It is difficult to remain an emperor in presence of a physician... the professional eye saw in me only a mass of humors, a sorry mixture of blood and lymph.
	-- The Memoirs of Hadrian

The Library of Congress' catalog shows that a new book about Abraham Lincoln appears every 5 1/2 days. Can anything new be said about this man?

Yes!

With only one old exception, all existing books about Lincoln discuss "the mental Lincoln," meaning his thoughts, speeches, politics, jokes, emotions, and so on. These characteristics are responsible for his reputation, of course, but they are only part of his story.

The book you hold in your hands completes the story. It unveils "the physical Lincoln" -- his body.

Some bits of the physical Lincoln are well known. He is history's tallest President, at 6-feet 3 3/4-inches. He was strong, and a good wrestler. He grew a beard to disguise his ugliness. These few facts, however, no more reveal the full physical Lincoln than the Gettysburg Address reveals the full mental Lincoln.

In short, The Physical Lincoln analyzes Abraham Lincoln as a physical organism. It takes you on a tour of his body, starting with his height, but going further. What were his feet like? What is that "mole" on his cheek? What did his voice sound like? Could he really do that? (See Chapter 8.) No such analysis has been published before now.

Ultimately, the tour leads to a new diagnosis. The Physical Lincoln proposes that Lincoln suffered from a very rare genetic disorder that affected him, literally, from toe to skull. The physical Lincoln was just as rare as the mental Lincoln.

The ramifications of the diagnosis are many, and they extend beyond medicine. Dozens of observations about Lincoln, previously thought to be just personal quirks, are now explainable as products of his disease. Some of the early deaths in his family are similarly explainable.

The diagnosis also provides fresh perspectives on questions old and new, such as: Was Lincoln depressed? Was the Presidency killing him? If he had not been shot, would he have lived another six months?

Some of these perspectives will be controversial. Nevertheless, one of the book's most interesting conclusions is that misinterpretations of the physical Lincoln have led to misinterpretations of the mental Lincoln. The physical Lincoln is, after all, the vessel that housed and supported the mental Lincoln.

* * *

If you want to read about Lincoln now, please turn to page 23. In the remainder of this Preface, I want to say a few things about the book itself.

The Physical Lincoln is written for laypersons, not professors or physicians. This is the audience Lincoln always tried to reach.

I tried writing for a physician audience, but found I could not effectively present the evidence for the new diagnosis in only 2000 words, the usual length of an article in a medical journal. Worse, I could not even present it in a single book!

The Physical Lincoln has a dense companion book, written for scholars, called The Physical Lincoln Sourcebook. The Sourcebook is a compendium of raw historical data, organized as a physician would organize any patient's medical history. (Lincoln's medical records, if any, have not survived. His autopsy was limited to the brain.)

The syntheses and assertions in The Physical Lincoln derive from it. Readers seeking the basis for any statement herein will often find a pointer to a specific entry in the Sourcebook, where the raw material may be reviewed. No such compendium has previously been assembled.

The companion book attempts to be exhaustive -- to cover all aspects of Lincoln's medical history, including the medical histories of his close blood relatives. It follows the physician's approach of recording all data on the first pass -- no matter how dubious or inconsistent -- to await a later sorting-out.

By contrast, The Physical Lincoln is selective. It is, effectively, the sorting-out of Lincoln's genetic disorder. This genetic focus is not as narrow as it seems, because Lincoln's disorder affected many bodily systems, had numerous observable manifestations, and afflicted some of his close blood relatives. The book is more like the explanation that a physician would give to a (very patient) patient, but without the requisite solemnity, and certainly without technical language. I have also added stories from my own voyage of Lincolnian discovery.

Unfortunately, even two books cannot completely cover the topic of the physical Lincoln. There are simply too many sources to read and too many avenues to explore. It would take years (or decades) for me to produce a book that tied down every loose end about Lincoln's health -- if possible at all.

Thus, in the parlance of software development, this book is very much a 1.0 release. What does that mean? It means the book, in its current state, tells the story I want to tell, and, most importantly, tells it now. It also means the book could be better in a thousand ways, from deeper research to sterling prose to glossy photos. Before investing a thousand hours to make it better, however, I would like to see how it does.

Readers are advised that The Physical Lincoln is in no way a medical textbook. The book presents a great many medical concepts, but only those needed to explain the Lincoln story. Omissions are the rule, and over-simplifications are used without apology. Anyone looking for a rigorous treatment of medical concepts should look elsewhere, potentially guided by the book's legion of reference notes. The emphasis here is on Lincoln.

* * *

Some of the many people who revere Lincoln may be offended by this book's apparent disregard for his dignity. Please be assured that medical detachment, not disrespect, is the only intent (Figure xvii).

Figure xvii. Mud spattered on the President. Lincoln visited the battlefield at Antietam, Maryland on October 3, 1862 and posed for several pictures. Dirt or mud is visible at the bottom of his overcoat. Pointing this out does not subtract from the dignity of the man. Dirt is dirt, and there was plenty of it at Antietam. The officer at far right, wearing the cavalry hat, is George Armstrong Custer. See also page 46.

It may be worthwhile, therefore, to emphasize that this book is largely an entertainment. It solves a puzzle. Lives do not hang on its contents, nor even reputations.* Lincoln has no living descendants. Physicians have an obligation to investigate everything that may shed light on their patient's health; I have simply approached Lincoln as if he were my patient.

* * *

Finally, a note about the book's design. Just as Lincoln was famously indifferent to his personal appearance and knew that the true measure of a person comes from inside, I have been somewhat indifferent to the physical appearance of this book. The book is designed for function, not beauty. It benefits hugely from TeX, LaTeX, and the memoir.sty typesetting software, but has warped their fine designs to its own purposes.

How to Read This Book

If you like, read this book for fun: ignore the footnotes and end notes. If, however, you are a scholar, a student seeking a project, or a Lincoln aficionado, you may occasionally want to look at those items because they point to more information. Every annotation's prefix (or lack of prefix) tells you where to turn for this additional information, as follows:

Example	Meaning
e32	Pointer to an "extra-note" -- see Appendix B
32	Pointer to a reference note -- see Appendix C
¶32	Pointer to a paragraph in The Physical Lincoln Sourcebook
* , † , ...	Pointer to a footnote at page-bottom.

"Extra-notes" are categorized separately from reference notes because they contain a comment over and above a simple reference citation. In other words, if you look up a reference note, you will get only a reference citation. If you look up an extra-note, you will get something more.

"Projects" are areas of investigation that I would someday pursue, were time and resources unlimited. I print them for readers needing things to do!

Dividing end-matter into these categories increases reading efficiency (by helping the reader decide whether to turn to the back of the book) and reduces the physical size and cost of the book (by enabling space-conserving text layouts in the appendices).

Readers may also notice -- and, I hope, forgive -- a few crotchets:

• Figures and tables are numbered according to the page on which they appear. This makes it easier to find them within the book.
• The name "Lincoln," used without qualification, refers to Abraham Lincoln, the 16th President of the United States.
• Original sources are quoted exactly, preserving their errors.
• British-style hyphenation is occasionally noticeable.

Acknowledgments

The Physical Lincoln and The Physical Lincoln Sourcebook owe their existences to immensely helpful people, organizations, and technology.

People. My greatest thanks goes to those who read the entire manuscript of The Physical Lincoln and provided detailed, page by page comments: William Petros, Georgette Sotos, and George P. Sotos. Their improvements to the book cannot be underestimated, and my gratitude to them knows no bounds.

Drs Kevin Olden, Jeffrey Jones, and Hugh Rienhoff, Jr. read the entire manuscript and provided invaluable suggestions. Hugh has been my guide in all things TGF-beta, but, more than that, has for 28 years been a fount of encouragement and a treasured friend. Olden I have learned to tolerate. :-) A beer with him and Dr. Fergus Shanahan got me going on the Presidents.

Many other physicians contributed their expertise in helpful discussions, for which I am grateful: David Walton, Thomas Traill, George A. Sotos, Mindy Shapiro, Chad Prodromos, John Mulliken, Neil Miller, Victor McKusick, Justin MacArthur, Richard Lange, Douglas Jabs, Tripp Heard, Henry Halperin, William Gottesman, Robert Gagel, Ronald Fishman, Charis Eng, Hal Dietz, Kevin Boylan, Kenneth Baughman, Douglas Ball, and Stephen Achuff. Dr. Lori Marion was my refraction-tutor. Please do not assume that these professionals endorse my conclusions!

Many other friends & family generously gave guidance, inspiration, and moral support: Carol & Rob Younge, Dr. James Weiss, Dr. Charles Wiener, Susan Weiner, Bruce Tognazzini, Dr. David Thiemann, Barbara Schroll, Marilyn Prodromos, Jacqueline Parker, the Litt family, Dr. Paul Ladenson, Dr. Kathryn Hodge, Dr. David Herrington, Al Henning (and the Dartmouth Club of Silicon Valley), Judge Lauren Heard, Dr. Nicholas Fortuin, Doris Egan, John Catsis, David Brown, John Branscum, and Peter Blake.

To a greater extent than all these people realize, this book is a smorgasbord of their ideas (and restraints!). Many I know from Johns Hopkins, where the pervasive spirit of inquiry allows anyone to walk up to anyone else and begin a conversation, saying: "I've been working on this idea..."

The special roles of Richard Benson and James Mellon are discussed on page 251. Richard went above and beyond, graciously helping me understand how he did what he did, and explaining the subtleties of 19th century photography. For supplying images, I am grateful to Gabor Boritt, Eugene Knox III, Dr. Ronald Fishman, Dan Ostendorf (and family), and to Keya Morgan, who also took time to dispel some of my misconceptions about Lincoln photographs. Suzanne Walsh taught me the rudiments of graphics processing long ago; I wish she had taught me some of her artistic skill!

Professional advice from DeAnna Gibbons, Jonathan Baruch, and Richard Abate was much appreciated. Jason Emerson greatly helped my search for sources. Cindy VanHorn and Jane Gastineaux at the Lincoln Museum were unfailingly good-humored about my requests. Cindy, especially, helped in so many ways over a period of several months. Sue Cornacchia and Hallie Brooker of the U.S. Coast Guard Academy and Museum were nicer to me than I had any reason to expect. Carol Johnson at the Library of Congress went out of her way to answer my questions about Mary Lincoln photographs.

Heroically, George P. Sotos read a thick draft of The Physical Lincoln Sourcebook, cover to cover. That is a real example of parental love! He and my mother are the best parents imaginable; I owe everything to them.

Organizations. I am grateful for the services provided by · Stanford University Libraries · the Library of Congress · Palo Alto City Library · Lincoln Museum of Ft. Wayne, Indiana · National Portrait Gallery · San Francisco Public Library · Welch Medical Library and Eisenhower Library of the Johns Hopkins University · National Archives and Records Administration · Holt-Atherton Special Collections at the University of the Pacific Library · Georgetown University Library Special Collections · Waupaca Area Public Library (Wisconsin) · Lincoln Shrine and A.K. Smiley Public Library of Redlands, California · Abraham Lincoln Presidential Library and Museum of Springfield, Illinois · United States Coast Guard Museum · Medical Society of the State of New York · Massachusetts Medical Society · Smithsonian Institution.

Of these, Stanford University deserves special thanks for its policy of giving the community access to the vast majority of their libraries. My thanks to the staffs of the Green, Lane, SAL, art, SAL3, and Falconer libraries.

Technology. Software has played a huge role in the books. I am happy to say that the books were developed entirely with open-source software. To all who contributed to developing these systems, thank you. · TeX · TeXShop · LaTeX · memoir.sty · the GIMP · Python · PIL · Mediawiki + Apache (to organize Lincoln photographs).

The Internet Archive (archive.org) and Google Books (books.google.com) are fantastic resources for anyone needing access to out-of-copyright books. I used both heavily, with gratitude at every download.

Finally. The errors in this book are mine alone -- but if you don't tell me about them, they will be your errors in future editions. :-)

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^* Well, maybe my reputation is at stake: there is a nonzero risk of looking like an idiot if, after 310 pages of text, I have missed the diagnosis. Theodore Roosevelt spoke memorably about taking such risks, but I prefer the view of one of the greatest physicians I know: "No balls, no babies."