Abraham Lincoln was a physical anomaly. At 6’4”, he didn’t just tower over his contemporaries; he looked like he belonged to a different species altogether. If you’ve ever stared at those late-presidency photos, you see it. The gaunt cheeks. The sunken eyes. The weirdly long, spider-like fingers that seemed to wrap around his knees twice. People at the time noticed it too, but they just called him "homely" or "raw-boned."
Honestly, modern medicine looks at those same photos and sees something else entirely. We aren't just talking about a tall guy. We’re talking about a man whose DNA might have been fundamentally different from yours or mine. When people ask what disease did Lincoln have, they usually expect a simple answer like "depression" or "smallpox." But the real rabbit hole goes way deeper than that. It involves rare genetic mutations that might have actually killed him before an assassin’s bullet ever could.
The Marfan Syndrome Theory: More Than Just Being Tall
For decades, the leading theory was Marfan Syndrome. It makes sense on the surface. Marfan is a genetic disorder that affects the body’s connective tissue. People with it are usually tall and thin with long arms, legs, and fingers. They often have a sunken chest and a curved spine.
Lincoln hit almost every one of those marks.
In the 1960s, a doctor named Abraham Gordon really pushed this idea. He noticed that one of Lincoln's descendants definitely had Marfan, which suggested the gene was floating around the family tree. Connective tissue is basically the "glue" that holds your cells together. When that glue is faulty, your heart’s aorta—the big pipe moving blood away from the heart—can suddenly stretch and burst.
If Lincoln had Marfan, his heart was a ticking time bomb.
But here’s the thing: historians are kinda skeptical now. While Lincoln was spindly, he was also incredibly strong. He was a champion wrestler in his youth. He split rails. People with Marfan Syndrome usually have weak joints and heart murmurs that make that kind of physical labor nearly impossible. Plus, his face doesn't quite fit the typical "Marfan look." It’s too rugged, too asymmetric.
MEN2B: The New Contender in the Lincoln Medical Mystery
About fifteen years ago, a cardiologist named Dr. John Sotos threw a massive wrench into the Marfan theory. He proposed that the answer to what disease did Lincoln have was actually Multiple Endocrine Neoplasia Type 2B, or MEN2B.
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This one is rare. Really rare.
MEN2B causes tumors to grow on your glands and nerves. It also gives people a very specific "marfanoid" appearance—tall, thin, and lanky—but with some distinct differences. Sotos points to Lincoln’s thick lower lip and the small bumps (called neuromas) visible in high-resolution photos of his face.
Wait. It gets more interesting.
MEN2B isn't just about looks. It causes massive digestive issues because the nerves in the gut grow tumors. Lincoln was famously constipated. Like, legendary levels of "blue mass" mercury pill-popping constipation. He also suffered from chronic fatigue and headaches. Sotos argues that if you look at Lincoln’s sons—Eddie, Willie, and Tad—who all died young, their symptoms actually align with MEN2B better than any other explanation.
Basically, if this theory is right, Lincoln was dying of cancer throughout his entire presidency.
Imagine leading a country through its bloodiest war while your own body is slowly producing internal tumors. It adds a whole new layer of "tragic hero" to the man. But again, it’s a theory. We can't know for sure without testing his hair or bone fragments held at the National Museum of Health and Medicine. And so far? The museum has said "no" to DNA testing. They want to preserve the samples.
The "Melancholy": Dealing With 19th-Century Depression
You can't talk about Lincoln’s health without talking about his mind. He called it "the hypo." We call it clinical depression.
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It wasn't just "sadness." It was a paralyzing, soul-crushing weight. In 1841, he was so depressed he couldn't even leave his bed. His friends literally removed all knives and razors from his room because they were afraid he’d kill himself.
- He suffered from "survivor's guilt" after losing his mother, sister, and sweetheart.
- He had a morbid obsession with dreams and premonitions.
- His poetry was dark. Like, really dark.
Some historians, like Joshua Wolf Shenk, argue that Lincoln’s "disease" of the mind was actually what made him a great leader. He had already survived his own internal civil war. By the time the actual Civil War broke out, he was uniquely equipped to handle the despair of a nation. He didn't avoid the pain; he sat in it.
Smallpox in the White House
Here is a wild fact: Lincoln was actually coming down with Variola (smallpox) while he was giving the Gettysburg Address.
Think about that.
He was lightheaded. His head throbbed. On the train ride back to Washington, he was lying down with a wet towel on his forehead. For weeks after, he was quarantined in the White House. He even joked about it, saying, "Now I have something I can give to everybody!"
While it was a "mild" case—varioloid—it still would have killed a lesser man. His strength, despite whatever genetic hand he was dealt, was honestly terrifying.
The "Lump" and the Asymmetry
If you look closely at Lincoln’s life mask from 1860, you’ll notice his face is lopsided. His left side is much smaller than his right. This has led some neurologists to suggest he had Craniofacial Microsomia.
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Others think it was just a result of being kicked in the head by a horse when he was nine. He was unconscious for hours. Some think he was actually dead for a moment. That kind of trauma can mess with bone growth and nerve development. It might also explain his occasional double vision. He once mentioned seeing two images of himself in a mirror—one slightly ghostlier than the other. He took it as an omen that he’d be elected to a second term but wouldn't survive it.
Pretty spooky, right?
Why Does It Even Matter?
You might wonder why we’re obsessing over a dead man’s medical charts.
It matters because it humanizes a myth. When we see Lincoln as a man struggling with MEN2B, or Marfan, or debilitating depression, his achievements become ten times more impressive. He wasn't a marble statue. He was a guy whose joints probably hurt every time he sat down, whose stomach was in knots, and whose mind told him everything was hopeless—and he still saved the Union.
So, what disease did Lincoln have?
The truth is likely a cocktail of things. He likely had a genetic mutation (MEN2B is the strongest current candidate), chronic clinical depression, and the lingering effects of childhood trauma. He was a medical marvel who lived long enough to change the world.
How to Explore the Lincoln Mystery Further
If you’re a history buff or a medical nerd, don’t just take my word for it. There are specific places where you can see the evidence for yourself.
- Visit the National Museum of Health and Medicine: Located in Silver Spring, Maryland, this museum holds the lead balls that killed him, along with fragments of his skull. You can see the actual physical evidence doctors use for these theories.
- Read "Lincoln's Melancholy" by Joshua Wolf Shenk: This is the gold standard for understanding his mental health. It moves away from "diagnosing" him and toward understanding how his depression shaped his character.
- Examine the High-Res Life Masks: The Smithsonian has digital versions of the 1860 (Volk) and 1865 (Clark Mills) life masks. Compare them. You can literally see the progression of his physical decline over the war years.
- Check out Dr. John Sotos’ work: His book The Physical Lincoln goes into grueling detail about the MEN2B theory, using photographic evidence to map out every bump and blemish on the President’s face.
By looking at the primary sources—the photos, the masks, and the letters—you start to see the man behind the stovepipe hat. He wasn't just a politician; he was a medical mystery that we are still trying to solve 160 years later.