Lincoln and the Marfan Syndrome: The Medical Diagnosis of a Historical Figure

LINCOLN AND THE MARFAN SYNDROME: THE MEDICAL DIAGNOSIS OF A HISTORICAL FIGURE Gabor S. Boritt Adam Borit Thirty-one years after Abraham Lincoln's death, in 1896, Antoine Bernard-Jean Marfan, professor of pediatrics in Paris, published the case history of a five-and-a-half-year-old girl who suffered from a syndrome that was to bear his name. During the decades that followed others defined the disease with increasing precision. The Marfan syndrome thus became known as a dominantly inherited illness of the connective tissues with incomplete penetrance, and its cardinal manifestations as being skeletal (elongation and thinness of the bones), ocular (displacement of the lens), and cardiovascular (dilatation and dissection of the ascending aorta). Ninety-seven years after Abraham Lincoln's death, in 1962, he was identified as a victim of the Marfan syndrome.1 The first diagnosis came from Abraham M. Gordon, a Kentucky internist affiliated with the University of Louisville Medical School, who had both clinical and research experience with the Marfan Syndrome. His findings, published in theJournal of the Kentucky MedicalAssociation , were based chiefly on the physical description of the lanky president and to a lesser degree on corroborating evidence in Lincoln's maternallineage —high-pitched voice, andhighintelligence. Gordon tentativeA longer version of this paper was presented at the seventy-fifth annual meeting of the Organization of American Historians, in Philadelphia, on April 2, 1982. We acknowledge our indebtedness to the commentators, David Brion Davis of Yale University, James M. McPherson ofPrinceton University, and Reed E. Pyeritz ofTheJohns Hopkins University Medical School, as well as to the earlier comments of Don E. Fehrenbacher of Stanford University, and the subsequent comments of anonymous readers. 1 A. B. Marfan, "Un cas de déformation congénitale des quatre membres, plus pononcée aux extrémités, caractérisée par l'allongement des os avec un certain degré d'amincissement ," Bulletin et mémoires de íes société médicale des Hôpitaux de Paris 13 (1896): 220-26; Victor A. McKusick, Heritable Disorders of Connective Tissue, 4th edition (St. Louis, 1972), 61-65; Abraham M. Gordon, "Abraham Lincoln—A Medical Appraisal," The Journal of the Kentucky State Medical Association 60 (1962): 249-53. The term "dominantly inherited"means that of the two gene alleles, one from each parent; the one causing the disease is dominant over the other. "Incomplete penetrance" means that the disease shows upwith variable frequency in individuals carrying the affected gene, depending on other factors, genetic, environmental, or both. LINCOLN AND THE MARFAN SYNDROME213 Iy noted the possibility of ocular symptoms as well. And his conclusions were far-reaching. More important than explaining Lincoln's peculiar physical appearance, the Marfan syndrome, Gordon suggested, helped explain Lincoln's greatness. In an interview with the medical columnist of Newsweek magazine he promised further research. "I'd like to find out how much of Lincoln is Lincoln and how much is Marfan Syndrome."2 Gordon believed that his diagnosis could help resolve the questions about Lincoln's ancestry as well and identify the presumably unknown sire of his mother. "I would search," he wrote, "for a Virginia family that carries the stigma of this disease who were probably neighbors to Joseph Hanks, Lincoln's great-grandfather. If such a family canbe uncovered I believe Lincoln's maternal grandfather will be found among them."3 Then in February 1964, a more persistent champion of the LincolnMarfan diagnosis appeared in California physician Harold Schwartz, an instructor at the University of Southern California School of Medicine. Writing in The Journal of the American Medical Association, he suggested the Marfan diagnosis for Lincoln through the paternal line. In 1959 Schwartz had diagnosed a young patient as suffering from the Marfan syndrome. Some months later when the boy's grandmother came to inquire about the child, her name turned out to be Lincoln. This was my " 'burning bush' moment," Schwartz later said in an interview with Time magazine. He had connected the sixteenth president with the Marfan syndrome, independently from Gordon.4 Schwartz went about trying to substantiate his hunch methodically. He provided skeletal indices for Lincoln and eye findings, and he noted the lack of cardiovascular involvement, while raising...