The Doctor's Bag
The blog about Medicine and Surgery in the Old West
By Keith Souter aka CLAY MORE
The health of President Abraham Lincoln, one of the most revered leaders in history, has attracted much attention and speculation over the years. During the Civil War a reporter described him as 'a tall, lank, lean man considerably over six feet in height with stooping shoulders, long pendulous arms terminating in hands of extraordinary dimensions which, however, were far exceeded by his feet.'
Abraham Lincoln (1809-1865), 16th President of the United States
His mother, Nancy Hanks Lincoln (1784-1818), had a similar build and was tall and slender. It was said that Abraham Lincoln inherited his build from her. Only portraits of her exist.
Abraham Lincoln is sad to have suffered from bouts of depression, but otherwise he is said to have had great energy and generally good health.
One of the great debates about President' Lincoln's health is whether or not he had Marfan syndrome. Interestingly, some of the evidence comes from photographs. Not just the ones that give a clear image, but also those where his feet or his head seemed blurred.
The Marfan Syndrome debate
In 1962 a Cincinnati physician, Dr A.M. Gordon suggested that the president's appearance was suggestive of Marfan syndrome.
Marfan syndrome is a disorder of the body's connective tissues, a group of tissues that maintain the structure of the body and support internal organs and other tissues. it was first described by Dr Antoine-Bernard Marfan in 1896.
Typical characteristics of Marfan syndrome include:
- being tall
- abnormally long and slender limbs, fingers and toes (arachnodactyly)
- heart defects
- lens dislocation – where the lens of the eye falls into an abnormal position
The gene defect leads to abnormal production of a protein called fibrillin, resulting in parts of the body being able to stretch abnormally when placed under any kind of stress.
The defective fibrillin gene also causes some bones to grow longer than they should. A person with Marfan syndrome may grow tall because their arms and legs grow for longer than normal.
In 1964 a Californian cardiologist, Dr Harold Schwartz described the case of a 7 year old child that he had diagnosed with Marfan syndrome. Her ancestry could be traced back to Lincoln's great, great grandfather, Mordecai Lincoln ll.
Drs Gordon and Schwarz supported the view that Abraham Lincoln probably did have Marfan syndrome. However, this was debated against by Dr J Willard Montgomery, on the grounds that his health was so good and it was unlikely that he had any heart problems, as are common in Marfan syndrome.
The matter of the pulse
The pulse has been recognised as being a fundamental and measurable sign of health or illness by every culture in the world. The earliest references to it are to be found in the Ebers papyrus and the Edwin Smith papyrus, two texts on medicine and surgery from Ancient Egypt. There are specific hieroglyphs for measuring the pulse at the wrist, and instructions on assessing it by using a water clock made from an earthenware vessel with a hole in the bottom through which water escaped drop by drop.
The hieroglyph in the Edwin Smith papyrus, showing the image on the right, counting seeds from a container
The Egyptian clock. the pulse was counted by correlating it with the drops escaping from the bottom
Although the Egyptians used a water clock and the Romans developed hour-glasses to try to measure the pulse, it was not until the Renaissance that a more practical method was developed. Interestingly, this came about through the work of the genius, Galileo Galilei, who designed a clock with a pendulum. He called this a ‘pulsogium.’ He developed the idea from a principle he discovered in 1583 by timing the oscillations of a chandelier on the altar of the Cathedral of Pisa against his own pulse.
Over the next century pulse clocks of greater sophistication were developed by Santorio Santorio and Christian Huygen, but it was not until the eighteenth century that watches capable of measuring minutes and seconds could be adapted to the purpose. In 1707 Sir John Floyer, a Staffordsire physician invented a small pulse watch and published a landmark book entitled ‘The Physician’s Pulse Watch.’We still use that technique to feel the pulse of life.
Abnormalities of the pulse
Physicians over the centuries worked out that differences in rate, rhythm and character of the pulse were indicative of various anomalies of the heart.
One very specific heart anomaly, which is commonly in Marfan syndrome is called aortic insufficiency. It occurs when the aortic valve in the heart, one of four heart valves, does not close completely during heart beats. It effectively leaks. Over time, this can lead impaired circulation of blood and the person may get breathless on exertion and when lying down.
There are many, many signs that have been associated with the curious pulse that occurs in aortic insufficiency. In the past it was considered a significant contribution to medicine if a doctor had a sign named after him. Aortic insufficiency had an unusually large number of such signs.
Corrigan's pulse
This was the name of the 'collapsing pulse' that characterises aortic insufficiency. It was named after Sir Dominic Corrigan (1802-1880), a Dublin born physician. It was also called the cannonball, collapsing, pistol-shot, trip-hammer or water-hammer pulse - or most poetically, the vascular dance. A visibly pulsation can be seen in the carotid arteries in the neck.
Corrigan's pulse
This was the name of the 'collapsing pulse' that characterises aortic insufficiency. It was named after Sir Dominic Corrigan (1802-1880), a Dublin born physician. It was also called the cannonball, collapsing, pistol-shot, trip-hammer or water-hammer pulse - or most poetically, the vascular dance. A visibly pulsation can be seen in the carotid arteries in the neck.
Sir Dominic Corrigan (1802-1880)
The vascular dance and President Lincoln
A manifestation of the vascular dance of aortic insufficiency is the way that the user leg bounces when the legs are crossed at the knee.
In 1972 Dr Harold Schwartz published an article about an anecdote about a photograph in the possession of the National Library of Medicine. Lincoln said when it was taken that his left foot seemed blurry in the photograph. Noah Brooks, a journalist who was interviewing him suggested it was because the president was seeing his arteries pulse when the legs were crossed. Lincoln tested it and exclaimed "That's it! That's it! No that's curious, isn't it?"
The long exposure of the camera, due to the increased shutter time, would catch the leg movements and blur the image of the foot.
Schwartz suggested that this should be called the Lincoln-Brook sign, an indicator of aortic insufficiency.
Interestingly, in later life Lincoln was noted to nod his head-on every heartbeat and on some photographs with the increased shutter time, his head appeared blurred. This phenomenon is actually called de Musset's sign. It was named not after a doctor, but a patient, the French poet Alfred de Musset, who died from syphilitic aortic insufficiency.
Alfred de Musset (1810-1857)
Without testing Abraham Lincoln's DNA the debate will go on. Blood-stained artefacts from the president might give sufficient DNA to determine whether or not he had a gene that could give rise to Marfan syndrome, or to one of the other possibilities. That, of course, raises many questions (some ethical) as to whether such analysis should be done. Until then, the blurred photograph phenomenon is interesting.
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If you are interested in reading more about medicine and surgery in the frontier days, then you may find The Doctor's bag useful. It is a collection of my past blog posts, published by Sundown Press.
The novel about Dr George Goodfellow, the Tombstone surgeon to the gunfighters
