An American cardiologist believes he has finally solved the mystery behind Abraham Lincoln's swift deterioration of health, writes Michelle McDonagh
ONE OF the most enduring mysteries in American history is what was it that made Abraham Lincoln so tall, thin and unattractive? What gave the 16th president of the US his long limbs, large feet, high voice, odd lips and astonishing joint flexibility?
And why, in his last months was the president so haggard in appearance that numerous editorials in major newspapers urged him to take a vacation?
These questions have been the subject of intense speculation among historians and physicians over the past 150 years, but American cardiologist Dr John Sotos believes he has finally solved the mystery behind Lincoln's odd appearance and the swift deterioration of his health during his final months.
He proposes that Lincoln had a rare genetic condition called multiple endocrine neoplasia, type 2B, known as MEN2B which would account for his strange body shape, large bumpy lips, constipation and a family history of the disorder.
Sotos believes Lincoln would have died of advanced cancer within a year had he not been assassinated on Good Friday, April 14th, 1865, aged 56.
He accepts his theory is somewhat controversial, but says it could also explain the early deaths of Lincoln's mother and two of his three sons. Lincoln's longevity is the principal challenge to the MEN2B theory, which, says Sotos, could be proven by DNA testing.
Since 1962, there has been a simmering but low level debate that Lincoln might have had Marfan syndrome, but Sotos claims there is stronger reason to think he did not have this genetic disorder of the connective tissue. "I will get plenty of argument but I believe with only microscopic doubt that Lincoln had this disorder," he says.
"He had so many of the major features of MEN2B including his height, his pouty lower lip and long thin limbs and constipation.
"Another major factor is that there is good evidence that three of his four sons had it. The three sons who had bumpy lips like Lincoln himself died before the age of 20 while the one son with normal lips lived to the age of 82."
In his book, The Physical Lincoln, Sotos, who spent 20 years affiliated with John Hopkins University, examines Lincoln's physical life in detail and claims that the diagnosis of MEN2B upends several Lincoln myths.
A cardiologist with a special interest in the medical histories of American presidents, he has written a number of books on this topic. Sotos was in Ireland last week to give a lecture at University College Cork, hosted by the Department of Medicine and the Alimentary Pharmabiotic Centre (APC), on the topic of Abraham Lincoln: A Unifying Diagnosis.
Sotos is currently chief executive of Apneos Corporation, and a colonel and chief flight surgeon in the California Air National Guard. He is a medical consultant to the US television series House, MD.
Contrary to popular myth, Lincoln was not depressed or ground down by the American Civil War, according to Sotos - he was actually displaying features of MEN2B.
The author remarks: "I don't know why I'm so fascinated with the medical history of the American presidents; I have been since the age of about 10 years. I don't think the topic has been given the attention it deserves. I was surprised to learn how much illness was among the presidents that as school children we did not learn about."
Sotos admits he was somewhat intimidated by the thought of tackling Lincoln as there was already so much written about him. However, when he heard about a genetic disease called Loeys-Dietz syndrome a couple of years ago, he thought he had discovered the answer to the mystery of the president's strange body shape.
"I thought somebody else would figure it out so I dived into the literature on Lincoln. It took me a few months to realise I was wrong about this disease. I was kind of disgusted with myself at this point so I put the project aside."
However, several months later, Sotos was reading an article in a medical journal about MEN2B and he instantly realised that this was a much more likely diagnosis for Lincoln.
Sotos believes that Lincoln's mother (died aged 34), three sons and the president himself all died from cancer, which is also associated with MEN2B.
"If you look at photos of Lincoln in the last 13 months of his life, you will see a horrifying degradation in his physical appearance. There were multiple editorials in the papers at the time saying the president looked terrible and was being worn down by his workload, but I think he was in an advanced state of cancer in his last year and would not have lived much longer if he had not been shot."
One major feature of MEN2B is a lack of muscle tone which Sotos says would explain why so many thought Lincoln, with his sad face, was depressed.
"Lincoln could be the centre of hilarity in a tavern or hotel telling jokes and laughing uproariously with friends. He would then move to the side and sit thinking and his features would take on an appearance of profound gloom. However, if he went back into the group, he would reanimate in a flash. People with the clinical illness we know as depression today can't change as quickly as this."
Sotos studied over 130 photos of Lincoln during his research and examined three plaster casts made of the president's head and hands as well as many of the thousands of books and eye witness accounts written about him and even the American $5 note. The photos can be seen on his website at www.physical-lincoln.com