Medical and mental health of Abraham Lincoln

The physical and mental health of Abraham Lincoln has been the subject of both contemporaneous commentary and subsequent hypotheses by historians and scholars.

Physical health

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

Childhood

There were fears for young Lincoln's life during a 24-hour period of unconsciousness that followed a horse kicking him in the head. He was nine years old. On another occasion, he fell into a creek and almost drowned.^[1]

Infectious disease

• Malaria: Lincoln had malaria at least twice. The first was in 1830, along with the rest of his family.^[3] 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, he was sent to a neighbor's house to be medicated and cared for.^[4]
• Syphilis: Claims that Lincoln had syphilis about 1835 have been controversial. The most recent analysis by a physician accepts the diagnosis.^[5] No biographer accepts the claim. Lincoln's law partner William Herndon said Lincoln contracted the disease, specifically stating that "Lincoln told me this."^[6] There is no physical evidence that Lincoln had the disease, but physical evidence would not necessarily be expected, given that 50% of infections do not progress beyond a transient local infection, even without treatment.^[7] Syphilis was a common worry among young men before the introduction of penicillin^[8] but this is not unexpected, given the commonness of syphilis in that era. Writing in 2003, biographer David Donald declared "Modern physicians who have sifted the evidence agree that Lincoln never contracted the disease,"^[9] however, these physicians have never published their analyses.

• 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]

Trauma

Lincoln died from a bullet wound to the head in 1865. His other episodes of adult trauma were minor. He was clubbed on the head during a robbery attempt in 1828,^[13] was struck by his wife (apparently on multiple occasions),^[14] cut his hand with an axe at least once,^[15] and incurred frostbite of his feet in 1830-1831.^[16]

Body habitus

The shape ("habitus") of Lincoln's body attracted attention while he was alive, and continues to attract attention today among medical professionals.^[17] Geneticists are now skeptical of the hypothesis that Marfan syndrome was the cause of his unusual habitus (see below).

• Height: As a child, Lincoln was tall, describing himself as "though very young, he was large of his age."^[18] 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 in 1831,^[19] but this is inconsistent with the emphatic statement of Henry Lee Ross ("The facts are Lincoln never weighed over 175 pounds in his life"),^[20] the recollection of David Turnham ("weighed about 160 lbs in 1830"),^[21] and a New Salem neighbor named Camron ("thin as a beanpole and ugly as a scarecrow"). Lincoln's self-reported weight was 180 lbs in 1859.^[22] He is believed to have weighed even less during his presidency.^[23]
• 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.^[24]

Lincoln's unremarkable cardiovascular history and his normal visual acuity have been the chief objections to the theory, and today geneticists consider the diagnosis unlikely.^[25]

• Multiple Endocrine Neoplasia: In 2007, Dr. John Sotos proposed that Lincoln had multiple endocrine neoplasia, type 2B (MEN2B).^[26] This theory suggests Lincoln had all the major features of the disease: a marfan-like 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 "pseudo-depression" are also suggested as manifestations of MEN2B. MEN2B is a genetic disorder, and recently it has been demonstrated that Lincoln's biological mother, Nancy Hanks Lincoln, had many of the same unusual facial features as her son, as well as a marfanoid body habitus.^[27] Lincoln's longevity is the principal challenge to the MEN2B theory: Lincoln lived long enough to be assassinated at age 56, while untreated MEN2B is generally understood to result in death by the patient's mid-thirties. There are, however, several reported cases of MEN2B patients surviving into their 50s with no or little treatment. The theory could be proven by DNA testing.^[28]

Other

The theory that Lincoln was afflicted with type 5 spinocerebellar ataxia^[29] is no longer accepted.^[30] The theory that Lincoln's facial asymmetries were a manifestation of craniofacial microsomia^[31] has been replaced with a diagnosis of left synostotic frontal plagiocephaly,^[17] which is a type of craniosynostosis.

Mental health

Lincoln was contemporaneously described as suffering from "melancholy," a condition which modern mental health professionals would characterize as clinical depression.^[32]

Lincoln suffered depression and hence avoided carrying sharp things, such as a knife, fearing he would use it on himself.

It was during his time as an Illinois legislator that Joshua 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.^[33]

Whether he may have suffered from depression as a genetic predilection, as a reaction to multiple emotional traumas in his life,^[34] or a combination thereof is the subject of much current conjecture.^[35]

Lincoln suffered depressed mood after major traumatic events, such as the death of Ann Rutledge in August 1835,^[36] the cessation of his (purported) engagement to Mary Todd Lincoln in January 1841 (after which several close associates feared Lincoln's suicide),^[37] and after the Second Battle of Bull Run.^[38] However, it is not clear that any of these episodes meet modern medical criteria for depression.^[39]

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.^[40]

Lincoln would often combat his melancholic moods by delving into works of humor, likely a healthy coping mechanism for his depression.^[41]

It has been proposed that Lincoln took "blue mass" pills to improve his mood.^[42] There is, however, no support for this in the written record.^[43] (See "Medication" section, below.)

Medication

The recollections of Lincoln's legal colleagues (John Stuart, Henry Whitney, Ward Lamon, and William Herndon) all agree that Lincoln took blue mass pills because of constipation^[44] (constipation is a troubling symptom in Multiple Endocrine Neoplasia Type 2B, described above). The active ingredient of blue mass is elemental mercury – a substance now known to be a neurotoxin in its vaporic state.^[45] Whether mercury poisoning may have affected Lincoln's demeanor before or after he ceased its use in 1861 is unknown, but still remains the subject of conjecture by some historians.^[46] Lincoln's only known assessments of the medication are that it made him "cross" and that he preferred it above others.^[47]

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. 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 never had done so before, and both concluded they would get no more medicine there, as the attendant evidently did not understand making up prescriptions."^[48]

References

1. "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. Sotos, "Sourcebook", paragraphs 2001-2007.
4. Sotos, "Sourcebook", pages 385-386.
5. Sotos, "Sourcebook", pages 390-400.
6. Hertz, Emanuel (ed.) (1938). The Hidden Lincoln: From the Letters and Papers of William H. Herndon. Viking Press. p. 259.
7. Merritt, H. Houston; et al. (1946). Neurosyphilis. Oxford University Press. p. 4.
8. Douglas L. Wilson (2011). Honor's Voice: The Transformation of Abraham Lincoln. Random House Digital, Inc. pp. 129, 184.
9. David Herbert Donald (2004). We Are Lincoln Men: Abraham Lincoln and His Friends. Simon and Schuster. p. 99.
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. Sotos, "Sourcebook", paragraph 3582.
14. Sotos, "Sourcebook", paragraph 3589.
15. Sotos, "Sourcebook", paragraph 1490.
16. Sotos, "Sourcebook", paragraph 930.
17. Sotos, "The Physical Lincoln", pages 194-204.
18. Sotos, "Sourcebook", paragraph 478.
19. Sotos, "Sourcebook", paragraph 363.
20. Sotos, "Sourcebook", paragraph 368.
21. Sotos, "Sourcebook", paragraph 361.
22. Sotos, "Sourcebook", paragraph 369.
23. White, p. 108.
24. 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.
25. 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. See also: Ready, Tinker (1999). "Access to presidential DNA denied". Nature Medicine 5 (859).
26. Sotos, "The Physical Lincoln".
27. 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.
28. "Scientist Wants to Test Abraham Lincoln's Bloodstained Pillow for Cancer". Discover Magazine. April 20, 2009. "Lincoln'd Shroud of Turin". Philadelphila Inquirer. April 13, 2009.
29. 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. Lay summary – University of Minnesota Medical Bulletin (Spring 2006).
30. Sotos JG. (2009). "Abraham Lincoln did not have type 5 spinocerebellar ataxia.". Neurology 73 (16): 1328–1332. doi:10.1212/WNL.0b013e3181bd13c7. PMID 19841386.
31. 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.
32. Shenk, Joshua Wolf (October 2005). "Lincoln's Great Depression". The Atlantic. Retrieved 2009-10-08.
33. Joshua Wolf Shenk (June 2004). "The Suicide Poem". The New Yorker.
34. During his life Lincoln experienced the death of multiple close family members, including his mother, his sister, close confidant Ann Rutledge, and two of his sons, Eddie and Willie. 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.
35. Donald, p. 27.
36. Donald, p. 57.
37. Donald, p. 88.
38. Donald, p. 371.
39. Sotos, "Physical Lincoln". pages 220-233.
40. Schreiner, p. 154.
41. 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.
42. Hirschhorn N, Feldman RG, Greaves IA. (2001). "Abraham Lincoln's blue pills. Did our 16th president suffer from mercury poisoning?". Perspect Biol Med. 44 (3): 315–322. doi:10.1353/pbm.2001.0048. PMID 11482002.
43. Sotos, "Physical Lincoln", pages 137-139.
44. "Sourcebook". paragraphs 612-626.
45. Hayden, p. 130.
46. Mayell, Hillary (July 17, 2001). "Did Mercury in 'Little Blue Pills' Make Abraham Lincoln Erratic?". National Geographic News. Retrieved 2009-10-12.
47. Wilson, DL (1998). "Herndon's Informants". University of Illinois Press. Retrieved 2010-09-22.
48. California Digital Newspaper Collection – Late Atlantic Intelligence, Sacramento Daily Union, Volume 29, Number 4497, 21 August 1865

Bibliography

• Donald, David Herbert (1996) [1995]. Lincoln. New York: Simon and Schuster. ISBN 978-0-684-82535-9.
• Hayden, Deborah (2003). Pox: Genius, Madness, and the Mysteries of Syphilis. New York: Perseus Publishing. ISBN 978-0-465-02881-8.
• Schreiner, Samuel Agnew (2005) [1987]. The Trials of Mrs. Lincoln. University of Nebraska Press. ISBN 978-0-8032-9325-0.
• Sotos, John G. (2008). The Physical Lincoln. Mt. Vernon Book Systems. ISBN 978-0-9818193-2-7.
• Sotos, John G. (2008). The Physical Lincoln Sourcebook. Mt. Vernon Book Systems. ISBN 978-0-9818193-3-4. Full-text index here.
• White, Jr., Ronald C. (2009). A. Lincoln: A Biography. Random House, Inc. ISBN 978-1-4000-6499-1.