Umut Akova
Atlanta, Georgia, United States

Marfan syndrome is a rare, inherited genetic disorder that affects the body’s connective tissues. People with Marfan syndrome often have distinctive physical features such as tall stature, long limbs, joint hypermobility, and a narrow face. The condition is primarily caused by mutations in the FBN1 gene, which is located on chromosome 15 and encodes for fibrillin-1, a vital glycoprotein essential for the structural integrity of connective tissues throughout the body. Although these mutations can be inherited in an autosomal dominant manner, around 25% of cases result from de novo mutations with no familial history.¹ The genetic mutations result in a disruption of the extracellular matrix, leading to the syndrome’s characteristic features and potential health risks. Marfan syndrome can also impact the eyes, musculoskeletal system, and cardiovascular system. Cardiovascular issues, in particular, are a hallmark of Marfan syndrome and may include aortic root dilation, mitral valve prolapse, and aortic dissection. Eye problems, including nearsightedness and lens dislocation, are common. Some affected individuals also experience dural ectasia, skin stretch marks, respiratory problems, and hernias.²

In the annals of American history, few figures stand as tall as Abraham Lincoln. The sixteenth president of the United States is celebrated for his leadership during one of the most tumultuous periods in American history. But an intriguing medical enigma persists about Abe Lincoln—the possibility that he may have had Marfan syndrome. While remembered for delivering eloquent speeches, exhibiting steadfast leadership throughout the Civil War, and issuing the Emancipation Proclamation, his physical appearance and reported health issues have long intrigued historians and medical experts. At 6 feet 4 inches, Lincoln’s towering stature, unusually long limbs, and elongated face align with the outward manifestations of Marfan syndrome. His large hands and feet, combined with his thin frame, further contribute to speculation regarding his condition. Lincoln’s documented health problems, including unexplained episodes of fatigue, chest pains, and occasional fainting spells, have also fueled questions about his cardiovascular health.³

Diagnosing a medical condition in a historical figure who lived in the nineteenth century presents significant challenges. The lack of modern medical records and the limitations of historical accounts make it impossible to provide a definitive diagnosis. One of the primary challenges in diagnosing Lincoln is the absence of concrete, medical evidence from his time. A diagnosis of Marfan syndrome typically relies on a combination of clinical features, genetic testing, and imaging. In the case of historical figures, such evidence is largely unavailable, making any diagnosis speculative at best.

The first person to make a connection between Abraham Lincoln and Marfan syndrome was Cincinnati physician Abraham Gordon, who noted the similarity in physical appearance between the president and his mother, Nancy Hanks Lincoln.⁴ Soon after, an article was published describing a patient with Marfan syndrome who had traced his ancestry back to Lincoln’s great-great-grandfather, Mordecai Lincoln II (1686–1736).⁵ After the identification of the genetic cause of Marfan syndrome in the early 1990s, there have been several instances where the genetic sampling of artifacts related to Lincoln have been proposed; however, none have been performed for Marfan syndrome.⁶ Scientists have, however, tested Lincoln’s DNA for multiple endocrine neoplasia type 2B (MEN2B), whose manifestations could explain Lincoln’s stature and some facial features. This testing did not yield conclusive evidence.⁷

While Lincoln’s tall stature is often cited as a potential indicator of Marfan syndrome, it is important to note that not all individuals with this condition are exceptionally tall. Moreover, Marfan syndrome is associated with certain facial features, joint hypermobility, and other signs that were not prominent in historical accounts of Lincoln’s appearance. It is an autosomal dominant genetic disorder, meaning it is typically inherited from a parent who carries the genetic mutation. However, there is no historical evidence to suggest that Lincoln’s parents or immediate family members displayed the physical characteristics or health issues associated with Marfan syndrome. One of the most serious potential consequences is aortic aneurysms and dissections. While Lincoln did experience health issues during his lifetime, including bouts of fatigue and chest discomfort, there is no concrete historical evidence to support a cardiovascular condition. And his documented bouts of depression, fatigue, and sleep disturbances⁸ could have had multiple causes, including the significant stress of his political career and the tumultuous period of the Civil War.

The intriguing possibility of Abraham Lincoln having Marfan syndrome adds layers of complexity to our understanding of this iconic leader. While Lincoln’s historical significance remains undeniably profound, the exploration of his potential medical condition underscores the dynamic relationship between medicine, history, and the enduring mysteries that shroud the lives of historical figures.

References

1. Dietz, Harry, et. al. “Marfan syndrome caused by a recurrent de novo missense mutation in the fibrillin gene.” Nature 352, no. 6333 (1991): 337-9.
2. Robinson, Peter, and Maurice Godfrey. “The molecular genetics of Marfan syndrome and related microfibrillopathies.” Journal of Medical Genetics 37, no. 1 (2000): 9-25.
3. Shenk, Joshua. “Lincoln’s Great Depression.” The Atlantic. October 2005. https://www.theatlantic.com/magazine/archive/2005/10/lincolns-great-depression/304247/.
4. Gordon, Abraham. “Abraham Lincoln–a medical appraisal.” Journal of Kentucky Medical Association no. 60 (1962): 249 -53.
5. Schwartz, Harold. “Abraham Lincoln and the Marfan Syndrome.” JAMA 187, no. 7 (1964): 473-9.
6. Reilly, Phillip. Abraham Lincoln’s DNA and Other Adventures in Genetics. New York: Cold Spring Harbor Laboratory Press, 2000.
7. Townsend, Angela. “Cleveland Clinic geneticist takes part in testing of Abraham Lincoln’s DNA.” The Plain Dealer. February 21, 2011. https://www.cleveland.com/metro/2011/02/cleveland_clinic_geneticist_ta.html.
8. Siegel, Robert. “Exploring Abraham Lincoln’s Melancholy.” NPR. October 26, 2005. https://www.npr.org/2005/10/26/4976127/exploring-abraham-lincolns-melancholy.