Is Lincoln Earliest Recorded Case of Rare Disease?

In the patients Moley sees, droopy eyelids with thickened edges and prominent, bumpy upper lips are the most striking features. Most patients also have massively enlarged colons that bulge visibly, gurgle audibly and produce large amounts of gas -- symptoms not generally attributed to Lincoln.

[an error occurred while processing this directive]

"The facial appearance is not convincing. Overall, I don't think so," Moley said after learning of the theory and consulting a few pictures of Lincoln.

But, he added, there are always exceptions. Some abnormalities are so subtle that not even the patient notices them. "I would not rule it out completely," Moley said.

Others have speculated that Lincoln might have had Marfan syndrome, a genetic condition characterized by long arms, legs and fingers, loose joints, often a breast-bone deformity and a weakness of the aorta, the body's largest artery, which can burst and cause sudden death.

The discovery in 1991 that Marfan syndrome is caused by one of numerous mutations in a gene for fibrillin, a component of elastic tissue, led some people to propose testing Lincoln's DNA for the defect. That was never done, in part because it would have consumed significant amounts of Lincoln's bodily relic.

MEN 2B can also cause a "marfanoid" appearance, and that's what first brought the diagnosis to mind, Sotos said. What clinched it was the 16th president's lips.

One of MEN 2B's many manifestations are neuromas, or lumps of nerve tissue, on the tongue, lips and eyelids. There are no pictures of Lincoln's tongue, but his lips have a bumpy appearance in photographs. The hint of a lump on the right side of his lower lip is even visible in the engraved image on the $5 bill.

These growths also occur in the intestines and can cause constipation and diarrhea. Lincoln had lifelong constipation, and briefly during his presidency he took mercury-containing pills called "blue mass" to relieve it.

Sotos believes several things point to a diagnosis of cancer. Numerous observers commented that Lincoln became thinner in the White House. Three months before he died in April 1865 at age 56, he fainted while getting up quickly from a chair. He had periodic severe headaches and cold hands and feet. All are symptoms of pheochromocytoma, an adrenaline-producing tumor that is one of the two MEN 2B-associated cancers.

Furthermore, Sotos believes that two of Lincoln's sons, Willie and Tad, also had MEN 2B.

Photographs of them show somewhat irregular lips. Willie died at 11, probably of typhoid fever, and Tad at 18, reportedly of tuberculosis. Sotos believes that Tad had thyroid cancer that had spread to his chest and caused fluid to accumulate outside his lungs, a condition noted by physicians several times.

Lesser arguments for the diagnosis include Lincoln's famously sad face and his predilection for lounging horizontally whenever possible. Sotos believes those were signs of weak muscle tone, sometimes seen in MEN 2B.