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Health of Abraham Lincoln

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Abraham Lincoln
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16th President of the United States
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Abraham Lincoln's health has been the subject of both contemporaneous commentary and subsequent hypotheses by historians and scholars. Until middle age, his health was fairly good for the time. He contracted malaria in 1830 and 1835, the latter was the worst of the two cases. He contracted smallpox in 1863 during a 1863 to 1864 epidemic in Washington, D.C.

Throughout his life he experienced periods of depression, which could be genetic, due to life experiences or trauma, or both. Lincoln took blue mass pills, which contained mercury. Based on his behavior and physical condition while taking the pills and after he quit taking them, Lincoln may have suffered from mercury poisoning. It has been theorized that Lincoln had Marfan syndrome or, more likely, Multiple endocrine neoplasia type 2B, both rare genetic diseases.

Health and trauma

Despite the following occurrences, Lincoln's health up until middle age was fairly good for his day.[1][2]

Trauma

When he was nine years old, Lincoln was kicked in the head by a horse at the Noah Gordon Mill and was knocked unconscious for several hours.[3] Other injuries or trauma throughout his life include having cut his hand with an axe at least once,[4] incurred frostbite of his feet in 1830–1831,[5] was struck by his wife (apparently on multiple occasions),[6] and was clubbed on the head during a robbery attempt in 1828. Lincoln died from a bullet wound to the head in 1865.[7]

Infectious disease

  • Malaria: Lincoln had malaria at least twice. The first was in 1830, along with the rest of his family.[8] They had just arrived in Illinois that year. The second episode was in the summer of 1835, while living in New Salem. Lincoln was then so ill that he was sent to a neighbor's house to be medicated and cared for.[9]
  • Smallpox: Lincoln contracted smallpox shortly after delivering the Gettysburg Address in November 1863. Long thought to have been only a mild case, recent work suggests it was a serious illness.[10][11][12] Although it did not debilitate Lincoln, the disease did significantly affect his White House routine, and limited the advisors with whom he could meet.[1] While caring for him, Lincoln's valet William H. Johnson contracted the disease and ultimately died in January 1864.[13][14] Lincoln arranged and paid for Johnson to be buried at Arlington National Cemetery.[14]
Further information: William Henry Johnson (valet) § Smallpox

Mental health

Lincoln was contemporaneously described as suffering from melancholy, a condition which modern mental health professionals would characterize as clinical depression.[15] Lincoln suffered depressed mood after major traumatic events, such as the death of Ann Rutledge in August 1835,[16] the cessation of his (purported) engagement to Mary Todd Lincoln in January 1841 (after which several close associates feared Lincoln's suicide),[17][a] and after the Second Battle of Bull Run.[19] During his life Lincoln experienced the death of multiple close family members, including his mother, his sister, and two of his sons, Eddie and Willie.[20] Mary Lincoln felt her husband to be too trusting, and his melancholy tended to strike at times he was betrayed or unsupported by those in whom he put faith.[21] Whether he may have suffered from depression as a genetic predilection, as a reaction to multiple emotional traumas in his life,[20] or a combination thereof is the subject of much current conjecture.[22]

Lincoln often combated his melancholic moods by delving into works of humor, likely a healthy coping mechanism for his depression.[23]

Medication

The recollections of Lincoln's legal colleagues (John T. Stuart, Henry Clay Whitney, Ward Hill Lamon, and William Herndon) all agree that Lincoln took blue mass pills,[24] which were commonly prescribed for hypochondriasis[b] and melancholia.[25] It has been used since the 16th century to treat syphilis and by the mid-19th century was prescribed for a wide variety of ills.[25] The active ingredient of blue mass is elemental mercury – a substance now known to be a neurotoxin in its valproic state[26][c] and has been known to be poisonous for centuries.[25][d]

Lincoln may have taken the blue mass pills for constipation,[25][27] as well as hypochondriasis, or what has been called persistent constipation-melancholia complex. Both conditions which were well known by his friends and family to have significantly affected Lincoln throughout his life.[25][e]

Authors of Abraham Lincoln's Blue Pills: Did Our 16th President Suffer from Mercury Poisoning? find that it is a reasonable assumption that Lincoln had experienced mercury poisoning due to the differences in his behavior and physical condition when he was taking the blue mass pills versus when he stopped taking the pills.[25] When he was taking the blue mass pills, he was prone to outbursts of rage, bizarre behavior, memory loss, and insomnia. His hands trembled when he was under stress. Taking the medicine made Lincoln feel "cross". These issues, described in detail by those who were close to him, are common symptoms of mercury poisoning. When he stopped taking the medicine, and during a period of profound personal and professional stress, he "behaves like a saint".[25][f] Lincoln may also had long-term effects as the result of mercury poisoning, such as nerve damage that affected his gait.[25]

Shortly after his 1861 inauguration, Lincoln had a sudden and disquieting outburst of rage during a White House conversation. Finding that the blue mass pills made him "cross", Lincoln stopped taking them about August 1861 (5 months after his March inauguration). Then his anger greatly diminished, so much so that he rarely expressed anger and then only when it was situationally appropriate.[25]

The remarkable thing about Lincoln's temper is not how often it erupted, but how seldom it did, considering how frequently he encountered the insolence of epaulets, the abuse of friends and opponents alike, and the egomaniacal selfishness of editors, senators, representatives, governors, cabinet members, generals, and flocks of others who pestered him unmercifully about their own petty concerns.

— Michael Burlingame, The Inner World of Abraham Lincoln, 1994[25]

Body habitus

The habitus, or structure, of Lincoln's body attracted attention while he was alive, and continues to attract attention today among medical professionals.[30]

  • Height: as a child, Lincoln was tall, describing himself as "though very young, he was large of his age."[31] He reached his adult height of 6 feet 4 inches (1.93 m) no later than age 21.
  • Weight: although well-muscled as a young adult, he was always thin. Questionable evidence says Lincoln weighed over 200 pounds (90 kg) in 1831,[32] but this is inconsistent with the emphatic statement of Henry Lee Ross ("The facts are Lincoln never weighed over 175 pounds in his life"),[33] the recollection of David Turnham ("weighed about 160 lbs in 1830"),[34] and a New Salem neighbor named Camron ("thin as a beanpole and ugly as a scarecrow"). Lincoln's self-reported weight was 180 lbs (81.5 kg) in 1859.[35] He is believed to have weighed even less during his presidency.[36]

The theory that Lincoln's facial asymmetries were a manifestation of craniofacial microsomia[37] has been replaced with a diagnosis of left synostotic frontal plagiocephaly,[30] which is a type of craniosynostosis.

Genetic disorder theories

Several claims have been made that Lincoln's health was declining before the assassination. These are often based on photographs of Lincoln appearing to show weight loss and muscle wasting. [38] The theories are that he suffered from multiple endocrine neoplasia type 2B (MEN2B) or Marfan syndrome, rare genetic disorders.[38] DNA analysis of a pillowcase stained with Lincoln's blood, currently in possession of the Grand Army of the Republic Museum and Library in Philadelphia may be able to resolve open questions about Lincoln's health.[38][39]

Marfan syndrome

Based on Lincoln's unusual physical appearance, Dr. Abraham Gordon proposed in 1962 that Lincoln had Marfan syndrome. Testing Lincoln's DNA for Marfan syndrome was contemplated in the 1990s, but such a test was not performed.[40]

Lincoln's unremarkable cardiovascular history and his normal visual acuity have been the chief objections to the hypothesis, and today geneticists consider the diagnosis unlikely.[41][42]

Multiple endocrine neoplasia type 2B

In 2007, Dr. John Sotos proposed that Lincoln had multiple endocrine neoplasia type 2B (MEN2B).[43] This hypothesis suggests Lincoln had all the major features of the disease: a marfanoid body shape, large, bumpy lips, constipation, hypotonia, a history compatible with cancer—to which Sotos ascribes the death of Lincoln's sons Eddie, Willie, and Tad, and probably his mother. The mole on Lincoln's right cheek, the asymmetry of his face, his large jaw, his drooping eyelid, and pseudodepression are also suggested as manifestations of MEN2B. MEN2B is a genetic disorder, and recently it has been demonstrated that Lincoln's biological mother, Nancy Lincoln, had many of the same unusual facial features as her son, as well as a marfanoid appearance.[44]

Lincoln's longevity is the principal challenge to the MEN2B hypothesis: Lincoln lived long enough to be assassinated at age 56. Untreated MEN2B is generally understood to result in death by the patient's mid-thirties, but there are several reported cases of MEN2B patients surviving into their 50s with no or little treatment. The hypothesis could be proven by DNA testing.[45][46]

Debunked theories

Syphilis

Claims that Lincoln had syphilis about 1835 have been controversial.[g] Syphilis was a common worry among young men before the introduction of penicillin[50] because syphilis was somewhat common in that era.[51] Physicians likened the fear of syphilis, syphilophobia, to the modern fear of AIDS, which is also deadly and incurable.[48]

Writing in 2003, biographer David Donald declared, "Modern physicians who have sifted the evidence agree that Lincoln never contracted the disease." For instance, he did not have any of the signs of tertiary syphilis. Physicians suggest that he had syphilophobia.[51][e]

Spinocerebellar ataxia

The theory that Lincoln was afflicted with type 5 spinocerebellar ataxia[52] is no longer accepted.[53]

Notes

  1. ^ It was during his time as an Illinois legislator that Joshua Fry Speed said Lincoln anonymously published a suicide poem in the Sangamo Journal; though he was not sure of the date, a suicide poem was published on August 25, 1838, making Lincoln 29 years of age. The poem is called The Suicide's Soliloquy; historians are still divided on whether or not Lincoln was the author.[18]
  2. ^ Ironically, Abraham Colles, an Irish physician, found in 1837 that long-term use of mercury would worsen hypochondriasis.[25]
  3. ^ The way in which the mercury was processed for the blue mass pills directly correlated to how poisonous the pills would be. The authors of The National Dispensatory stated, "All agree that the efficacy of the [blue mass] preparation is proportionate… to the degree in which the metallic globules disappear."[25]
  4. ^ The standard dose for blue mass pills was one pill two or three times a day. This would mean that the patient took in 130 to 185 mg of mercury. If absorbed, this would mean that the patient received 9,000 times the allowable amount of mercury that day, and the impact would compound with each additional day.[25]
  5. ^ a b There is also conjecture that he took the blue mass pills for syphilis,[28] however, it is considered unlikely that he had syphilis, due to the timing of initial infection and reemergence after four or five years later would have been exceedingly rare for secondary syphilis. Since fear of syphilis was common among patients with hypochondriasis, it is more likely that the issue was that Lincoln feared that he had syphilis.[25]
  6. ^ In 1865, speaking with the Washington correspondent of the Pittsburgh Chronicle, Mrs. Lincoln described an instance in which her husband's "usual medicine," the mercury-based blue pills made him terribly ill prior to his second inauguration. He was very pale, anxious, and bedridden for days.[29] The correspondent recorded the interview as follows: Mrs. Lincoln "recalled the fact that her husband had been very ill, for several days, from the effects of a dose of blue pills taken shortly before his second inauguration." She said he was not well, and appearing to require his usual medicine, blue pills, she sent to the drug store in which Harrold was employed last and got a dose and gave them to him at night before going to bed, and that next morning his pallor terrified her. 'His face,' said she, pointing to the bed beside which she sat, 'was white as that pillow-case, as it lay just there,' she exclaimed, laying her hand on the pillow—'white, and such a deadly white; as he tried to rise he sank back again quite overcome!' She described his anxiety to be up, there was so much to do, and her persistence and his oppressive languor in keeping him in bed for several days; said he and she both thought it so strange that the pills should affect him in that way; they had never done so before, and both concluded they would get no more medicine there, as the attendant evidently did not understand making up prescriptions."[29]
  7. ^ Lincoln's law partner, friend and biographer William Herndon said that Lincoln told him that he contracted the disease.[47] It has been suggested by historian Charles B. Strozier that if Lincoln told Herndon that he had syphilis, it was likely due to his ignorance, confusion,[48] or fear of having caught syphilis.[49]

References

  1. ^ a b "Abraham Lincoln's Health". The Lincoln Institute. Retrieved 2009-10-12.
  2. ^ Shutes, Milton H. (1957). Lincoln's Emotional Life. Dorrance & Company. p. 103. ASIN B001OKE1F0.
  3. ^ Miller, Richard Lawrence (2006). Lincoln and His World. Stackpole Books. p. 61. ISBN 978-0-8117-0187-7.
  4. ^ Sotos, "Sourcebook", paragraph 1490.
  5. ^ Sotos, "Sourcebook", paragraph 930.
  6. ^ Sotos, "Sourcebook", paragraph 3589.
  7. ^ Sotos, "Sourcebook", paragraph 3582.
  8. ^ Sotos, "Sourcebook", paragraphs 2001-2007.
  9. ^ Sotos, "Sourcebook", pages 385-386.
  10. ^ Goldman AS; Schmalstieg FC Jr. (2007). "Abraham Lincoln's Gettysburg illness". J Med Biogr. 15 (2): 104–110. doi:10.1258/j.jmb.2007.06-14. PMID 17551612.
  11. ^ Sotos, "Sourcebook", pages 411-431.
  12. ^ Bryner, Jeanna (2007-05-21). "Study: Abraham Lincoln Nearly Died From Smallpox in 1863". FoxNews.com. Retrieved 2009-10-13.
  13. ^ Schroeder-Lein, Glenna R. (2015-01-28). The Encyclopedia of Civil War Medicine. Routledge. pp. PT528. ISBN 978-1-317-45709-1.
  14. ^ a b Hopkins, Donald R. (2002-09-15). The Greatest Killer: Smallpox in History. University of Chicago Press. pp. 280-281. ISBN 978-0-226-35168-1.
  15. ^ Shenk, Joshua Wolf (October 2005). "Lincoln's Great Depression". The Atlantic. Retrieved 2009-10-08.
  16. ^ Donald, p. 57.
  17. ^ Donald, p. 88.
  18. ^ Joshua Wolf Shenk (June 2004). "The Suicide Poem". The New Yorker.
  19. ^ Donald, p. 371.
  20. ^ a b Warren, Louis Austin (1959). Lincoln's Youth: Indiana Years: Seven to Twenty-One. Indianapolis: Indiana Historical Society Press. p. 175. ISBN 978-0-87195-063-5.
  21. ^ Schreiner, p. 154.
  22. ^ Donald, p. 27.
  23. ^ Shenk, Joshua Wolf (2006) [2005]. Lincoln's Melancholy: How Depression Challenged a President and Fueled His Greatness. New York: Houghton Mifflin Harcourt. p. 116. ISBN 978-0-618-77344-2.
  24. ^ "Sourcebook". paragraphs 612-626.
  25. ^ a b c d e f g h i j k l m n Hirschhorn, Norbert; Feldman, Robert G.; Greaves, Ian A. (February 2001). "Abraham Lincoln's Blue Pills: Did Our 16th President Suffer from Mercury Poisoning?". Perspectives in Biology and Medicine. 44 (3): 315–332. doi:10.1353/pbm.2001.0048. PMID 11482002 – via PubMed.
  26. ^ Hayden, p. 130.
  27. ^ "Sourcebook". paragraphs 612-626.
  28. ^ Roberts, WC (2004). "Facts and ideas from anywhere". Proc (Bayl Univ Med Cent). 17 (1): 89–94. doi:10.1080/08998280.2004.11927961. PMC 1200645. PMID 16200093.
  29. ^ a b California Digital Newspaper Collection – Late Atlantic Intelligence, Sacramento Daily Union, Volume 29, Number 4497, 21 August 1865
  30. ^ a b Sotos, "The Physical Lincoln", pages 194-204.
  31. ^ Sotos, "Sourcebook", paragraph 478.
  32. ^ Sotos, "Sourcebook", paragraph 363.
  33. ^ Sotos, "Sourcebook", paragraph 368.
  34. ^ Sotos, "Sourcebook", paragraph 361.
  35. ^ Sotos, "Sourcebook", paragraph 369.
  36. ^ White, p. 108.
  37. ^ Fishman RS; Da Silveira A (2007). "Lincoln's craniofacial microsomia: three-dimensional laser scanning of 2 Lincoln life masks". Arch. Ophthalmol. 125 (8): 1126–1130. doi:10.1001/archopht.125.8.1126. PMID 17698764.
  38. ^ a b c Verghese, Abraham (May 20, 2009). "Was Lincoln Dying Before He Was Shot?". The Atlantic. Palo Alto, California: Emerson Collective. Archived from the original on April 13, 2014. Retrieved October 8, 2014.
  39. ^ "What Can Lincoln's DNA Tell Us?". February 13, 2009. Retrieved February 20, 2020.
  40. ^ Gordon, Abraham M. (March 1962). "Abraham Lincoln – a medical appraisal" (Free full text). Kentucky Medical Association. 60 (60): 249–253. ISSN 0023-0294. PMID 13900423.
  41. ^ Marion, Robert (1993). Was George Washington Really the Father of Our Country?: A Clinical Geneticist Looks at World History. Addison-Wesley. pp. 88–124. ISBN 978-0-201-62255-3.
  42. ^ Ready, Tinker (1999). "Access to presidential DNA denied". Nature Medicine. 5 (8): 859. doi:10.1038/11287. PMID 11645164.
  43. ^ Sotos, "The Physical Lincoln".
  44. ^ Sotos JG (2012). "Abraham Lincoln's marfanoid mother: the earliest known case of multiple endocrine neoplasia type 2B?". Clinical Dysmorphology. 21 (3): 131–136. doi:10.1097/MCD.0b013e328353ae0c. PMID 22504423.
  45. ^ "Scientist Wants to Test Abraham Lincoln's Bloodstained Pillow for Cancer". Discover Magazine. April 20, 2009.
  46. ^ "Lincoln's Shroud of Turin". Philadelphia Inquirer. April 13, 2009.
  47. ^ Hertz, Emanuel (ed.) (1938). The Hidden Lincoln: From the Letters and Papers of William H. Herndon. Viking Press. p. 259. {{cite book}}: |author= has generic name (help)
  48. ^ a b Donald, David Herbert (2007-11-01). We Are Lincoln Men: Abraham Lincoln and His Friends. Simon and Schuster. p. 99. ISBN 978-1-4165-8958-7.
  49. ^ McGovern, George S. (2008-12-23). Abraham Lincoln: The American Presidents Series: The 16th President, 1861-1865. Macmillan. p. 4. ISBN 978-1-4299-5088-6.
  50. ^ Douglas L. Wilson (2011). Honor's Voice: The Transformation of Abraham Lincoln. Random House Digital, Inc. pp. 129, 184. ISBN 9780307765819.
  51. ^ a b David Herbert Donald (2004). We Are Lincoln Men: Abraham Lincoln and His Friends. Simon and Schuster. p. 99. ISBN 9780743254700.
  52. ^ Ikeda, Yoshio; et al. (Feb 2006). "Spectrin mutations cause spinocerebellar ataxia type 5". Nature Genetics. 38 (2): 184–90. doi:10.1038/ng1728. ISSN 1061-4036. PMID 16429157. {{cite journal}}: Unknown parameter |lay-url= ignored (help); Unknown parameter |laydate= ignored (help); Unknown parameter |laysource= ignored (help)
  53. ^ Sotos JG. (2009). "Abraham Lincoln did not have type 5 spinocerebellar ataxia". Neurology. 73 (16): 1328–1332. doi:10.1212/WNL.0b013e3181bd13c7. PMID 19841386.

Bibliography


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