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The ailments of Honest Abe

Peter McCarthy writes about a US cardiologist’s theory that Abraham Lincoln may have suffered from multiple endocrine neoplasia type 2B.

Abraham Lincoln suffered from a rare genetic syndrome which accounted for his unusual appearance and he would likely have died of cancer within a year if he had not been assassinated, according to a US cardiologist and author.

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Doctor John G. Sotos — creator of a website on the medical history of American presidents and an advisor on top-rated TV series ‘House, MD’ — believes the Civil War president had multiple endocrine neoplasia type 2B (MEN 2B) and probably had advanced cancer when he succumbed to an assassin’s bullet in April 1865.
The Johns Hopkins University-trained physician also believes that the first Republican president’s famed mercy — one of the reasons why Lincoln is remembered as fondly as he is — may have been partly inspired by an awareness that he was dying.
Dr Sotos outlined his theory as the guest speaker at the 10th Annual De Pazzi Lecture of University College Cork’s Department of Medicine/Alimentary Pharmabiotic Centre on October 23. The lecture series honours Sister De Pazzi, an administrator at Cork’s Mercy Hospital for almost 50 years.
Sufferers of MEN 2B develop cancer in hormone-producing organs such as the thyroid and adrenal glands. The disease stems from a gene variant which can be spontaneous or inherited, and it is believed to affect only about one person in a million. Dr Sotos studied eyewitness accounts, the 130 photographs that exist of Lincoln, two head casts and a hand cast, and his book, The Physical Lincoln, puts forward evidence which he claims explains over 50 different observations about the twice-elected president who abolished slavery and led the North to victory over the South in the 1861-65 war.
h4. Tallest US president
For decades, physicians have been intrigued by the unusual physical characteristics of the 16th president. Rather than the ‘Frontier Hercules’ he was often reputed to be, Lincoln was in fact, in Dr Sotos’ words, ‘odd looking’ — tall and thin (the tallest US president ever, at close to 6-foot 4-inches), long-armed with large hands and feet; a small, thin head; and a high-pitched voice. As well, his face showed a marked asymmetry with his ears and eyes at different vertical levels.
A theory put forward in 1962 suggested that Lincoln had Marfan Syndrome, a genetic disorder of the connective tissue. People with Marfan tend to be tall and thin. However, Dr Sotos could not find evidence that Lincoln suffered from any of the other characteristic features of Marfan such as eye, aorta and heart problems.
Dr Sotos concluded that while Lincoln clearly had a Marfanoid build (which is also seen in MEN 2B sufferers), other physical features such as thick, bumpy lips and sluggish bowels point to MEN 2B rather than Marfan.
This would also explain the president’s facial asymmetry and, Dr Sotos believes, contradict the theory that Lincoln was depressed. Many contemporaries described Lincoln as the saddest man they ever saw.
But Dr Sotos believes that his behaviour was not consistent with depression, and his sad face with its drooping eyelids can actually be attributed to the low muscle tone seen in MEN 2B.
He also thinks that Lincoln’s declining health in 1865 can be attributed to cancer and not, as is commonly believed, being worn down by a terrible war that killed 600,000 people.
Lincoln was visibly thinner and more haggard than a year before, and several newspaper editorials said the president needed to take a vacation. However, in Dr Sotos’ opinion, the symptoms — dramatic weight loss, headaches, fainting, tiredness, temporal wasting as evidenced by an 1865 life mask — all point to advanced cancer.
The main stumbling block for the MEN 2B theory is Lincoln’s longevity: “The problem is that Lincoln lived too long… With that downhill slope he was having in those last few months, I don’t think he would have made it to 57. But still 56 is very old for this syndrome,” Dr Sotos concedes.
MEN 2B sufferers typically develop cancer in their twenties and would be unlikely to live beyond their thirties without treatment. However, Dr Sotos argues that this rare disease is little studied and a small percentage of people do live longer.
“A lot about the disease is unknown because there are so few people to study,” he says. He also believes that Lincoln’s mother and three of his four sons may have had the disorder (only one of Lincoln’s sons lived beyond twenty).
A DNA test would quickly show whether Dr Sotos’ theory is correct. Even though no direct descendants of Lincoln are alive today — the last one died in 1985 — plenty of biological material exists, including pieces of skull from the autopsy and various materials on which he bled after the shooting at a Washington theatre, such as his wife’s dress, a pillowcase and a US flag that was placed under his head.
The American Civil War ended on April 9, 1865 with the South’s surrender. Lincoln had promised reconciliation and to ‘bind up the nation’s wounds’, but he was gunned down by a Southern supporter five days after the war’s end.
h4. Merciful attitude
Dr Sotos believes ‘Honest Abe’ knew his health was failing and this may have contributed to his merciful attitude: “Lincoln was a very smart guy and he would have known something wasn’t right… I think Lincoln knew he was dying… you’ve just got to wonder how a dying man looks at running a war, looks at rebuilding a country.”

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