The diagnosis strongly suggests that Lincoln was dying of cancer in his last months, and also explains many previously mysterious Lincolnian characteristics:

• Lincoln's body shape, i.e. his height, long limbs, big feet, leanness, high voice, flat feet, sunken chest.
• Lincoln's sagging face, that witnesses mistakenly thought was sadness or depression.
• Lincoln's bumpy lips and big lower lip.
• The large bump on Lincoln's right cheek.
• Lincoln's fatigue, headaches, fainting, and cold hands & feet in his last months.
• Lincoln's intermittently drooping eyelids.
• Lincoln's constipation.
• Lincoln's high voice.
• Lincoln's propensity to lie on the floor when reading, and rest his feet on a table when sitting.
• Lincoln's asymmetric face and homeliness.
• Lincoln's loose-jointedness.
• The death of three of Lincoln's sons before age 20, and, probably, his mother's death at 34.

Austin Gollaher ... claims to have saved Lincoln from drowning one day as they were trying to 'coon it' across Knob Creek on a log. The boys were in pursuit of birds, when young Lincoln fell into the water, and his vigilant companion ... fished him out with a sycamore branch. 5a

This does not mean Lincoln had Marfan syndrome, however. More than a dozen different medical conditions cause this same type of body shape; Lincoln had one of these other disorders (MEN 2B). Still, it is proper to say that Lincoln was "marfanoid," meaning he was shaped like a person with Marfan syndrome.

For his time, Lincoln was about 7.5 inches taller than average 2d. His height came from his legs. Sitting, he was no taller than the average man 2e. (See photo.)

It has been said that a cast of Lincoln's hands show them to be muscular and powerful, not the slender hands of Marfan syndrome 10 11. This is not correct. True, the casts show that Lincoln did not have the classic long, graceful hands and fingers of Marfan syndrome. But they also show that his hands were longer than normal and that his fingers were longer than normal. It is important to remember that Lincoln used an axe more or less all day every day from the time he was about 8 years old until he was 23. No physician practicing today knows what that level of hand exertion does to the hands of someone with Marfan syndrome 2f.

Evidence for other features of Marfan syndrome (ocular, cardiovascular, familial) in Lincoln has been presented, but found weak 2g 12a. In 1959, Marfan syndrome was diagnosed in a distant relative of Lincoln's (a third cousin four times removed) on his father's side 13. Sharing 1/4096th of Lincoln's genetic material, it is difficult to ascribe much significance to this fact 12b. Although the world's greatest authority on Marfan syndrome thinks it's "50-50" that Lincoln had the condition 3h, other geneticists (and Dr. Zebra) think it unlikely 12c 14 2h.

(None of the several physicians who saw Lincoln's naked body at autopsy remarked on a sunken chest 12e. It is difficult to attach much significance to the effusive, hyperbolic, nonspecific statements of these physicians 2i.)

Much of the evidence for Lincoln's depression derives from observations of his facial expression. This is unreliable, however. Lincoln's low muscle tone (a consequence of MEN 2B) made his face sag whenever he was disengaged from his surroundings. This gave him a profoundly sad appearance, regardless of his internal mood. Dr. Zebra calls this phenomenon "pseudo-depression" 2j.

The intermittent drooping in his right eyelid may actually have resulted from hyper-elevation of his *left* eyelid, i.e. had he allowed his left eyelid to droop, it would have blocked his vision in that eye.

This is a type of craniosynostosis caused by the early fusion of the left frontal and parietal bones during growth of the skull. Abnormal skull shapes are part of the MEN2B syndrome.

New York Republicans had written Lincoln about the same time also urging a beard, to disguise his long neck 2p.

Did Lincoln have cancer? If he had MEN2B, the answer is certain: yes. The historical record also suggests he had cancer.

Lincoln began losing weight in 1860. There is no quantitative data about his weight after becoming President, but many people wrote of his declining appearance and increasing thinness. Casts of his face in 1860 and 1865 show a striking loss of soft tissue. Temporal wasting is present on the 1865 cast.

In his last months, Lincoln had headaches, cold feet & hands, exercise intolerance & sweating, pervasive fatigue that a work respite did not ease, fainting, and nausea. These findings are compatible with a pheochromocytoma 2s.

MEN 2B is rare -- perhaps about one in a million people have it -- and there are no large studies on survival statistics. Lincoln lived to be quite old for someone with MEN2B. This topic is discussed in great detail in 2 and in 3.

"[It] wellnigh broke the President's heart, and certainly an affliction more crushing never fell to the lot of man. ... Strong as he was in the matter of self-control, he gave way to an overmastering grief, which became at length a serious menace to his health. ... A deep and settled despondency took possession of Mr. Lincoln; and when it is remembered that his calamity -- for such it surely was -- befell him at a critical period of the war, just when the resources of his mighty intellect were in most demand, it will be understood how his affliction became a matter of the gravest concern to the whole country."

Comment: Aortic regurgitation is caused by a leaky heart valve. When severe, large swings in blood pressure occur with every heartbeat, causing structures in the body to pulsate. Diagnosing aortic regurgitation from photographic blurriness is a clever idea, but, in this case, wrong. First, other photographs demonstrate that Lincoln's foot was simply out of focus 2v. Second, such pulsatile foot movement is normal (even Dr. Zebra has it). Third, Lincoln was incubating smallpox when the photograph was taken, so possibly he was vasodilated for that reason and more prone to foot movement.

With some difficulty, smallpox was eventually diagnosed. It was reported to the public as "varioloid," which is the mildest of the four clinical syndromes of smallpox. Clearly, however, Lincoln had full-blown smallpox, not varioloid. Although the acute crisis had passed by early December, he is described as still recovering through the entire month. Only on January 1, 1864 does someone observe: "he has a hue of health to which he has long been a stranger" 3l.

During the whole of his presidency, Lincoln was beset by people asking for jobs, commissions, pardons, and other favors. When informed that his disease was highly contagious, Lincoln remarked "There is one good thing about this. Now I have something I can give everybody" 24a 3m.

While visiting troops in the field, days before his death, Lincoln picked up a heavy axe, chopped wood for several minutes, then held the axe straight out, horizontally, "without its even quivering." Several strong soldiers, tried to duplicate this feat, but could not 3n.

Yet, just two years before, he was described as "cadaverous and emaciated" in appearance 18c.

Lincoln performed the "horizontal" feat several times, e.g. at Milwaukee, WI on Sept. 30, 1859 18d. Comment: I accept some stories of Lincoln's strength in youth, but I have been unable to find the primary reference for the 1865 wood-chopping performance.

Eyewitness accounts of the shooting and its immediate aftermath are available from Dr. Leale MORE and from Dr. Charles Taft MORE.

An autopsy was performed in the White House (restricted to the head only), as was the embalming 3p.