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Is Lincoln Earliest Recorded Case of Rare Disease?

A big argument against the theory, however, is Lincoln's age. Some people with MEN 2B die of cancer in childhood. Only recently have many survived into their 40s. Sotos says he has found just two reports of people surviving untreated into their 50s, and admits that Lincoln would have to be a similar rarity.

MEN 2B patients in Japan tend to live longer than those in the United States, even though everyone has the same mutation in the RET gene. Moley, the Washington University expert, speculates that that is because other genes, common among the Japanese but infrequent in Western populations, somehow modify the disease.

Sotos is well aware that a surprisingly large amount of Lincoln biological material exists. In addition to the skull fragments, the National Museum of Health and Medicine in Washington has a lock of hair clipped from around Lincoln's head wound, and the bloodstained cuffs from one of the physicians who performed the autopsy. The autopsy did not include examination of the neck, chest or abdomen, an investigation that might have revealed cancer, if Sotos's hypothesis is correct.

Tim Clarke Jr., spokesman for the museum, said curators in the past decided that "destroying nonrenewable, historically significant material is not in the public's interest," but added that "as technology changes and the social and ethical environment changes, it could be addressed" again.

The National Park Service collection at Ford's Theatre contains a Brooks Brothers overcoat and suit that Lincoln wore the night he was shot; at least two pillows from his deathbed in the Petersen house across the street; and some towel fragments, all with bloodstains, said Bill Line, the Park Service spokesman. He said the service has two "director's orders" that prohibit research that "destroys or consumes" artifacts.

The Chicago History Museum has the bed where Lincoln died, the mattress, a bloodstained bottom sheet, and a bolster. The collection also includes a shawl worn by Mary Todd Lincoln containing bloodstains that are probably from Henry R. Rathbone, an Army major who accompanied the Lincolns to the theater and was stabbed by John Wilkes Booth, Lincoln's assassin.

Russell Lewis, executive vice president and chief historian, said that while the museum has previously rejected the idea of DNA testing of one of those objects, "I think it's definitely possible now that there could be a way to extract something" without destroying the relic.

But that's not the only issue. The museum must first decide the value of the knowledge that might be gained, and the cost it might have for Lincoln's, and possibly others', privacy.

"We are living in a time where people sometimes feel that they have the right to know everything," Lewis said. "As a museum, we have the obligation to consider whether medical information or private information should be revealed."

For his part, Sotos is not going to press for testing. "I think it will happen eventually, and I'm patient enough to wait for that," he said.

One thing is certain. He came by his diagnosis honestly. While in medical school at Johns Hopkins, he wrote "Zebra Cards," a once-popular accessory to an intern's white jacket. It consisted of a deck of cards (later pages of a book) with one side of each card listing a physical finding or symptom, and the flip side all the rare diseases where it was found.

The title refers to the advice to young doctors: "If you hear hoofbeats behind you, don't expect to see zebras." This means: "Resist the temptation to attribute common findings to exotic diseases" or, more roughly translated, "Don't get fancy."

However, a variant of this aphorism is: "When you hear hoofbeats, don't forget about zebras." It is the acknowledgment that rare diseases do exist, and some people do have them. "Zebra Cards" were a way to keep that knowledge at hand.

Sotos thinks he has found a zebra in the American pantheon.

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