Honest Abe's Buried Secrets

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In the decades following his assassination, Abraham Lincoln’s coffin was moved 17 times, re-opened 6 times, and (after an attempted grave-robbing) finally embedded in a block of concrete and steel.1 Now, over a century later, people are still trying to gain access to Lincoln’s remains—or more specifically, his DNA. Scientists have long pondered over Lincoln’s medical history, attributing his unusual physical features and known health ailments to various rare genetic disorders. Without sequencing his DNA, it’s impossible to definitively diagnose a specific disease, but in the meantime, speculations abound.


On October 3, 1862, President Lincoln visited Union officers in Antietam, Maryland--just 16 days after the bloodiest single-day battle in American history. Even without his signature top hat, Lincoln would have been taller than any of the men pictured here; it's his unusual height that's fueled so much discussion about his medical history...

The Theories

One of the early retro-diagnoses, Marfan Syndrome, is based largely on Lincoln’s unusually tall, lean body shape and long, thin fingers; both are typical features of Marfan patients. Caused by mutations in the Fibrillin-1 gene,2 Marfan Syndrome is multisystem disorder that’s characterized by long bone overgrowth, skeletal abnormalities, and most fatally, cardiac defects.3 Indeed, famous confirmed Marfan patients include Flo Hyman, an Olympic silver medalist that died of sudden aortic dissection during a volleyball game. Most recently, NBA hopeful, Isaiah Austin, at a towering height of 7’1”, was diagnosed during a pre-draft medical check; sadly, he had to end his competitive basketball career, since the risk of heart rupture was too great. In Lincoln’s case, the evidence for cardiovascular problems is slim, which has been a major criticism of detractors. Still, the Marfan theory gained prominence in the 1960s, particularly after one of Lincoln’s living relatives was diagnosed with this rare genetic disease.4 The young patient was descended from Lincoln’s great-great grandfather, Mordecai Lincoln II, but was not a direct descendant of President Lincoln… and so the debate remains murky.


As anyone that's taken a selfie can attest, sometimes pictures just come out blurry. But in this particular portrait of Lincoln, his blurry foot (perhaps caused by movement from throbbing arteries) has been used as evidence of loose-jointedness and cardiovascular defect4--both symptoms of Marfan Syndrome.

More recently, MEN2B (Multiple Endocrine Neoplasia, type 2B) has been offered as an alternative diagnosis.1 Consistent with Lincoln’s physiology, MEN2B patients also exhibit “marfanoid” features, meaning that they tend to be tall and lanky, with unusually long limbs and fingers. Other symptoms consistent with this disease include Lincoln’s well-known history of constipation, and facial asymmetries. The greatest challenge to this theory is that MEN2B causes cancer; in the last few months of his life, the President’s health had declined drastically (in a potentially cancer-like fashion)—but he still had survived to the relatively old age of 56.


In MEN2B patients, benign tumors accumulate in the mouth and eye, causing a lumpy appearance. Supporters of the Lincoln-MEN2B theory point to Lincoln's asymmetric and bumpy lower lip; one of the lumps on his lip is supposedly visible on the $5 bill.1

Solving Lincoln’s Mystery

Constipation and lumpy lips aside, these theories—as compelling, or tenuous as they seem—can only be confirmed or refuted through DNA sequencing. With Lincoln’s body encased in concrete and buried underground, this mystery might have gone unsolved. However, a limited amount of Lincoln’s DNA remains above ground and might be extractable from multiple sources: his surgeon’s blood-stained shirt,5 a bloody pillowcase from his deathbed,6 and even skull fragments from his autopsy.1 However, concern about technical difficulties, and more so, the potential destruction of important historical artifacts, have stalled these requests for now. Nevertheless, support for the project continues; the major argument is that confirmation of such diagnoses could bring much-needed public awareness and advocacy to rare diseases.


The first American president to be assassinated, Abraham Lincoln was shot in the head on April 15, 1865, and died the next morning. These are skull fragments from his autopsy, and the probe used to locate the bullet.

Perhaps one day we’ll finally sequence Lincoln's DNA, and discover the truth about him. Maybe he did have a rare genetic disease. Or maybe he was just a tall, skinny man dealing with the everyday stresses of leading a nation. In the end, science may reveal that he had a normal bill of health, but history has already proved, without a doubt, that Abraham Lincoln was certainly far from ordinary.

References:

1. Maher, Brendan. “What Lincoln Had.” Nature News. 30 November 2007. Retrieved 18 July 2014 from http://www.nature.com/news/2007/071130/full/news.2007.226.html
2. Dietz HC et al. (1991) Marfan syndrome caused by a recurrent de novo missense mutation in the fibrillin gene. Nature 352(6333):337-9.
3. Keane MG, Pyeritz RE. (2008) Medical management of Marfan syndrome. Circulation 117(21):2802-13.
4. Schwartz, Harold. (1972) Abraham Lincoln and Aortic Insufficiency: The Declining Health of the President. Calif Med 116:82-84.
5. “What Can Lincoln’s DNA Tell Us?” Newsweek. 13 February 2009. Retrieved 18 July 2014 from http://www.newsweek.com/what-can-lincolns-dna-tell-us-82789
6. Bixler, Jennifer Pifer. “DNA test could shed light on Lincoln’s last days, doctor says.” CNN. 5 May 2009. Retrieved 18 July 2014 from http://www.cnn.com/2009/HEALTH/05/05/lincoln.cancer.pillow/index.html?iref=24hours