claim Lincoln had several periods of major depression: (1) After the death of his mother, (2) After the death of his fiancee, Ann Rutledge (see Malaria/1835, above), and (3) About the time of interpersonal difficulties with Mary Todd in early 1841. Other cited instances are: after the terrible Union loss at the battle of Chancellorsville (he mentioned suicide, but there ` is no way to know if this was serious or just Lincoln speaking in a vivid metaphor) and after the death of his son Willie (he signed no official documents for four days). 4b 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" 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



vertical strabismus Lincoln's intermittently-upturned left eye is consistent with failure of the left superior oblique muscle 16 . Proposed causes of this malfunction are: (1) the horse kick (see above) damaged the trochlear nerve, which controls the muscle, (2) a malformation of his skull in which the size of the eye's bony socket is mismatched to the length of the muscle 17 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. 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.



presbyopia 4c. Lincoln did not wear eyeglasses until age 47. He then got reading glasses -- a completely normal occurrence for people at that age 2k . The spectacles that were in his pocket when he was shot have been analyzed. Their prescription is consistent with simple aging of the eye (known as presbyopia). 2k



jaw fracture A dentist broke off part of Lincoln's jaw bone while pulling a tooth -- without anesthesia 4c . The extraction may have taken place in Louisville, KY in Sept. 1841 18a



penetrating voice 2l 3i. Lincoln had a high-pitched voice that could be heard over great distances. When excited, the pitch went higher still, and sometimes became unpleasant. Still, his voice was an asset because it could be heard by all the crowds that gathered outdoors to hear him speak. (Microphones did not yet exist.) For example, at least 15,000 people heard him give the Gettysburg Address (photo) and "acres of people" heard his first inaugural address (photo)



swollen feet In 1858 Lincoln walked from the Danville, IL train depot to the home of Dr. William Fithian (116 Gilbert St.), with a crowd in tow. Lincoln went upstairs, took off his boots to relax, but the crowd insisted on a speech. Unable to easily get his boots on over his swollen feet, Lincoln, at Fithian's suggestion, spoke from the window, so the crowd could not tell he did not have his boots on. 18b



scarlet fever? In July 1860, Lincoln developed sore throat, headache, fever, and malaise which lasted for a few days. Simultaneously, his son Willie was in bed with scarlet fever. Lincoln felt he might have had a form of the same disease. 4c



domestic violence Lincoln was several times the victim of domestic violence at the hands of his wife, Mary. (a) About 1860: Mary struck him "on [the] head with a piece of wood while reading paper in South Parlor -- cut his nose -- lawyers saw his face in Court next day but asked no questions" (b) Before 1861: Angry at his choice in meat for a guest, Mary "abused L. outrageously and finally was so mad she struck him in the face. Rubbing the blood off his face Lincoln and [the guest] left" (c) there are also records of Mary throwing coffee at him, throwing potatoes at him, chasing him down the street with a knife (once) or a broomstick (frequently), pulling out part of his beard, and of a strike to his face in his last weeks alive. 3j



asymmetries A detailed analysis 2m of photographs and casts of Lincoln's head & face discloses several asymmetries. Specifically, his eye-sockets, cheek bones, ears, nose, chin, forehead, and skull vault were all asymmetric. These multiple asymmetries fit the pattern seen in a mild case of left synostotic frontal plagiocephaly. (This is too complicated to explain here. See The Physical Lincoln .) 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. 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.



premature aging Lincoln was called "Old Abe" as early as age 30 2n . Friends commented that his facial skin was creased and yellow from a young age. The cause of this is unknown 2o



face, neck, beard Lincoln began growing his beard about the time he was elected President in November 1860. On Feb. 16, 1861 his inauguration train stopped in Westfield, NY where he sought out 11 year old Grace Bedell, who had before written to advise him to grow a beard: "I have got 4 brother's [sic] and part of them will vote for you any way and if you let your whiskers grow I will try and get the rest of them to vote for you[;] you would look a great deal better for your face is so thin." 2p New York Republicans had written Lincoln about the same time also urging a beard, to disguise his long neck New York Republicans had written Lincoln about the same time also urging a beard, to disguise his long neck 2p



corns Biographers sometimes say things like Lincoln "suffered mightily" from corns and bunions 19 . This is overblown. It derives from a letter Lincoln wrote for podiatrist Isachar Zacharie, saying "he has operated on my feet ... with considerable addition to my comfort." The nature of Lincoln's foot ailment(s) are unknown, beyond having flat feet 2q



constipation At least four people close to Lincoln (John Stuart, Henry Whitney, Ward Lamon, and William Herndon) testified that Lincoln was constipated. It seemed almost an idée fixe with Stuart, who urged Lincoln to take mercury-containing "blue mass" pills. Lincoln did this for several months, but stopped, saying that they made him "cross" 2r



food poisoning 1861: "One night every member of the family except the servants, was taken ill, physicians were hastily summoned, and for a time whisperings of `Poison' were heard, but it proved to be only an over-indulgence in Potomac Shad, a new and tempting dish to western palates" 3k . (Shad is a fish and Potomac is a river bordering Washington.)



dentist phobia It has been said that Lincoln was afraid of dentists (see episode above for a good reason why he might have been). In 1862 Lincoln developed a severe toothache and consulted Dr. G. S. Wolf, who had an office near the White House. As Wolf prepared to pull the tooth, Lincoln asked him to wait. Lincoln "took a container of chloroform from his pocket, inhaled it deeply, and sleepily gave the signal for the dentist to proceed" 4c



cancer Multiple endocrine neoplasia type 2b (MEN2B) is a genetic cancer syndrome. Its most common cancers occur in two endocrine glands: the thyroid (medullary carcinoma of the thyroid) and the adrenal (pheochromocytoma). Did Lincoln have cancer? If he had MEN2B, the answer is certain: yes. The historical record also suggests he had cancer. 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. 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 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 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



Willie's death "[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 Lincoln's son Willie died in 1862. One of Lincoln's friends described the aftermath 21a In fact, Lincoln went only four days without writing official documents 19



pulsations A photograph taken November 15, 1863 shows Lincoln sitting with legs crossed. The image of the left foot -- the one nearest the camera -- is blurry, however. Lincoln noticed this and wondered why. Newspaperman Noah Brooks suggested it was because throbbing of the arteries may have imparted a slight motion to the foot. To test this idea, Lincoln crossed his legs, watched his foot, ... and saw that it moved. "That's it! That's it! Now that's very curious, isn't it?" he exclaimed 2t . This incident is cited as evidence that Lincoln had aortic regurgitation 22 23 . Dr. Zebra doesn't buy it. (Full discussion of Lincoln's cardiovascular health in 2u .)



smallpox After delivering the Gettysburg Address on Nov. 19, 1863, Lincoln developed a severe headache on the train ride back to Washington. He did not miss work over the next couple days, but his sense of humor vanished. He went to bed early on Nov. 25, with a headache, and was sick in bed the next day. From Nov. 26 to Dec. 1, he issued no official correspondence 3l . A scrawled note on Nov. 27 shows the shaky handwriting of a very sick man 2w 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" 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" 3m. 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



strong Lincoln was physcally strong, but not that strong. He ascribed his prowess in wrestling and axe-use to his long arms, which were as long as a man 7-feet tall 2x 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 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 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 Lincoln performed the "horizontal" feat several times, e.g. at Milwaukee, WI on Sept. 30, 1859 18d



receding hairline Lincoln is generally not thought of as bald, but a photo showing the top of his head in November 1863 (while giving the Gettysburg address) discloses significant temporal recession of his hairline. [See photo MORE



gas leak On Sept. 9, 1864 Lincoln was almost overcome by gas leaking from lighting fixtures in his White House office 25 . (I'd appreciate it if anyone having another reference to this incident would let me know. Thanks.)



upset stomach On Mar. 24-25, 1865, Lincoln had an upset stomach for at least 24 hours while sailing to City Point, VA to visit the headquarters of General Ulysses Grant . Sea-sickness and bad drinking water on-ship were suspected causes. Arriving at City Point on the 25th, Lincoln refused a drink of champagne, saying many people get "sea-sick ashore from drinking that very article" 3o